Mental health and brains, etc. (200 words)

We each differ in terms of how much stress or trauma we can endure before we fall to pieces. If you are fortunate enough to have close friends you trust or you are wealthy, then you can endure more. Even though individuals cope to varying degrees, it does not follow that research should focus on individual characteristics. Too many studies investigate genes, brain chemicals, and personality traits and too few examine social stressors and support. Although twin studies model how much variance is “explained” by the environment, they typically do not uncover exactly what it is in the environment that matters. The very word “environment” obscures what is going on; your family are in there as well as how close you are to a park. There could be more brain imaging studies investigating the neural correlates of, say, solidarity, or receiving adequate welfare support, rather than obsessing over mindfulness training and psychoactive pills. However, it is unclear how brain studies would help improve people’s lives. Allowing that brains and genes play an important role in distress does not imply an individualistic approach. Nor does it imply that psychiatry – or indeed professional psychology – supply the most effective ways to help people.

(Thanks to the wonderful user-led group for mental health survivors and supporters, Recovery in the Bin, for inspiring this post.)

Scrap of writing: Sustainable minds and relationships

I’ve just rediscovered a scrap of a note, which sort of still makes sense – throwing it out here in case it makes sense to someone else too!

“Differential” psychology orders people from clever to stupid (Nisbett et al., 2012; Spearman, 1904). Some have argued that instead of evaluating thinking ability, psychologists should instead study what it is that people care enough to think about and do (Raven, 1988). What might this mean? Perhaps we (social science, broadly?) should study:

  1. What people could think about;
  2. What people are thinking about, i.e., what they make an effort to think about and what thoughts come effortlessly;
  3. Why people don’t think about things that they could think about;
  4. What they can do;
  5. Why they are or aren’t doing things they can/could do.

The goal would be to shift studies of ability as a score to qualitative studies of the nature of what people think, feel, and do. This leads to an interesting set of problems. Let’s define a desired-action as an action which others’ want or need either to do themselves or to delegate to others and a desired-skill is what’s required to do those actions. Even with a qualitative model of thoughts, feelings, and actions, there remains the problem that:

  1. Some desired-skills are in more scarce supply than others.
    1. As a corollary, the abilities and motivations required for scarce desired-skills can be difficult to modify at the population and individual level (high gSpearman’s “general factor in intelligence” – is thought to enable desired-skills; attempts to increase it through, e.g., “brain training” have failed);
  2. Some desired-skills are more in demand than others.
    1. Another corollary: there may be no “good reason” for demand other than that a group of people have arbitrarily come to decide that they want something;
    2. In-demand doesn’t imply “useful” (in any sense) for self or society (see also ideas around social closure and opportunity hoarding; Wright, 2009);
  3. People are rewarded for doing scarce and in-demand desired-actions.
    1. This reward is currently often seen as financial, but there are other ways people can feel rewarded.

One possible conclusion (with a bit of an arm-wave) is that social scientists should be working out how to reduce the set of things that feel scarce. Perhaps it all comes down to human motivation (Maslow, 1943):

  1. Physiological
  2. Safety
  3. Love
  4. Esteem
  5. Self-actualisation
  6. To know and understand

Another way to think about this is that needs are part of a psychosocial ecosystem. And, much like how – if we want to stop the destruction of the planet – we have to find ways to live in a more sustainable way in terms of the material resources we use, we also – if we want to stop the destruction of our minds and relationships – have to help each other manage our needs. Think about an example of material sustainability. Do we really need to have a new plastic bag every time we go shopping? Are some of our apparent needs which rely on scarce-actions just arbitrarily so?

[And the scrap fizzled out here… Over to you…]

References

Maslow, A. (1943). A theory of human motivation. Psychological Review, 50, 370–396.

