Letters: the dyslexia debate

the dyslexia debate; the fall and rise of the NHS; alternatives to psychology; active procrastination; self-publishing; journalism and trauma; and more

The dyslexia debate – words of caution

I am sure as a specialist tutor for students with a label of dyslexia or specific learning difficulties in higher education it is not surprising that I would take umbrage at Professor Elliott and Professor Grigorenko’s vigorous promotion of their book The Dyslexia Debate and related conference ‘The end of dyslexia in HE?’. I am clearly not impartial. However, I would like to say a little about why these ideas and their promotion make me so uncomfortable, and offer those interested a couple of things to hold in mind when they come to read Elliott and Grigorenko’s book.

Elliott considers mainstream understanding of dyslexia to be based upon a number of myths: dyslexia is a ‘special’ difficulty experienced only by a proportion of poor readers; ‘special tests’ are needed to identify these people; dyslexia ‘will remove false attributions of laziness or stupidity’; ‘diagnosis’ will positively shape appropriate intervention; and ‘special accommodations’ are rightly given to those with the label (see Elliott & Grigorenko’s research briefing: tinyurl.com/pjaygwl).

It would be inappropriate to answer this claim fully before having a chance to read the book (soon to be released as I write), and I am sure others will be lining up to do so in due course; but I would like to pick out elements of the authors’ position and offer my reflections upon these as a practitioner in HE.

Firstly, Elliott and Grigorenko make a couple of valid points that are hard to dispute. Their characterisation of dyslexia diagnosis as inconsistent, unclear and over-professionalised is justified. As a specialist teacher who has to battle with an array of diagnostic reports, some of which are poor quality and base diagnosis upon a very narrow range of tests, I wholeheartedly agree there is a need for regularisation and debate about what makes a sound assessment (interestingly, though, assessments undertaken by specialist teacher assessors appear to have greater consistency now they are rigorously monitored by the Professional Association of Teachers of Students with SpLDs).

Secondly, their position on the use of discrepancy with ‘intelligence’ as a means of diagnosis is spot on. The idea of a single, measurable intelligence is one few in my field would go along with.

However, from my perspective as a teacher within higher education I disagree with the idea that those with a label of dyslexia should not be identified as distinct from others with reading difficulties. The dyslexic students we teach are as good at grasping concepts, solving problems, thinking critically and generating ideas as their non-dyslexic peers; they are not as good as their peers in demonstrating these abilities through assessment methods which demand they process information quickly, memorise and regurgitate information, or read and write under timed conditions. This is because they have specific difficulties with reading and writing, and very often with working memory and processing speed in these narrow academic contexts. With specialist help, these students can build strategies that help them perform better on such tasks, and allow them to more accurately represent their conceptual understanding. It is the specific nature of their difficulties at this level of education that justifies access to specialist help.

For students who do not have a specific difficulty in performing on the described tasks, but instead have a more generalised intellectual difficulty that includes difficulty in reading, working upon the same strategies would arguably make little difference to the level of their participation in the higher education context. Whether they instead should be entitled to all-round help with intellectual understanding is a different argument (though still an important one).

Elliott and Grigorenko’s work is important, and I do not doubt that their arguments will be rigorously supported, nor do I consider that the authors’ will deny the difficulties some people experience with literacy at any level; but I am concerned that the broad interpretation of their work will be an understanding that dyslexic people are taking something they don’t deserve.

The ‘selling’ of Elliott’s ideas in order to increase book sales and cement a kind of fame lends itself to oversimplification and misunderstanding of the message, which, in such reduced form is easy fodder for those in influential positions to argue for the removal of supports for students who rely upon assistance to participate on a more even playing field to their peers.

Removal of support is not the answer. A well-balanced conversation between dyslexic people, educators and scientists is surely necessary before sweeping conclusions are drawn and radical reform is imposed. With this in mind, I would ask that readers of The Dyslexia Debate and attendees at the conference ‘The end of dyslexia in HE?’ also engage with some of the alternative perspectives on this topic, question the extent to which Elliott and Grigorenko have sought to explore the experiences of educators and students within the higher education system, and consider the tensions between the desire to sell books and their desire to make positive change.
Harriet Cameron
University of Sheffield

Editor’s note: An article by Elliott and Grigorenko will appear in The Psychologist later this year.

