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psychologist vol 27 no 6
june 2014
Being a man – putting life before death Special feature – male psychology
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letters 382 news 390 careers 446 reviews 456
opinion: the Scottish referendum 398 interview: Dorothy Miell, new Society President 432 one on one… with Elizabeth Peel 464
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Being a man – putting life before death Martin Seager and David Wilkins address the need for this special feature on male psychology
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A tapestry of oppression 406 Jennie Williams, David Stephenson and Frank Keating on how gender inequality is interwoven with other dimensions in society
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Psychology, men and cancer 410 Peter Branney, Karl Witty and Ian Eardley call for a consideration of masculinity in understanding and treating the disease
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Are mental health services inherently feminised? 414 Linda Morison, Christina Trigeorgis and Mary John investigate Engaging with the emotional lives of men 418 Roger Kingerlee, Duncan Precious, Luke Sullivan and John Barry consider the design of malespecific services and interventions
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...looks back
Cover US Agency for Healthcare Research and Quality advertising campaign © Copyright for all published material is held by The British Psychological Society, unless specifically stated otherwise. Authors, illustrators and photographers may use their own material elsewhere after publication without permission. The Society asks that the following note be included in any such use: ‘First published in The Psychologist, vol. no. and date. Published by The British Psychological Society – see www.thepsychologist.org.uk.’ As the Society is a party to the Copyright Licensing Agency agreement, articles in The Psychologist may be photocopied by licensed institutional libraries for academic/teaching purposes. No permission is required. Permission is required and a reasonable fee charged for commercial use of articles by a third party: please apply in writing. The publishers have endeavoured to trace the copyright holders of all illustrations. If we have unwittingly infringed copyright, we will be pleased, on being satisfied as to the owner’s title, to pay an appropriate fee.
Masculinity and mental health – the long view 426 Ali Haggett gives a historical perspective
The Psychologist is the monthly publication of The British Psychological Society. It provides a forum for communication, discussion and controversy among all members of the Society, and aims to fulfil the main object of the Royal Charter, ‘to promote the advancement and diffusion of a knowledge of psychology pure and applied’.
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Associate Editors Articles Michael Burnett, Paul Curran, Harriet Gross, Marc Jones, Rebecca Knibb, Charlie Lewis, Wendy Morgan, Paul Redford, Mark Wetherell, Jill Wilkinson Conferences Alana James History of Psychology Nathalie Chernoff Interviews Gail Kinman, Mark Sergeant Reviews Emma Norris Viewpoints Catherine Loveday International panel Vaughan Bell, Uta Frith, Alex Haslam, Elizabeth Loftus
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psychologist vol 27 no 6
the issue
...reports news psychologists get busy at The Hub; combating ‘isms’ in fashion; Brain Prize; a ‘play revolution; teachers and neuroscience; and more
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society new President and President Elect; Society accreditation goes global; Spearman Medal and Doctoral Award; voices and voice hearers seminar series; and more
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...debates letters 382 training places – competition and support; the dyslexia myth; Wikimedia; the Royal College of Psychologists debate; the NHS; dementia research challenges; clinical psychology in Sri Lanka; and more opinion 398 three academics give their views on the Scottish independence referendum and the likely outcome
...digests offensive slurs, psychology’s vocabulary, and implicit bias, in the latest from the guest hosts on our free Research Digest (see www.researchdigest.org.uk/blog)
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...meets interview from ‘year Dot’ to the future: we talk to the Society’s new President, Dorothy Miell
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careers 446 we talk to Chartered Psychologist Dawn Reeves, and Peter Storr reminds us that we are in charge of our careers 432
june 2014
one on one with Elizabeth Peel, Professor of Psychology and Social Change in the Institute of Health and Society, University of Worcester
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If I was looking for my own personal crisis of masculinity as I thrust into my 40s, my recent reading matter would have provided plenty of prompts. Am I a ‘Latte Dad’ (tinyurl.com/lattepappa)? A ‘Crappo’ (see p.396]? Or a ‘soushoku danshi’? This latter identity (see tinyurl.com/danshi) is particularly interesting. Literally translated, ‘grass-eating boys’ are named for their lack of interest in sex and their preference for quieter, less competitive lives. Japan’s ‘herbivores’ are apparently provoking a national debate about how the country’s economic stagnation since the early 1990s has altered men’s behaviour. ‘Have men gotten weaker?’, ask the talk shows. Martin Seager and David Wilkins, introducing a special feature on p.404, might well argue that the position of ‘male psychology’ remains too weak. A series of articles consider this particular form of ‘gender blindness’ and its impact. Male or female, academic or practitioner, experienced writer or novice, please do consider writing for us: see tinyurl.com/psychowrite. Dr Jon Sutton Managing Editor @psychmag
...reviews exploring epilepsy through art and science; Damon Albarn; The Examined Life; the meaning of life with Richard Herring; The Island with Bear Grylls; The Shock of the Fall; Vertigo Roadtrip; and much more
the
psychologist vol 23 no 6
The Psychologist and Digest Editorial Advisory Committee Catherine Loveday (Chair), Phil Banyard, Nik Chmiel, Olivia Craig, Helen Galliard, Rowena Hill, Peter Martin, Victoria Mason, Stephen McGlynn, Tony Wainwright, Peter Wright, and Associate Editors
june 2010
The aware mind in the motionless body Martin Monti and Adrian Owen go looking for consciousness
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forum 450 news 458 careers 516 looking back 534
our emotional neighbourhoods 474 raising school attendance 482 reimagining our school system 486 talking therapies with David Clark 488
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Four years ago Go online for our archive, including Martin Monti and Adrian Owen on ‘The aware mind in the motionless body’
Big picture centre-page pull-out artists Denis Connolly and Anne Cleary on a collaboration with psychologist Dr Patrick Cavanagh
NEWS
Psychologists get busy at The Hub Margulies (Max Planck Institute for Human Cognitive and The first residents of The Hub at Wellcome Collection, Brain Sciences) and poet James Wilkes (University of East a flagship new space for interdisciplinary projects around Anglia). The group will start their occupancy at Wellcome health and well-being, will investigate the busyness of modern Collection in October 2014, as the venue opens new spaces life. Bringing together a rich network of scientists, artists, and galleries after a humanists, clinicians, public £17.5m development. health experts, broadcasters The ambitious project and public engagement will be nourished by the professionals, the group research resources of will explore states of rest and Wellcome Collection, the noise, tumult and stillness, Wellcome Library and the and the health implications Wellcome Trust and will for lives increasingly lived embrace the noisy city in a hubbub of activity. They beyond and the people have been awarded £1 million who live in it. The group, to develop the project over selected from 55 two years. applications, will have The group is led by social freedom to develop ideas scientist Felicity Callard and outputs over their (Durham University) with residency. The Hub will core contributing members gather international comprising psychologist and experts investigating writer Charles Fernyhough hubbub and rest at (Durham University), different scales, to breathe psychologist and broadcaster new life into the questions we Claudia Hammond (BBC’s The group is led by social scientist Felicity Callard (centre) ask about rest and busyness. All in the Mind and Health Charles Fernyhough (bottom right), Claudia Hammond (top left), Should we slow down, or Check), neuroscientist Daniel Daniel Margulies (bottom left) and James Wilkes (top right)
COMBATING ‘…ISMS’ IN FASHION Natalie Fernandes and Carolyn Mair report from Better Lives 2014, London College of Fashion, University of the Arts London
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ZOE STERLING BA (HONS) LONDON COLLEGE OF FASHION
This year, as last, London College of Fashion’s (LCF) Better Lives series has focused on the relationship between fashion and psychology as part of LCF’s initiative to use the discipline of fashion to drive change, build a sustainable future and improve the way we live. The 2014 series, concerned with ‘…isms in fashion’, was curated by Dr Carolyn Mair (LCF), Reader in Psychology and Course Leader of the MSc Applied Psychology in Fashion and MA Psychology for Fashion Professionals. The first seminar brought together Dr Ros Jennings (Gloucester University) and Professor Paul Matts, a Research Scientist from P&G. Dr Jennings presented thoughtprovoking case studies from a sociocultural perspective of two women in popular culture, Dame Shirley Bassey and Petula Clarke, demonstrating different approaches to ageing. Professor Matts presented data from studies demonstrating the importance of skin appearance on perceived attractiveness.
He argued that skin is an indicator of both health and youth. Therefore, taking an evolutionary psychology perspective, Professor Matts claimed that men are attracted to younger-looking women because they signal fertility and the potential to increase their chances of reproduction and survival. He argued that what is perceived as attractive is also perceived as healthy. The talks were
followed by an audience discussion whereby the main conclusions were that although evolutionary processes are difficult to overcome, cultural influences can affect behaviour. Given the increasing population of people aged over 50, the fashion industry needs to address this population’s needs as well as those of the very narrow demographic currently catered for. The second seminar looked at racism in fashion. Jody Furlong, director of The Eye Casting Company and The Eye Models, demonstrated how stereotyping develops in childhood using a YouTube video replication of Kenneth and Mamie Clark’s 1940s experiment (www.youtube.com/watch?v=ybDa0gSuAcg). Furlong criticised the lack of black models in Vogue and on the catwalk in New York, Paris, Milan and London. However, his optimism that change could happen was supported by the second speaker, James Lyon, a photographer and spokesperson for Models of Diversity. James claimed that consumers could influence change by supporting designers
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should we embrace intense activity? What effects do each of these states have on the health of our bodies and minds? The space at Wellcome Collection will provide a base for the group to perform rigorous, creative research and to stage scientific and artistic experiments, data-gathering and public events. While neuroscientists study the ‘resting’ brain and mind, artists will explore the borders between signal, sound and noise, psychologists will track people’s bodily activity, and social scientists will map the city’s noise and silences. Felicity Callard said: ‘Our team is enormously excited to take up the first residency of The Hub, and to work with this extraordinary physical and conceptual space to showcase what can be achieved through experimental interdisciplinary endeavours. Our collaborative work on rest and noise will have members of the public at its heart and will create new possibilities for people from all backgrounds to find their own kinds of rest in the busy city. Through our research activities and creative adventures we want to transform how rest and its opposites are understood - and give us all an urgently needed intimacy with a hidden but vital part of our lives.’ Charles Fernyhough said: ‘We’re thrilled to be the first team to occupy this extraordinary research space in the heart of the busy city. Psychologically speaking, “rest” is a puzzle, with debates about whether the mind is ever actually still or silent. Our project will see neuroscientists working with psychologists on new ways of assessing subjective experience during rest, integrating it with what we know about the resting brain, and feeding into broader interdisciplinary experiments that draw on insights from the humanities, arts and social sciences to explore how people mentally and physically negotiate the boundaries between rest and busyness.’
who embraced diversity and boycotting those who didn’t. Audience members agreed with this and were passionate about the importance of education. Dr Mair stressed that education is a continuous process and encouraged those present to take forward the seminar’s message to others. Three speakers presented at the third seminar, Ablism in Fashion. Listening to paralympian and model Stef Reid describing how she had successfully adapted to becoming disabled, following a boating accident aged 16, was inspirational. Stef articulated the problems of striving to conform to the narrow stereotype of ‘normal’ and encouraged the audience to challenge the current paradigm. She emphasised the need for the fashion industry to celebrate difference rather than view it as a reason for exclusion. Michael Shamash, Chairman of the Restricted Growth Association, writer, researcher and selfdescribed disabled person pointed out that disabled people consume fashion with as strong a sense of style as anyone else; however, they are typically ignored in the industry. He suggested that for change to happen, disabled people needed to occupy positions of power within fashion and that education needs to embrace diversity. Finally, Kelly Knox, winner of 2010’s Britain’s Top Missing Model, actress and ambassador for
For Claudia Hammond, the exciting thing about the project is ‘the number of different ways that members of the public will be able to get involved, from watching poetry performances in the Restmobile (a specially-adapted campervan) to lying on a couch in Wellcome Collection telling us their daydream’s. Clare Matterson, Director of Medical Humanities and Engagement at the Wellcome Trust, said: ‘In a field of exceptional applications, Felicity Callard and her team inspired us with a topic of rich potential and pressing concern. The pressures and health implications of unrelenting activity are an inescapable but underexplored part of the environment of modern life. We look forward to the process and outputs of their collaborative curiosity and anticipate their work leaving rich a legacy for academic and creative inquiry, clinical practice and public policy and for The Hub’s future as a crucible for innovative interdisciplinary research.’ JS
REACH, The Association for Children with Upper Limb Deficiency, spoke about how reaching out to others who were struggling with confidence issues had made her aware of her ‘disability’. ‘I am disabled by the attitudes in the fashion industry, not by my missing arm.’ The audience discussion covered the lack of diversity behind as well as in front of the cameras. Again, the consensus was for a more inclusive attitude from the fashion industry. Dr Mair concluded by referring to Donald Norman’s work on inclusive design: design for all people. The final seminar was a panel session chaired by Dr Phil Sams (LCF, and Visiting Professor at Northumbria University). The panel comprised Caryn Franklin MBE, James Partridge OBE, Zowie Broach, Dr Chris Pawson (University of East London) and Dr Carolyn Mair. Each speaker was given a few minutes to make a point before the audience discussion. Caryn Franklin is a Visiting Fellow at LCF, broadcaster, fashion editor, co-editor of i-D magazine, and co-founder of All Walks Beyond the Catwalk which challenges the fashion industry’s dependence on unachievable body ideals by promoting diversity and inclusivity. She spoke about the importance of educating designers, stylists and journalists. James Partridge OBE, Founder and CEO of Changing Faces, the leading UK charity supporting and
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representing people with disfigurements, presented the audience with statistics demonstrating the large demographic on people with disfigurements in the UK. He argued that children are exposed to stereotyping through games in which the ‘baddie’ is scarred. He also showed how ‘disfigurements’ can be considered beautiful. He stressed the importance of fashion in developing social norms and argued for an industry that represented and respected individuals regardless of their appearance. Zowie Broach (LCF) is a partner in Boudicca, a design house respected for its integrity, depth of design and attention to detail. Zowie spoke about the beauty of images that were created to be different. Next was Chris Pawson, who spoke about the importance of clothing not only for other people’s perceptions of us, but for our own cognitions and mood. Giving examples from his own work, he emphasised the importance of fashion in wellbeing. Finally, Dr Carolyn Mair summed up the other speakers’ comments and reiterated the recurring theme of the narrow focus of ‘beauty’ and ‘normality’ currently promoted by the fashion industry. The concluding remarks emphasised the uniquely important role held by the fashion industry and the mission of LCF which is to use fashion to drive change, build a sustainable future and improve quality of life.
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Teachers to be trained in neuroscience Teachers look set to receive training in neuroscience, after members of the Association of Teachers and Lecturers (ATL) voted for a motion calling for materials and policies on applying neuroscience to education. Perhaps prompted by the announcement earlier this year of a government-backed Education Endowment Foundation and the Wellcome Trust’s launch of a £6 million scheme that will fund neuroscientific research into learning, members at the union’s annual conference narrowly supported the motion. However, the news brought a mixed reaction. Dr Catherine Loveday, a neuropsychologist at the University of Westminster, told us: ‘I am delighted about the recent financial support for educational neuroscience research, and I very much welcome initiatives to integrate robust and relevant neuroscience into educational practice. However, I think we have to be careful about how this is done. There is a real tendency for neuroscience to be taken out of context, misunderstood and misapplied. Julia Neal, member of ATL and supporter of the motion, is quoted as saying that an
FILM AWARD Devil in the Room, the sleep paralysis film that featured in our November 2013 ‘Big picture’, has won the Best Documentary Prize at the Cineglobe International Film Festival at CERN, Geneva. The biennial festival is based in the Globe of Science and Innovation, in the heart of CERN, which is home to the Large Hadron Collider, birthplace of the World Wide Web and one of the seats of modern science. The festival accepts films that are ‘inspired by science’, and the 2014 theme was ‘Beyond the Frontier’. Filmmaker Carla MacKinnon said: ‘It was a great honour to receive the award and have the film played in such a beautiful and meaningful location.’
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understanding of neuroscience could help teachers support creative “right brain thinkers”, a concept that would fill most neuroscientists with horror [see tinyurl.com/73h2xan]. Applying good, up-to-date empirical knowledge of the brain and mind to educational processes is an utterly vital step forward, but any training must be done carefully, appropriately and by the right people.’ We also spoke to Helen Knowler, a Senior Lecturer in Education at the University of Bristol, who said: ‘I am not a neuroscientist, but I have been a teacher who has attended countless hours of “training” over the years. Some of it was excellent and some of it was very poor! It is not uncommon to read in research literature or mainstream media that teachers need more “training”. My feeling is that this has become something of trope which obscures what we know about the complex and multifarious ways that teachers learn to do their work. There is plenty of evidence that neuroscientific insights can be useful for teachers. There is also, however, plenty of evidence that teachers have been exposed to a range of “neuromyths” whereby spurious and even bizarre approaches to teaching and
learning have been adopted in classrooms in the name of “brain science”! More “training” sounds like a good thing, but research tells us that in order for teachers to participate in high-quality professional development that has the capacity to transform experiences for learners, this needs to be more than a superficial roundup of everything we know about, in this case, the brain. Professional development for teachers, when done well, is a powerful and important tool for school improvement. Poorly designed courses, that do not attend to the cognitive, affective and ethical dimensions of teaching are likely to be a waste of time in the long run, and will not endear teachers investing time to learning more about the ways that neuroscientific insights can promote pedagogical innovation. I wholeheartedly support the idea of carefully evaluated professional development in the field of neuroscience for teachers, but would argue that it needs to be in-depth, long-term and offer some robust practical examples of the ways that this understanding translates into practice.’ JS I Share your views by e-mailing psychologist@bps.org.uk
Memories on cue A new €2 million collaboration has launched, partnering the Department of Psychology at the University of Essex and computer scientists at Lancaster, Stuttgart and Lugano. The 'RECALL' project aims to use wearable technology to improve and augment human memory. Professor Geoff Ward told The Psychologist: 'Technology has always had a direct impact on how and what humans remember. This impact is both inevitable and fundamental – technology radically changes the nature and scale of the cues that we can preserve outside our own memory in order to trigger recall. Such change is not new – we have seen the transition from story-telling to written books, from paintings to photographs to digital images and from individual diaries to collective social networks. However, in recent years technology has opened up entirely new ways of augmenting human memory – near-continuous collection of memory cues has become possible through the use of technologies such as Microsoft’s SenseCam, social networks and interaction logs; advances in data storage and processing now enables widespread mining of stored cues for proactive presentation; and the presence of ubiquitous displays (both in the environment and
via personal devices such as Google Glasses) provides many new opportunities for displaying memory cues to trigger recall.’ The project aims at a targeted breakthrough to create a memory augmentation technology that provides the user with the experience of an extended and enhanced memory, but is based on improvements in the collection, mining, and presentation of appropriate information to facilitate cued memory recall. Professor Ward says: ‘One of our proposed activities, to be undertaken in the next six months, includes booking out a very large country holiday cottage, and inviting volunteer participants to wear all kinds of wearable sensors, cameras, et cetera., and then to see how the data captured can be used to test, supplement and modify memory. He adds that 'the project is high risk – numerous technical and societal challenges need to be addressed before augmented memory systems are possible; and potentially high pay- off – if successful, the project will contribute to our fundamental understanding of human memory and have a transformational impact on all spheres of life – the workplace, family life, education, and psychological well-being.’ JS
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‘Play’ is not a four-letter word Jon Sutton reports from the Idea Conference in Billund, Denmark There is a serious issue with the way our learning environments are fostering empathy, creativity and social cognition. We need to redefine play and reimagine learning: ‘play’ has a stigma that is robbing our children of an opportunity, to experience, to experiment, to explore. That was the message from Randa Grob-Zakhary, Chief Executive Officer of the LEGO Foundation, launching this two-day event. The Foundation, endowed by LEGO’s founding family, is committed to ‘inspire the world to recognise, appreciate and take action to support the transformative role of play in learning’. They do this through philanthropic activity and through the funding and dissemination of academic research in the field. After a pop science quiz on how the mind learns, I enjoyed a breakout session with Professor Peter Gray (Department of Psychology, Boston College) on ‘freeing the play instinct’. Gray referred to evidence suggesting that children’s sense of control over their lives has continuously decreased over the past 35 years, before going on to attempt a causal link between this and declining opportunities to play. The first half of the 20th century, Gray said, was the golden age of play, as child labour laws freed the young from the workplace. Beyond 1955 or so, adults began to take over children’s non-labour activities and hobbies were replaced by classes. ‘When I talk about what my childhood was like,’ said Gray, ‘young parents are shocked. When I was five, as long as I had a responsible six-year-old with me I was free to roam.’ Play is how children learn to solve their own problems, take control
of their lives, regulate their emotions and get along with peers, and Gray argues that we need to create the ‘optimal context for self-education’ – learning how to learn rather than a formal education based on storing facts and
know how their brain works. Achieving this ‘mind mastery’ – which Whitebread describes as a combination of skill, will and thrill – appears to predict a whole range of lifespan outcomes (such as high school grades, earnings, arrest
assessment. He points to a number of curriculum-free, ‘democratic schools’ across Europe and suggests that these produce more rounded individuals, rather than the increasing levels of narcissism found in numerous academic studies. ‘Playmates can’t tolerate someone thinking they’re the centre of the universe’, Gray concluded. A second session led by Professor David Whitebread, a developmental cognitive psychologist at the University of Cambridge, asked how children become ‘selfregulating’ and why it is important. Self-regulated learners know what to do when they have a problem; enjoy solving problems; and
history), better than measures of early literacy. Yet education policy retains its focus on the ends rather than the means. ‘The thing is’, says Whitebread, ‘it’s not difficult – I can train a group of teachers to support playful education in five or six weeks. It’s about making metacognitive and learning strategies explicit, and encouraging children to reflect upon and talk about their learning.’ After lunch, ‘Expert in Residence’ at the Harvard University Innovation Lab, Tony Wagner, delivered a clear and passionate call to educate young people to be ‘creators, not consumers’. ‘The world no longer cares how much our students know’, he said, ‘it’s
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about what you can do’. ‘Just dig in and go figure it out’ is the only job description you need, yet schools and workplaces are not set up to encouraged ‘disciplined play’ of their personnel. ‘Just imagine if our schools followed the Google rule – 20 per cent of your time given over to exploration, to be the architect of your own learning.’ Instead, Wagner argued, we penalise mistakes, leading to a fear of failure and subsequent risk aversion. ‘Fail early and fail often’, Wagner advises. ‘It’s about iteration – reflect on what you have done, and set new learning goals.’ These themes continued on the second day, with a conversation between psychologist Kathy HirshPasek (Director of the Infant Language Laboratory at Temple University) and Mitch Resnick (Director of the Lifelong Kindergarden Group, MIT). We can’t just open up the head of a child and pour in facts, in a world that is constantly changing: instead, the emphasis should be on projects, peers, passion and play. In his later talk, Jack Shonkoff (Director of the Centre on the Developing Child at Harvard University) agreed: Colleges need to consider what their ‘value added’ is, in an era of the Massive Open Online Course. It’s about coaching, not teaching. Putting their money where their mouth is, the LEGO Foundation launched the #play2learn Re-imagine Learning Challenge. This is open to individuals, organisations, and partnerships who are using play or playful approaches to enrich learning. The deadline is later this month – see www.changemakers.com/play 2learn for more details.
