The headlines were dramatic and for once they were justified. 'Scientists read the minds of the living dead' was The Independent's chosen angle; 'A voice for the voiceless' trumpeted New Scientist. The cause of the excitement was a brain-imaging study of 54 seriously brain-damaged patients, published in the New England Journal of Medicine (http://bit.ly/9aDxFS). At the time of scanning, the patients had awoken from coma, but showed either no outward signs of awareness (a persistent vegetative state: PVS) or inconsistent signs of awareness, with no ability to communicate (known as a 'minimally conscious state' - a term introduced only in 2002).

Martin Monti at the MRC Cognition and Brain Sciences Unit at the University of Cambridge, and colleagues, scanned the brains of these patients while instructing them to imagine either playing tennis or walking around their house or home town. Amazingly, five of the patients appeared to heed the task instructions - their brain activity varied across the two imagery conditions in exactly the same way as observed among a group of 16 healthy controls. Exhaustive bedside testing of two of these five patients had identified no outward signs of awareness whatsoever. And yet here they were, participating in a visual imagery task.

But the greatest excitement arose from further testing with one of these five patients, to see if the imagery task could be used as a communication tool. The man had been diagnosed as PVS, although at the time of scanning he showed some fragile, fleeting signs of awareness consistent with a diagnosis of a minimally conscious state. Monti's team asked the man six questions, such as 'Is your father's name Alexander?', with the instruction to imagine playing tennis to answer 'no' and to imagine navigating his house to answer 'yes', or vice versa.

Despite exhibiting the briefest flickers of awareness on the outside, and having no outward ability to communicate, the man manipulated his brain activity in such a way as to answer five of the six questions with 100 per cent accuracy. For the sixth question, no reliable brain activity pattern was detected. It's not known if the patient had fallen asleep, lost consciousness or chosen not to answer.

This isn't the first time that a PVS patient has been shown to respond to visual imagery instructions. A study published in 2006 in Science described a female PVS patient whose brain activity varied according to the tennis or navigation commands. Similarly, last year, neuropsychologist Caroline Schnakers at the University of Liege instructed a female PVS patient to pay special attention to the sound of her name, which led to an enhanced EEG signal compared with when the instruction wasn't given. However, this latest research represents the first time that brain imaging has been used to 'converse' with a patient judged unable to communicate by traditional means.

The implications of the new study are profound. Other patients judged to be unaware by traditional methods may also have inner awareness with the cognitive capacity to converse. 'In patients without a behavioural response, it is clear that functional MRI complements existing diagnostic tools by providing a method for detecting covert signs of residual cognitive function and awareness,' the researchers said.

The findings also pose disturbing, yet intriguing questions about what it feels like to be conscious within a frozen exterior. Did the researchers have the chance to ask the patient who conversed any questions about how he feels or what he wants? 'We didn't,' co-author Adrian Owen told us. 'At the time of the scan we only had ethical permission to ask him the same biographical questions that we asked the volunteers in the control study. Of course, this is something that we will pursue in future subject to the appropriate ethical frameworks being set up.'

'We are really only in the first stages of the research,' Owen added 'that is to say, we have only just shown that it is possible to do this - the next step is to ascertain whether we can do this with others, how many people it applies to and then, what should we do with them. Only further research will tell us what kind of "consciousness" these patients have.'

--Christian Jarrett

Researchers at Duke University have reported new details concerning the neurodevelopmental roots of schizophrenia. Terrie Moffitt and colleagues investigated 1073 participants born in 1972 or 1973 in Dunedin, New Zealand, all of whom undertook repeated cognitive tests between the ages of three and thirteen. By 2005, 2.5 per cent of the cohort had received a diagnosis of schizophrenia and 1 per cent were on antipsychotic medication.

Analysis of the participants' childhood test results revealed that those later diagnosed with schizophrenia had early, stable deficits in verbal and visual knowledge acquisition, reasoning and conceptualisation, together with slower growth than their peers in processing speed, attention, visual-spatial problem-solving ability and working memory. Crucially, these distinctive patterns of cognitive development were not observed in participants who would go on to receive a diagnosis of depression in adulthood.

The researchers hope that further insights into the developmental roots of schizophrenia will provide opportunities for early intervention. 'What we think of as adult psychiatric disorders have their roots much earlier in life,' said co-author Avashalom Caspi.

--Christian Jarrett

One of the co-founders of the Baby Einstein range of DVDs for infants is suing the University of Washington. William Clark wants access to data reported in two studies, both co-authored by Dimitri Christakis. The first, published in 2004 in Pediatrics, tested 1200 seven-year-old children, and found they were 10 per cent more likely to have attentional problems for every hour of television they watched daily between the ages of one and three.

The second paper, cross-sectional in design and published in 2007 in the Journal of Pediatrics, involved interviews with over a thousand parents. It reported that for 8- to 16-month-old infants, every hour per day spent watching baby DVDs and videos was associated, on average, with knowing six to eight fewer words, compared with infants who did not watch them. The latter paper specifically mentions Baby Einstein products.

Clark and his wife Julie Aigner-Clark sold Baby Einstein to Walt Disney in 2001 and have no ongoing commercial interest in the company. 'All we're asking for is the basis for what the university has represented to be groundbreaking research,' Clark said in a press statement. 'Given that other research studies have not shown the same outcomes, we would like the raw data and analytical methods from the Washington studies so we can audit their methodology, and perhaps duplicate the studies, to see if the outcomes are the same.'

In a separate statement Aigner-Clark said the motivation behind the litigation was her and her husband's legacy: 'The researchers who conducted the studies have apparently lost all of the records for one study, and refuse to share all of the raw data for their other study. I believe it's because their claims that my videos harm children are invalid. I want to clear my name. I'm proud of what I made.'

The developments follow a decision by Walt Disney last year to offer refunds to anyone who purchased a Baby Einstein DVD between 2004 and 2009. This was claimed as a victory by the Campaign for a Commercial Free Childhood (CCFC), led by psychologist Susan Linn (see December News).

