Concern over diagnostic dangers
I am concerned about the implications for learning disability of the proposed revision to the DSM and ICD. The broad aim of the revision is to move from a descriptive to an aetiological grouping of disorders, as discussed in volumes 39 and 40 of Psychological Medicine. It is proposed that learning disability will be included under Cluster 2 of the new metastructure, which is labelled Neurodevelopmental Disorders. This cluster will replace some of the disorders currently included in the DSM-IV ‘Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence’ and the ICD-10 ‘Mental Retardation’, ‘Disorders of Psychological Development’ and ‘Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence’ (Andrews et al., 2009).
Eleven criteria or ‘validating factors’ are used to decide which disorders might be included in Neurodevelopmental Disorders. These include organic factors, such as ‘shared genetic risk factors’ and ‘shared neural substrates’, and non-organic factors, such as ‘shared temperamental antecedents’ and ‘symptom similarity’. The evidence base for the proposed change is given in the form of 112 references, nearly half of which apply to autistic spectrum disorders. Other citations refer to ADHD, dyslexia and stuttering! There is only one reference to a genetic syndrome known to be associated with learning disability, and mild learning disability is not mentioned at all. Nevertheless, on the basis of this bizarre selection of the literature, and despite the admitted paucity of genetic data, the authors reach the conclusion that they have identified a ‘broad phenotype’ that increases the risk of autistic-type symptoms and ‘other forms of cognitive impairment’: ‘This dimensional model posits that Autism and Asperger’s disorders fall at the “severe” end of the genetic spectrum whereas disorders such as mild mental retardation occur at the “mild” end of the spectrum’ (Andrews et al., 2009, p.2016).
In other words, all learning disability (and other developmental problems) are to be subsumed under autistic spectrum disorder.
I do not need to rehearse here the theoretical arguments against diagnostic systems in general. But whatever their philosophical or scientific integrity, we are stuck with them, and there is a danger that, with the current restructuring of the NHS, they may become more rather than less influential. Do we not therefore have a responsibility to try to ensure that revisions are at least appropriately evidence-based? Is the BPS involving itself in this debate? If so, how? If not, what can we do to ensure that we have a voice in the decisions that are being made on the future of learning disability diagnosis? Or is it too late?
Community Team for People with Learning Disability
Andrews, G., Pine, D.S., Hobbs, M.J. et al. (2009). Neurodevelopmental disorders: Cluster 2 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine, 39(12), 2013–2023.
Response from Professor Pam Maras, British Psychological Society Honorary General Secretary:
The British Psychological Society is collaborating with World Health Organization (WHO) through our membership of the International Union of Psychological Science (IUPsyS) in order to provide input into the revision of the ICD-10 which is currently under way. WHO are engaging in an international and multilingual process in order to assess the views and opinions of psychologists around the world regarding the problems with current classification systems and how their clinical utility can be improved.
The WHO expects to publish the ICD-11 in 2014. During the revision process, the British Psychological Society will be invited to provide scientific and clinical input to strengthen, broaden, and improve the revision process. The first way in which we have collaborated is through an online survey, which was sent to a random sample of 1000 members. This is only the first of a series of opportunities Society to participate in the revision of the ICD-10, which will involve a number of surveys and field studies.
We will feed in any comments received from members to this review and welcome the opportunity to be involved in this process.
One of the interesting group of articles in the special issue ‘Psychology, religion and spirituality’ (April 2011) changes the name of the famous Gifford lectures by William James, given by him in Edinburgh in 1901/2 (and permanently in print ever since), from The Varieties of Religious Experience to The Varieties of Religious Behaviour!
It is worth emphasising that the study of ‘anomalous experiences’ mentioned by Loewenthal and Lewis in their article ‘Mental health, religion and culture’ in the same issue is carried on outside the relatively narrow world of psychology of religion. Two sections of the society, viz. the Consciousness and Experiential Psychology Section and the Transpersonal Psychology Section both have an interest in this area, and some overlap between these sections and the world of psychology of religion might be advantageous for all parties.
Drugging schoolchildren as social control?
