Drama vultures: Some comments on social media

For young people, social media can be a very significant part of their social life. As Mark Brown put it, “Social media went big at the same point that austerity did. We lost our libraries, youth clubs and schools funding but we got smartphones and snapchat instead.” It has also been a means of connection for people who were technologically savvy but socially isolated. This is a surprisingly broad group, including both “geeks” (with subgroups of angry young men who have been radicalised by anti-feminism and the alt-right), those with social communication deficits (who like entirely written communication, as it means that they no longer feel excluded by the pace and non-verbal elements of real life social interactions) and people who are socially isolated because of their geography, disabilities, sexuality, gender identity, culture or more introverted personality, as well as an increasingly broad demographic who have simply discovered the convenience of social media as a means to connect with likeminded others. It can be enticing as a way to gain some social validation, either through “likes” of your content or photographs, or through a sense of belonging to a community of people with shared values or interests. And with so many different platforms, there can be many different qualities to this interaction, and functions that social media serves in people’s lives.

With niche communities, pockets of self-referencing and self-reinforcing cultural norms appear. Whether it is the sensitive niche sexualities of tumblr, or the offensive-as-possible culture on 4chan, the visual memes of imgur, the glamorous selfies of instagram, the endless stream of headlines from twitter, the business focus of linkedin, the many facets of reddit, videos on youtube, livestreaming on twitch or periscope, various blog platforms, an almost endless variety of podcasts, massive web forums on every topic imaginable, or even the comments sections of various publications, each has a different personality and norms. Some are ephemeral, with content disappearing after a certain time. Others stand as searchable archive with a long-term record of past content. Some allow people to broadcast outwards and collect followers, whilst others are focused on more reciprocal relationships. Some allow privacy restrictions that mean you can limit access to friends and family. But most have some means for others to indicate their approval or disapproval. And that means that there can be a sense of being judged or rewarded according to what you post. Sometimes this is based on the quality of the content, but it can also be based on political/group affiliation or appearance – with attractive young women who post photographs or video in particular getting a lot of attention. Some sites allow interesting or amusing content to float to the top where more people will see it, allowing particular posts to be read by remarkably large numbers of people. These can include inspiring content like non-zero days or unintentionally hilarious content like the penis dunking thread on mumsnet (mildly NSFW) that had me failing to contain my laughter during a BPS committee meeting. Some people seek out notoriety by writing controversial or entertaining content. Others who feel they don’t get enough positive attention seek out more negative peer groups, or seek attention in less functional ways. There are also less healthy pockets of social interaction on the internet. There are pro-anorexia communities, and sites that discuss and even encourage self-harm and suicide. There are bullies and trolls, and even people who fake being bullied in order to seek sympathy or justify introspective disclosures*.

One of the great advantages, and problems, with social media is the potential to be anonymous. This is a great leveller because it makes other users blind to your gender, age, race, appearance, physical ability/disability, sexuality, wealth, social class or other sources of prejudice – although many people choose to display these characteristics anyway and seek out similar people for a sense of belonging within specific online communities. However, the very anonymity and ability to create a character for yourself online can be problematic, as anybody can pretend to be anything. As well as the proverbial middle-aged lorry driver pretending to be a teenage girl, there are people pretending to be of different social demographics to infiltrate or undermine these communities. For example, many alt-right trolls attempting to fuel the gamergate conflict signed up “sock puppet” accounts as women and people of colour to pretend that their movement was more diverse or to defend them from criticism for sexism and racism. More obviously there are trolls, who use the anonymity to bully, harass and try to get a rise out of others, safe in the knowledge that social media is functionally a lawless zone, where only the very most serious of attackers, who challenge national security or make repeated overt threats towards targets in the public eye ever see any attempt at identification or prosecution.

By contrast, if you slip up on social media and say something stupid or embarrassing it can be shared with hundreds of thousands of people, your identity can be outed, and the impact can spill out into your real life in unpredictable ways leading to a roulette of inequality in which an ill-judged racist or sexist joke having more consequences than a year-long campaign of rape and death threats.  Or, you can become a target whose personal details are released on the internet (known as doxxing) by someone who dislikes your opinion or feels slighted by you, or subject to “revenge porn” where intimate photographs are published by an ex-partner without the consent of the subject. In America you can even become the target of hoax calls intending to send in an armed response team (known as swatting). And (as in many things) it is women and people of colour who always end up being disproportionately punished.

Having been on the internet since the 1990s, I’ve had an interesting personal history on social media. I was part of the eBay forums around the launch of eBay.co.uk for several years. As well as giving advice about scams and using eBay to buy and sell, there were lively off-topic discussion, running jokes and fundraising activities. But even within a seemingly diverse and healthy community of strangers there were many interesting signs of dysfunction. There were cliques and factions with marked animosity between them. There were people who claimed to be things they were not, including a “detective” and a “vet” (who was so desperate to uphold the facade she tried to get the Royal College of Veterinary Surgeons to amend a register entry for a genuine vet to match her name). There was a lady who faked her own death and posted as her (supposedly bereaved) husband, but was rumbled by an astute poster spotting contradictions in her story. When I foolishly mentioned being a psychologist in a conversation that only contained four other active users, that information spread much more widely than I had expected. I started to receive disclosures and allegations, messages about distressing feelings and even what appeared to be a suicide note (with the help of moderators I alerted authorities, and the suicide was not completed) so I soon learnt to be much more private and anonymous.

On clinpsy we have also had our fair share of tea-cup sized dramas, despite having very little need to intervene as moderators compared to the large volume of members and posts. I blogged about some examples two years ago, and I can only think of two people we have banned since then (although I did block someone from registering after they were very antagonistic and inappropriate on facebook after we failed to activate their registration between 10pm one night and 4am the following morning). I did recently have the interesting experience of having someone apply to work for me who had been banned from the forum. They didn’t seem to think I’d know about that, despite the fact that they used the same email address in their application as they had when they had been banned. They withdrew their application when I said that I knew and we’d need to have a conversation about it if they wished to progress their application.