A Royal College of Psychologists? 

Editor's note: The following appeared in the April issue, and is reproduced here with the official Society response below it.

The British Psychological Society has been at the centre of our profession for more than a hundred years, providing a focus for our work and an invaluable channel for communicating with each other. But at a time of regulatory upheaval within our profession we believe the BPS risks losing influence and becoming marginalised, which is why we are asking you to support our plan to reform the Society so it can meet the challenges of the 21st century. To achieve our aim, we want to establish a Royal College of Psychologists.This is not a radical step: the BPS is already ‘Royal’. The Queen granted a Royal Charter to the BPS in 1965, but in the intervening years we doubt whether it has taken full advantage of the opportunities presented by the award. Our belief is that the profile of our entire profession will be enhanced in the eyes of the public, government and business by establishing and using the title of Royal College of Psychologists. It will also bring the BPS into line with many other organisations that already proclaim their equivalent status, such as the Royal College of Physicians, the Royal Institute of British Architects, and the Royal College of Psychiatrists.We feel this enhanced title will galvanise the organisation, arrest the slump in recruitment, provide a strong reason for existing members to remain in the organisation and attract new members. The latest data from the BPS shows that after more than 70 years of growth, the total number of members has been stagnating at around 49,000 since 2011. Furthermore the number of student members has been falling. Without a steady stream of new recruits, overall membership levels could soon
slip into decline, which could be difficult to correct and would bring about financial strain.
To understand better the mood, we sampled opinions of colleagues and have found a marked degree of dissatisfaction regarding the BPS. In an online survey of 456 psychologists (including 374 BPS members) we found that most believe the BPS neither provided value for money nor met their professional needs. Some respondents questioned the continuing relevance of the BPS, after the statutory regulation of psychologists was entrusted to the Health and Care Professions Council in 2009: ‘My practising licence is issued by the HCPC, and I allowed my membership of the BPS to lapse three years ago’, said one respondent. Another wrote: ‘I maintain my membership of the BPS because it’s what I’ve always done, and I don’t know if I have to, to maintain my HCPC registration…in the last few years, the BPS has been positively destructive to the profession of psychology’.
Other respondents told us they felt the BPS was lacking effectiveness as an advocate for the profession. ‘It’s poor at making a stand, representing the profession, and making any sort of decision’, said one psychologist. While another commented: ‘I don’t believe the BPS can meet the professional representation needs of psychologists with its current configuration.’
By contrast, our respondents were overwhelmingly enthusiastic about the formation of a Royal College of Psychologists, 90.4 per cent supporting the idea. Among the main reasons given in support were that a College would act ‘as a unified voice’ to safeguard the professional integrity of all psychologists, as well being an active advocate for how psychologists and their work are perceived. It would also act as ‘the definitive authority’ in the eyes of the public, both
at home and abroad.
The great majority of respondents (84 per cent) also believed a Royal College would play a valuable role in protecting the needs of psychologists. So we in the Campaign also wish to protect the title ‘psychologist’. We want to establish the right of all psychologists to be equitably registered, and to lobby the government towards these goals.
How do we hope to achieve Royal College status?
The principal aim of our campaign has been to gain enough support to petition the BPS to work towards the status of a Royal College, by mandating a decision to create a College of Psychologists. Once that has been achieved we would seek to secure Royal patronage. Our Campaign has already recruited 1000 psychologist supporters (a number which equals over 2 per cent of the BPS membership) and a number of highly eminent psychologists have become patrons. So we have already achieved well over the number needed to require the BPS to act, although we would still like many more members to back our campaign (please visit our website).
There is also a historical precedent for what we are proposing. At its inception in 1901, our organisation was called the Psychological Society, but within five years, the founders felt compelled to change the name to the British Psychological Society as a protective measure in response to a rival group of non-academics who had set up their own version of the Psychological Society. By the same token, we wish to establish a Royal College of Psychologists to protect and enhance the professional standing of the membership, be they academics, practitioners or teachers. We believe this move is in accord with both the intentions and actions of the Society’s founders.
Dr Maxwell J. Benjamin, Professor Robert Bor, Dr Joel Dawson, Madeleine Devon, Dr Clare Eldred, Peter Farnbank, Professor Emeritus Peter Farrell, Dr Alex Linley, Professor A. Malik, Dr Denise McCartan, Dr Mathew McCauley, Karen Moore, Garret O’Moore, Annabel Poate-Joyner, Dr Seema Qurashi, Dr A. Michael Rennie, Professor Peter Saville, Martin Shankleman, Clive Sims, Dita Stanis-Traken, Dr James Thompson, Dr Mark J. Turner, Professor Barbara A. Wilson, Hatice Yildiran