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DOMESTIC VIOLENCE CASE CHANGE Since the introduction of the new legal aid scheme in April 2013, certain forms of specified evidence of domestic violence, or the risk of domestic violence, are now required in order to access funding for legal aid in private family law matters. The Ministry of Justice has reviewed the evidence requirements over the first year of operation, and the definition of ‘health professional’ has now been expanded to include practitioner psychologists. The Ministry of Justice is currently updating the template letters and guidance at www.justice.gov.uk for victims of domestic violence and organisations responding to requests for evidence.
PAIN GARDEN People who endure regular pain are finding
Brixton reading group growing
some relief after using an innovative map that helps them to create a ‘garden’ of their suffering. Created by Professor of Rehabilitation at Teesside University Denis Martin and Animmersion, a Teesside DigitalCity company, the Pain Garden is supported by Arthritis Research UK and allows people to link up the multidimensional aspects of the impact of pain on their lives. By answering questions relating to emotion, sensory experience and well-being a digital garden, accessed via a website, is grown that thrives or wilts as a patient’s health and well-being alters. Professor Martin said: ‘Pain can be confusing for people as it runs alongside different emotions. They find it difficult to get this across. Getting people to understand what chronic pain impacts is important to help them deal with it. The idea of a garden came about as pain has different dimensions – sensory, emotional and general well-being that can sit as well-defined items themselves, but they all link together. When you use the metaphor of a garden you have the garden as a whole but also within it distinct elements like plants, trees and water features. When you put it altogether you create the garden.’
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In psychology bestseller The Social Animal, American journalist David Brooks describes how regularly attending a reading group can contribute to people’s subjective well-being. So if you are in London, consider getting yourself down to the London Psychology Reading Group, founded 18 months ago by Brunel University PhD student Morgan Ereku (pictured above). The reading group is supported by Lambeth Library who, keen to encourage community initiatives, provide the groups books and a room in Brixton Library where the group convenes on the last Sunday of each month. Each reading group session features a book falling into psychology, popular science or general well-being categories (e.g. recent best sellers such as Thinking Fast and Thinking Slow by Daniel Kahneman, Outliers by Malcolm Gladwell, as well as popular classics like Helen Fisher’s Anatomy of Love). Occasionally the group features biographies and multicultural fiction, to explore how a psychological reading of these texts can deliver additional cognisance of the contemporary lived experience. Morgan describes two aspects that contribute to the reading group’s success. ‘Firstly, the public penchant to draw on psychology to understand everyday concerns and desires that has flourished with the growing prominence of popular science books by trailblazing psychologists.
And secondly, people’s desire for a forum to meet and discuss the insights garnered from the solitary act of reading such books. In the case of the London Psychology Reading Group, doing so provides the opportunity to learn, share and discuss the daily stream of new psychological findings with other enthusiasts.’ The group has been advertised through local blogs, social networking platforms, and Lambeth Library channels, leading to a diverse range of members from north and south of the river. ‘We’re looking to attract a younger audience to reading groups,’ Morgan explains. ‘Members are mainly in their twenties and thirties, and include psychologists, sociologists, health professionals, undergraduates, as well as a fair proportion of members with no specific psychology qualifications besides a keen hobbyist interest in the science of the mind.’ Given this, perhaps we will see a growth of similar reading groups? ‘I hope so,’ Morgan says. ‘Meeting in a relaxed environment to discuss the latest research on psychology, and reflect on what it reveals about ourselves and others, is a wonderfully rewarding way to while away a Sunday afternoon.’ JS I If you are interested in joining the London Psychology Reading Group, contact Morgan Ereku (morgan.ereku@ brunel.ac.uk) or Brixton Library on 020 7926 1067 or follow @LDNPsychology
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Mind Media Awards 2014 The Mind Media Awards, which celebrates the best examples of reporting and portrayals of mental health in print, broadcast and digital media, are open for entries with a deadline of 27 June. The event, organised by the mental health charity Mind, invites journalists, broadcasters and production teams to submit work that has helped to raise awareness of mental health problems and tackle outdated stereotypes. Last year’s winners included Newsnight’s feature on postpartum psychosis, BBC One drama series The Village and comedian Jon Richardson’s Channel 4 documentary A Little Bit OCD.
FUNDING NEWS The International Federation of University Women invites applications for its international fellowships and grants to women graduates from any learning discipline that are enrolled in a PhD programme. A number of awards are available for the purpose of postgraduate research, study and training, including funds reserved for graduates based in Great Britain. Applications should be received by 30 June 2014. I tinyurl.com/qzs5z9q
Paul Farmer, Chief Executive of Mind, said: ‘This year we are looking for programmes, blogs and news reports which challenge myths, misinformation and clichés about mental health, encourage positive debate and tackle stigma and discrimination. It’s important that audiences are able to see people with mental health problems as they are as a whole rather than just in relation to their diagnosis and we’re keen to see work that includes the voices of people who have experienced mental health problems.’ JS
The Wellcome Trust is accepting applications for its Short-term Research Leave Awards for clinicians and scientists. The awards enable clinicians or scientists to undertake a short-term period of research at a department with academic expertise in medical humanities. Applicants can be scientists, clinicians or healthcare professionals who would return to their established post on completion of the award and must be residents of the UK or the Republic of Ireland. Applications should be received by 18 July 2014. I tinyurl.com/mlewzov
I For more information about the categories, criteria and how to enter, visit www.mind.org.uk/awards
Brain Prize The winners of this year's annual Brain Prize have been announced at a ceremony in Denmark. Giacomo Rizzolatti, Stanislas Dehaene and Trevor W. Robbins CBE – from Italy, France and the UK respectively – shared the accolade for their outstanding contribution to European neuroscience. Each year's prize recognises highly original and influential advances in any area of neuroscience, and these three scientists distinguished themselves in studies on higher brain mechanisms, motivated behaviour, social
Trevor W. Robbins CBE
interaction and cognitive and behavioural disorders. Professor Robbins is a Fellow of the British Psychological Society. You can read about his work in cognitive neuroscience,
behavioural neuroscience and psychopharmacology in an interview in our May 2012 issue. Chairman of the Foundation's board Professor Povl KrogsgaardLarsen said the three winners complement each other in spanning a wide spectrum of challenging issues of higher brain function. ‘We are pleased to award this year’s prize to scientists who are providing us with a better understanding and better treatment of cognitive and behavioural diseases that are huge burdens to society,’ he added.
The Society for Reproductive and Infant Psychology invites applications its three Conference Bursaries for Students to attend the annual conference of the Society for Reproductive and Infant Psychology. Preference will be given to students who are presenting a paper or poster and those who have limited or no funds to attend. The bursary will cover conference fees and up to £150 towards travel and accommodation. The SRIP also invites applications for its Conference Bursary for NHS Staff. Applicants will have engaged directly with the implementation of evidence-based practice and the conduct of appropriate research. Applications are also invited for the SRIP’s annual Doctoral Thesis Prize. The prize is for a research thesis submitted as a full or partial requirement for a postgraduate degree, the subject of which may be any aspect of reproduction, birth or infancy. The prize includes £250, a year’s membership to the society and all expenses paid attendance to the annual conference. Applications for all the above should be received by 31 July 2014. I www.srip.ac.uk/funding.php
People diagnosed with diabetes are three times more likely to be diagnosed with depression than people without it, and this can have a serious impact on their ability to self-manage their condition. PsychologyOnline has secured Small Business Research Initiative for Healthcare funding to see how its approach to cognitive behavioural therapy (CBT) can be used to treat 'diabetes distress', a term used to describe the sense of frustration, anger and disillusionment that can lead to neglecting the condition over time. The collaborative project aims to improve glycaemic control and psychological well-being through integrated care. It is led by Ann Hayes, chair of PsychologyOnline, who says: 'PsychologyOnline provides one-to-one CBT via instant messaging and we use highly experienced psychotherapists. We will be working with King’s College Hospital to train diabetes specialists nurses to provide CBT integrated with structured diabetes education and will pilot this approach in a small focused patient study.
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‘DIABETES DISTRESS’ PROJECT
For BPS awards and grant schemes, see www.bps.org.uk/awards&grants Funding bodies should e-mail news to Emma Smith on emma.smith@bps.org.uk for possible inclusion
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DIGEST
‘What else can you expect from a Crappo?’ Which slur is worse: ‘cracker’ or the ‘n-word’? After a July 2013 debate on CNN in which a panel discussed this exact question, researchers from NYU – Abu Dhabi, The Sage Colleges, and Tilburg University set out to determine why people might perceive slurs directed at some groups as more offensive than those directed at others – and whether group status has anything to do with it. P.J. Henry, Sarah Butler and Mark Brandt first gathered over 200 college students and asked them to generate the most offensive word that they could think of for 15 target groups (like ‘African-Americans’, ‘obese people’, or ‘highly intelligent people’). After generating these words, participants then had to rate the offensiveness of each word, and the relative status of each target group in American society. As expected, there was a strong negative correlation between perceived status and offensiveness – the lower in status participants perceived a group to be, the more offensive they thought that slurs directed at that group were. For example, slurs directed against EuropeanAmericans (like ‘cracker’ or ‘honkey’) or men (like ‘dickhead’) were seen as significantly less offensive than slurs directed against the mentally disabled (e.g. ‘retard’), obese (e.g. ‘fat ass’), or African-Americans (e.g. the ‘n-word’). These differences were also reflected in the perceived status of these groups. Men, European-Americans, straight people, and highly intelligent people all enjoyed perceived group statuses that averaged around 8.5 out of 9 (and the offensiveness of their group-based slurs hovered between 3 and 6 on an 11point scale). On the other hand, groups like the mentally ill, mentally disabled, Arab-Americans, obese people, Latino(a)s, gay people, and African-Americans had average statuses below 5 on the 9-point scale, and the offensiveness of slurs against them averaged between 7 and 9 on the 11-point scale. However, the obvious flaw in this study is its correlational nature – it is impossible to tell the causal direction, if any, that this relationship might take. Are slurs more offensive because the groups are lower in status, or do the groups possess low status because the slurs against their groups are so much worse? Or is there a separate variable entirely explaining this association? In order to test this question experimentally, the researchers first had to somehow find a ‘slur’ that would In Journal of Experimental Social Psychology be completely separated from all of the ones we already know, with their historical/cultural entanglements and all of the confounding factors that would accompany them. The researchers solved this conundrum by making up a brand new slur of their very own. Over 250 participants read a story about ‘creative developers’, a group in a hypothetical workplace that either make very good money, have very good benefits, get three-day weekends and are very important and influential (high status) or make very little money, have no benefits, have to work on the weekends and are not important or influential at all (low status). The participants then imagined hearing someone in payroll derogate one of the creative developers for not understanding something, finishing up by saying, ‘What else can you expect from a crappo?’ Crappo, as the vignette explains, is a derogatory combination of the words ‘creative’ and ‘poser’. As expected, participants who thought that creative developers were a low-status group rated the term ‘crappo’ as significantly more offensive than those who thought that the creative developers were a high-status group. Importantly, they also thought that the ‘crappo’ in question would feel significantly more insulted, bad about himself, and angry if his group was low-status – and this difference in expected emotional reactions explained (at least partially) the difference in perceived offensiveness. Overall, group status is an important determinant in how ‘offensive’ we perceive slurs to be. Slurs directed at lower-status groups in society are seen as significantly more offensive as those directed at higher-status groups, at least in part because we feel that lower-status group member will react to those derogatory terms with more negative emotions. I By guest host Melanie Tannenbaum, UIUC social psychology PhD candidate and Scientific American blogger (http://blogs.scientificamerican.com/psysociety)
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Our own vocabulary? In History of Psychology If you were to pick up the flagship journal from a discipline that is foreign to you and flip to an article at random, how much do you think you would understand? The vocabularies used by any given discipline overlap with those of many other disciplines, although the specific meaning associated with a given term may be dissimilar from discipline to discipline. Anglophone psychology, for instance, has been previously shown to share much of its vocabulary with other disciplines, especially: biology, chemistry, computing, electricity, law, linguistics, mathematics, medicine, music, pathology, philosophy, and physics. But how much of psychology’s vocabulary may be said to be unique to itself? John G. Benjafield of the Department of Psychology at Brock University (Canada) compared the histories of the vocabularies of psychology and the 12 disciplines listed above. Constructing databases for each of the disciplines using entries in the Oxford English Dictionary, Benjafield examined the rate of primary vs. secondary words (i.e. how often a word was used for the first time by a discipline vs. how often a word was appropriated from the vocabulary of another discipline) along with the dates of first use of these terms, and the polysemy of the vocabularies (i.e. the number of different meanings held by a given word). So does psychology have its own vocabulary? The answer seems to be… somewhat. The
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Getting to grips with implicit bias In Journal of Experimental Psychology majority of the vocabularies of all 13 disciplines were formed of secondary words; that is, the bulk of their vocabularies are formed of words that were first used in the English language by another discipline (often with another meaning). But, psychology was nonetheless found to have some unique characteristics with regard to its vocabulary that you might not have expected. First, Benjafield found that computing and linguistics have the highest percentage of secondary words in their vocabularies (97 per cent and 94 per cent respectively), while psychology and chemistry had the lowest rates (65 per cent and 62 per cent). In light of these results, psychology’s vocabulary may be described as being less metaphorical in nature than previously assumed (especially when compared to computing and linguistics). Moreover, whereas the other subjects in this study showed a collective tendency over time to increasingly assign new meanings to existing words, psychology has been following the opposite pattern – over time, psychology has tended more and more to invent new words for its purposes than the other disciplines. Finally – and surprisingly – Benjafield’s vocabulary analysis painted a picture in which psychology has been strongly influenced by the naming practices not of philosophy and physics, but of chemistry. I By Jennifer Bazar, University of Toronto.
Implicit attitudes are one of the hottest topics in social psychology. Now a massive new study directly compares methods for changing them. The results are both good and bad for those who believe that some part of prejudice is our automatic, uncontrollable, reactions to different social groups. The implicit association test (IAT) is a simple task you can complete online at Project Implicit which records the speed of your responses when sorting targets, such as white and black faces, into different categories, such as good and bad. Even people who disavow any prejudiced beliefs or feelings can have IAT scores that show they find it easier, for example, to associate white faces with goodness and black faces with badness – a so called ‘implicit bias’. The history of implicit bias research is controversial – with arguments over what exactly an implicit bias means, how it should be measured and whether they can be changed. Now a new paper in the Journal of Experimental Psychology reports the results of a competition that challenged researchers to design brief interventions aimed at changing people's implicit biases. The interventions had to be completed online, via the Project Implicit website, and take less than five minutes. Samples of 300–400 people were then randomly assigned to take each intervention, allowing a high statistical power to estimate the effect of the
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intervention on IAT scores. Overall, 17 interventions were tested, and nine appeared to work, while eight had estimated effect sizes close to zero. The paper reports that interventions that focused on trying to shift the underlying attitude of the participants fared badly. Interventions such as ‘instilling a sense of common humanity’, ‘training empathetic responding’, encouraging taking the perspective of the outgroup or imagining positive interracial contact all seemed not to work. These failures to shift IAT scores suggest that the IAT measures something that is relative stable – a real thing in our cognitive makeup, and something that can be measured in a way that can’t be as easily manipulated as selfreport. The interventions that did work included some that targeted response strategies, including a straight ‘Faking the IAT’ intervention, a practising
the IAT intervention and several other priming and training interventions. That these worked is also both good and bad news. That IAT scores can be shifted by faking and training is bad news for the reliability of the measure, but there is some comfort in knowing that the successful interventions all relied on sophisticated knowledge of how the IAT worked – most participants in implicit bias studies wouldn't come up with these strategies on their own. The big unknown is how long term any of the effects are. It could turn out that sustained change on implicit biases requires longer than five minutes intervention, but with more sustained interventions it really is possible to shift the underlying attitudes, and not just people’s response strategies. I By Tom Stafford, University of Sheffield.
The material in this section is taken from the Society’s Research Digest blog at www.researchdigest.org.uk/blog, and is currently provided by a series of guest hosts. Visit the blog for full coverage including references and links, additional current reports, an archive, comment and more. Subscribe by RSS or e-mail at www.researchdigest.org.uk/blog Become a fan at www.facebook.com/researchdigest Follow the Digest editor at www.twitter.com/researchdigest
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The Scottish question We sought views on September’s Scottish independence referendum. Here we publish three replies and encourage you to continue the debate.
here is much debate concerning the extent to which issues of identity might affect the independence referendum. But, even to the extent that they will, it certainly isn’t a matter of those who feel more Scottish being more likely to vote Yes. In the first place, there are many studies, including our own, that demonstrate that there is little relationship between strength of Scottish identification and support for an independent Scotland. The reason is quite straightforward. What identification does is to create a concern for the fate of the group, and many passionate Scots believe that independence would be bad for Scotland. They point to the fact that the greatest flourishing of national culture in the Scottish enlightenment occurred after the Treaty of Union. In the 19th century there was even a movement of nationalist unionism that urged stronger ties to England in the interest of Scots. This doesn’t mean that Scottish identity is irrelevant to the question of independence. It means that we need a more nuanced approach to the relationship. My research with Nick Hopkins and with Denis Sindic suggests that we look more closely at the content of Scottishness: at the norms and values associated with Scottish identity; at the vision of ‘the good society’ that they project. For those who do identify themselves as Scottish, the key question then becomes, does union with England and Wales promote or undermine this
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Dollard, J. et al. (1939). Frustration and aggression. New Haven, CT: Yale University Press. Lemma. A. (2003). Defences and resistance. In A. Lemma (Ed.) Introduction to the practice of psychoanalytic psychotherapy (pp.200–229). London: Wiley. McGowan, J. (2013, 15 April). We can’t let
vision? If the answer is ‘undermine’ – that is, if there is a sense that English and Scottish values are at odds and that, in the UK, policies reflecting English values are imposed on the Scots – then independence becomes an attractive option. The pitch of the Scottish National Party (SNP) is oriented precisely to this issue. Scots, they tell us, are inherently more communal and progressive and even internationalist than the English. The ability of Scots to build a fairer society is ever undermined by English conservatism and insularity. And anything that serves to validate this viewpoint will serve to strengthen the cause of independence. Now let me turn to a second reason why the independence question does not hinge on the strength of Scottish sentiment. At the start of January this year, Nicola Sturgeon, the SNP Deputy First Minister of Scotland, launched the independence campaign with a speech on my doorstep, at the University of St Andrews. The speech reflected the fact that the SNP cannot win the independence vote on SNP votes alone. They need others, in particular the left in the Labour Party and beyond. So Sturgeon spent a lot of time claiming Labour and left icons in Scotland – Tom Johnston, the legendary Secretary of State for Scotland, and the Red Clydesiders, radical trades unionists during and after the First World War – for the independence cause. It was a bold claim, especially as far as
Maggie go [blog post]. Discursive of Tunbridge Wells. Retrieved from http://discursiveoftunbridgewells.blog spot.co.uk/2013/04/we-cant-letmaggie-go.html Poppe, E. (2001). Effects of changes in GNP and perceived group characteristics on national and ethnic stereotypes in Central and Eastern
Red Clydeside was concerned. They were resolute anti-imperialists who opposed the First World War and who saw it through the lens of class not nation. Now, the Scotland of today is very different to the Clydeside of a century ago. The country is far from uniformly radical. But still the radical tradition persists and, for those who support it, independence should be seen in similar class terms. Such people feel more in common with workers in Wapping than lairds in Largs. To them, identification with Scotland is largely irrelevant. Whether they vote for a new constitutional arrangement hinges on an entirely different identity and entirely different interests. Whether they vote for independence depends upon whether they think it will advance the radical cause north and south of the border. A number of scenarios present themselves. The first is promoted by the SNP (and was stressed by Nicola Sturgeon), who are well aware of these issues. It is that a successful Scotland will act as a beacon that will lead the English to abandon their conservatism and embrace the radical cause. The second is that cutting off the more progressive parts of the UK will leave England and Wales as a permanent reactionary rump who suffer as the Scots thrive. The third, and even bleaker scenario (at least from a radical perspective) is that even if Scotland is a separate country it will still be dominated by its larger neighbour and so the reactionary rump will make a Scottish alternative impossible. Everyone will languish together.
Europe. Journal of Applied Social Psychology, 31, 1689–1708. The New Yorker (2008, 6 October). Donna Brazile: ‘If I were running this campaign’ [Video file]. Retrieved from www.newyorker.com/online/blogs/fest ival/2008/10/brazile-campaign.html
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Obviously, only the first of these three scenarios would promote a radical vote for independence. But perhaps there is a fourth that would also suffice. A counsel of despair. A sense that England is a lost cause and all one can do is save the Scottish masses. Sauve qui peut! Again, anything which serves to validate this viewpoint will serve to strengthen the cause of independence. Now, social scientists are not soothsayers. We cannot say what will happen, but we can map out the levers that will
determine whether things happen. Or, in more familiar terms, we can identify the variables that will impact the referendum outcome. That is what I have sought to do here. Independence becomes more likely to the extent that, firstly, English values are seen to be opposed to Scottish values, and, secondly to the extent that England is seen as inescapably right wing and insular. In a sense, these are already strong claims. They suggest, somewhat counterintuitively perhaps, that insularity can be at odds with the desire for a separate Scottish nation rather than associated with it. But this is supported by recent evidence showing that Scots who are against immigration from outside the UK are overwhelmingly against independence while those who are for such immigration predominantly support independence. I won’t go as far as predicting whether
the referendum will actually be supported or not, partly because these issues are not determined, but are the stuff of political struggle and unforeseeable events. However, I will go this far. One of the key factors in the referendum debate will be the outcome of the European elections in May. If UKIP do extremely well in England and extremely badly in Scotland, (you will know, but we go to press before polling day), then it becomes easier for nationalists to argue that the English are different and for radicals to feel that England is irredeemable. So May could be a turning point. And the great achievement of UKIP would be to help break up the United Kingdom. Now what an irony that would be!