--Christian Jarrett

Never mind a mountain to climb, there's a whole range to traverse before the courts of England and Wales will accept the use of fMRI-based lie detection evidence. That was the gist at least of a presentation made to the UK Parliamentary and Scientific Committee in January by David Omerod, Professor of Law at Queen Mary, University of London.

Such evidence would contravene the 'principle of orality', Omerod said, which is that jurors are supposed to base their judgement on what they hear the suspect say in court. Among other problems is that the questions in the lab wouldn't replicate those in the trial. 'Many questions can't be addressed with a simple Yes/No answer,' Omerod explained - imagine a question about stealing; a suspect might admit to taking something but claim that he believed he had consent. 'You'd effectively need to conduct the trial in the lab,' Omerod said.

But the final killer blow to fMRI evidence playing any part in an English or Welsh trial is that it's just not reliable enough. 'You'd need to show the evidence was necessary for the jury to hear for their understanding of the case,' Omerod said. However, technophiles need not lose all hope. The Offender Management Act 2007 apparently allows polygraph tests to be used as a condition for release, for example to see if treatment has worked. Omerod was speaking as part of a meeting on the probable social impacts of new brain research. Professor David Nutt, sacked from his position as a government adviser late last year, opened the session with a warning about the increasing use of synthetic compounds to circumvent drug regulations - laws which he said are not currently fit for purpose.

Professor Colin Blakemore followed with an overview of the neuroscience and psychology-related breakthroughs likely to pose ethical questions for society, including new ways of eavesdropping on the brain, technologies for controlling and extending brain function, and challenges to the concept of responsibility. 'I've tried to show that I'm not too impressed by the stage of many of these technologies,' Blakemore concluded, 'but the situation will improve, so we need to discuss these issues now.'

--Christian Jarrett

A new resource to be used in the teaching of qualitative methods has been made freely available online.

The resource, based around a set of five semi-structured interviews, was funded by the Higher Education Academy Psychology Network. In 2005 they established a working group to develop resources and disseminate ideas for teaching qualitative research methods at undergraduate level. Stephen Gibson, of York St John University, has chaired the group since 2008. He told us: 'Changes in the requirement for Society-accredited undergraduate degrees to cover qualitative approaches appears to have led to increased demand for teaching resources. We felt that one thing likely to be lacking was access to primary empirical data for use in qualitative methods teaching.'

Video, audio and transcripts of the hour-long interviews, conducted with undergraduate students on the topic of 'friendship', are available via tinyurl.com/yayb57e. They are intended to support a wide array of teaching activities, ranging from a basic introductory session on interviewing methods, to a full-blown practical course aimed at introducing specific approaches to qualitative research design and analysis (e.g. discourse analysis or grounded theory).

--Jon Sutton

Chairing the opening symposium of this conference, on the past, present and future of occupational psychology, Professor Fiona Patterson (City University) promised to find lots of things to be optimistic about. The speakers were not so sure, with Professor Rob Briner (Birkbeck) warning that there was nothing he liked more 'than to give a moany, depressing rant to start a January conference'. Occupational psychologists, he said, had 'lost our way a bit. We're in a bit of a mess, but can we fix it?'

Professor Don Ferrin (Singapore Management University) certainly thinks occupational psychology has the tools. 'Just think - we can measure something as intangible and ethereal as trust,' he enthused. Yet he bemoaned the fact that 90 per cent of occupational psychology's empirical evidence is laboratory based and cross-sectional, and we don't have the research on the effectiveness of interventions. Academics have to start collaborating with practitioners more, and ensuring that knowledge produced is applicable cross-culturally - otherwise, in a globalised world, it becomes increasingly irrelevant.

In the midst of a move back to the UK from Holland, Professor Neil Anderson flagged up some cultural differences between the two in terms of occupational psychology. There is a split between science and practice in the Dutch professional body, but Anderson's impression is that links are better and occupational psychology consequently has a stronger influence on government policy there. He also warned that the migration of UK occupational psychology departments to become part of business schools raised challenges for its independent status.

Briner followed, saying that occupational psychology is 'churning out boring, pedantic, badly written and irrelevant research - and that's me trying to put it nicely'. There is no attempt to pull together and evaluate what we know and do not know about a range of important issues, he said. 'We peddle fads rather than killing fads.' Briner called for more 'practice-based evidence', and said that 'we shouldn't allow ourselves to be defined by technical competence'.

More confident in the profession's ability to put things right in organisations was Professor Mike West (Aston Business School), who said we should be training occupational psychologists to be leaders in organisations. 'If not us, then who?'
He agreed with Briner that occupational psychologists shouldn't just be technicians, saying that the failure of the entire capitalist system internationally has been about values, and the profession should therefore be values-based.

Providing graphic illustrations of that the following day, Professor Don Ferrin returned to talk about the rise and fall of trust: 'A great leader has to have absolute integrity in everything he or she does... said Ken Lay, founder and CEO of Enron.' But according to Ferrin, 'Only 51 per cent of employees have trust and confidence in senior management, and there has been a huge drop in trust in recent years. Competence, concern and character are what is needed, and if a leader has these traits there will be a strong correlation with their employees' commitment and job satisfaction, but less so with performance.' However, Ferrin argued that trust problems are not automatically an indictment of character, and we should remove the taboo from talking about trust. Leaders need to be much more inquisitive about how they are perceived: if your employees are reluctant to accept vulnerability in your presence, you may have a trust problem.

Trust was also identified as crucial by Will Hutton (Executive Vice Chair, Work Foundation), who gave an enthralling account of just what a state we are in. He said that a 10 per cent increase in employees' trust in management has the same effect on general levels of satisfaction as a 36 per cent increase in monetary reward. There are clear opportunities for occupational psychology, he said, in increasing control and autonomy in the workplace, developing a skills agenda, improving employee engagement and organisational development, and helping employers and employees deal with a changing relationship. This would be based on 'flexicurity': ease of hire and fire must be matched by high benefits and investment in active labour market programmes to equip unemployed people with the skills they need to find work in a rapidly changing economy. The approach is well established in Denmark and has contributed to high levels of growth and employment over the last decade. Perhaps most of all, Hutton said, Britain needs a thriving 'knowledge economy', driven by an 'innovation system' that can create knowledge and disseminate it into business: a clear role for occupational psychology.

