Monday 30 October 2023

‘Could vs should’ in AI therapy

Barry Orr ponders how industrial action might be considered, or averted, from psychological therapists.

16 October 2023


Like it or loathe it, Artificial Intelligence is increasingly part of the landscape across human life – including psychological therapies. Papers and scholarly debates have considered both current and potential roles of AI therapies (e.g. Abrams, 2023; Horn & Weisz, 2020; Jackson, 2023; Knox et al., 2023). Here, I consider less discussed AI boundaries and considerations.

In particular, I look to the entertainment industry for the possible consequences of disrespecting or ignoring such boundaries. Are we psychologists sleepwalking towards legal or industrial actions over AI? In the words of Dr Ian Malcolm from the film Jurassic Park, are our scientists ‘so preoccupied with whether or not they could, that they didn't stop to think if they should’?
From entertainment, to elsewhere

Recent strikes of writer and actors’ unions have partly been around AI concerns – for example, the prospect that all future programming made and released becomes AI depictions of scanned likenesses/digitally created actors (Fitzgerald, 2023). Here, and in elements of the IT industry – whether for profit/economy concerns, displaying innovation, or other reasons – some appear to want AI use to become the norm. Therapists might be wise to pay attention to these strike outcomes: especially if entertainment law rulings could suggest relevant precedents.

In therapy innovation, we appear to be moving, or at least aspiring in some quarters, towards a Turing-test passing, AI virtual therapist. Imagine a therapist capable of being ‘customised’, like a computer game avatar or today’s ChatGPT request. A digitally ‘resurrected’ facsimile of Freud, Horney, Beck etc., or ‘in the style of’ a living therapy giant is possible.

Maybe that, in itself, could seem useful and non-problematic to you. But how far could and should we take AI in catering for preferences? Imagine a digital therapist where gender, race, age, disability statuses could be specified: might that be a potential fostering of discriminatory attitudes? Legally, might such preferences be ruled as concerning a ‘computer’ rather than a person, leaving any discrimination claims difficult to even consider? A challenging issue, but one seemingly overlooked to date.
Mechanised assumptions

Ironically, many therapies have already had traditions of increasing ‘mechanisation’ or ‘manualisation’, with varied views on the merits of this over the decades (e.g. Carey et al., 2020). Mechanised elements have likely also sometimes aided marketability of therapies, as well as replication research (Leichsenring et al., 2017). There could then be the prospect of some therapy practitioners desiring titles and/or status from being the first to ‘pioneer’ or patent forms of ‘replicable’ AI-based therapies. Perhaps by claiming empirically validated trial (EVT) status ‘superiority’ with AI?

Again, maybe you would argue that if mechanised/manualised elements have always been part of therapy, there’s no issue here. But I would counter that spontaneous, ‘here and now’, human elements have always been central to classical therapies: EVT ‘validated’ or not. Spontaneity has been strongly suggested as playing a crucial therapy role (e.g. Yalom, 2002). Can digital displays of past human interactions, or programmed randomness/spontaneity by AI, really compete? Is such spontaneity even replicable?

Perhaps also of relevance here is that previous attempts to port therapy to computers have typically reported limited efficacy, and low adherence rates to date (Musiat et al., 2022). Yet 55 per cent of respondents in one recent study suggested a preference for an AI therapist (Aktan et al., 2022). However, this was from a non-clinical sample. Would we still see that preference in a double-blind type condition, where patients did not know if they were being treated by AI or not?
Training in human relations, exclusively by machine modelling?

Now considering some areas – social anxiety, forms of autism, agoraphobia, etc. – where part of what a good therapist is seeking to do is improving socialisation with others. Perhaps such clients may be particularly likely to express a preference for therapy via AI; but is it really wise to entrust something so intrinsically social and human to machines?

There’s also the issue of how different people respond at different times. Secondary or tertiary care patients have not been necessarily considered separately from primary care patients, for AI. What if the former were to sustain a significant psychotic episode; a severe self-harming relapse; a suicidal attempt; or an undiagnosed brain injury? If any or all of these present, and/or in a co-morbid fashion – can we know how exactly how AI would respond to such complex factors, if a sole therapeutic lead? There has already been at least one case where a ‘large language model’ was implicated in a suicide (Xiang, 2023), as well as reports of chatbot involvement in an assassination attempt on the Queen.

There are also considerations inherent to pretty much any technology. Accessing AI intervention relies on availability to electronic devices. The inaccessibility of automated therapy interventions, for some patients, is already an issue. Patients who lack IT or mobile app access or expertise, or who have a relevant disability, or limited financial means, have always been for services of various kinds. Would this accessibility remain, as the use of AI expands?

As for IT security, consider the possibility of hackers infiltrating AI software, to witness and/or manipulate therapeutic treatments. Could we see ransom demands, and/or the selling of patient disclosures and data; for money, revenge, control? This topic appears to have received little discussion or consideration yet, but may be of critical importance.

Then there are the human relations of the therapists themselves. Workers in some fields have been replaced already by AI automation (Hunt et al., 2022). This alone may already have been cited as too high a cost, by some, for their well-being (Field, 2023). Will they end up being offered therapy or other intervention from the very AI that has replaced them?
Consult early – prevention could be better than cures

To my knowledge, NHS Trusts or Health Boards have not launched yet mass public consultations, around many of these issues. I would be interested to hear from readers whether I am wide of the mark there; or if you have other concerns over the expansion of AI in Psychology I have not covered here.

To be absolutely clear, I am no luddite. I am not adverse to some AI assistance in human therapies. This has already been introduced in some areas, as therapist adjuncts, in non-acute care service efforts. Perhaps, if there is unequivocal health service and public support for AI, voices like mine will inevitably end up minimised or disregarded. It would be natural to perceive self-preservation in what I am saying. I accept that. But again, I encourage you to look at what is happening in other fields. AI implementation is facing legal challenges, for example with authors claiming plagiarism of their works by AI programmers (e.g. Vynck, 2023). If such challenges succeed, AI may change or ultimately not be implemented at all, regardless of the interests of that particular field.

Any linked industrial action would hopefully be a last resort. But if we don’t heed the warnings of Dr Ian Malcolm and myself, might we find ourselves at a ‘point of no return?’ Can we ‘roll back’ to ‘effective enough’ human therapists, potentially augmented by careful and ethical use of AI as a tool, if many of us have been replaced entirely?

Dr Barry Orr is a clinical psychologist, formerly of the NHS, and currently incoming with the Te Whatu Ora health board (Health New Zealand).
Key sources

Abrams, Z. (2023). AI is changing every aspect of psychology. Here’s what to watch for.

Aktan, M. E., Turhan, Z., & Dolu, İ. (2022). Attitudes and perspectives towards the preferences for artificial intelligence in psychotherapy. Computers in Human Behavior, 133, 107273.

Carey, T. A., Griffiths, R., Dixon, J. E., & Hines, S. (2020). Identifying Functional Mechanisms in Psychotherapy: A Scoping Systematic Review. Frontiers in Psychiatry, 11, 291.

Field, M. (2023, September 18). Home workers will be first to lose jobs to AI, Oxford study warns. The Telegraph.

Fitzgerald, T. (2023). SAG 2023 Strike May Hinge On Same Issue As The Writers’ Strike: AI. Forbes.

Horn, R. L., & Weisz, J. R. (2020). Can Artificial Intelligence Improve Psychotherapy Research and Practice? Administration and Policy in Mental Health and Mental Health Services Research, 47(5), 852–855.

Hunt, W., Sarkar, S., & Warhurst, C. (2022). Measuring the impact of AI on jobs at the organization level: Lessons from a survey of UK business leaders. Research Policy, 51(2), 104425.

Jackson, C. (2023). The big issue: The brave new world of AI therapy.

Knox, B., Christoffersen, P., Leggitt, K., Woodruff, Z., & Haber, M. H. (2023). Justice, Vulnerable Populations, and the Use of Conversational AI in Psychotherapy. The American Journal of Bioethics, 23(5), 48–50.

Leichsenring, F., Abbass, A., Hilsenroth, M. J., Leweke, F., Luyten, P., Keefe, J. R., Midgley, N., Rabung, S., Salzer, S., & Steinert, C. (2017). Biases in research: Risk factors for non-replicability in psychotherapy and pharmacotherapy research. Psychological Medicine, 47(6), 1000–1011.

