Deep brain stimulation is a medical procedure that involves implanting electrodes permanently into the brain and using them to alter the functioning of specific neural networks. A battery inserted subcutaneously in the chest provides the device with power. One application of the technology is as a treatment for Parkinson’s Disease, a neurodegenerative condition that causes tremors and difficulties moving. While the treatment can bring about an impressive alleviation of symptoms, research suggests that Parkinson’s patients often struggle to adjust psychologically. Now a case study published in the British Journal of Health Psychology has provided some of the first insights into what it’s like for a patient to contemplate undergoing surgery for deep brain stimulation, and then to adjust in the immediate aftermath.
In England there’s an independent health advisory body that provides guidelines to clinicians working in the NHS, to make sure that wherever patients are in the country, they receive the best possible evidence-backed care. The National Institute for Health and Care Excellence (NICE) was set up in 1999 and many of its guidelines pertain to mental health, and they often promote psychological approaches – for example, the guidelines for depression state that talking therapies should be the first-line of treatment for all but the most severely affected patients. While clinical and counselling psychologists have been involved in producing these guidelines, many of their colleagues – especially those in practice – are highly critical of them. Why? A series of interviews with 11 clinical psychologists, published in Clinical Psychology and Psychotherapy, sheds new light on the scepticism and concern felt towards NICE guidelines, and why some psychologists are even deliberately ignoring them.
Anyone who knows anyone who is a clinical psychologist or other kind of psychotherapist will know about the stories they carry in their minds and hearts. Stories of other people’s struggles, pain, trauma, hurt, love and sometimes, wonderfully, recovery. When the psychologist returns home, the stories stay with them, but now in a parallel world of partners, children, friends and mundanity. What is this life like for the psychologist and her loved ones? How do they cope?
Some clues come from in-depth interviews with nine senior psychologists and three senior psychiatrists in Norway, published recently in Psychotherapy Research by Marit Råbu and her colleagues. The interviewees – 7 women and 5 men, aged 68 to 86 – had worked as psychotherapists for between 35 and 56 years and some were now retired. All had started out their careers with a psychoanalytic orientation, but several had since branched into other approaches, including cognitive therapy.
As newly obtained figures from the NHS show a dramatic increase in the number of young people being hospitalised following self-harm, a timely study in Archives of Suicide Research has reviewed what we know so far about how people who self-harm manage to stop. Tess Mummé and her colleagues identified 9 relevant studies to review – three quantitative, four qualitative, and two using a combination of these approaches – together involving hundreds of people aged 12 to 60, the majority female. Among the key insights, the researchers found family support is crucial for stopping self-harming, perhaps more than support from friends or professionals. But ultimately the review concludes that we need more research. Continue reading “Family support crucial for helping people to stop self-harming”
When the dreadful news arrives that a child has cancer, understandably the focus of parents and health professionals turns to supporting the sick child as best they can. But also caught up in the nightmare are the child’s siblings. Not only will they likely be consumed by shock and fear, but they must adapt to the cancer journey the whole family has to embark on.
Official health guidance here in the UK and in the USA states that it’s important to provide support to the siblings of children with cancer. Yet the reality is we know relatively little about their experience. A new study in Clinical Child Psychology and Psychiatry helps address this research gap, based on interviews with two brothers and four sisters – now aged 12 to 18 – of children and teenagers with cancer. The results reveal the shock and fear the siblings experienced, and the challenges they’ve faced, but also uncover a silver lining in the form of “post traumatic growth”. Continue reading “What’s it like to be a child and your sibling is diagnosed with cancer?”
We usually think of boredom as a state to be avoided. The existentialist philosopher Søren Kierkegaard even went so far as to say that “boredom is the root of all evil”. But in a new paper in Qualitative Research in Psychology, Tim Lomas at the University of East London says there is under-recognised value in this much maligned emotional state. To prove his point, Lomas deliberately subjected himself to an intense period of boredom, and then introspected on each minute of the experience. He claims his findings show that “boredom is not necessarily the dull, valueless state that it is commonly taken to be but rather can facilitate a fascinating array of experiences and insights.” Continue reading “You’re not bored, you’re meditating – on finding value in a maligned emotion”
According to Hollywood stereotypes, there are the clever, nerdy young people who spend most of their time sitting around thinking and reading, and then there are the jocks – the sporty, athletic lot who prefer to do as little thinking and studying as possible. This seems like a gross over-simplification and yet a new study in the Journal of Health Psychology suggests there may be a kernel of truth to it. Continue reading “Are brainy people lazy? “Need For Cognition” correlates with less physical activity”
Judges are not perfect, but we expect them to approach their cases clinically and with detachment, interpreting them on their merits, uninfluenced by stereotypes around skin colour, age, or … gender.
