Freudian Snips

EVA A SPRECHER is an Experimental Psychology graduate from the University of Oxford where her research focused on learning theory and contingency learning. She is a qualified teacher having completed the two year Teach First programme teaching Physics in a London based academy. She is now studying for a Msc in Developmental Psychology and Clinical Practice at the Anna Freud Centre at UCL. When not studying she spends her time working to set up a residential foster home and cycling around London looking for sushi and new books to read.

[freudiansnips-blog]

Social Identity Theory: You Can’t Sit with Us

A dummy’s guide to the psychology of racism and xenophobia

Racism and xenophobia have had an insidious influence on human society since time immemorial. Has there ever been a time when one group or another were not facing prejudice and injustice from another group? Unlikely.

Do we have a predisposition as a species to hold prejudiced views against those who are different to us and to treat them worse than we treat those we consider similar to us? Many people would respond with the knee-jerk ‘of course not! I treat all people equally’. In fact, such a response may be less than helpful as it shows a blithe ignorance of the underlying predisposition humans may have to prejudice and, therefore, cheats us out of recognising and addressing this issue. Would it be helpful to say in response to the question, ‘do humans have a tendency to catch colds?’, ‘no of course not!’? Clearly not as if we believed such a thing we would not take the necessary precautions to prevent colds and to recover from them. It is much the same story with prejudice.

So, what is the evidence here? Let’s start at the basics. A key figure who you should be aware of as a pioneer in the psychology of racism is Henry Tajfel. As a Polish Jew who was at one point captured by the German army, and held as a prisoner of war, he was all too familiar with witnessing prejudice first hand. There is little mystery about Tajfel’s motivations in studying prejudice in social psychology.

One seminal experiment of Tajfel’s demonstrated a rather disturbing characteristic of human behaviour. A group of school boys were recruited to take part in an experiment where they were shown two pictures, one by the artist Klee and one by Kandinsky. The boys were asked independently which picture they preferred and then grouped by their choice. This was followed by an activity in which the boys were required to allocate money to their own group and the other group respectively. It was found that, despite the arbitrary nature of their groupings, school boys were inclined to give the other group less money than their own, even when it was to the detriment of their own group. For example, a boy would rather give his own group £4 and the other £3 than giving both £5. This experiment has been replicated a number of times, sometimes with nothing deciding the group allocation other than a totally random coin toss and, still, the same result.

Tajfel’s key theory which arose from this research was the idea of Social Identity Theory. This theory suggests that all persons are inclined to favour members of their in-group as compared to an out-group

This experiment is, of course, not without flaws. Firstly, the age of participants may have influenced the findings – do we become less prejudiced and susceptible to bias as we grow older (or more so)? Of course, just using boys is far from ideal, perhaps women represent our kinder nature and are more open minded to other groups?

This study is only the tip of the ice-berg when it comes to the social psychology of racism but certainly provides some food for thought. If prejudice really does permeate our psyches in such a fundamental way, then the need for active civil rights work and constant work to ensure equality in our society is vital.

More on this topic to come soon subject to interest.

[freudiansnips-blog]

Red light on the government’s green paper?

What is the government’s new green paper on the mental health provision for children and young people really trying to say?

The press keeps no secrets from us regarding the poor state of the mental health of children and young people in the UK. Around 1 in 10 children 5-16 suffer with a diagnosable mental health illness while only approximately 25% of these receive interventions or help from public services. Figures from Public Health England quoted last December suggest a particularly high rate of conduct disorder (68,100 children affected), anxiety (39,500 children affected), ADHD (18,900 children affected) and depression (10,800 children affected). Rumours of investment in mental health services have been hovering around for some time now but what is the government really planning in terms of mental health policy for young people and children?

This year on the December 4th the UK government released a Green Paper, entitled ‘Transforming Children and Young People’s Mental Health Provision’, outlining the latest proposed strategies for improving the mental health of the country’s young people. So, what has been suggested and what does it mean?

To most readers the most striking message of the paper is an increased emphasis of the role of schools in identifying and supporting children and young people facing mental health challenges. The document suggests that every school ought to employ a designated senior lead for mental health, similar but in addition to a special educational needs coordinator (SENCO). This professional would work in collaboration with NHS specialist child and adolescent mental health services (CAMHS) and would, according to the paper, allow children to access the support they need faster and in a less stigmatising manner than the current system of referral to CAMHS directly.

Now that might all sound very lovely until we begin to think about it in even a little more detail.

Firstly, while the green paper states that ‘the school environment is non-stigmatising’ this claim could not be more unfounded. The US adage of ‘high school is hell’ doesn’t come out of nowhere; the Ant-Bullying Alliance explains the bi-directional nature of the relationship between bullying and mental health challenges. Mental health problems make you more vulnerable to being bullied while bullying increases risk of developing mental health challenges. The majority of bullying experienced by children and young people takes place in schools, therefore, a great deal of the stigmatisation around mental health issues in young people also takes place in schools. Already this is not sounding like a ‘non-stigmatising environment’. While individual schools may vary in the extent to which young people facing mental health challenges feel stigmatised the gross generalisation that schools generally are ‘non-stigmatising’ is really introduced into this green paper for the purpose of implying that specialist CAMHS services are stigmatising. In my mind I can think of fewer more effective ways of stigmatising CAMHS services than the government all but labelling them openly as stigmatising environments, bit of an own goal there.