Nisbett, R. E., Aronson, J., Blair, C., Dickens, W., Flynn, J., Halpern, D. F., & Turkheimer, E. (2012). Intelligence: new findings and theoretical developments. American Psychologist, 67, 130–59. doi:10.1037/a0026699

Raven, J. (1988). Toward Measures of High-Level Competencies: A Re-examination of McClelland’s Distinction Between Needs and Values. Human Relations, 41, 281–294. doi:10.1177/001872678804100401

Spearman, C. (1904). “ General Intelligence,” Objectively Determined and Measured. The American Journal of Psychology, 15, 201–292.

Wright, E. O. (2009). Understanding Class: Towards an Integrated Analytical Approach. New Left Review, 60, 101–116.

Thick description

I love this on “thick description” (p.543):

“Thick description” of social actions promotes “thick interpretation” of these actions, which lead to “thick meaning” of the findings that resonate with readers (Ponterotto & Grieger, in press). I like to use the metaphor of a tree to explain the interconnection of these three concepts. The “thick description” constitutes the roots of the tree that nourish and feed “thick interpretation,” represented by the solid trunk of the tree, which in turn feeds the branches and leaves of the tree,which represent the “thick meaning.” It is the branches and leaves that most capture the viewers’ attention, as is the case with “thick meaning,” which grasps the attention of the reader of the study.

I think it’s fascinating how we use stories to evoke emotion, and stories are an important facet of social research, but this stuff on “thick description” reads (to me) like satire!

Reference

Ponterotto, J. G. (2006). Brief Note on the Origins, Evolution, and Meaning of the Qualitative Research Concept Thick Description. The Qualitative Report, 11, 538-549.

Critical realism

Everything you wanted to know about Critical Realism:

 

From methods to goals in social science research

Note. This is quite a ranty blog post – especially the first two paragraphs. Readers may therefore wish to read it in the voice of Bernard Black from the series Black Books to make it more palatable. You may also be interested in this short BMJ comment.

History_of_Screaming.jpg

Onwards…

Many of the social science papers I read have long jargon-heavy sections justifying the methods used. This is particularly common in writeups of qualitative studies, though not unheard of in quantitative work. There are reflections on epistemology, ontology, and axiology – sometimes these must be discussed by doctoral students if they are to acquire a degree, especially in applied psychology. There’s discussion of social constructionism, critical realism, phenomenology, interpretation, intersubjectivity, hermeneutics. “But what is reality, really?” the authors ponder; “What can we know?” Quantitative analysis is “positivist” and to find or construct meaning you need a qualitative analysis (it is claimed).

Although I like philosophy, most of this methodological reflection bores me to tears. Am I alone in this?

I think many differences between methods (at the level of analysis found in empirical papers) are exaggerated, clever-sounding words (often –isms) are fetishised, grandiose (meta-)theories are used to explain away straightforward study limitations such as poor sampling. I bet some people feel they have to reel off fancy terminology to play the academic game, even though they think it’s nonsense.

But there are different kinds of research in the social sciences, beyond the dreary qual versus quant distinction as usually discussed. Might it be easiest to see the differences in terms of the goals of the research? Here are three examples of goals, to try to explain what I mean.

Evoke empathy. If you can’t have a chat with someone then the next best way to empathise with them is via a rich description by or about them. There seems to be a bucket-load of pretentiousness in the literature (search for “thick description” to find some). But skip over this and there are wonderful pieces of work to be found which are simply stories. I love stories. Biographies you read which make you long to meet the subject are prime examples. Film documentaries, though not fitting easily into traditional research output, are another. “Interpretative Phenomenological Analyses” manage to include stories too, though you often have to wade through nonsense to get to them.