I used to have a Scottish passport. I was about nine at the time and, though the memory is a little hazy, I swear it had a smart navy cover embossed with a thistle. To enhance the Celtic authenticity, the front also featured Nessie, bagpipes and a haggis, rendered as if in the wild. The Scottish passport was a much more distinguished document than my current British one; its provenance, from a shop selling Jaws mirrors and ‘World’s Greatest Dad’ statuettes only adding to its allure. Its primary disadvantage, failing to facilitate foreign travel, seemed negligible. Such were the shortcomings of laying claim to a Scottish, rather than a British, nationality. However, according to the SNP Scottish Executive, the limited functionality of a Scottish passport, and a good many other problems besides, may be remedied by a ‘Yes’ vote in the independence referendum on 18 September this year. There is certainly romance in the Scottish cause, which has, through Jacobite rebellions and devolution referenda, been simmering pretty much
from the moment of union in 1707. I don’t propose to get into that here. And, though the issues at stake (currency, EU membership and management of natural resources) are undoubtedly important, let’s also leave those to one side. Rather, I’d like to think a little about which psychological process may inform my compatriots’ decision to stay or go. I’m often struck when hearing political professionals talk (see the New Yorker 2008 debate, referenced below), that they frequently describe votes in simple terms: as either being for change, or for the status quo. All the other complicated arguments basically get pulled in to bolster one or other position. Such a binary choice is even starker in a referendum. Arguing either the need for a new broom, or that we are safer as we are, is hugely influential on tactics. It means that the job of Scottish First Minister Alex Salmond is to damn the Act of Union as the root of all ills, from lost oil revenues to a national inferiority complex. He also has to tell us how wonderful the alternative Scandinavian-style state would be with a cosmopolitan culture and a permanent leftie government. (Scotland only has one Tory MP.) Alistair Darling and the Better Together campaign must conversely inform the electorate of the economic apocalypse independence would likely cause, and emphasise Scotland’s general too-smallness to hack it alone in a world of bigger states. Painting a rosy picture of the Union might be a bit more difficult as it has been knocking around for three hundred years and, as we know, the grass is always greener. The idea that politicians deal in self-
serving simplifications, talk down the opposition and make unrealistic promises should not come as a huge surprise to anyone. A more interesting question is why such tactics are effective. A partial answer, observed by psychologists of many stripes, concerns our human tendencies to see the world in somewhat polarised terms, and to seek others to blame when things go wrong. Recognition of such thinking is a significant part of many clinical models of distress. Cognitive behavioural therapy captures some measure of our propensity to be black and white, all or nothing, and for our moods to be affected by extreme internal rules and by unhelpful attributions of blame. It’s psychodynamic theories though, that really chime in with our political selves. The splitting of the world into good and bad Objects (Melanie Klein’s good and bad breasts), is absolutely fundamental to ideas of defence against painful feelings (see Lemma’s 2003 account of defence mechanisms). Once split, our feelings can be projected into another person or group who become idealised or hated. Think we’re not all capable of this? Ask yourself what you observed when Margaret Thatcher died. I argued at the time (McGowan, 2013), that the extreme reactions this prompted, even among the middle-aged and mildmannered, were very much in line with the idea of primitive defence like splitting. Maggie was either Britannia or the Wicked Witch, and the 1980s held up as either national redemption or the end of civilisation as we knew it. One of the jobs of a psychotherapist is to help us recognise and tolerate shades of
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Steve Reicher Professor of Social Psychology School of Psychology and Neuroscience University of St Andrews
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grey. Rules need not be absolute. People aren’t totally good or bad. In our politics though, we often fail to obtain such restraining counsels. That the tendency to blame and find scapegoats extends to groups as well as individuals has been well researched in social psychology, at least since the 1930s (e.g. Dollard et al., 1939). We may experience an increased tendency to blame others on the basis of religion, skin colour, sexual identity, nationality or other factors that imply difference or that someone is out of our group. More recent studies, such Poppe’s (2001) survey of attitudes during a period of economic decline in Eastern Europe suggest that, when times get tough, views about those outside central cultural groups can become sharply more negative. Scapegoating other groups has ugly connotations and may be more commonly associated with racist groups or political parties, such as UKIP, which have been explicitly set up for protest. The SNP is clearly less xenophobic than the UKippers, but there are in the position of encouraging some of the same
psychological process. The Sassenachs need to be seen as the source of Scotland's troubles in order to be cut loose. The blaming of the outgroup however, is somewhat gentler with the SNP than with parties like UKIP, partly because they are in a classic political dilemma: wanting to blame someone else for what goes wrong
but also encumbered with actual power. The SNP have genuine executive authority and need to be seen as credible big shots, responsible for successful policies and speaking for their whole nation. Of course, being in charge also leaves you in the firing line for failure. The time-honoured tactic in this situation is to blame the previous government. Though there are limits to how much a politician can palm it all off on the last lot, a really skilled one can manage it many times before the gig is up. In the case of Scotland there is an additional sucker to blame: the Westminster government. Alex Salmond has managed to do this quite brilliantly and deserves the epithet most frequently attached to him: canny. (His enemies more pejoratively describe him as wily.) All of which brings us to the possible outcome in September. How will it turn out? I don’t know, but I do know what may influence it.
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bookies as the outcome is anyone’s guess. Could the Scots go? If they decide to blame the bad times on the Auld Enemy you just watch them. I might just go and see if I can find my haggis passport. Just in case.
It was Bill Clinton who pointed to the centrality of economic factors in all elections, to which I’d add even elections that seem to be about nationalism, history and pride. For all Alex Salmond’s cunning, the majority of Scots at present seem reluctant to blame the Union for their woes, or at least to blame it enough
to vote for independence. If the current prediction of economic recovery is borne out it’s hard to see this position changing and I’d have my money on the Better Together campaign. However, if the economy tanks again, the search for scapegoats will be on in earnest. If that happens I think I’ll skip the visit to the
Later this year the Scottish people will go to the polls and determine whether Scotland will maintain its place in the United Kingdom or part ways with the Union and begin life as an independent nation. Clearly, the social and political consequences of this vote will be farreaching, and so understanding the factors that will determine the referendum outcome is of considerable importance. Perhaps unsurprisingly, nearly all media coverage appears to centre on the geopolitical issues: much North Sea black gold and political clout (such as EU membership) is at stake! But psychological factors are also known to influence political attitudes, and there is no reason to believe that Scottish independence is much different in this regard. With this in mind, can psychological theory and research contribute to an understanding of the Scottish referendum? Graeme Brown and I were intrigued by this possibility and set about collecting data shortly after the referendum was announced in the autumn of 2012 to explore how psychological factors might predict independence sentiment. A set of moral values scales recently developed by Jon Haidt and colleagues were of particular interest to us as they have previously been shown to predict political orientation. These moral values tap preferences for minimising harms/maximising fairness (often termed ‘individualising’), and concerns over group norms and rules (often termed ‘binding’). Previous work perhaps confirms intuition: higher individualising and lower binding tend to predict those who identify with the political left. We felt that this specific moral lexicon had considerable value as a means to characterise the psychological aspects of the Scottish independence movement. Nationalism is often noted to reflect right-
distinct components, demonstrating the wing characteristics; however, Scottish importance of exploring this issue from nationalism has typically been regarded multiple psychological vantage points. as a left-wing movement. This gives rise What do these findings have to say to some interesting possible associations between preferences for independence and about predicting the results of the referendum? Firstly, moral sentiment may these moral values. On the one hand, if provide a fairly decent barometer to the one considers desire for independence outcome of the vote on 18 September. within the typical psychological analysis Such results also suggest that political of nationalism (i.e. as a right-wing party appeals of a particular nature may phenomenon), one would predict that higher concern for group norms (binding) be of special salience in this debate. For example, emphasising the possibilities and less concern for social justice that independence may bring for (individualising) would predict the enhancing social justice may aid the SNP preference for Scotland to leave the in confirming the support of those voters Union. Conversely, if the preference who highly value individualising. Of for independence reflects the desire to course, the reverse possibility also exists: generate a more left-wing political state, those who favour maintaining the Union one would make might choose to highlight to high the reverse individualisers that a larger union could predictions; better support a generous social welfare namely, lower binding and higher programme. At this stage the politics can become rather messy! individualising To close, while the economic and predicting desire political issues surrounding Scottish for independence. independence will likely rule the media Finally, one might and politicians’ agendas for much of this expect that desire debate, psychological factors should not for independence be ignored, at least not by those who are might be more seeking to understand the forces that nuanced still, drive individuals to one or the other side perhaps reflecting of the fence. Humans certainly vote aspects of rightselectively in order to secure their wing sentiment (e.g. concern for group economic future; but they also care very deeply about their social institutions and cohesion and authority, coupled with how these institutions operate – albeit heightened concerns over social justice). often in markedly different ways from So what did the data say? In short, each other – and these sentiments will higher individualising and lower binding almost certainly feed into any decision significantly predicted independence concerning the future of one’s nation. sentiment. In other words, stronger moral sentiment for valuing individual rights Gary Lewis and less concern for group norms and University of York traditions appear to independently drive preferences for Scottish Do you have an alternative view, or perhaps independence. These results you come at this topic from a completely are consistent with the common perception of different perspective? Scotland as a left-wing nation. Moreover, these results Continue the debate by e-mailing your letters suggest that those in favour to psychologist@bps.org.uk or connect with us of Scottish independence sit on Twitter @psychmag. to the left of the political spectrum on at least two
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John McGowan Canterbury Christ Church University
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Being a man – putting life before death Martin Seager and David Wilkins address the need for this special feature on male psychology hy a special feature of The Psychologist on male psychology? It would perhaps be better – especially at the centenary of the First World War in which so many young men gave their lives – to turn this question around and ask why there has not been one before. There are two reasons why this might be the case: I Men have traditionally been considered the ‘dominant’ sex, and so it might be presumed that they have no gender issues or needs and that maleness is somehow the ‘norm’ (Addis, 2008); I There are pressures on men to appear ‘strong’ and invulnerable (Gilmore, 1990; Levant, 2007; Mahalik et al., 2003).
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Despite the fact that providers of public health and care services are under a statutory duty to tackle gender inequalities, it is still often overlooked that gender inequalities affect men as well as women. This introduction to the special feature first explores some possible reasons for this male ‘gender-blindness’ and sets out some basic facts about health inequalities relating to men. After highlighting the need to research and develop male-friendly services that are tailored in particular to male patterns of emotional communication and help-seeking behaviour, the special feature editors introduce the collection of articles that follow.
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Do higher suicide rates, higher addiction rates, higher rates of homelessness, and higher incarceration rates mean that we are failing adequately to support men who are in psychological distress?
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Why are men poorer users of psychological services? Is it up to men to change their attitudes, or is it up to service providers to adapt what they offer to better meet male need?
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Support a Male Psychology Section of the British Psychological Society: https://response.questback.com/british psychologicalsociety/malepsychsection
Addis, M. (2008). Gender and depression in men. Clinical Psychology Science and Practice, 15, 153–168. Cochrane, S. & Rabinowitz, F. (2000). Men and depression. San Diego, CA: Academic Press. Connell, R. (2005). Masculinities (2nd edn). Cambridge: Polity. Crisis (2011). The hidden truth about homelessness, experiences of single homelessness in England. London:
This means that there may be an equal covert pressure in our society not to write about or study the male gender too closely. As psychologists, it is, however, our role to study the full spectrum of the human condition and to replace prejudice in all its forms with the light of understanding. Here is a simple vignette: In the corner of a railway station waiting room a young woman is sitting alone. Tears are rolling down her face. At first there is embarrassment among those who notice the young woman’s distress, but after a minute or two a fellow passenger goes over to ask if she can help. Soon the young woman is telling this sympathetic stranger her sad story.
Author. Department of Health (2012). Statistics from the National Drug Treatment Monitoring System: Vol. 1. The Numbers. London: Author. Gilmore, D. (1990). Manhood in the making. Yale: Yale University Press. Good, G.E. & Brooks, G.R. (2005). The new handbook of psychotherapy and counselling for men. San Francisco: John Wiley & Sons.
On the platform outside the waiting room, a young man is half drunk. He sits on a bench staring at the place between his feet where some empty beer cans lie. Occasionally he shakes his head. Travellers waiting for the train prefer to stand rather than to sit alongside him. Eventually the man is approached by railway staff who politely ask him to leave the station. The man nods to indicate his willingness, gets slowly to his feet and goes on his way.
Does this story have a ring of truth? Does it tell us something about actual gender difference, hidden perceptions about gender, or both? The truth is that we don’t entirely know, but as psychologists we should be leading the way in finding out. Sadly, until now, most enlightenment about the male gender has come not from the world of science but from the arts: from novelists, film makers, playwrights and even comedians. One thing we do know, however, is that many men avoid seeking help in all its forms and men are more likely to ‘act out’ rather than reflect on their distress (Cochrane & Rabinowitz, 2000; Connell, 2005). But why should this be the case, and what can be done about it?
Why study the male gender? Leaving aside the fact that males account for one half of the human population, the answer to this question should be clear from the following statistics: I Men represent a large majority of all suicides across the world (see tinyurl.com/3cusfc); I Men represent a large majority of those with major addiction problems in the UK (DH, 2012); I Men represent a significant majority of single homeless people in England (Crisis, 2011); I Men represent 95 per cent of the prison population (Wilkins, 2010),
Levant, R.F., Smalley, K.B., Aupont, M. et al. (2007). Initial validation of the male role norms inventory-revised (MRNI-R). Journal of Men's Studies, 15, 83–100. Mahalik, J.R., Locke, B.D., Ludlow, L.H. et al. (2003). Development of the Conformity to Masculine Norms Inventory. Psychology of Men & Masculinity, 4, 3–25. Office for National Statistics (1998).
Psychiatric morbidity among prisoners. London: Author. Wilkins, D. (2010). Untold problems: A review of the essential issues in the mental health of boys and men. London: Men’s Health Forum.
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and a significant majority of prisoners have very serious mental health problems (ONS, 1998).
physical and mental health, and the psychological challenge that cancer may make to the sense of self. Next, Dr Linda Morison, Dr Christina Trigeorgis and Dr Mary John examine the very interesting question of whether men’s attitudes to psychological services are influenced by the fact that the majority of psychologists are female (less than a quarter of psychology graduates are men). At the same time of course, the great majority of senior managers making decisions on policy and commissioning are
BELINDA LAWLEY
These facts alone show us that whilst many men may want to appear invulnerable, something very different is going on behind the scenes. The collection of articles in this issue reflects the fact that there is at least now some emerging public recognition of the need to examine these underlying themes. The success of the inaugural three-day ‘Being a Man’ Festival at the South Bank Centre in London in February also exemplifies people’s new willingness to discuss what was previously almost a taboo subject. How to find ways of reaching men in distress was high on the agenda, and several active campaigners on male health issues were among the speakers (including one of us, David Wilkins). In the articles that follow some of the issues associated with male psychology and male help-seeking behaviours are explored. All illuminate, in different ways, how health The success of the ‘Being a Man’ Festival exemplifies services might evolve on the people’s new willingness to discuss what was assumption that there is a need previously almost a taboo subject to offer men with health problems the same gendermale. Does either of these factors have an sensitive commitment that we presently impact on the kinds of services that are offer women (Good & Brooks, 2005; provided? They also raise the very Wilkins, 2010). challenging question of whether there is Next up in this special feature, Dr ‘some fundamental contradiction between Jennie Williams, Dr David Stephenson and how psychological therapy is traditionally Dr Frank Keating show the complexity of practised and traditional masculinity, and socialised power relationships and explore whether or how psychological the impact of social and racial inequalities interventions can be adapted to reach out on male mental health. They identify a to those who conform strongly to number of ways in which the lived traditional masculine norms’. experience of being male both increases Following on from this idea, Dr Roger the risk of some mental health problems Kingerlee, Dr Duncan Precious, Dr Luke and militates against the likelihood of Sullivan and Dr John Barry begin by getting appropriate and timely help. It also examining the evidence base in relation uses a variety of examples to remind us of to male mental health. Their view is that the important point that all men are not we are by no means doing as well as we the same. might. The NHS exists to save lives, In their article, Dr Peter Branney, Dr but if we consider the preponderance of Karl Witty and Dr Ian Eardley explore the male deaths from suicide we can see that psychological trauma of cancer in men. we are letting down those men in greatest The cancer they choose to look at is not need of support. The authors show us just any cancer – it is penile cancer, a rare that, although the academic evidence base form of the disease that strikes very about ‘what works’ with men is not strong, directly at the most basic biological there are some thriving examples of local manifestation of masculinity. The authors good practice. They also point to some also look at breast cancer in men. This intriguing evidence that suggests that disease threatens masculinity in a different the outcomes of some psychotherapeutic way. Has the patient developed a ‘woman’s interventions may differ between men and disease’? This article is an opportunity to women. think about the relationship between
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Finally, some startling evidence that our cultural attitudes to gender differences are not necessarily fixed for all time is offered by Dr Ali Haggett’s historical perspective paper. Dr Haggett tells us that in the 18th century the word ‘manly’ would generally be taken to mean ‘virtuous and wise’, not strong and dominant as it tends to mean today – and there was no stigma during that period against men in being ‘sensitive’. By the time of the First World War, ‘shell shock’ was identified as a psychological (rather than a physical) condition and it was commonly believed that it was an indication of ‘weakness’ to suffer from this terrible affliction. Evidence from the years following the Second World War suggests that this belief was still ingrained. Arguably, we are still struggling with these difficulties today despite our much more developed understanding of PTSD. The conclusion of Roger Kingerlee and his co-authors is one that serves well for this entire collection of articles: Now – perhaps more than ever – we need to provide and promote psychological interventions and services that, drawing on existing scientific and epidemiological evidence, tackle the stigma associated with male help-seeking, engage men more effectively in treatment and, above all, at critical points in their existence, help them put life before death.
Having read all the articles in this collection, it is hoped that you will agree that there is a need for a Male Psychology Section of the British Psychological Society to further our understanding of these issues. If so, you are invited to register your interest (see ‘Resources’, opposite). A conference to discuss many of these issues relating to male psychology will take place at UCL on 20 June. If you are interested in attending, please visit www.malepsychology.org.uk.
Martin Seager is Honorary Consultant Psychologist with the Central London Samaritans mjfjseager@tiscali.co.uk
David Wilkins is Policy Officer for the Men’s Health Forum david.wilkins@menshealth forum.org.uk
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A tapestry of oppression Jennie Williams, David Stephenson and Frank Keating on how gender inequality is interwoven with other dimensions in society This article highlights the centrality of gender for men’s mental health and illustrates how it interacts with other systems of inequality. A key argument is that societal expectations of men place them at risk of depression, psychosis and suicide. An analysis of gender should therefore be the starting point for building knowledge about men’s mental health difficulties.
questions resources
Wilkins, D. & Kemple, D. (2011). Delivering male: Effective practice in male mental health. London: Men’s Health Forum. Retrieved from tinyurl.com/cpnfdy6 www.menshealthforum.org.uk/21826first-ever-male-mental-healthguidelines
references
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Why is an analysis of gender important for men’s mental health?
Addis, M.E. & Cohane, G.H. (2005). Social scientific paradigms of masculinity and their implications for research and practice in men’s mental health. Journal of Clinical Psychology, 61(6), 633–647. Addis, M.E. & Mahalik, J.R. (2003). Men, masculinity, and the contexts of help seeking. American Psychologist, 5(1), 5–14. Baker-Miller, J.B. (1971). Psychological
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ow that men’s mental health is beginning to receive the specific attention it deserves (Wilkins & Kemple, 2011) this is a good time to draw lessons from developments in related fields. The study of women’s mental health has been advanced through gender analysis, and we suggest this perspective can also help us understand and respond to the mental health needs of men. The gender system impacts on men as well as women, it is underpinned by processes that define males and females as different and that provide the justification and conditions for their inequality. Gender is potent because of its centrality to identity and the high level of interaction between women and men. Yet despite a long-standing and productive endeavour exploring the relevance of gender inequality for women’s mental health (Baker-Miller, 1971; Williams & Paul, 2008; Women’s Resource Centre, 2013), this concept is largely absent from the rapidly growing literature on men’s mental health. Instead attention is directed to the mental health implications of manifestations of gender inequality such as gender differences, roles, lifestyles, and relationships. As a power structure, gender inequality interacts with other systems of inequality including those founded on class, race, ethnicity, age and sexuality – so even though the male gender confers certain privileges, many men do not have privileged lives and fall within disadvantaged groups for other reasons. There is some willingness to consider how social inequalities impact the mental health
What are the psychological effects of disadvantage for certain groups of men?
consequences of sexual inequality. American Journal of Orthopsychiatry, 41, 767–775. Becares, L (2013). Dynamics of diversity: Evidence from the 2011 Census. Manchester: Centre on Dynamics of Ethnicity. Chapline, R., Flatley, J. & Smith, K. (2011). Crime in England and Wales 2010/11. London: Home Office Statistical Bulletin.
of those groups of men who can be defined as disadvantaged in these ways (e.g. Robinson et al., 2011; Samaritans, 2013). In this article, we counter the pervasive assumption that men only accrue advantages from the gender system and that there are no detrimental effects; and we look at how gender inequality interacts with other dimensions of privilege and disadvantage.
Inequalities are mad making The ways that inequalities can affect the mental health of people who are socially disadvantaged are well known; potential mediating factors include poverty, deprivation and discrimination. The implications for public health and therapy are not difficult to formulate. For example, policies can target the reduction of childhood poverty, and troubled clients can be offered therapies to help them deal constructively with the psychological consequences. More elusive are the mental health implications of the ideologies that deflect attention from inequalities, and support their paradoxical existence in a democracy where legislation and political rhetoric supports social equality. Justification and explanations for the existence of inequalities are woven into the fabric of our society and tolerated as part of normal everyday life, whilst open scrutiny and opposition is discouraged. This lack of transparency poses a significant threat to mental health; it is difficult for individuals who are harmed by inequalities to make sense of their experiences. To illustrate, a young man who has a deep-rooted commitment to being strong in the face of difficulty and loss, and whose family and friends share this gendered expectation, may not be able to fathom his responses to the death of someone significant. He is denied access to helpful words, explanations, social support and validation. Instead his struggle to survive may precipitate him into the criminal justice system or reliance on alcohol and
Connell, R. (1995). Masculinities. Cambridge: Polity. Connell, R. (2011). Confronting equality: Gender, knowledge and global change. Cambridge, Polity. Eliot, L. (2010). Pink brain, blue brain: How small differences grow into troublesome gaps – and what we can do about it. Oxford: OneWorld. Erens, B. Primatesta, P. & Prior, G. (Eds.) (2001). Health Survey for England: The
health of minority ethnic groups. Volume 1: Findings. London: The Stationery Office. Fernando, S. & Keating, F. (2009). Mental health in a multi-ethnic society (2nd edn). London: Routledge. Fine, C. (2010). Delusions of gender: The real science behind sex differences. London: Icon. Floyd, K. (2000). Affectionate same-sex touch: The influence of homophobia
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drugs, or may be read as signs of madness by himself, his family and professionals alike. In the last 40 years much has been written about how gender analysis can inform mental health work with women (Women’s Resource Centre, 2013), and to some extent men from disadvantaged groups (Robinson et al., 2011; Samaritans, 2013). Men from disadvantaged minority groups are in fact particularly vulnerable to having their experiences named for them by those who have more power. In contrast, very little has been written that considers the implications for men positioned as privileged. Yet white middleclass men are not spared mental health difficulties; furthermore they may encounter particular difficulties decoding their experiences in the absence of the understandings, solidarity and support that can be gained from belonging to a disadvantaged social group. At this point it would be easy to be
Global capitalism and nationalism benefit from the defining features of masculinity, such as bravery and domination
on observers’ perceptions. Journal of Social Psychology, 140(6), 774–788. Harland, K. (2008). Masculinity and mental health. Retrieved from www.ycni.org/downloads/misc/Masc ulinity_Mental_Health.pdf Harland, K. (2009). Acting tough: Young men, masculinity and the development of practice in Northern Ireland. Nowhere Man Press. Available at: www.man-ni.org/resources/
distracted by a comparative analysis, to try to quantify which groups of men are most under siege in terms of their mental health; this is not helpful. The main challenge is to map the links between social inequalities and mental health and gain understanding of the complex intersections of privilege and disadvantage. Below are some of the key issues that need consideration.