Musiat, P., Johnson, C., Atkinson, M., Wilksch, S., & Wade, T. (2022). Impact of guidance on intervention adherence in computerised interventions for mental health problems: A meta-analysis. Psychological Medicine, 52(2), 229–240.

Vynck, G. D. (2023, September 20). ‘Game of Thrones’ author and others accuse ChatGPT maker of ‘theft’ in lawsuit. Washington Post.

Xiang, C. 'He Would Still Be Here': Man Dies by Suicide After Talking with AI Chatbot, Widow Says. Vice.

Yalom, I. D. (2002). The gift of therapy: Reflections on being a therapist. Piatkus.


SOURCE:

Monday 23 October 2023

A decade of power posing: where do we stand?


Tom Loncar examines power posing’s 10-year journey to date, and the challenges that still remain.

08 June 2021


In 2010, researchers from Columbia and Harvard Universities examined whether brief postural adjustments – ‘power poses’ – could produce positive psychological, behavioural and hormonal outcomes. Their experiment revealed an emphatic ‘yes’ on all three questions, with the everyday implications clearly apparent. Stressful interpersonal contexts, such as job interviews, presentations and important meetings, could be helped through preparatory postural adjustment.

As the decade progressed, power posing became an idea whose time had come; a hugely successful TED Talk, widespread organisational acceptance and a number of eye-catching interpretations by leading politicians. Despite this widening embrace, deeper academic questions emerged. Replication attempts did not reproduce the complete breadth of original results, and by 2016 power posing was firmly embroiled in the ‘replication crisis’ affecting social psychology.

But power posing would not go away. Larger quantitative examinations of its evidentiary credentials have suggested that significant benefits do remain… though with some caveats. With a recent systematic review and meta-analysis shedding further light on how postures can affect our emotions and behaviours, it is time to reflect on power posing’s chequered first decade. Where it came from, where it now stands … and where to next?
Origins

Within social psychology, research into embodiment and embodied cognition explores how our postures and bodily movements can influence our emotional states (Veenstra et al., 2017). Its lineage can be traced back to the ideomotor action ideas of 19th century philosopher and psychologist William James, who asserted that emotions arise from physiology, so that bodily expressions contributed to the consequent feeling of emotions (James, 1950). In more recent times, embodiment has provided a rich terrain for exploration. The manipulation of facial expressions, voice management, breathing and posture can induce diverse emotional feelings, including happiness, sadness, anger and fear (Laird & Lacasse, 2013).

Physical posture has provided a particularly insightful lens for examining feelings of power – and powerlessness – across both human and animal studies (Ellyson & Dovidio, 1985; Huang et al., 2011). And referencing the gamut of postural research literature, three researchers from Columbia and Harvard Universities – Dana Carney, Amy Cuddy and Andy Yap – put forward an elegantly simple question in the September 2010 issue of Psychological Science: Can posed displays cause a person to feel more powerful?
Power posing is born

The researchers identified two distinct nonverbal dimensions universally associated with demonstration – and absence – of power, with high-power postures based on expansiveness and openness (e.g. leaning back on a chair with arms behind the head), and low-power poses based on contractive and closed positions (e.g. sitting tensely in chair with hands held tightly in lap). (You can see the poses in the figures here).

Their hypotheses were ambitious; they put forward that high-power poses would lead to positive results across three measures.Psychological changes (through participants feeling more ‘powerful’ and ‘in charge’, subjectively assessed on a 4-point scale).Neuroendocrinal changes in dominance and stress hormones (with dominance hormone testosterone increasing and stress hormone cortisol decreasing, measured via saliva samples pre and post pose).Adaptive behavioural changes through increased risk-tolerance (measured through a gambling task).

In their experiment, 42 participants (26 females/16 males) were randomly assigned to each condition, and then held two postures for one minute each. The participants weren’t wise to the researchers’ true purpose; an elaborate cover story was used in setting up the poses in order to facilitate the ecological validity of the experiment. All participants were told the study was about the science of physiological recordings and electrode placements, with their bodies then positioned by an experimenter into high-power or low-power poses.

Statistically significant outcomes emerged across each of the hypotheses. Hormonally, testosterone went up over baseline for the high-power group, and down for the low-power group, with cortisol going the opposite way. Behaviourally, there was a higher reward-focus in the high-power group, while psychologically, the high-power group felt more powerful and in control than their low-power counterparts. While consideration of experimental limitations was discussed, other areas for methodological circumspection were not covered at all (for example, the fact that all participants were Columbia University students was not mentioned). There was an exciting message to share: ‘That a person can, by assuming two simple 1-minute poses, embody power and instantly become more powerful has real-world, actionable implications’ (Carney et al., 2010, p.1363).
2012-2015: Power posing stands up and gets noticed

Power posing’s breakthrough into wider awareness occurred at the TEDGlobal conference in June 2012, when Amy Cuddy branched off from her collaborators with her talk ‘Your body language may shape who you are’. Her presentation offered compelling evidence along with a moving personal narrative; a brilliant student, who had a very bad car accident resulting in significant brain injury, who then had to relearn everything in re-orienting herself in her academic world. With support from her doctoral advisor Susan Fiske, Cuddy learned to fake it till she became it, with postural awareness a key part of her success. Her talk resonated and remains the second-most watched TED Talk of all time (behind only the late Sir Ken Robinson’s iconic ‘Do schools kill creativity?’). By 2015, power posing’s reach was successfully making inroads across society, including some awkwardly fulsome interpretations by politicians at the 2015 Conservative Party conference. With Amy Cuddy’s book Presence also released that year, 2015 was the year where everything seemed to be coming together for power posing.

Yet a starkly contrasting narrative was also emerging…
2015: Replication issues emerge

Beneath the public embrace, serious academic questions also began to emerge. In March 2015, the first notable question was raised in Psychological Science by the University of Zurich’s Eva Ranehill and colleagues. Their ‘conceptual replication’ – while successfully replicating self-reported feelings of power – failed to produce significant results for the behavioural and hormonal measures. Their study featured more participants (N = 200), and provided a more even gender mix than the original study (98 females/102 males) (Ranehill et al., 2015).

The original authors were quick to respond. The very next month in the same journal they listed the numerous methodological departures made by Ranehill and colleagues, including a longer posture duration (six minutes), the extent of participant briefing, the nature of behavioural tasks and timing of saliva measurement (Carney et al., 2015). They also provided a narrative review of 33 studies which featured experiments examining nonverbal expansive postures more broadly, with a total of over 2500 participants and with statistically significant results across a range of dependent variables (in addition to feelings of power, these also included pain tolerance, feelings of pride, self-esteem and action orientation). They emphasised the need for future replication efforts to be as direct as possible and, in the spirit of openness, lead author Dana Carney made original research materials available on her academic web portal. The researchers urged this review to serve as a springboard to ‘moving forward the study of nonverbal expansiveness’ (Carney et al., 2015, p.662).
Embroiled within the replication crisis

Despite this transparency, a broader replication crisis was brewing across social psychology, where established domains of evidence that had been held in high regard were simply failing to replicate.

A central reference point was The Reproducibility Project led by Brian Nosek and the Center for Open Science, a crowdsourced collaboration of 270 researchers seeking to replicate 100 published psychological studies (Nosek et al., 2015). The project, which commenced in 2011, was ready to report in August 2015. It found that only 36 per cent of these apparently rigorous studies could replicate. With further replication questions emerging in 2016 (Deuter et al., 2016; Garrison et al., 2016), power posing’s original lead author Dana Carney announced a stark personal turnaround in September of that year: ‘I do not believe that “power pose” effects are real’ (Carney, 2016).
2017: Social psychology draws a line

Amidst the discord, the journal Comprehensive Results in Social Psychology (CRSP) sought to draw a definitive line on the topic through a special issue devoted entirely to power posing, comprising seven pre-registered studies (Cesario et al., 2017). Dana Carney herself reviewed all submissions and provided feedback to the researchers who submitted. Each study offered distinct examinations of behavioural and hormonal outcomes, with the aggregated evidence strongly indicating there was ‘virtually zero effect’ on these two measures (Jonas et al., 2017, p.140).