It is an interesting thing that social media crosses the boundaries of communication that we are familiar with. The written form seems somehow impersonal and emotionless compared to forms of communication that contain the non-verbals, and yet somehow emotions are conveyed and evoked. The nature of speaking to strangers who may or may not be conveying the truth, and where we know little about them except for what is posted, involves a lot of extrapolation and ambiguity. It is hard to judge the response of the audience or how far information will spread, and deceptive safe feeling that we are posting in our own homes and usually under pseudonyms, yet it can suddenly become very personal and intrusive. On the clinpsy forum we monitor usage quite closely, and have zero tolerance of personal abuse or inappropriate content. In order to avoid knee-jerk responses or being hooked into unhelpful patterns, and to help us keep on top of maintenance and development tasks on the clinpsy forum, we work as a team. We keep a log of moderator discussions, user reports of concerns and reasons for banning users in a hidden moderators area on the forum. We tend to have quite a rapid response time for removing content for moderator consideration, and quite consistent views about where to draw the line, which has made clinpsy relatively drama free.

That isn’t the case on other forums, where much more banter and jokes are let fly, and these can be quite offensive, particularly if the dominant demographic is young white men. Racism, sexism and misogyny are quite prevalent in some online communities. Many women hide their gender to avoid quips about getting back in the kitchen, or banter about rape (which can be a term used in video gaming communities to refer to trouncing another player). But in some places it can even go a step further than that. 4chan, for example, used to ask for topless photos if anyone mentioned being female with the delightful phrasing “tits or GTFO”, and provoked many young women (at least one of whom appeared to be below the age of consent) to share sexually explicit images of themselves. 4chan also had links to child pornography (although I believe that this was eventually prohibited and split off onto another forum). Reddit has subreddits for misogynist men’s rights activists, pick-up artists, and incels (men who consider themselves to be involuntarily celibate – that is, they are too unpleasant to attract consenting female partners but do not recognise this, and turn the blame onto the women instead, with extreme examples like Elliot Rogers and the man behind the recent Toronto van attack), although again some attempts at prohibition and moderation are creeping in after bad publicity following the recent school shooting.

As a female poster in some male-dominated communities it was initially quite a culture-shock, but it is good to socialise outside the same narrow bubble, and there are also very positive aspects of being part of an online community. There is a hive mind of information on every topic that means you can gain immediate and often highly skilled advice on everything from how to rewire a light fitting, or how to distinguish a wasp from a mortar bee, to which model of television has the best features within a certain price bracket, or how to complain if a parcel doesn’t arrive. The community might be a rapid source of news, or entertaining new memes. There can be reviews of films, music, events or games that lead you to try new things, and erudite discussion about politics, current affairs, history, different cultures, religion, sports, science, religion, mental health, relationships and any topic that takes your interest. There can also be mutual concern and support when things are not going well, and shared delight when people experience unexpected success. So there are definite positives. The problem is that they can come at a price, and some people are more likely to pay the price than others.

Anyone who has been part of an online community knows about how they seem to inevitably create remarkable interpersonal dramas. These are like road traffic accidents – as a neutral spectator they both repulse you and make compulsive viewing, but as a participant they have the ability to cause genuine harm. When a person starts posting erratically or there is public conflict, or even when a person or group is bullying a vulnerable member if they do so in a way that is seem as amusing, it is viewed as entertainment or public spectacle. And, like a fight in a school playground, they inevitably attract a circle of spectators who both encourage and influence the unfolding drama, both joining in to sub-conflicts in the audience, and throwing in more fuel if it seems to be petering out. I’ve been in that circle a few times for different reasons, and it isn’t a fun experience. And as it starts feeling more personal and more antagonistic emotions start showing in how you post, and that seems to fuel the aggressor to go in for the kill, and other posters to join in. Our ability to reason and to predict the way that others will interpret and react to our posts reduces, and the stakes start to feel higher, and yet it somehow becomes harder to leave the conversation whilst feeling threatened or misunderstood. So you get drawn in to the battle, trying to clarify your intended meaning, defend yourself from perceived attack, or persuade others to see your point of view. Perhaps you criticise the other person, who then becomes more antagonistic or defensive. By the time you are in the thick of things there isn’t an obvious exit without either victory or shame.

Walking away from an online community because you don’t like how you are treated feels a lot like social exclusion and can have a significant impact on your sense of self, but to stay once you have attracted negative attention can mean the slow attrition of insults and snide digs that someone once described as “death by a thousand paper cuts” (a less severe/more protracted version of the Chinese torture method death by a thousand cuts, in which it is hard to criticise any individual action as being unduly aggressive or breaking any rules). Frustratingly these can often be the kind of microaggressions that align with real life experiences reflecting the casual degradation of disempowered/minority groups. And, as ever, women and minority groups seem to be disproportionately the target for them. Even a phrase like “calm down love” is loaded with patronising layers of meaning about women being ruled by their emotions and lacking the calm logical analysis of men. It implies that caring about anything enough to show some emotion about it is already losing the battle.

