Assessing for the right to die
ON 10 October a packed House of Lords sat until after midnight
debating a select committee report on whether doctors should be allowed
to help terminally
ill patients end their lives in response to a ‘considered and persistent request’. Lord Joffe, a human rights lawyer, had introduced a bill to liberalise the law, but this
ran out of time in the last parliament. A new Assisted Dying for the Terminally Ill Bill is expected to be introduced in the Lords soon.
Meanwhile in the Netherlands, where assisted suicide and active euthanasia were formally legalised in 2002, researchers have been examining the case reports
of hundreds of terminally ill patients who requested help from their doctor to end their lives but then changed their mind. The findings suggest psychologists could play a vital role in identifying patients who are likely to withdraw a request for physician-assisted suicide.
Of 3615 Dutch GPs who took part in the survey, 1681 had received a request from a patient to help them end their life. These doctors provided researchers with clinical evaluations of their patients taken at the time of the request, and also provided retrospective reports on the patients.
Patients who changed their mind before their request was granted were more likely to be depressed or anxious, and to have unstable mood, being happy one day and tearful the next, than were patients whose requests were ultimately granted. Those patients who had their request refused had even worse mental health.
The findings clearly show that the doctors were taking into account their patients’ mental health when deciding whether to grant their request, but they also point strongly to the need for specialist psychological assessment of patients requesting physician-assisted suicide. ‘The findings emphasise the physician’s duty to detect potential depression or anxiety problems that could influence such a request,’ says the report of the study by Isabelle Marcoux (Vrije Universiteit Medical Centre) and colleagues that appears in the September issue of the journal Psychological Medicine.
Should the UK law change to permit assisted suicide, psychologists will clearly
have a vital role to play in that assessment process. In June the British Medical Association ended its ‘objection in principle’ to physician-assisted suicide, paving the way for potential new legislation ending prohibition of the practice in the UK.
Elsewhere, psychologists have already influenced the law regarding treatment withdrawal, otherwise known as passive euthanasia. A case report by Tom McMillan, Professor of Clinical Neuropsychology at the University of Glasgow, and Dr Camilla Herbert at the Brain Injury Rehabilitation Trust was influential in altering the Adults with Incapacity Act in Scotland, which now specifically mentions the need for specialist assessment by clinical psychologists in cases where there are communication difficulties.
They documented the case of a young woman badly brain-damaged in a car crash when she was 22. Because of a statement she’d made before her accident, that she would not wish to continue living if ever severely disabled, a request was made to a court to permit the withdrawal of the artificial feeding and hydration that was keeping her alive. However, neuropsychological assessment found evidence of sentience of expression and a wish to live, and the request was rejected.
Further recovery was shown by the patient 7–10 years after her injury, and she now lives in the community with 24-hour care and is able to converse and interact, and demonstrates a spontaneous sense of humour. The report of this case, published in Brain Injury last year, concludes: ‘…the progress made 10 years after injury again emphasizes the importance of initial specialist clinical neuropsychology assessment if there is doubt about whether someone is in a vegetative state, as now recommended in the UK.’ CJ
Labour lord calls for revolution
A SENIOR government adviser has called for 5000 more clinical psychologists in the next five to ten years.
On 12 September Lord Richard Layard (Professor of Economics at the LSE) gave
the first Sainsbury Centre for Mental Health Lecture (see tinyurl.com/bdl2v). Setting out his plans to expand access to psychological therapy, the Labour peer called for a revolution in therapy. Provision would be through psychological treatment centres, headed by a psychologist and concentrating on cognitive behaviour therapy. It is widely believed that Lord Layard’s paper Mental Health: Britain's Biggest Social Problem? (tinyurl.com/b2uhz) was influential in Labour’s manifesto commitment on the topic.