Becoming male Psychologists have been major contributors to the study of gender socialisation (Fine, 2010). Right from the enthusiastic ‘colour coding’ of young children to remind everyone, including them, of their gender categorisation (Eliot, 2010), beliefs, expectations and attitudes about what it is to be a man and a woman give substance to the gender system. Indeed there are indications that gender socialisation has become increasingly robust as legislative barriers to equality have been removed. Socialisation continues to encourage women to develop characteristics and competencies that suggest they are not well suited to exercising power, but which are compatible with a position of subordination. These include being useful and pleasing to others, compliant and uncomplaining. In contrast men continue to be socialised to develop psychological characteristics that are consistent with the exercise of power (Connell, 2011; Seguino, 2007). Global capitalism and nationalism benefit from the defining features of masculinity, such as competition, acquisition, bravery and domination, and when required large numbers of the right sort of people can be delivered to military life (Sjoberg & Via, 2010). However, while shaping men’s identities and lives in this way may serve the collective interests of some groups; this is at considerable cost to the mental health of individual men. The central requirement of hegemonic masculinity which is crucial for perpetuating the gender system – that men are strong, tough, winners and
kenspeech.pdf Karlsen, S., Nazroo, J., McKenzie, K. et al. (2005). Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychological Medicine 35, 1795–1803. Robertson, S. (2007). Understanding men and health. Buckingham: Open University Press. Robinson, M., Keating, F. & Robertson, S. (2011). Ethnicity, gender and mental
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providers – has important mental health ramifications. To begin with, there is good evidence that gender socialisation places heavier constraints on males than females. Men are being trained to be powerful and to take power, and the greater cultural value attached to ‘masculine’ compared to ‘feminine’ interests and behaviours means that more tolerance is shown to women who stray from what is expected. This is nicely illustrated by the comparative value of ‘sissy’ and ‘tomboy’. Young men inhabit a world where being described as ‘gay’ or ‘like a girl’ is a taunt rather than an observation or compliment; where the rapid commodification and commercialisation of all things male – including appearance – makes being a ‘real’ man completely unrealistic; not least because of their limited access to power. Young men are under pressure to give up physical affection from their parents; to demonstrate their independence and capacity to thrive without emotional and physical intimacy (Floyd, 2000). They also have to negotiate the world of shifting relationships without many of the skills young women are expected to develop; men tend to have fewer close friends than women and to feel less well connected to their communities. It should not be surprising then that young men exposed to the full force of the unreasonable and unrealistic expectations of masculinity should be at risk of: depression, psychosis and suicide; becoming reliant on drugs and alcohol; retreating into the fantasy worlds of sex and power provided by new technology; and of feeling entitled to having their sexual needs met by young women (Harland, 2008; 2009; Sanders, 2011). The common thread of masculinity also exists in a nexus of other social inequalities, and is modified by material and social processes (Connell, 1995; Robertson, 2007). The hierarchal ordering of these variants of masculinity then positions men from black and minority ethnic (BME) groups and other disadvantaged categories as subordinate
health. Diversity in Health and Care, 8, 81–92. Sanders, J.M. (2011). Coming of age: How adolescent boys construct masculinities via substance use, juvenile delinquency, and recreation. Journal of Ethnicity in Substance Abuse, 10, 48–70. Samaritans (2013). Men, suicide and society: Why disadvantaged men in mid-life die by suicide. Ewell, Surrey:
Author. Retrieved from tinyurl.com/busss26 Seguino, S. (2007). Plus ça change? Evidence on global trends in gender norms and stereotypes Feminist Economics 13(2), 1–28. Sjoberg, L. & Via, S.E. (Eds.) (2010). Gender, war, and militarism: Feminist perspectives. Santa Barbara: Praeger. White, A. (2002). Social focus in brief: Ethnicity. London: Office for National
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experience of gender and marginalised. Such inequality is not always selfsubordination involves directed. It can take forms that cultural stigmatisation, which harm the psychological wellmeans that BME men are being of the individuals they marginalised from full live with, for example, through participation in society with the misuse of their relational devastating psychological and emotional power sequelae (Robinson et al., (Williams et al., 2008). The 2011). It is known that groups complexities of interpersonal who are in lower societal violence and abuse played out hierarchies suffer from greater in the context of gender and psychological difficulties; that other inequalities needs to be this is associated with a greater acknowledged and charted. risk of psychiatric Unfortunately, thinking, hospitalisation is unsurprising practice and service responses (Fernando & Keating, 2009). are commonly influenced by While all men may the dichotomous assumption recognise something of their that survivors are female and own experience in this brief perpetrators are male. The outline, most negotiate the belief that men are too strong constraints and contradictions and tough to be victims of masculinity without serious protects gender inequality harm to themselves or others. at men’s expense. This is the This suggests there are also context within which protections against the insults victimised men make sense of gender inequality. The most Commercially driven solutions to men’s feelings of powerlessness of their experiences; which obvious is being valued for are traps that prevent rather than enable them to build meaningful invites them to conclude that who you are rather than for connections with their fellow humans if they didn’t stop it happening how well you approximate the they must be weaklings, or wimps. caricature of a ‘real’ man. Unconditional Male dominance is not only based on Damage and harm to men is hidden and love in early life and safe, valued, a hierarchy of men over women, but some relationships in later life are likely to be men over other men. From childhood, minimised when the complexity of genderespecially important in this respect. Being men are required to engage in power based power relations are ignored. This male may also confer other protections struggles to establish pecking orders; also happens when the sexual exploitation such as opportunities, money and the bullying, violence and fear of violence play of young men by older women, and power to define rather than be defined. Yet a significant role in these power struggles violence against men from women is such advantages are not equally shared by (Addis & Cohane, 2005; Harland, 2008). treated as comedy, and when it is all men. The majority Racial violence is still a common feature in considered normal for young men to of BME men are not in positions of power the lives of BME men: race attacks count experience violence on the streets. and lack the resources (e.g. economic) that for four fifths of hate crime in which 80 The domestic and work roles that have can help other men to benefit from male per cent of the perpetrators are white men traditionally provided men with hegemony. (Chapline et al., 2011). opportunities to feel powerful are also Seen from this perspective it becomes changing. Evidence is accumulating about clear that men’s violence against women is the toll on men’s mental health of linked to men’s violence against other men unemployment, redundancy, economic loss Men’s lives and also to the internalisation of violence; and relationship breakdown; problems that Evidence is gradually being pieced to violence against the self. Male power is are typically felt more keenly by men than together about the mental health risks also exercised through emotional and women, partly because the directive to be embedded in the gendered lives of men. sexual abuse; the victims include men ‘strong and powerful’ is often translated Given the mental health significance of as well as women. It also needs to be into being a ‘provider’ (Samaritans, 2013). trauma, it is relevant to consider the recognised that women’s resistance It is also important to remember that these extent to which violence and trauma are towards, and rage against, their lived risks are not evenly distributed amongst gendered in origins and implications.
Statistics. Wilkins, D. & Kemple, D. (2011). Delivering male: Effective practice in male mental health. London: Men’s Health Forum. Retrieved from tinyurl.com/cpnfdy6 Williams, J.R., Ghandour, R.M. & Kub, J.E. (2008). Female perpetration of violence in heterosexual intimate relationships: Adolescence through adulthood. Trauma Violence Abuse.
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9(4), 227–249. Williams, J. & Miller, J. (2008). Gender inequality and the mental health of women and men. In T. Stickley & T. Basset (Eds.) Learning about mental health practice. London: Wiley. Williams, J. & Paul, J. (2008). Informed gender practice: Mental health acute care that works for women. London: Department of Health. Retrieved from tinyurl.com/qe42wfv
Women’s Resource Centre (2013). Women’s mental health. In Women’s equality in the UK – a health check (Appendix 22): Shadow report from the UK CEDAW Working Group. Retrieved from tinyurl.com/oebdzqz
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men: for example, young black men are particularly vulnerable. They generally have higher rates of unemployment, live in poorer housing, report poorer health and have lower levels of academic achievement, higher rates of exclusions from schools and overrepresentation in prison statistics (Becares, 2013; White, 2002). The well-documented relationship between perceived racism and mental health (Karlsen et al., 2005) is exacerbated by the social disadvantages experienced by BME men (Erens et al., 2001, Robinson et al., 2011). Commercially driven solutions to men’s feelings of powerlessness are traps that prevent rather than enable them to build meaningful connections with their fellow humans. Included here would be using alcohol and drugs, including steroids, and boundless opportunities to identify with powerful protagonists in online games and pornography. Many culturally specific solutions, such as gang membership, are also high-risk, because of the invitation to categorise some men as bad and to socially marginalise and reject them. Indeed following the case of Christopher Clunis – a black man with a diagnosis of schizophrenia who killed Jonathan Zito in 1992 – simply being a BME man experiencing mental health difficulties may be sufficient to trigger the stereotype of ‘big, black and dangerous’. Within the constraints of the gender system it isn’t only feelings of powerlessness that are hard for men to acknowledge. Other feelings such as fear, shame, sadness and vulnerability are inconsistent with hegemonic masculinity. Acknowledging and expressing such taboo feelings can be inhibited by the dread of being diminished – of being ‘unmanly’. This isn’t simply a private matter. Reponses of family and friends can be crucial in giving, or denying, a man permission to be real. This isn’t as easy as it sounds – vulnerable men can unsettle gender relations. As one young woman memorably remarked about her partner, ‘I’d rather he hit me than cried’. Anger and aggression are not the only ‘manly’ ways of surviving, other ways include reliance on drink or drugs and other distractions, hyperactivity, risk taking as well as suicide and psychosis. It is common for such behaviours to be labelled as normal, bad or mad and for their origins in unacknowledged distress to be unexamined. We invite you to reflect on the ways that manifest behaviour may be rooted in efforts to survive life’s difficulties and trauma within the constraints of masculinity, and to not be content with superficial explanations, especially when
they ignore the existence of gender inequality.
needs to be the starting point for building knowledge about men’s mental health difficulties and shaping service responses to their needs (Williams & Miller, 2008). We all have significant stories to tell Service responses about our lived experience of gender and It is widely recognised that the mandate other inequalities, and this recognition to be ‘tough’ and ‘strong’ can prevent men needs to inform the help offered to men communicating vulnerability and from with mental health needs as well as seeking informal and professional help women. Professionals need training and (Addis & Mahalik, 2003). However, it support to become effective genderwould doubtless be easier for men to informed practitioners who are aware of overcome this reticence if there were the opportunities and limitations of their unequivocal evidence that mental health practice and service contexts. services had something to offer them; that It is also important to learn from those they really could be helped to decode exceptional services that have an explicit their ‘signs and symptoms’ of psychological commitment to working with men from harm and to move forward in their lives. an inequalityUnfortunately, gender inequality is informed not only a determinant of men’s perspective. Some mental health, but also of the ways “it isn’t only feelings examples are that services respond, or fail to of powerlessness described later in respond to these needs. that are hard for men this issue by our For example, when mental colleagues health staff in training are asked to to acknowledge” Kingerlee et al. explain why women are usually This is a public centre stage in discussions about health matter for which we are all gender and mental health they consistently accountable through our participation say it is because men are supposed to be in the systems and practices that sustain strong and not have mental health inequalities. Increased awareness of the problems. The strength of this unhelpful harm caused to men as well as women will belief is demonstrated by its paradoxical make change more possible. The case for existence in services where large numbers change is strengthened by the recognition of men are in treatment. The pernicious that liberating women from restrictive effects of the gender system are also gender roles and gendered oppression is evident in the assumptions and practices of inpatient mental health services. For inextricably bound up with liberating men example, a common problem for service from the same things. It is not a zero sum managers is that the majority of inpatient game; though it is mainly men (often staff would rather work with men than particular groups of men) who control women; men are typically less keen to talk the money, cultural power and political about their needs and emotional lives and authority needed for this to happen. hence place fewer demands on hardpressed staff. Furthermore, anxieties about evoking feelings of powerlessness and Jennie Williams distress in men can result in staff being is Director, Inequality reluctant to engage them in therapeutic Agenda conversations. Recognising the risk to jennie@inequalityagenda. masculinity of feeling vulnerable and out of co.uk control, staff collude with men in keeping their emotions and thoughts under lock and key rather than providing the safety they need to talk. It seems that the private David Stephenson is an Associate Mental constraint many men experience when it Health Worker, Barnet, comes to talking about their difficulties is Haringey and Enfield paralleled by professional reticence to Mental Health NHS Trust acknowledge and respond to men’s mental david.stephenson@behhealth needs. The mental health needs of mht.nhs.uk men in these kinds of settings are likely to remain unknown and unmet. The uncontested workings of gender inequality Frank Keating are manifest in this collusion of silence. is Senior Lecturer, Royal Holloway University of London Frank.Keating@rhul.ac.uk Conclusion Gender inequality is interwoven with other dimensions of oppression and
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Psychology, men and cancer Peter Branney, Karl Witty and Ian Eardley call for a consideration of masculinity in understanding and treating the disease he term cancer has terrifying connotations. It can refer to evil, a social disease or to a collection of over 200 medical pathologies. Under the 1997–2010 Labour administrations, psychologists cautiously welcomed the Department of Health’s 2007 Cancer Reform Strategy (Jarrett, 2008). The strategy was unique for devoting a subsection to gender (p.90–91) and highlighting the issue of greater cancer morbidity and mortality in men compared to women. Nevertheless, a key concern for psychologists was that the strategy failed to explicitly identify roles for them. Here, we address the core issue of the relationship between masculinity and cancer and explore what psychology can contribute to the understanding and treatment of cancers specifically across the spectrum of the male population.
A disease of the anatomical or social body, cancer raises fears about the uncontrollable division and multiplication of some abnormality that will lead ultimately to the destruction of those very conditions that make possible our lives. Cancer incidence and mortality rates are higher in men than women, raising questions about the roles for psychologists in relation to gender and cancer. Psychologists are wont to question the division of population level statistics by sex rather than other, such as behavioural, categories. Conceptual distinctions between biological sex and psychosocial gender are taught early in the psychology curriculum, but cancer of the breast questions the easy separation of the biological body and psychosocial society.
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Across the world, public health systems for the collection of morbidity and mortality data, such as ‘cancer registries’ or ‘public health observatories’, are integrated into civil and health services. For example, the annual reports of mortality in the UK by the Office for National Statistics are a legislative requirement dating back to a 1953 Act of Parliament. There is a format for such public health reports whereby causes of death are routinely reported by age and sex. It is statistics such as these that have prompted the Men’s Health Forum’s mission to ‘tackle the issues and inequalities affecting the health and wellbeing of men and boys’ (emphasis added).
Behavioural epidemiology Whether or not the epidemiological argument for focusing on men and cancer is persuasive, population-level differences call for population-level interventions. Through behavioural epidemiology (Sallis et al., 2000), psychologists have a role in exploring and identifying links between behaviour and cancer and devising interventions to influence those behaviours. Most notably, there is good evidence to suggest that there are several avoidable factors that can cause cancer, with tobacco use being the most prominent. However, the relationship between tobacco use and
questions resources
Breast cancer in men: http://healthtalkonline.org/peoplesexperiences/cancer/breast-cancermen/topics Penile cancer: http://healthtalkonline.org/peoplesexperiences/cancer/penilecancer/topics
Branney, P., Witty, K. & Eardley, I. (2011). Patients’ experiences of penile cancer. European Urology, 59(6), 959–961. Jarrett, C. (2008). Cancer care concerns. The Psychologist, 21, 2. Maddineni, S., Lau, M. & Sangar, V. (2009). Identifying the needs of penile cancer sufferers: A systematic review of the quality of life, psychosexual and psychosocial literature in penile
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Is sex a useful category at the population level?
The argument for classifying men with cancer together as a group (White et al., 2009, 2010; Wilkins, 2007) is based on epidemiological, population-level statistics. Broadly, men do appear to be more vulnerable to non-sex-specific cancers. Sex differences in annual standardised rates of cancer registration and deaths attributable to cancer are simple and powerful (e.g. 221 deaths due to cancer for every 100,000 men each year compared with 146 for every 100,000 women: Wilkins, 2007), though questions will inevitably be asked about how such data is conceptualised, collated and used.
cancer. BMC Urology, 9(1), 8. Martin-Moreno, J.M., Soerjomataram, I. & Magnusson, G. (2008). Cancer causes and prevention: A condensed appraisal in Europe 2008. European Journal of Cancer Care, 44, 1390–1403. Payne, S. (2001). ‘Smoke like a man, die like a man’? A review of the relationship between gender, sex and lung cancer. Social Science and
Medicine, 53(8), 1067–1080. Prescott-Clarke, P. & Primatesta, P. (Eds.) (1998). The health of young people. 1995– 1997 Health Survey for England. London: The Stationery Office. Sallis, J.F., Owen, N. & Fotheringham, M.J. (2000). Behavioral epidemiology: A systematic framework to classify phases of research on health promotion and disease prevention.
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What roles can psychologists take in relation to men and cancer?
references
Epidemiological arguments
Annals of Behavioral Medicine, 22(4), 294–298. Singleton, P., Fawkner, H., White, A. & Foster, S. (2009, October). Men’s experience of cosmetic surgery: A phenomenological approach to discussion board data. QMiP Bulletin, Issue 8, pp.17–23. White, A.K., Thomson, C. & Forman, D. (2009). The excess burden of cancer in men in the UK. London: National
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sex or gender also appears to be important. For example, Martin-Moreno et al. (2008) describe cancer rates of 29–38 per cent in male smokers compared with 2–10 per cent in female smokers. The Tobacco Control Report by the WHO Regional Office for Europe (2007) shows that more men smoke daily than women in 37 countries of Europe with the exception of Iceland and Sweden. Nevertheless, the public health interventions that have been implemented to reduce tobacco use – low-tar and filtered cigarettes, taxation, restrictions on smoking in indoor workplaces, pubs and restaurants, advertising limitations and changes to packaging – have been designed and implemented without any explicit reference to gender. Tobacco use is a complex set of behaviours that arguably form some of the conditions through which it is possible to be feminine or masculine. Payne’s (2001) review of gender and lung cancer, for example, shows sex differences in the depth and rate of inhalation, whether or not tobacco is used as a buffer against negative emotions, to increase positive feelings, or is used in social situations. Workplace smoking bans are an example of a population-level intervention through which behavioural epidemiology can highlight a complex set of behaviours with sex differences. Employees who go outside to smoke because smoking bans are in place are likely to smoke faster and with a greater depth, and frequency, of inhalation (Payne, 2001). Payne argues therefore that whilst an overall reduction in the incidence of tobacco-related cancers could result from such bans, there would also be a concomitant increase in the severity of those cancers that do occur. Because more women than men work in environments where such bans are in place (Prescott-Clarke & Primatesta, 1998), we can therefore further argue that women would be more likely than men to benefit from the general reduction in workplace smoking and passive-smoking. Nevertheless, those women that do smoke are therefore also more likely than men to
Cancer Intelligence Network/Cancer Research UK. White, A.K., Thomson, C.S., Forman, D. & Meryn, S. (2010). Men’s health and the excess burden of cancer in men. European Urology Supplements, 9(3), 467–470. WHO Regional Office for Europe. (2007). The European Tobacco Control Report 2007. Wilkins, D. (2007). Tackling the excess
be disadvantaged by an increase in the severity of tobaccorelated cancers.
The sex and gender of breasts
Experiences of penile cancer
Breasts and breast cancer are I ‘Because of the surgery what I’ve had I could never bring myself to say you know asking a lady out simply surely an example of treating because I feel like most of my manhood’s been taken something that is gendered away like’ (Paul, 61 diagnosed 59) as if it were biologically I ‘I don’t feel a proper man. I feel… completely determined. In Western emasculated and it’s difficult to explain but I still have, society, breasts are arguably a problem wearing jeans. I still have a problem wearing symbolic of femininity, both shorts. Because I think that people know’ (Mark, 48 in terms of biological sex and diagnosed 46) psychosocial gender. It is no I ‘As I say, our sex life is back to something approaching accident that the UK charity, normal or something slightly different and certainly no the Breast Cancer Campaign, worse than it was before. Perhaps after nearly thirty promotes Pink Science and years of marriage then perhaps things had got a bit, bit that its (non-sex specific) routine, a bit regular, and this has, you know, forced us vision to ‘cure breast cancer’ is to spice things up’ (Tim, 54 diagnosed 53) explained in a video that starts I ‘What’s particularly nice is that... you know a lot of with the stark fact: ‘1 in 8 people have bothered about me and sent me cards and women in the UK will be boxes of chocolates and things like that so that’s just diagnosed with breast cancer’. great and nice bottles of wine. So that’s the upside, you Men may know someone with know that people care about you rather than you’re just cancer; they may be their son, a part of the furniture’ (Jordan, 58 diagnosed 57) father, lover, husband, friend; they may even don pink clothing and raise money for breast cancer charity; but they don’t largely dormant throughout their life. get breast cancer, do they? Breasts are not technically a sex difference, Anatomically, both men and women even if they play a considerable role in have breasts. We could make a distinction gender differences. between size of breasts between men and As for breast cancer, men do in fact women (that men’s are too small to be get it. Additionally, men can carry the considered breasts), but this would be to hereditary BRCA gene mutations that ignore the great variation in our bodies. At increase the risk of breast cancer and, for a young age, there is rarely any difference those diagnosed, recurrence and reduces in breast size between boys and girls. In survival. The Cancer Research UK adulthood, both men and women’s breasts (CRUK) information web pages have vary in size. Breasts in men are sometimes a section on what they term ‘male breast mockingly referred to as ‘moobs’ (man cancer’, which is listed as a type of breast boobs). Gynaecomastia is the medical term cancer even though the condition has no for men’s breasts that swell unduly, and sex. Like CRUK, healthtalkonline.org (see some men have surgery to reduce their size box on p.412) had a module on breast (Singleton et al., 2009). Alternatively, we cancer that was created from interviews could make a distinction between men and with 53 women about the experiences of women in terms of the anatomical their condition. At the launch of a function to produce breast milk. Yet some module with interviews of men who had men’s breasts do produce milk (Singleton been diagnosed with breast cancer the et al., 2009) and in women the function is language changed to ‘breast cancer in men’ and ‘breast cancer in women’. The section title ‘W hat should breast cancer in men be called?’ is telling. While some of the men interviewed unthinkingly used incidence of cancer in men. London: ‘male breast cancer’ others disliked the Men's Health Forum. term and thought people should know Wilkins, D., Payne, S., Granville, G. & that it is the same disease whether in Branney, P. (2008). The Gender and a man or woman. One interviewee, who Access to Health Services Study: Final report. London: Department of Health. you can see speaking on the site, had Witty, K., Branney, P., Evans, J. et al. contacted cancer charities and persuaded (2013). The impact of surgical all but CRUK to stop using ‘male breast treatment for penile cancer: Patients’ cancer’ (CRUK started using ‘breast perspectives. European Journal of cancer in men’ for the section heading Oncology Nursing, 17(5), 661–667. in October 2013 while still using ‘male
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breast cancer’ within the text of the page). Reports of the excess incidence of cancer in men that use epidemiological data usually exclude sex-specific cancers, such as cancer of the penis or vulva. It is notable that breast cancer is also usually excluded. Wilkins and his colleagues followed this same approach in the Gender and Access to Health Services study (Wilkins et al., 2008) because the incidence of breast in cancer in women is so great that the aggregate excess incidence of all other cancers in men diminishes. This does raise a question about the utility of clustering all cancers together, when there is such great variation in their incidence, effects and treatments. Yet we could also ask about the utility of dividing epidemiological statistics by sex rather than, for example, behaviour.