The economic downturn remained on the agenda the final day, with Kamma Braham of PDI Ninth House, a 'global leadership solutions company', recalling how last year's conference was all about the expected 'doom and gloom' of the coming year. Her own organisation responded by leaving empty roles vacant, freezing freelancers, and inviting staff to take voluntary salary reductions, though thankfully Braham said there had been no occupational psychology redundancies in the UK.

Another consequence of the recession was a change in demand from clients, with more money spent on selection and assessment and less on talent programmes. 'I've actually been doing more assessment work than I've done for the last ten years,' Braham said, as clients wanted to make sure that the few empty posts they did have were filled successfully.

An occupational psychologist in the audience whose firm works with the public sector said they had noticed how organisations were increasingly taking work in-house. Another audience member had similarly noticed that clients wanted to be upskilled so they could take work in-house. 'It's good short-term work but could be damaging later on,' she said.

Looking forward, Braham said there was likely to be a 'résumé tsunami' as job openings begin to appear. There were already hopeful signs of more demand from clients, she said, but also an increased desire to see evidence for a financial return from occupational psychology services. On that note, Braham pointed to a recent study her firm had conducted on work they'd done with American Express. This showed that the blended training programme they devised and recommended (involving classroom and online study) led to increased sales among staff, equating to a 1599 per cent return on the cost of the course.

In his keynote address, also on the topic of the recession, Dr John Mahoney-Philips, Global Head of Human Capital at UBS AG, sounded a less optimistic note. He warned that uncertainty still exists and that discretionary spending ('that includes us') will reduce further. 'It's going to be a tough time, and yet also an opportunity to become more relevant to organisations.'

How can occupational psychologists capitalise on the new economic world order? Mahoney-Philips candidly discussed various weaknesses that the profession needs to fix if it is to adapt rather than die:

Occupational psychologists often don't know enough about their clients and their clients' strategy, so make sure you do your research.

Get more involved in performance definition and appraisal: 'it's vital and core to management and engagement with staff,' Mahoney-Philips said, 'yet we're not thinking about this enough.' In particular, he added, there should be greater use of 360-degree rating scales (feedback about an employee from everyone who works with them).

Our assessment tests haven't changed much in years, besides putting them on computer, Mahoney-Philips said. 'We need to assess people's competencies for dealing with future uncertainties, not their competencies that got them where they already are.'

New forms of virtual communication are posing challenging questions about trust - this is a whole research area that could be exploited.

Bridge the practitioner/academic divide. At UBS, Mahoney-Philips has deepened links with the University of East London master's programme and initiated a project with Kings College. Post-docs have come into the organisation to work on UBS data on staff engagement.

There's a lack of a good independent outlet that reports occupational psychology findings in a language that's understood by those who can use and implement it at speed. [But watch this space for news of an occupational Research Digest]

Training needs to become more vocational, perhaps requiring MSc and PhD candidates to have work experience. 'We need real-world simulations of practitioner assignments', Mahoney-Philips said.

Edited: 16/02/2010 at 02:47 PM by jonsut

Susan Paddock of QinetiQ described how her team applied a human factors approach to the design of a new data-processing control room for a security client. 3D visualisations, user interviews, mapping of desk to equipment and desk to window distances, consideration of shift-patterns all fed into the design. The client was so impressed with the end result they've asked for the same approach to be applied to the rest of the building.

A diary and interview study of 29 healthcare engineers by Kevin Daniels at Loughborough University found that effective problem solving was associated with a mix of high motivation, support from others and having the autonomy to change things when necessary. Poor problem solving tended to be associated with relying on past solutions, avoidance and low motivation.

From a survey of 188 UK clergy - an under-researched group in occupational psychology - Gail Kinman of the University of Bedfordshire found that greater job involvement, past training in counselling and social support all buffered against the emotional demands of the job.

A mismatch between one's felt emotion and the emotion that must be conveyed on the job - known as 'dissonance' - was a particular threat. Younger clergy appeared to be at greater risk, even though they reported greater overall job satisfaction.

Edited: 16/02/2010 at 02:48 PM by jonsut

Christine Kalus, Lead Consultant Clinical Psychologist in Specialist Palliative Care at The Rowans Hospice/Portsmouth City tPCT, reports from the 1st Inaugural Elson Ethics Lecture, St Georges Chapel, Windsor Castle, 20 November 2009.


To hear the lecture go to:
www.st-georges-windsor.org/st-georges-house/lectures/elson-ethics-lectures