Responding to the speech in the November issue of Clinical Psychology Forum, Dr Tony Roth and Pam Stirling (Sheffield Care Trust) called for further discussion on the length of treatment, clear links to existing services, more detail on training routes, and for credible and achievable targets for effectiveness. They note that the ‘obvious area of controversy is the focus on CBT, the use of NICE guidance to declare this as the only evidence-based therapy, and the indication that this would be the exclusive model within treatment centres’. However, Roth and Stirling question ‘whether it makes sense to enter into arguments about which therapy should be advocated, especially because treatment centres represent new services (so current practitioners of all persuasions will not be adversely affected)’. This, they say, ‘could risk the profession appearing to be more preoccupied by narrow concerns and infighting than supporting a venture which could markedly broaden access to therapy’.
Dr Roth and Ms Stirling said: ‘This is a fast-moving strategy, and no doubt by the time this piece appears more information will have become available. It will be crucial for the BPS and its members to be involved – we have relevant expertise in training and in the delivery of clinical services, and are familiar with the technologies required for monitoring and evaluation.’ JS
Increased awareness in abused children
PHYSICAL abuse can leave children highly tuned to signs of nearby
anger. That’s according to Seth Pollak and colleagues (University of
Madison–Wisconsin) who found that physically abused children aged four
to five were more sensitive to an angry conversation than children who
hadn’t been abused.
In a room adjacent to where 11 physically abused four- and five-year-old children and 22 unharmed controls were performing a computer task, researchers placed a stereo playing the sound of a couple having an argument. Measures of the children’s heart rate and sweating suggested the unharmed children noticed the argument but soon went back to the task in hand. In contrast, the abused children showed less arousal at the beginning of the playback – with the researchers suggesting that the conflict was less intense than they were used to – but more arousal as the exchange entered a silent phase that culminated in one person slamming a door.
‘When the interpersonal situation became quiet, unresolved, and somewhat ambiguous, abused children became more concerned than their non-abused peers. Perhaps given their histories, such experiences are particularly frightening for abused children,’ the researchers wrote in the September/October issue of the journal Child Development.
Lead researcher Seth Pollak stressed that no child showed a fear response: ‘the abused children were not scared, they were simply anticipating that something scary could develop.’ However, Pollak said: ‘These results may help explain why abused children may be especially distracted in classroom and social situations. They may be anxious about aspects of the environment that other children or adults might not even notice.’ However, it should be noted that in this study, the abused children’s performance at the computer task was no different from the controls, despite their accentuated physiological response to the nearby argument. CJ
A round-up of research from the latest BPS journals.
Dead mice still get angry with their brothers, according to kindergarten children. In a study where an anthropomorphised mouse puppet was eaten by an alligator, young children were likely to still attribute emotions and desires to the dead mouse, but not biological and perceptual functions (e.g. his brain doesn’t work and he can’t still hear the birds singing). So-called ‘cessation responses’, i.e. indicating that functions cease at death, increased with age and were higher among children from a secular school than children from a Catholic school. (BJDP, November)
Contrary to expectations, younger children perceive enemies more often as concrete others, while older children perceive enemies more often as non-human, fictitious others. Girls more often thought of enemies as individuals, whereas boys perceived enemies to operate in groups. (BJDP, November)
Patients with bipolar disorder who were currently depressed were found to have less consistency between their perceived actual and ideal selves in comparison with non-patient controls and patients with bipolar disorder who were currently manic, hypomanic, or in remission. The authors suggest that the grandiose ideas of manic patients serve the function of preventing awareness of distressing thoughts about the self. (BJCP, November)
Previous research has proposed two types of paranoia: poor me paranoia,
in which the persecution is believed to be undeserved, and bad me paranoia, in which it is seen as a deserved. But a new study of 40 participants with early psychosis found an extremely low rate of bad me paranoia, suggesting that it only develops later as the result of stigma and depression. (BJCP, November) JS
- Society members can subscribe to BPS journals for just £19 per year (£14 for students). See www.bpsjournals.org.uk.
