Returning to the cuckoo’s nest
Guilty Except for Insanity – Maddening journeys through an asylum
A documentary film by Jan Haaken
The film One Flew Over the Cuckoo's Nest, stemming from novelist Ken Kesey’s time as an orderly in a mental health facility, has become
a staple of sixth-form and undergraduate psychology classes. Praised for its realism, it was shot on location at Oregon State Hospital and even featured former Superintendent Dr Dean Brooks as Dr Spivey. Speaking in Guilty Except for Insanity, Dr Brooks declares with some glee, ‘Everything that you see in the movie never, ever happened. But it’s all true!’
This documentary, made by clinical psychologist and film maker Professor Jan Haaken (see interview, July 2011), tells a different side of the story. The film unfolds as five interwoven stories of patients who enter the hospital through the insanity plea, how their lives spin out of control and the consequences of their encounters with the criminal justice system. It’s a compelling watch, with sections prefaced by clips from One Flew Over the Cuckoo’s Nest and beguiling music written and performed by patients, staff and allies in the mental health system.
Haaken largely allows the patients’ stories to speak for themselves, but she clearly thinks her subjects are paying a terrible price for their deliverance from criminal responsibility. Perhaps if more psychological support had been available to these people, they wouldn’t be caught in a system where ‘the search for care is as maddening as are the terms of confinement’. As Haaken says, ‘When people fall apart in America there is not much to catch them’. Forensic psychologist Dr Joel Gregor concurs: ‘The best way to get mental health treatment for a lot of people in this state who don’t have families that are watching out for them or people who can pay for their care is unfortunately to get arrested.’
There is no doubt that the crimes involved are horrific: the childhood friend of one patient tells her ‘I remember the recording of your 911 call, when you told them you had shot your son, and then turned around and yelled at him because he was bleeding on the carpet’. Yet it’s testament to the skill of Haaken as a film maker that it remains easy to identify with the patients and their accounts.
However, at times I found myself questioning whether my imagined reactions to the situation held any relevance. According to Brandy Adams, the restraints used on her ‘feel like you’re getting a great big hug’; ‘the razor wire provides some comfort and stability’. Haaken asked her what she was nervous about. ‘Leaving. Institutionalisation is a wonderful thing.’
The DVD sleeve describes ‘patients and staff caught in an insane system – one that reflects larger national trends toward incarceration of individuals suffering mental health crises’. But personally I’m not sure the system came across as ‘insane’: it seemed to be one with a lot of thoughtful professionals making difficult decisions about risk while treating patients with humanity and with innovative methods. ‘Whether people drown, or ride the rough currents of history, depends on what is there to hold them, and the kinds of boats available to keep them afloat’, Haaken concludes. But I could have done with more of her own views on the ship’s seaworthiness, and the film has also left me curious as to how the UK system compares.
Reviewed by Jon Sutton
The film is available for educational use from www.guiltyexcept.com.
For your chance of winning a copy, tweet us on @psychmag with your views on our new ‘Reviews’ section.
At a stroke
Psychological Management of Stroke
Nadina Lincoln, Ian Kneebone, James Mcniven & Reg Morris
I selected this book to review as I work in a stroke service and was interested to see what the book could contribute to my practice. I was heartened to find that the first chapter contained comments from people who had experienced strokes and references to further books providing personal accounts of stroke. For me, this was important to help connect the reader with the felt experience of stroke.
The book included an excellent chapter on stroke services and well-researched sections exploring neurological, cognitive, emotional and social issues relating to stroke. The authors discussed a number of psychological interventions for post-stroke difficulties and focused in detail on cognitive and behavioural approaches. One of the real highlights was the chapter on cognitive behaviour therapy for fear of falling. Further exploration of the potential applicability of other psychological and sociological models would have been interesting, although this may reflect the greater infancy of the research base for other approaches within stroke.
Overall I found this a timely text that would be an excellent resource for anyone working in stroke services.