I was asked to represent the BPS at this inaugural lecture because of my involvement with the Role of Psychologists in End of Life Care, and having acted as the Chair for the group that produced this document for the BPS. I was accompanied by my colleague, Dr Rebecca Coles-Gale. I must admit to being very pleased that Psychologists were included on the guest list, as this is recognition that we have a role to play in trying to make sense of this difficult and controversial issue.
It was an auspicious event, being the first of its kind, and having been endowed by a former American Ambassador to Denmark, Edward Elson. Ambassador Elson has a long association with St Georges House, a philanthropic organisation attached to the Chapel, which seeks to further understanding of important moral and ethical matters from both a Christian and non-Christian perspective.
The setting is beautiful, combining sumptuous artwork and religious iconography, numerous historical artifacts, and the tombs of previous monarchs and noblemen and women stemming back many hundreds of years, and this contributed to the sense that this was an auspicious occasion.
Lord Harries is a well known theologian, moral ethicist and broadcaster, having appeared for many years on Radio 4's Thought for the Day. This was apparent in his accomplished and wide ranging presentation of many of the arguments in relation to Assisted Dying.
The lecture consisted of a half hour talk by Lord Harries, followed by a further 30 minutes question and answer between broadcaster Martin Stanford and Lord Harries.
Lord Harries began by outlining the common misunderstanding and difficulty that pervades the understanding of the Christian perspective on the issue, which is not to "strive officiously to keep alive", but rather to be aware of the sanctity of (in this case human) life. This means the recognition that one always needs to be mindful of "extreme exceptions" to the rule of the sanctity of life (eg: when one has to take into account that the needs of the many could lead to the known and deliberate sacrifice of the few).
He also outlined the Doctrine of Double Effect, which is considered by many to be central to the practice of medicine (and relates to the "extreme exception" above), in which, for example, if a medical practitioner gives a patient a dose of opioids to manage pain, then an unintended consequence might be that their death is hastened, thus intention is paramount. However, this is to ignore the fact that in many cases doses of pain relieving opioids, if properly titrated, are well below the threshold that would constitute a lethal dose, thus making the Doctrine of Double Effect, (within Palliative Care at least), redundant.
Lord Harries is of the opinion that many doctors in palliative care are against Assisted Suicide, or other forms of assisted dying, and also that pain and symptom control have improved to the extent that many people do not die in pain or suffering from other profoundly distressing symptoms. However my understanding and experience is that while it is the case that pain and symptom control have improved significantly over the past 15 years, there is still a significant minority of patients for whom this is not the case, and who would choose to have help to die if they were given the option.
Lord Harries then went on to describe the four main themes he intended to address:
. The need for a change in the UK law on Assisted Dying, and making a direct comparison with the Oregon Model.
. The threat to the doctor/patient relationship if such a law is introduced.
. That the introduction of such a change in the law would lead to a reduction in the resources given to the care of the dying person, and also into a reduction into research into better methods of pain and symptom control.
. The dangers of the "slippery slope", in that vulnerable adults, including older persons, would feel a personal moral obligation to request assistance to die if they perceived themselves to be burdensome in any way, or that legislation could lead the way to abuse by the medical profession.
Unfortunately he failed to address two of these themes, namely the threat to the doctor/patient relationship, and the reduction in resources into research and direct patient care. Thus the main thrust of his argument rested on comparisons with the Oregon Model and the "Slippery Slope" argument.
To take these in turn, the Oregon Model for Assisted Suicide is the one on which Lord Joffee based his paper that the Select Committee debated for some months in 2004/5 when considering what model the UK would want to adopt should the law be changed in favour of Assisted Suicide. The State of Oregon has a clear legislative position and also robust research into the enactment of said legislation, which makes it a helpful comparator when considering the issues in changing legislation, and supporting such changes from a bio-medical, legal, social and moral perspective in this country. In the event the Bill was rejected, and a redrafting of the legislation is under consideration.
It is also important to note that other European countries have laws which support active euthanasia as well as assisted suicide, neither of which have been considered by the UK to date.
Lord Harries presented a partial view of the research that has come out of Oregon, which had a superficial appeal, but did not stand further analysis. He stated that the Oregon Hospice movement was initially opposed to the Bill, and in fact there was considerable ambivalence expressed by both the legislature and the medical/hospice movement in Oregon in the early 1990's towards a change in the law, but once the evidence started to demonstrate that the fears expressed by these bodies was unfounded the Hospice movement in particular became a strong advocate for Assisted Suicide. The research demonstrated that many of their practitioners (who had the right to withdraw their care on personal moral/religious grounds) found their relationships with patients and families improved as a result of the open conversations about how people want to die, and also that bereavement care was enhanced in a significant number of cases.
This evidence militates against both the "Slippery Slope" argument, and also the danger to the doctor/patient relationship, but was sadly not introduced into Lord Harries discussion. There is also evidence that Oregon has increased its resources into both service provision and research into pain and symptom control over the past 13 years, since the Act has been law, thus challenging one points that Lord Harries had proposed to address.
Lord Harries also talked about the Christian view that to be human is to be a social being, not something that Psychologists would necessarily disagree with, although many might not place a religious or specifically Christian bias on this assertion. He used this as a platform to argue that the mutual dependence that we have for one another can lead to confusion about the decisions that we make with regard to moral dilemmas that we are faced with in our lives (and in my experience often does so), and thus we find it hard to make "right" decisions. He gave the example of a teenager who asks for help to commit suicide, and he stated that it would be wrong on all levels to offer them such help. While arguing that we must dissuade the teenager from taking their life is a compelling argument on the surface, it fails to take context into account. For example, if the said teenager had a treatable depression or other mental health difficulty, then one would clearly be failing in one's duty to help them consider all options, including medication, to help reverse their desire to die. If, however, the teenager had a serious life-limiting disease or disability that limited their life to the extent that they had no quality of life either currently or for the foreseeable future, one would have a different conversation, and might make a different judgment. One could also argue that this should be the case regardless of age.
Similarly Lord Harries talked about the view expounded by Thomas Aquinas that while a society needs consequentially based rules, eg against stealing or murder, there will always be "extreme exceptions". Here Lord Harries gave an example of the truck driver who is in a burning cab. The cab driver knows he cannot get out on his own, so asks to be shot, rather than experience a horrendous death. In that case, Lord Harries argued, one is faced with an "extreme exception", and it would be alright to shoot (ie murder) the driver.
An alternative view, that was not considered is that one should also consider that if one is close enough to shoot the driver, (always assuming one has a gun), one may well be close enough to pull them to safety, and thus save their life.
With regard to the "slippery slope" Lord Harries cited the potential for exploitation of "old" and "vulnerable" people, conflating the two concepts, which has an emotional appeal, even if it is not borne out by the evidence as I understand it from Social Gerontology and Psychology, in that not all old people are ill, or inevitably "vulnerable", and not all younger people who are ill are invulnerable, and therefore able to cope with serious illness or disability. his argument certainly does not take into account the wisdom and cognitive ability that many older people possess, and thus the ability to make autonomous decisions on how to both live their lives to the best of their ability, and also the decisions they might make about how to end their life, which for physical rather than emotional reasons, they may need help with.
The case for Assisted Suicide, and for the autonomy of the individual, regardless of age, in a post-modern compassionate society is elegantly argued by Baroness Mary Warnock and Dr Elisabeth Macdonald in their 2009 book "Easeful Death", and Lord Harries' lecture would have benefited greatly from reference to this in offering a balance to his argument. It is also important to note that any change to the legislation about Assisted Dying in the UK will also be informed by the Mental Health Act (2007) and the Mental Capacity Act (2008), both of which give clear guidance on the assessment care and treatment of vulnerable people, including those with dementia and other degenerative diseases that affect cognitive performance. Interestingly, and in my view controversially, Baroness Warnock has some compelling arguments about older persons' desires for the end of their life, should they develop cognitive impairments. These relate to the concept of Altruistic Suicide which is enacted in certain other societies.
Many of the arguments that Lord Harries put forward within a Christian framework could equally well be understood from other perspectives. Humanists and Buddhists have long been concerned with the issues of what it means to be human, interdependence, suffering, compassion, and managing the end of life in a compassionate and dignified way.
Finally, Lord Harries also made it very clear that the dilemmas one faces at the end of ones life are ultimately deeply personal and often difficult to resolve, and to his great credit he stated that should he ever find himself facing such dilemmas at the end of his life, he was unsure as to how he would feel and behave in the face of such suffering. Having worked in the field of Specialist Palliative Care for the past 15 years I can only endorse his view.
Assisted Dying remains a dilemma, and I believe one that should not remain principally in the domain of the religious and medical professions or the legislature, but be opened out to the citizens of the country. One can conduct attitudinal surveys across the population, within professional groups and suchlike, but until there is an open public debate to enable citizens to thoroughly understand the issues relating to good care at the end of life, what "choice" really means in this context, and having the courage to allow individuals and families to make their own decisions (which Advanced Directives to Refuse Treatment go some way to addressing), we are not going to be able to make rational and considered decisions about Assisted Dying and other important issues at the end of our own lives.
In summary, this was an important and interesting lecture, and one that could have benefited from being in the form of a debate to a much wider public. However, I am sure that we will be hearing more about the issues raised over the coming months and years.