However, this was not the case for subjective feelings of power (referred to as ‘felt power’ throughout the issue). Here, an aggregated Bayesian meta-analysis applied to all observations (N = 1071) by Gronau et al. (2017) revealed significant results for the overall sample, as well as for sub-sample breakdowns based on prior power posing awareness (for example, knowledge of Cuddy’s TED Talk). In summarising CRSP’s special issue, 28 co-authors indicated that ‘it is clear that an effect on felt power was observed’ (Jonas et al., 2017, p.139), with future research best directed at disentangling what this means (for example, in research designs that account for gender, degree of extraversion and cognitive flexibility).
The p-curving wars of 2017-2018

Despite this emergent cordiality in 2017, another quantitative war was also transpiring. Parallel to CRSP’s examination, Simmons and Simonsohn (2017) submitted Carney et al.’s (2015) 33 studies to a p-curve analysis. P-curving is useful within replication contexts through showing the distribution of statistically significant p-values within a body of research. Examining the shape of p-values can inform whether selective publication, p-hacking and/or data-mining is present (Simonsohn et al., 2014). The p-curve for these studies was flat and therefore lacking in empirical support (Simmons & Simonsohn, 2017). A major caveat to this conclusion, however, became apparent; the main analysis excluded p-values associated with subjective feelings of power, which the authors described as manipulation-checks rather than dependent variables.

A p-curving response from Amy Cuddy with colleagues from Harvard’s Institute for Quantitative Social Science soon followed (Cuddy et al., 2018). They argued that subjective experience is a central tenet of social psychology, and worthy of treatment as an equally weighted dependent variable. Further to the 33 studies, 21 additional studies were identified through a systematic literature search for what they termed postural-feedback literature. Their p-curving analyses revealed ‘very strong’ and ‘strong’ evidentiary support across their analyses, including those studies specifically examining feelings of power. They suggested these findings annulled Simmons and Simonsohn’s (2017) conclusions and that researchers should be encouraged to continue investigations.

So, by 2018, a clearer and quantitatively-backed narrative was appearing for power posing. Large analyses seemed to be indicating that while original neuroendocrinal and behavioural claims could not be supported, some promise still remained in the subjective domain… with power posing capable of facilitating significant and potentially beneficial feelings of power in individuals.
2019: An elephant in the room

Despite all the attention placed upon power posing’s evidentiary credibility, a crucial elephant in the room was largely ignored until September 2019 when Iowa State University’s Marcus Credé made an important observation in the journal Meta-Psychology (Credé, 2019). He noted that an overwhelming number of studies included by Cuddy et al. (2018) excluded a control or ‘neutral pose’ condition. In other words, this evidentiary base was largely comprised of experiments located at lower levels of the hierarchy
of scientific evidence.

The implication is that significant results could have been driven by a positive effect of an expansive pose, or a negative effect of a contractive pose… or a combination of both! The absence of a neutral reference point means we cannot truly know. In delving further into the few studies – four in all – that actually included a control or neutral pose, Credé observed overall effects predominantly driven by a negative effect from a contractive pose, rather than a positive effect emanating from an expansive pose.
And in 2020…

This theme was more recently expanded in June 2020 through a systematic review and meta-analysis conducted by Emma Elkjær with colleagues from Aarhus, Witten/Herdecke and Columbia Universities, published in Perspectives on Psychological Science (Elkjær et al., 2020). Their search identified randomised experimental studies examining whole body motor displays in healthy adults, with the aim of inducing an expansive or contractive posture (with Carney et al. (2010) referred to as the ‘cardinal study’ for their paper). Their search process identified 73 studies (underpinned by 7038 participants), of which 48 were appropriate for inclusion in their statistical meta-analysis, with the remainder examined through narrative synthesis. Four moderating factors were explicitly taken into account: (i) the comparison conditions, including whether a neutral condition was present; (ii) the nature of experimental manipulation of bodily displays; (iii) the type of outcome assessment (e.g. affective and/or behavioural – with hormonal outcomes also included in the latter); and (iv) the contextual conditions, namely the intra and interpersonal environment of the experiment.

Pooling the data together, their meta-analysis showed two significant comparison outcomes: expansive versus contractive and contractive versus neutral, with the latter comparison more positive. The expansive versus neutral comparison, however, was not significant. The authors concluded that experimental effects are more influenced by the absence of contractive rather than the presence of expansive displays. As Credé observed earlier, the authors did note the paucity of studies with a neutral control (they identified 14 through their search). They made the following preliminary conclusion: ‘Together, these results can be taken as preliminary evidence of the impact of contractive displays on affective and behavioral responses’ (Elkjær et al., 2020, p.22).

In addition to advocating for future designs to include neutral controls, two other interesting recommendations emerged from their analyses.

Firstly, cortisol was included as an outcome measure within four of the included studies, with their net inference distilling an effect size ‘trending toward significance’ (Elkjær et al., 2020, p.23). While this contrasts with the CRSP analyses, it may indeed be too early to entirely dismiss cortisol as an outcome of relevance. Given its measurement challenges and complexities, the need for improved protocols (such as collecting blood samples as opposed to saliva, and more carefully sequenced assessment points) was strongly endorsed.

Secondly, contextual factors emerged as a potentially problematic area in studies to date. For example, five of their included studies indicated that incongruent conditions, such as adopting expansive postures when experiencing personal failure, had the potential to cause quite distressing outcomes. Future experiments need to be mindful of the interpersonal and personal contexts that participants are placed in, including consideration of using personally relevant goals (rather than experimentally induced goals).
‘These findings are vindicating’

The toll on Amy Cuddy in defending postural research against often vitriolic academic attack over the years has undoubtedly been heavy (Dominus, 2017). So how did this latest meta-analysis land with power posing’s foremost proponent? In a tweet on 27 June 2020, she indicated: ‘At this point, anyone who claims these effects are not real cannot support that claim with science. These findings are vindicating’. With Cuddy’s next book Bullies, Bystanders, and Bravehearts scheduled for publication in 2021, a positive and forward-looking new chapter for the power posing narrative has potentially emerged (TED Talk Books, 2019).
Where next?

Ten years on, power posing has possibly – and belatedly – arrived at the future research springboard that had been hoped for in the narrative review of 2015 (Carney et al., 2015). The more nuanced springboard of 2020 has been made possible by more recent large-scale quantitative scrutiny which has suggested that posture does matter when it comes to subjectively experienced feelings of power… but it may be a question of mindful avoidance of any contractive postural tendencies, rather than forced expansion. Adding neutral posture controls into future research designs will elucidate this important evidentiary – and practical – question. Intra and interpersonal contexts must be more carefully addressed in experimental settings, through systematically addressing for who, how, and where postural adjustment can be most beneficial. This will elevate power posing from a potentially misinterpreted one-size-fits-all idea, to more specific and actionable understanding.

While it may be through paths quite different to those originally envisaged by Dana Carney, Amy Cuddy and Andy Yap, after an eventful ten year journey, power posing may now be ready to expand.
About the author

Tom Loncar is an executive coach, writer and researcher on leadership psychology, and founder of Grow GravitasTM. He examined power posing’s evidentiary foundations in his MSc (Psychology and Neuroscience of Mental Health) dissertation with King’s College London.
tom@tomloncar.com

SOURCE:

Wednesday 18 October 2023

Φέρσου όμορφα στη νέα μαμά. Κι απλά αγάπα την με όποιον τρόπο μπορείς

12 ΟΚΤΩΒΡΙΟΥ, 2023

×



Στη νέα μαμά…


Φέρσου της όμορφα.

Μόλις βίωσε τη μεγαλύτερη σωματική και συναισθηματική αλλαγή στη ζωή της.

Το σώμα της έχει πληγές που έχουν ανάγκη να θρέψουν, τις οποίες εσύ δεν βλέπεις.

Κάτω από το τεράστιο εσώρουχό της φορά μία εξίσου τεράστια πάνα.


Δεν αναγνωρίζει καν το σώμα της. Είναι εντελώς διαφορετικό – και ίσως να παραμείνει έτσι για την υπόλοιπη ζωή της.

Οι συσπάσεις της δεν έχουν σταματήσει.

Ανασαίνει ακόμα μέσα από αυτές, ίσως χωρίς και η ίδια να το συνειδητοποιεί.

Μην παραπονεθείς ποτέ για το πόσο της παίρνει να θηλάσει.

Οι θηλές της είναι πληγιασμένες και το στήθος της πονάει με έναν τρόπο που δεν θα μπορούσε ποτέ να φανταστεί ότι είναι εφικτός.

Εκείνη και το μωρό της προσπαθούν να βρουν έναν ρυθμό μεταξύ τους, με κάθε θηλασμό.

