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Fear is a basic emotion that is activated in response to perceived threat

COVID-19 Milestone Series

This post republishes: “The four horsemen of fear: An integrated model of understanding fear
experiences during the COVID-19 pandemic” by Adriano Schimmenti, Joël Billieux and Vladan Starcevic

Citation: Schimmenti, A., Billieux,J., Starcevic, V. (2020). The four horsemen of fear: An integrated model of understanding fear experiences during the COVID-19 pandemic. Clinical Neuropsychiatry, 17 (2), 41-45. https://doi.org/10.36131/ CN20200202 Copyright: © Clinical Neuropsychiatry

Authors: Adriano Schimmenti, Joël Billieux and Vladan Starcevic

In this article, we argue that fear experiences during the COVID-19 pandemic are organized on the psychological level around four interrelated dialectical domains, namely (1) fear of the body/fear for the body, (2) fear of significant others/fear for significant others, (3) fear of not knowing/fear of knowing, and (4) fear of taking action/fear of inaction. These domains represent the bodily, interpersonal, cognitive, and behavioural features of fear, respectively. We propose ways of addressing these fears and minimising their impact by improving appraisal of the body, fostering attachment security, improving emotion regulation, adopting acceptance and promoting responsibility.

The coronavirus pandemic poses a huge challenge to the society because it tests its ability to cope with a multifarious threat under the constraints of the situation.
Political actions are taken in the realm of health
management, public security, financial economics,
protection of assets and production of goods. Although
important, psychological health is probably the most
neglected aspect of the COVID-19 pandemic. It is
not an immediately visible part of the global picture
of this disaster, but the negative psychological impact
of the pandemic and measures taken in response to
the pandemic is well known (Brooks et al., 2020;
Morganstein, Fullerton, Ursano, & Holloway, 2017).
Crucially, the resilience of a society facing such a
catastrophic event also depends on how its individual
members cope with their anxiety and fears. Widespread
fears of aloneness, contagion and death affect our
sense of agency, relatedness and the way we behave,
in addition to restrictions imposed by governments.
Coping with these fears is thus critical on the individual
level, and effective coping can also help the society to
better manage the pandemic.

Fear is a basic emotion that is activated in response to perceived threat.
In the current article, we propose that fear during the COVID-19 pandemic
is organized on the psychological level around four
interrelated dialectical domains. These domains of fear
are (1) fear of the body/fear for the body, (2) fear of
significant others/fear for significant others, (3) fear
of not knowing/fear of knowing and (4) fear of taking
action/fear of inaction, and they represent the bodily,
interpersonal, cognitive, and behavioural features of
fear, respectively. We contend that the four domains of
fear observed during the COVID-19 pandemic reflect
the main psychological means of grasping the reality.
Moreover, we propose a dialectical structure of the
identified fears, whereby each aspect of a fear domain
may coexist with its counterpart (the apparent opposite)
and may relate to the aspects of other fear domains.
Thus, fear domains and their aspects are not organised
in a hierarchical manner and represent “ingredients” of
the complex experience of fear during the pandemic.
Figure 1 provides a graphical representation of
the domains of fears and their reciprocal interactions.
These “four horsemen of fear” are discussed in more
detail in the next section.


The four horsemen of fear during the COVID
pandemic


The first domain of fear (fear of the body/fear for the
body) concerns the body and its signals. The body is the
first organizer of our human experience (Stern, 1985)
and it “keeps the score” (van der Kolk, 2015) of events
that threaten our physical and psychological integrity. In
the current experience of the COVID-19 pandemic, fear
of the body relates to a sense of physical vulnerability
due to which the body is a potential source of danger and
cannot be trusted (Starcevic, 2005). Such perception of

The second domain of fear (fear of significant
others/fear for significant others) relates to important
interpersonal relationships. As Aristotle said in his
Politics (Lord, 2003), human beings are by nature
“social animals”. Interpersonal relationships are at
the core of human identity, especially those involving
attachment figures such as parents, offspring and people
with whom we have romantic relationships. These
individuals provide us with a safe haven and a secure
base (Bowlby, 1988) from which we feel comfortable
to explore our internal experience and the external
world. The COVID-19 pandemic has affected our
perception of close interpersonal relationships with the
recommendations surrounding “social distancing”. We
are told by the authorities that maintaining a physical
distance even from people to whom we are attached
will slow down the spread of the coronavirus and keep
everyone safe. The consequence of this is a perception
that even the loved ones might harm us or kill us,
although unwittingly. Therefore, instead of providing
protection or a sense of safety, a parent, a child or an
intimate partner becomes a potential threat, with our
survival possibly depending on protecting ourselves
against people with whom we have the strongest
affective bonds. Conversely, we experience ourselves
as being potentially dangerous to our loved ones and
responsible if they become infected. We are thereby
deprived of our normal role to care for them or protect
them. These changes have profound consequences not
only in terms of how we relate to the significant others,
but also in terms of further undermining our sense of
safety and our need to “be there” for our loved ones.