I Wiley Blackwell; 2012; Pb £39.99
Reviewed by Liane Hubbins who is a clinical psychologist
Straightforward self-help tool
Panic Attacks: 10 Steps to Conquer
This app from myCBT was developed by Sue Kemp-Wheeler (Consultant Clinical Psychologist, and lecturer in psychology at the University of Reading). The app delivers a straightforward self-help tool for panic and agoraphobia based on the principles of CBT. It offers clear information about panic attacks and how to over come them, including guidance on strengthening healthy self-talk and healthy imagery in relation to anxiety, ‘instant help’ audio files, and editable interactive tools for diary keeping and overcoming avoidance and safety behaviours associated with panic. Whilst there is evidence that self-help tools based on the principles of CBT can be engaging and helpful for some people in overcoming panic, there doesn’t yet appear to be any evidence for the effectiveness of this specific app.
Panic Attacks is available from iTunes for iPhone or iPad, £2.99
Reviewed by Kate Cavanagh, Senior Lecturer in Clinical Psychology, University of Sussex
A useful resource
When to Use What Research Design
W. Paul Vogt, Dianne C. Gardner & Lynne, M. Haeffele
The selection of a research design that is appropriate to answer a particular question is a central aspect of research, but one that is often tempered by preferences and familiarity. When to Use What Research Design provides a hugely useful resource to navigate through
the initial stages of research design, applicable to students and seasoned researchers alike.
The text is divided into three main sections concerned with design, sampling, and ethics respectively, and within each a chapter dedicated to each of six methodologies – surveys, interviews, experiments, observations, archival research and combined research.
The layout of the book allows the reader to easily select those chapters that are most relevant to their interests, and is facilitated by signposting of additional resources to support the reader. The book is well written and accessible, posing questions throughout to guide the reader through the research process. A useful resource for any researcher.
Guilford Press; 2012; Pb £26.99
Reviewed by Kareena McAloney who is at the University of York
Navigating identity and selfhood
Social Identity in Question: Construction, Subjectivity and Critique
In this book Parisa Dashtipour reads research from the social identity framework (i.e. social identity theory, self-categorisation theory, minimal group studies and group processes) through the work of Lacan and Lacanian scholars. Readers of this book need not be already familiar with the work of Lacan, as Parisa does an excellent job of explaining Lacanian concepts with examples.
She writes that discursive and experimental research does not account for how social categories influence its members. The arguments through the book lead to a convincing justification for why
a psychoanalytic approach to social identity processes is needed. Indeed, she points out that many social identity concepts are in fact rooted within psychoanalysis. This inevitably has implications for consideration of the underpinning concepts of the experimental social identity framework, making it then necessary to question certain concepts in psychology that are taken to be ‘fact’, such as individuals as being unitary, rational and transparent.
Overall, the book makes for a sophisticated and first-class account of the social identity framework and should be considered of interest by students and scholars in psychology.
Routledge; 2012; Pb £19.99
Reviewed by Alexander John Bridger who is a Senior Lecturer at the University of Huddersfield
Make time for quality radio
All in the Mind: The Digital Human
BBC Radio 4
I have to admit BBC Radio 4 doesn’t play a big part in my life. While some people seem to manage to listen to the Today programme while getting their kids ready for school, I’m more likely to be subjected to Pokémon or Phineas and Ferb. Once at work, the online temptation of the written word leads me to bypass the iPlayer. But my new year’s resolution has to be to listen to more, and in particular to never miss an episode of All in the Mind or the Digital Human.
I’ve written about both in The Psychologist before, and I make no apologies for doing so again. They are simply fantastic. The presenters, Claudia Hammond and Aleks Krotoski, are engaging and well-informed – both with a background in psychology. Both are instrumental in shaping the series, ably supported by first class producers.
I think what impresses me the most is how both programmes deal with caveats and nuances. In print, even in the ‘quality’ newspapers, there is often a tendency to hyperbole. Radio, or these series at least, seem far less susceptible to this. For example, in the episode of All in the Mind I have just listened to, Hammond tackled polygraph testing for sex offenders (as we did in ‘News’, September 2012). First, she talked to Dr Jane Wood, a forensic psychologist from the University of Kent and one of the authors of the Midlands polygraph pilot evaluation, describes the results which so impressed the Ministry of Justice that they are planning, subject to parliamentary time and approval, to roll out compulsory testing within 12 months in England and Wales. Convicted sex offenders who'd served their sentence and were out on licence in the community were more likely to admit to risky behaviour if they were to be given a polygraph test. It was in the pre-test discussion that offenders seemed to reveal the most: as Hammond said, perhaps it’s the fear of the test as much as the test itself. Hammond also spoke to Dr Sharon LeaI, from the International Centre for Forensic Research in Psychology at the University of Portsmouth, who criticised the lack of evidence around polygraph use, and Don Grubin, Professor of Forensic Psychiatry at Newcastle University, who said the polygraph can play an important role in the management of dangerous sex offenders.