THE search for psychological universals – the features that unite
humankind – is a foundation of our discipline. But the bedrock of the
psychological database, consisting of layer upon layer of findings from
Western middle-class college-educated young adults and their children,
prevents us from testing these assumptions. And recent research
exploring cultural diversity in psychology may actually have piled
problems even higher. Now a new review article has called for
psychologists to take a step back to reconsider how ‘universals’ are
conceptualised and studied.
Writing in the current issue of Psychological Bulletin, Ara Norenzayan and Steven Heine (University of British Columbia) describe how psychology’s biological heritage and the computer metaphor both assume a shallow surface of variability over an easily discernible deep structure of universal psychology. But the methods don’t suit the task at hand: 99 per cent of the papers in the history of the Journal of Personality and Social Psychology emerged from Western countries, and student samples are standard in many areas of psychology. As the authors say, the critique is not new but still the practice continues. But wait – here come two knights in shining armour to save the day, in the form of evolutionary and cultural psychology. Surely now we can get on with generalising psychological findings across disparate populations having different ecologies, languages, belief systems and social practices?
Well, no. According to Norenzayan and Heine, what is needed is not exhaustive sampling of every culture in the world, it’s some guidelines on what universality really means and what standard of evidence is required to show it.
First, consider the sample. The first option is to take two populations: the more divergent the contexts, the more powerful are the claims of universality. So the fact that a similar mentalistic understanding of behaviour emerges at about the same age in Western children and Baka children in the rainforests of Cameroon strengthens the case that false-belief understanding is a functional universal. But if the findings don’t point to universality, it’s difficult to pinpoint the cultural candidate behind the differences. Another culture can be added, varying on one theoretically important dimension from one of the previous two cultures. Or you can go the whole hog and study a wide range of different cultures, like the study of 35 samples from 19 diffferent countries finding that men engage in same-sex homicide far more than women in each one. Unfortunately researchers in this kind of large-scale study often take shortcuts and use brief questionnaire measures that are prone to all sorts of methodological artefacts.
Next, what should be studied? According to Norenzayan and Heine, the key is to find the level of abstraction that renders potential universals useful in research, general enough to occur, yet tangible enough to have psychological authenticity. For example, we all like to feel good about ourselves. But dig deeper and you find that Americans have a self-enhancing orientation, which basically means they give up when the going gets tough, in favour of a new task; the Japanese approach is a self-improving one, persisting with the task in an effort to reduce shortcomings. Same warm glow, different methods.
This leads the authors to propose three key questions. First, are the ‘tools’ in the cognitive toolboxes – psychological processes, including cognitive structures, emotions and motivations – the same or different across cultures? Second, even if the tools are the same or nearly the same, are different tools used in the same situations? Third, even if the tools are the same, and the same tools are used to solve a given problem, is the tool accessed with the same facility or frequency?
The answers suggest four degrees of universality: nonuniversals (different
tools), existential universals (same tool but different functions), functional universals (same tool and same function or use but different accessibilities), and accessibility universals (same tool, use, and degree of accessibility).
Norenzayan and Heine argue that many psychological processes are implicitly assumed to be accessibility universals, but really this level demands stringent evidence. Possible examples include quantity estimation, and the way people are more positive towards familiar objects in comparison with unfamiliar ones. Further down the scale, most psychological processes that have been investigated appear to meet the standards of existential universals, but some might not: certain arithmetic reasoning strategies only emerge among abacus users.
Specifying the level at which a universal is posited can sharpen theoretical debates. For example, gender effects in mate preferences are found consistently across cultures, but in varying sizes. This supports the conclusion that gender differences predicted by sexual selection theory are functional universals, but not accessibility universals.