There is little time for compassion or reflection online, and it is hard for an onlooker to intervene in a way that is helpful to diffuse conflict. Thus vulnerable people may end up re-victimised, and people with dysfunctional ways of relating often play these out over and over online. I can particularly recall one poster who had a distinct cycle of debate, feeling criticised, rage and then burning out to a final phase of being shamed and apologetic, trying to make amends to avoid rejection – and the community becoming increasingly intolerant of these emotional extremes. At times it felt like observing a digital version of a disorganised attachment relationship, with the forum community functioning as the inconsistent/abusive parent. It came as no surprise to read disclosures about an abusive childhood, use of crisis mental health services and a personality disorder diagnosis. But s/he was far from alone in having dysfunctional ways of relating to others online. In fact it seems that many people with such difficulties are strongly attracted to the accessibility and 24 hour nature of online communication, and can find significant support from strangers there. But it often comes at a high cost, or with significant risk, because of the prevalence of trolls and the way dramas are amplified by having an audience, and the way social media can serve as a written record of whatever unfolds that is hard to erase. There might be the right to be forgotten under GDPR, but how does this actually work in practise when comments are quoted and replied to, or captured in screenshots and posted elsewhere?

There are plenty of examples of how vulnerable people are enticed by the sense of belonging in a group, or the superficial success of social media influencers, but harmed by the messages they are given. This can range from unhealthy roles models such as the one I blogged about previously to being encouraged to harm others or given advice on how to harm themselves or commit suicide (the Daily Mail recently ran a scare piece on a “Blue Whale” game that culminates in telling children to commit suicide, though snopes felt there was little evidence to substantiate this). It would seem to me that the bigger concern is the indoctrination of larger numbers of young, socially isolated people in toxic beliefs such as alt-right ideologies, through writing that blames others for their ills. Whether it is “psychologist” Jordan B Peterson whose 12 rules for life serve as an introduction to his regressive beliefs including “enforced monogamy” in which he appears to advocate that to prevent male violence women should be allocated to partners and forced to remain monogamous to them (which is rightly being called out as sexist/stupid/victim blaming). It might have sold 1.1 million copies, and he might make £80k/month in patronage, but this isn’t a new enlightenment. Enticing simplistic sexist answers are not the cure for angry young men who feel left behind by progress, I would argue they are the very fuel that will convert them into the school shooters, rapists and perpetrators of future violence and harassment. But it is hard to offer up an alternative perspective or contradictory evidence when an angry mob descends on any divergent opinion, claiming that they are the true victims and that the sexist/racist drivel they promote is being censored by sensitive snowflakes (the new version of “its political correctness gone mad”). Ironically, these repugnant views that are allegedly suppressed/unspeakable are getting lots of airtime, whilst stifling free expression of opposing/alternative views** as progressive voices fear becoming a target of the mob.

In short, its a messy and unregulated space, and there are both interpersonal conflicts and large scale culture wars playing out in it. How to protect people in a digital age needs a lot more thought, both at the level of educating children about critical thinking and empathy, and in terms of regulation of social media, and enforcement of crimes committed via digital media. But with middle aged and older politicians doing the legislating it is hard to see how that is going to happen.

*if you find this surprising, consider the bug chasing community, who are people actively seeking HIV infection in order to gain care, sympathy and a sense of belonging
**including me, as I avoid using certain terms on social media or in the tags and category labels for this blog, as I dislike the surge of abusive/antifeminist responses they trigger

Solve for happiness: Some thoughts on big data/AI and mental health

We are hearing a lot about the use of big data at the moment, mostly that it has been an underhand way to manipulate people politically, that has been used by those with no ethical compunctions to get people to vote against their own best interests*, and in favour of Brexit and Trump. Cambridge Analytica and AIQ seem to have commercially exploited academic research and breached data protection rules to try to nudge political behaviour with targeted messaging. Whether or not that was successful is up for debate, but to the public the narrative is about big data being bad – something technocrats are exploiting for nefarious reasons. I can understand that, because of the associations between gathering data on people and totalitarian political regimes, and because of concerns about privacy, data protection and consent. There is increasing awareness of what had previously been an unspoken deal – that websites harvest your data and show you targeted advertising, rather than charge you directly for services, and the new GDPR means that we will be asked to explicitly consent to these types of data collection and usage.

But what about the potential for big data to do good? I know that DeepMind are doing some data crunching to look at whether AI algorithms can help identify indicators that determine outcomes in certain health conditions and point doctors towards more effective treatments. Their work to identify warning signs of acute kidney injury was criticised because of breaches to data protection when they were given access to 1.6 million medical records without individual patient consent, but whilst the data issues do need to be sorted out, the potential for projects like this to improve health and save lives is undeniable. Computers can look through huge amounts of detailed data much more quickly and cost-effectively than humans. They can also do so consistently, without fatigue or bias, and without a priori assumptions that skew their observations.

Research often highlights findings that seem counterintuitive to clinicians or human researchers, and that means that using the data to generate the patterns can find things that we overlook. One example I read about today was the fact that admitting offending behaviour does not reduce the risk of recidivism in sexual or violent offenders (in fact those who show most denial offend less, whilst those who demonstrate more disclosures and shame are more likely to reoffend). But this is also true about telling people they are being given a placebo (which will still produce positive placebo effects), using positive mantras to enhance self-esteem (which seem to trigger more negative thoughts and have a net negative impact on mood and self-esteem) or about expressing anger (rather than this being cathartic and leading to a reduction in anger, it actually increases it). Various fascinating examples are listed here. There is also the well-known Dunning Kruger effect, whereby ignorance also includes a lack of insight into our own ignorance. As a population, we consistently overestimate our own ability, with people in the bottom percentiles often ranking themselves well above average.