Following my keynote address at the Association of Educational Psychologists’ Annual Course in November 2010 and my seminars at the BPS Division of Educational Psychology (DECP) conference in January, there has been a lot of media interest in my call for a national review of psychotropic drugs used to control behaviours that are sometimes within the normal range. Also, I have highlighted the concern about the imminent arrival of DSM-5 from the US, with it’s more inclusive spectral definitions of mental health, such as ‘sub-clinical, normal variation ASC, ADHD, social anxiety [shyness], and depression [sadness]’. Dr Tim Kendall (representing the Royal College of Psychiatrists and NICE) agreed with my level of concern on a Radio 4 Woman’s Hour programme on 11 February, stating that the revised DSM-5 should not be readily adopted by psychiatrists, paediatricians and psychologists alike in the UK.
I was delighted when the chairs of the BPS Division of Clinical Psychology (DCP) and DECP both lent their support my call for a national review of this strategy in their statement of 9 February.
Peter Kinderman, chair of DCP stated in this press release, which was published in the March issue of The Psychologist: ‘Clearly, it is important to understand children’s behavioural and psychological problems fully, and to invest in proper, expert, therapeutic approaches. We would be very concerned if children were being prescribed medication as a quick fix rather than accessing the full assessments and psychological therapies which take may longer and cost more, but ultimately are likely to be better value in the long run.’
I am naturally delighted with the support for a national review about the safeguarding issues involved in overmedicating school children.
We must act quickly prior to the release of DSM-5 produced by the American Psychiatric Association. A lot of UK practitioners may use this schedule unless there is resistance from the professional bodies such as the BPS and the Royal College of Psychiatrists in this country.
Within the BPS there is close work with psychiatrists to ensure better mental health across the board. If there is evidence of inappropriate use of drugs or medication then we’re sure that our psychiatry colleagues would be equally concerned.
The time is right to extend the debate amongst practitioners of all disciplines before it is too late and we adopt by default the shocking American practice of drugging 12 per cent of their whole school population for attention difficulties alone, and then high percentages for other conditions. Drug companies would ideally like to medicate 20+ per cent of all children who they claim have one mental health diagnosis or another. The eminent psychologist Dorothy Rowe concludes in the foreword of the new edition of Making Us Crazy – DSM: The Psychiatric Bible and the Creation of Mental Disorders (2010) by Herb Kutchins et al. that it is reasonable to conclude that this practice is a systemic form of social control.
I urge psychologists, medical practitioners and teacher colleagues to contemplate their own response to this crucial societal issue.
No place for partisan view
I have noted the proposals made by Alexis Makin (Letters, March 2011) that psychologists should recommend that the government stop sending British forces to Afghanistan and that they should speak out against national institutions such as the Ministry of Defence. The letter portrays the public image of the military as resulting from the government and right-wing media investing heavily in ‘domestic propaganda’.
The problem, of course, with letters of this kind is that they seek to speak on behalf of psychologists, while in fact representing the personal political views of an individual. The Society is made up of many individuals, and they occupy the full range of political, religious and other personal viewpoints, including those viewpoints diametrically opposed to the ones expressed in the letter.
There are many psychologists working for the Ministry of Defence, and I am sure that they hold the same values as Alexis Makin regarding the horrors of war and the tragedy of human suffering. These values are likely to represent a consensus among psychologists. Such a consensus was perhaps best summarised by Prilleltensky and Nelson (1997) in terms of the values of health, caring and compassion, self-determination and participation, human diversity and social justice. However, these values will not best be taken forward through partisan views castigating right-wing media and the Ministry of Defence any more than through partisan views castigating left-wing media and pacificism.
University of Strathclyde
Prilleltensky, I. & Nelson, G. (1997). Community psychology: Reclaiming social justice. In D. Fox & I. Prilleltensky (Eds.) Critical psychology: An introduction (pp.166–184). London: Sage.
Eysenck - an inspiration
It is sad that Hans Eysenck is not around to read what is written about him (‘The controversial Hans Eysenck’, April 2011) and to defend himself as he did so well. What perhaps was most neglected in the article was the humanity of Hans Eysenck and how easy it was to converse with him about a number of subjects, usually about work, and the friendliness he showed to lesser academic such as myself.
