Andrew Marshall

What is the Hearing Voices Movement?

Published on 03/31/202206/02/2022 by Andrew Marshall1 Comment

Introduction

The Hearing Voices Movement (HVM) is the name used by organisations and individuals advocating the “hearing voices approach”, an alternative way of understanding the experience of those people who “hear voices”.

In the medical professional literature, ‘voices’ are most often referred to as auditory verbal hallucinations. The movement uses the term ‘hearing voices’, which it feels is a more accurate and ‘user-friendly’ term.

The movement was instigated by Marius Romme, Sandra Escher and Patsy Hage in 1987. It challenges the notion that to hear voices is necessarily a characteristic of mental illness. Instead it regards hearing voices as a meaningful and understandable, although unusual, human variation. It therefore rejects the stigma and pathologisation of hearing voices and advocates human rights, social justice and support for people who hear voices that is empowering and recovery focused. The movement thus challenges the medical model of mental illness, specifically the validity of the schizophrenia construct.

Refer to Hearing Voices Network.

Brief History

The international Hearing Voices Movement is a prominent mental health service-user/survivor movement that promotes the needs and perspectives of experts by experience in the phenomenon of hearing voices (auditory verbal hallucinations). The main tenet of the Hearing Voices Movement is the notion that hearing voices is a meaningful human experience.

The Hearing Voices Movement regards itself and is regarded by others as being a post-psychiatric organisation. It positions itself outside of the mental health world in recognition that voices are an aspect of human difference, rather than a mental health problem. One of the main issues of concern for the Hearing Voices Movement is empowerment and human rights as outlined in its Melbourne Hearing Voices Declaration 2013 and Thessaloniki Declaration 2014.

The Hearing Voices Movement also seeks holistic health solutions to problematic and overwhelming voices that cause mental distress. Based on their research, the movement espouses that many people successfully live with their voices. In themselves voices are not seen as the problem. Rather it is the relationship the person has with their voices that is regarded as the main issue. Research indicates that mindfulness-based interventions can be beneficial for people distressed by hearing voices.

The Hearing Voices Movement has developed interventions for mental health practitioners to support people who hear voices and are overwhelmed by the experience.

Position

The position of the hearing voices movement can be summarised as follows:

Hearing voices is not in itself a sign of mental illness.
Hearing voices is part of the diversity of being a human, it is a faculty that is common (3-10% of the population will hear a voice or voices in their lifetime) and significant.
Hearing voices is experienced by many people who do not have symptoms that would lead to diagnosis of mental illness.
Hearing voices is often related to problems in life history.
If hearing voices causes distress, the person who hears the voices can learn strategies to cope with the experience.
Coping is often achieved by confronting the past problems that lie behind the experience.

Theoretical Overview

The work of Marius Romme, Sandra Escher and other researchers provides a theoretical framework for the movement. They find that:

Not everyone who hears voices becomes a patient. Over a third of 400 voice hearers in the Netherlands they studied had not had any contact with psychiatric services. These people either described themselves as being able to cope with their voices and/or described their voices as life enhancing.
Demographic (epidemiological) research carried out over the last 120 years provides evidence that there are people who hear voices in the general population (2%-6%) who are not necessarily troubled by them). Only a small minority fulfil the criteria for a psychiatric diagnosis and, of those, only a few seek psychiatric aid indicating that hearing voices in itself is not necessarily a symptom of an illness. Even more (about 8%) have peculiar delusions and do so without being ill.
People who cope well with their voices and those who did not, show clear differences in terms of the nature of the relationship they had with their voices.
People who live well with their voice experience use different strategies to manage their voices than those voice hearers who are overwhelmed by them.
70% of voice hearers reported that their voices had begun after a severe traumatic or intensely emotional event such as an accident, divorce or bereavement, sexual or physical abuse, love affairs, or pregnancy. Romme and colleagues found that the onset of voice hearing amongst a patient group was preceded by either a traumatic event or an event that activated the memory of an earlier trauma.
Specifically, there is a high correlation between voice hearing and abuse. These findings are being substantiated further in on-going studies with voice hearing amongst children.
Some people who hear voices have a deep need to construct a personal understanding for their experiences and to talk to others about it without being designated as mad.

Romme, colleagues and other researchers find that people who hear voices can be helped using methods such as voice dialoguing cognitive behaviour therapy (CBT) and self-help methods.

Romme theorises a three phase model of recovery:

Startling	Initial confusion; emotional chaos, fear, helplessness and psychological turmoil.
Organisation	The need to find meaning, arrive at some understanding and acceptance. The development of ways of coping and accommodating voices in everyday living. This task may take months or years and is marked by the attempt to enter into active negotiation with the voice(s).
Stabilisation	The establishment of equilibrium, and accommodation, with the voice(s), and the consequent re-empowerment of the person.

Alternative to Medical Model of Disability

The Hearing Voices Movement disavows the medical model of disability and disapproves of the practises of mental health services through much of the Western world, such as treatment solely with medication. For example, some service users have reported negative experiences of mental health services because they are discouraged from talking about their voices as these are seen solely as symptoms of psychiatric illness. Slade and Bentall conclude that the failure to attend to hallucinatory experiences and/or have the opportunity for dialogue about them is likely to have the effect of helping to maintain them.

In Voices of Reason, Voices of Insanity, Leudar and Thomas review nearly 3,000 years of voice-hearing history. They argue that the Western World has moved the experience of hearing voices from a socially valued context to a pathologised and denigrated one. Foucault has argued that this process can generally arise when a minority perspective is at odds with dominant social norms and beliefs.