Norenzayan and Heine conclude that the complicated search for universals should teach us to be slow to judge other cultures: we can’t plead against inhuman tyrannies if we don’t know what’s inhuman. ‘Psychology is at the cusp of expanding its narrow empirical base from middle-class, technologically advanced, primarily Western college-aged samples to humanity at large, with all its cultural diversity,’ they say. ‘As the field of psychology absorbs the lessons of cultural variability, greater empirical attention to psychological universals, their scope, contours, and the conditions under which they emerge, stand to greatly advance the field.’ JS
Norenzayan, A. & Heine, S.J. (2005). Psychological universals: What are they and how can we know? Psychological Bulletin, 131, 763–784.
Chat-bots and the Turing test
HOW will we know when we’ve created a truly intelligent computer
that can think? British mathematician Alan Turing suggested one way
would be if a person couldn’t tell from conversations with a computer
and a human which was which – the Turing Test (see tinyurl.com/74zh8).
With his programme Jabberwacky, British AI Researcher Rollo Carpenter
has just won the latest $2000 Loebner Prize awarded each year for the
is deemed to have chatted in the most human-like fashion. Transcripts of the judges’ conversations with each computer and human confederate can be viewed at tinyurl.com/cxnul. Jabberwacky improves all the time as it stores everything anybody has ever said to it, and it uses contextual pattern matching techniques to find the most appropriate way to respond.
- You can chat at www.jabberwacky.com. The $100,000 for the first computer to actually pass the Turing Test remains unawarded. CJ
Who are the risk takers?
A SURVEY of 22,000 people in Germany has found that gender, height,
age and parents’ educational background all predict a person’s
willingness to take risks. Men, younger people, taller people and those
whose parents had a longer education all tended to be bigger risk
A report on the work published by the Institute for the Study of Labor (Discussion Paper 1730 available via www.iza.org) discusses how the findings point to ways that changing demographics could affect a country’s politics: ‘Demographic changes leading to a large population of elderly are predicted to lead to a more conservative pool of investors and voters, which could substantially influence macroeconomic performance and political outcomes, increase the resistance to reforms, and delay necessary but risky policy adjustments.’
Dr Thomas Dohmen (Institute for the Study of Labor) and colleagues obtained the results by asking participants hypothetical questions like whether or not they would gamble half of a 100,000 euros lottery prize for a 50 per cent chance of winning another 100,000 euros. Tests with real money on a subsample of the participants showed such thought experiments were a good predictor of actual risk-taking behaviour.
The study also found that people who are more willing to take risks tend to be happier with life, but the researchers aren’t sure why. Professor Armin Falk (University of Bonn) said: ‘It’s a classic chicken and egg problem. Are people who are satisfied more optimistic because they are satisfied, and thus more ready to take risks? Or is someone who is not afraid of risks a person who takes their life into their own hands and shapes it the way they want to?’ CJ
More from the latest BPS journals.Older people in care homes are
often encouraged to reminisce, but a new study finds equivocal evidence
for accompanying good psychological health. In fact, high frequency of
reminiscence and the presence of regrets were associated with negative
psychological health. The authors suggest that care staff should be
aware that regrets might suggest a need for more structured, expressly
therapeutic psychological input. (BJCP, November)
People reporting a previous out-of-body experience (25.5 per cent of a sample largely comprising female psychology students) experience higher levels of dissociation between their perceptual body and self, have a heightened self-awareness, are more dissatisfied with their bodies, and lack confidence in presenting themselves physically (e.g. shaking hands). (BJP, November)
In a study of 191 adults, the insecure attachment styles of preoccupied and fearful were associated with increased symptom reporting. This relationship was mediated by the non-expression of anger, and perceived social support. The authors suggest regularly scheduled appointments with the same staff member for the preoccupied attachment group, as this would increase their confidence about the availability of this person to meet their needs. (BJHP, November) JS
- For more information see www.bpsjournals.org.uk.
Research project of the year nomination
S OCIETY members Dr Michelle Ryan and Professor Alex Haslam
(University of Exeter) have been nominated as one of four finalists for
the Times Higher Education Supplement Research Project of the Year.