Patients’ experiences of penile cancer Like breasts with women, the penis is arguably the key signifier of masculinity;
an anatomical symbol of the wider conditions that make it possible for bodies to be male and masculine. As a rare condition (Branney et al., 2011), those who receive a diagnosis of penile cancer are unlikely to meet anyone who has direct or indirect experience. The primary form of treatment is surgical excision of the tumour and a 1 cm margin of healthy tissue. While some can recover full urological function after a period of rehabilitation, up to two thirds report impaired sexual functioning (Maddineni et al., 2009), such as low confidence in erectile function, an inability to achieve an orgasm, or reduction in sexual activity, desire and/or satisfaction with intercourse. Consequently, we worked with healthtalkonline.org to create a module on penile cancer as a resource sharing patients’ experiences. The primary audience of this site is those affected and their friends and family, although it will also be useful for psychologists. As the healthtalkonline.org research primarily uses video interviews with patients, it
Health talk online www.healthtalkonline.org is a unique, award-winning website produced by the DIPEx charity; it features video and audio clips from carefully conducted in-depth interviews with people about their experiences of health and illness. Over 75 separate ‘modules’ covering different conditions or health topics are currently available on the site, including prostate and testicular cancers and the prostate-specific antigen blood test. Each module is based on a rigorous qualitative research study exploring the experiences of people facing the condition, health or social care issue. Each module presents careful analysis of around 25 of the most important issues identified within these indepth interviews, illustrated with around 250 video, audio and written extracts from the interviews. Research for all
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healthtalkonline studies uses ethically approved methods developed over many years by the Health Experiences Research Group at the University of Oxford. The penile cancer study was led by researchers at Leeds
Metropolitan University in close collaboration with the Oxford team. The healthtalkonline modules reflect what is important to people facing different health conditions and also harness the appeal of patients’ experiences to impart accurate, useful information to range of users, including the public,
patients and their families, and health and social care professionals. The website has been evaluated with patients and as a teaching resource and is registered with the Information Standard. Healthtalkonline modules are intended primarily for people who have the condition, but also to educate health and social care professionals. Partners, families and colleagues will also be able to learn about a wide variety of perspectives on the condition. Applied psychologists are increasingly being encouraged to recommend reliable websites to their clients. Healthtalkonline has a reputation as a site that can be trusted because it is based on rigorous research; it has been widely cited as an example of good health information on the Internet and commended in the national press.
was expected that recruitment would be extremely difficult because men might be reluctant to talk about the dismemberment of their penis. It is standard procedure for clinical trials to close if a specified number of potential participants decide to opt out. Practically and ethically it would make no sense to continually attempt recruitment when too few are interested. In fact, of those clinical penile cancer trials of which we are aware, all have closed early because of insufficient recruitment. Nevertheless, our group found 27 men who were willing to share their experiences of penile cancer and as the site shows, there is a wide variation in experiences (see ‘Experiences of penile cancer’; Witty et al., 2013). For example, in one case cancer had a devastating impact on the man’s marriage whereas another man actually enjoyed finding new ways of being intimate with his wife.
Psychology as critique Every day by adorning our bodies in particular ways, ticking male/female on forms and dividing epidemiological statistics into two, we habitually create and recreate both gender and sex. This presents psychologists with a number of potential roles beyond the clinical. Psychologists can continue to explore how gender and sex are constructed in relation to cancer; they can examine and share patients’ experiences of cancers that are in some ways marginalised by contemporary understandings of gender and sex; and psychologists can ask critical questions about epidemiology, health care and wider society. Peter Branney is in the School of Social, Psychological & Communication Sciences, Leeds Metropolitan University P.Branney@leedsmet.ac.uk Karl Witty is at the Institute of Health & Wellbeing, Leeds Metropolitan University K.Witty@leedsmet.ac.uk
Ian Eardley is in the Pyrah Department of Urology, Leeds Teaching Hospitals NHS Trust ian.eardley@leedsth.nhs.uk
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Research. Digested.
The British Psychological Society’s free Research Digest Blog, email, Twitter and Facebook
www.researchdigest.org.uk/blog ‘Easy to access and free, and a mine of useful information for my work: what more could I want? I only wish I’d found this years ago!’ Dr Jennifer Wild, Consultant Clinical Psychologist & Senior Lecturer, Institute of Psychiatry ‘The selection of papers suits my eclectic mind perfectly, and the quality and clarity of the synopses is uniformly excellent.’ Professor Guy Claxton, University of Bristol
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Are mental health services inherently feminised? Linda Morison, Christina Trigeorgis and Mary John investigate A man entering mainstream NHS psychological services will correctly perceive this world to be predominantly populated by women. He might wonder if such services are meant for him – will he be misunderstood or judged, will he be forced to talk about his feelings? So are mental health services indeed ‘feminised’ and therefore off-putting to men? This can be considered from a number of different angles – the gender of those who provide psychological services; how policies and services potentially influence men’s ability to access help; and whether men might experience the psychological interventions provided as feminised and therefore not appropriate or helpful for them.
ake a look at the graph on the right, which we have compiled from various data sources (available on request). It shows the sex of the staff who provide psychological help in England. The vast majority (around 70 per cent to 85 per cent) are women, and there is no reason to expect that it might be different in other parts of the UK or the West generally. Women also predominate in the immediate management of psychological services, with around 65 per cent of managers being women. The Equality Act 2010 requires organisations – including the NHS – to ensure that services do not discriminate between men and women, and it also actively promotes equality of opportunity for both sexes. Given the disproportionately low number of men working in frontline mental health service provision in the UK, some parts of the NHS are trying to redress this. For example, the British Psychological Society has raised concerns about diversity in the applied psychology workforce and, alongside efforts to recruit from minority groups, is making efforts to recruit men. As an example, the clearing house for postgraduate clinical psychology training courses website (https://chpccp.leeds.ac.uk/Default.aspx) has as its second sentence:
questions
In what ways might mental health services be particularly off-putting for men who need help?
resources
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Smith, M. (2011). Failing boys, failing psychology. The Psychologist, 24, 390–391. Wilkins, D. & Kemple, D. (2011). Delivering male: Effective practice in male mental health. London: Men’s Health Forum. Retrieved from tinyurl.com/cpnfdy6
Why do we need to recruit more male applied psychologists?
We welcome applications from people from ethnic minority backgrounds, people with disabilities and men as these groups are currently underrepresented in the profession.
references
It is not clear what impact this message
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Bradley, J. (2013, December). Where are all the men? [Letter to the editor] Therapy Today. Retrieved 21 March 2014 from www.therapytoday.net/article/show/ 4052/ British Psychological Society (2004). Widening access within undergraduate psychology education and its implications for professional psychology: Gender; disability and
ethnic diversity. Leicester: Author. Department of Health and Aging [Australia] (2010). National male health policy: Building on the strength of Australian males. Canberra, ACT: Author. Department of Health (2002). Women’s mental health: Into the mainstream. London: Author. Department of Health and Children [Ireland] (2008). National men’s health
has on applications, but our experience on the clinical psychology programme at Surrey remains of vastly more applications from women than men. This gender imbalance is echoed in all branches of the psychological therapies (e.g. see Bradley, 2013, expressing concern at the lack of males in counselling training). One reason put forward for this is that applied psychology is associated with the more feminine ‘caring’ aspects of human nature and, as with nursing, this makes men reluctant to pursue it as a profession. In addition, some argue that being seen as a ‘female’ profession also bestows lower prestige and levels of pay (Willyard, 2011), therefore deterring men. In our experience as trainers in clinical psychology, male trainees often comment on the difficulty of being a very small minority, amongst predominantly female trainees, female course staff and female supervisors. They say that as well as questioning the appropriateness of clinical psychology as a career for them they also question the extent to which the complexity of masculinity and identity is addressed in the training. However, the ‘lack of men’ does not become apparent only at the level of postgraduate training. The number of men applying for and graduating with a psychology degree is disproportionately low. In 2004 only 22 per cent of applications to psychology undergraduate programmes were from men (British Psychological Society, 2004), and more recent data from the Universities and Colleges Admissions Service (UCAS) shows little change. In a previous article in The Psychologist, psychology teacher Marc Smith (2011) argues that by the time students choose A-levels, psychology is already seen as a ‘female’ subject, with boys making up only around a quarter of those who take it. Smith considers as possible explanations for this: the predominance of women among teachers of psychology; the choice of topics within psychology that teachers tend to focus on; psychology’s image as less scientific than chemistry, physics and biology; methods of
policy 2008– 2013: Working with men in Ireland to achieve optimum health and well being. Dublin: The Stationery Office. Equality and Human Rights Commission (2013). Women, men and part-time work. Retrieved 1 January 2014 from tinyurl.com/nqktqfh King’s Fund (2013). Women continue to face barriers to taking senior leadership positions in the NHS, new
research finds. Retrieved 12 August 2013 from tinyurl.com/nsdtw8b Martin, L.A., Neighbors, H.W. & Griffith, D.M. (2013) The experience of symptoms of depression in men vs. women: Analysis of the National Comorbidity Survey Replication. JAMA Psychiatry, 70(10), 1100–1106. Office for National Statistics (ONS) (2013). Labour market statistics, November 2013. Retrieved 1 January
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assessment that favour girls; and the fact that a boy who chooses to study psychology will be in the minority. It is clear that if the proportions of men providing psychological services are to be more representative of the general population, these factors need to be addressed at this early stage.
Where are all the men? These graphs show the proportions of men (blue) and women (pink) in the provision, immediate management and shaping of psychological services in the NHS (sources available from authors). They show that around 80 per cent of those who provide psychological services are women. The proportion of men increases when we consider the management of services, but the majority are managed by women (around 65 per cent). Psychiatrists, who manage at a more senior level but who also treat patients, was the most evenly balanced category, with 47 per cent being women. When considering who shapes mental health services within the NHS, a different pattern is seen: men make up around 85 per cent of commissioners and cabinet members.
Who shapes mental health services? NHS mental health services are shaped by politicians, senior civil servants and commissioners. Unlike the provision of services, women are underrepresented at this level, and in this case barriers to women taking senior leadership roles need to be understood (Kings Fund, 2013). So has the high proportion of men making decisions about services resulted in ‘male friendly’ services? A decade ago the Department of Health produced a document called ‘Into the Mainstream’ with the expressed intention to facilitate service providers and commissioners in paying attention to the needs of women (Department of Health 2002). It seems, however, that genderspecific has become synonymous with addressing women’s issues, largely because historically it has been women who were disenfranchised. This policy has proved powerful in ensuring services are reorganised to meet the needs of women, but there has been no parallel strategy for men. This approach is in contrast to that taken by the governments of Australia and Ireland. These two countries have produced policies explicitly articulating the needs of men and paying attention to individual, societal and community contextual factors (Department of Health and Aging [Australia], 2010; Department
2014 from tinyurl.com/pzt44vd Richardson, N. & Smith, J.A. (2011). National men’s health policies in Ireland and Australia: What are the challenges associated with transitioning from development to implementation? Public Health, 125, 424–432. Wilkins, D. (2010). Untold problems: A review of the essential issues in the mental health of men and boys.
of Health and Children [Ireland], 2008). However, Richardson and Smith (2011) argue that while these policies identify men’s health as a priority there are substantial challenges to implementing such policies, especially when they are not associated with additional funding. The NHS has adopted the phrase ‘protected characteristic,’ to highlight characteristics such as age, sex and disability that might lead to discrimination. This does provide a potential framework for men’s specific needs to be recognised, but there is at the moment no clear policy directive or funding mechanism. As yet, we would argue that the predominantly male decision makers have not conceptualised men’s distress in ways that require help through mental health services.
Less accessible to men? At a practical level one issue that might create an obstacle for men who have
London: Men’s Health Forum. Willyard, C. (2011). Men: A growing minority? gradPSYCH, 9(1), 40.
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some motivation to seek help is opening hours. While employment rates are similar among men and women (77 per cent and 70 per cent respectively) (Office for National Statistics, 2013) the proportion working full-time is larger for men (87 per cent) than women (56 per cent) (Equality and Human Rights Commission, 2013). To this end accessing GPs and specialised mental health help poses a challenge owing to the hours of access, which for the most part fall within the nine-to-five timeframe. Services under the Improving Access to Psychological Therapies (IAPT) programme are available from 8am to 8pm and Saturday mornings, and may thus be helpful to men in this regard. The Department of Health and local primary care trusts require GPs and other services to provide access to health care out of hours. NHS Direct, the 111 service and out-of-hours clinics have begun to provide a means to access such support. However, individuals working within NHS Direct or 111 operate using checklists of symptoms with an associated timeframe of distress. If a person does not fit neatly within the set framework there is an automatic redirection to alternative services unless there is an emergency. The subtlety of men’s distress is unlikely to be captured in this process. Since April 2012 adult mental health services in the NHS have been organised around Care Pathways and Payment by Results. These two processes are meant to promote evidence-based practice that responds to the needs of individuals rather
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Are the therapies appropriate? Men might also question how applicable to them the psychological therapies practised within services are. We considered the four main psychotherapeutic approaches adopted within the NHS: psychodynamic, humanistic, cognitive/behavioural and systemic. In all cases the approaches were originated by (white, Judeo-Christian) men. However, many of the ideas underlying these approaches could be seen as counter to traditional masculine norms, particularly the masculine norms of self-reliance and control over emotions. For example, psychodynamic approaches place great emphasis on emotional disclosure and emotional dependence. The humanistic approaches emphasise the provision of an intimate therapeutic environment based on empathy and unconditional positive regard, which might feel counter to traditional masculine norms. On the other hand, cognitive approaches which emphasise ‘rational’ thinking and systems approaches (with their grounding in cybernetics) could be seen as being more compatible with traditional masculine norms. However, even the cognitive-behavioural and
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than just being reliant upon a formal diagnosis. However, diagnosis is still used as a primary method for making decisions about access to services, which leads to a variety of challenges. The way that men and women articulate and express mental and emotional distress is different; in particular, men are more likely to externalise their feelings. Whereas women are more likely to present with anxiety or depression, data show that men are more likely to turn to substance abuse, aggressive behaviour, violence and suicide (Wilkins, 2010). Such men are thus more likely to be directed towards punitive interventions where their behavioural needs may take precedent over their emotional distress. A recent paper describes how differences in the ways men express depression lead to a substantial proportion of cases being missed by traditional diagnostic criteria (Martin et al., 2013). Fear that their distress might be misunderstood and lead to punitive interventions might also therefore make men reluctant to seek help.
experience, CPD seminars relating to men and mental health seem rare, although there are indications of an increase recently. Many psychological services providers work as part of multidisciplinary teams, and it is still possible that an individual practitioner who has a good awareness of men’s issues may find themselves in a team that does not share that awareness. The need for team discussion as well as individualised CPD is therefore critical. Given the significant number of women in mental health work, providing space for reflection and consideration of male gender issues is likely to be of benefit, just as considering female gender issues has been beneficial for male practitioners.
Conclusion systems approaches incorporate an empathetic approach and acknowledge the importance of direct emotional disclosure that could be perceived or experienced as un-masculine. This raises the question of whether there is some fundamental contradiction between how psychological therapy is traditionally practised and traditional masculinity, and whether or how psychological interventions can be adapted to reach out to those who conform strongly to traditional masculine norms. Some important preliminary answers to this question are provided by Roger Kingerlee and colleagues in the following article in this collection.
Training and professional development of NHS staff Training should ensure that practitioners are enabled to adapt their interventions to the diverse needs of the population. This is particularly pertinent for working with men, given the high proportion of female service providers and what is known about male help-seeking behaviour. As far as we are aware there seems to be little included in training curricula to date on the extent to which men and women might have differing mental health needs, the challenges this could raise and potential ways of addressing such challenges. We suggest that closing this training gap is an urgent goal that would be relatively quick and simple to attain. Once qualified, professionals are required to undertake continuing professional development (CPD). In our
We have argued that the lack of men in service provision, combined with arguably feminised psychotherapeutic approaches, is likely to be off putting for men who are known to be less likely to seek help in the first place. There is an urgent need therefore to increase gender awareness in the NHS and to highlight the ways in which services might not be serving men well. This information could be incorporated into training, and could go some way towards meeting the aim of a more gender-sensitive provision of mainstream services for everyone.
Linda Morison is Senior Lecturer, School of Psychology, University of Surrey l.morison@surrey.ac.uk
Christina Trigeorgis is Clinical Psychologist, School of Psychology, University of Surrey c.trigeorgis@surrey.ac.uk
Mary John is Programme Director, Clinical Psychology, School of Psychology, University of Surrey, and with Sussex Partnership NHS Foundation Trust m.john@surrey.ac.uk
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Engaging with the emotional lives of men Roger Kingerlee, Duncan Precious, Luke Sullivan and John Barry consider the design of male-specific services and interventions
Given that men experience and express their psychological needs differently, it is welcome that some innovators are starting to design services specifically to meet their needs. Below we provide some examples from a range of recently developed male-specific services that stretch the boundaries of the traditional ‘talking therapy’ model.
Reaching out to men in need If the principal function of health services is to keep people alive and well, then the disproportionately high male suicide rate alone suggests that the needs of men are not being optimally served. Picking up on the theme set out by Linda Morison and colleagues in the previous article of this special feature, it is argued that health services for men can be improved if gender awareness is incorporated into their design, promotion, and implementation.
questions resources
www.mensmindsmatter.com Blazina, C., & Shen-Miller, D.S. (2011). An international psychology of men: Theoretical advances, case studies, and clinical innovations. Routledge Series on Counseling and Psychotherapy with Boys and Men, Vol. 7. New York & Hove: Routledge.
references
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Is ‘beta bias’ responsible for gender blindness to men’s mental health problems?
Andrews, G., Cuijpers, P., Craske, M. et al. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable, and practical health care: A meta-analysis. PLoS ONE, 5(10), e131196. doi:10.1371/journal.pone.0013196 Benenson, J.F. & Koulnazarian, M. (2008). Sex differences in helpseeking appear in early childhood. British Journal of Developmental
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t seems probable that significantly poorer health outcomes in men must have some basis in meaningful sex and gender differences. There is evidence, for example, that males have different experiences of being parented (Diamond, 2004; Pollack, 1995), and show different behaviours under stress (Kolves et al., 2010) compared to females. Gender for males, as for females, helps to shape life experience and behaviour, impacting most strikingly upon help-seeking and engagement with health services (Sullivan 2011; Sullivan et al., 2014). Sex differences in help-seeking are shown to emerge by around age six (Benenson & Koulnazarian, 2008). By the time of adulthood such differences may crystallise into recognisable patterns of avoidance, both in relation to help-seeking and psychotherapy (Sullivan et al., 2014). Males tend to externalise distress more than females and are more likely to be destructively violent to themselves or others (Logan et al., 2008). In England and Wales men produce around 80 per cent of antisocial behaviour (UK Government, 2012). Consequently, men’s distress may lead to incarceration rather than psychotherapy (Men’s Minds Matter, 2013). Yet even when men do seek help there is evidence that less extreme forms of male distress may routinely go unrecognised (Swami, 2012), because men, and those around them, effectively abandon psychological reflection (Kingerlee, 2012). Consequently, men’s psychological needs may go unmet until extreme behaviours come to the attention of the authorities.
Do males and females access and engage in psychological help in the same ways? If not, is a one-size-fits-all psychological approach to the sexes sufficient?
Psychology, 26(2), 163–170. Bigos, K.L., Pollock, B.G., Stankevich, B.A. & Bies, R.R. (2009). Sex differences in the pharmacokinetics and pharmacodynamics of antidepressants: An updated review. Gender Medicine, 6, 522–543. Burns, J.M., Webb, M., Durkin, L.A. & Hickie, I.B. (2010). Reach Out Central: A serious game designed to engage young men to improve
Little is yet known about how to motivate men to make more use of health services, but some work is starting in this area. Charity campaigns In the UK the charities Mind and Samaritans have run campaigns highlighting men’s difficulties in helpseeking and other issues, but the impact of such interventions is still too early to assess. Action research and community psychology approaches These methods aim to empower marginalised groups in generating change and opportunity with some promising results for male populations. For example, the ‘Men’s Sheds’ organisation in Australia has helped to engage isolated older men in communal activity through furniture restoration; this is now also being established in the UK. There is also a scheme in Brighton (UK) called ‘A Band of Brothers’, where older males mentor troubled younger men. This scheme has been so effective that strong links have been forged between local youth, probation and police services (www.abandofbrothers.org.uk). One of us (DP) set up a men’s mental health group in Newmarket with the aim of reducing the barriers to men accessing appropriate mental health services. The initial focus was to gain an understanding of the local issues affecting men and their mental health and then to establish the support of local charities and key stakeholders. Newmarket is renowned as the UK home of horseracing. The
mental health and well-being. Medical Journal of Australia, 192(11), Supplement, S27–S30. Diamond, R. (1998). Stepping outside and not knowing: Community psychology and enduring mental health problems. Clinical Psychology Forum, 122. Diamond, M.J. (2004). The shaping of masculinity. International Journal of Psychoanalysis, 85, 359–380.
Gould, M.S., Munfakh, J.L., Lubell, K. et al. (2002). Seeking help from the internet during adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1182–1189. Kingerlee, R. (2012). Conceptualizing men: A transdiagnostic model of male distress. Psychology and Psychotherapy: Theory, Research, and Practice, 85(1), 83–100. Kiresuk, T.J., Smith, A. & Cardillo, J.E.
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community psychology framework (see Diamond, 1998), it also drew on ‘common sense’ and the lived experiences of members. At the outset, participants selected the topics they wanted to focus on. Interestingly, the ‘difficult’ emotions (such as anger, anxiety and sadness) were a popular choice. Each individual had the opportunity to discuss difficulties and share personal experiences. Then the group worked together to make sense of their difficulties, using group members’ knowledge, combined with psychological principles and theories. It was noticeable that the group process enabled members to develop meaningful relationships quite rapidly (see Yalom, 2005). All who completed the course gave positive feedback. Qualitative feedback included ‘self-understanding’, ‘helping others’, ‘sharing common experiences with likeminded people’, ‘being part of a non-stigmatising group’, ‘learning and consolidating ways of improving mental and emotional health’, ‘expressing difficult emotions’ and ‘making friends’. Quantitative feedback was obtained by using goal attainment scaling (Kiresuk et al., 1994). Goal attainment was rated at: 52 per cent ‘much more than expected’, 32 per cent ‘more than expected’, 16 per cent ‘as expected’ and 0 per cent ‘less than expected’. Finally, a main aim of the course was that members would plan and follow up with a social action that would improve Men’s psychological needs may go unmet until extreme their lives: the course behaviours come to the attention of the authorities members did indeed choose to continue to meet up and support each other. It also felt liberating as were put in local newspapers and posters a male psychologist to be giving attention were placed in pubs, gyms and working to the emotional lives of other men, and men’s clubs. preconceptions about the difficulties of Whilst the course adopted a horseracing industry has an insular, traditional and masculine culture and some parallels can be drawn with military life. It attracts young men and women from disadvantaged areas, demands long hours, offers low pay and has endemic problems with substance misuse and gambling. Tragically, there continues to be a relatively high suicide rate in men within the local horseracing industry. An eight-week men’s mental health course was offered to local men aged 18 and over. The course was part therapeutic, part educational, part debate forum and part mutual support group. In order to engage a broader range of men including those who might not normally access mainstream services, the course was conducted during the evening in a local community centre. Advertisements
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(1994). Goal attainment scaling. Hillsdale, NJ: Lawrence Erlbaum Associates. Kolves, K., Ide, N. & De Leo, D. (2010). Suicidal ideation and behaviour in the aftermath of marital separation: Gender differences. Journal of Affective Disorders, 120(1), 48-53. Levant, R.F., Good, G.E., Cook, S. et al. (2006). Validation of the Normative Male Alexithymia Scale. Psychology of
Men and Masculinity, 7, 212–224. Levant, R.F., Hayden, E.W., Halter, M.J. & Williams, C.M. (2009). The efficacy of alexithymia reduction treatment: A pilot study. Journal of Men’s Studies, 17(1), 75–84. Logan, J., Hill, H.A., Black, M.L. et al. (2008). Characteristics of perpetrators in homicide-followedby-suicide incidents. American Journal of Epidemiology,
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such a group proved to be unfounded. The compassion and understanding that these men showed one another, and the respect that they showed for the whole group process, was overwhelming. These approaches demonstrate how the mould of mainstream mental health provision can be broken to reach a broader range of men. Could inaccurate preconceptions, reflecting wider social stereotypes and dominant notions of masculinity, be preventing other mental health professionals from delivering malespecific interventions?