Organisation

The Hearing Voices Movement was established in 1987 by Romme and Escher, both from the Netherlands, with the formation of Stichting Weerklank (Foundation Resonance), a peer led support organisation for people who hear voices. In 1988, the Hearing Voices Network was established in England with the active support of Romme. Since then, networks have been established in 35 countries.

INTERVOICE (The International Network for Training, Education and Research into Hearing Voices) is the organisation that provides coordination and support to the Hearing Voices Movement. It is supported by people who hear voices, relatives, friends and mental health professionals including therapists, social workers, nurses, psychiatrists and psychologists.

INTERVOICE was formed in 1997, at a meeting of voice hearers, family members and mental health workers was held in Maastricht, Netherlands to consider how to organise internationally further research and work about the subject of voice hearing. The meeting decided to create a formal organisational structure to provide administrative and coordinating support to the wide variety of initiatives in the different involved countries.

The organisation is structured as a network and was incorporated in 2007 as a non-profit company and charity under UK law. It operates under the name of International Hearing Voices Projects Ltd. The president is Marius Romme and the governing body is made up of people who hear voices and mental health practitioners.

Activities

Hearing Voices Groups

Hearing Voices Groups are based on an ethos of self-help, mutual respect and empathy. They provide a safe space for people to share their experiences and to support one another. They are peer support groups, involving social support and belonging, not necessarily therapy or treatment. Groups offer an opportunity for people to accept and live with their experiences in a way that helps them regain some power over their lives. There are hundreds of hearing voices groups and networks across the world. In 2014 there were more than 180 groups in the UK. These include groups for young people, people in prison, women and people from Black and Minority Ethnic communities.

World Hearing Voices Congress

INTERVOICE hosts the annual World Hearing Voices Congress. In 2015 the 7th Congress was held in Madrid, Spain, the 2016 Congress will be held in Paris, France. Previous conferences have been held in Maastricht, Netherlands, (2009); Nottingham, England (2010), Savona, Italy (2011), Cardiff, Wales (2012); Melbourne, Australia (2013); Thessaloniki, Greece (2014); Madrid, Spain (2015).

Annual World Hearing Voices Day

This is held on 14 September and celebrates hearing voices as part of the diversity of human experience, It seeks to increase awareness of the fact that you can hear voices and be healthy. It also challenges the negative attitudes towards people who hear voices and the assumption that hearing voices, in itself, is a sign of mental illness.

Website and Social Media Platforms

INTERVOICE maintains several forums on Twitter, Facebook and other social media platforms.

Research Committee

INTERVOICE has an international research committee, that commissions research, encourages and supports exchanges and visits between member countries, the translation and publication of books and other literature on the subject of hearing voices and other related extraordinary experiences.

Impact

Appearances in Media

Hearing Voices, Horizon Documentary, BBC, UK (1995).
Angels and Demons directed by Sonya Pemberton, f2003; produced by ABC Commercial, in Enough Rope, Episode 162.
The Doctor Who Hears Voices, Channel 4, UK.
The voices in my head TED2013, Filmed February 2013.

Hearing Voices Network Cymru (Wales) maintains a media archive of articles and news items about hearing voices for the last seven years.

A study investigating media reports of the experience of hearing voices found that 84% of the articles in the study contained no suggestion that voice-hearing can be ‘normal’. Half of those that did, put voice-hearing in a religious or spiritual context, for example considering the case of Joan of Arc. Most of the articles (81.8%) connected voice-hearing to mental illness. In some cases, auditory verbal hallucinations were simply equated with insanity.

Criticism of the Hearing Voices Movement

The Hearing Voices Movement has been criticised for its stance on medication and schizophrenia and for promoting non-medical and non-evidence-based approaches to severe mental illnesses in articles by Susan Inman from the Huffington Post, such as “People Who Hear Voices Need Science-Based Advice” in 2013, and “What You’re not Hearing About the Hearing Voices Movement” in 2015.

Specific criticisms of the hearing voices approach include:

Using ideas that do not support science-based ways of understanding illness.
Undermines people’s trust in medical help that might be crucial to their wellbeing.
Encourages people to focus on their voices when they may be having a hard time differentiating between what is real and what is not real.
Does not recognise the very different needs of people with severe mental illnesses.
By failing to differentiate between the needs of people who actually have psychotic disorders and those who do not, HVM poses serious risks.
Poses real danger for the substantial number of people who lack insight into their psychotic disorder.
People struggling with psychotic symptoms should not be advised to emphasize the meaning of auditory hallucinations.

What is Hypervigilance?

Published on 03/31/2022 by Andrew MarshallLeave a comment

Introduction

Hypervigilance is when the nervous system is inaccurately filtering sensory information and the individual is in an enhanced state of sensory sensitivity.

This appears to be linked to a dysregulated nervous system which can often be caused by traumatic events or post-traumatic stress disorder (PTSD).

Background

Normally, the nervous system releases stress signals in certain situations as a defence mechanism to protect one from perceived dangers. In some cases, the nervous system becomes chronically dysregulated, causing a release of stress signals that are inappropriate to the situation, creating inappropriate and exaggerated responses. Hypervigilance may bring about a state of increased anxiety which can cause exhaustion. Other symptoms include:

Abnormally increased arousal;
A high responsiveness to stimuli; and
A constant scanning of the environment.

In hypervigilance, there is a perpetual scanning of the environment to search for sights, sounds, people, behaviours, smells, or anything else that is reminiscent of activity, threat or trauma. The individual is placed on high alert in order to be certain danger is not near. Hypervigilance can lead to a variety of obsessive behaviour patterns, as well as producing difficulties with social interaction and relationships.