A second concerning statement in this paper is that ‘as the school environment can present triggers for many difficulties (such as social anxiety), it is therefore also a good place to find support to manage them’. This statement seems to run in direct contrast to the previous quotation, describing schools as non-stigmatising, and further confuses the message of the paper. Furthermore, by referring to factors at school as ‘triggers’ as opposed to ‘causes’ the paper assumes a stance which suggests that mental health problems lie like ticking time bombs, or the virus from 28 days later, present in some individuals and dormant until a switch is flipped, and the mental health crisis is released in all its terror. As research has highlighted, over and over again, a large proportion of mental health challenges faced by young people have environmental causes; perhaps experience of early maltreatment or trauma, perhaps prolonged exposure to poverty or conflict, perhaps, even, negative experiences at school. By using language such as ‘trigger’ we individualise mental health problems faced by young people by saying ‘it’s YOU! The problem in YOU and it is part of YOU and the system around you has nothing to do with it’. What we really need is for the systems around young people to recognise their role in the challenged faced by individual children as opposed to pathologizing individual young people.

The paper speaks about ‘children at risk [being] identified and interventions… offered to address problems’. Where is the room in this model for prevention of mental health problems? Again, we come back to the idea of a virus lying unnoticed until, praise the heavens, a specialist mental health professional can identify this toxin. This can be described as ‘professionalising’ mental health work. By suggesting that mental health problems are a specific issue that arises only in individuals and is not related to the world around them we suggest that the only way to deal with them is for a specially trained person to intervene. This runs contrary to a great deal of research that suggests that well thought through changes to the environment, such a school or family, could prevent the development of a mental health problem in a young person even before it became ‘identifiable’.

This paper is just one of the side effects that has arisen, despite many good intentions, from the ‘parity of esteem’ model that we have begun applying to mental health. Parity of esteem originated as the idea that we should treat mental and physical health problems as equally important. I stand by this belief with all my heart. However, this idea has unfortunately been misunderstood by policy makers, journalists and researchers alike to mean that we should treat mental and physical health issues the same as one another. And here in lies the problem. If a person comes to their doctor with a broken leg and they tell their doctor ‘doctor, I have a broken leg’ and the doctor checks it out and says ‘yup, that’s broken’ at the end of this, the leg is still as broken as then the patient came in. However, if someone with social anxiety comes to tell their doctor ‘doctor, I have a problem, I become very anxious in certain social situations’ and they talk this through with their doctor their current experience of their social anxiety may change, for better or for worse, their anxiety may change even before they speak to the doctor when they walk into the room. This is just one simple demonstration of how, while we should give equal respect to physical and mental health issues, we ought not to treat them the same. Mental heath challenges, for adults as well as young people, are affected by context and, therefore, to treat or prevent them we need to look at the context surrounding the person in distress. There is no point providing some wonderful one-on-one therapy for someone if they leave and go straight back into an environment which reinforces their distress.

Once we begin to recognise, as a society and at the policy level, that no child is an island and that mental health issues do not arise in a vacuum but are frequently related to systemic factors surrounding a child we will get closer to truly ‘transforming’ the mental health provision for children and young people.

Have your own say before March when consultation on the Green Paper ends at https://engage.dh.gov.uk/youngmentalhealth/ 

[freudiansnips-blog]

Why are we waiting we are suffocating?

Asking the hard questions about why we haven’t had a survey of children’s mental health in the UK since 2004

As I write this piece it is the 3rd of February 2017 and my question is – what do we really know statistically about the mental health of children and young people in the UK?

The last published survey of children and young people’s mental health was published in 2004. Just to remind you – that was 13 years ago, babies have been born and become teenagers in this time. That makes almost a decade of children whose mental health remains a mystery.

Imagine a civil servant writing a mental health policy targeted at GCSE age (14-16 year olds) children in the UK. They will be basing their interventions, in part, on statistics collected from 14-16 years olds in 2004. That means the ‘children’ who they are basing their work off are now at least 27. Whether you are a fan of statistics, or not, it should be fairly evident that this is not the wisest way of planning such interventions.

In 2016 the Office for National Statistics (ONS) and NatCen Social Research were commissioned by the government to conduct a new survey to establish what changes there have been to the state of the mental health of children and young people in the UK. They finished their consultation period around Spring of 2016 and since then there has very much been all quiet on the Western front.

The survey conducted previous to the 2004 review was published in 1999. That meant only a 5 year gap was left between these two survey times making comparisons over this time period of some longitudinal use. For example, if a policy had been enacted to target depression in teenagers over that 5 year period the data would allow researchers to see if there was a possibility that this had bene effective. However, in 13 years so many mental health policies have come and gone that it will be close to impossible to pick out anything of empirical value from this new data regarding change over time.