Indirect interventions Another effective way of helping men access psychological interventions is to combine them with sporting activities. In this way, barriers to male-helpseeking – including the perceived social threat associated with being in need of help – can be reduced. An excellent example here is an integrated exercise/CBT intervention with young men in Dublin (McGale et al., 2011). In this randomised controlled trial, 104 men between the ages of 18 and 40 were recruited via local advertisements. Participants were allocated for a 10-week period to one of three groups: (a) an Individual Exercise (IE) group, involving aerobic and resistance training, (b) a Back of the Net (BTN) group involving football (chosen as an integrated team sport), plus training in CBT concepts and techniques like goal-setting, problem-solving, and resilience; and (c) a control group, who did no exercise during the study. Qualitative and quantitative data were obtained, and the results were encouraging. There were significant decreases – evident from five weeks into the study – in depressive symptoms, with pre- to post-depression scores falling by 52 per cent in the IE condition and 45 per cent in the BTN condition (McGale et al., 2011). Moreover, the IE group showed significantly greater perceived social support than the team-based BTN group at eight-week follow up – a surprising finding
168(9),1056–1064. McGale, N., McArdle, S. & Gaffney, P. (2011). Exploring the effectiveness of an integrated exercise/CBT intervention for young men's mental health. British Journal of Health Psychology, 16, 457–471. Men’s Minds Matter (2013). The psychological wellbeing of men. Retrieved 24 March 2014 from www.mensmindsmatter.com/mens-
psychological-well-being.html Parker, G., Blanch, B. & Crawford, J. (2011). Does gender influence response to different psychotherapies in those with unipolar depression? Journal of Affective Disorders, 130, 17–20. Peterson, B., Boivin, J., Norré, J. et al. (2012). An introduction to infertility counseling: a guide for mental health and medical professionals. Journal of
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that may be explained by greater individual contact in the IE group. Above all, as the authors say, significant gains in men’s psychological health occurred via an intervention that, by combining sport and psychotherapy, neatly side-stepped male concerns around formal help-seeking.
Internet-based services Young males are a high-risk group for suicide but also widely use the internet – including for support (Gould et al., 2002; Strasburger et al., 2010). Evidence for the general value of computer-based interventions is beginning to accumulate (e.g. Andrews et al., 2010). Consequently, internet-based services that target young men are starting to emerge. For example, in Australia between 2003 and 2006, Reach Out Central (ROC: http://roc.reachout.com.au/flash) was developed as a ‘serious’ computer game that could help change health-related behaviours (Burns et al., 2010). The design of ROC incorporated various elements, including cognitive behaviour therapy. The game was highly marketed and included young men in its target audience. Focusing on such themes as depression, alcohol use and loss, ROC aimed to help players build skills in communication, problem-solving and optimism, in a virtual but realistic setting (Burns et al., 2010). The results of the intervention were mixed. On the one hand, site uptake figures were quite high. ROC was launched in September 2007, and there were 76,045 website visits, with 10,542 new members joining Reach Out. Moreover, 52 per cent of new members were male. As Burns et al. (2010) say, the advertising campaign was effective. On the other hand, while ROC initially attracted young men, it did not keep them engaged, nor did it significantly impact their symptomology. A single-group, quasiexperimental design with repeated measures of well-being, stigma, and helpseeking (pre-game, post-game, and twomonth follow-up) showed that female
Assisted Reproduction and Genetics, 29(3), 243–248. Pollack, W.S. (1995). No man is an island: Toward a new psychoanalytic psychology of men. In R. Levant & W. Pollack (Eds.) A new psychology of men (pp.68–90). New York: Basic Books. Shandley, K., Austin, D., Klein, B. & Kyrios, M. (2010). An evaluation of ‘Reach Out Central’. Health
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players became less distressed, and improved in the areas of life-satisfaction, problem-solving and help-seeking. However, there were no significant changes for male players, whose recruitment to the study was lower, and attrition rate from the study was relatively high. Only 88 of the 266 participants (33 per cent) were male; and 22 dropped out before twomonth follow-up (Shandley et al., 2010). The ROC game, however, underlines the potential of the internet in reaching younger males – something also recognised in Ireland, where a similar game targeting young men was launched in autumn 2012 (www.workoutapp.ie).
Male-specific psychotherapies Although it is known that men and women can respond differentially to medications such as antidepressants (Bigos et al., 2009), sex differences in the efficacy of psychotherapies have seldom been investigated. What data there is, however, is striking. For example, within
Education Research, 25(4), 563–574. Strasburger, V.C., Jordan, A.B. & Donnerstein, E. et al. (2010). Health effects of media on children and adolescents. Pediatrics, 125(4), 756–757. Sullivan, L. (2011). Men, masculinity and male gender role socialisation. Doctoral thesis, Canterbury Christ Church University. Available at http://create.canterbury.ac.uk/1019
the field of infertility counselling it is established that it is ‘essential that infertility counselors be aware of how men and women experience infertility differently’ (Peterson et al., 2012: p.245). In a review of studies of CBT for depression, Parker et al. (2011) found a sex difference in treatment response in a third of the studies, though the reasons for these differences remain unclear and require further investigation. Some clinicians have targeted psychotherapeutic interventions at key aspects of male psychology. One such psychotherapy, developed in the United States, is alexithymia reduction treatment (ART) (Levant et al., 2009). The designers of the treatment argue that male socialisation leads men to develop fewer emotional skills, including being less able to identify and articulate their feelings. Some men may be, in other words, ‘alexithymic’, and most studies of nonclinical populations, at least, suggest that men tend to be more ‘alexithymic’ than women (Levant et al., 2006). As Levant et
9 Sullivan, L., Camic, P. & Brown, J. (2014). Masculinity, alexithymia and fear of intimacy as predictors of UK men’s attitudes towards seeking professional psychological help. British Journal of Health Psychology [Advance online publication]. doi:10.1111/bjhp.12089 Swami, V. (2012). Mental health literacy of depression. PloS ONE, 7(11),
e49779. UK Government (2012). Anti-social behaviour order (ASBO) statistics – England and Wales 2012. Available at tinyurl.com/nn95bj2 Yalom, I.V. (2005). The theory and practice of group psychotherapy (5th edn). Cambridge, MA: Basic Books.
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al. (2009) note, alexithymia could be considered to be an aspect of ‘normative’ or traditional masculinity and as such poses a major barrier to men seeking therapy, getting benefits from therapy and achieving general relationship satisfaction. ART involves men being guided through in-session and homework exercises aimed at increasing their emotional skills. In a small pilot study, Levant et al. (2009) hypothesised that ART would lower scores on alexithymia, reduce endorsement of traditional masculine ideology and increase willingness to seek psychological help. There were six participants in the treatment group, aged 18–33 years, with an average age of 24. The six-session, manualised intervention included: (1) male emotion socialisation; (2) developing a vocabulary for emotions; (3)learning to read the emotions of others; (4) keeping an emotional response log; (5) practice; and (6) moving to deeper issues. The results were promising. The experimental group showed significant reductions in normative male alexithymia and in the endorsement of traditional masculinity ideology. The treatment as usual group did not show these changes.
However, neither group showed significant change in help-seeking. As Levant et al. (2009) admit, there were significant methodological limitations to their study over and above the small sample. Nevertheless, the fact that significant changes of this kind were found does hold some clinical promise for the future.
Conclusion Traditional models of mental healthcare, with their heavy and implicit reliance on
overt help-seeking and on individual faceto-face encounters involving direct emotional disclosure, can unintentionally present barriers to men. Now, perhaps more than ever, we need to provide and promote psychological interventions and services that, drawing on existing scientific and epidemiological evidence, tackle the stigma associated with helpseeking, engage men more effectively in treatment and, above all, at critical points in their existence, help men put life before death.
Roger Kingerlee is Principal Clinical Psychologist with the Norfolk and Suffolk Partnership Trust roger.kingerlee@nsft.nhs.uk
Luke Sullivan is Clinical Psychologist with the Barnet, Enfield & Haringey Mental Health Trust Luke@mensmindsmatter.com
Duncan Precious is Clinical Psychologist with the Royal Army Medical Corps at Catterick Garrison duncanprecious@hotmail.co .uk
John Barry is a Chartered Psychologist and Research Co-ordinator with the University College London Medical School john.barry@ucl.ac.uk
ACT for Young People Build your skills to create extraordinary young lives 22 & 23 September 2014 | Central London location This two-day workshop will help you extend your ACT skills so you can use ACT experiential techniques confidently and dynamically with young people aged 12 to 24 years.
You will learn: How to use ACT principles while also considering the developmental stage of young people aged 12 to 24. We will focus on skills that are easily presented to a young person.
This is the workshop that will help you to have fun using ACT with young people.
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How to adapt the six core principles of ACT into exercises for young people Developmental considerations when using ACT techniques ACT ways of talking collaboratively with young people and creating an experiential space for behaviour change How to create your own ACT exercises for young people using readily available resources How to help young people connect mindfully in sessions How to create mindful exercises that young people can use at in their lives
Over two days we will introduce participants to many exercises that have been shown to work well with young people, and teach you how to approach ACT with young people. The workshop is fun and creative. We focus on getting experiential about ACT rather than talking at young people.
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You will use • art materials • actions and movement • stories, youtube, media and music • you will have fun too!
Who is this for: This workshop is suitable for all professionals who work with young people,, including psychologists, counsellors, social workers, teachers etc.
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Early bird rate: £199 (ends 3rd August) | Late rate: £239. For more details go to: www.contextualconsulting.co.uk
The Trainer: Louise Hayes, PhD, Clinical Psychologist, Orygen Youth Health Research Centre, The University of Melbourne and Private Practice Louise is a world expert in ACT for young people and the co-author of Get Out of Your Mind and Into your Life for Teenagers: A Guide to Living an Extraordinary Life, the first ACT book for adolescents. Louise is an academic, clinical psychologist and peer reviewed ACT trainer. She has developed ACT with young people and found it is energising, engaging and makes therapy a shared journey in development. She completed one of the first research trials using ACT for adolescents, she has an active research program in schools, therapy settings, and online. Louise also works in private practice with young people. Find out more at www.actforadolescents.com or www.louisehayes.com.au
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LOOKING BACK
Masculinity and mental health – the long view Ali Haggett gives a historical perspective
However, my research suggests that s a medical historian engaged in the statistical landscape reveals only part research on the history of men’s of the story. We know that 75 per cent of mental health, it is striking how suicides are currently among men, and we little research exists on the ways in which can trace this trend back historically to men have coped with professional and data that suggests this has been the case personal pressures. The literature on male since the beginning of the 20th century psychological and emotional disorders is (Watts, 1966; Wilkins, 2009). Alcohol equally sparse. Why this history has been abuse, a factor often related to suicide, is so poorly recorded is a matter for also significantly more common in men, considerable debate. who are more than twice as likely to As the authors of the introduction to become alcohol dependent than women this special feature have noted, scholars (Wilkins, 2009). This trend too is wellof gender studies have broadly tended established and is a consistent theme to assume a male norm and focus throughout the studies of general practice consequently on ‘femaleness’ and morbidity that differences from the norm, emerged during while academic historians (and the late 1950s feminist historians in “historically, the inhibition (Bancroft & particular) have focused of emotionality is by no Watts, 1959). repeatedly on deconstructing The subject the well-versed ancient means a constant or of help-seeking association between women immutable male trait” for psychological and ‘madness’. Some continue disorders certainly to argue that men are simply seems to be an area much less likely to be affected that presents particular challenges to by mood disorders and that women are masculinity, complicated by the fact that more naturally predisposed to such when men do seek help from medical conditions (Freeman & Freeman, 2013). practitioners they often present with Statistically, women do appear to suffer somatic or psychosomatic symptoms that more frequently from depressive and anxiety disorders, featuring more regularly may have an underlying emotional cause. in figures for consultations, diagnoses and It is therefore highly likely that male cases prescriptions for psychotropic medication. of depression and anxiety disorders are under-diagnosed (O’Brien et al., 2005; This has been consistently so since the Wilkins, 2009). Family doctors practising 1950s, with current figures suggesting that women are approximately twice more in the 1950s noted that women tended to present with symptoms of low-mood, likely to suffer from mood disorders than anxiety, lack of motivation and sadness men (WHO, n.d.).
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Bancroft, J.G. & Watts, C.A.H. (1959). A survey of patients with chronic illness in a general practice. Journal of the College of General Practitioners 2, 338–345. Berridge, V., Herring. R. & Thom, B. (2009). Binge drinking: A confused concept and its contemporary history. Social History of Medicine 22(3), 597–607. Camberwell Council on Alcoholism (1973–1975). Women alcoholics:
Seminars, student surveys, agencies, work-group, meetings, etc. Camberwell Council on Alcoholism Archive (SA/CCA/62). Wellcome Library, London. Cooper, C.L. & Marshall, J. (1976). Occupational sources of stress. Journal of Occupational Psychology, 49, 11–28. Darwin, C. (1859). On the origin of species. London: John Murray.
(which, for the most part were easy to recognise), whereas men were more likely to present with somatic symptoms, including a range of ill-defined disorders affecting the stomach, digestion, sleep and general well-being (Royal College of General Practitioners, 1956–1958). So it appears that the reluctance of men to speak about their own illness and the broader collective silence that surrounds the emotional world of men has a long history. However, interestingly, it is by no means a ‘continuous’ one. I will suggest that alternative constructions of masculinity observable in earlier times resulted in very different approaches to nervous disorders and symptoms of depressive illness. History can indeed tell us much about the origins of dominant forms of masculinity, and perhaps we might look to earlier periods and alternative constructions of masculinity to cultivate healthier ways of expressing emotional distress.
Georgian sensibility and the Victorian ‘stiff upper lip’ Although there is now widespread acceptance among social scientists and historians that masculine traits are not essential attributes, but that they are in large part socially and culturally constructed, it is the familiar image of the tough, stoic male that remains the dominant or ‘hegemonic’ masculinity in the developed Western world. However, historically, the inhibition of emotionality is by no means a constant or immutable male trait. During the Georgian period (1714–1830), for example, advances in scientific and anatomical knowledge from the practice of dissection suggested that the central nervous system was fundamental to understandings of the body. There was widespread discussion about how it worked, and physicians thought that many diseases and afflictions were connected in some way to it. This resulted in a new interest in nervous disorders, which were thought to affect
Fraser, R. (1947). The incidence of neurosis among factory workers. London: HMSO. Freeman, F. & Freeman, J. (2013). The stressed sex: Uncovering the truth about men, women and mental health. Oxford: Oxford University Press. Fry, J. (ca1950–ca1980). Research notes: Peptic ulcers. John Fry Personal Papers, Royal College of General Practitioners Archive. Haggett, A. (2012). Desperate housewives,
neuroses and the domestic environment 1945– 1970. London: Pickering and Chatto. Haggett, A. (in press). Do you know what caused your drinking? Gender, stress and alcohol abuse in post-war Britain. In M. Jackson (Ed.) Stress in post-war Britain. London: Pickering and Chatto. Hall, L. (2000). Sex, gender and social change in Britain since 1880. Basingstoke: Macmillan.
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Hopkins, P. (1955). The general practitioner and the psychosomatic approach, in D. O’Neil (Ed.), Modern trends in psychosomatic medicine. London: Butterworth. Jones, E. & Wessley, S. (2005). From shell shock to PTSD: Military psychiatry from 1900 to the Gulf War. Hove: Psychology Press. Lemle, R. & Mishkind, M.E. (1989). Alcohol and masculinity. Journal of Substance
disassociate themselves from the lower social orders. That ‘good blood and bad nerves went hand in hand’ was broadly manifest in the attitudes and associations of society and shaped the ways in which people viewed themselves in sickness and in health (Micale, 2008). Scholars have long shown how the huge social and cultural changes of the Victorian period (1837–1901) that followed resulted in new gender constructions and ideas about what it was to be a man or a woman. However, it is only more recently that historians have begun to explore the ways in which these changes, and the consequent stigmatisation of male emotionality, impacted upon male mental health (Micale, 2008). By the mid-19th century, Britain had become the world’s leading industrial nation, and it is hard to overstate the scale of changes wrought by industrialisation and imperialist pursuit. British ascendency in the world required
Abuse Treatment, 6, 213–222. Micale, M. (2008). Hysterical men: The hidden history of male nervous illness. Cambridge, MA: Harvard University Press. O’Brien, R., Hunt, K. & Hart, G. (2005). ‘It’s caveman’s stuff, but that is to a certain extent how guys still operate’: men’s accounts of masculinity and help-seeking. Social Science and Medicine, 61, 503–516.
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men and women alike. Among Georgian society, the individuals thought to be most seriously affected by ‘nervous distempers’ were those from the cultured, well-to-do classes, who were considered to have a more refined nervous system, which was more prone to collapse. Nervousness among the higher social strata was commonly accepted and seen as a sign of ‘good breeding’. The display of emotion among men in this period was not associated with sexual practice or effeminacy. Being ‘manly’ meant different things in Georgian Britain; primarily being virtuous and wise. Male emotionality therefore crossed no inappropriate boundaries nor brought undue negative attention. As a consequence, men were quite comfortable looking inwardly and being reflective about their own physical and psychological experiences. During this period, an explosion of nerve doctors and medical treatises emerged providing advice on remedies and lifestyle. The physician George Cheyne, for example, published a text entitled The English Malady in 1733, in which he described symptoms of melancholy, lowness of spirits, insomnia and agitation. These, he argued, were common in wealthy people and had several causes, most notably the pace of new modern life, luxurious living and immoderate lifestyle. In the book, he urged people to take up what he called a ‘low regimen’, meaning a temperate lifestyle. Cheyne’s own experience informed his writing, for he suffered himself from many of these symptoms, including headaches, lowness of spirit and disturbance of appetite. Many of his case studies focused upon men. By demarcating nervous distempers as unique to the cultured classes, physicians were able to
the projection of ‘power’ and ‘control’; qualities that did not fit well with a notion of male nervous instability. More generally, the preceding intellectual movement – the Enlightenment – had espoused a range of values that were increasingly seen as excessively liberal and egalitarian. Women, for example, had begun to fight for equal rights in suffrage, divorce and inheritance. The 19th century was in many ways a backlash to this liberal Enlightenment thinking, and on a range of levels a period of social and cultural conservatism emerged. Industrialisation itself promoted the division of labour by sex and heavy factory work, mining and construction became distinctively ‘male’ environments, while symbolically, women became ‘angels in the house’. This term was coined in 1854, by Coventry Patmore, in a poem of the same title. It was used increasingly to describe women who embodied the perfect Victorian ideal of the dutiful wife and mother. At the same time, these social changes were bolstered by the evolutionary theories of Charles Darwin and Herbert Spencer that emphasised core differences between men and women (Darwin, 1859; Spencer, 1864). Women were thought to be biologically inferior to men, dominated by their reproductive systems and prone to irrationality. Men, in contrast, were considered to be rational, ‘restrained’ beings. Other factors duly reinforced these developments. The rise in Protestant religious enthusiasm, for example, favoured personal values of will-power, obedience and fidelity. Christian ‘manliness’ meant being a good husband and father, leaving little room for emotional self-expression. Within European medicine and psychiatry, the study of human sexuality emerged, promoted by individuals such as Iwan Bloch, Richard von Krafft-Ebing, Maunus Hirschfeld and Havelock Ellis (Hall, 2000). This new ‘science’ of sexology began to investigate and regulate sexual practices, and attempts were made to
Roper, M. (1995). Masculinity and the British organization man since 1945. Oxford: Oxford University Press. Royal College of General Practitioners (1956–1958). Psychiatry and the general practitioner working party papers, agendas notes and reports. Royal College of General Practitioners’ Archive (A CE G 12-1). Spencer, H. (1864). The principles of biology. London: Williams and Norgate.
Watts, C.A.H. (1966). Depressive disorders in the community. Bristol: John Wright and Sons. Wilkins, D. (2009). Untold problems. London: Men’s Health Forum. Wilkins, D. & Kemple, M. (2011). Delivering male: Effective practice in male mental health. London: Men’s Health Forum. World Health Organization (n.d.). Gender disparities in mental health. Available at tinyurl.com/mga8snh
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psychological and psychosomatic ill health in men during the decades following the Second World War. General practitioners noted increasingly during the 1950s, for example, that somatic symptoms were ‘a mask’ and an excuse with which to come to the doctor (Hopkins, 1955). A physical symptom was viewed as ‘more acceptable’ to the patient, his family and his friends than the underlying emotional cause (Hopkins, 1955). The 20th century and beyond John Fry, a post-war pioneer of In Edwardian Britain (the reign of King general practice-based research, kept Edward VII 1901–1910), the rigid social meticulous personal notes about his hierarchy continued to be held together patients, which were also regularly by the shared values of national pride and interspersed with references to male imperialism. ‘Authority’ was everywhere patients with dyspepsia and ‘epigastric and cultivated in the military, in schools, pain’, a term used to describe pain in the the Church and other organisation (such gastric region (often aggravated by as the Boy Scouts, Mothers’ Union, the alcohol), for which no organic cause Territorial Army and the Temperance could be found. Such patients were often League). Within the military, discipline additionally described as ‘agitated’, was an absolute requirement. Desertion sometimes ‘depressed’, but seldom and cowardice were punishable by death, ‘neurotic’, a term that was largely still serving as a deterrent to other soldiers. reserved for anxious women (Fry, The emphasis on courage and ca.1950–ca.1980, Personal strength was intimately connected papers). to Victorian and Edwardian notions It seems that most GPs had of ‘manliness’. The symptoms of great difficulty relating causal mental illness were heavily or precipitating factors to stigmatised and frequently confused psychogenic symptoms, and and conflated with a range of social there was acceptance that problems, such as crime, alcoholism much male psychological and vagrancy. Most psychiatric illness remained undiagnosed patients were managed within in the community. Recent asylums. Freud’s theories were research continues to suggest underdeveloped and carried less that men still present with influence in Britain where a somatic conditions that might biological view of mental illness have a psychological predominated. Psychological dimension. Symptoms not approaches were treated with only include gastric disorders, suspicion because they encouraged but also erectile dysfunction introspection and egoism which and obesity, suggesting that might aggravate an existing symptoms might acquire deficiency of ‘willpower’ (Jones & different significance in Wessley, 2005). different cultures, contexts and Soldiers exhibiting strange times. It would certainly seem somatic and psychological that the number of men symptoms presented very quickly experiencing common mental after the onset of the First World disorders is still War, 100 years ago. Symptoms were underestimated, a problem initially thought to have been the exacerbated when practitioners result of damage to the central rely on their male patients’ ability nervous system from heavy artillery to volunteer information about explosions. The term ‘shell shock’ Soldiers exhibiting strange somatic and psychological mental health concerns (Wilkins was first used by the physician symptoms presented very quickly after the onset of the & Kemple, 2011). Charles Myers (1873–1946) in his First World War Physicians treating patients 1915 article in the Lancet, although in the three decades following the which men appear less likely to he did not invent the term. Symptoms inauguration of the National Health experience depression and anxiety, in included blindness, deafness, palpitations, Service admitted that they were poorly part because they are less comfortable paralysis, muscle tremor and anxiety. The trained in psychological medicine and expressing their feelings and less willing condition caused alarm because it that they often unwittingly colluded with to seek help for their problems. It is challenged Victorian notions of stoicism stereotypical views about femininity and indeed perhaps instructive that the and moral will. Fundamentally, the weak, masculinity, providing psychiatric research from my current project has degenerate and effeminate had diagnoses for women and somatic uncovered evidence of widespread traditionally been associated with define ‘normal’ and ‘abnormal’ sexual behaviour. Consequently, the notion that homosexuality was deviant behaviour resulted in anxieties about homo-social affection and its potential association with effeminacy. The values put forward by the British military and the public school system also notoriously fostered strict morality, stoicism and the ‘stiff upper lip’.