I knew both his wife Sybil and Hans, and I know that the manner in which he conducted himself with his family, always being available to guide and to help in every way. He was an inspiration to myself, most especially because he did not accept authority at face value. I have attempted to follow in his footsteps in a very minor key.
Forum guest column: the real world
The day of the Census was the day after the massive Anti-Cuts March in London.
The newspapers that day were full of anarchists and mayhem. Indeed, only one paper led on the main march itself. All the others had pictures of conflict and destruction.
At one level, this a graphic example of an old story: crowds are only reported in the media when they are violent, so gradually an equation is made between crowds and violence. The lowest estimate of numbers on the march was 250,000. The highest estimate of ‘troublemakers’ was ‘several hundred’ (let’s say 500 to be generous). So 0.02 per cent of those protesting received the lion’s share of the coverage. It would be hard to be much more biased.
But there is more.
Of the ‘several hundred’ defined as troublemakers, the great majority were non-violent protestors from UK UnCut. This group mounts peaceful occupations of shops and companies (in this instance Fortnum & Mason’s) which they accuse of avoiding tax. Only a few were the notorious ‘Black Block’ who attacked police and property. Moreover, of around 200 arrests, all but 13 were of UK UnCut activists.
So, as Ben Goldacre noted the following Saturday in The Guardian, by lumping these very different groups together in a single rather threatening category, two things were achieved. First, the level of danger was greatly increased (‘several hundred’ people rampaging through London sounds rather frightening). Second, the success of the police in dealing with the danger was likewise increased. So, on a day of anti-cuts activism, perhaps the police were the most effective in making a case for retaining their public funding.
So much for the coverage of the march. After the excitement of our Sunday papers, we turned to our census forms and to something entirely different. Or was it?
To start with everything was rather dull and straightforward: we answered questions about who we live with, our date of birth, our country of birth. But then things got trickier: how would you describe your national identity; what is your ethnic group (our emphases) – as if the former were a judgement and the latter a fact. And then, of course, came complexities of how to fit oneself within the categories provided.
This year, the most complex and controversial issue concerned the religion question. What is the criterion for saying one is religious – that one believes, or that one is part of a congregation, or that one was brought up in a particular way, or even that one comes from a family with a certain tradition?
There is no simple answer to these questions. Even more complex is the question of how the information will be used. If more people say they are religious, will it lead to greater state support for religion through changes in educational and social policy? That was certainly the fear of the Secular Society in calling for people to put down that they were of no religion. It was certainly in our minds when we filled in the forms.
And at this point, the lessons from the Census and the March begin to merge. Numbers might be neutral. But the categories that form the basis for our counting are always political. And if those who collect and report statistics are using categories to shape the world to their own ends, then it is a fair assumption that when people respond to these categories in the process of completing questionnaires they are attempting to do the same. Numbers never speak for themselves.
Steve Reicher is at the University of St Andrews. Alex Haslam is at the University of Exeter. Share your views on this and other ‘real world’ psychological issues – e-mail [email protected]. An archive of columns can be found at www.bbcprisonstudy.org.
Forum Twitter debate
This month’s question via @psychmag
If, in some cataclysm, all scientific knowledge were to be destroyed, and only one sentence passed on to the next generation of creatures, what psychology-related statement would contain the most information in the fewest words?
Don’t get caught in the nature/nurture debate again (@thekieran)
George Herbert Mead (1934) ‘Each to each a looking glass reflects the other that doth pass’ (@sianemilyjones)
‘Human beings crave for patterns’ from which a lot come (stereotypes, causal reasoning, belief in supernatural/god..) (@aFrenchParadox)
Behaviour is the result of nature and nurture (@dralicejones)
Your memory for events can be wrong, your senses are easily fooled and other people are capable of rational thought (@sophiescott)
‘Information is just variation’ whether temporal or spatial, over all sensory domains. (@science_fairy)
Join the debates by following @psychmag at www.twitter.com/psychmag
- This month will see the first event in a monthly ‘Psychology in the pub’ series, at the Showroom in Sheffield (tinyurl.com/2g65ugh).