So, why does this data matter so much? What can we use it for?

Government departments simply cannot fund research or interventions in all areas of mental health in children and young people. There is a limited amount of money floating around, as much as we might wish it otherwise. Thus, it surely makes sense to know where the real problem areas are in the UK’s dealing with child mental health. If there are rising depression and anxiety rates in young children, then the primary schools need more support on this. If instead conduct disorder is rising over 16 year olds, then perhaps sixth forms need help to address this. Of course, it isn’t as simple as all that, but it’s simple enough to know we need this data and sooner rather than later.

[freudiansnips-blog]

Love in a confusing climate

Just because a creature has been growing in your womb for the last 9 months does it mean that you will have a better relationship with them? Results suggest you might be in for a shock.

Surrogacy has all the makings of a legal minefield. Surrogate mothers carry to term a baby who will them be given up to a new family. It seems impossible that such an emotionally fraught situation could go off without a hitch and that the child and adults involved could not have some ambivalence about such a process.

One story which may have added fuel to the fire of surrogacy related doubts was that of Baby Manji. Baby Manji was born in India to an Indian surrogate mother who was being employed by the Akanksha Infertility Clinic in Gujarat. Surrogate mothers working for the clinic are typically paid around £5000 for the trouble of bearing a surrogate child who will then be passed onto paying families. Interestingly, the families who sign up for this service at the Akanksha clinic typically can pay almost four times the amount surrogate mothers receive for their time – quite the overheads. Baby Manji was conceived using the sperm of a Japanese man, the potential father of the baby, and a donated egg from an unknown source. However, by the time Baby Manji was born in India the Japanese couple who had paid for the surrogacy had divorced. This situation lead to a highly complex and long-winded legal confusion about what the fate of this baby should be given its lack of either Japanese or Indian nationality. Finally, a compromise was made with an emergency Japanese visa being issued to the child of humanitarian grounds with Indian authorities facilitating travel out of India.

Given stories like that of Baby M perhaps it is no wonder that a great number of countries have banned surrogacy for financial gain all-together. For example, in the UK surrogate mothers may only be paid what they might use in expenses over the course of the pregnancy. This does not mean surrogacy does not occur as many women chose to act as ‘altruistic surrogates’, carrying babies for families without desire for financial reimbursement. However, the process remains uncertain for the waiting families as, in the UK, surrogate mothers have a right to determine whether or not they want to keep the baby after birth until official adoption papers have been filed and approved.

From a psychological perspective, we know that infants in the womb are able to recognise the voice of their mother and differentiate this voice from others. Thus, one might expect that the biological mother of an infant might have a bond with their baby that could not be matched by any other woman wishing to take over as a parent. However, a study on the reflective functioning of surrogacy families by Golombok et al. (2006) has found that mothers who adopt surrogacy babies actually showed more positive relationships than mothers whose babies were naturally conceived. Furthermore, fathers in these families show lower levels of parenting stress than those in typical families.

Golombok and colleagues used a questioning schedule called the Parent Development Interview (PDI), a rich and complex interview which asks parents a great number of questions about their experiences of parenting and their relationship with their child. In this study a specific coding scheme was used to extract information from transcripts of these interviews regarding the parents emotional (affective) tone, their coherence in talking about their infant and the type of content found in these interviews. Interestingly, the results of this analysis showed lower levels of anger, stress and guilt and higher levels of joy in surrogacy parents in comparison to typical parents.

Perhaps these two points come as no great surprise to anyone who has witnessed the stresses to both members of a couple during pregnancy. It is not that hard to believe that parents may be less stressed when beginning to look after a baby following a relatively normal 9 months as opposed to a period of discomfort and worry which pregnancy can be associated with. However, that surrogacy should have such a profound effect on even the levels of anger in the mother-child relationship is quite astonishing. In any case, it seems that we can safely say that we need not lose too many hours sleep over surrogacy babies if they manage to make it to their correct destinations without being held up in customs.

[freudiansnips-blog]

Checking your privilege

A beginner’s guide to cultural competence in a clinical setting

Barely a week goes by at present without some mention of the concept of ‘checking your privilege’ appearing in either a news piece or on social media. The idea is commonly referred to in relation to equal rights discussions where those in a privileged position due to cultural biases are encouraged to consider their position objectively. Overall, I think we can all agree that this is no bad thing for people to get into the practice of.

From the point of view of privileged individuals, as a clichéd example a white, wealthy male, the process of ‘privilege checking’ could create both positive and negative effects on wider society. One advantage for the rest of the world might be a greater appreciation from these individuals of all those in less privileged positions have achieved. Some people in such socially constructed positions of power may use this to society’s advantage to effect positive social change in a way which may not be possible for those with fewer resources available to them. In contrast such self-insight may also be used in an exploitative way with the privileged simply becoming more privileged.

From the point of view of less privileged individuals ‘checking privilege’ may be a form of giving some context to the challenges that life has provided. For example, an individual who is the first to go to university from their family could be argued as more successful than someone who is the latest in several generations of a family who have all been university educated. Contrastingly it could be argued that awareness of one’s disadvantage in a wider context only serves to discourage.