The third domain of fear (fear of not knowing/fear
of knowing) concerns the cognitive aspect of mastering
the situations. In the context of the current COVID-19
pandemic, knowledge about the pandemic is bounded
and partial, which is deeply unsettling. One way of
coping with this situation is using the availability
heuristic (Tversky & Kahneman, 1973), that is, relying
on information that can be recalled, usually information
to which the person was exposed very recently. This

Figure 1. The “four horsemen” of fear (the four domains of fear) during the COVID-19 pandemic. Each fear

The fourth domain of fear (fear of taking action/fear
of inaction) concerns behavioural consequences of fear
during the COVID-19 pandemic. Our lives also consist
of actions, that is, intentional and purposeful activities
that are not reflexive, but are subjectively meaningful
(Davidson, 1980). As already noted, fears in the bodily,
interpersonal and cognitive domains often have a direct
impact on the behaviour. This is especially the case
when the “mutually opposing” fears alternate quickly,
producing indecisiveness and paralysing action. For
example, it may be very difficult to decide whether to
visit one’s elderly parents because of the possibility
of infecting them; such a person is torn between a
duty to care for parents and responsibility for keeping
them safe by avoiding such visits. In some vulnerable
individuals, a fear of taking action may manifest itself
in obsessive doubts about doing simple things, such
as buying groceries or opening a package sent from a
parent living in a heavily contaminated area. The other
“side of the coin” in this fear domain relates to people
who have a strong need to take some action and who
may be afraid of being passive or of being perceived
as such. This may explain the behaviour of individuals
who became hyperactive on social networking sites
only during the COVID-19 pandemic. Such individuals
spend most of the time online, going live on webcams,
publishing their own pictures or videos or posting news
related to the pandemic. In addition to alleviating these
individuals’ fear of inaction and of being invisible in
the world of the social media, such behaviour may
satisfy their narcissistic needs (Gnambs & Appel,
2018) and/or a need for belonging to a group that might
provide a sense of security. However, this behavioural
pattern may also reflect the problematic use of social
networking sites or apps which may have addictive
aspects that are difficult to attenuate and could require
clinical intervention.


Managing fear domains


Conquering pathological fear in the context of
the COVID-19 pandemic requires measures that
are relatively simple, as well as those that are more
complex and are best implemented in collaboration
with a mental health professional. Considering a
need to maintain social distance, psychoeducation
and psychological treatment delivered remotely via
communication technologies can provide individuals
with appropriate support (Sucala, Schnur, Constantino,
Miller, Brackman, & Montgomery, 2012) and improve
their quality of life (Lange, van de Ven, & Schrieken,
2003).

In fact, improving psychological health of
individuals is vital for strengthening the resilience
of the society as a whole. We argue here that this
objective could be achieved by applying the following
measures: (a) improving appraisal of the body, (b)
fostering attachment security, (c) improving emotion
regulation, (d) adopting acceptance and (e) promoting
responsibility.


Improving appraisal of the body


It is crucial for people in the midst of a pandemic
to be able to accurately appraise the physiological
signals of their bodies and to neither underestimate
nor overestimate their susceptibility to infections and
the associated physical threat. Most people find useful
physical and mental exercises that increase the feelings
of safety and control over the body, such as improving
posture (Weineck, Messner, Hauke, & Pollatos, 2019),
tracking the body autonomic response (Porges & Dana,
2018) and practicing mindfulness (Gibson, 2019).
People who are severely anxious about their health or
develop a full-blown hypochondriasis may need further
psychological treatment that specifically addresses
their bodily concerns (Bouman, 2014); sometimes,
this approach can be accompanied by antidepressants
(Harding & Fallon, 2014).


Fostering attachment security


Developing secure attachments is likely to improve
coping with the fear of the significant others and fear for
the significant others. Secure attachment has been linked
with the positive quality of interpersonal interactions
(including interactions with strangers; Roisman, 2006)
and with a capacity for effective self-regulation and topdown control (Pallini, Chirumbolo, Morelli, Baiocco, Laghi, & Eisenberg, 2018). Attachment security can
be fostered in the family and in other relationships via
mutually constructive communication (Domingue &
Mollen, 2009) that involves synchronous interactions
(e.g., by phone, if the communication partner is not
present; Gentzler, Oberhauser, Westerman, & Nadorff,

2011). When problematic relationships in the context of
the fears of COVID-19 call for a clinical intervention
improving the capacity to represent and mentalize the
internal states and the interpersonal motivations of
the significant others may be critical for both adults
(Allen & Fonagy, 2006) and children (Midgley, Ensink,
Linqvist, Malberg, & Muller, 2017). Also, it is important
to assess the quality of the attachment relationships,
identify the problems in these relationships and address
any internal conflicts that may surround the problems
(Lemma, Target, Fonagy, 2011). This should make a
tailored intervention to interpersonal fears possible.