The Digital Human is similarly thorough. For every bit of ‘brave new world’ boggling of the mind, there’s a cautious and evidence-based step back. The programme raises profound and surprising implications of technology without ever getting carried away. Krotoski talks to
a wide variety of characters but always takes a scientifically informed approach.
I’m also amazed by how much these programmes can pack into half an hour. That All in the Mind episode also featured Ellie Ratcliffe, an environmental psychology postgraduate at University of Surrey, on the benefits of birdsong, and contributions from Nichola Rumsey and Diana Harcourt from the Centre for Appearance Research in Bristol (see ‘Big picture’, December). As a discipline, I think psychology
is lucky to have these programmes, and with so much effort clearly going into making each perfectly produced package it’s the least I can do to make half an hour to listen to them.
I Reviewed by Jon Sutton
Expert advice for expert witnesses
Psychopathy and the Law: A Practitioner’s Guide
Helinä Häkkänen-Nyholm and Jan-Olof Nyholm (Eds.)
Psychopathy is a concept that is often used in the criminal justice system and that can have important implications for sentencing decisions; however, it is not listed as a specific disorder in either
the DSM-IV or ICD-10. This unusual situation presents unique difficulties for professionals involved in the legal aspects of the assessment of psychopathy.
Those working in the fields of both law and forensic mental health have a professional and moral duty to ensure that they have
a clear understanding of the many complex issues involved in this area. This book is a collection of writings by many of the leading practitioners in the fields of forensic psychology and psychiatry.
It provides clear, practical information for the assessment of psychopathy and a good overview of current research and the legal implications of empirical findings. In addition, there are chapters
on specific areas such as psychopathy in women and in adolescents.
This book is essential reading for anyone who is involved in providing or utilising expert witness evidence in cases pertaining
to individuals with psychopathic traits.
I Wiley-Blackwell; 2012; Pb £32.99
Reviewed by Evelyn Gibson who is a Chartered Psychologist
Question your assumptions
Motivate – Tool for motivating using psychology
Wise Leader Group
In the words of its developer, Society member Terry Sexton: ‘The “Motivation” app applies Dr David McClelland’s theory of motivation. In our consultancy work we spend a lot of time helping managers to understand how people have different motivation drivers. We find most managers start their career with the unconscious assumption that other people are motivated in the same way they are. We use McClelland’s work as it is a simple way to help managers recognise the different drivers in other people to enable them to “flex” their own approach. Essentially, we have now put the insights we give managers, on development programmes, in an App form. This overcomes the fact that we all forget most of what we learn on course very soon after we walk out of the room. Managers can now keep the insights with them in their pocket.’
It’s a simple app, just a few questions where you select which of the three statements are most and least like the person you are trying to motivate. A profile is created, with recommendations for how to motivate that person. As Sexton says, it has value as a simple reminder that questions your assumptions. I discovered that what I am doing is spot on, so that’s £1.49 well spent.
I Motivate, Influence, and Team Build apps, all from the Wise Leader Group, are available from iTunes for iPhone or iPad, priced £1.49 or £1.99
Reviewed by Jon Sutton
In the picture
Journal of Visualised Experiments
If a picture speaks a thousand words, jove.com is the journal with an almost unlimited word count. Based on the idea that science progresses through the replication of experimental studies, and that the ‘written word and static picture-based traditional print journals are no longer sufficient to accurately transmit the intricacies of modern research’, it publishes video journal articles of research experiments. For the more neuroscience-oriented psychologists among us it provides a useful addition to the research arena, and a great opportunity for budding neuroscientists to see research firsthand.
I Reviewed by Paul Redford, UWE Bristol
The big question
Do you know what I’m thinking?
University of Manchester
‘Can you tell what I’m thinking?’ As psychologists, it’s a question we’ve all been asked. Now a group of psychologists from University of Manchester School of Psychological Sciences have given their answers.