We got the idea from the London Pub Psychology (tinyurl.com/6kp7j6v), but there is also one in the West Midlands (Psychologists in the Pub (tinyurl.com/6x6sn6n). For our event, we are planning on inviting an expert along every month to talk about a popular aspect of psychology and how it applies to our everyday lives. The first three sessions will deal with social networking (18 May), sexualisation of young people (21 June), and deception (20 July).
We're keen for engaging and energetic speakers to cover a wide range of psychology-related topics. For more information, see tinyurl.com/6ydwoy5
Lecturer in Psychology, Open University
- A new CLRN-funded initiative in Coventry & Warwickshire for researchers in the mental health field, and developed by a team of specialists knowledgeable in both IAPT services and research, aims to help researchers gain access to primary care patients. The CWPT IAPT service receives over 1000 referrals a month and holds a database (IAPTus) that includes a record of patients who have already given their consent to be contacted by researchers. IAPTus also records lifestyle and psychological measures and is capable of extension for research purposes.
To find out more about what the team can offer researchers visit: www.covwarkpt.nhs.uk/IAPTRR
Dr Kay Wright
Coventry & Warwickshire Partnership Trust
- I am a teacher in a secondary school and I have been asked to find if there is any evidence that children learn better in single-sex groupings. I would be grateful for any information on research in this area.
- I’m a PhD student researching graduate-level applicants applying to an organisation in which online testing is used for the recruitment process. The study will involve these job applicants completing two short questionnaires: (i) at the time of applying for posts, and (ii) after the recruitment process.
If an organisation would like to participate in this research, please contact me.
Leslie Henderson (1942-2011)
Everything that Leslie Henderson did in his professional, social and cultural life was characterised by elegance. In the professional sphere, this elegance expressed itself in the clarity and erudition of his language, both spoken and written, and in the acuteness with which he penetrated to the heart of any idea or discussion. His book Orthography and Word Recognition in Reading (Academic Press, 1982) was a model of scholarship; nearly 30 years after its publication, I still love to browse through to rediscover the countless witty but deep observations about human writing systems and reading processes.
Much of Leslie’s academic career was spent at the University of Hertfordshire, first as Lecturer, then Reader and then Professor of Experimental Psychology.
His colleagues there report that he was instrumental in attracting good scholars/researchers to join the department, and that he played an outstanding role in inspiring and supporting students. Another of Leslie’s significant achievements and services to the community of experimental psychology in the UK was his eight-year period first as Associate Editor and then as Editor-in-Chief of the Quarterly Journal of Experimental Psychology.
As most of Leslie’s friends and colleagues already know, he was diagnosed with Parkinson’s disease at an incredibly young age, before he turned 40: a tragically bad hand dealt to him and his wife Sheila. Despite this grim news and the gradually worsening effects of the disease on Leslie’s capacity to live the life that he wanted, he continued for a number of years to make serious contributions to research, some in his original field of psycholinguistics, but increasingly with a focus on the study of reaction times and eye movements in various neurological conditions including Parkinson’s disease. It came as no surprise to anyone lucky enough to know Leslie that this irrepressibly intellectual man responded to his own condition partly by working to illuminate it.
No tribute to Leslie would be complete without some comment on his exquisite taste in classical music, painting, poetry, food and wine. Leslie was a brilliant cook: many years ago, when he entered a Sunday Times contest for non-professional cooks, he achieved one of the top awards. His knowledge of fine wine was exceptional. ‘Patience’ is not necessarily a word that I would use to describe Leslie, but he had endless time for anyone wanting to learn about and improve what they were cooking, eating or drinking.
His death is a terrible sadness to all of his family, friends and colleagues; but to have had our lives made richer and more elegant by knowing him is a source of joy.
University of Cambridge
Martin Cranshaw (1943-2010)
There are a number of people who have consistently and persistently given outstanding service to students and practitioners of occupational psychology. Martin, who died on 18 November 2010, was one of these.