Peter Banister, BPS Vice President, responds: 'There may well be a need for a debate about a Royal imprimatur in the title of the Society. If this is the intention of the signatories to the letter entitled ‘Call for formation of a Royal College of Psychologists’ (April 2014) it is unclear. The www.rcpsychol.com website, however, says that the intention is to provide a new home only for statutory registered psychologists, which of course will exclude many members, including our very important students.
Examining the proposal in more detail, it is unclear as how becoming a Royal College would actually address any of the issues raised, nor how it would automatically make for greater influence. The Society vigorously pressed for the protection of the title ‘psychologist’ in the run up to statutory regulation, to no avail; this debate unfortunately seems to be lost. There is no evidence presented that the inclusion of ‘Royal’ will produce any different reaction from the government and others when dealing with psychology, or whether it will have any effect on our status in the eyes of the public.
Furthermore, there is the question of how this would all be paid for. The Honorary Treasurer has looked at figures for a range of Royal Colleges in 2012 (2010–11 figures) that showed that the BPS had the lowest membership fee (much cheaper than for nurses and in the region of 25 per cent of that for medical Royal Colleges for example), a lower annual income than anyone but the Royal College of Anaesthetists and much lower assets than anyone but Royal College of Psychiatry.
Indeed the pursuit of Royal status in itself would be a significant expense both financially and in terms of diverting the Society from other activity. That too would need paying for, potentially in increased membership fees. What is more, if becoming ‘Royal’ was not simply a renaming of the existing Society, the current assets of the charity would not transfer and the new College would be starting from scratch.
It is important to emphasise the current inclusiveness and breadth of our Society which (unlike the HCPC) exists (to quote our Royal Charter) ‘to promote the advancement and diffusion of a knowledge of psychology pure and applied and especially to promote the efficiency and usefulness of Members of the Society by setting up a high standard of professional education and knowledge’. It is clear that we are not always the best publicist of our own activity and that there is much more that could be done or done better. We do need to find ways of especially improving our media coverage, and it is hoped that the new Strategic Plan will provide an impetus to progress.'

 

Think outside the psychology box

I am writing in response to Lauren Bishop’s letter (‘Alternatives to clinical psychology’, March 2014). I agree with Lauren in that I have also seen many fellow graduates battle to secure the almost elusive ‘assistant psychologist’ post, and struggle to get ‘clinical’ experience. I think we all need to be more open-minded and look beyond the classical ‘clinical’ route. It is important to remember that our skills as psychology graduates are sought after in so many other disciplines and avenues.

I graduated with BA Hons Psychology from NUI Maynooth (Ireland) in 2009 and then travelled to Australia. I have gained great experience here and now work as a Community Living Coordinator for the Autism Association of Western Australia, whilst currently completing my MSc in Health Psychology through the University of Ulster, in the UK. In my post, I work collaboratively with psychologists, psychiatrists, nurses, speech pathologists and occupational therapists, as well as in-depth with individuals and their families. I couldn’t have asked for better experience and opportunities – but it took me to look beyond what everyone else was doing, and to take a risk elsewhere.

So many people become disheartened by psychology, and I’ve heard so many people who say they should have chosen a different degree... but there is no need – you just have to have the courage to think outside the box.
Sarah R. Lappin
Perth
Western Australia

The NHS – excitement and dejection

I was interested to read Ian Wray’s interpretation of the ‘Decline of the NHS’ (Letters, February 2014). I can relate to Ian’s concerns over ‘increasing control from above, with clinicians’ opinions being ignored’. In my own Trust, there is very much a feeling amongst clinical staff of ‘being done to’ by management. This seems to be beginning to change slowly, but there are still huge problems and what I would describe as a massive abyss between management and ward level, which desperately need to be addressed.