References
Mary Warnock and Elisabeth Macdonald.
"Easeful Death: Is There A Case For Assisted Dying?"
OUP 2009

Mental Health Act DoH 2007

Mental Capacity Act DoH 2008

Psychological theory underpins some of the core recommendations in a report published late last year by Her Majesty's Inspectorate of the Constabulary (HMIC), the organisation charged with monitoring police performance. With damaging allegations of aggressive policing at the G20 protests last year, and an eye on the 2012 Olympics and other future large-scale public events, the HMIC report Adapting to Protest - Nurturing the British Model of Policing was commissioned to provide a thorough scrutiny of public order policing in England, Wales and Northern Ireland.

Alongside recommendations concerning practical issues, such as training inconsistencies between regional police forces and the lack of a core doctrine on the use of force, the report also includes a prominent chapter on crowd psychology. Based on a report to the HMIC by Dr Clifford Stott at the University of Liverpool, the chapter explains how an outmoded view of the psychology of crowds as irrational and easily exploitable has led the police to rely on containment-based tactics such as those deployed at the G20 protests.

The HMIC report favours instead the 'Elaborated Social Identity Model' (ESIM), developed by the psychologists Professor Steve Reicher at the University of St Andrews, Dr John Drury at Sussex University and Dr Clifford Stott. The ESIM predicts that the inappropriate and indiscriminate use of force by the police, as was witnessed at G20, can actually create the psychology of a 'riot'. A unified sense of grievance is fostered among the crowd, leading normally peaceful individuals to form common bonds of identification with a violent minority in an effort to resist what they perceive as illegitimate police action.

Stott further explained to The Psychologist that years of social psychological research grounded in this model have highlighted the importance of dialogue between the police and protest groups, before, during and after public events. This approach can encourage the majority of crowd members to identify with the police rather than with the minority who are bent on violence. 'We have seen major successes with policing based on our theories, such as the 2004 European Football Championships in Portugal,' Stott said. 'Our research on these successes suggests that there needs to be a systematic commitment in the police to creating genuine and ongoing dialogue, even with radicalised groups who are hard to reach.'

Stott and his colleagues have been working on the theoretical underpinnings to their recommendations since the 1980s. It has taken years of painstaking work, often with collaborating police forces, for them to obtain credibility in the eyes of organisations such as the HMIC. 'It's that ongoing process of a relationship between science and practice that's given us the opportunity we needed to develop scientific evidence. And it is that evidence that's forced the agenda through which the HMIC were prepared to acknowledge the validity of the theory,' Stott told us.

'This is a case study of what social psychology should be doing in terms of achieving scientific "impact",' Stott added. 'Engaging with practical issues in a meaningful way should be a defining characteristic of our discipline. But I don't believe that it is. We've only achieved this major success for social psychology by coming outside of the laboratory. We've dealt with the difficulties of producing theory and data from crowd events that's valuable both to practitioners and to a sceptical scientific audience that tends to under-value qualitative research and see crowd psychology as some kind of parochial exercise.'

--Christian Jarrett

Would you like to experience how science is reported by spending 3-8 weeks with a national press, broadcast or internet journalist on a summer placement, working with them to produce accurate, well informed news pieces about developments in science? Then the British Science Association Media Fellowships could be for you.

Applications are encouraged from UK-resident scientists, social scientists or clinicians, with a minimum of two years' postgraduate experience. click for details and apply by 2 March 2010.

You can also nominate psychologists for the British Science Association Award Lectures. The organisers are looking for people in the early stages of their career who show outstanding skills in communication to a non-specialist audience. See http://bit.ly/4Frxe6 for more details.

Last year ended with a rush of reports that, taken together, provide impressive evidence for the growing recognition among British policy makers and advisers of the importance of psychological health and needs.

Early in December the UK government launched its much-anticipated New Horizons programme, which aims to improve the well-being of the nation and the care provided to people with mental health problems. The Department of Work and Pensions (DWP) also published an independent review, Realising Ambitions, about employment support for people with mental health issues. And finally, the Young Foundation, a UK think-tank, published its report Sinking and Swimming, Understanding Britain's Unmet Needs about the psychological needs of the nation and the importance of helping the minority of people who struggle to bounce back from adversity. British Psychological Society members led or advised on both the DWP and Young Foundation reports.