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neurosis, yet men of all ranks appeared to succumb to the condition. It prompted physicians to consider the possibility of a psychological cause and caused division and debate between physicians who supported organic causes and those who believed in the psychological origins of trauma. Although the report of the War Office Committee of Enquiry into ShellShock that took place in 1922 after the war suggested that there was measured acceptance of the psychological origins of war trauma, and of some psychological therapies, considerable cultural ambivalence and antagonism to new ideas remained. ‘Misfits’ and poor recruits, for example, were still thought to break down more easily under stress and neurosis continued to be associated implicitly with weakness and lack of will. The radical social and cultural changes that took place during the Victorian period continued to influence ideas about masculinity and the emotions well into the 20th century and provided the precursors to the current situation in
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diagnoses for men. A number noted that, within medicine, a strong association persisted between women, ‘hysteria’ and menstrual or menopausal mood changes. Until the late 1970s, most GPs were male themselves and thus often affected by the same difficulties when challenged to be reflective or emotionally expressive during the patient consultation process (Haggett, in press). Although health services have developed greatly since this time, there is nonetheless still evidence that society’s narrow view of ‘how men should behave’ impacts upon health professionals’ ability to understand and cater for men’s needs (Wilkins & Kemple, 2011). A longer narrative also illustrates how notions of ‘weakness’ that became tied to mental breakdown influenced men’s willingness to recognise symptoms of depression and anxiety. Michael Roper (1995), for example, has shown how a ‘cult of toughness’ existed among men working in British organisations during the 1950s and that this was heavily influenced by the experience of compulsory national service, which did not end until 1960. Until the 1980s, studies on stress in industry tended to focus on physical and chemical hazards to health and on absenteeism, while mental illness was of subsidiary interest (Cooper & Marshall, 1976). This one-sided picture was further confused by medical sickness certificates that rarely confirmed a psychiatric diagnosis owing to the stigma it might bring the worker. That male neurosis did exist is nonetheless undisputed, due to evidence that emerged in a handful of publications in response to concerns about nervous illness and absence from work following the stress of war (Fraser, 1947). However, no formal discussion developed about neurotic and depressive illness in men, despite evidence that it occurred. In contrast, a gendered landscape that assumed women were more likely to experience mental illness duly provided fertile ground for academics, clinicians and social commentators alike (Haggett, 2012). It is clear that elements of stoic, Victorian masculinity still survive because the common view remains that men often interpret symptoms of emotional distress as ‘weakness’, and that this provides a barrier to seeking help. Historical parallels can also be drawn between earlier debates on alcohol abuse and current concerns about bingedrinking. Alcohol consumption has long been widely accepted as one of the most common ways in which men selfmedicate for emotional distress; however, it is consumption among young females
that has tended to attract negative attention. From Hogarth’s desperate 18thcentury depiction of a syphilitic, drunken woman in Gin Lane to the current media depictions of intoxicated, scantily clad, young women outside nightclubs, it is long-established moralistic overtones about women and alcohol that are most often reflected. The focus on women carries with it familiar historical connotations of ‘women’s classic role within public health as both “innocent victim” and vector of infection’ (Berridge et al., 2009, p.600). During the 1960s, concerns about alcohol abuse and a renewed focus on the disease theory of alcoholism led to a developing interest among some in the medical community. However, the focus was largely upon the recognition, diagnosis and treatment of alcoholism and upon the social problems caused by drunken offenders. Although men were significantly overrepresented in statistics for alcohol abuse, few enquired further about the reasons for the onset of drinking. In contrast, discussion about women who drank tended to explore the ways in which aspects of the female role (their conditioning, upbringing and lifeexpectations) might cause them to drink (e.g. Camberwell Council on Alcoholism, 1973–1975). Debates about alcohol say much about the wider tensions and contradictions that have existed in postwar Britain about masculinity, male emotional health and gendered ‘ways of coping’ (Haggett, in press). Without undermining the importance of health concerns about women and binge-drinking, the fact remains that older men remain the group with the highest alcohol-related mortality. It is certainly the case that throughout the second half of the 20th century, social drinking increasingly became a primary cultural symbol of ‘manliness’ (Lemle & Mishkind, 1989). Heavy drinking symbolised greater masculinity than lighter drinking, and the more a man tolerated his alcohol, the more manly he was deemed (Lemle & Mishkind, 1989). However, the British media’s focus on young women indicates that social and cultural factors continue to influence ideas about masculinity, femininity and vulnerability to stress and mental disorders.
Reflections So, how might history inform current knowledge and practice? Historians look at the social and the cultural as well as the medical and psychological. We seek to view ideas about male behaviour and
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psychological illness within the context of their time and illustrate how symptoms might appear in new forms and be understood differently through time in response to prevailing cultural and medical forces. In practice, history offers novel public engagement opportunities in schools, sports venues and doctors’ surgeries, to educate young males about alternative masculinities, such as the ‘nervous male’ of the 18th century. As Mark Micale reminds us, during the Georgian ‘cult of sensibility’, Britons of both sexes ‘monitored their transient psychological aches and pains as never before’, and the expression of male emotion in literature included ‘copious shedding of tears’ (Micale, 2008, pp.27, 25). One challenge might be whether we confront or exploit familiar notions of stoic masculinity in order to persuade men to think about their mental health. As recent researchers have noted, behaviours and attitudes take a long time to change, and while early intervention might allow young boys to foster healthier ways of expressing emotion, the mindset of the generations of men who are already adults might be less easy to transform (Wilkins & Kemple, 2011). History does, however, offer the opportunity to expose, uncover and perhaps ‘normalise’ male mental illness, where it seemed previously hidden, but was in fact prevalent – either existing undiagnosed in the community, or presenting in complex psychological and psychosomatic forms in primary care. It might also be worth reminding current generations of men that many of the most famous male figures in history were challenged by a host of psychological and psychosomatic symptoms; Charles Darwin, John Stuart Mill and Winston Churchill, despite firmly inhabiting the age of the ‘stiff upper lip’, were among the most notable. Historians are well placed to work alongside psychologists, health scientists and policy makers to facilitate change and provide advocacy supported by evidence from the longer view. Based on past experiences, historians are also appropriately positioned to help inform policy makers where a change in direction might seem politically unpalatable. An allegiance to one discipline does not, after all, exclude openness to other perspectives. A sense of the whole can most usefully inform the part. I Ali Haggett is Senior Research Fellow in the Centre for Medical History, University of Exeter A.N.Haggett@exeter.ac.uk
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INTERVIEW
From ‘year Dot’ to the future
Society, and so hopefully this will soon start to turn round. We’ve also got people all over the world interested in associating and working more closely with UK psychology, so it’s good to see the new developments in the Society to make more connections internationally.
The Society’s new President (see p.435), Dorothy Miell, outlines some priorities for her term and beyond. Our Editor, Jon Sutton, poses the questions
o what extent does the President pilot the ship? T Well, you have to have some sort of direction setting, but it’s not a personal agenda – you’re doing it as Chair of the Board of Trustees, not as somebody who is setting out their own personal stall. I don’t think you should be pushing a particular individual position, you’re helping set and steer a collective direction. This can only be taken forward by the work of the whole Society – with the Chief Executive responsible for the operationalisation and management of that direction, working with staff of the Society, and the members contributing via their work on the Boards and in the various member networks. And what is your collective direction? During my term, I think the most important thing will be agreeing on then starting to work to the new Strategic Plan. That is something I was really bothered about getting done… it can have a lasting influence by helping the Society decide on priorities and then deliver them. When the Trustees consulted with the membership and staff as we developed the plan, the sort of issues they were raising about the Society were very similar to the ones we’d identified. The plan will help us focus on these agreed areas and avoid getting overloaded or indeed sidetracked by other things that are less clearly our main concerns. The plan lays out broadly three priority areas: promoting the advancement of the knowledge base and practice; making psychology more visible in both policy making and public discourse; and improving services to members, which will not only support our existing members but also hopefully grow the membership further. What could the Society be better at? We could be better at communicating what the membership fee goes towards, what we actually do. I was struck when I was chairing the Psychology Education
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That need to make connections presumably relates to other disciplines as well. Yes. One of the things I see as an academic is that we are blurring the edges of the discipline, and developing more of an understanding of the benefits of multiBoard, we had lots of prizes, awards and and interdisciplinarity in addressing the grants but not enough people seemed to questions that concern society. I think it’s know about them. And of course there are really important that we find ways to help many different reasons why people choose us to work even more effectively with to be members, and we may all want colleagues in other disciplines. And this somewhat different things from the applies to practice as well as academia – Society, so what we communicate needs working in multidisciplinary teams with to speak to as much of that range as patients and clients is common, but possible. Independent clinicians or perhaps we could do more in training consultants, employed practitioners, and CPD to teach how to work in such undergraduate students, academics, all teams? I’m particularly interested in need to hear how the Society developing relationships is working for them. with similar, adjacent Before my three years as subject areas, learned Chair of the Psychology societies and professional “Let’s do what we do Education Board, it had been bodies and the strategic better, and show quite a long time since I’d plan talks about building people why it’s worth been involved in the running such collaborations. being part of” of the Society, and it was Every funding body, quite opaque to me why and every policy body talks how things happen the way about the benefits of they do. I would like to review how interdisciplinarity, and I’m pleased that the Society works and clarify and we are planning to build really strong communicate its functions and processes, connections with others, both in the UK so members can understand more about and internationally. it and get as much value as possible from what’s available. Let’s do what we do That would presumably go some way better, and show people why it’s worth towards countering a common charge being part of. There’s a lot to do here – levelled at the Society, that we are not from improving what’s available through visible enough. the website and how easy it is to find, to In terms of how we improve the public offering training and support to those visibility of the subject and the Society, members who give their time to serve on the Strategic Plan proposes increasing the many committees of the networks and the number of large scale, public-facing the Society more generally, and there’s a events. We’ve had some major successes lot in the plan about how we might start with some of these already such as our on this work with some urgency. exhibits at the Big Bang Young Scientists and Engineers fair and the Cheltenham Is the membership in good health? Science Festival. Also, there’s a new Psychology is one of the most popular proposal from Research Board for a A-levels, and it’s still one of the most Festival of Psychology in 2019 that will popular degrees at university, yet over be an important international event. I’d the last few years our membership has also like to encourage us to develop not been growing in line with this overall support for ‘citizen scientists’, using apps growth in interest. That means there are and other technologies to help interested more and more people that are getting members of the public to get more close to psychology but not yet seeing involved with understanding the benefits of membership of the BPS. psychology – and indeed contributing I’m impressed with the work being done to its development in accessible and fun by staff and members with schoolchildren ways, for example by ‘crowdsourcing’ data and students to explain more about the on everyday behaviour.
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Can you give me an example? The app ‘Mappiness’ (www.mappiness.org.uk) is fantastic. It was put together by academics in geography and environmental science who were interested in how people’s feelings are affected by features of their current environment – things like air pollution, noise and green spaces. The app alerts you a number of times a day, and when you get the alert you key in where you are, what you’re doing, and how you feel on a number of dimensions. It only takes a minute or two to do, and you then get access to your own data so you can start to chart out where and when you’ve been at your happiest. It’s really interesting for the person concerned but at the same time, it’s developing a database for the academics who are running it which is built up from people’s ratings and sound samples from all over the world. This isn’t a psychology example I know, and I’m aware of many colleagues in psychology who are doing similarly excellent activities, but there’s more to be done here I think and the Society could help with growing this strand of work. However, planning such events and initiatives obviously takes longer than the one year any President serves, so change can’t be achieved quickly. Working on the strategic plan allows us all to think about what can be done in five years rather than one, and gives a broader framework for the specific ideas any one President may have. Is there perhaps a more direct approach required when it comes to getting ourselves heard? We should have a far greater voice. What we could do more is have a small group of people who can be ‘The Voice’ of psychology and be more visible in public and policy spheres, who can ensure that our shared knowledge base of psychology and the value of its practice are being aired appropriately and often. What they say doesn’t need to surface the nuances of difference between all the branches of our discipline. We have to reassure our members that just because we may not all agree with every aspect of what that spokesperson has said, doesn’t mean to say that they aren’t doing a good service for psychology. Most people who are looking to psychology for some sort of insight are not looking for all those nuances, they are asking how they would get something of use from psychology, and where might they go to find out more. The BPS can communicate these broad-brush messages, and then point to
where other, more detailed, resources are available. How do the various member networks of the Society – Divisions, Sections, Branches – fit into this? I think we risk having an overcomplicated structure and duplicated set of groups, not all of which have a clear link to each other or to the overall goals of the Society. We perhaps need to improve the communication between the different networks and help them work together on matters of concern rather than setting up yet further new networks and subgroups. We also need to address how best to finance the various activities we agree as our priorities in the strategic plan, ensuring that networks have appropriate access to necessary funding
and using it effectively in order to support the things we agree are important. What other issues are close to your heart? I think it’s important we do more on equality issues. Psychology departments in universities with Athena SWAN recognition can apply for their own awards; yet approximately 60 departments in qualifying universities have not yet achieved this – why not? We’re a subject that attracts a far higher proportion of women students, and always has done, even at the postgraduate and professional training stages, yet you look round at those in senior roles both in academia and practice and the picture is very different. Through working with the Association of Heads of Psychology Departments, the Society could be providing a network of people who can help departments get that recognition within the Charter and start to improve the career prospects of women psychologists. And prospects for psychologists in
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general? We’re already working well with departments, for example to collect and share data on the long-term destinations of their graduates so that we can all learn more about how a psychology degree can be of use in later employment – information that’s useful across the board. The new partnership approach to accreditation of degrees is another success story I think – the Society is showing that it can work really positively with departments to improve psychology teaching and develop the curriculum. And whilst the Psychology Postgraduate Affairs Group (PsyPAG), funded by the Society’s Research Board, has done fantastic work to help postgraduates support each other through their studies, perhaps there’s an opportunity to do more for postdocs and newly qualified practitioners as they progress into the early parts of their careers? What was your own early career like? My own PhD research, with Professor Steve Duck at Lancaster, was on communication in developing relationships, and I have continued to focus on aspects of relationships and communication since. This has involved working in many different contexts – in primary and secondary schools looking at young children’s collaborations in their science, creative writing and music classes; interviewing women about their difficult relationship histories and experience of mothering; working with musicians, theatre directors, gallery directors and computer scientists to study how they collaborate to produce multi-media exhibitions and performances; and interviewing musicians about their changing sense of musical identity. I’m particularly interested in how people from different disciplines work productively together in developing their practice, and in how we might teach students, trainees and professionals in various fields to collaborate more effectively. After Lancaster I enjoyed many years at the Open University: their approach to opening up knowledge and learning through diverse and high quality materials was also very influential for me. Since 2010 I’ve been Vice Principal and Head of the College of Humanities and Social Science at the University of Edinburgh. The very international nature of the University and the close relationships we have with many outside agencies and disciplines have all further influenced my thinking about what the opportunities are for psychology.
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REVIEWS
Exploring epilepsy through art and science The London Brain Project is a public engagement initiative established by an ambitious group of PhD students from the UCL Institute of Child Health. Launched in 2013, the project engages scientists, patients and artists to explore the brain through art. The project kicked off in November with its first workshop focused on epilepsy. Artists, neuroscientists and neurologists were joined by people with epilepsy and their families to create artwork addressing the question ‘What does epilepsy mean to you?’. An exhibition of this artwork went on display to the public at Lumen URC in London, following a launch night on 13 March. The diversity of artwork was a testament to the huge interest in this unique project from the artistic community. On display were wire sculptures, collages and paintings, all inspired by the experience of living with seizures. Alongside artwork created during the workshop, two new pieces produced by artists were unveiled at the launch event. Julia Vogl transformed a patient’s seizure diary into a striking row of colourful screenprinted blocks, each representing a seizure. The colours and patterns correspond to seasons of the year and times of day, a soothingly methodical approach relished by the scientists in attendance. At 20 metres long and spanning several years, the piece is visually and conceptually mesmerising. Dotted along its length are brief notes on the circumstances of the seizure: ‘Flight (Melbourne – Shanghai)’, ‘Watching Downton Abbey Christmas Special’, a poignant insight into the unforgiving nature of epilepsy. Work by Sound Artist Chase Lynn was also unveiled and played at the launch inside a conical meditation room. Chase worked with doctors at Great Ormond Street Hospital to make EEG data from a nocturnal seizure audible, allowing you to ‘hear’ the brain activity. The result was an increasingly chaotic assembly of hums and buzzes that was both eerie and pleasantly euphonious. A mustlisten. Screened at the launch night was a short film by Piers Bailey, filmed during the workshop at which most of the artwork was produced. The film features interviews with the workshop participants and project directors, and illustrates the personal significance of the project for those involved. By elegantly documenting the unique atmosphere of the workshop, the film demonstrates that the process of creative discussion between scientists, artists and patients is as meaningful as the finished artworks themselves. Explaining the experience of a seizure is notoriously difficult – like explaining the colour blue to a blind person. Allowing patients to communicate their diverse experiences through art was not only thought-provoking and illuminating, but also incredibly beautiful. Integrating art and science is becoming a more common pursuit by professionals from both camps. Sadly, these attempts are often marred by patronising definitions of ‘art’ and vague or meaningless Beyond Seizures scientific themes. It is the utter absence of these common pitfalls Exhibition that makes the London Brain Project and this exhibition so unique. London Brain By focusing on real experiences of misunderstood neurological Project disorders, the project is reflective and meaningful in a way that is so often lacking in scientific public engagement. I For more information, see www.facebook.com/LondonBrainProject Reviewed by Rosie Coleman who is a PhD student in the Developmental Cognitive Neuroscience Unit at UCL Institute of Child Health
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An intimate experience Everyday Robots Damon Albarn The songs on Everyday Robots are finely crafted and personal, marking key moments and transitions in Damon Albarn’s life. But the album is not nostalgic; the songs are a form of reflection that comes with middle age, a pause in the process. Their content is intrinsically psychological, recounting events and states associated with, for example, relationships, drug use, and the alienating effects of technology. But far more interesting is the way in which the songs work. Albarn presents us with fragments of images, ideas and emotions very simply rendered, and often mournfully sung. The music uses samples of voices and sounds, sewn together with a melody, and this acts as a current that shifts the pieces, bringing order and an empathic appreciation of what Albarn feels. Listening to this album is an intimate experience. Albarn is sharing his thinking. At times his allusions bite, at others the listener experiences a perplexed distance from him. It is effortful, as all reflection is, and Albarn’s skill is to recognise the disjunction between intentional-level language and lived experience. As Timothy D. Wilson has it, so little of our lives are under conscious control and much of our thinking is an attempt to make sense, to apply narrative and to learn. If we want precision then it is a forlorn task, but Albarn has embraced the phenomenon, given it direction and made it beautiful. I Parlophone; 2014 Reviewed by Tom Dickins who is at Middlesex University
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reviews
Realities of modern therapy The Examined Life: How We Lose and Find Ourselves Stephen Grosz
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The result of over 50,000 hours of conversation, this fascinating book charts the journey of both patients and Stephen Grosz himself throughout his career in psychoanalysis. A range of anonymous stories are reported, featuring patients suffering from eating disorders and grief to pathological liars and the chronically boring! Great depth is given into each individual account, with psychological studies and theories lightly included to allow the curious to research topics further. Although individual case studies may follow many years of treatment, they are written in an accessible and concise format. Of great interest to me were the honest insights into Stephen’s everyday experiences as a psychotherapist. Problems such as lacking concentration towards the end of a busy day and the de-stressing value of coffee and internet were all frankly described. Exploration into the author’s own family background and life experiences is also provided, giving an insight into his career choice and own personal struggles. This combination of both psychotherapist and patient experiences provides an insightful picture into the realities of modern therapy. The range of patients also ensures that readers will undoubtedly find some advice or insight into their own mental state. The
accounts of two highly stressed PhD students from different backgrounds were of especial relevance to me! I feel that this book will be of great help to those currently experiencing mental illness who are unsure whether or not to seek help. Psychotherapy is well described here as a partnership between patient and therapist. I hope this overarching sincere message will encourage some readers to take their first steps into therapy. I devoured this book in less than two days. I have no doubts that many readers of The Psychologist will do the same! I Vintage; 2014; Pb £8.99 Reviewed by Emma Norris who is a postgraduate student at University College London and Associate Editor for ‘Reviews’
Sample titles just in: Future-Minded: The Psychology of Agency and Control Magda Osman Inside Children’s Minds Valerie Yule Acts of Consciousness Guy Saunders The Power of Others Michael Bond For a full list of books available for review, see www.bps.org.uk/books. Send books for potential review to The Psychologist, 48 Princess Road East, Leicester LE1 7DR Remember, ‘Reviews’ now covers much more than books. Get in touch on jon.sutton@bps.org.uk or follow us on Twitter @psychmag for opportunities to contribute.