Improving emotion regulation


Adopting acceptance

Clinical interventions based on acceptance
and compassion target the maladaptive emotional
avoidance and the unwillingness to experience
negatively evaluated feelings, sensations and thoughts
that generate inappropriate or detrimental behaviours.
These interventions increase flexibility and allow
adaptive behavioural change.


Promoting responsibility


Finally, situations like the COVID-19 pandemic
may bring out both the best and the worst in people.
It is a test of human ability to empathise, exhibit
solidarity and put the good of the society above one’s
own interests. Thus, individual responsibility is crucial
in the time of the COVID-19 pandemic. Individuals
are moral agents and their actions may positively or
negatively affect the lives of other people. Therefore,
promoting awareness of the pandemic and responsible
behaviour towards oneself and others may help people
feel morally sustained when confronting their fears.
Ultimately, it is responsible action that may prove
critical for our survival.


References


Allen, J. G., & Fonagy, P. (Eds.). (2006). The handbook of
mentalization-based treatment. New York, NY: John Wiley
& Sons Inc.
Bouman, T. K. (2014). Cognitive and behavioral models and
cognitive-behavioral and related therapies for health
anxiety and hypochondriasis. In Starcevic, V., & Noyes,
R. (Eds.). Hypochondriasis and Health Anxiety: A Guide
for Clinicians (pp. 149-198). New York, NY: Oxford
University Press.
Bowlby, J. (1988). A secure base. Clinical applications of
attachment theory. London, UK: Routledge.
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L.,
Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The
psychological impact of quarantine and how to reduce it:
Rapid review of the evidence. The Lancet, 395(10227),
912–920. https://doi.org/10.1016/S0140-6736(20)30460-8
Davidson, D. (1980). Essay on Actions and Events. Oxford,
UK: Oxford University Press.
Domingue, R., & Mollen, D. (2009). Attachment and conflict
communication in adult romantic relationships. Journal of
Social and Personal Relationships, 26(5), 678–696. https://
doi.org/10.1177/0265407509347932
Garcia, D., Al Nima, A., & Kjell, O. N. E. (2014). The
affective profiles, psychological well-being, and harmony:
Environmental mastery and self-acceptance predict the
sense of a harmonious life. PeerJ, 2, e259. https://doi.
org/10.7717/peerj.259
Gazzillo, F., Schimmenti, A., Formica, I., Simonelli, A., &
Salvatore, S. (2017). Effectiveness is the gold standard
of clinical research. Research in Psychotherapy:
Psychopathology, Process and Outcome. https://doi.
org/10.4081/ripppo.2017.278
Gentzler, A. L., Oberhauser, A. M., Westerman, D., &
Nadorff, D. K. (2011). College students’ use of electronic
communication with parents: Links to loneliness,
attachment, and relationship quality. Cyberpsychology,
Behavior and Social Networking, 14(1–2), 71–74. https://
doi.org/10.1089/cyber.2009.0409
Gibson, J. (2019). Mindfulness, Interoception, and the Body:
A Contemporary Perspective. Frontiers in Psychology, 10.
https://doi.org/10.3389/fpsyg.2019.02012
Gnambs, T., & Appel, M. (2018). Narcissism and Social
Networking Behavior: A Meta-Analysis. Journal of
Personality, 86(2), 200–212. https://doi.org/10.1111/
jopy.12305
Harding, K. J. K., & Fallon, B. A. (2014). Pharmacological
treatment and neurobiology of hypochondriasis, illness
anxiety, and somatic symptoms. In Starcevic, V., & Noyes,
R. (Eds). Hypochondriasis and Health Anxiety: A Guide for
Clinicians (pp. 241-258). New York, NY: Oxford University
Press.
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L.,
& Pistorello, J. (2013). Acceptance and commitment therapy
and contextual behavioral science: Examining the progress
The four horsemen of fear
Clinical Neuropsychiatry (2020) 17, 2 45
of a distinctive model of behavioral and cognitive therapy.
Behavior Therapy, 44(2), 180–198. https://doi.org/10.1016/j.
beth.2009.08.002
Koole, S. L. (2009). The psychology of emotion regulation: An
integrative review. Cognition and Emotion, 23(1), 4–41.
https://doi.org/10.1080/02699930802619031
Lange, A., van de Ven, J.-P., & Schrieken, B. (2003). Interapy:
Treatment of post-traumatic stress via the internet.
Cognitive Behaviour Therapy, 32(3), 110–124. https://doi.
org/10.1080/16506070302317
la Repubblica (2020). Coronavirus, l’allarme dei cardiologi: ‘Per
il timore contagi meno ricoveri per infarto’ [Coronavirus,
the cardiologists’ alarm: “Due to fear of contagion, less
ospitalization for infartion”]. (2020, March 25). Retrieved
from https://www.repubblica.it/salute/medicina-ericerca/2020/03/23/news/coronavirus_meno_ricoveri_per_
infarto_si_teme_il_contagio-252070598/
Lemma, A., Target, M., & Fonagy, P. (2011). Brief Dynamic
Interpersonal Therapy: A Clinician’s Guide. Oxford, UK:
Oxford University Press.
Lord (2003). Aristotle’s Politics. Chicago, IL: University of
Chicago Press.
Midgley, N., Ensink, K., Lindqvist, K., Malberg, N., & Muller, N.
(2017). Mentalization-based treatment for children: A timelimited approach. Washington, DC: American Psychological
Association. https://doi.org/10.1037/0000028-000
Morganstein, J. C., Fullerton, C. S., Ursano, R. J., & Holloway, H.
C. (2017). Pandemics: Health Care Emergencies. In Ursano,
R. J., Fullerton, C. S., Weisaeth, L., & Raphael, B. (eds.).
Textbook of Disaster Psychiatry (2nd ed., pp. 270–284).
Cambridge, NY: Cambridge University Press.
Pallini, S., Chirumbolo, A., Morelli, M., Baiocco, R., Laghi,
F., & Eisenberg, N. (2018). The relation of attachment
security status to effortful self-regulation: A meta-analysis.
Psychological Bulletin, 144(5), 501–531. https://doi.
org/10.1037/bul0000134
Philippot, P. (2013). Emotion Regulation: A Heuristic Paradigm for
Psychopathology. Journal of Experimental Psychopathology,
4(5), 600–607. https://doi.org/10.5127/jep.034513
Porges, S.W., & Dana, D. (2018). Clinical Applications of the
Polyvagal Theory: The Emergence of Polyvagal-Informed
Therapies. New York, NY: WW Norton.
Roisman, G. I. (2006). The role of adult attachment security in nonromantic, non-attachment-related first interactions between
same-sex strangers. Attachment & Human Development,
8(4), 341–352. https://doi.org/10.1080/14616730601048217
Schimmenti, A., Santoro, G., La Marca, L., Costanzo, A., &
Gervasi, A. M. (2019). Emotion dysregulation: a correlation
network analysis. Psychotherapy and Psychosomatics,
88(S1), 115. https://doi.org/ 10.1159/000502467.359
Starcevic, V. (2005). Fear of Death in Hypochondriasis:
Bodily Threat and Its Treatment Implications. Journal of
Contemporary Psychotherapy, 35(3), 227–237. https://doi.
org/10.1007/s10879-005-4317-0
Starcevic, V. (2017). Cyberchondria: Challenges of Problematic
Online Searches for Health-Related Information.
Psychotherapy and Psychosomatics, 86(3), 129–133. https://
doi.org/10.1159/000465525
Stewart, J. M. (2014). Mindfulness, acceptance, and the
psychodynamic evolution. Oakland, CA: Context Press.
Stern, D. N. (1985). The Interpersonal World of the Infant: A View
from Psychoanalysis and Developmental Psychology. New
York, NY: Basic Books.
Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J.,
Brackman, E. H., & Montgomery, G. H. (2012). The
therapeutic relationship in e-therapy for mental health: A
systematic review. Journal of Medical Internet Research,
14(4), e110. https://doi.org/10.2196/jmir.2084
Tversky, A., & Kahneman, D. (1973). Availability: A heuristic for
judging frequency and probability. Cognitive Psychology, 5(2),
207–232. https://doi.org/10.1016/0010-0285(73)90033-9
van der Kolk, B. (2015). The Body Keeps the Score: Mind, Brain
and Body in the Transformation of Trauma. New York, NY:
Penguin Random House.
Watkins, E. R. (2016). Rumination-focused cognitive-behavioral
therapy for depression. New York, NY: Guilford Press.
Weineck, F., Messner, M., Hauke, G., & Pollatos, O. (2019).
Improving interoceptive ability through the practice of
power posing: A pilot study. PLoS ONE, 14(2). https://doi.
org/10.1371/journal.pone.0211453

Commentary by DFM:

  1. There are multiple connections between this paper and the The General Theory of Behaviour.
  2. Emotion regulation by the ‘four horsemen’ follows principles of homeostasis laid out in the theory.
  3. The regulation of fear makes the difference between chaos and control.