Unfortunately, a new study in Psychiatry, Psychology and Law has analysed the sentencing remarks made by judges in domestic murder cases (defined as murder between heterosexual spouses) and found that they framed killings by men in far more lenient and forgiving terms than killings by women. Continue reading “Killer wives are “wicked”, killer husbands are “stressed” –uncovering the sexism in judges’ closing remarks”
Depression has been called a “we-disease” because when the dark clouds arrive, it’s not just the depressed person who is affected, but all those close to them. A new study in the Journal of Social and Personal Relationship explored these spillover effects in the context of romantic couples, where one or both individuals have a diagnosis of clinical depression. The US study broke new ground by asking both partners in each couple to provide their perspective on how depression had affected their relationship. Liesel Sharabi and her colleagues said their results show how “the experiences of both partners should be considered when treating depression.”
In all, 135 couples, most being heterosexual and white, provided open-ended answers online. The average age of the participants was 40 years, and just over 70 per cent of the couples were married or in a similar life-long commitment. The researchers identified several key themes, the most commonly mentioned was the emotional toll of depression on the relationship. Other themes included: problems with romance and sexual intimacy, over dependence on the relationship, and feelings of uncertainty about the relationship.
The study provides striking examples of the impact of depression on the non-depressed partners. For example, many of them spoke of the support they were required to give to their partner: “Raising a child in our household poses its own challenges since many times I feel like a single parent. And many times I have to parent my spouse such as making certain he wakes up, stays motivated … eats, exercises and baths” said a 34-year-old woman. Another participant with a wife who has psychotic depression, described the contagion effects of depression: “If my partner is sad or depressed, it makes me feel sad and helpless”. And the wife of a man with major depression described her loneliness: “I feel like my husband’s depression affects our sex life. He always seems to be not in the mood, like he is sad.”
The answers given by depressed participants (with a non-depressed partner) also illustrate how the dynamics between the couple can sometimes make life extra difficult or complicated for the depressed person, including the frustrations they can feel at the lack of understanding. “He doesn’t understand what depression feels like, that feeling of being at the bottom of a deep, dark hole with no way out,” said one woman. “When I am feeling depressed, I feel guilty for not acting like my ‘normal self’,” said another. “I feel sometimes he thinks I can just ‘get myself out of it’ so to speak,” said a 33-year-old woman with postpartum depression.
There was a silver lining in that some couples – more often those where both partners were depressed – described feelings of enhanced intimacy that were fostered by depression. “It brings us closer at times by supporting one another,” said a woman with depression who’s husband is also depressed.
Another approach the researchers took was to see how often partners in a couple mentioned the same issues. In fact, 80 to 100 per cent of the time, partners described different effects of depression on their relationship – a potentially useful insight for clinicians working with couples.
Overall, the researchers said their findings show just how “difficult it is to disentangle the effects of depression on the individual versus the relationship.” For example, their participants’ stories show how: “When a depressed person’s sex drive is suppressed, the sexual needs of his or her partner go unmet; when a depressed person goes into isolation, his or her partner is shut out; when a depressed person refuses to leave the house, his or her partner must face the world alone. Thus, our findings provide poignant illustrations of how depression ripples beyond individuals to reverberate within couples.”
Sharabi, L., Delaney, A., & Knobloch, L. (2015). In their own words: How clinical depression affects romantic relationships Journal of Social and Personal Relationships, 33 (4), 421-448 DOI: 10.1177/0265407515578820
What does it feel like to be depressed?
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An in-depth interview with a formerly violent right-wing extremist has provided psychologists with rare insights into the processes of disengagement and deradicalisation. John Horgan at Georgia State University and his colleagues interviewed “Sarah” face-to-face for several hours, and also followed up with telephone calls. Their account is published in Behavioral Sciences of Terrorism and Political Aggression. The woman had previously been a member of various Neo-Nazi right-wing groups and was ultimately imprisoned for her part in the armed robbery of a shop. Today, Sarah works to combat violence and racism by speaking to at-risk youths, and says she feels a “responsibility to go out and try to undo damage.”