Hypervigilance is differentiated from dysphoric hyperarousal in that the person remains cogent and aware of their surroundings. In dysphoric hyperarousal, a person with PTSD may lose contact with reality and re-experience the traumatic event verbatim. Where there have been multiple traumas, a person may become hypervigilant and suffer severe anxiety attacks intense enough to induce a delusional state where the effects of related traumas overlap. This can result in the thousand-yard stare.

Hypervigilance can be a symptom of PTSD and various types of anxiety disorders. It is distinguished from paranoia. Paranoid diagnoses, such as can occur in schizophrenia, can seem superficially similar, but are characteristically different.

Symptoms

People suffering from hypervigilance may become preoccupied with scanning their environment for possible threats. They might ‘overreact’ to loud and unexpected noises, exhibit an overactive startle response or become agitated in highly crowded or noisy environments. They will often have a difficult time getting to sleep or staying asleep.

Sustained states of hypervigilance, lasting for a decade or more, may lead to higher sensitivity to disturbances in their local environment, and an inability to tolerate large gatherings or groups. After resolution of the situation demanding their attention, people exhibiting hypervigilance may be exhausted and require time to ‘recharge’ before returning to normal activities.

On This Day … 31 March [2022]

Published on 03/31/202203/22/2022 by Andrew MarshallLeave a comment

People (Births)

1930 – Yehuda Nir, Polish-American psychiatrist (d. 2014).

People (Deaths)

2007 – Paul Watzlawick, Austrian-American psychologist and philosopher (b. 1921).

Yehuda Nir

Yehuda Nir (31 March 1930 to 19 July 2014) was a Polish-born American Holocaust survivor, psychiatrist and author of The Lost Childhood.

Nir posed as a Roman Catholic and learned Latin to escape Nazi persecution in Poland during World War II. Nir’s ordeal led him to a career as a psychiatrist, specialising in the treatment of post-traumatic stress disorder and severely ill children. He immigrated to the United States in 1959 to complete medical residencies in New York City and Philadelphia. He served as the chief of child psychiatry of Memorial Sloan-Kettering Cancer Centre from 1979 until 1986.

Paul Watzlawick

Paul Watzlawick (25 July 1921 to 31 March 2007) was an Austrian-American family therapist, psychologist, communication theorist, and philosopher.

A theoretician in communication theory and radical constructivism, he commented in the fields of family therapy and general psychotherapy. Watzlawick believed that people create their own suffering in the very act of trying to fix their emotional problems. He was one of the most influential figures at the Mental Research Institute and lived and worked in Palo Alto, California.

Who is Jaqueline Gomes de Jesus?

Published on 03/30/2022 by Andrew Marshall1 Comment

Introduction

Jaqueline Gomes de Jesus (born 07 March 1978) is a Brazilian psychologist, writer, and LGBT activist.

Biography

Jesus is the daughter of a computer operator and a mining science teacher. She has a sibling, a younger brother. Jesus lived most of her life in Ceilândia.

A good student, she studied chemistry, for a year before switching majors. She holds an M.Sc. in Psychology from the University of Brasília, and a PhD in Social Psychology, Work and Organisations from the same institution.

She worked at the University of Brasília from 2003-2008 as a diversity adviser and also coordinated a centre for black students. She was one of the organisers of Brasilia’s Pride parade, and participated in the development of Brazil’s goals for the UN’s Millennium Dome. Jesus has proactively addressed discriminatory actions, refusing to accept passive prejudice. She began her human rights activism in 1997, with “Estructuración”, a Brasilia homosexual group, serving first as secretary and in 1999, became president. In that period, she worked alongside government and educational institutions, in fighting prejudice and valuing differences, speaking at the opening of the 5th National Conference on Human Rights.

Jesus participated in various social movements. In 2000, with Luiz Mott, she co-founded the Academic Association of Gays, Lesbians and Sympathizers of Brazil, serving as general secretary. She was appointed to the editorial board of the Grupo Gay Negro de Bahia; and founded the NGO Acciones Ciudades en Orientación sexual.

Key Publications

Homofobia : identificar e prevenir, 2015 (tr. “homophobia: identifying and preventing”).
Ainda que tardia : escravidão e liberdade no Brasil contemporâneo, 2016 (tr. “Although late: slavery and freedom in contemporary Brazil”).

Who was Morton Bard?

Published on 03/30/2022 by Andrew Marshall1 Comment

Introduction

Morton Bard (born 07 March 1924 in Brooklyn, New York and died 04 December 1997) was an American psychologist, known for the research he undertook on the psychology of crime victims. He was a one-time member of the New York Police Department, a psychologist, and a professor who studied the reactions of crime victims.

Bard, in partnership with the police, conducted studies of crime victims (e.g. hostages, rape victims, and the families of murder victims). He published two volumes on domestic violence and crisis intervention. He also is recognised for having laid the foundation of victim-focused training into many law enforcement academies and the FBI National Academy.

In 1979, Bard co-authored The Crime Victim’s Book. This volume provides practical information on how best to identify and support the needs of crime victims. The Crime Victim’s Book was considered a “bible” for not only advocates but also crime victims. He is considered to have been a pivotal critical thinker in the development of the modern discipline of crisis intervention. He also wrote scholarly articles on the training of police officers in the application of different forms of crisis intervention out in the field.

Education

Bard received a bachelor’s degree in 1947 from St. John’s University. He later went on to receive a master’s degree in 1948 and a doctorate in 1953, both in psychology from New York University.