Featured

Fear of COVID-19

COVID-19 Milestone Series

In previous posts, here and here, I have drawn attention to the role of functional fear in human responses to COVID-19 pandemic. For various imaginable reasons, the government’s policy advisors do not openly discuss the use of fear in public health interventions, yet it is obvious to any observer that increasing fear is the primary target of governmental interventions to control the public’s responses to the pandemic.

Here I republish the Abstract of a significant article concerning the Fear of COVID-19 Scale. It provides a valuable tool for the assessment of this fundamental driver of human behaviour and the authors are to be congratulated.

Int J Ment Health Addict. 2020 Mar 27 : 1–9.doi: 10.1007/s11469-020-00270-8 [Epub ahead of print]PMCID: PMC7100496PMID: 32226353

The Fear of COVID-19 Scale: Development and Initial Validation

Daniel Kwasi Ahorsu,1Chung-Ying Lin,1Vida Imani,2Mohsen Saffari,3Mark D. Griffiths,4 and Amir H. Pakpour5,6

Author informationCopyright and License informationDisclaimerCopyright © Springer Science+Business Media, LLC, part of Springer Nature 2020This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.This article has been cited by other articles in PMC.Go to:

Abstract

Background

The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals worldwide. The present study developed the Fear of COVID-19 Scale (FCV-19S) to complement the clinical efforts in preventing the spread and treating of COVID-19 cases.

Methods

The sample comprised 717 Iranian participants. The items of the FCV-19S were constructed based on extensive review of existing scales on fears, expert evaluations, and participant interviews. Several psychometric tests were conducted to ascertain its reliability and validity properties.

Results

After panel review and corrected item-total correlation testing, seven items with acceptable corrected item-total correlation (0.47 to 0.56) were retained and further confirmed by significant and strong factor loadings (0.66 to 0.74). Also, other properties evaluated using both classical test theory and Rasch model were satisfactory on the seven-item scale. More specifically, reliability values such as internal consistency (α = .82) and test–retest reliability (ICC = .72) were acceptable. Concurrent validity was supported by the Hospital Anxiety and Depression Scale (with depression, r = 0.425 and anxiety, r = 0.511) and the Perceived Vulnerability to Disease Scale (with perceived infectability, r = 0.483 and germ aversion, r = 0.459).

Conclusion

The Fear of COVID-19 Scale, a seven-item scale, has robust psychometric properties. It is reliable and valid in assessing fear of COVID-19 among the general population and will also be useful in allaying COVID-19 fears among individuals.

Keywords: COVID-19, Fear, Iran, Psychometrics, Fear of COVID-19 Scale

Featured

Fear of Coronavirus

COVID-19 Milestone Series

Original article published in: J Anxiety Disorders 2020 Aug; 74:102258. doi: 10.1016/j.janxdis.2020.102258. Epub 2020 Jun 10.

Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020

Gaëtan Mertens 1Lotte Gerritsen 2Stefanie Duijndam 3Elske Salemink 2Iris M Engelhard 2

Abstract

Fear is an adaptive response in the presence of danger. However, when threat is uncertain and continuous, as in the current coronavirus disease (COVID-19) pandemic, fear can become chronic and burdensome. To identify predictors of fear of the coronavirus, we conducted an online survey (N = 439) three days after the World Health Organization declared the coronavirus outbreak a pandemic (i.e., between March 14 and 17, 2020). Fear of the coronavirus was assessed with the newly developed Fear of the Coronavirus Questionnaire (FCQ) consisting of eight questions pertaining to different dimensions of fear (e.g., subjective worry, safety behaviors, preferential attention), and an open-ended question. The predictors included psychological vulnerability factors (i.e., intolerance of uncertainty, worry, and health anxiety), media exposure, and personal relevance (i.e., personal health, risk for loved ones, and risk control). We found four predictors for the FCQ in a simultaneous regression analysis: health anxiety, regular media use, social media use, and risks for loved ones (R2 = .37). Furthermore, 16 different topics of concern were identified based participants’ open-ended responses, including the health of loved ones, health care systems overload, and economic consequences. We discuss the relevance of our findings for managing people’s fear of the coronavirus.

Keywords: Coronavirus; Fear; Health anxiety; Intolerance of uncertainty; Media.