New Horizons is described by government as their 'new over-arching vision for mental health in England'. Flagship policy announcements included a new network of mental health coordinators in every Jobcentre Plus, the launch of occupational health advice lines, the national roll-out of the Improving Access to Psychological Therapies programme, as well as new plans to tackle mental health stigma.

New Horizons also draws heavily on recommendations made in the DWP Realising Ambitions report led by BPS Associate Fellow and Chartered Psychologist Dr Rachel Perkins. She told us: 'We looked at ways we can better support people who are out of work, and who have mental health conditions, to get and keep employment.'

Recommendations in the report include ways that existing systems can work better and ways to implement evidence-based practice to extend support to those who need help. 'The report makes it clear that health services must see employment and educational issues as a core part of their work and the outcomes of their work - it's not sufficient to focus on reducing symptomatology,' Perkins said. 'We must help people rebuild their lives and a core part of that is employment, pursuing your career.'

Dr Perkins is Director of Trust Assurance for South West London and St George's Mental Health NHS Trust and has spent many years setting up programmes that help people into employment, and showing that these can be effective. 'Very often outcomes speak louder than statements,' Perkins told us.

'I think it's vital that mental health professionals get involved at a broader level than just looking at health services,' Perkins added. 'I think that mental health has to be across departments - it's all our business. And I found the DWP very interested and often a lot more constructive and positive than some other departments, as reflected in their responses to some of my recommendations.'

The Sinking and Swimming report from the Young Foundation describes our society as 'brittle' and includes case studies from South Wales, London, Teesside and Bedford. The report asks 'why some people can cope with shocks and setbacks and others can't' and discusses the implications this has for public policy. It recommends a focus on helping people make transitions, whether from adolescence to adulthood, or from reliance on care to independence. Professor Nicholas Emler at the University of Surrey, a Fellow of the British Psychological Society, was a key adviser to this report.

--Christian Jarrett

Over 400,000 enthusiasts tuned into a webcast last December, not for the latest film trailer or YouTube hit, but rather to watch scientists at the University of California, San Diego slice up the brain of Henry Molaison - the most famous case study in the history of contemporary psychology.

Molaison, known as HM in the literature, died last year having spent the majority of his life as a severe amnesic. For 53 hours, on 2 - 4 December, Jacopo Annese and his colleagues worked diligently, slicing Molaison's brain into 2401 paper-thin sections. The team first froze the brain to - 40o Celsius, before performing the slicing from front to back, in coronal section, perpendicular to the ground. The tissue slices will be preserved in slides and uploaded to create a whole-brain digital map that Annese has likened to a Google Earth of the brain. Staining was due to begin last month, a technique that will allow observers to see the cellular architecture of the brain.

--Christian Jarrett

TheBrain Observatoryis keep a blog of the project.

The world lost one of its most unusual and remarkable minds last December with the passing of Kim Peek, aged 58. Nicknamed 'Kim-puter' by his friends, Peek was the inspiration for the autistic savant character in the multi-Oscar-winning film Rain Man. Peek himself was actually a non-autistic savant, born with brain abnormalities including a malformed cerebellum and an absent corpus callosum (the massive bundle of tissue that usually connects the two hemispheres). His savant skills were astonishing and included an encyclopaedic knowledge of history, literature, classical music, US zip codes and travel routes. It was estimated that he read more than 12,000 books in his life time, all of them committed to flawless memory.

In a 2005 article for Scientific American, the psychiatrist Darold Treffert and neuroscientist Daniel Christensen - both of whom had met and tested Peek - speculated that his extraordinary abilities could stem from neural backchannels that substituted for his missing callosum. 'Perhaps the resulting structures allow the two hemispheres to function, in certain respects, as one giant hemisphere,' they wrote.

Although outgoing and sociable, Peek struggled with abstract or conceptual thinking. He also had coordination problems. He walked with a sidelong gait and struggled to button his own clothes and brush his teeth. However, his coordination appeared to be improving with age, even to the extent that he had learned to play the piano several years prior to his death. 'Savantism offers a unique window into the mind,' Treffert and Christensen wrote in 2005. 'If we cannot explain it, we cannot claim full understanding of how the brain functions.'

--Christian Jarrett

New York Times Obituary

The 23rd best job to have in the USA is to work as a clinical psychologist. That's according to a CNN Money analysis, based on pay and growth prospects, that's ranked psychology one place above psychiatry. Clinical psychology was also listed as the sixth most beneficial profession to society based on professionals' views of their own jobs (GPs were number one). A separate listing by the Wall Street Journal, based on environment, income, prospects, physical demands and stress, placed psychologist as USA's 69th best job out of 200, with psychiatry at 98.

The Royal Society reaches the grand age of 350 this year and is celebrating with a range of public events and special publications. Already available are the Trailblazing website which provides free access to 60 ground-breaking articles from the Royal Society journal archive, arranged along an interactive timeline. Among the featured articles are a 1952 paper by Alan Hodgkin and Andrew Huxley on the nervous impulse and a paper from 1980 by David Marr and Ellen Hildreth on edge detection in the visual brain. The Royal Society has also published open-access special review issues of its journals: Philosophical Transactions of the Royal Society A and B. The latter includes a review paper by Uta and Chris Frith, 'The social brain: Allowing humans to boldly go where no other species has been'

With torrents of rain and melted snow endlessly sluicing down the streets this winter it's easy to be dismissive of the need to conserve water. However, for its population size, the UK actually has less water than most other countries in Europe. Parts of the South East have even less of the wet stuff available per person than Syria and Sudan. With our population rising, the sustainable approach is to reduce our waste of water rather than to keep building more reservoirs. Moreover, water use contributes to the carbon emissions that are fuelling global warming. It's against this backdrop that last December the British Psychological Society co-sponsored an event targeted at water companies to help inform them about some of the psychological strategies being used in other environmental campaigns.