While this summary is incredibly simplistic and really does not do justice to the vast discussion of these issues (I defer to experts in the field here) it does have relevance in a realm I am more familiar with from a psychological standpoint; the therapy room.

In order to really understand what goes on in a therapy room in terms of the roles of therapist, family members and the ability of each to understand the other the idea of privilege and cultural competence is a vital one. Divac and Heaphy (2005) proposed ‘cultural competence’ as a skill that should be consistently demonstrated by therapists working in mental health. They developed an idea of the Social GRACES as an acronym to help trainee counsellors and therapists consider the social and cultural factors which clients and practitioners bring into the therapy room.  The characteristics that they believed therapists should consider about themselves were:

G (gender, geography)

R (race, religion)

A (age, ability, appearance)

C (class, culture)

E (ethnicity, education, employment)

S (sexuality, sexual orientation, spirituality)

An example of how this theory might be relevant would be in relation to the recent influx of child asylum seekers entering the UK. Imagine a young girl, aged 11, from Syria being taken to a psychotherapist in London to discuss traumatic events she has been exposed to over the past year. The psychotherapist is a London born, gay, white, 45 year old Jewish male. What are the cultural dynamics in this room?

It seem clear that the therapist holds the position of power in the relationship given he is older and no doubt physically larger. He probably has a more secure grasp of the English language given the girl’s only recent arrival in the UK.  Each individual would no doubt identify differently in religious and cultural terms. How might the therapy session taking place in the therapist’s home country affect this dynamic further? It is clear that he will have a lot to think about if he is going to engage this new client on the right level which will require some serious consideration of these factors on his part.

However, consider a second scenario where this same therapist is now working in a small country town where his latest client is the major of the town. The major is 60 years old, married with several children who are prominent figures in the community, and he is a practicing Catholic. What are the power dynamics here?

I will not go through the ways in which this scenario differs from the first in detail but it is clear the therapist is no longer holding the cultural position of power. This phenomenon of flexibly privilege is known as ‘multiplexity’ (Akamatsu, 1998). I think the idea captures nicely how assessing privilege just once is never sufficient – it is a socially constructed concept and is relativist in nature. In a synagogue being Jewish gives you a position of stability and control, however, being Catholic puts you in this position when you are in a church.

In order to work effectively with a range of people in a clinical context it is always pertinent to consider the interplay of these factors in order to in some way mediate them or be aware of their possible effects. In summary, don’t just check but check, check and check again.

Are there any other factors you think therapists should consider?

[freudiansnips-blog]

Have I got poos for you

IBS: uncovering the truth behind the unspoken syndrome affecting almost 1 in 5 people in the UK

Episode 1: Stigma

For any of you who have never heard of IBS (lucky you) the acronym stands for Irritable Bowel Syndrome. It is an extremely common disorder affecting almost 1 in 5 people in the UK according to the NHS. Yet, despite this incredibly high percentage of sufferers IBS is rarely spoken about publicly and it is still very poorly understood. I am planning to write a series of featured blog pieces on the topic of IBS covering issues including stigma, diagnosis, misdiagnosis, recent research, treatment types, and individual experiences. I will be including anonymised experiences of IBS sufferers and the aim of this is to, in a small way, open up the discussion a little more on this silent terror that usually dwells in private behind bathroom doors.

Today’s article, Episode 1 of the series of posts, will focus on the stigma associated with IBS. For any of you totally unfamiliar with IBS as a disorder it is worth saying that there are as many different forms of the syndrome as there are sufferers. For some people symptoms may be nausea, for others constipations and yet more diarrhoea. These symptoms may be constant, come and go, or  switch between different types. Some people find them to be stress triggered, others by certain foods, others by a totally different set of foods. Some forms of IBS appear to be responsive to treatment (in the form of medication or change in diet) others appear to not be. Given this huge range of manifestations of the syndrome of course many people will have totally different experiences to those described here or elsewhere but opening the discussion is part of dealing with the issue.

In 2009 a group of researchers in the US, Jones et al., conducted a study of the stigma experienced by 148 IBS patients relating to their IBS. Jones et al. developed a 10-item questionnaire for Perceived IBS Stigma that demonstrated reliably and with validity that IBS sufferers perceived stigma in several areas.

The study showed that most participants felt some stigma particularly with co-workers, friends and employers. This is a crucial finding given the fact that IBS can affect people’s daily working lives and attendance to work – you can imagine that having to sit through meetings for hours is extremely difficult when you normally need the toilet every 20 minutes. If sufferers feel unable to talk to their employers and co-workers about their IBS then they may not get the workplace support and understanding they need to be able to balance their symptoms with work.

The area where participants in the study felt the most stigma regarding was the lack of knowledge and understanding they thought most people had regarding IBS. This can no doubt be linked to the almost total absence of any reference to IBS in popular media – it really does appear the people have the view that ‘we don’t talk about poo’.