Featured

The Fear Motive – Missing from the Model

Capability, opportunity, and motivation to enact hygienic practices in the early stages of the
COVID-19 outbreak in the United Kingdom

COVID-19 Milestone Series

Extract from the originally published article in the British Journal of Health Psychology (2020), 25, 856–864. Authors: Jilly Gibson Miller et al.

Open Access. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
These few extracts from the published article indicate that all is not well with the COM-B model. The level of empirical support is weak, with only three of six factors showing the predicted positive association with hygienic practices. The most significant factor, ‘reflective motivation’, includes habits and intentions and is difficult to interpret. Many other studies indicate that the strongest predictor of health protective behaviours is the fear motive, notably missing from the COM-B model. Replacing Motivation with Fear Homeostasis, and removing Capability and Opportunity yields a more basic ‘Fear-Homeostasis- Behaviour’ (F-H-B) model, which already receives significant empirical support (e.g. Tannenbaum et al, 2015). As one would predict, in a recent Brazilian study, fear was significantly higher among those practicing protective measures against COVID-19 (facial mask, alcohol gel, and hand hygiene) and respecting social distancing (Giordani 2020).


Abstract

Objectives. The COVID-19 pandemic is one of the greatest global health threats facing
humanity in recent memory. This study aimed to explore influences on hygienic practices,
a set of key transmission behaviours, in relation to the Capability, Opportunity,
Motivation-Behaviour (COM-B) model of behaviour change (Michie et al., 2011).


Design. Data from the first wave of a longitudinal survey study were used, launched in
the early stages of the UK COVID-19 pandemic.

Methods. Participants were 2025 adults aged 18 and older, representative of the UK
population, recruited by a survey company from a panel of research participants.

Participants self-reported motivation, capability, and opportunity to enact hygienic
practices during the COVID-19 outbreak.

Results. Using regression models, we found that all three COM-B components
significantly predicted good hygienic practices, with motivation having the greatest
influence on behaviour. Breaking this down further, the subscales psychological capability,
social opportunity, and reflective motivation positively influenced behaviour. Reflective
motivation was largely driving behaviour, with those highest in reflective motivation
scoring 51% more on the measure of hygienic practices compared with those with the
lowest scores.

Figure 1:


Conclusions. Our findings have clear implications for the design of behaviour change
interventions to promote hygienic practices. Interventions should focus on increasing and
maintaining motivation to act and include elements that promote and maintain social
support and knowledge of COVID-19 transmission. Groups in particular need of
targeting for interventions to increase hygienic practices are males and those living in
cities and suburbs.]

What does this study add?
This study provides insight into the factors influencing UK citizens’ hygienic practices during the early stages of the COVID-19 pandemic.
We found that reflective processes were largely driving hygienic practices – these involve making plans to enact the behaviour and supporting the belief that the behaviour is a good thing to do.
Behaviour change interventions to improve and maintain hygienic practices throughout the lockdown and beyond should contain behaviour change techniques that focus on self-regulatory processes involving planning and goal setting.

Jilly Gibson Miller et al. (2020).

Commentary by DFM

The article contains a series of red flags suggesting that all is not well with the COM-B model.

  1. Only three of the six COM-B variables were positively associated with hygienic practices. Two COM-B variables were negatively associated with hygienic behaviours (opportunity – physical and motivation – automatic) and one COM-B variable (capability -physical) was not associated with hygienic behaviours.
  2. It is notable that the measures were self-reported capabilities, opportunities and behaviours. (see Appendix 1).There is no objective evidence that any of the COM-B variables were associated with actual behaviour change.
  3. The COM-B model accounted for only 17% of the variance in self-reported hygienic practices leaving 83% of the variance unexplained. This is typical of models in health psychology which rarely account for more than 20-25% of the variance in behaviour.
  4. The strongest association was between ‘reflective motivation’ and self-reported hygienic practices. However, the items used to define reflective motivation are diverse and include both intentions and habits.
  5. According to the authors “reflective processes were driving hygienic practices” – making plans to enact the behaviour and supporting the belief that the behaviour is a good thing to do. However ‘reflective processes’ are cognitive not motivational processes and these have been mislabelled by the investigators as ‘motivational’.
  6. There is no evidence of a causal connection between self-reported reflective processes and hygienic practices, only a statistical association. Thus words such as ‘driving’ are inappropriate and misleading.
  7. A truly motivational process – fear – is omitted from the COM-B model yet multiple studies indicate functional fear to be of primary importance in motivating hygienic and other protective behaviours in attempts to minimise the risk of COVID-19 infection.
  8. Governmental policies for public health protection based on the COM-B model remain unsupported by empirical investigations.
  9. Interventions must address the primary motive of COVID-19 behaviour change, which is fear.
  10. Indoor air quality and improved ventilation are key requirements in the fight to reduce SARS-CoV-2 infections, neglected factors in a neo-liberal policy of placing responsibility on citizens who are expected to conform to mandates and programmes of vaccination.