The scene was set by Kirsten Reeves, Head of the Sustainable Behaviours Unit at Defra (the Department for Food and Rural Affairs). She said that about two-thirds of people claim to be trying to control their water use, but that around 18 per cent say they don't want to, probably won't or haven't even thought about it. Changing people's water use is further hampered by beliefs such as that water is never lost but simply goes round in a circle (although true, it doesn't then necessarily fall where it's needed and energy is subsequently required for processing, pumping and heating), and by the fact that many water behaviours, such as showering, are conducted privately. This lack of visibility can make it difficult to establish sustainable social norms like those that are emerging for recycling.

An overview of the social norms literature was provided by psychologist John McAlaney of the University of Bradford and independent social researcher Kathryn Rathouse, who co-organised the day with the NGO Waterwise. They described how powerfully our own actions are influenced by how we think other people behave. Pioneers in the field include US psychologist Robert Cialdini who's demonstrated, for example, that people are far more likely to re-use their hotel room towels if a sign tells them that the previous occupant did so than if the card had the usual wording about protecting the planet.

Our tendency to be influenced by other people's behaviour wouldn't be so bad for the environment if we were accurate judges of what the norms are. Unfortunately, most of us over-estimate other people's profligacy, an error that then allows us to self-justify our own wasteful habits. In relation to water use, for example, a UK survey showed that 90 per cent of people believed that they use an average or less than average amount of water. Efforts to redress these misconceptions have already begun. A 2009 Waterwise poster campaign in association with the National Union of Students, for example, featured athlete Kriss Akabusi and the tagline '53% of 18 - 24 year olds take 10 minutes or less in the shower'.

Shower use is an important behaviour for campaigns to target. There's a widespread belief that showering is more economical than taking a bath and yet one need only shower for more than 10 minutes (less in a power shower) to use more water than a typical bath. What's more, shower use is one of the faster-growing water use behaviours, perhaps because of their convenience and the proliferation of luxury walk-in showers. As well as campaigning for shorter shower times and other frugal behaviours, Waterwise also encourages the take-up of water-conserving technologies, such as aerated shower heads and garden water butts.

The afternoon heard talks on the formation of habitual behaviours, and how best to alter them, from psychologist Bas Verplanken at the University of Bath and independent social marketing consultant Paul White. Habits, including many water-use behaviours, are mindless behaviours rendered largely impervious to changes in attitudes and intentions, Verplanken and White explained. Campaigners therefore need to target those instances when habits are most susceptible to being broken, such as when people's circumstances change. Leaflets for home movers would be an example of such an approach.

Lastly, Dr Sarah Darby of the University of Oxford described research from the field of energy use showing how people's consumption can be reduced by providing them with better, more informative feedback. 'Smart meter' domestic energy use displays and more informative bills have been shown to reduce long-term consumption by up to 10 per cent. Malta is apparently the first country in the world with plans to roll out combined electricity and water smart metering for every home. Here in the UK the idea is just beginning to filter through to the water industry - the French-owned firm Veolia Water UK provides bills that tell customers how much water they've used and how this compares to the usage of an efficient household of their size.

--Christian Jarrett

The event was funded by the Society's Public Engagement Grants Scheme:?see www.bps.org.uk/pegrant

Conference on Mental Health: Khmer Rouge Survivors and their Descendants.

With the first of the Khmer Rouge (KR) trials drawing to a close, it was timely for the first Cambodian mental health conference in Phnom Penh to focus on the psychological fallout from the regime.

The Transcultural Psychosocial Organisation (TPO), a community mental health service in Cambodia, organised the conference on December 3rd, attracting national and international speakers. With a lack of mental health workers and a poor understanding among many of the impact and treatment of psychological problems, this is a hot topic in Cambodia.

The years of the KR regime (1975-1979) saw one quarter of the population lose their lives. Thousands were displaced, with the cities left deserted. Findings suggest as many as one third of survivors witnessed the murder of a relative or close friend. It is widely believed that the outcome of the trials will have a significant effect upon the country's healing process.

Sotheara Chhim, executive director of TPO, introduced the intergenerational progression of unhealed trauma with a presentation on the cycle of violence and victimhood.

Nadine Stammel, from the Berlin Treatment Center for Victims of Torture, presented a recent study on mental health and readiness to reconcile in the context of the trials. Most respondents were not ready to reconcile with former KR members but had high expectations of the trials in contributing to reconciliation. Levels of post-traumatic stress (PTS), depression and anxiety were high, particularly among those who had applied to participate in the trials. Many said they did not participate as they still fear repercussions.

Loss and grief following the regime was discussed by Nigel Field, professor of clinical psychology at Palo Alto University. He reported higher levels of PTS and grief for interviewees experiencing that the deceased s physically present or dreams where the deceased communicated with them.

As the Cambodian belief in a mutual influence between the living and the dead is widespread it is difficult to fully explain these experiences as unresolved loss. The nature, rather than the presence, of the continuing bond should be of interest to mental health workers.

An intervention facilitating disclosure among regime survivors was evaluated by Michelle Balthazard, in-country co-ordinator for Cambodia, California University's Human Rights Center. Post-intervention, sense of community and disclosure rates show a significant linear increase over time. Social restraint about discussing the past was reduced. There was no change in the desire for revenge against perpetrators. Participants reported comfort from commemorative sites and memorials. An ongoing need for a safe environment to address the past and a possibility to go beyond information was highlighted.

As 70% of present-day Cambodians were born after the regime to parents who were likely to have experienced extreme trauma, Sochanvimean Vannavuth of the Royal University of Phnom Penh, examined second generation effects of trauma. Role-reversing and overprotectiveness was common. Parental PTS was associated with higher anxiety and depression in children. However, Cambodian society expects children to take care of their parents, complicating interpretation of role-reversal findings.

After 20 years of research in the Cambodian community, Maurice Eisenbruch, professor of psychology at Monash University, asked listeners to question the western concepts of trauma, war, justice, guilt and responsibility. He discussed how these concepts exist and are made sense of in Asian communities through religious and healing systems which may be unfamiliar to western researchers.