I often refer to the importance of knowing the boundaries of your own competence, and identifying your own “growing edges” when it comes to personal and professional development. We talk about the stages of insight and knowledge developing from unconscious incompetence to conscious competence, and finally to unconscious competence where we can use the skill without conscious focus. Confucius said “Real knowledge is to know the extent of one’s ignorance.” And it may well be that when it comes to solving some of the big problems we are limited by our own frame of reference, what we think of as relevant data, our preconceptions and our ability to build complex models. Using giant data sets and setting technology to sift through and make sense of them using various paradigms of AI might help open up new possibilities to researchers, or find patterns that are outside of human observation. For example, certain medications, foods or lifestyle traits might have significant impact on certain specific health conditions. I am reminded of a recent article about how a third of antidepressants are prescribed for things other than their primary function (for example, one can seemingly help with inflammatory bowel disease that has very limited treatment options). A computer sifting through all the data can pick up both these unintended positive effects and also rare or complex harmful side-effects or interactions that we may not be aware of.

What difference could this make in mental health? Well, I think quite a lot. Of course many predictors of mental health are sociopolitical and outside of the control of the individual, but we also know that some small lifestyle changes can have very positive impacts on mental health – exercising more, for example, or having a healthy diet, or getting more sleep, or using mindfulness, even just getting outdoors more, learning something new, doing something for others, or spending more time with other people (and less time on social media) can have a positive impact. There are also many therapy and therapist variables that may make an impact on mental health, for people who engage in some form of talking therapy, although variance in outcomes seems to actually boil down to feeling heard and believed by a therapist who respects the individuality and cultural context of the client. And of course there are many medical treatments available.

So is there a way of using big data to look at what really works to help people feel happier in their lives? I think the potential for apps to collect mass data and test out what makes impact is enormous, and there are a proliferation of apps in the happiness niche and more that claim to help wellbeing in a broader way. They seem to have found a market niche, and to offer something positive to help people make incremental life changes that are associated with happiness. What I’m not sure of is whether they reach the people that need them most, or if they are evaluating their impact, but presumably this is only a matter of time, as real life services get stripped back and technology tries to fill that gap.

I think there is huge need to look at what can make positive change to people’s wellbeing at a population scale, and I think we need to be tackling that at multiple levels. First and foremost, we need to make the sociopolitical changes that will stop harming the most vulnerable in society, and encourage greater social interconnectedness to prevent loneliness and isolation. We need to increase population knowledge and tweak the financial incentives for healthy lifestyle choices (eg with much wider use of free or subsidised gym memberships, and tax on unhealthy food options). And we need to invest in preventative and early intervention services, as well as much more support during pregnancy and parenting, and in mental health and social care. But I can also see a role for technology. Imagine an app that asked lots of questions and then gave tailored lifestyle recommendations, and monitored changes if the person tried them. Imagine an app that helped people identify appropriate local sources of support to tackle issues with their health and wellbeing, and monitored their impact when people used them. As well as having a positive immediate impact for users, I’m sure we’d learn a lot from that data that could be applied at the population level.

*I think the evidence is strong enough that the demographics who voted for these people/policies in the greatest numbers are the very people who have come out the worst from them, so I am just going to state it as a fact and not divert into my personal politics in this blog, given I have covered them in previous topics about Brexitmy politics, “alternative facts”, Trump, why and what next, the women’s march, and Grenfell and the Manchester bomb.

Six degrees of separation

My brother, David Silver, is panning out to be one of the significant players in the world of artificial intelligence. His PhD topic was applying reinforcement learning to the oriental strategy game of Go, and he has gone on to be the lead researcher on AlphaGo at Google DeepMind. That is the program that last year beat the world champion human player and became the best computer player of Go. More recently AlphaZero has taught itself to play Go from scratch (AlphaGo started by learning from thousands of top level human games) and has also taught itself to play chess and shogi, all to unprecedented levels of excellence. It has been very exciting following his progress, and going to the premier of the documentary film about AlphaGo (which is a lovely human drama, even if you don’t know or care much about the technology, so do give it a watch on netflix/prime/google play/itunes if you get the chance).

It is no surprise to me that David has gone on to find a niche that is intellectually impressive, as he has always been a pretty smart guy and done exceptionally well in education (though reassuringly he isn’t all that practical, makes the same silly mistakes as the rest of us, and has remained quite down to earth). I’ve always been glad to be the older sibling, as I think it would have been difficult to follow in his footsteps. As it was, I could be proud of my relative achievements before he came along and beat them all! He has always had a very analytical mind and enjoys solving logical puzzles. I guess I do too in some ways, but I’m much more interested in how people work than complicated mathematical calculations, and how we can reduce suffering and help people recover from trauma, rather than pushing the boundaries of technology. We’ve chosen quite different career directions, but I think we still have quite similar underlying values and ethics.

Although I’m proud of him, I’m not mentioning my brother’s achievements to show off (after all, I can take no credit for them) but because they’ve given me cause for reflection. Firstly, it would be easy to feel inadequate by comparison. After all, he is making headlines and working on the frontiers of technology, whilst I’m just a clinician running a tiny company and have made relatively little impact to date. It would be easy to be jealous of the financial security, publications and plaudits that he has got. He has made the news all around the world, and even has a wikipedia page! But I think I’d find that spotlight uncomfortable, and I suspect I’d find his job pretty stressful, as well as finding all the maths and computing pretty boring and unfulfilling. So whilst there is plenty to admire, I don’t really envy him and wouldn’t want to swap places.

Secondly, and perhaps more interestingly in terms of this blog, it has made me think about what my goals are. Making the best possible AI to play Go is quite a narrow and specific goal, and within that he selected a specific methodology with reinforcement learning, and he has focused on that for the past decade, before looking at what other applications the same system might have. Yet in that same time period I’ve been pulled in many different directions. I’ve been an NHS CAMHS clinician and service manager. I’ve been an at home mum. I’ve helped to found a parenting charity. I’ve set up and evaluated a project to improve outcomes for diabetes patients. I’ve bid for grants. I’ve tried to help recruit psychologists and improve clinical services within a children’s home company. I’ve undertaken specialist assessments of complex cases. I’ve been an expert witness to the family courts. I’ve delivered training. I’ve run a small therapy service. I’ve conducted research. I’ve tried to influence policy, and sat on committees. I’ve written a book about how to care for children affected by poor attachments and trauma. And I’ve developed outcome measures. Most of the time I’ve done several of these things in parallel. It is hard to keep so many plate spinning, and means I have not been able to invest my full energy in the things I most want to do. I’ve also had hesitations about investing in entrepreneurial ideas, because of guilt about saying no to other stuff, or fear that it won’t pay off  that have taken a really long time to shake off.