Είναι κουρασμένη.

Τόσο κουρασμένη.

Είναι αγχωμένη.

Δεν μπορεί απλά να σηκωθεί και να συνεχίσει τη μέρα της όπως έκανε παλιά.

Όταν το κάνει το σώμα της την τιμωρεί.


Μην της ζητάς να κρατήσεις το μωρό της.

Αν θέλει να σου δώσει το μωρό της θα στο προτείνει η ίδια.

Εκείνη και το μωρό της είναι βαθιά συνδεδεμένοι και αν σου δώσει το μωρό της απρόθυμα, η καρδιά και τα χέρια της πονούν αφάνταστα κάθε δευτερόλεπτο που το μωρό είναι μακριά τους.


Πιθανότατα κλαίει στα κρυφά τουλάχιστον δύο φορές την ημέρα, είτε από σωματικό πόνο, είτε από άγχος ή απλά από εξάντληση.

Φέρσου όμορφα στη νέα μαμά.

Άσε την να μείνει για λίγο ακόμα σε αυτήν τη γεμάτη οξυτοκίνη φούσκα της για όσο το έχει ανάγκη.

Και απλά αγάπα την με όποιον τρόπο μπορείς.


Κάθε μέρα από σήμερα και στο εξής, θα δίνει τη ζωή της γι’αυτό το μωρό.

Αυτή είναι η στιγμή που δικαιούται να είναι λίγο εγωίστρια.


Το διαβάσαμε στη σελίδα Μαρία Αϊβαζίδου, Ψυχολόγος- Παιδοψυχολόγος
Πρωτότυπο κείμενο: instagram.com/ruth_gerber

ΠΗΓΗ:

Monday 16 October 2023

‘The spectre of war was ever-present’

We hear from Dr Alistair Teager and Nadiya Rechun about rehabilitation in Ukraine.

11 July 2023


As a result of the Russian invasion of Ukraine in February 2022, there has been an upsurge in the number of people in Ukraine sustaining spinal cord injuries (SCIs) and traumatic brain injuries (TBIs) due to war-related injuries from bomb blasts and gunfire, for example. Due to the increase in clinical need, an international multidisciplinary humanitarian team was deployed to establish the need for specialist rehabilitation support, and to help develop a National Rehabilitation Centre.

The team included medicine, nursing, occupational therapy, physiotherapy, psychology, and interpreters. Dr Alistair Teager is a Consultant Clinical Neuropsychologist working at Manchester Centre for Clinical Neurosciences (MCCN), and he spent several months as a part of this humanitarian mission in Ukraine.

We asked him about that work.

Has your work in trauma in the UK prepared you for this?

I’ve been fortunate enough to work in inpatient major trauma and neurorehabilitation for a number of years, and more recently we have developed a spinal cord injury service at MCCN. I also had some experience of major incidents, having led the acute psychosocial support provided at MCCN following the Manchester Arena Attack. My clinical experience was therefore pretty decent, but applying those skills in another country, during wartime, through interpreters, was a real challenge personally and professionally.

A large part of the work was developing training for the psychologists and other MDT members at the National Rehabilitation Centre in Ukraine. I felt pretty comfortable with what needed to be delivered, as lots of it was around core psychological principles such as goal-setting, MDT-working, and motivational interviewing. But were other elements that I was less familiar with, such as sex and sexuality after SCI, and equipment procurement.

Fortunately, however, there were people such as Dr Jane Duff, Consultant Clinical Psychologist at the National Spinal Injury Centre in Stoke Mandeville, and specialist networks such as the British Psychological Society’s Division of Neuropsychology (DoN) and the International Spinal Cord Society (ISCoS), that I was able to lean upon and draw support from.

What has it been like, on a personal and practical level?

I was doing two weeks away in Ukraine, and two weeks back in my normal job, but with a fair amount of juggling both at the same time. It takes a good two or three days to get there as you can’t fly commercially in or out of Ukraine at the moment, so that was draining, and it usually took me a few days when I got back to recalibrate. To some degree, it was actually really good to continue with some aspects of work back in the UK, as connecting with my colleagues for supervision and to check-in was quite grounding.

Being able to fully experience Ukraine and its culture was great, but the spectre of war was ever-present. The army were always around, there are curfews every night, power supplies come and go, and air raid sirens go off most days, but as we were based in North West Ukraine, the sense of threat was less than if we were in areas that have been heavily targeted, or nearer the frontline, for example. My wife and parents were incredibly proud and supportive, if a concerned for my safety, but after my first trip out there in December 2022 I think they felt a bit better about it all.

What are some of the differences you’ve seen in terms of providing psychological support?

The most obvious is that care is being provided during an ongoing conflict; everyone in Ukraine is at risk of harm, and everyone knows someone who’s fighting, been hurt, or been killed as a result of the war. In essence, the psychologists at the National Rehabilitation Centre are providing support to people who have individual traumas, but against a backdrop of collective trauma.

The vast majority of patients at the National Rehabilitation Centre are young men, and many are concerned about what their lives will look like, and how they could contribute to Ukrainian life moving forward. Displacement is also a huge issue; many of the patients and their families cannot be discharged home because where they lived is in an occupied territory, or may even have been destroyed. As such, families have moved to live on-site at the Centre, and discharges can be really tricky to plan.

Where does this work go next?

The humanitarian work in Ukraine is ongoing, with the next phase focusing on upskilling teams earlier in the patients’ journeys and establishing regional rehabilitation units so that they have more consistent care across the pathway. For me, however, I have returned to my usual role in Manchester, as I could only commit to a relatively short-term contract, and I am very grateful to MCCN for loaning me out. I have felt quite blessed to have been able to contribute, but I also feel really conflicted in that I know that there is more to do.


‘The war has determined who I am now’

We also heard from a colleague of Alistair’s, Nadiya Rechun.

Could you tell us about your typical day working in Ukraine with people with spinal cord injuries (SCIs) and traumatic brain injuries (TBIs) as a result of the war?

I’ve been working as a psychologist with patients at the National Rehabilitation Centre since November 2022. My work week is from Monday to Friday, every day starts with me waking up (often to the sound of air raid sirens) and traveling to work. It takes me about an hour to get to work, and I use this time to read the news and mentally prepare myself for the day. This is because it’s highly likely some terrifying news will emerge about attacks on hospitals or residential areas, or that somebody I know has been killed in action or missing, so I feel like I need to ‘steel’ myself before I start my job.

At 9am, my team and I go to the shift handover to understand what changes in patients have occurred overnight, usually there are more patients every day, because the war does not stop for a moment.

Together with colleagues, we set goals for the day and going forward, sometimes we discuss the future of patients whose stay in the centre is coming to an end, as defined by the by law, because many of them no longer have their own homes because they were destroyed by shelling. I divide my working time with patients into different stages: visiting, triaging requests for consultations, and planning. I visit patients in their wards, get to know those who have been hospitalised, and provide psychological support to the patients' families. I also spend time triaging referrals or requests for consultation. A lot of time is also spent trying to plan my time, as I have so little time for 20-25 patients assigned to me, who might have SCIs, TBIs, or both.

How does the war affect your work as a psychologist?

Actually, in a certain way, the war has determined who I am now. Although I received a Master's degree in psychology back in 2019, it was difficult to find a job for young professionals. Now, in the 14 months of war, the need for mental health professionals has increased significantly and our country is on the way to integrating psychological help into people's lives, because, to be honest, before working with a psychologist on mental health was not a priority for many Ukrainians.

Working as a psychologist during the war is a challenge for me, because most of my patients receive their injuries in the hot spots of Ukraine, and who have been side by side with my relatives who are now also defending our independence and life. In these conditions, supervision, interviews, and training help me maintain my integrity and professionalism. Supervision sessions, interviews with colleagues, and support groups for psychologists help to maintain their integrity and professionalism, of which there are many, thanks to the work of various international humanitarian organisations.

Are there psychological implications of the patients being mostly young men?

Definitely. After all, this is the age when a man strives for achievements in his career and family, and in general, realises his full potential. In my practice, I observe that young men who suffer from SCI, TBI, or those who lose limbs, are in a depressed psycho-emotional state, especially in the acute period, immediately after the injury. They are now faced with the question of accepting their bodies, which now works differently, looks differently. They are worried about the possibility of further sexual life, whether they will be able to satisfy their partner, be attractive for him/her. They are worried about how they can provide financially for themselves, their spouse, and how to raise children, how to self-actualise in society, whether it is possible to enjoy life now, and sometimes whether it is worth to continue living.