For me, the crux of the problem is communication. If we can develop efficient, effective and transparent systems of communication and consultation throughout our Trusts, we will be able to stall the ‘decline’ and build the first-class organisation that the NHS should be.

In the short time I’ve worked for the NHS, I have seen many examples of senior management imposing unreasonable, impractical and frankly useless processes on ward-level staff. Decisions are made without consideration of the views of people who will be involved in actually implementing the change. It’s all well and good to prescribe a process that fits in terms of organisation-level goals, but without any idea of the practicalities involved in implementing changes on a ward, all that’s happening is extra work is being created often for little or no benefit. Either that or the process simply doesn’t get done, meaning everyone’s time has been wasted and nothing achieved.

Imagine that a proportion of the time spent discussing a new system at Board level were spent consulting with ward staff to determine a mutually beneficial solution? A simple and (I think) obvious suggestion, yet this type of communication simply is not happening. All the while, tasks that are supposedly in the interest of ‘patient safety’ are demanding disproportionate quantities of nurses’ time and preventing them from giving the good-quality care they strive to provide.

What’s needed it for us to all work together a little more, with management taking the time to really understand clinical staff and vice versa. Systems that enable this need to be implemented; for instance, board members should spend more time on wards, and the expertise of people who understand both sides of the coin need to be utilised. I do what I can to encourage this in my own Trust.

I have seen some small improvements starting to happen across the Trust, but I find it frustrating how much is still wrong and feel that things are not changing anywhere near fast enough. However, I am hopeful that the changes started will continue to develop and help us grow into the excellent organisation we have the potential to be.

Anyway, it’s not all bad! Whilst a lot needs to change, great things are happening in mental health services at the moment. Recovery-focused treatment is really coming to the fore, and hospitals across the country are implementing fantastic initiatives such as Safewards. Personally, I’m really excited about these advancements and proud to work for a Trust that is embracing them. And, of course, I’m keen to do my bit to make sure they are successful and that positive changes continue to be made!

So, in sum, whilst I share Ian’s despair over the decline of the NHS in England, I can see good work emerging and things starting to get better. We must endeavour not to get disheartened and disillusioned with the bad stuff; if those of us who want to change things lose our enthusiasm and give up, things aren’t going to get better. Instead, let’s take positive steps towards changing the bad stuff, embrace the good stuff with open arms and each do our bit to contribute to the rise of the NHS.
Lauren Bishop

 

I was, by turns, highly sympathetic, frustrated and then dejected on reading Dr John Kelly’s letter ‘Lean times in the NHS’ (March 2014). My sympathy arises from being subjected to a working lifetime of managerial rhetoric, predominantly of American origin, which – like
the ‘Lean’ production techniques referenced by John Kelly – is predicated on the ‘machine’ model of organisations (Morgan, 1997). No matter that the notion of ‘Lean’ stems from manufacturing; doctors, nurses, paramedics, administrators and the rest are merely, to the mechanistic management mind, usable and disposable components of production.

My frustration is that, nearly 100 years after the death of F.W. Taylor – the woefully misnamed ‘father of scientific management’ (Taylor, 1911) – his influence on management thinking remains so salient and profound. It is as though all the real science, and particularly the enormous contribution of psychologists and sociologists (for the most part American) stands largely ignored, or at best occasionally cherry-picked to suit particular interests. Why? Because, as Morgan (1997, p.25) asserts, ‘one of the great attractions of Taylorism rests in the power it confers to those in control’.

Twenty years ago I was naive enough to believe that, ultimately, good science would prevail; that managers would one day realise that applying evidence-based psychology to the workplace would prove – economically as well as socially – more fruitful than allowing themselves to be influenced by the bare-faced quackery of numerous ‘consultants’ and peddlers of ‘one best way’ panaceas.

My dejection stems from my fear that social science has all but lost the battle, including in the NHS. It seems a bitter irony that an organisation that strives to apply scientific rigour to the treatment of its patients appears unable or unwilling to take the same approach to the treatment of its employees.
Dr Graham Mole MBPsS
Woodbridge, Suffolk

References
Morgan, G. (1997). Images of organization. London: Sage.
Taylor, F.W. (1911). Principles of scientific management. New York: Harper & Row.