Now, of course this study did focus upon measuring individual’s perceptions of stigma surrounding IBS. This gives no guarantee that people do make any value judgements on people based on this diagnosis or harbour any prejudice regarding the topic. However, it does say something that 57% of the people interviewed felt some stigma relating to their diagnosis.

As we all know one of the best ways to overcome stigma is to be open and discuss stigmatised issues without judgement. In order to do a little bit of that here I would like to share some quotations of brave IBS sufferers on their experiences of this syndrome. I will be sharing some real life anecdotes like this in each of these blog posts to help share the wisdom of the IBS community (in addition to information from studies discussed here). All quotations from contributors are anonymised.

Contributors on reactions from doctors

"It's just stress. Do you eat enough fibre? Do you drink enough water? Do you take laxatives? Oh. Hmmmm. Well. Stress is a big factor. Try these laxatives. Or these. Or these. Eat porridge. Drink up!"

“I was told it was all in my head.”

“I spent about 2 minutes with the doctor after they decided it was a minor medical issue.”

“I was told that it would be best to google my symptoms by one doctor who also had a go at me for having too many problems ha!”

 If you would like to share your stories of IBS experiences, have any related questions or would like to suggest blog topics please get in touch to do so.

[freudiansnips-blog]

Does hysteria still exist?

How strong is the link between the mind and the body? Can a thought become a physical symptom?

In December 1885 Freud began treatment of a British Governess who had an extra-ordinary symptom – so bizarre that her doctors were totally stumped by it. This was the beginning of the second of Freud’s ‘Studies in Hysteria’. These were cases where the weird and wonderful symptoms that defied medical explanation were examined by Freud and his colleague Breuer. These patients were known as ‘hysterics’.

In the 1800s almost any behaviour of women that was thought to be abnormal by the stringent standards of society could be classified as ‘hysteria’. These ‘symptoms’ could be anything from insomnia to sexual desire. It has been suggested (Briggs, 2000) that this catch all disorder was a social construction invented for the pure purpose of keeping women in the home and behaving as males at the time thought appropriate. The treatments for hysteria ranged from removing women’s wombs, extended warm baths, ‘pelvic massages’ from doctors and being confined to an asylum.

Freud and Breuer had a more progressive take on the range of symptoms shown by their female patients. The British Governess, Lucy R, who Freud treated had the head-scratching symptom of a reoccurring and distressing smell of ‘burnt pudding’ which had confused doctors who were at a loss to explain the cause of this phenomena. Through a great deal of talking therapy and a close examination of recent significant events in this patient’s life Freud was able to ascertain that this symptom appeared to be caused by an unconscious memory bubbling to the surface of Lucy’s mind. Freud believed that a mental conflict had been triggered for Lucy about whether to stay working for an employer who she loved unrequitedly or to return home to her mother in a particular incident where the smell of burnt pudding had been present. Freud’s hypothesis was that instead of confronting this conflict Lucy R had repressed these difficult ideas and that they had later tried to break back into her consciousness in the form of her unusual symptom.

This whole story may seem incredibly far-fetched to most of us. Is it really possible for there to be such a seemingly logical link between a symptom and a psychological idea? Could such a profound symptom really be caused by something purely in the mind? Is this story just a relic of a strange period of the late 1800s?

If Lucy R had been treated today it is highly likely that she would have been given the diagnosis of Somatic Symptom Disorder, a disorder that can be found in the DSM-5 the manual used by most clinicians for diagnoses in the UK. Strange symptoms without an obvious physical cause still very much exist today. One extreme and under-diagnosed form of a Somatic Symptom Disorder is that of PNES (psychogenic non-epileptic seizures). Approximately 20-30% of patients who come to epilepsy centres for treatment for reoccurring seizures end up with a diagnosis of PNES. The seizures of these patients are extremely difficult to distinguish from ‘true’ epilepsy and the patient does not have control over them in any way. This disorder can be debilitating and dangerous. Sufferers may be unable to leave the house or drive due to fear of seizures and they may be given epilepsy medication for many months of years before they receive a correct diagnosis. It has been noted that such seizures can often be linked to maltreatment or abuse in childhood and the symptoms may reduce or disappear after psychotherapy.

PNES is just one of many, many forms of Somatic Symptom Disorder which exist today. These symptoms may not come in the same forms as those of Freud’s ‘hysterics’ and we may be more discerning about what is a symptom compared to behaviour that is simply socially frowned upon but such somatic patients still very much exist. This under-spoken about group face untold challenges of misdiagnosis, challenges of finding appropriate treatment and extreme stigma of those that suggest that they have control of their symptoms. We are still learning how to accept that just because something has a psychological cause it does not make it any less serious or distressing for the patient.

What other unexplained physical symptoms may be caused by psychological phenomena?

What small ways might we experience the link between the mind and body in our daily lives?

Does this explain ‘man flu’?

[freudiansnips-blog]

5 Reasons Not to Forget Freud

Let’s talk about whether it is time to get over the eccentric ideas of the sex obsessed father of psychoanalysis.