What have you learned, and how have services developed, in the past year?

The last year has been very fruitful in terms of learning: I continue to study counselling in the field of positive psychotherapy. I constantly attend seminars and workshops where I learn the peculiarities of working with the victims of war, the program from Dr Alistair Teager on working with patients with TBI and SCI, and the training methods of psychological assistance in case of loss of loved ones due to death, and many others. The challenge of the year was my decision to work in the hospital, because I do not have a medical education and have not worked in a medical institution before, so I had to learn many subtleties of organising the rehabilitation process.

How has the input from the international team / overseas Psychologists helped you?

The international team and, in particular, the psychologist Dr Alistair, introduced us to the experience of different countries in organising the rehabilitation process and compared it with ours. This helped us to choose the best approaches in dealing with complex traumas and combined cases from around the world, and we have already started to work by following their example.

I hope that our cooperation with the international team will not end at this stage, but will only be the start of further projects.

What needs to happen next?

We will continue to study, work, improve ourselves and the quality of rehabilitation services to our patients, because everyone, even if they have sustained a complex injury, has the right to live their happy life in a free, prosperous, mentally healthy country!

SOURCE:

Moving on after trauma

Megan Drysdale on her unusual role in an inpatient drug and alcohol service, starting with the service user perspective.

15 September 2023


Attending your first-ever trauma therapy group can bring up lots of emotions. You’re sitting in an unfamiliar room with a group of people you do not know. You are unaware whether the content will be triggering, whether you will have to share your experiences, as well as trying to gauge the other attendees. Are they going to judge what you say? How will they perceive you, and will they relate?

The facilitator reassures the group that no one will be asked to share their experiences and it is important to keep ourselves safe. We are told the focus will be on learning how trauma is processed and skills to help us manage the symptoms. The group starts by discussing the definition of trauma and what symptoms we may experience. The group shares ideas such as nausea, anxiety and increasing the use of alcohol; all of which I relate to. I had no idea that trauma could have such a physical impact on our health.

The facilitator explains what happens to the body when in our fight and flight response. They go on to say how trauma can keep us in that state, even after the event has happened. It helps me understand why I am so easily startled. We talk through some grounding techniques and finish the group with a progressive muscle relaxation exercise. I feel safe and regulated, I feel understood and I feel ready to engage.

I’m an Assistant Psychologist (AP) on an inpatient drug and alcohol detoxification and stabilisation ward. The scenario you have just read is pulled together from feedback I’ve had from our patients. These are people living with a dual diagnosis, defined as having both a mental health and substance use problem, who often slip through the gaps in services.

Over 70 per cent of those in drug and alcohol services identify as having a mental health need (Delgadillo et al., 2012). A further 54 per cent of suicides in people experiencing a mental health issue, involve those with a substance use background (NCISH, 2016). With a large amount of this population with co-occurring conditions being excluded from services (CQC, 2015), people commonly find themselves trapped in a cycle with very little support.

This called for change. The government commissioned Dame Carol Black for an independent review on drugs which enabled the creation of Project ADDER. Project ADDER focuses on drug treatment, recovery and prevention as well as the creation of many new job roles, including my own. My role is the first psychological role to be based on the ward, and one where there is no Clinical Psychologist physically present, alongside.

Helping to set up a new mental health provision within the prison service in my previous role, I had some experience, but this role certainly came with its own challenges. My job role has so many positives, and our team are continuously working together to develop our service. Nonetheless, with a new job role in a new environment and no previous AP to shadow, my resilience was put to the test.
‘Not a mental health ward’?

When I started my role, I had my job description and guidance from my Clinical Psychologist Supervisor, but instructions on how to fit into the ward did not exist. I learned very quickly that clinical staff on the ward were very unfamiliar with psychological staff and had no conception about how I would fit in on the ward. Many staff believed that the two to three weeks that patients were with us were to physically detox, and this was not the time to be exploring their mental health. On a couple of occasions when seeking advice, I was met with we are ‘not a mental health ward’.

With my confidence gradually decreasing and my instinct to seek help and support from the team, I ended up moulding to the absent role of the group facilitator. The team had been without a group facilitator for a couple of months and our HCAs were burnt out from covering the group programme trying to cover the content. So, I stepped in. I created new content for the group programme and trained in delivering MOAT (Moving on after Trauma) groups.

Many of our patients, especially in the first week, can find it very difficult to engage in an hour long group whilst feeling so physically unwell. Going through a detox, patients will be experiencing withdrawals and exhaustion. We typically have up to 10 patients on the ward and with limited support staff available, I was frequently facilitating these groups on my own. After around six months of this routine, my confidence grew as my ability to manage a large group setting on my own improved. I became more knowledgeable and comfortable with the material that I was delivering. It was rewarding to work with patients who are so passionate and motivated to learn and move forward in their recovery.

Even though I gained so much joy from facilitating the group programme, there was still a part of me feeling misunderstood and underappreciated by the team. The support I received from my manager and supervisor were requisite in me moving forward. However, even with this support, I was continually aware that solely doing groups was never intended to be my role.
Arrival to discharge

I wanted to become familiar with what my role should look like. There was no other NHS inpatient units in the surrounding area, and therefore no one with my role. I got in contact with my Supervisor to see if they had knowledge of any similar roles. I was given the contact for an AP in an inpatient detox unit in Manchester. This team had a wider Psychology team with a Psychologist present, which educated me on the potential our ward held. Moving forward, I started to attend more training to widen my skillset and build my relationships with wider teams. This is when I started to increase my understanding of what my role should look like.

I created an ‘arrival’ questionnaire to complete with patients on their admission, to gain an understanding of their mental health need. Where applicable, psychometric measures would also be completed. I engage in 1:1s with patients which mostly involve teaching healthy coping strategies and together forming a plan for when in crisis and/or distress. As well as this, I created a ‘discharge’ questionnaire to go through with patients to monitor how their mental health need had progressed throughout their stay with us.

Many of our service users will have a history of developmental trauma, which can be difficult without a Clinical Psychologist on the ward. There was no option of going back to the office for a reflective de-brief amongst your Psychology colleagues. That being said, being within a team all working all in the same environment naturally created a safe space to provide each other support. My clinical supervision is key in navigating these experiences and prioritising my self-care. I quickly learnt that I was able to reach out to my Supervisor or call any of the Community Psychology Team when required.

Whilst I was developing and building my role, we had a group facilitator join the team, which really helped with my capacity. My relationships with the team were stronger and I was able to be boundaried regarding the work I was now carrying out. With time, staff were beginning to understand the purpose of my role and started to seek out my knowledge when a patient was in distress. I felt empowered having got to this place in my role, considering my feelings when I started. The challenges I now faced was having the capacity to provide 1:1 work to all of our patients as well as any unprecedented situations we face on the ward. We started to grow the Psychology team on the ward and once a week I had a Psychology student and another AP supporting me. Although staffing levels vary, the presence was growing.

I was approached by a Clinical Psychologist, enquiring about co-facilitating a CBT group on our ward. Knowing the benefits and impact this could have, we were very quick to implement this. Due to capacity, we started to trial the group by having the Clinical Psychologist link in virtually. This was very new to us – we had not used any technology in our groups up until this point. We have now been doing this group for around a year, collecting feedback from patients to gather their thoughts. Generally, the feedback has been really positive, with patients scoring it an average of 15/20. It was anticipated that hosting the group virtually would raise some comments. However, only one person had mentioned they would have preferred the facilitator in person. We hope to continue this and plan to keep this routine enduring.

I am now at a place where I am building on my existing skills and pushing myself further. This includes co-facilitating training to drug and alcohol services in our area, co-facilitating research, leading an AP group within our trust and future plans to share at conferences. Each day will continue to bring new challenges and learning opportunities. I am very grateful to be in the role I am and look forward to what comes next.

References

Care Quality Commission (2015) Right here, right now.

Delgadillo, J., Godfrey, C., Gilbody, S., & Payne, S. (2013). Depression, anxiety and comorbid substance use: association patterns in outpatient addictions treatment. Mental Health and Substance Use, 6(1), 59-75.

The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2016: England, Northern Ireland, Scotland and Wales October 2016. University of Manchester.

SOURCE:

Monday 9 October 2023

Pain sensitivity predicts support for political opponents

New research shows link between sensitivity to pain and sympathy for the views of those across the aisle.