Greg McKeown says in his brilliant articles for Harvard Business Review about ‘essentialism’, that success can bring on demands that cause you to diversify, and ultimately reduce your focus on your primary goal and cause failure, and that is exactly what I’ve experienced. It reminded me of a reflective exercise I did as a trainee on a workshop about creative methods, where I made an amoeba shape out of clay to represent the pulls I felt in different directions. The amoeba was a resonant image for me as it can’t spread too thin without losing its depth at the centre, and it can’t travel in two directions at once. Finding the right direction of travel and resisting other pulls on my time is something I am still working on 20 years later! It has been a growth curve to learn what to say ‘no’ to so that the company does not become overloaded or incoherent*. There are also other forces that influence what a small business can deliver – we have to do work that we are passionate about, uniquely skilled to deliver and that there is a market for. There is no point offering services that nobody wants to buy, or that other people can provide better, or that you are not enthusiastic about, so we need to stick to things that we can deliver brilliantly and build a positive reputation for. However, with the breadth of clinical psychology there will always be multiple demands and opportunities, and it is necessary to find a focus so that we have a single defined goal** in order to attain the most success.

I’ve taken time to refine my goal from “applying clinical psychology to complicated children and families facing adversity” (which is actually quite a broad remit, and includes a wide range of neurodevelopmental, mental health, physical health and social aspects of adversity, being applied to all sorts of different people) to “applying clinical psychology knowledge to improving services for Looked After and adopted children” to “using outcome measurement tools developed through my knowledge of clinical psychology with placement providers and commissioners to improve outcomes for Looked After and adopted children”. Likewise, it has taken me time to clear space in my head and in my diary, and to be in good enough physical health to give it sufficient time and energy. But I am finally able to dedicate the majority of my working time to making people aware of BERRI, doing the statistical analysis to validate and norm it, and supporting/training those who subscribe to it. I have secured an honorary research fellowship at UCL and some data analyst support, and a trainee from Leicester is making it the subject of her doctoral research, so I very much hope that 2018 will be the year that we publish a validation of the measure and methodology, and can then roll it out more widely. I believe that is my best chance to make a difference in the world – to improve the standards of care for children living outside of their family of origin by encouraging universal psychological screening, regular outcome measurement, and the ability to identify and track needs over time.

Finally, my brother’s achievements have given me pause for thought because him working at Google has made me feel a sense of being somehow distantly connected to silicon valley, and all the technological and entrepreneurial activity that goes on there. Suddenly the people who founded Google, Facebook and Tesla/SpaceX are no longer as abstract as Hollywood actors or international politicians, but are now three steps away in a technology game of six degrees of Kevin Bacon. It makes the world feel a little smaller and making an impact seem more possible, when your kid brother is connected (however peripherally) to the technology giants who are changing the world.

Alongside this, in my ImpactHub coaching peer group several people have gone on to make successful social businesses that have rapidly scaled and made an impact on the world. Proversity for example, have expanded massively into the digital education space. Old Spike Roastery & Change Please have expanded their coffee businesses that employ homeless people, and School Space have scaled up a project they started at the age of 17 to help their school rent out its premises out of hours into a thriving business that has generated £350,000 of income for participating schools. Code Club have partnered with the Raspberry Pi Foundation to teach children in 10,000 clubs in 125 countries all around the world to program computers. And Party for the People have made a competitor for TicketMaster or SeeTickets where the fees go to a good cause, and have set up arts spaces in old factory buildings.

In this context, it seems possible to dream big, to think that an idea could become a reality that has an impact on the world. So whilst my main vocation remains to bring the process of regular outcome measurement to services for Looked After Children (and that is making some really positive steps at the moment), I’ve started to work out how to make my back-burner project a reality. This one is a proper entrepreneurial idea in the digital space and tied in a little to my previous blog topic of the issue of how the public understand the evidence for different kinds of interventions. I’m hoping I can develop a pilot and then seek some investment, so watch this space as I’ll report back how it goes.

In the meanwhile, I still want to make some changes in my personal life. I’m generally feeling quite upbeat about the future at the moment, and I’ve sorted out the issues I mentioned in a prior blog about disappointment. We’ve also pulled in payment for many of the outstanding invoices, and the business is the best organised it has ever been. But after reviewing how I spend my time and who I interact with the most, I have become much more aware of my various different networks, and to what degree I feel able to express myself authentically within them. I am being a bit more thoughtful about my networks, both in real life (where I want to make greater efforts to meet like-minded people locally) and online, where I need to spend less time (and I’ve recognised my shamefully judgemental feelings of rage and disgust when interacting with people using image filters, especially those that put puppy ears and noses onto reshaped faces with features made to conform with patriarchal standards of beauty). I have realised that I haven’t been choosing the company I keep well enough, so I am trying to connect more  with those who are positive influences on my life, and to pull away from people who are a drain on my emotional resources. I am also choosing to engage more with people in the social entrepreneurial space. As Jim Rohn is much cited as saying “you are the average of the five people you most associate with” and hanging out with inspiring people allows us to be more creative and entrepreneurial ourselves.