Career

Bard started off his career in health psychology. From 1951 to 1961, he was a member of a clinical and research group at Memorial Sloan-Kettering Cancer Centre. There, he analysed the psychological effects of cancer and cancer surgery. During this time, Bard shifted the psychological focus from the role of personality in predisposing one to illnesses to the psychological consequences of living with illnesses like cancer.

From 1965 to 1970, Bard taught at the City College of New York and was the director of its Psychology Centre. In 1971, Bard joined CUNY’s graduate school and university centre. He was a professor in the graduate school’s doctoral programs in social psychology and criminal justice. At the CUNY Graduate School, Bard studied hostage situations, third-party interventions in disputes, and the effects of personal crimes. Bard was a psychology professor at the City University of New York until his retirement in 1986.

In 1982, Bard was named chairman of the American Psychological Association’s task force on victims of crime and violence. In 1982, he was awarded the New York State Psychological Association ’s Kurt Lewin Award.

In 1985, he was appointed to a committee to advise the New York Mayor, Edward I. Koch, on the police department. The panel went on to make recommendations that included comprehensive changes in the training of police officers. Bard laid down the groundwork for training police as specialists in family crisis intervention. This included training for police officers on innovative crime prevention and mental health techniques so they were better able to provide immediate crisis intervention when emergencies arose and other professionals (e.g. social workers, psychologists) were not available.

In the 1980s, Bard was a consultant in psychology to the departments of medicine and neurology at Memorial Sloan-Kettering, which in 1987 awarded him the Arthur M. Sutherland Award for “pioneering research in psycho-oncology.”

He was also the American Cancer Society’s national vice president for service and rehabilitation from 1986 to 1991.

Personal Life

Bard married Arlene Cohen in 1948 and had two daughters (Erica Riley and Pamela Richlin).

Death

Bard died of cancer in his home in Atlanta, Georgia at the age of 73 on 04 December 1997.

Publications

Bard, M., & Sutherland, A. M. (1955). Psychological impact of cancer and its treatment IV. Adaptation to radical mastectomy. Cancer, 8(4), 656-672.

Bard, M., & Berkowitz, B. (1967). Training police as specialists in family crisis intervention: A community psychology action program. Community Mental Health Journal, 3, 315–317.

Bard, M. (1969). Family intervention police teams as a community mental health resource. Journal of Criminal Law, Criminology and Police Science, 60, 247–250.

Bard, M., & Sangrey. D. (1986). The Crime Victim’s Book. Secaucus, NJ: Citadel Press.

Zacker, J., & Bard, M. (1973). Effects of conflict management training on police performance. Journal of Applied Psychology, 58(2), 202.

What is Foreclosure (Psychoanalysis)?

Published on 03/30/2022 by Andrew MarshallLeave a comment

Introduction

Foreclosure (also known as “foreclusion”; French: forclusion) is the English translation of a term that the French psychoanalyst Jacques Lacan introduced into psychoanalysis to identify a specific psychical cause for psychosis.

Brief History

According to Élisabeth Roudinesco, the term was originally introduced into psychology ‘in 1928, when Édouard Pichon published, in Pierre Janet’s review, his article on “The Psychological Significance of Negation in French”: “…[and] borrowed the legal term forclusif to indicate facts that the speaker no longer sees as part of reality’.

According to Christophe Laudou, the term was introduced by Damourette and Pichon.

Freud vs Laforgue

The publication took part against the background of the Twenties dispute between Freud and René Laforgue over scotomisation. ‘If I am not mistaken’, Freud wrote in 1927, ‘Laforgue would say in this case that the boy “scotomises” his perception of the woman’s lack of a penis. A new technical term is justified when it describes a new fact or emphasizes it. This is not the case here’. Freud went on to suggest that if one wanted to ‘reserve the word “Verdrängung” [“repression”] for the affect, then the correct German word for the vicissitude of the idea would be “Verleugnung” [“disavowal”]’.

Lacan’s Introduction of Foreclosure

In 1938 Lacan relates the origin of psychosis to an exclusion of the father from the family structure thereby reducing this structure to a mother-child relationship. Later on, when working on the distinctions between the real, imaginary and symbolic father, he specifies that it is the absence of the symbolic father which is linked to psychosis.

Lacan uses the Freudian term, Verwerfung, which the “Standard Edition” translates as “repudiation”, as a specific defence mechanism different from repression, “Verdrängung”, in which “the ego rejects the incompatible idea together with its affect and behaves as if the idea has never occurred to the ego at all.” In 1954 basing himself on a reading of the “Wolf Man” Lacan identifies Verwerfung as the specific mechanism of psychosis where an element is rejected outside the symbolic order as if it has never existed. In 1956 in his Seminar on Psychoses he translates Verwerfung as forclusion, that is foreclosure. “Let us extract from several of Freud’s texts a term that is sufficiently articulated in them to designate in them a function of the unconscious that is distinct from the repressed. Let us take as demonstrated the essence of my Seminar on the Psychoses, namely, that this term refers to psychosis: this term is Verwerfung (foreclosure)”.

Lacan and Psychosis

The problem Lacan sought to address with the twin tools of foreclosure and the signifier was that of the difference between psychosis and neurosis, as manifested in and indicated by language usage. It was common analytic ground that “when psychotics speak they always have some meanings that are too fixed, and some that are far too loose, they have a different relation to language, and a different way of speaking from neurotics.” Freud, following Bleuler and Jung had pointed to ‘a number of changes in speech…in schizophrenics…words are subjected to the same process as that which makes the dream’. Lacan used foreclosure to explain why.