09 October 2023

By Emma Young


The idea that certain traits make someone more likely to be politically conservative or liberal has received a good deal of attention. Now, Spike W.S Lee and Cecilia Ma at the University of Toronto report finding an individual difference that is linked not to a person’s own political affiliation, but to their level of support for some of the moral and political attitudes of their ideological opponents.

This difference is sensitivity to physical pain. Across a series of studies on more than 7,000 Americans, Lee and Ma consistently found that liberals who were more sensitive to pain reported greater endorsement of some typically conservative stances. Those who were less sensitive, conversely, were less likely to be moved by conservative ideology.

The researchers used the well-validated Pain Sensitivity Questionnaire (PSQ) in their research. This questionnaire describes 17 commonplace experiences, such as ‘You burn your tongue on a very hot drink’, and asks participants to rate how painful they imagine that would be on a 10-point scale.

In three initial studies, participants completed the PSQ and rated their political orientation on a scale from extremely liberal to extremely conservative. They also completed measures of disgust sensitivity, emotional reactivity, anxiety, anger proneness, and empathy, all of which have been linked to moral attitudes.

Finally, they completed the Moral Foundations Questionnaire. This questionnaire assesses the extent to which people prioritise five domains in moral decision-making. Two of these domains, care/harm and fairness/cheating, are generally thought to be more important for liberals than conservatives, though not all the findings on this are clear-cut. Work also suggests that the other three domains — loyalty/betrayal, authority/subversion, and sanctity/degradation — are prioritised more by conservatives than liberals.

In all three studies, Lee and Ma found that higher pain sensitivity predicted greater endorsement of the three ‘conservative’ moral foundations. Interestingly, this association was stronger among liberals than among conservatives. It also predicted stronger support for the two ‘liberal’ moral foundations more strongly among conservatives than liberals (without undermining levels of support for the moral foundations typically linked to the participant’s own political affiliation).

These findings held even when the team controlled for scores on the other measures known to relate to moral attitudes, such as disgust sensitivity. Their analysis also showed that people who were more sensitive to pain were no more likely to be politically moderate, so variations in the strength of their political affiliation could not explain the findings, either.

In further studies, the team found that participants who were more sensitive to pain reported stronger support for a range of contentious political attitudes than lose with less pain sensitivity. They were more likely to have harsher stances on illegal immigration, for example, or support the right to own guns — views that are typically held by their ideological opponents.

Some of the more pain sensitive participants reported greater support for opposition politicians — and were even more likely to vote for the ideologically opposed candidate in the US 2020 presidential election. However, the researchers stress, the key phrase here is “some of”. Not all highly pain sensitive liberals voted for Donald Trump; far from it. Still, pain sensitivity (or at least factors associated with it) did seem to draw some people towards voting that way.

A fresh study explored the researcher’s hypothesis for why it might play a role. In this study, of more than 1,600 people, Lee and Ma found that people who are more sensitive to pain perceived that more harm would result from violations of the moral foundations typically associated with their ideological opponents. (For example, a highly pain-sensitive conservative would have been more likely than a less pain-sensitive conservative to feel that cheating would be harmful.) This finding is important for understanding the results as a whole, the researchers believe.

Both physical and social pain (resulting from exclusion, for example) share some neural bases, and research shows that there is overlap in the way our brains represent our own pain and someone else’s pain. “This suggests that individuals with higher sensitivity to their own physical pain may be more sensitive not only to their own social pain but also to others’ physical and social pain,” the researchers write. And this is why, compared to less pain sensitive people, they might feel that violations of moral foundations other than those typically associated with their political views would cause more harm — leading them to place a greater value on these moral foundations (and on political attitudes in which these moral concerns play a role).

As the researchers put it, for a liberal, if their ideology and media diet already tell them that racism, sexism, and inequality are immoral, their level of pain sensitivity is unlikely to influence their perceptions of the levels of harm caused by these things. But it could influence their perceptions of harm from violations of more ‘conservative’ moral beliefs.

There are limitations to the conclusions we can draw from the study, however. The findings might fit with the researchers’ interpretation of what is going on, but there could be other explanations.
As they acknowledge, more work is needed to tease apart the influences of physical and social pain sensitivity, and to explore the precise nature of the role of harm perception in the effects. Still, the consistent evidence that someone’s degree of pain sensitivity relates to their support for political opponents’ views is certainly interesting.


SOURCE:

Wednesday 4 October 2023

«Μαμά είμαι ο χειρότερος στην τάξη μου»: Τι απαντάμε για να βοηθήσουμε τα παιδιά να αποκτήσουν αυτοπεποίθηση;

03 ΟΚΤΩΒΡΙΟΥ, 2023

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«Μαμά, είμαι ο μόνος στην τάξη που δεν μπορεί να διαβάσει»… ψυχή μου, τι του λέμε τώρα; Αν είσαι από αυτούς τους γονιούς που το παιδί τους έχει μοιραστεί την ανησυχία του για κάτι που πιστεύει ότι δεν κάνει καλά, είτε αυτό είναι το αν ζωγραφίζει καλά, αν παίζει καλό ποδόσφαιρο ή αν ξέρει καλά αγγλικά, και δεν ξέρεις πώς να το βοηθήσεις όχι μόνο να μην συγκρίνει τον εαυτό του με τους άλλους αλλά και να αποκτήσει αυτοπεποίθηση ώστε να συνεχίσει να προσπαθεί, τότε η παρακάτω συμβουλή θα είναι πολύ χρήσιμη.

Όταν τα παιδιά μας λένε ότι δεν είναι αρκετά καλά σε κάτι, σύμφωνα με την ψυχολόγο Becky Kennedy, δεν χρειάζονται από εμάς να τους πούμε «αυτό δεν είναι αλήθεια» ή «δεν πειράζει, είσαι καλός σε κάτι άλλο». Απλά θέλουν να δουν σε εμάς- για να το νιώσουν κι εκείνα- ότι δεν πειράζει, ότι δεν φοβόμαστε επειδή δεν είναι καλά σε κάτι!

Αυτό που θέλουν να νιώσουν είναι σιγουριά και ασφάλεια και αυτό μπορούμε να το καταφέρουμε επιβεβαιώνοντας αυτό που λένε «έχεις παρατηρήσει ότι δεν είσαι καλός ε;», το συναίσθημά τους «δεν νιώθεις καλά με αυτό;» και να νιώσουν σύνδεση μαζί μας «πες μου περισσότερα για αυτό».

Αυτοπεποίθηση δεν είναι να νιώθεις ότι είσαι καλός σε όλα, αυτοπεποίθηση είναι να νιώθεις έχεις εμπιστοσύνη στον εαυτό σου και να νιώθεις σιγουριά παρόλο που μπορεί να μην είσαι καλός σε όλα. Να σου αρέσει ο εαυτός σου ενώ δεν είσαι τέλειος σε κάτι. Κι όσο περισσότερο τα παιδιά μας βλέπουν ότι εμείς τα αποδεχόμαστε και μπορούμε να είμαστε εντάξει παρά το γεγονός ότι δεν είναι τέλεια σε όλα, τόσο πιο εύκολα θα το αποδεχτούν κι αυτά.

ΠΗΓΗ:


Sunday 1 October 2023

‘Britishness is an incredibly flexible identity’


Dr Peter Olusoga in conversation with his brother, the historian and broadcaster David Olusoga, about the major new BBC series, 'Union'.

28 September 2023


Dr Peter Olusoga is a Chartered Psychologist, Senior Lecturer in Psychology and host of the Eighty Percent Mental Podcast. His brother, David Olusoga, is a historian and broadcaster. Peter and David discussed his new series, Union, and the psychological themes within.

David, you’re a well-respected historian and established documentary maker, and your films and TV series have covered a range of topics. What was the motivation for focusing on the Union for this latest one?

I’m afraid it wasn’t romantic or creative… it was about the pandemic. We were making a series about the empire. At the heart of that story was India and China, and we couldn't go there. We had to put that one on ice – we’re restarting it right now – and whatever new project we did had to be based in the United Kingdom.

So it was a very simple calculation… what are the big issues in which history is alive? Where is it shaping debate, and decisions, and our lives in the 21st-century? Where can you trace the history and see it causing effects? Unquestionably, one of the histories that falls into that category is that of the four nations in the union of United Kingdom.