So hopefully 2018 will be the year where I make a success of BERRI, complete the validation research and get some publications out. I’d also like to get a pilot of my entrepreneurial idea up and running. And in my personal life I’d like to get back to the gym, to get the planning permissions sorted out for my house, and most importantly to make more real life social connections with people who share my values. If I’m only a few degrees of separation from people who have achieved all of these things, then maybe I can too.

 

*I wrote more about developing my business model and setting up a social enterprise in clinical psychology forum number 273 in Sept 2015

**or failing that, a primary goal, secondary goal and fall-back plan, in ranked order of preference (with an awareness than only exceptional polymaths like Elon Musk can achieve in more than one area at the same time).

Why is there always a can of worms?

I’ve run http://www.clinpsy.org.uk for 9 years now, and built it up to 6900 members, 600,000 users and nearly 10 million page views per year. I’ve put enough hours into that site to add up to more than two years of full-time work, and I’m proud of what we’ve achieved. It is an informative, welcoming community that allows people to network and ask questions. It also levels the playing field of information and reduces the impact of personal connections within the early stages of the profession, and I hope that this will in the long-term act to increase diversity in the profession. Over those 9 years, members have written upwards of 135,000 posts on the forum, and our wiki of information and answers to frequently asked questions has been viewed millions of times, with some posts about preparing for interviews, the route to qualifying, formulation, writing a reflective journal, and transference proving particularly popular – the latter having been read over 115,000 times.

In all of that time we have had remarkably little need to intervene in the forum as moderators. We remove the occasional bit of spam, and we have sometimes anonymised posts in retrospect on the request of the author, and from time to time we have to explain to service users that this is not an appropriate place to ask for advice, but we rarely have to warn or ban forum users. I think the total to date is seven banned individuals and one banned organisation. Not bad when we’ve had 10,000+ sign-ups, and 135,000 posts! This is perhaps a reflection of our clear guidance about how we expect users to behave on the forum, and also of the large number of regulars who act as a more informal feedback loop. We also have quite a large number of qualified clinical psychologists who log into the forum regularly and often act to provide information and correct misconceptions. This is a very important function, as the pre-qualification arena can often become an anxiety-provoking echo chamber, where rumours are propagated and exaggerated without being confirmed or refuted. It also allows us to have a (hidden) peer consultation forum, which is a very good place to discuss concerns with peers in a safe environment in which every member is an HCPC registered clinical psychologist.

However,  the few times when intervention is necessary always tell an interesting story. And the strange thing is, that every single time somebody has been a persistent concern on the forum, this has opened a can of worms that makes us worried about wider ethical issues for the same individual. We had someone who was very unboundaried, and at times threatening to their colleagues and other members in the LiveChat space, and transpired to have caused concern with aggressive conduct in real life. We had a member who was somewhat grandiose and wanted to be a moderator, who attempted to delete and vandalise site content. They later had issues in their workplace, with a similar theme of acting beyond their level of competence. One poster lied to persuade successful applicants to share their applications for clinical training and plagiarised them, and when we identified them it transpired they had plagiarised site content into a publication without acknowledgement and had been unprofessional in numerous other ways. Another odd poster used the same username to post topless pictures on another website. And most recently we have had an organisation recurrently attempt to circumvent payment for advertising on the forum by signing up stooge accounts to promote their service, where it would appear that the appearance of an ethical non-profit organisation instead covers a profitable privately owned tour operator.

It has made me wonder whether ethics and professionalism are the kind of thing people have or they don’t, and that show in numerous domains of their life. Or, is the seeming anonymity of an internet forum a place where traits are exaggerated and played out. Either way, the association between inappropriate use of the forum and inappropriate professional behaviour in other domains seems too high to be a coincidence.

Yet the ethical and professional guidance for psychologists has little that applies in our context. We have had to work out our own boundaries amongst the moderating team (we now comprise ten qualified psychologists and a lay member, although many joined the team as APs or trainees). It makes me realise how much unique our position is, on the technological frontier, and how we are learning case by case. For example, we have had to interpret the balance between confidentiality and risk to apply to our unique setting. We settled on a position that is broadly consistent with what I’d do with clients in real life; we would identify and report a member if we felt they were at risk or presented a risk to others, but otherwise aim to respect the pseudo anonymity of using a posting ID, where only a minority of people choose to be identifiable as a specific professional, or in a way that could be recognised in their workplace. Likewise, we have learnt to log everything typed into our LiveChat space, so that we are able to review the usage of particular members, or read the content if a report is made of inappropriate behaviour. I’d like to think that we’ve reached a good place, and have always been transparent in how we behave. It has been an interesting process though, so I’m thinking of presenting some of the ethical dilemmas and our process at the CYPF conference later this year.

High on scare, low on science: a tale of charity, politics and dodgy neuroscience

In 2011 when I took a voluntary redundancy from the NHS I was asked to help set up a parenting charity* focusing on the period from conception to age 2. I agreed to be the founding Clinical Director and to help them set policies, sort out pathways of treatment and recruit staff. I worked for them one day per week. After less than six months it was clear that there was a divergence between what I felt was most clinically helpful to say about supporting parents in this critical period and the primary goals of the charity**. This was particularly evident in what was being said to promote the launch event of the charity. The title of the launch conference was the dramatic and pessimistic pronouncement, “Two is too late”. This title was cast in stone despite my repeated protests that parents would feel blamed and might think that there was nothing they could do beyond the age of two if they had not had a perfect attachment relationship before this point (when the evidence suggests that there are in fact many effective strategies for enhancing attachment relationships beyond this point, and many therapies for helping children and even adults to learn to emotionally regulate, mentalise and have successful relationships, even where there has been poor attachments, neglect or maltreatment).