When Lacan first uses the Freudian concept of Verwerfung (repudiation) in his search for a specific mechanism for psychosis, it is not clear what is repudiated (castration, speech). It is in 1957 in his article “On a question preliminary to any possible treatment of psychosis” that he advances the notion that it is the Name-of-the-Father (a fundamental signifier) that is the object of foreclosure. In this way Lacan combines two of his main themes on the causality of psychosis: the absence of the father and the concept of Verwerfung. This ideas remains central to Lacan’s thinking on psychosis throughout the rest of his work.

Lacan considered the father to play a vital role in breaking the initial mother/child duality and introducing the child to the wider world of culture, language, institutions and social reality – the Symbolic world – the father being “the human being who stands for the law and order that the mother plants in the life of the child…widens the child’s view of the world.” The result in normal development is “proper separation from the mother, as marked out by the Names-of-the-father.” Thus Lacan postulates the existence of a paternal function (the “Name of the Father” or “primordial signifier”) which allows the realm of the Symbolic to be bound to the realms of the Imaginary and the Real. This function prevents the developing child from being engulfed by its mother and allows him/her to emerge as a separate entity in his/her own right. It is a symbol of parental authority (a general symbol that represents the power of father of the Oedipus complex) that brings the child into the realm of the Symbolic by forcing him/her to act and to verbalise as an adult. As a result, the three realms are integrated in a way that is conducive to the creation of meaning and successful communication by means of what Lacan calls a Borromean knot.

When the Name-of-the-Father is foreclosed for a particular subject, it leaves a hole in the Symbolic order which can never be filled. The subject can then be said to have a psychotic structure, even if he shows none of the classical signs of psychosis. When the foreclosed Name-of-the-Father re-appears in the Real, the subject is unable to assimilate it and the result of this collision between the subject and the inassimilable signifier of the Name-of-the-father is the entry into psychosis proper characterized by the onset of hallucinations and/or delusions. In other words, when the paternal function is “foreclosed” from the Symbolic order, the realm of the Symbolic is insufficiently bound to the realm of the Imaginary and failures in meaning may occur (the Borromean knot becomes undone and the three realms completely disconnected), with “a disorder caused at the most personal juncture between the subject and his sense of being alive.” Psychosis is experienced after some environmental sign in the form of a signifier which the individual cannot assimilate is triggered, and this entails that “the Name-of-the-Father, is foreclosed, verworfen, is called into symbolic opposition to the subject.” The fabric of the individual’s reality is ripped apart and no meaningful Symbolic sense can be made of experience. “Absence of transcendence of the Oedipus places the subject under the regime of foreclosure or non-distinction between the symbolic and the real’; and psychotic delusions or hallucinations are the consequent result of the individual’s striving to account for what he/she experiences.

What is Functional Analysis (Psychology)?

Published on 03/30/2022 by Andrew MarshallLeave a comment

Introduction

Functional analysis in behavioural psychology is the application of the laws of operant and respondent conditioning to establish the relationships between stimuli and responses.

To establish the function of operant behaviour, one typically examines the “four-term contingency”: first by identifying the motivating operations (EO or AO), then identifying the antecedent or trigger of the behaviour, identifying the behaviour itself as it has been operationalised, and identifying the consequence of the behaviour which continues to maintain it.

Functional assessment in behaviour analysis employs principles derived from the natural science of behaviour analysis to determine the “reason”, purpose, or motivation for a behaviour. The most robust form of functional assessment is functional analysis, which involves the direct manipulation, using some experimental design (e.g. a multielement design or a reversal design) of various antecedent and consequent events and measurement of their effects on the behaviour of interest; this is the only method of functional assessment that allows for demonstration of clear cause of behaviour.

Applications in Clinical Psychology

Functional analysis and consequence analysis are commonly used in certain types of psychotherapy to better understand, and in some cases change, behaviour. It is particularly common in behavioural therapies such as behavioural activation, although it is also part of Aaron Beck’s cognitive therapy. In addition, functional analysis modified into a behaviour chain analysis is often used in dialectical behaviour therapy.

There are several advantages to using functional analysis over traditional assessment methods. Firstly, behavioural observation is more reliable than traditional self-report methods. This is because observing the individual from an objective stand point in their regular environment allows the observer to observe both the antecedent and the consequence of the problem behaviour. Secondly, functional analysis is advantageous as it allows for the development of behavioural interventions, either antecedent control or consequence control, specifically designed to reduce a problem behaviour. Thirdly, functional analysis is advantageous for interventions for young children or developmentally delayed children with problem behaviours, who may not be able to answer self-report questions about the reasons for their actions.

Despite these benefits, functional analysis also has some disadvantages. The first that no standard methods for determining function have been determined and meta-analysis shows that different methodologies appear to bias results toward particular functions as well as not effective in improving outcomes. Second, Gresham and colleagues (2004) in a meta-analytic review of JABA articles found that functional assessment did not produce greater effect sizes compared to simple contingency management programmes. However, Gresham et al. combined the three types of functional assessment, of which descriptive assessment and indirect assessment have been reliably found to produce results with limited validity Third, although functional assessment has been conducted with a variety host of populations much of the current functional assessment research has been limited to children with developmental disabilities.

Professional Organisations

The Association for Behavioural and Cognitive Therapies (ABCT) also has an interest group in behaviour analysis, which focuses on the use of behaviour analysis in the school setting including functional analysis.

Doctoral level behaviour analysts who are psychologists belong to the American Psychological Association’s division 25 – Behaviour analysis. APA offers a diplomate in behavioural psychology and school psychology both of which focus on the use of functional analysis in the school setting.