It seems as if Martin was always engaged in some BPS Committee: For occupational psychology, he was an early member and subsequently Chair of the Training Committee; he was a founder member of the Board of Examiners, and when this was running smoothly he became Chair of the Division. His last position for occupational psychology was to become Chair of the Board of Examiners, managing the transition of the regulation of the occupational psychologists from the BPS to the Health Professions Council. He stayed as a Chair until the summer of last year and it is an indication of his light touch and lack of self-importance that not one of us realised that he was so ill.
For the wider Society, Martin was a member of the Membership and Qualifications Board, and the Professional Affairs Board, both formerly senior boards of the Society. After the Professional Affairs Board became the Professional Practice Board he became its Chair and a member of the Board of Trustees of the Society. In addition to his active committee work Martin was practically and professionally engaged in the creation of the National Occupational Standards in Psychology that now underpin BPS chartered membership and HPC registered member status.
Martin’s first career was ship’s engineer before he became an academic psychologist. His love of sailing and engineering never left him – his family remember him variously as ‘all about boats and books’ – and his detail consciousness spanned both careers.
Martin became Director of the MSc in Industrial Psychology at Hull University in the late 1980s. His care for his students passed all reasonable expectations. His door was always open and he was happy to discuss anything that students brought to his door – sometimes for hours. Liam Healey a former student remembers: ‘He was like my occupational psychology Dad. I can remember going down to Hull for an unofficial visit in 1993, it was just him and me, and he spent two hours with me! If I did turn out half decent, I can trace it back to the advice I received and decisions I made that day down in Hull with Martin.’ This sentiment will be instantly recognised and echoed by many who did their MSc in Industrial Psychology in Hull.
Martin was a man who got work and life in good balance long before the phrase became popular. He was a happy family man, husband, father and grandfather. He was a great colleague with many friends: his fund of stories was second to none and almost without end; he loved books, boats, crosswords and croquet and long humorous conversations. He leaves behind his wife Angela and children John and Ruthie and their families. He was a friend to many people. We all are better for having known him.
Philip Marcus Levy (1934-2011)
Few individuals had more influence in the shaping of academic psychology during the 1970s and 1980s than Phil Levy, who died on 23 January 2011. Phil was President of the BPS in 1978/79 when he was confronted by a Society facing a financial crisis and needing organisational renewal. He was the ideal person to steer the Society through examining itself and developing the new strategies that defined the organisation for many years to come. Phil also chaired the highly charged meeting of Council that debated the allegations of fraud against Sir Cyril Burt. Phil guided the Society’s first strategy in response to what was, for the Society, a novel, divisive and highly public issue. There was a certain irony in this as Phil was, at the time, the Editor of the British Journal of Mathematical and Statistical Psychology, which Burt had edited for many years.
Phil was known for his disinterested honesty and insight, and he was in considerable demand to be a member of Chair panels by universities who were expanding their psychology departments. He also played a major role on national funding bodies. He was chair of three different committees within the Social Science (later the Economic and Social) Research Council between 1979 and 1989. Phil also jointly chaired the Psychology panel for the first university Research Assessment Exercise in 1986.
Phil was born in Redcar, North Yorkshire, in 1934, but was brought up in Leeds. He took his degree at Leeds University, graduating in 1952. Phil’s PhD on the use of discriminant analysis to identify the appropriate items in a psychological test (Birmingham University, 1958) marked his lifelong interest the application of statistics to practical problems.
He was appointed as the first Chair of the newly created Psychology Department at Lancaster University in 1972. He assembled a team of keen young academics, and for many years the average age of the staff in the department remained below 30. Phil was inevitably drawn into the management of the university, chairing the very influential Research Committee, although he refused several offers to be made a Pro-Vice Chancellor.
Phil’s normal attire of a suit and a bow tie made him stand out. He claimed that he wore the bow tie because he had once been taught to tie one and it seemed a skill worth adopting. He was enormously popular with those who worked with him. At times his driving hope of obtaining consensus on a disputed issue could seem to prolong debate, but his concern for the issues and for the people with whom he worked were never in doubt. Despite progressive problems with his eyes, but assisted by his difficulty in sleeping, he used most hours of the day and night for working. Departmental seminars appeared to provide an opportunity for him to take a nap, but then he would ask the first and insightful question! Phil’s death is a great loss to those who knew him and valued both his friendship and his many abilities.
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