A 2008 survey examining how Cambodians have moved on from the regime was summarised by Phuong Pham, assistant professor at Tulane University and Research Director at California University Human Rights Center. Seventy one per cent wanted to see those responsible suffer, while thirty nine percent said they had forgiven them: a contradiction highlighting language interpretation discrepancies. Many who have forgiven still feel hate. The importance of the trial outcomes was reinforced as many said those responsible would need to be punished before they could forgive.

The day closed with the conclusion that, alongside increased support services, it is necessary to empower Cambodians to conduct the necessary research to expand these findings. Contradictions and confusion around unfamiliar cultural and religious beliefs, as well as language and translation barriers, face the western researcher. This could lead to the creation of a narrative shaped by western beliefs which barely reflects the true experience of the Cambodian people.


Angela Simcox


Edited: 01/04/2010 at 12:08 PM by jonsut

Mental well-being in the workplace is the focus of the latest psychology-related guidance to be published by the National Institute for Health and Clinical Excellence (NICE). Over 13,000,000 working days are lost annually because of work-related mental health issues, the guidance says, costing the UK economy over £28 billion. The recommendations given in the guidance, which was published in November, include: flexible working hours where possible; improved line management through supportive leadership styles providing feedback and motivation; routine monitoring of employee well-being; and a workplace culture that reduces the potential for mental health-related stigma. A number of psychologists helped produce the new guidance, including Professors Susan Michie, Cary Cooper, Ivan Robertson and Dr Peter Kelly.

Michie, who is at the BPS Centre for Outcomes Research and Effectiveness at University College London and member of the Public Health Interventions Advisory Committee at NICE, said: 'Workplace mental well-being is important both for staff and the organisation's productivity. Some of the key features relevant to all employers include the need to provide employees with the necessary levels of support, praise, control over their work and constructive feedback. The guidance also highlights the need for good communication between employees and their managers and the need
to treat people as valued individuals.'

As well as providing recommendations for workplace practices, the new guidance also identifies a number of gaps in the existing evidence base. These include: a dearth of quality UK-based research on organisation-wide approaches that aim to improve employee well-being; a lack of validated measurements for recording employee well-being; and a lack of research on the potential costs and benefits of introducing organisation-wide measures for promoting employee well-being.

Publication of the new guidance coincided with the launch of a new website, aimed at stressed workers, produced by the national anti-stigma programme Time to Change, and with an announcement by NHS employers of its Open Your Mind campaign, which aims to improve the working environment forNHS staff.

--Christian Jarrett

I The NICE guidance is at ">http://guidance.nice.

org.uk/PH22

When Briton Brian Thomas killed his wife by strangulation on holiday in 2008, he was asleep and not in control of his actions. In the official jargon, he had experienced a sleep-related automatism. That was the verdict of expert witnesses for the prosecution and defence in a trial that concluded in November. Consequently, the judge told Thomas that he bore no culpability for his wife's death.

Chartered Psychologist Dr Chris Idzikowski of the Edinburgh Sleep Centre acted as an expert witness for the defence and was responsible for conducting tests to find out whether Thomas had a sleepwalking disorder. He told The Psychologist that sleep disorder centres are getting better at identifying individuals who are likely to have sleepwalked but that difficulties can arise with infrequent sleepwalkers or dubious claims of sleepwalking.

Idzikowski explained that cases are examined on two levels - '(a) examining the detail of the alleged offence and whether it is compatible with other cases and (b) an examination of the individual to assess whether they are suffering from a sleepwalking disorder, or disorders associated with sleepwalking, and whether they have the 'triggers' for sleepwalking'. He also told us that apart from straightforward recordings, 'procedures also now can include recording after sleep deprivation or acoustic provocation after sleep deprivation'.

This focus on noise triggers and sleep deprivation comes after a after study published in 2008 showed that sleepwalkers are particularly prone to somnambulistic episodes when disturbed after a period of sleep deprivation. Mathieu Pilon and colleagues at the Centre d'Étude du Sommeil in Montreal tested 10 sleepwalkers and 10 controls and found that all the walkers, but none of the controls, sleepwalked when disturbed by a buzzer after 25 hours of prior sleep deprivation (Neurology).

However, Idzikowski added that research in this area is largely going through a consolidation and review stage rather than there being any recent breakthroughs in understanding. Indeed, the overall incidence of sleepwalking is still unknown.
'If night-staff at hotels are a guide,' he said, 'it's possible that anyone who is tired, partially sleep-deprived and has had some alcohol, may be triggered into a sleepwalking episode (like going to the loo but walking out of the hotel room) - if these individuals are involved in an incident, we may not find any sleepwalking disorder.'

--Christian Jarrett

Psychological therapy is at least 32 times more cost-effective at increasing happiness than money (in press; Health Economics, Policy and Law). That's the striking conclusion of Christopher Boyce at the University of Warwick and Alex Wood at the University of Manchester, after they compared longitudinal data on the effects of psychological therapy and various life events, including bereavement and lottery wins, on subjective well-being.

Citing data published in the BMJ, the pair argue that cognitive behavioural therapy and non-directive counselling alleviate psychological distress by one and a half standard deviations, at a cost of £800 over four months. The psychologists go on to say that to achieve this effect with money would require 'somewhere in the region of £179,000 to £292,000 of extra income every year' based on longitudinal data gathered from the British Household Survey, published recently by economists. Boyce and Wood further argue that this has relevance for the compensation awarded in tort law, whereby claimants are given money to compensate for the effects of traumas such as bereavements and injuries . 'Currently monetary compensation seems to be unquestionably taken in law courts as the only way of helping an individual overcome psychological distress after a traumatic event,' they write. 'The values currently offered as compensation are arbitrary ... and, according to economists' subjective well-being equations, should actually be much higher ... Rather than giving individuals more income to cope with distress it seems sensible to consider other alternatives such as psychological therapy.'


--Christian Jarrett