The World Association for Behaviour Analysis offers a certification for clinical behaviour therapy and behavioural consultation, which covers functional analysis.

The UK Society for Behaviour Analysis also provides a forum for behaviour analysts for accreditation, professional development, continuing education and networking, and serves as an advocate body in public debate on issues relating to behaviour analysis. The UK-SBA promotes the ethical and effective application of the principles of behaviour and learning to a wide range of areas including education, rehabilitation and health care, business and the community and is committed to maintaining the availability of high-quality evidence-based professional behaviour analysis practice in the UK. The society also promotes and supports the academic field of behaviour analysis with in the UK both in terms of university-based training and research, and theoretical develop.

Who was Adolf Meyer?

Published on 03/30/2022 by Andrew MarshallLeave a comment

Introduction

Adolf Meyer (13 September 1866 to 17 March 1950) was a Swiss-born psychiatrist who rose to prominence as the first psychiatrist-in-chief of the Johns Hopkins Hospital (1910-1941).

He was president of the American Psychiatric Association in 1927-1928 and was one of the most influential figures in psychiatry in the first half of the twentieth century. His focus on collecting detailed case histories on patients was one of the most prominent of his contributions. He oversaw the building and development of the Henry Phipps Psychiatric Clinic at Johns Hopkins Hospital, opened in April 1913, making sure it was suitable for scientific research, training and treatment. Meyer’s work at the Phipps Clinic is possibly the most significant aspect of his career.

Meyer’s main theoretical contribution was his idea of ergasiology (a term he derived from the Greek for “working” and “doing”) to describe a psychobiology. This brought together all the biological, social and psychological factors and symptoms pertaining to a patient. It considered mental illnesses to be a product of dysfunctional personality not a pathology of the brain. Believing that whole-life social and biological factors should be central to both diagnosis and treatment Meyer was one of the earliest psychologists to support occupational therapy as an important connection between the activities of an individual and their mental health, and incorporated community based activities and services to develop people’s everyday living skills.

Personal Life and Education

Adolf Meyer was born in Niederweningen, Switzerland, in 1866. He was the son of a Zwinglian pastor. Meyer received his MD from the University of Zurich in 1892, where he studied neurology under Auguste Forel. During his time at the university, he studied abroad in Paris, London and Edinburgh, working under John Hughlings Jackson and Jean-Martin Charcot. Unable to secure an appointment with the university, he emigrated to the United States in 1892. Meyer married Mary Brooks on 15 September 1902. They had one daughter, Julia Lathrup Meyer, on 14 February 1916. Meyer died on 17 March 1950, in Baltimore, Maryland, at the age of 83 of a heart attack.

Medical Career

Early Career

After moving to the United States, Meyer first practiced neurology and teaching at the University of Chicago, where he was exposed to the ideas of the Chicago functionalists. He was unable to find a paid full-time post at the University of Chicago, so his time at the university was short-lived. From 1893 to 1895, he served as pathologist at the new mental hospital at Kankakee, Illinois, after which he worked at the state hospital at Worcester, Massachusetts from 1895 to 1902, all the while publishing papers prolifically in neurology, neuropathology, and psychiatry.

Time in New York

In 1902, he became director of the Pathological Institute of the New York State Hospital system (shortly afterwards given its present name, The Psychiatric Institute), where in the next few years he shaped much of American psychiatry by emphasizing the importance of keeping detailed patient records and by introducing both Emil Kraepelin’s classificatory system and Sigmund Freud‘s ideas. While in the New York State Hospital system, Meyer was one of the first importers of Freud’s ideas about the importance both of sexuality and of the formative influence of early rearing on the adult personality. Meyer found many of Freud’s ideas and therapeutic methods insightful and useful, but he rejected psychoanalysis as a wholesale etiological explanation of mental disorders in favour of his own theory of psychobiology. He never practiced psychoanalysis and always kept it at arm’s length from Johns Hopkins because of Freud’s increasingly dogmatic insistence on the psychical causation of mental illnesses. As he wrote in his presidential address to the 84th Annual Meeting of the American Psychiatric Association: “Those who imagine that all psychiatry and psychopathology and therapy have to resolve themselves into a smattering of claims and hypotheses of psychoanalysis and that they stand or fall with one’s feelings about psychoanalysis, are equally misguided”. Meyer was Professor of Psychiatry at Cornell University from 1904 to 1909.

The Phipps Clinic at Johns Hopkins

In 1908, Meyer was asked to become the director of a new psychiatric clinic at the Johns Hopkins Hospital after Henry Phipps Jr. donated 1.5 million dollars to open the clinic. Meyer accepted the offer, which he described as “the most important professorship [in psychiatry] in the English-speaking domain.” He oversaw the building and development of the clinic and made sure the building was suitable for scientific research, training and treatment. The Henry Phipps Psychiatric Clinic opened in April 1913.

Meyer’s work at the Phipps Clinic is arguably the most significant aspect of his career. His model for the Phipps Clinic combined clinical and laboratory work, which was the first time these elements were combined in a mental institute in the United States. Though the Phipps Clinic did not use the clinical model of Emil Kraepelin, Meyer did incorporate some of Kraepelin’s practices into the clinic. These practices include extensive observations of the patients and studying both the pre-symptomatic and remissive phases of mental illness, along with periods of acute illness.