The background to this from a research perspective is that violent extremism remains, thankfully, rare. Therefore psychologists rely on insights into the deradicalisation process mostly from interviews with professionals, family and friends who have contact with extremists. Interviews with extremists themselves are hard to obtain, making this in-depth case study a rare opportunity. A major limitation is that some or all of the processes involved in this case may not generalise to other extremists.
The researchers applied their “arc framework” to Sarah’s story – this is the idea that the path from extremist to de-radicalisation goes from involvement, to engagement, to disengagement, and that the nature of disengagement and deradicalistion – often a long-term process, rather than a sudden moment – will likely be shaped by the reasons behind initial involvement and engagement.
Sarah’s involvement in right-wing extremism came about through teenage feelings of alienation. These feelings were fostered by a religious schooling that clashed with her parents’ alcoholism and racism, and her emerging sexual interest in other girls. Sarah fell in with skinheads at high school. This group later split into Neo-Nazi and anti-fascist groups, and Sarah chose the former where she found a sense of purpose and belonging.
Sarah’s true engagement began when she volunteered to expel another member. “That to me was my crossover and where I said okay this is … now at this time I’m making this commitment, you know, to follow these rules, to be a member of the group.” She got more Neo-Nazi tattoos and was exposed to right-wing literature – she says this didn’t influence her beliefs, so much as give her a way to impress the other extremists around her. In fact, she says ideology only played a small part in her involvement – rather, she found the alternative and socially challenging lifestyle an attractive option, especially in light of her uncomfortable family circumstances.
The roots of Sarah’s disengagement run deep. She describes feeling doubts very early on, not least because she engaged in activities that she knew ran contrary to the beliefs of the groups she was involved with, such as her sexual promiscuity, including being involved with a Hispanic man. Her doubts were later compounded by the 1995 Oklahoma City bombing (by a right-wing extremist), including the image of an infant victim. But still, as her doubts intensified, she drowned them in more drink, drugs and deeper extremist involvement. As this tension between her desires to leave and her commitment took their toll, Sarah says she simply lacked the resources to leave and her involvement continued to provide her with “self-worth, validation and protection”.
The turning point came when Sarah was arrested for her part in an armed robbery, which she’d undertaken with her then-boyfriend who was a key figure in her extremist group. Her subsequent imprisonment meant involuntary disengagement from the group. This changed Sarah. She took responsibility for her actions, and whereas we often hear about people being radicalised in prison, the researchers say it was clear that the physical distance created by imprisonment provided the space and opportunity for Sarah to confront her doubts.
Once in jail she befriended black women and was surprised by their acceptance of her (despite her notoriety and racist tattoos). Sarah took a degree, broadened her outlook. She “started realizing the world truly is so much bigger than [her] and [her] beliefs and ideas and, you know, [her] feelings” which, she says, gave her a “terrific sense of freedom”. She subsequently began teaching in prison, including tutoring other inmates in how to read and write. She discovered her capacity for compassion and empathy, “you know actually caring about people that I professed to hate for so many years – those kind of experiences changed me tremendously.”
On her release, Sarah was terrified that she had “hardwired her brain” in her earlier life, but she made a conscious decision to challenge any racist thoughts that emerged in her mind, a process she likens to “breaking a bad habit”. Sarah’s feelings of responsibility to undo past damage and her newfound social role as preacher of tolerance have also been protective – helping to deepen her disengagement and making it psychologically meaningful. Today her fears of being hardwired to be racist have subsided.
The researchers acknowledged that their account of Sarah’s case is “partial, idiosyncratic and limited”, but they noted that “most of what is said and written about violent extremist offenders [is] rarely complemented by insights from the offenders themselves.” They concluded: “We do firmly hope that this case study serves as an illustration for future research purposes.”
Horgan, J., Altier, M., Shortland, N., & Taylor, M. (2016). Walking away: the disengagement and de-radicalization of a violent right-wing extremist Behavioral Sciences of Terrorism and Political Aggression, 1-15 DOI: 10.1080/19434472.2016.1156722
The psychology of violent extremism – digested
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