Appendix 1

Table A1. Descriptive data for survey items used to measure hygienic practices and COM-B

Hygienic Practices (3-point scale)Mean
B1“Washed your hands with soap and water more often.”2.72
B2“Used hand sanitising gel if soap and water were not available.”2.38
B3“Used disinfectants to wash surfaces in your home more frequently.”2.22
B4“Covered your nose and mouth with a tissue or sleeve when coughing or sneezing.”2.64
B5Touching eyes and mouth (5-point scale)3.62
COM-B items (5-point scale) 
 Psychological Capability 
C1“I knew about why it was important and had a clear idea about how the virus was transmitted.”4.21
C2“I knew about how and when to do it.”4.21
C3“I was able to overcome the physical and/or mental barriers that might have stopped me from doing it.”3.92
 Physical opportunity 
O1“I had the necessary time to do it.”4.20
O2“It was easy for me to do it.”4.21
 Social opportunity 
O3“People were doing it around me.”3.81
O4“I had reminders that prompted me.”3.46
O5“I had support from others.”3.55
O6“I felt like doing it was normal and expected.”4.15
 Reflective motivation 
M1“I intended to do it.”4.18
M2“I felt that I wanted to do it.”4.17
M3“I believe that it was a good thing to do.”4.31
M4“I developed a specific plan for doing it.”3.36
M5“I developed a habit of it in my everyday routine.”3.95
 Automatic motivation 
M6“It made me feel anxious.”  R2.68
M7“It made me feel disgusted.” R2.14
M8“I felt like I could control my emotional reactions so I could do it.”3.42

Notes: Higher scores relate to higher compliance/agreement with that measure. R indicates item is reverse-coded.

Reference

Tannenbaum M. B., Hepler J., Zimmerman R. S., Saul L., Jacobs S., Wilson K., et al. (2015). Appealing to fear: a meta-analysis of fear appeal effectiveness and theories. Psychol. Bull. 141 1178–1204. 10.1037/a0039729

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Functional Fear Predicts Public Health Compliance in the COVID-19 Pandemic

COVID-19 Milestones Series

Authors: Craig A. Harper, Liam P. Satchell, Dean Fido & Robert D. Latzman

Originally published in the International Journal of Mental Health and Addiction (2021) 19:1875–1888: https://doi.org/10.1007/s11469-020-00281-5 “Functional Fear Predicts Public Health.

Here I republish the first page (p. 1875) only.

Abstract

In the current context of the global pandemic of coronavirus disease-2019 (COVID-19), health professionals are working with social scientists to inform government policy on how to slow the spread of the virus. An increasing amount of social scientific research has looked at the role of public message framing, for instance, but few studies have thus far examined the role of individual differences in emotional and personality-based variables in predicting virus-mitigating behaviors. In this study, we recruited a large international community sample (N = 324) to complete measures of self-perceived risk of contracting COVID-19, fear of the virus, moral foundations, political orientation, and behavior change in response to the pandemic. Consistently, the only predictor of positive behavior change (e.g., social distancing, improved hand hygiene) was fear of COVID-19, with no effect of politically relevant variables. We discuss these data in relation to the potentially functional nature of fear in global health crises.

*

Lead author: Craig A. Harper craigaharper19@davidfmarks2018

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Omicron

Covid-19: Omicron may be more transmissible than other variants and partly resistant to existing vaccines, scientists fear

COVID-19 Milestone Series

Originally published by the BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2943 (Published 29 November 2021)

Cite this as: BMJ 2021;375:n2943

Author: Ingrid Torjesen

Omicron, the SARS-CoV-2 variant responsible for a cluster of cases in South Africa and that is now spreading around the world, is the most heavily mutated variant to emerge so far and carries mutations similar to changes seen in previous variants of concern associated with enhanced transmissibility and partial resistance to vaccine induced immunity.

Daily case numbers in South Africa had been fairly low but then rose rapidly from 273 on 16 November to more than 1200 by 25 November, more than 80% of which were in the northern province of Gauteng, where the first cases were seen.

Europe’s first case of the variant was confirmed in Belgium on 26 November in a person who tested positive for covid-19 on 22 November. By 29 November cases had been reported in the Netherlands, France, Germany, Portugal, and Italy. The UK had recorded nine cases by the morning of 29 November, six of them in Scotland.

Elsewhere in the world cases have been reported in Botswana, Hong Kong, Canada, and Australia, which has had extremely tight border controls through the pandemic.