 

Ian Wray’s letter focusing on the way the setting of targets has been helping to destroy the NHS in England (along with other organisations), which was given prominence in the February issue of The Psychologist, prompts the question of why psychologists have not more often banded together to protest against evidently misguided management policies in education, health care and elsewhere. The answer usually given is that it would not be appropriate for the members of a professional association to engage in political activity.

But there is also a serious ethical argument suggesting that it might indeed be not only appropriate but actually required by our Charter to take concerted professional action. Psychologists have privileged professional knowledge of the destructive effects of many policies pursued in the ‘educational’ and ‘healthcare’ systems. As such, it seems to me that they have a professional ethical responsibility under their Charter to challenge these policies and procedures.

To appropriately inform policy debate one requires comprehensive studies of all the short- and long-term, personal and social, desired and desirable and undesired and undesirable consequences of alternatives. But instead one finds thousands of psychologists proudly presenting what they claim to be studies to support ‘evidence-based policy’ which look only at average scores on short-term outcomes on only a few selected ‘variables’ (many of which are, in fact, incapable of supporting claims to measure change) when, in fact, different people respond very differently and most important outcomes cannot show up on the kinds of psychometric measures we have come to espouse. This is both unethical and unprofessional.

In reality, this is the tip of an iceberg. What image of governance or management gave a couple of ministers in a temporary government the right to take decisions which bind the behaviour of tens of thousands of professionals and millions of people?

Whatever one may think of Adam Smith and Fred Hayek (both of whom have been proposed for the title of ‘greatest psychologist of all time’) they were concerned to harness the expertise which lies in the hearts, heads and hands of billions of people… information which is continuously changing and mutually influencing. They were concerned to facilitate the expression of diverse reactions to current provisions and meet these divergent needs and priorities. They were concerned to promote a process of evolution, not the system-wide implementation of some half-baked ideology.

Smith’s ‘market mechanism’ was not designed to make money as some believe but was rather a design for a public management – governance – system which would operate without central direction. Many people even seem to be unable to grasp the basic notion that an organic, non-hierarchical, multiple-feedback system can be construed as a governance system.

Instead, in practice, we attempt to operate on the basis of Weberian models crudely based in ideology and soundbites in which central government prescribes procedures and sets targets. It conspicuously does not and cannot work. Researchers such as Deming and Seddon have essentially shown that, from the point of view of at least the manifest goals of policy, targets always make things worse.

This is but one lesson from systems research which shows that common-sense-based intervention in poorly understood social systems always has counterintuitive, and usually counterproductive, effects.

My point is this – whatever about protesting about current policies, surely it behoves psychologists to band together through their professional organisations to promote research designed to evolve more appropriate images of the forms of governance that are required in complex organisations and societies.
John Raven
Edinburgh

 

The media, vulnerability and consent

I read Sian Williams article on the media dealing ethically with those they interview with interest (Voices of the vulnerable’, March 2014). I think, however, she has missed a trick by focusing on vulnerable groups, which provides a rather parochial view of the problem. Generally, if policy or practice needs modifying to account for a, usually, minority, group, then we normally have to consider whether it would actually benefit everyone. Many of the aspects she discussed should, ideally, be in place for dealing with everyone, as informed consent is not just an issue for the vulnerable.

I was also curious about her discussion of the effect of war zones, disasters, etc., on the reporter. This is not just an issue of the reporter: if they think that being an observer of slaughter and disaster is traumatising to them, have they ever considered what the effect is on
their viewers? How many times have the UK news media shown us pictures of mutilated dead bodies? And from my observations, it is usually those who have died in the Middle East or Africa, not from disasters in Western countries. This suggests that it is appropriate to show the dead and dying from ‘other’ countries, not our ‘own’, which just furthers outgroup thinking. Where is the informed consent in this situation, in terms of the dead and dying, their families, and us the viewer?