Meyer also served as a Professor of Psychiatry at Johns Hopkins School of Medicine from 1910 to 1941. In his beginning years at Johns Hopkins, Meyer helped oversee the work of a few of his aspiring students. Phyllis Greenacre, from the University of Chicago, and Curt Richter, a Harvard graduate, both had the opportunity to study under Meyer. Most notably, Richter studied the behaviour of rats with Meyer and John Watson, a behavioural psychologist. Adolf Meyer worked at Johns Hopkins until his retirement in 1941.

Legacy

People

Many of Meyer’s students went on to make significant contributions to American psychiatry or psychoanalysis, though not necessarily as Meyerians. Most of the founders of the New York Psychoanalytic Society had worked under Meyer at Manhattan State Hospital, including its chief architect Abraham Arden Brill, and Charles Macfie Campbell.

Meyer and William Henry Welch played an instrumental role in Clifford Beers’ founding of the Connecticut Society for Mental Hygiene in 1908. Under Meyer’s direction, Leo Kanner founded the first child psychiatry clinic in the United States at the Johns Hopkins Hospital in 1930.

Contributions to Psychology

Meyer’s main contribution was in his ideas of psychobiology, where he focused on addressing all biological, social and psychological factors and symptoms pertaining to a patient. Meyer coined the term “ergasiology”, which has Greek roots for “working” and “doing”, as another way to classify psychobiology. One of his ideas was that mental illnesses were a product of a dysfunctional personality and not from the pathology of the brain. He also stressed the idea that social and biological factors that affect someone throughout their entire life should be heavily considered when diagnosing and treating a patient. Another contribution of Meyer was that he was one of the earlier psychologists that supported occupational therapy. He thought there was an important connection between the activities of an individual and their mental health. Taking this into consideration he looked for community based activities and services to aid people with everyday living skills.

Meyer was a strong believer in the importance of empiricism, and advocated repeatedly for a scientific, and, particularly, a biological approach to understanding mental illness. He hoped that the Phipps Clinic would help put mental illness on the same ground as every other human illness. He insisted that patients could best be understood through consideration of their “psychobiological” life situations. He reframed mental disease as biopsychosocial “reaction types” rather than as biologically specifiable natural disease entities. In 1906, he reframed dementia praecox as a “reaction type”, a discordant bundle of maladaptive habits that arose as a response to biopsychosocial stressors.

Meyer was also involved with the Eugenics Records Office, which he viewed as a natural extension of the mental hygiene movement which he helped to create. He served on the advisory council of the American Eugenics Society for 12 years, from 1923 to 1935. Meyer’s views on eugenics have not yet been studied closely and his association with the Eugenics Record Office cannot be equated straightforwardly with the extremism of some eugenicists, especially in light of the fact that the fundamental premise of Meyerian psychobiology contradicted the genetic determinism that underpinned scientific racism in the first half of the twentieth century.

Publications

Meyer never published a textbook. Between 1890 and 1943, he published roughly 400 articles in scientific and academic journals, mostly in English, but also in his native German and in French. Most were published together after his death in 1950 in four bound volumes called The Collected Papers of Adolf Meyer.

The Collected Papers of Adolf Meyer (Baltimore: Johns Hopkins University Press, 1951).
The Anatomical Facts and Clinical Varieties of Traumatic Insanity (1904).
The Nature and Conception of Dementia Praecox (1910).
Constructive Formulation of Schizophrenia (1922).

On This Day … 30 March [2022]

Published on 03/30/202203/22/2022 by Andrew MarshallLeave a comment

People (Births)

1882 – Melanie Klein, Austrian-English psychologist and author (d. 1960).

People (Deaths)

1873 – Bénédict Morel, Austrian-French psychiatrist and physician (b. 1809).

Melanie Klein

Melanie Klein (née Reizes; 30 March 1882 to 22 September 1960) was an Austrian-British author and psychoanalyst known for her work in child analysis.

She was the primary figure in the development of object relations theory. Klein suggested that pre-verbal existential anxiety in infancy catalysed the formation of the unconscious, resulting in the unconscious splitting of the world into good and bad idealisations. In her theory, how the child resolves that split depends on the constitution of the child and the character of nurturing the child experiences; the quality of resolution can inform the presence, absence, and/or type of distresses a person experiences later in life.

Benedict Morel

Bénédict Augustin Morel (22 November 1809 to 30 March 1873) was a French psychiatrist born in Vienna, Austria.

He was an influential figure in the field of degeneration theory during the mid-19th century.

Who is Tanya Byron?

Published on 03/29/2022 by Andrew Marshall1 Comment

Introduction

Tanya Byron (born 06 April 1967) is a British psychologist, writer, and media personality, best known for her work as a child therapist on television shows Little Angels and The House of Tiny Tearaways.

She also co-created the BBC Two sitcom The Life and Times of Vivienne Vyle with Jennifer Saunders, and still contributes articles to various newspapers.

In 2008, she became Professor of the Public Understanding of Science at Edge Hill University and is the first and current Chancellor of the same institution.

Early Life

Byron’s father was the film and television director John Sichel, founder of ARTTS International in Yorkshire. Her mother was a nursing sister and a model.

When Byron was 15 years old, her German-born paternal grandmother was murdered by being battered to death by a woman who abused illicit drugs. Her grandmother knew the woman, who was in pursuit of money. Byron was perplexed by this cruelty, and at about that time she began to try to understand how anyone could do such a terrible thing and began to be interested in psychology.

Education

Byron was educated at North London Collegiate School, University of York (BSc Psychology, 1989), University College London (MSc Clinical Psychology, 1992), and University of Surrey (PhD, 1995). Her PhD thesis was entitled “The evaluation of an outpatient treatment programme for stimulant drug misuse”, and was completed at University College Hospital.