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Not just another manual Forensic CBT: A Handbook for Clinical Practice Raymond Chip Tafrate & Damon Mitchell (Eds.) The title of this book doesn’t really do it justice. Yet another CBT manual you many think. Well you would be wrong! It has chapters on different offender groups, such as adolescents and female offenders, as well as focusing on different offences such as intimate partner violence. Also, importantly, the book combines this approach with looking at CBT in its different formats, for example schema and ACT. Clearly written by practitioners who know what they are talking about, this book is a refreshing change to just focusing on theory and how the treatment ‘should be done’ according to certain manuals. The book discusses iatrogenic issues that are often missing in texts not written by practitioners and more helpfully gives in its appendix differing templates of in-session materials that are always welcome. It is up to date in that it refers to DSM-5 diagnostic criteria and has specific chapters on disorders such as PTSD and personality disorder, dealing with both clinical and criminogenic need, which is often an issue for practitioners working in the field. To be picky it is definitely not a book for students as it is fairly detailed in parts and more practice-focused, so maybe not really suitable as accompanying reading material for academic courses. To be fair to the authors, from the get-go they are clear that this book is for practitioners and not necessarily students; that they stick to being predominantly concerned with applied issues is a refreshing change, making it easy to recommend this book to newly qualified and more experienced practitioner psychologists alike. I Wiley Blackwell; 2013; Pb £34.99 Reviewed by Dr Claire Thompson who is a Registered Forensic Psychologist and Senior Lecturer, Nottingham Trent University
Too busy to read this? Mindfulness for Busy People: Turning Frantic and Frazzled into Calm and Composed Michael Sinclair & Josie Seydel You can probably tell from the title that this book aims to prove that just about everyone can practise mindfulness, regardless of how busy you (might think) you are. The first chapter seems to be dedicated to ‘selling’ the idea to the reader, and convincing them that they should read on and give it a go. However, this does get to a stage of feeling like you want to hurry up and get to the mindfulness practice – we are all busy after all! I was convinced though, and once fully briefed on what mindfulness will, and importantly, will not do (i.e. quick-fix everything), the authors move into varying aspects of practice. They point
out why, as busy people, we think we do not have time to practise mindfulness, and this in itself can be eye-opening; and that there are common things we do without even realising that can make us believe we are too busy for anything else, like worrying about how busy we are, and that we don’t have time… The audio aids online are a great supplement to an already easy-to-use book; so even if you are too busy to read the book, you can practise using the online aids. I Pearson Education; 2013; Pb £12.99 Reviewed by Lynsey Mahmood who is a PhD candidate, University of Kent
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reviews
Self-testing mental health My Mind Checker Channel 4 website
Attracting an audience Beautiful People Live in Beautiful Homes Robert Burriss (podcast) Hosted by Dr Robert Burriss, the monthly Psychology of Attractiveness Podcast provides a 15-minute overview of the latest in sexual attraction research. Taking an evolutionary perspective, this edition explored how sexual attractiveness changes over time according to the environment. Firstly, Burriss describes research from Dr Steven Arnocky at Nipissing University, Canada, finding that men and women report themselves to be 50 per cent more competitive when primed to believe partners were scarce. This suggests emotions around sexual conflict may be transient depending on external situations. Next, Burriss explains new research asking if someone can be made more attractive by placing them in more desirable surroundings. Research from Dr Michael Dunn at Cardiff Metropolitan University developed two sets of images of the same male or female in either a regular or luxury apartment setting. Females rated the same man 33 per cent more attractive in luxury surroundings, whereas there was no significant difference in male ratings. Thankfully, female shopping stereotypes were avoided in the discussion! Instead consideration was given to the evolutionary basis of women’s preference, seeking a male with more material benefits as a wiser investment in child-rearing. Finally, do younger fathers have better looking kids? Research by Dr Susanne Huber at University of Vienna explored this using data from the Wisconsin Longitudinal Study. Cohort participants had been rated for attractiveness in a previous study and Dr Huber additionally analysed age of parents at birth. Younger fathers were found to have more attractive offspring, with evolutionary functions in fewer sperm mutations at younger ages discussed. Burriss is an extremely likeable host, providing an overview of findings in an accessible manner to a broad audience. Some critique of the research presented would be welcome, probably lacking due to the wide intended audience. This podcast is a prime example of public engagement and academic promotion via the internet. Although this was my first listen to the long-running podcast (since 2009), I will definitely be making it a part of my monthly listening schedule! I See http://psychologyofattractivenesspodcast.blogspot.co.uk Reviewed by Emma Norris who is a postgraduate student at University College London and Associate Editor for ‘Reviews’ MORE REVIEWS ONLINE See www.thepsychologist.org.uk for this month's web-only reviews
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This interactive site has been launched to coincide with the latest live series of Embarrassing Bodies. Using a range of validated tests, users can self-test themselves for eight mental health conditions including ADHD, Autism Depression and OCD. A clear disclaimer is provided stating that these tests are for informative and not diagnostic purposes. Results are accompanied by somewhat detailed descriptions of your assessment: all reminding concerned participants to contact their GP. As well as examining your own tendencies and habits, you are also provided with interesting comparisons against other users. For example, after completing Baron-Cohen’s Autism Quotient, I was informed that engineers are currently
displaying the most autistic traits and teachers the least. Whilst I am wary of mental health being branded under ‘Embarrassing Bodies’, surely any opportunity for users to take time out to consider their mental health is beneficial. At the time of writing, over one and a half million tests have been taken. Clearly this site is reaching a vast audience and producing data that many psychologists would love to analyse. It is vital that these outputs are adequately assessed to allow in-depth follow-up results in the future. I www.channel4.com/ mymindchecker Reviewed by Emma Norris who is a postgraduate student at University College London and Associate Editor for ‘Reviews’
Taking evolutionary psychology to the West End – a personal reflection Lance Workman reflects on his appearance in a live show and podcast with comedian Richard Herring (while fellow psychologist and partner Sandie Taylor provides a slightly different version of events) Lance: Over the last 20 years I have made numerous appearances in the media, but when I was invited onto Richard Herring’s ‘The Meaning of Life’ comedy show my heart leapt. Finally a chance to combine evolutionary psychology with humour! Following his piece in the April 2013 issue of The Psychologist, Richard had been in touch with our editor, who had recommended me. The offer was a promise of a ‘fun time with RH followed by drinks and a cheque’. I packed my bags and headed off to the
Leicester Square Theatre. ‘The Meaning of Life’ consists of a series of shows where Richard looks at a major theme each month and, following a one-hour stand-up routine and a refreshment break, engages in a 30-minute discussion with a celebrity/expert. For one show he wanted an evolutionary psychologist who was ‘game for a laugh’ to explain to him and the audience why we have evolved the propensity to be good or bad. So how did it go? Following a very humorous first hour (involving Richard
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A myth explored
Uncompromising
The Myth of the Untroubled Therapist: Private Life, Professional Practice. Marie Adams Marie Adams has written an excellent book of interest to all who work as therapists, raising sensitive, even uncomfortable issues. From an experience of having a professional complaint made against her (which was later dropped), the author went on to question the role of issues in the personal lives of therapists and their impact in therapeutic practice with 40 therapists for her doctoral research, resulting in this book. The chapters helpfully examine a broad range of issues that can befall therapists in their personal lives. The topics addressed include therapists’ experience of depression, physical illness and family problems, including separation. I was very moved and impressed by the author’s humanity, courage and directness, and her not sparing of herself or her experience in an effort to bring these issues to a broader audience. The most helpful idea is the acknowledgement that we all have our own issues in what draws us into careers as therapists, and in our personal lives as therapists, and that these issues can either potentially enrich or obstruct our therapeutic work. The book explodes the myth of the untroubled therapist and is essential reading for therapists at any stage in their career. I Routledge; 2014; Pb £19.99 Reviewed by Dr Paul Gaffney who is a Senior Clinical Psychologist, Assessment, Consultation & Therapy Service, TUSLA, Ireland
simulating sex with a doughnut and dismantling the Ten Commandments), I was wheeled out to do my bit with Richard. I managed to bring in a lot of evolutionary psychology whilst engaging in a number of gags. The audience (around 2000), having been warmed up and suitably ‘refreshed’ at the bar, were up for all of this, laughing at the appropriate places and looking sufficiently interested as I explained reciprocal altruism,
kin selection and coalitional affiliation in the ancient past. As the 3000-strong crowd cheered and applauded at the end I felt really quite pleased with how the evening had gone. Oh, and I think I managed to slip in a mention of my new book Evolutionary Psychology (with Will Reader). On the train journey home I happily reminisced with my partner Sandie on how well the evening had gone…
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Nebraska Alexander Payne (Director) Nebraska is a blackly humorous and unsentimental film about old age and family relationships. An old man stumbles along the side of a busy highway. Woody (Bruce Dern) is frail, and seems confused. He wants to walk hundreds of miles to Lincoln, Nebraska to collect $1 million winnings promised in a letter. Both disconcerted and inspired by his father’s uncharacteristic determination, his son David (Will Forte) decides to drive them there. David’s ulterior motive is a final attempt to get close to his taciturn, alcoholic father; and maybe incipient dementia is not the only explanation for Woody’s behaviour. Dern gives an uncompromising performance, more than
matched by June Squibb’s as his long-suffering and acerbic wife Kate. At times the monochrome cinematography is stark, but beautiful. It serves to remind us that where families are concerned, nothing is ever really black and white.
Sandie: As Lance’s partner for the last 20 years I have had to endure his obsession with evolutionary psychology and his constant stream of gags. So when he was offered the opportunity to appear in a West End comedy show where he was encouraged to do both – my heart sank. Knowing that I would be expected to go along to show support, I steeled myself for the ordeal. They had wanted an expert or a celebrity – but having failed to locate either – they made do with Lance instead. The Leicester Square Theatre was considerably smaller than I had expected and the audience was around 200. Before the show Richard explained to Lance that he wanted a good mix of psychology and humour and that Lance could do any gags that came to mind during their double act. Lance grinned and rubbed his hands in anticipation. I smiled weakly.
Following a very funny (and more than a little irreverent) stand-up by Richard, I was amazed by how much the audience put away at the bar in the interval. Then the moment arrived. The curtain was raised and Richard came out to introduce Lance to much applause. They both held microphones and engaged in conversation where Lance did his usual ‘evolutionary psychology explains everything’ spiel interspersed with gags and shameless repeated plugs of his book. The audience appeared to find his gags funny (they don’t have to live with him) and at the end of the evening they engaged in good-natured applause. Overall a successful evening, but of course Lance was unbearable on the long train journey home.
I Reviewed by Kate Johnstone who is a postgraduate student at University College London
I To download the podcast, see www.comedy.co.uk/podcasts/ richard_herring_meaning_of _life
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Standing committees?
Beautifully poignant
Are You Sitting Comfortably? BBC Radio 4
The Shock of the Fall Nathan Filer
Coinciding with a national government consultation into physical activity in the UK, this 30-minute radio documentary explored new research into the dangers of sedentary behaviour. Presenter Chris Bowlby interviewed various researchers and advocates of active lifestyles in both work and the home, setting himself the challenge of giving up sitting at his desk for Lent. A general overview into the range of epidemiological and experimental evidence supporting the effects of sedentary behaviour on cardiovascular health, diabetes and lifespan was presented. Via case studies, including Chris himself, the perceived pros and cons of a more active work lifestyle were explored. Psychological barriers such as social norms were frequently expressed; for example, not wanting to appear odd by using a standing desk in front of peers. Potential office costs were also stated as a barrier, however this needn’t be so. Integrating stair climbing and standing breaks into working lives are free ideas to boost activity. Experienced benefits were plentiful, such as improving and changing working relationships by holding walking meetings. These can change the typical balance of power experienced in chaired meetings
towards more equal, functional exchanges. Brief interviews included Professor Alexei Marmot at UCL, a leader at the university’s new Centre for Behaviour Change. Unfortunately, despite having a behaviour change expert on the show, no real discussion was channelled on how best to change sedentary lifestyles. Research into changing sedentary behaviour would undoubtedly require another episode in itself. However, an overarching message of this programme was that sitting is a conscious decision. Choose to sit less and integrate more activity into your lifestyle, and you will feel the benefits. Being more conscious about our sitting behaviour and knowledgeable about the risks that regular, prolonged sitting can have to our health are useful starting points. If attention is given to this issue by a large scale of individuals, changes in work and social perceptions will hopefully follow. So, are you sitting comfortably? Hopefully less so after this programme! I Reviewed by Emma Norris who is a postgraduate student at University College London and Associate Editor for ‘Reviews’
The Shock of the Fall follows 19-year-old Matthew, a schizophrenic, as he struggles to come to terms with the death of his big brother. The reader is given access into Matthew’s world through his ‘writing therapy’ as he goes back 10 years to the day his brother Simon died. Despite learning of Simon’s death early on in the book and finding that Matthew blames himself, the suspense is expertly built as to how this happened and whether Matthew had any involvement. Through Matthew’s eyes, the reader sees the impact of the aftermath (‘the shock of the fall’) on him and his family, beautifully capturing the ripple effect of grief throughout the family when a child is lost. In the present, Matthew is receiving care for his schizophrenia. His account of his experience in the psychiatric ward is laced with dark humour, which serves to further endear the reader to Matthew and provides a poignant image of institutionalisation: ‘I live a Cut & Paste kind of life’. Matthew mocks the psychiatric jargon used (‘Patient is engaged in writing behaviour’ ‘I draw pictures too. Is that drawing behaviour?’) and highlights his frustrations with the staff who can’t relate to him (‘Steve made that little clicking noise with his tongue, and winked at me, as if to show that he was on my side or something. Except you’re not on my side, are you Steve?’). Full of issues of interest to psychologists, this book tackles grief and loss; child care-givers; and mental health conditions, institutions and treatment. Nathan Filer, a registered mental health nurse, has skilfully drawn on his experiences to create believable and loveable characters. I must admit to being disappointed at how quickly I read this book; I would like to have spent more time with the characters. However, this easy-reading book does not lack substance, and will reach a large audience. The focus of the book is timely with current mental health awareness campaigns (e.g. www.time-tochange.org.uk), and offers a compassionate view of a mental illness that has historically been demonised. This is a beautifully poignant book, written with sympathy and sensitivity, well deserving of its Costa Book of the Year award. I HarperCollins; 2013; Pb £7.99 Reviewed by Caroline Flurey who is a postdoctoral research fellow at the University of the West of England
Programmed to buy The Brain Sell: When Science Meets Shopping David Lewis David Lewis, a Chartered Psychologist in neuroscience, has spent 30 years investigating the human brain and how it can be influenced, for both research and commercial purposes. He wrote this book to increase awareness for the consumer of the different strategies utilised in marketing and advertising that encourage us to buy. Lewis writes in a flowing, very readable style, providing research studies and interviews from commerce and academia. The book would suit students and researchers in marketing, advertising and psychology, and, equally, the general reader. Lewis describes methods used in neuroscience to monitor our behaviour and emotions and how these are applied in the commercial world, covering the ‘science’ behind selling, hidden persuaders that influence how we shop, atmospherics (e.g. lighting,
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music played in shops), and brand ‘priming’. He writes in a somewhat impartial manner until the chapter discussing the influence of television. Here Lewis describes TV as ‘an all-pervasive and powerful medium of persuasion’ leading us to believe that true happiness is gained only by ‘continual acquisition and consumption’. He discusses the ‘Big Data’ collected about us from information we provide online, in social media, mobile phones and even Kindle usage. This data can be used to develop marketing strategies targeting our subconscious brain to encourage us to buy more. However, Lewis also provides a brief outline of how we can protect ourselves against such data collection and the persuasive power of advertising. I read this book with mixed feelings, ranging from fascination to
vol 27 no 6
june 2014
reviews
Unanswered questions… The Island Channel 4 The Island centres on 13 men stranded on a remote Pacific island with only basic equipment, a day's supply of water, and each other. The premise of the show, orchestrated by leading survivalist Bear Grylls, is to uncover whether man has lost the evolutionary ability to survive in difficult situations due to the influx of technology in recent years. While the initial idea is not particularly different to its predecessors, such as Shipwrecked or America's Survivor, what sets The Island apart is the complete lack of any noticeable assistance from trained professionals; even the camera footage is pioneered by the castaways themselves. While this gives viewers a rare opportunity to gain a reasonably undistorted account of how relationships are formed and bonds are made in the most bizarre, and often dangerous, of situations, there were aspects of episode one that couldn't help but leave you wanting more. A majority of the air time in the first hour was spent showing the viewer the different struggles the men faced with the very basics of survival, such
as lighting a fire. Very little air time was given to how leadership roles were formed, and whether they were as a result of a democracy or an alpha male asserting his dominance. Footage such as this might have given the episode the depth it seemed to be lacking. Ultimately, the cast knew their time on the island wasn't going to spiral into a reconstruction of Lord of the
Flies, and at any time they could leave, so whether constructed reality shows like The Island will ever fully capture the extent to which these modern men retain a primal instinct to survive still remains unanswered, though it is definitely worth watching the remainder of the series to see how the cast develop. I Reviewed by Alice Hobbins who is at the University of Worcester
feeling almost nauseous and quietly smouldering. As the author presents it, in the commercial world we are automated allconsuming robots, not human beings. It may make you want to give up TV and social media, or instead just be more wary when shopping and online. With a wry smile I did note two things whilst reading. First, given the topic of the book, both websites provided for his work and further reading are incorrect; and second, the scrap of paper I absentmindedly used as a bookmark happened to be a ‘clubcard’ voucher from that ubiquitous supermarket. Ah, the allpervading power and presence of advertising. I Nicholas Brealey; 2013; Pb £14.99 Reviewed by Kate Sparks who is a self-employed Chartered Psychologist
read discuss contribute at www.thepsychologist.org.uk
…Would we survive? Dr Howard Fine, who acted as consultant psychologist on The Island, ‘reviews’ his own involvement. A full version of this piece is available online at www.thepsychologist.org.uk. Aside from making for a voyeuristic experience for the viewers, this programme offers a unique opportunity to showcase an almost laboratory environment to observe survival through adversity – with the exception that the castaways could choose to withdraw, and were somewhat safe in the knowledge that they will be ‘saved’ from this challenging environment after 28 days of captivity. As a clinical psychologist with an interest in post-traumatic stress disorder and resilience, I was tasked with offering psychological screening for the potential castaways prior to being deployed into such a hostile environment. This included screening interviews, mental health reviews and personality profiling to consider the robustness of the individuals and risk management. Further support involved monitoring of adaptation or failure to adapt to the hostile environment at the individual level, and identifying individual behaviours that support adaptation or that were counterproductive to support adaptation, as well as being on-call to offer direct support should this be required. On the return from the island, opportunities for debriefing and reverse cultural shock were also offered. Prior to being involved in this project, I was grateful to be able to consult with Professor John Leach, a SERE psychologist (survival, evasion, resistance & extraction), who shared his expertise and guidance on survival psychology [see also his article for The Psychologist, tinyurl.com/leachjan11]. The group who applied for the project were self-selecting and quite heterogeneous. This diversity could be seen as equating to a survival scenario (shipwreck or airline crash), with a broad spectrum of individuals, with their only commonality being the drive to get from A to B, to survive from day 1 to 28. Whilst not your typical reality television characters, the Islanders most generally were considered to be relatively robust and open to new challenges (a positive resilience trait), hence their motivation to apply in the first place. Observing this group of castaways over the series may offer a further view of the psychodynamic survival pattern of behaviour following a disaster incident, pre-impact, impact, recoil and adaption. We may further examine how personalities change in order to try and meet social expectation, goals, or social roles required to survive. Within the survival scenario, the Islanders may adapt to fit with the social norm, and may take on stronger traits in order to survive. Similarly, as the days pass, the group will be adapting to their situation and environment, and the group dynamic will evolve to help meet these needs, and work together to tackle any challenges and problem-solve. In order to achieve this, the group will be expected to progress through Tukeman’s (1965) stages of group development, Forming – Storming – Norming – Performing. Based on the size of the group, it may be able to function without requiring any formal organisation, hierarchy, or specific alpha male or group leader. The extreme environmental conditions and organic group may challenge such expectations of group development. We may therefore have an opportunity to identify the unfolding psychological phases of behavioural adaptation and survival, at an individual and group level. Should this social experiment be replicated or re-commissioned, it would be fascinating to take on an experimental design, profiling longitudinal changes consequent upon individual experiences. Reflecting on our own academic and professional knowledge and experience, would we be able to psychologically resource ourselves to adapt and remain resilient? Would we be able to influence the dynamic on the island to enable a group to perform? Ultimately, would we survive?
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The dizzy heights of psychology in the media Vertigo Roadtrip BBC One Dramatic, vibrant and fast-paced, Vertigo Roadtrip aired in May. It provided a whirlwind tour of height phobia, treatment with exposure therapy, and some of the world’s most stunning vertiginous locations. The programme profiled five of the UK’s most severe acrophobics – sufferers of an irrational and extreme fear of heights. Lee, Jodie, Louise, Glenn and Pauline are among the 3.5 million people in the UK suffering from this condition. Clinical psychologist Dr Jennifer Wild and presenter Mel Giedroyc take the initially sceptical group from meltdowns 12 metres up a staircase to enjoying the view from a terrace on the 152nd floor of the world’s tallest building. It is a convincing and astounding demonstration of the potential for therapy to be transformative. Rather than the baby steps we might typically associate with graded exposure therapy, this brave bunch took leaps, in Lee’s case literally: Dr Wild asks Lee to confront his worst fear, diving boards, head on. Initially horrified and upset, after reasoning and encouragement he faces the
board and creates a splash with great success. Louise’s compelling journey showed the link between early traumatic experiences and the development of phobias. We see her conquer her ‘nemesis’, bridges, after years of avoiding them after her brother terrorised her in the middle of the Clifton suspension bridge when she was just nine years old. Dr Wild calmly and persistently encourages the group to try ever-greater heights. She told me: ‘I was keen that the group learned that they were in no real danger whether they were on a staircase or travelling up a mountain in a cable car. I thought if they could conquer the Burj Khalifa, then this would give them the confidence to visit the top floor of any other building.’ This seems ambitious, but with every success the viewers’ doubt drops along with the phobics’ anxiety. Coping strategies like viewpoint, corrective information-seeking and distraction are touched upon. The more typically slow and gradual process of exposure therapy would admittedly not have
made such good viewing, but I would like to have seen more of the work that Dr Wild carried out with the group. Her proficiency in changing unhelpful thoughts seemed, at times, magical, and perhaps needed more explanation. For example, no explanation was given for her encouraging the group to do jumping jacks. I followed this up with her and she said: ‘To change the group’s beliefs about falling over when their legs felt wobbly, I had them jump up and down. The aim was to show that even when their legs felt their weakest, they were strong and steady enough to jump up and down.’ Vertigo Roadtrip is an engaging and valuable education for the general public about the nature of anxiety disorders such as specific phobias. It is sure to help to reduce stigma, inspire hope, and encourage people to seek evidence-based treatments, the best possible outcome of psychology in the media. I Reviewed by Petrina Cox, a Research Psychologist at the Oxford Centre for Anxiety Disorders and Trauma, University of Oxford
Postgraduate Psychology at UCLan At UCLan, you will receive an excellent BPS-accredited academic study based in a first-class research environment. You will be taught by and work with distinguished practitioners and leading researchers in the field. Among the 40 state-of-the-art laboratories, research facilities include the Health Psychology Suite, the Cognitive Psychology Complex, the Brain Imaging Lab, Sport Psychology Labs and the Child Observation Suite. Completing one of our accredited postgraduate Psychology programmes will provide you with stage 1 of the training to become a Chartered Psychologist.
Postgraduate advice session 25th June, 2pm-4pm 01772 892400 Book at http://psychologypg.eventbrite.co.uk
Innovative thinking for the real world
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vol 27 no 6
june 2014
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