The pair have been nominated for their study published in the British Journal of Management in June. They found that women are gaining positions on the board of FTSE 100 companies, but they tend to be at companies that are performing badly. According to Dr Ryan, the ‘glass cliff’ idea ‘resonated with people outside academia’.
She added: ‘Although the competition is very strong, it’s encouraging that psychological research is achieving national recognition. Fingers crossed for the awards dinner on 23 November!’ JS
The Society’s free Research Digest service has over 15,000 subscribers. To join them, send a message to [email protected]. Here’s a sample, by the Digest editor Christian Jarrett.
Sex doesn't sell
The Moral Majority would approve of this new study by Brad Bushman
at the University of Michigan showing that adverts embedded in violent
and/or sexual TV programmes are less effective than adverts embedded in
more family-oriented entertainment.
Bushman asked 336 volunteers aged between 18 and 54 to watch either a violent programme like 24; a sexy programme like Sex in the City; a violent and sexy programme like Buffy the Vampire Slayer; or a family programme like America’s Funniest Animals. Halfway through the programmes he embedded the same twelve, 30-second ads for some fairly obscure, branded products, including sugar substitute and plasters.
Those participants who watched the violent, sexy, or violent and sexy programmes were less likely than viewers of the family programmes to recall the names of brands that had been advertised; were less likely to say they intended to buy the advertised brands in the future; and given the choice of some fake money-off vouchers for a range of obscure brands at the study end, were less likely to choose vouchers for the advertised brands. This pattern of results held regardless of participants’ age, gender or whether or not they enjoyed the programme they’d watched.
Bushman said that to advertise in such programmes might be ‘bad for society and bad for the advertiser’s business’.
Bushman, B.J. (2005). Violence and sex in television programmes do not sell products in advertisements. Psychological Science, 16, 702–708.
RESEARCH FUNDING NEWS
The Economic and Social Research Council has launched new funding schemes for researchers at all stages of their careers.
The ‘first grants’ scheme is open to those who have held their PhD for less than six years (four if spent in an academic post), and aims to give them experience of managing and leading research projects. It will fund projects of up to three years at a maximum cost of £400,000. Closing date for this annual competition is 4 January.
The ‘large grants’ programme is for experienced researchers requiring longer term support for research groups or networks. The scheme will fund projects of up to five years in length, for between £1.5 million and £5 million. Closing date: 31 January.
The ESRC has also made it easier to collaborate with researchers in other countries through its International Collaborative Grants, and from this month linked PhD studentships can be applied for on any ESRC grant.
o Visit tinyurl.com/7bezs for more information.
In its Strategic Plan 2005–2010, the Wellcome Trust announced that it is to set aside 10 per cent of its annual budget – approximately £45 million – for a rapid response fund to support research ideas that do not fit into its current priority areas. Applications can be made directly to the fund but should be discussed with the Trust before submission.
o For more information go to www.wellcome.ac.uk.
The draft EU Framework 7 programme has been published. Project grants
will be funded from the ‘Cooperation’ theme. There are nine proposed areas
of activity; Health; Food, Agriculture and Biotechnology; Information and Communication Technologies; Nanosciences and new Production Technologies; Energy; Environment; Transport; Socio-Economic Sciences and the Humanities; and Security and Space.
o For more information see http://Framework7.com.
The Food Standards Agency has set up a scheme to train young scientists
in skills relevant to the anticipated requirements of the agency. Research scholarships starting in October 2006 are invited in the following areas: public interpretations and understandings of food labelling; factors affecting consumers’ food purchase practices and/or their impact on food choice and dietary patterns; and the economics of food safety. Closing date for applications is 31 March 2006.
o For further details and an application form see www.food.gov.uk.
The National Institutes of Health are inviting applications surrounding
the identification, prevention and treatment of combat-related post-traumatic psychopathology and similar adjustment problems. The funding targets studies involving troops in current and recent military operations. A letter of intent is required by 28 December, with an application closing date of 25 January.
o For further details see tinyurl.com/dazlg.
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