You talked there about the history of the union in shaping debate, people’s lives, opinions. Watching the series, one of the things that stood out to me as a psychologist was the theme of identity, which came through in a number of different ways. Our identities, our self-concept, the beliefs and ideas that we have about ourselves, are defined and influenced by a number of different things. A specific set of physical, psychological, and interpersonal characteristics that are just ours, not shared with anyone else, but also the affiliations that we have to different groups, based on race, gender, sexual orientation, class, but also the social roles that we inhabit – parent, athlete, coach, politician, bus driver, historian, psychologist.

What is your perspective, as a historian having just made this documentary, on the factors that really shape how we see ourselves?

One of the first things to say is a great number of people feel very ambivalent about these forms of identity, or very confused or conflicted about them. I think that's particularly so in England. Englishness has become in some ways the default of the United Kingdom. Englishness is an identity that doesn't need to call itself into question often, but I think it's very different in other parts and among other communities even within England. And there are a great number of people in Britain who have a strong sense of identity which is built around community, built around religious identity, and built not just on history but on interpretations of the history. And that's in all four nations… particularly I would say in Ireland, both sides of the border, but it’s there in Scotland, it’s there in Wales and it’s there in parts of England.

One of the great ironies in British history is that you have a nation that defines itself in opposition to Catholicism – and very often opposition to Frenchness – and sees itself as Protestant, and then becomes one of the least religious nations on Earth. That is a huge factor in the story. There are a lot of surprising nations that have a higher level of irreligiosity, and even anti-clericism among some Catholic nations, but Britain is a nation that built itself by saying ‘we’re Protestant, not Catholic’. This identity of Britishness is built around Protestantism. To then have that religiosity fade away rather rapidly poses a big identity problem for a great number of people. And those who cling on to that identity, in which Protestantism is at its centre – particularly the Ulster Unionist community in the north of Ireland, but also many people in Scotland and other parts of the United Kingdom – they have a sense of identity which is much more rooted in a version of the history and much more clear and defined and central to their lives than many people in Britain.

Most people, because it's a wealthy country with lots of interpersonal freedoms, have identities that are pulled from all sorts of different places. History is just one of those places. It's often a very vague sense of history, and you can see that even in this word ‘union’. If you tell somebody in Scotland, ‘I’m making a TV series about the union’, they know exactly what you're talking about. If you say that in Northern Ireland, people know exactly what you're talking about, but they’re thinking of the union of 1801 that brought Ireland into United Kingdom, rather than the 1707 Union that joined England, Wales, and Scotland. If you say that in England, people might think you were talking about trade unionism, or one of many other uses of that word, because this process by which other nations were brought largely into England’s sphere of influence is much more vivid in those countries. They’re places where people are much more likely to grab onto bits of history and say ‘this is a foundation stone for my identity’.

In Northern Ireland it is astonishing. Whenever I go there, it is astonishing to me how alive the 17th century is. The 17th century feels very over in Bristol where I live, or in Manchester where I teach. Whereas 1600 dates in Ireland – they’re on murals, flags, t-shirts, they are part of people's lives. Those wars of the 1680s, which mean very little to people outside of that part of the world, are very clearly part of people’s identities.

The result is this extreme of ambivalence, and in some ways disinterest in the union, and a carelessness out it. The arguments against Brexit that it would damage the Union got very little attention, made little headway. Contrast that with people for whom this history, or their interpretation of this history, is alive and central to their sense of who they are.

So history important in shaping identity, but also place…

Absolutely. These are geographically specific identities. To be Welsh in the north of Wales is a very different identity to the south of Wales. The north-south divide in Wales is every bit as important as the one in England. The north-south divide in Ireland is obvious and clear and has a border running through it. There's an East West split historically in Scotland. The east of Scotland used to be where the wealth and the power was concentrated; the industrial revolution and the access to what was then formally the English empire brought Glasgow and the west into a period of economic dominance.

So these countries have regional divisions and splits and again, that shapes identity. It’s where you are, what happened there, but it’s also how it’s taught. Remember, we don't have a universal shared history curriculum. There are multiple curricula from different exam boards in the different nations. All of that shapes the extent to which history – interpretation of history – shapes people’s sense of identity.

That sounds challenging for a historian.

Linda Colley has written some of the most important books ever written about the story of the union of the nations. All historians can do is present the history, and they need to recognise that people’s relationship with that history, or interpretation of that history, will not always be things that historians agree with. It will not always bear the weight of the historical evidence. That creates a very difficult job for the historian, which I think is to complicate things. Our job is to say ‘you may have built an identity on that bit of history, but actually it’s more complicated. You may associate with this group having this characteristic and this backstory but actually it's less clear cut’. And trying to make television which is immediate, with no footnotes, over in 58 minutes, with that weight of identity resting upon this history, and the history doesn't always reinforce and support that identity… that is a challenge both for the programme makers and also for the viewer.

The documentary spans several hundred years, and you’ve just talked about the changes in national identity and the make-up of the Union… I’m interested in how those shifts are reflected in where we are now, in what you see today.

When you look at people’s relationship with Britain today, what you see is the complexities of a multi-nation state. The United Kingdom of Great Britain and Northern Ireland, to give it its proper term, is a multi-nation state. There isn't a singular identity, and the one that we have – the UK – is one that in all sorts of ways is problematic and complicated.

Most people don't have strong emotional feelings when you say the UK. Very often our romantic identarian relationship with country is smaller than the actual nation state that we live in. People don’t think of themselves as UK citizens. There is no UK equivalent to Britain or Scot. And I think that speaks to the complexity.

One of the difficulties is that we don't often speak the language of this complexity. We use the word ‘nation’, ‘state’, ‘country’, interchangeably. I also think it is possible – much more so in England than for other nations – to be rather unaware of this history, of the fragility of this nation. It is by no means unique… there are all sorts of multi-nation states with borders and linguistic and historical and religious differences. It's not unusual. But I think we tend to see ourselves as a much more simple nation, with a simple story, a single flag… Spitfires, and the Second World War, and Churchill. There are other stories of people that aren’t thought of much in England, but that are deeply embedded in people’s sense of identity in the other nations. Most people in England couldn't tell you who the kings and leaders were of these islands in the 17th century. I don't think the Stewarts and the Glorious Revolution, and the Williamite War are very vivid in the minds of people in England. I don't think Edward I means very much to people in England, but he means a hell of a lot of people in Wales, because he began a process that stamped English power on the landscape. And of course Scotland has a whole panoply of Scottish kings and Scottish leaders right up into 1603 who have stories and who have legends associated with them. It's very easy to not really notice that if you live in England.

One of the other big changes is demographic. In the middle of the 19th century, when the whole of Ireland was part of United Kingdom, a third of the subjects of Queen Victoria were Irish. So England’s dominance wasn't as apparent as it is today. With dominance comes thinking your story is the only story, that it is the default.

What would we do to strengthen the union?

For me, it's about making sure that everybody understands these complex histories. The fact that we don't have a module – probably in civics rather than a history module – that explains how these four nations were brought together, I think that is a profound weakness.

One of the reasons I wanted to do the series is that I was brought up in England went through an English education system: GCSE History then A-level History, and on to an English university. At that English University, because it was Liverpool, for the first time in my life I had Irish friends from both sides of the border. Liverpool in many ways is the one English city where the history of Ireland is unavoidable. And what I realised in my first term of my first year was I knew more about the United States than the United Kingdom. In Irish history we had done home rule which is mainly about it as a political problem of Gladstone and Westminster Prime Ministers. A little bit about Parnell, we'd done a tiny bit of partition in ‘22 and ‘23 and that was it. I didn’t understand that in the early 17th century, Scottish and English settlers were sent to Ulster to colonise, that the land was confiscated from the local people, and the consequence of that through the 17th century. I couldn’t have given you the date of the battle of the Boyne. I didn't really understand who King Billy was.

So that English default version of this history, in a state made up of four nations with different histories, is a profound danger and destabilising force. It also makes people feel like their identity is marginalised. If this a Union, a union of equals, then that’s not a healthy position for the state to be in.

Image: Peter and David Olusoga, circa 1980


It’s interesting that you’re talking about this simplistic version of history. You and I were asked to speak to the England men’s football team just before the World Cup in 2018. We talked to them a little bit about identity. Historically, that’s a team whose identity has been very much tied up with a very specific and very particular imagery... a cultural attachment to not only a non-complex version of history, but to things that have very little meaning to a group of people born in the late 1990s. An attachment to a history that may or may not really exist. History, or interpretation of history, is important in forming our identity… but also there are things that we need to let go of?