Career

Prior to training in Clinical Psychology, Byron worked as a researcher on the BBC’s Video Diaries documentary series. Once she qualified, Byron worked in the British National Health Service for 18 years in a number of public health areas such as drug addiction, STDs, and mental disorders.

In 2005, Byron was featured on French and Saunders’ Christmas Special as herself, who came in to sort out Dawn and Jennifer’s childish behaviour on the show. Subsequently, she co-wrote the series The Life and Times of Vivienne Vyle with Jennifer Saunders. Byron has also co-authored a book on parenting based on the Little Angels show and two other books on child development and parenting, as well as writing weekly articles for The Times and contributing to several women’s magazines. She has also worked with the Home Office on the current changes to the Homicide Act as it relates to children and young people, and she also works with the National Family and Parenting Institute advising government and ministers on related policy.

In September 2007, it was announced that she would head an independent review in England – supported by the Department for Children, Schools, and Families, as well as the Department for Culture, Media, and Sport – into the potentially harmful effects of both the Internet and video games on children. This was published in March 2008 as “Safer Children in a Digital World”, but is commonly called the Byron Review.

In April 2008, Byron fronted a four-part show called Am I Normal? exploring the boundaries of acceptable behaviour.

In May 2008, she was elected as the first Chancellor of Edge Hill University, in Lancashire and installed at a ceremony in December 2008. Edge Hill University also appointed her to the post of Professor of the Public Understanding of Science, and she delivered her inaugural lecture, “The Trouble With Kids”, in March the following year.

In 2009, Byron was awarded an honorary doctorate by the University of York.

Byron is the patron of Prospex, a charity which works with young people in North London. She is also a partner in a media company, Doris Partnership.

She has published The Skeleton Cupboard: The Making of a Clinical Psychologist in 2015.

Personal Life

Byron married The Bill actor Bruce Byron in Barnet, London, in 1997. They have a daughter (born 1995, Hendon, London) and a son (born 1998, Barnet). Tanya and Bruce met when Bruce applied to the very first ARTTS course.

Television

Little Angels

Tanya Byron, Stephen Briers, Rachel Morris and Laverne Antrobus became household names working on the British TV show Little Angels (which ran for three series), a docu-soap that follows the lives of families where the children have behavioural problems that are causing the parents difficulty. The show is seen as a ‘life line’ by the parents who are effectively calling professionals with years of experience of working with children and families to help them fix a problem that they believe beyond their ability to fix. Tanya Byron, Stephen Briers, Rachel Morris and Laverne Antrobus, monitor the behaviour of the family and the children before discussing with the parents the real underlying causes of the problem (which are nearly always in some way either caused by or contributed to by the parents themselves – usually by inadvertently rewarding inappropriate behaviour with their attention). They then discuss a course of action with them and later they coach them in how to change their own and their children’s behaviour to improve the situation (this is frequently done in scenes where the family is filmed doing something together with the parents receiving advice from the attending professional via an ear piece). The show is intended to be instructive to viewers in how to deal with common problems as well as of real help to the family being filmed (and of course entertaining).

The House of Tiny Tearaways

In 2005 Tanya began to host her own show called The House of Tiny Tearaways, a reality TV style show that brings three families experiencing problems into a large, purpose-built house where they are monitored and aided for a week. The show is vaguely similar to programmes like Big Brother, in that all the rooms have cameras in them and the families are frequently monitored in their activities with the audience shown highlights of a particular day. Each family stays in the house for six days in which time Tanya monitors them all for one day before having very honest and direct discussions with the parents about the issues and how they can be dealt with, and then guiding the families through courses of action, exercises and deliberate changes of behaviour on the parents’ side to deal with the problems. Tanya does not do this entirely singlehandedly, as one element of the programme is the support the parents receive from the other families who are in the house with them at the same time.

The show is characterised by: scenes of children misbehaving, therapy sessions between Tanya and the parents of the children (which are often very emotional and are sometimes the first time they have ever really discussed the problems they are facing), tasks in and outside the house which the families are set to help them practice the skills they have learnt (often having to do things they would normally find difficult, like take a child with eating problems to a restaurant) and by the ending, the families review any improvements or shortcomings they’ve made.

In 2007, Byron stated that she did not want to make any more television programmes on parenting as it had become “a well-marketed area”.

Am I Normal?

In 2008 Tanya presented a four-part series called Am I Normal? exploring the boundaries of acceptable behaviour. The episodes explore the themes of addiction, faith, sex and body image. The programme presents both behaviours and treatments which Dr Byron is able to explore objectively but with some common sense cynicism. Is having sex with 5,000 men within the range of normal behaviour? Is being attracted to pre-pubescent girls okay if you do not act on that attraction in a way that harms or coerces them? Are sex addiction or addiction to computer games real physiological addictions? Is hearing God different to hearing voices? These are the questions that she explores, without yielding to the temptation to give easy answers. This was based on the radio series presented by Vivienne Parry.

Radio

In 2020, Tanya Byron presented “Word of Mouth”, on BBC Radio Four, featuring an investigation into the benefits of ‘Talking to Strangers’. Previously, she presented All in the Mind, a BBC magazine radio programme about psychology and psychiatry.

In October 2013 she was the guest for BBC Radio 4’s Desert Island Discs. Her choices were “Absolute Beginners” by David Bowie, Baba O’Riley by The Who, Take Five by Dave Brubeck, “I Want That Man” by Debbie Harry, Perhaps, Perhaps, Perhaps by Doris Day, Uncertain Smile by The The, Canon in D Major by Johann Pachelbel and That’s Life by Frank Sinatra.