You can watch Deborah Talmi, Penny Lewis, Luke Jones, Warren Mansell, Ellen Poliakoff and Daniela Montaldi at http://t.co/FmRIXFIY. Poliakoff makes an interesting point: ‘People can be quite uncomfortable with the idea that you can read their mind, and it makes me think that I shouldn’t mention psychology when I meet people. Whether saying “cognitive neuroscience” is any better is an open question.’
I Reviewed by Jon Sutton, Managing Editor
There’s more coming up
Drugs live: the Ecstasy trial
This year, a television company funded a scientific research study for the first time. Channel 4 funded an experiment on the condition they could film part of it for a documentary: Drugs Live: the Ecstasy Trial. University College London and Imperial College collaborated with the television team in this novel way, which may provide a template for future science-media collaborations.
‘When Channel 4 first approached us we thought being live was a dreadful idea’, said Val Curran, Professor of Psychopharmacology at University College London. Professor Curran devised the study along with Professor David Nutt, of Imperial College. Professor Curran was very aware of the ethical dilemmas that the programme could pose. The programme filmed a study where people were being given either a placebo or a controlled dose of MDMA. Potentially participants would be consenting to being filmed in a drug-altered state. In the end the people taking part in filming were those who were used to television recording them or had some experience of working in or handling the media: Lionel Shriver, author of We Need To Talk About Kevin, was one participant. Deputy Editor of New Scientist, Graham Lawton, was another.
In the current climate of financial difficulties in higher education, it was no small gesture that Channel 4 funded the study. It meant the difference between the research happening or not. ‘Having the first 16 participants go through in the usual way was great and then subsequent people who volunteered were media-savvy people who were filmed’, said Professor Curran. ‘It was quite an adventure’, she continued. ‘Some people thought it was a sensationalist thing to do but we wanted to get across the science of drug research. It was a compromise. We had to talk in soundbites, sometimes at the expense of details about the science.’ Professor Curran acknowledged the tensions: ‘It was a two way thing, a process of trust between the scientists and the television folk. We wanted to keep the science rigorous and they wanted to make the TV programmes exciting. We learnt how to communicate and understand their viewpoint, and vice versa.’
In the end Professor Curran thought the compromise worked out well enough. ‘I hope people saw that we did try to achieve a balance. We would have liked more science in the programme but 2.3 million people – many between 18 and 25 – watched the first episode… we wouldn’t get 2.3 million 18-25 year olds reading our scientific papers.’ As Professor Curran recognised, the programme was a hot topic: ‘Twitter went crazy’.
The issue of the controlled use of MDMA as an adjunct to therapy hit the mainstream press as well. Professor Curran’s interests lie in the clinical applications of the use of some of the drugs which are usually seen as ‘recreational’, and MDMA has been highlighted as potentially useful in treating post-traumatic stress disorder. ‘I’m interested in the psychological mechanisms by which MDMA might impact on psychological therapies, for example via enhancing the therapeutic alliance’, said Professor Curran. ‘If we can find things that work synergistically with psychological treatments then that’s a good thing.’ Professor Curran notes the evidence-base is as yet not substantial enough to draw firm conclusions about the role for MDMA in therapy, but is hopeful about this avenue of research:
‘I don’t think that the evidence is there yet but it’s important that people at least have a look. Let’s explore possibilities.’
As for collaborating in this type of way with television, Professor Curran seemed cautiously optimistic. ‘Having done the programme once we’ve learned a lot. There’s probably more coming.’ Watch this space.
I Reviewed by Lucy Maddox, a Clinical Psychologist in the NHS and Associate Editor for ‘Reviews’
‘Flying along by the seat of our pants’
The Mind Reader: Unlocking my Voice
BBC One Panorama
Professor Adrian Owen, University of Western Ontario, Canada, reviewed his own involvement in the BBC One Panorama special, which followed a group of severely brain injured patients and revealed the revolutionary efforts made by Professor Owen and his team to help them communicate with their families and the outside world. For more information on the research, see Professor Owen’s article in the June 2010 issue (tinyurl.com/owen0610).
The programme generated a lot of interest from around the world, both from the media and from families of patients, and without exception it was positive. I was impressed with how the BBC managed to weave together the stories of the five patients with the science behind our investigations. They had a very tough job to do and it took the best part of two years to do it. I suppose me moving from Cambridge to London Ontario mid way through didn’t help them, but they were very keen to ‘follow the science’ and came out twice to spend a week or so following my team and I as we went from patient to patient.