The media were given soundbites to promote the event that suggested a baby is born with only one third of their brain active, and the rest relies on the quality of parenting received to grow. The news coverage in the Telegraph*** said that “a failure to help troubled mothers bond with their babies can stunt the development of the children’s brains”. The BBC coverage*** stated “a growing body of research suggests that the amount a baby is loved in the first few months of its life determines to a large extent its future chances” (when love and the quality of the attachment a parent is able to provide are quite different things, the most critical period is usually cited as 6-18 months of age, and the change in prognosis is most impacted by significant maltreatment).

Although our tiny pilot had kept 5 children out of 6 at home with parents successfully, despite them being referred on the edge of care, we had feedback from service users and user groups that they felt stigmatised by some of these messages. I am passionate about the value of improving attachment relationships and I had written a brief literature review on the impact of poor early care to ensure that the project was informed by the evidence. I was also writing a book about attachment and the impact of maltreatment, but I couldn’t match my views up with the politics of the organisation. I felt that to stay would conflict with my professional ethics, and my desire to honour the evidence base and respect the people who needed the service, so I quit before the launch. My colleague decided it would be unsafe to practise in my absence and left at the same time, leaving the charity with no clinical staff. Nonetheless, they decided to make a very big launch event, that I could only describe as one third professional conference, one third stately home wedding and one third party political broadcast for the blue party. It sold 500 tickets to health professionals and other interested parties, and I went along to see the show.

The speakers included a Conservative Peer, Ian Duncan Smith and Andrea Leadsom, along with Dr Amanda Jones (who shared a case study of parent infant psychotherapy). The fantastic Camilla Batmanghelidjh was also present (and made a good job of challenging the lack of empathy from politicians for the people they serve and quipping that this reflects their avoidant attachment styles). I had invited Dr Michael Galbraith (a Consultant Clinical Psychologist who has run community children’s services in Liverpool for many years) to talk about the health economics of early intervention. He did so persuasively and he also challenged the politics that came before his talk (with genuine zeal, as his entire service had been closed in a cost-saving ‘reorganisation’ a few weeks prior to the conference). But the biggest draw was that Baroness Susan Greenfield was invited to talk about the epigenetic effects of early attachment experience on the infant’s developing brain****. As I had not heard of her work prior to this event I was intrigued.

The talk that Prof Greenfield gave was baffling from the off. It massively overran her time-slot, and the program was rearranged to give her a second slot in the afternoon to complete what she wanted to say. My recollection was of a chaotic set of shock images and headlines, with provocative statements which appeared to contradict my knowledge of the literature, despite the fact she claimed they were scientifically founded in hard neuroscience research. Thankfully the pdf of the PowerPoint she used was circulated after the event, so you can see the content for yourself (zip file to download here).

Her title was “The mind of the 21st Century Infant” overlaid on a stock photograph of a baby using a computer. She immediately moved on to dramatic images of a youth celebrating in front of a fire during the recent riots, blaming the riots on the lack of attachment young people have grown up with, which she said had been replaced by technology. She then showed scary images of “artificial intelligence” before trying to define the mind. Then she made a knight’s move to demonstrate that “environment trumps genes” through a single study of rats given genes that cause Huntingdon’s Chorea which had less symptoms if they lived in a more stimulating environment. Then back to human babies, and images of how neurones proliferate during the first 2 years of life. Then a study showing that the Hippocampi of taxi drivers are enhanced, and then some blobs designed to indicate that mental practise of piano also activates the brain like physical practise. Then back to rats, showing more neural connections in a richer environment than when rats are isolated in boring cages. Then a description of how the mind shifts during development, from sensory processing to cognitive experience and gives greater meaning over time, with the view this is driven by experience.

She then claimed the mind might be “changing in unprecedented ways” due to interaction with technology, and showed alarming headlines circled in red, and book titles reflecting her view that internet use is changing our brains.

Prof Greenfield then showed a study counting children’s hours of screen time reported by parents, according to the child’s age. The source cited turns out to be a report saying that children have always used whatever media is current, mostly watching TV (which has been on for 7 hours per day since the 1970s) and although digital media is rapidly proliferating including learning toys, music and phones, total media use by white children had only increased by 38 minutes between 2004 and 2010, though it was more prevalent in low income families and had increased more in BME families. It states there is no evidence yet about how much is too much when it comes to media consumption but states that “media platforms by themselves are neutral; what matters most are the choices made by parents, educators, educational production companies, and other content providers in order to encourage a balanced pattern of consumption” using the metaphor of needing a balanced diet. This was not reflected in Prof Greenfield’s narrative about this amount of media being harmful, and it is unclear how she extrapolated the figures in her table.

Another leap, and we were onto how dopamine is the reward chemical and behind all addictive behaviour. Prof Greenfield said that it changes neural activity, inhibiting the frontal lobes. This is why children are becoming fat, sedentary and obsessed with technology. They are all addictions, and disrupt our frontal functioning. Then a leap to schizophrenia not having sufficient frontal lobe activity, and reverting the brain to sensory processing which is fragmented and without meaning. Another slide full of brains: The prefrontal cortex is not mature until your 20s. Then a claim that schizophrenia, gambling, over-use of screen technology and over-eating have a common pattern of prioritising our senses over reason, due to dopamine making us mindless rather than able to synthesise meaning. It felt very alarming to have schizophrenia and addictions linked to the same pathways as attachment difficulties and technology use. The implication was that parents could cause these difficulties in how they parented babies, or by allowing children to use digital media. These are claims for which I have never read any scientific evidence, despite being a clinician working in this area and trying to keep abreast of the research literature.