Studying at the Anna Freud Centre just a few doors down from the Freud Museum it is a regular event for me to be interrogated about why we still study Freud. The typical questions I get range from ‘wasn’t he just wrong about everything anyway?’ to ‘so, that means you really believe I want to kill my dad and marry my mum?’. I feel perhaps a lot of these questions come from a black-and-white outlook on psychology and a also a lack of information about Freud’s work and how it is still used. Therefore, here are a few reasons to begin explaining why we still care about Sigmund and what he had to say.

1.       ‘The Talking Cure’

Imagine you have been feeling down, depressed and unable to cope with the everyday stresses of life. You wake up feeling the same dread you do every morning, call in sick to work, force yourself out of bed, stay on the phone for 20 minutes trying to get a walk-in appointment with your GP and a few hours later you are sitting in their room pouring your heart out. It has taken all your energy to work up the courage to do this and it’s your last resort. The doctor sits back thinking carefully about what you’ve told them. After an agonising silence he gives you the pearl of wisdom you’ve been looking for ‘Well, I think you ought to take a daily warm bath’.

 This was the response that faced a great deal of people struggling with depression and other mental health issues before the founding of Freud’s ‘talking therapy’. However, it didn’t simply stop at warm baths – more extreme treatments for all sorts of psychic distress took the form of dangerous treatments such as removing the womb.

 Freud was inspired by the work of Charcot and other researchers who were interested in how hypnosis could be used in the treatment of patients with psychological difficulties. Out of this research Freud began to develop his own take on this work in the form of using talking therapy to uncover underlying causes of his patient’s difficulties – it is worth reading the case of Lucy R for an example of this in its early form.

 Without developments such as these in the way we think about treating mental health problems it is conceivable we wouldn’t have the range of therapeutic approaches we do today – such as psychoanalysis, CBT, systemic therapy. It is probably fair to say we have Freud to thank, to a certain extent, for these hugely beneficial treatments. Who has done more to combat the dangerous ‘stiff upper lip’ approach to not talking about our most challenging problems?  

 2.       The unconscious

 Have you ever said something without knowing there the words came from? Ever disliked someone without knowing why? Or found someone extremely attractive without knowing why?

 These are just a few examples of how unconscious ideas might be influencing our everyday behaviour. While Freud was by no means the first to have the idea that ideas that we have no conscious access to might be influencing our behaviour he certainly brought the idea forwards in his extensive writing on the subject.

 Modern day examples of clinical cases which rely upon understanding the idea of the unconscious are extremely well explained in Stephen Grosz in his book ‘The Examined Life’ where several stories of Grosz’s patients are explored. Grosz powerfully explains how we are all to a certain extent guided by a ‘story that cannot be told’, how everything from how we behave when we lose our wallet to how we approach our love life is affected by unconscious ideas that we cannot necessarily articulate or access.

 3.       Talking about sex

 Freud conducted his research around and after the turn of the 20th century in Europe – a notoriously repressed society where talking openly about sex was simply not done. Whether intentionally or not Freud did a great deal to change this attitude given his strong belief that much of human motivation was due to the ‘sex drive’ leading us to seek out pleasure and avoid pain (the pleasure principal).

 Much of Freud’s talking therapy involved encouraging patients to discuss ideas which might have been construed as vulgar by modern society without judgement or shame. This is not to say Freud was advocating a free loving and sexual society but his approach was certainly a forward thinking one for the time.

 4.       Childhood matters

 ‘Seen and not heard’ summarises the prevailing view of psychologists and lay-persons alike towards children at the time Freud began his work. There is still a tendency to think of babies, especially very young ones, as beings with purely physical needs with little advanced understanding of the world around them.

 Freud, contrastingly, found that when excavating the difficulties of his patients that invariably they could be linked back to some event in early childhood. This finding was quite extraordinary given the fact that up till this point it was assumed infants and small children were too busy waiting for their next fix of milk to be deeply affected by what was going on around them.

 Indeed, Freud also went one step further to suggest that adult sexual behaviour was determined by the contents of childhood experiences – an extremely controversial view at the time for the reasons discussed above. While Freud himself did little work with children these ideas were brought forward by his contemporaries including Anna Freud, Melanie Klein and Winnicott to name but a few.

 5.       Cut him some slack

 As a wise lecturer once said to me ‘Freud did a great deal of his work almost 100 years ago and we have to give him a break about that’.

 Some of Freud’s theories, such as penis envy (the idea that all women are envious of males for having penises), may seem incredible strange and outdated to us but we need to bare in mind when these ideas were conceived. It might be possible that in Victorian Europe, where women rarely held jobs or owned property, it would have made more sense for females to have these feelings towards men and their genitals.

 I feel it is almost dishonourable to simply declare Freud as ‘wrong’ without any further consideration. It doesn’t really make us that clever to be more correct that a man who died in 1939 given all that has been found out in the intervening years but we certainly can still recognise his huge contribution to the development of treatment and theoretical ideas relating to the mind.

Should we still study Freud?

What areas of his work do you still think are relevant?

[freudiansnips-blog]

Shelving Self-Diagnosis: Who’s advice should you really buy on mental health issues?