In the end I was very happy with how our studies were portrayed. It pretty much is just like it appeared in the programme… flying along by the seat of our pants most of the time, often making difficult decisions depending on whether a patient is responsive or not and how responsive they are.
The families were fantastic. Given all they have to put up with it was very generous of them to give up their time and help make the programme. I hope it raises awareness about these patients and how little is being done to mitigate their challenging circumstances. I also hope it shows the public how science really works day to day and how their precious research funds get spent!
Oh brother – plenty to learn
A Friend’s and Relative’s Guide to Supporting the Family with Autism:
How Can I Help?
The first thing I noticed about Ann Palmer’s most recent book on autistic spectrum disorder (ASD) was its ease of accessibility. The book is written in a very friendly, engaging and honest manner, drawing on Palmer’s personal experiences as well as those of other parents of children with ASD.
There is just enough background information on prevalence, research and theories without being jargon-heavy, but with signposting to further reading and resources should one be interested developing their understanding of the disorder.
The narrative is very normalising, whilst acknowledging the diversity of experiences people will have, and the individuality of each child with autism.
The book will be a valuable resource for relatives, friends and parents, with clear and achievable guidance for each party. Although not aimed at professionals, the book may aid understanding and empathy.
As a sibling of a, now adult, girl with Asperger’s syndrome, I would have welcomed this resource during my family’s adjustment to life with ASD. Even now, there is plenty that I can learn from this book, both as a professional and a brother.
I Jessica Kingsley; 2012; Pb £12.99
Reviewed by Nicolas Burden who is an assistant psychologist – Recovery/Service Development
Music from the dark side of the mind
I’m going slightly mad
In common with Jimmie Lunceford and his Orchestra on the first track of this compilation, ‘I’m nuts about screwy music’. When it comes to wearing mental abnormality on their sleeve, today’s pop stars can’t come close to some of the protagonists in these stories of suicide, psychopathy and spasms stretching from 1935 to 1962.
Highlights include Betty Hutton, rising to fame during World War II against a background of her deserting father’s suicide and mother’s alcoholism. Her theatrical ‘Blow a fuse (It’s oh so quiet)’ was overhauled in 1995 by everyone’s favourite eccentric chanteuse Björk, but it’s well worth watching the original on YouTube. So is Beatrice Kay’s spectacularly unhinged ‘Hooray hooray, I’m going’ away’.
Buddy Knox’s ‘I think I’m gonna kill myself’ is rather more jolly than the title would suggest, and Little Willie John’s ‘Spasms’ is an interesting attempt to reconjure in more manic fashion the magic of lovestruck ‘Fever’. Woody Leafer’s ‘There are drums in my typewriter’ is genuinely unnerving.
Not the most politically correct compilation you’ll come across, but an intriguing historical and cultural artefact for those who prefer to confront the dark side of the mind head on.
I Available from www.chromedreams.co.uk
Reviewed by Jon Sutton
Death: A self-portrait
The Wellcome Collection’s major winter exhibition is all about the iconography of death. Designed around five themed rooms, there are 300 objects on show from the private collection of Richard Harris, a former antique-print dealer based in Chicago.
My favourite artefact is ‘Curious snake exploring a skull’, by Izumi Sukeyuki from around 1900. This ‘okimono’ expresses the Buddhist vision of the ongoing existence of the soul, which is believed to undergo perpetual transformation into new states of being. The skull is inhabited by the snake, which is believed to be reborn every time it sheds its skin.
The exhibition runs until 24 February at the Wellcome Collection, Euston Road, London. A website supporting the exhibition, with images, interviews and more, can be found at http://tinyurl.com/welldeath.
I Reviewed by Jon Sutton
As you may have noticed, ‘Book reviews’ have changed. We are now interested in covering psychology in any form of media: books, yes, but also film, app, play, TV, radio, newspaper, music, exhibition… you name it, we would like to hear your suggestions for what to cover. Please e-mail the Associate Editor, Lucy Maddox, on [email protected].
We still need book reviewers. Sample titles just in:
The Psychology of Coaching and Mentoring Passmore et al. (Eds.)
Bullying Interventions in Schools Ken Rigby
Development Through Adulthood Oliver Robinson
For a full list of books available for review and information on reviewing for The Psychologist, see www.bps.org.uk/books
Send books for potential review to The Psychologist,
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