Another leap to social media and how it makes us “alone together”. Prof Greenfield told us how real communication is three dimensional, and little of the meaning is conveyed in the words, whilst 90% is in eye contact, body language, tone of voice, perhaps even touch and pheromones. But online we have only the words. According to her, this is why empathy has dropped over the last 30 years (another newspaper headline, not a scientific study, and with no reflection on the socio-political changes that might explain this). The lack of empathy required is why people with autism are so at home with technology and on the internet. People also have reduced identity, so they have to record their existence online. Prof Greenfield characterised the development of online communication as going from describing your cat sneezing on Blogger, to putting up a photo on Flickr, to a video on YouTube, to live Tweeting the action, saying that such activities reflected the author as a disconnected “nobody” who needs to prove they exist. She postulated that a rise in social networking is the cause of reduced empathy and people having a less robust identity, but it seems to me that even if these two things co-occur the direction of causality could be the reverse.

She then skipped on to the evils of video games, inserting a slide with MRI scans to show reduced listening when looking at something else, before blaming video games for the increase in methylphenidate prescriptions. Prof Greenfield claimed ADHD could be caused by video games because they lead to “fragmented attention, shorter attention span and increased recklessness” because they activate the dopamine system. Another headline in a red circle saying children who love video games have “brains like gamblers”. Then she showed us her own work bringing this together: a proposed cycle of how the intense stimulation and immediate feedback lead to high arousal and dopamine release, reward seeking behaviour and this makes brain changes which cause “conditions of childhood, schizophrenia, obesity” and a drive for sensation over cognition increasing the appeal of screen based stimulation in a continuous cycle. Again, I don’t believe any of these claims have appeared in peer reviewed publications or have any evidence to substantiate them, and even if there was evidence of co-occurrence the direction of causality is far from certain. There is however a growing body of evidence that some symptoms that could be interpreted as ADHD-like are caused by early trauma and maltreatment having an impact on neural development. To end that section, Prof Greenfield juxtaposed the “mindless” brain slide with a shot of World of Warcraft and mocked the lifestyle she believed was typical of those who play the game.

Then Prof Greenfield turned her attention to search engines, claiming they give fragmented information but nothing about meaning. By way of example she claimed that you can’t possibly understand what honour is from the search engine results produced by that term. Again, she claimed digital media is all fragmented content, lacking metaphor, depth and meaning. She strongly asserted that nobody could care about a character in a video game like you care about characters in a novel. Again, I would disagree with this. Like any media, video games are very diverse in style and quality and you pick ones that fit your taste, just as you would with a book or a film. If you don’t like violence, don’t pick a violent one. You don’t have the same expectations for the latest chick lit/flick as you do a weighty classic. Some examples are also of better quality than others, some focus on special effects over plot, others are low budget and whimsical. In my opinion if you feel immersed and the story is told well it feels like time well spent and you care about the characters and outcomes, whether the media is a video game, a book or a film. Its disingenuous of her to pick a random game she has probably never played and say nobody could care about a character in it as much as one in War and Peace.

Prof Greenfield then talked a little about the benefits for children of reading with a parent, and how we need to “make up our own minds”. She finished by advertising her books, and claiming that “mind change is the new climate change, the biggest issue facing us in the 21st century”. I’d share the comments on this claim raised here.

The whole felt to me like a mishmash of pseudoscience, headlines and speculation that didn’t even address the topic of the conference. Even if there was persuasive scientific research about the impact of using digital media (which I wasn’t persuaded), it wasn’t relevant to the conference as babies don’t use it. Her talk wasn’t about the importance of relationships between conception and two, which was what the conference was designed to highlight. She had come with a single agenda to sell. And it was clear that she was very much an outsider looking in when it comes to technology; judging it with minimal knowledge of social media, the internet, or video games.

As someone fairly immersed in that world, I could pick out numerous examples of violence in TV, film and video games, particularly violence against women and children. I might even be able to make a prima facie case that we are being desensitised to human suffering (and violence and sexism is being normalised). It is possible that the manufacturers of such products are buying into various ‘exciting’ neurochemical pathways that deal with arousal and reward (cortisol, adrenalin, dopamine), over those that deal with relationships, empathy, love and the ability to soothe (oxytocin and the work of the prefrontal cortex). But I think Susan Greenfield is making a huge correlation-causality error when she blames new media for people becoming isolated and lacking social skills and healthy relationships. I think there is much more evidence that real life experiences of maltreatment prime certain brain changes that make people more sensitive to later triggers and confer vulnerability for later mental health problems (see the work of Prof Eamon McCrory, for example) than that digital media is the cause of the problem.

I do think that if people lack templates for how to do real relationships in a healthy way, and haven’t learnt empathy and self-soothing skills, then these kind of media have a stronger attraction and a different effect on their brain, and can perpetuate rather than ameliorate this pattern. However, in the end I figure that people can always fill their time with something that disconnects them from others, or anaesthetises their pain. In other words, it isn’t the availability of the internet or video games that is the problem (any more than the presence of cheap alcohol, or drugs), it is the unhappiness and isolation that creates the void people want to fill with those things. And that has much more complex solutions, though it might generate less click-bait headlines.

* It is now nearly 3 years on, and I am confident that the clinicians recruited after I left have been able to establish a high quality service, so I would not wish to imply any concern about the services they provide.

** I felt, cynically perhaps, that there was a second agenda designed to promote the MP who founded the project and her political party which was of more importance than our clinical goals, although this was never explicit.

*** http://www.telegraph.co.uk/women/mother-tongue/familyvideo/9273569/New-post-natal-depression-charity-will-address-huge-gap-in-provision.html

http://www.bbc.co.uk/news/uk-england-northamptonshire-18117945

****The promotional flyer for the event said “We are honoured to announce that Baroness Susan Greenfield, Professor of Synaptic Pharmacology at Oxford University, whose speciality is physiology of the brain will bring you up to date on the Science, Neuroscience and Epigenetics”.