“Life being what it is who can pay attention to anything for very long? Is it really a sign of mental health to be able to balance your checkbook, sit still in your chair, and never speak out of turn?”

These are the words of Dr. Edward Hallowell, a seasoned doctor and a writer on the subject of Attention Deficit Hyperactivity Disorder (ADHD) or as he calls it ASD (Attention Surplus Disorder). Hallowell discovered that he had ADHD while attending a university lecture on children with ADHD. Hallowell has spent a large amount of his professional life educating others with ADHD about the ways of seeing the benefits of the diagnosis and how it can give you the ‘special something’ which he claims has led to the success of geniuses such as Mozart. Hallowell is the poster boy of how ADHD children can grow into happy, successful adults – or is he?

Edward Hallowell is self-diagnosed with ADHD and has, in reality, never received an official diagnosis. This in and of itself doesn’t mean that he doesn’t have ADHD or that he doesn’t have useful information to give to those who do have such a diagnosis. However, while it might be said that Hallowell isn’t doing anyone any harm there is a wider question about self-diagnosis.

We have all heard an ill-informed but ultimately well-meaning friend make a comment such as ‘Oh I just love putting my coloured pens in order, I am so OCD!’. Again, it could be said that such comments are truly harmless but they are also undeniably ignorant. Such comments belittle the experiences of true OCD sufferers which can be extremely severe. One example of this is a man who essentially scratched out his own eye-ball having been compelled to do so by an obsession with the idea of an itch behind his eye. Another problem with these types of causal statements is that they imply that OCD is simply a diagnosis for a ‘neat’ person. In reality OCD may have nothing to do with ‘neatness’ - it may be a preoccupation with worrying that your house will burn down, it could be an obsession with certain numbers found in the Bible, it might manifest as a fear and avoidance of red stains for fear they might contaminate you with a disease. These are only a few select examples of a huge range of possible OCD symptoms. In short, claiming to have OCD when you in fact do not is a way of reinforcing stereotypes and simply adds to all the inaccurate information floating round about the disorder.

Celebrities have been joining in on the self-diagnosis game as well – Tim Burton has been diagnosed with Autism by his wife Helen Bonham-Carter. Now, while I love Edward Scissorhands as much as the next person (perhaps more) this is not a valid way for such things to be decided.  Again, I am not making a claim that Burton is not Autistic but I do believe the disorder is a specific and complex one which needs an expert to assess. People with autism have a huge range of experiences and have a range of different experiences of their condition and it is important that we try to represent them accurately and hear true voices of Autism in the media.

So, how do people get a genuine diagnosis?

There are several tools which doctors and psychologists use to decide on a diagnosis for an individual. The most popular is perhaps the DSM (Diagnostic Statistical Manual) which is currently in its fifth addition. The DSM contains descriptions of the criteria for diagnosis of a range of disorders and allows some sort of ‘standardisation’ or consistency of diagnoses between different doctors in different countries.

This system is by no means perfect, the DSM receives a great deal of criticism from researchers, clinicians and lay-persons alike. For example, the DSM is based on symptoms not causes of disorders so it is possible two individuals with the same diagnosis may have it as a result of different things and require different treatment. Additionally, the DSM may contain disorders which simply reflect society’s expectations of people and not genuine disorders – for many years homosexuality featured as a disorder in the DSM though it has now been removed.

While the DSM has its challenges the people who use it as a tool, for the most part, have a great deal of experience with a range of individuals with different clinical diagnoses. Therefore, it is fair to say that they can be, typically, more objective and knowledgeable than the average person trying to diagnose themselves. While the experiences of Hallowell and Burton are valid and interesting we must be very clear about these topics to avoid muddying an already confusing area of psychology.

What is your view on self-diagnosis?

How should we receive the advice of self-diagnosed individuals?

In what ways could we improve the diagnosis process for people?

What experiences of diagnosis do you have?

[freudiansnips-blog]

My First 5 Psychology Books

What do baby psychologists read before bed?

I first began reading seriously about psychology, as most people do, in the run up to applying to study the subject at university. What started as a desperate attempt to fill a personal statement has become a love affair that keeps me coming back for more 6 years late, and I am sure will continue to do so decades into the future. I largely owe my thanks regarding this interest to the first books I read on the subject. All of the titles described here are entry-level texts that I would recommend to anyone with even a vague interest in psychology and serve as a fantastic starting point for any budding psychologist.

Phantoms in the Brain: Human Nature and the Architecture of the Mind – V. S. Ramachandran

There are very few voices in psychological writing so gentle and comforting as that of Ramachandran. I mean this both in terms of his writing style and his actual speaking voice (I highly recommend the Reith Lectures he gave in 2003). In a world increasingly jam packed of poorly explained fMRI studies Ramachandran gives an incredibly human account of some of the fascinating cases he has worked on. Perhaps the most memorable of these are his cases relating to ‘Phantom Limb Syndrome’ where amputees retain feelings, often extremely painful ones, in their lost limb.