Coincidently, I was reading a chapter about New Age therapies and the issue of informed consent and vulnerable groups, which certainly broadens the view of vulnerability from just those with mental health issues. ‘Vulnerability is increased when an individual is elderly or aged, very young, brain damaged, ill, drugged, drunk or alcoholic, frightened, stressed, fatigued, exhausted, rushed, distracted, dependent, lonely, unsophisticated, uncertain, indifferent, or uninformed’ (Singer & Nievod, 2003, p.184–185). Williams appears to see vulnerability as dichotomous – you either are or are not – but it is likely that it can be better conceived of as a continuum; and given the right set of circumstances, we may all be vulnerable at some time or another. It is time that journalists and those associated with the media were held to a higher standard of account.
Dr Jo Saunders
School of Psychological Sciences and Health
University of Strathclyde

Reference

Singer, M.T. & Nievod, A. (2003). New Age therapies. In S.O. Lilienfeld, S.J. Lynn & J.M. Lohr (Eds.) Science and pseudoscience in clinical psychology (pp.176–204). New York: Guilford Press.

 

BPS – obsessed with false memory syndrome?

The Savile story broke in October 2012. In The Psychologist, between May 2013 and March 2014 there were at least five glowing articles about three psychologists linked to false memory syndrome (FMS) groups – Beth Loftus, Gisli Gudjonsson (twice) and Chris French (twice). In the latest edition (April 2014) there are two more. On the back page there is a one-on-one with Stephen Ceci. The centrefold ‘Crudely erased adults’ and subtitled ‘Image from A.R.Hopwood’s False Memory Archive’ is essentially an advert for a piece of FMS publicity.

There are two types of inaccurate memory – false positive (believing something has been experienced when it has not) and false negative (believing that something has not been experienced, when in fact it has). The FMS societies are only interested in false positives – they do not want to talk about false negatives.

Let's be clear. The term false memory syndrome’ is not to be found in DSM-5, because it is not a diagnosis recognised by any professional body. It is a term invented by a pressure group.

Dissociative amnesia, on the other hand, is defined in DSM-5 (‘An inability to recall important autobiographical information, usually of a traumatic or stressful nature…’), and inability to recall an important aspect of a traumatic event is one of the defining features of PTSD. Dissociative amnesia, unlike ‘false memory syndrome’, is recognised worldwide by the international professional community. Since October 2012 I cannot recall an article in The Psychologist about the real and relatively common phenomena of traumatic/dissociative amnesia, nor anything about the stress for victims of abuse, or how psychologists or courts might help this stress be managed and reduced. 

At the beginning of 2013 Frances Andrede, a mother in her forties, committed suicide mid-trial of the teacher who abused her decades earlier. This happened after she was accused by the defence barrister of being a liar and a fantasist. Her abuser was subsequently found guilty, and received a prison sentence. Within hours of this news breaking, the BPS decided to postpone its Ethics Committee investigation into members lending their names to inaccurate information about abuse on the British False Memory Society website.

We like to think of researchers as being objective. Those with links to FMS groups generally restrict themselves to research on false positives. This is where the conflicts begin. They research one part of a problem, and ignore another. Then they sit on FMS advisory boards, and BPS committees, and may act as expert witnesses (generally for the defence in criminal prosecutions), and are given glowing reviews in The Psychologist. This does not seem like good practice.

In contrasting FMS advocates with victims of abuse, a colleague put it succinctly to me: the former is a very small group with a very loud voice, whereas the latter is a very large group with a very quiet voice.

To an outsider it might very reasonably appear that the BPS, as portrayed through The Psychologist, makes the situation worse. It appears to have something of an obsession with the invented condition ‘false memory syndrome’ and no interest at all in dissociative amnesia, or in understanding the psychological consequences for victims of abuse, or helping these individuals with the problems arising from the abuse that they have suffered. I believe that this bias puts psychologists in a very poor light, and balance from The Psychologist is long overdue.

Ashley Conway PhD
Pinner, Middlesex

Jon Sutton, Editor of The Psychologist replies: Neither The Psychologist nor the British Psychological Society has links with the British False Memory Society. However, we see no issue with featuring the work of psychologists who are members of it; and some of our members will naturally also be members of the British False Memory Society. I am informed that the Ethics Committee meeting you refer to was cancelled due to unavailability of members and had to be rescheduled. We are and always have been very happy to receive submissions on the topic of dissociative amnesia or the consequences of abuse – see www.thepsychologist.org.uk/contribute. For example, last year we published an article on the effects of childhood abuse (featured on the November cover) and an interview with Kevin Browne on his international work with abused children (June).

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