Classify. This may be the classification of perspectives, attitudes, experiences, processes, organisations, or other stuff-that-happens in society. For example: social class, personality, goals people have in psychological therapy, political orientation, mental health difficulty, emotions. The goal here is to impose structure on material, reveal patterns, whether it be interview responses, answers on Likert scales, or some other kind of observation. There’s no escaping theory, articulated and debated or unarticulated and unchallenged, when doing this. There may be a hierarchical structure to classifications. There may be categorical or dimensional judgments (or both, where the former is derived from a threshold on the latter), e.g., consider Myers-Briggs (love or hate it) or the Big Five personality types. Dimensions are quantitative things, but there are qualitative differences between them. You can’t put Openness and Introversion on a dimension but both are themselves dimensions.

Predict. Finally you often want to make predictions. Do people of a particular social class tend to experience some mental health difficulties more often than others? Does your personality predict the kinds of books you like to read. Do particular events predict an emotion you’ll feel? Other predictions concern the impact of interventions of various kinds (broadly construed). What would happen if you voted Green and told your friends you were going to do so? What would happen if you funded country-wide access to cognitive behavioural therapy rather than psychoanalysis? Theory matters here too, usually involving a story or model (a deliberate simplification of reality) of why variables relate to each other.

What do you think?

Mental health funding FOI responses update

I asked Treasury:

Blame for insufficient mental healthcare funding has been passed around between Department of Health, NHS England, and individual Clinical Commissioning Groups (CCGs), however, the source of funding is the Treasury. Although CCGs and other mediating organisations make decisions about how much funding mental health receives, this is as a proportion of budgets decided at Treasury level. Any budgetary planning at Treasury level must therefore take mental health into consideration, alongside other areas of healthcare.

I am writing to request:

(i) names of individuals at Treasury and above, including advisors by official name or function, who are responsible for decisions made in relation to mental health care budgets;

(ii) documentation on budgetary decisions made, including evidence of how, in calculating the total health budget, mental health needs have been taken into consideration.

To (i) they said they don’t hold the information. To (ii) they said they do, but wouldn’t share it, citing Section 35 of the FOI act.

(Full response here.)

I asked the Department of Health:

CCGs and other mediating organisations make decisions about how much funding mental health receives, but this is as a proportion of budgets decided at Treasury level. Any budgetary planning at Treasury level must therefore take mental health into consideration, alongside other areas of healthcare.

I am writing to inquire about advice provided by Department of Health to Treasury on mental health budgets.

1. Who in DH provides this advice?

2. What advice has been provided to inform the most recent budget allocation for health?

They also confirmed that they held relevant information but refused to share it, citing s35(1)(a).

(Full response here.)

I asked NHS England the same question:

[…] I am writing to inquire about advice provided by NHS England to Treasury on mental health budgets.

1. Who in NHSE provides this advice?

2. What advice has been provided to inform the most recent budget allocation for health?

They provided a response.

1. Who in NHSE provides this advice?

Paul Baumann, Chief Financial Officer for NHS England, has responsibility for the organisation’s budgets including providing advice on these budgets. NHS England is an Arm’s Length Body (ALB) of the Department of Health (DH), much of the advice the Treasury would receive on Mental Health would be coordinated by the Department.

2. What advice has been provided to inform the most recent budget allocation for health?

NHS England’s view of the overall funding requirements of the NHS were set out in financial analysis conducted for the Call to Action (July 2013) [see, especially, the technical annex] and the Five Year Forward View (October 2014), which have been shared with DH and Her Majesty’s Treasury.

This analysis projects “do-nothing” expenditure using assumptions about the three main drivers associated with current health care demand and costs: demographic growth, non-demographic growth (e.g. technological development and medical advances) and health cost inflation. Historic trends for these drivers were reviewed and an estimation of future pressures developed for six service level ‘assumption sets’: Acute, Mental Health, Specialised Services, Primary Care, Prescribing and non-activity based costs. This high level analysis thus includes assumptions related to cost and demand growth for mental health services as part of the overall modelling.

Detailed analysis and costing is completed by NHS England on specific initiatives, the output of these models are used to inform budget announcements and the planning guidance information. These costings are developed by the Medical Directorate and Finance Directorate working together.

(Link to response here.)