I'm probably a bad person to take a position on this, because I am what former Prime Minister Theresa May referred to as a ‘citizen of nowhere’. That's not because I was born in Nigeria and moved to Britain, it's also because I'm from the north but I live in the south, it’s because I was brought up in what was a financially very working-class environment, and I now live in a middle-class part of the country and work in a very middle-class profession. I have an accent the people can’t place cause there’s bits of it from all over. I’m a dual national. In all of these clear definitions about class, region, nation, I'm somebody who has a fragmented identity, an identity that’s a palimpsest of different bits.

But there’s a great strength in recognising that things that you associate with, or things that you disassociate with, can change. The England team is a great growth example. The average age of the current players is 26 or 27, which means they were born in the late 90s. What happened to me and you in the 80s, what the flag of St George was associated with on leaflets that were put through our door, doesn’t mean anything to them. There’s a point when bits of your identity stop becoming building blocks of who you are and become baggage. It's liberating to say, ‘well, that’s changed, maybe I can have a new relationship with that symbol or that story, or that word or that identity’. A fluidity about identity is really important.

One of the most striking things about what's happening in the north of Ireland at the moment is a demographics shift that is absolutely stark and historically enormously significant. Northern Ireland was created from the six counties, designed to be demographically dominated by the Protestant community. It was a country... a nation... I’m not sure either of those definitions work for what Northern Ireland is… but it was in some ways demographically engineered to be majority Protestant. And now it isn’t. Last year, for first time ever, the Catholic community outnumbered the Protestant Potters community. I think a lot of people thought ‘well, that means a united Ireland is round the corner, wait til the kids are 18, and that’s what’s going to happen’. But we’re also seeing a rise of political parties, movements and organisations that are secular and non-sectarian. I think people have had enough of the dark side of identity, that led people into what was a civil war within our lifetimes in our nation. And a lot of people, in a much more challenging environment than anything I’ve known, are taking bits of their identity that they were brought up to hold as important, and challenging it, and questioning it, rejecting what community, what even family have traditionally associated with those events, symbols, dates, and stories. That flexibility – in even the most remarkably difficult of circumstances – that’s quite fundamental.

People talk about identity, about holding an opinion. You’re supposed to reach an opinion. But it’s not a destination. If that were the case, then you’d think what you were thinking when you were first thinking about the world in your teens. The idea that opinions and identities can be fluid, and that there’s a health both for society and the individual in that… I don’t think we talk about that enough. That letting go of some of this stuff is really important.

Talk to me about patriotism and nationalism.

I think we confuse the two. You can have a love of nation that is healthy and also be capable of criticism of your nation. It can be a sort of affectionate frustration as well as a romantic affection. But nationalism is very different. Nationalism is not just affection for your nation, it's an opposition to other nations. John le Carré in an interview – I was gonna say before he died, but obviously his interviews were mainly before he died, the quality’s dropped off enormously since! – said ‘nationalism needs enemies’. Trying to find forms of affection for country that are about the country and about the people, rather than their association with other people or their wars with other people, or what marks others out as different – that's really healthy.

That takes us back to football. An example of trying to find new ways of having an identity built on contested histories and heritages is the essay about England and Englishness that was written by Gareth Southgate. I think it is really striking that it is the England manager and the England team who are exploring different ways of imagining Englishness. 13 of those players that played in the last World Cup are dual national and their stories span the entire story the British Empire. Literally from Ireland in the 17th century through to the Caribbean to West Africa and the colonies acquired at the end of 19th century. Their heterogeneity in some ways is inevitably the demographic future of Britain. Gareth Southgate is a remarkable, unusual figure all sorts of ways, but it isn't perhaps so surprising that it is in football – one of the few places where young people are at centre of public life – that we are seeing big questions and answers even about identity, Englishness, and Britishness emerging in the 21st-century.

You spoke earlier about your own identity, and you’ve spoken before about how you identify as British, Black-British, or Black British-Nigerian, but that you don't particularly identify as English, even though we both have one English parent, you’ve lived most of your life in England... what are some of the things that shape your identity?

It's partly because Britishness is there. Britishness is an incredibly flexible identity. It's one of the great advantages that Britain has had since that identity emerged in the 17th century – that it is, by its nature, inclusive. It's an umbrella identity and it's allowed people to him to hold onto their old identities, to still feel Scottish Welsh, Irish, English, but to have a new identity as well.

So partly, it’s there and it’s convenient. They’re the pull factors. But the push factors are that for my childhood, if I had said I was English in public, in most settings that would have been met with hostility and rejection. You understand the psychology of identity far better than I do, but I think people are very frightened about having an identity they claim rejected by others. I think people go out of their way to try and avoid this. Now I don’t have the report that it comes from, but I think it was around 10 per cent of people today felt that Englishness was an ethnic rather than a civic identity. So there are a significant number of white English people and white British people who regard Englishness as an identity that can't be adopted by people who aren’t white.

This is ethnic nationalism as opposed to civic nationalism...

Yes. Much more so when I was young, but even now there are people who genuinely do not think that someone who is not white can ever see themselves as English. I, like most people if there's an alternative, don’t put forward or associate with identities that others feel I have no access to.

What is interesting is, and this is anecdotal, but talking to Black Scots and the ethnic minority membership and leadership of the SNP, a lot of people of colour in Scotland feel much more able to claim Scottishness than English people of colour feel able to claim Englishness. David Lammy has been pointing out that there is no Black and English box to tick in the census. Even an official process such as gathering census data didn’t recognise Black Englishness as an identity, but did recognise Black Welshness, Black Scottishness.

I do think that there is still a demographic in England who wants to fight for Englishness as a racial and ethnic identity rather than allowing it to be a civic one. And they're quite happy to yield the ground on Britishness. One of the great challenges that we face in England, in a world where the union collapses, is what happens to those people who are very comfortable seeing themselves as something British – Black British, Jewish British – but wouldn't really feel welcome or want to see themselves as English? I wrote a book Black and British, and I wouldn’t have felt comfortable with Black and English because that would've been a very public claiming of an identity that a great number of people feel like I'm not eligible for. It speaks to both the power and the flexibility of Britishness and lingering ideas about race, and nation, and nationality and identity, that we haven’t got rid of.

To bring it back to the documentary, in one of the episodes you visited our Great Great Great Great Great Grandfather’s grave just outside of Edinburgh. You talk about his life, his experience in the war and coming home from the war and his identity. In what ways are our own identities shaped by just simply having knowledge of our personal histories, knowledge of our ancestors?

I’ve been giving this so much thought. I'm so interested in this. We filmed at the farm outside Tranent, not far from Edinburgh. I was there a few weeks ago and took my daughter and my partner there and we walked around the wheat fields that my ancestors, our ancestors, used to farm. Our five times grandfather was a ploughman… he would've known every undulation of those hills all too well. The cottages where they lived were renovated in the 19 century, but the stables are still there. That sense that a part of the world that I've driven past dozens of times and felt nothing for, that I now know that I have ancestors who lived there... I'm still trying to process what that means. Is this something that I'm projecting because I'm seeking some sort of identity? Is there something real and emotional that's taking place and I'm trying to make sense of it? I can't work it out.

The reason I wanted to use our own family in the documentary is because I knew they had moved from Scotland to England, and one of the most important things to show is that in the story of identity and nationhood, millions of us have crossed borders. The percentage of people who call themselves English whose ancestors are Irish is absolutely enormous. And throughout the 19th and 20th centuries even in the years of the Windrush, the overwhelming majority of people settling in England were Irish. The relationship between those two countries, demographically, is huge. The idea that you can hold an identity in one of the nations, but your ancestors would've felt differently, had different accents, and felt differently about the same historical events – that complexity was important to get across.

Sounds like it has opened up lots of questions for you.

Yes, real questions that I’m enjoying working through. Like all people who think about these issues of identity and history, I’m experiencing things and analysing my experiences of them and then questioning them.

I was actually looking yesterday at some photographs that my partner took of me with my arm around my daughter in the cabbage field that my ancestors would have ploughed, and I did feel something, about my daughter being on the pieces of land where a long line of her ancestors spent decades earning their living. So I’m experiencing and trying to analyse my experiences of it… not very scientific, but I’m thinking about it quite a lot.

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