Eichmann in Jerusalem: A Report on the Banality of Evil - Hannah Ardent

A great deal of social psychology, not least Milgram’s work which is the next book on this list, arose from the world’s shock and horror at the events of World War Two, particularly the Holocaust. How could so many people behave in such abominable ways? Were all Nazis ‘bad apples’ and evil from birth? The psychological world shook with the need to answer some of these questions. Ardent’s account follows the trial of one Nazi war criminal, Adolf Eichmann, who facilitated and organised many deportments of Jews and other minority groups to concentration camps. This book was revolutionary in examining the ‘banality’ of evil and highlighting uncomfortable ideas that ‘going with the flow’ can in fact constitute an evil act depending on which river you are flowing with.

Obedience to Authority: An Experimental View - Stanley Milgram

Anyone with an interest in experimental design would do well to start with this masterpiece by Milgram. This book details the development of the famous ‘electric shock experiments’ that Milgram conducted having been inspired, by authors such as Hannah Ardent to examine how normal people can do unspeakable things. In this notorious experiment participants were instructed to shock another participant (an actor) as they participated in what they believed was a learning experiment. The findings of this study showed a surprisingly high proportion of people continued to shock the ‘learner’ (who they did not know to be an actor) even when they appeared to be in great pain or screaming. This book outlines in a great deal of detail the experiment’s findings, ethical implications and other aspects of the research design.

The Lucifer Effect: How Good People Turn Evil – Philip Zimbardo

Following on with the theme of social psychology Zimbardo’s best seller brings together ideas on the subject of how normal people can do bad things with more modern day examples in addition to an examination of his own study – The Stanford Prison Experiment. Zimbardo’s experiment involved two groups of volunteer students, one group who were given the role of prisoners, the others who were given the role of prison guards. What unfolds between these two groups over the course of the relatively short study was ground-breaking and in many ways horrifying. These findings have serious implications for the effect of environment on how atrocities such as those which occurred in Abu Ghraib occurred.

The ‘Wolfman’ and Other Cases – Sigmund Freud

There is nothing quite like reading a Freud case study if you have never done so before. The experience is somewhere between reading a Sherlock Holmes mystery and the work of a hardened academic. Freud’s style is surprisingly poetic and literary, particularly in his case studies as in this book. You can treat it as fiction, as a historical document or as a legitimate psychological text. Whatever you do, give it a go. If you’re not convinced of why we should still be reading Freud I will be posting on the subject in a few weeks.

[freudiansnips-blog]

Is bird the word?

What makes us human? Is it our language and communication? Is it our social interactions with other people? Is it our use of tools, technology and our manipulation of our environment?

One of the key factors which psychologists believe have allowed humans to become the world’s dominant species is our amazing memory. Particularly one type of memory called ‘episodic memory’. This doesn’t refer to our ability to remember every episode of Game of Thrones to date but instead is related to any episode or event from our lives. This is a distinct type of memory and is different to procedural memory, for example remembering how to ride a bike, or semantic memory, remembering the name of a fork. Episodic memory is the closest thing we have to a film in our minds of what we have done and what has happened to us. For example, you might remember your first bike ride or when you were taught by an old boyfriend to use chopsticks.

So are we the only animals with memory of particular ‘episodes’ in our lives? Do pandas get nostalgic remembering that that one time they found the perfect piece of bamboo?

Well, it seems an unlikely critter might also have demonstrated quite clearly that they too can have a memory with a particular location and time stamp – much like our episodic memories. These animals are scrub jays, rather attractive blue birds with a penchant for worms. Two researchers called Nicola Clayton and Anthony Dickinson conducted some fascinating research in 1998 which showed behaviour in scrub jays which might give evidence of episodic memory.

In this experiment scrub jays were given pieces of food to hide, a habit of scrub-jays to save food for later. They were given worms, the favourite food of a scrub-jay (think Ben and Jerry’s ice cream), and acorns, a less exciting meal for scrub-jays (think Ryvita). The birds hid these snacks in locations called ‘caches’ and then were taken away from their food stores for a set amount of time. When returned to the same place a few days later the scrub-jays would go straight back to their worm hiding places – as they ‘knew’ the worms would still be fresh and tasty. However, after a long time away from the food stores the scrub-jays wouldn’t bother finding the hidden worms having apparently ‘calculated’ that the worms would have begun rotting by this point. Instead the birds would go straight for the hidden acorns knowing they would have survived the time gap.

Does this mean scrub-jays can remember things that they have done in the same way humans do?

Not everyone agrees with this conclusion. Endel Tulving, another researcher with an interest in this area has suggested that this is just an example of a complex chain of learned behaviours from scrub-jays and that they are not going ‘back into the past in their own minds’.

Further work needs to be done in this area; for example finding out what is really happening inside the neurology of birds during apparent episodic memory. The argument for this style of memory would be more convincing if the formation of this type of memory could be prevented through certain types of brain damage in scrub-jays.

While we wait for the results to come in to settle the debate one way or the other it might be a good idea to think twice when kicking at a pigeon on your way home from work – they might hold a grudge.

What do you think makes us human?

Do you believe animals can ‘time travel in their minds’?

What do you think episodic memory is?