Some countries, including Japan and Israel, were quick to close their borders to all foreign travellers, while others, such as the UK and EU countries, enforced quarantine for travellers from South Africa and neighbouring countries after the World Health Organization designated omicron an official variant of concern on 26 November.

To slow the spread of the variant the UK government has announced that masks are again to become compulsory on public transport and in shops and schools, all contacts of people with a case of omicron will be required to isolate for 10 days, and all travellers entering the country will have to take a PCR test two days later and to self-isolate until they receive a negative result. On 29 November the government was expected to announce that the vaccine booster programme would be expanded to people under 40, after a recommendation from the Joint Committee on Vaccination and Immunisation.

Chaand Nagpaul, chair of council at the BMA, said that mandatory mask wearing should be extended to all public indoor and closed settings, including for staff in the hospitality industry, such as restaurants, and beauty salons. “This addition to government measures will have minimal economic and social impact, but evidence tells us that it will help to further reduce the spread of the virus,” he said. “We only have a small window of opportunity to get this right to ensure that we don’t lose control of this new variant, which has the potential to have a devastating impact on the health service. The government must act now, or we risk seeing even more unnecessary deaths.”

Novel mutations

Lawrence Young, a virologist and professor of molecular oncology at Warwick Medical School, said, “This new variant of the covid-19 virus is very worrying. This variant carries some changes we’ve seen previously in other variants but never altogether in one virus. It also has novel mutations that we’ve not seen before.”

In total, the variant’s genome has around 50 mutations, including more than 30 in the spike protein, the part that interacts with human cells before cell entry and that has been the primary target for current vaccines.

David Matthews, professor of virology at the University of Bristol, said that there have been several variants of concern that have turned out not to be as worrying as first thought but that it was important to be cautious at this stage. “There is also the risk that the variant might be better at spreading than the delta variant, and then you speed up the rate at which people are fed into the NHS or any healthcare system, particularly the unvaccinated, which makes it harder and harder for any healthcare system to cope,” he said.

Sharon Peacock, director of the COG-UK Genomics UK Consortium and professor of public health and microbiology at the University of Cambridge, said that the effects of the detected mutations on the omicron variant’s functionality were unknown. “Studies are being rapidly conducted in South Africa to look at antibody neutralisation of this variant, as well as interactions with T cells, but these studies are going to take several weeks to complete,” she said.

Even if current vaccines proved to be less effective against omicron, they were likely to still provide some protection, said Wendy Barclay, leader of the G2P-UK National Virology Consortium and research chair in virology at Imperial College London, and she urged the general public to take up all vaccine shots offered. “If we have a variant that is antigenically distant and isn’t neutralised at a certain level of antibody, there is something we can do: we can boost the overall antibody levels, because sometimes quantity can compensate for the lack of match,” she said. “I would strongly urge people to take the opportunity to give their immune systems the best quantitative chance that they have by getting booster doses and the full course of vaccination.”

Scientists praised South African authorities for their quick action in identifying the variant and putting the world on alert.

Investigation of a similar rise in cases last winter in Kent had also led to the quick identification of the alpha variant.

In contrast, lack of sequencing capability in India meant it took many weeks before the delta variant was found to be behind a rise in cases there. “By that point, delta had already seeded itself in many parts of the world,” said Jeffrey Barrett, director of the Covid-19 Genomics Initiative at the Wellcome Sanger Institute, at a Science Media Centre briefing.

One of the omicron variant’s mutations leads to “S gene target failure” (or “S gene dropout”), meaning that one of several areas of the gene that are targeted by PCR testing gives a false negative. This can be used as a “surrogate marker,” allowing genome sequencing to be targeted, Peacock said, particularly where circulating strains are predominantly S gene positive, as is the case with the delta variant.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage

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Pfizer’s Vaccine Trial Questioned

COVID-19 Milestone Series

Covid-19: Researcher blows the whistle on data integrity issues in Pfizer’s vaccine trial

Originally published in the BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2635 on 02 November 2021 by Paul D Thacker, investigative journalist

This post republishes an article about “Revelations of poor practices at a contract research company helping to carry out Pfizer’s pivotal covid-19 vaccine trial raise questions about data integrity and regulatory oversight. “

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained. https://bmj.com/coronavirus/usage

Author: Paul D Thacker 

In autumn 2020 Pfizer’s chairman and chief executive, Albert Bourla, released an open letter to the billions of people around the world who were investing their hopes in a safe and effective covid-19 vaccine to end the pandemic. “As I’ve said before, we are operating at the speed of science,” Bourla wrote, explaining to the public when they could expect a Pfizer vaccine to be authorised in the United States.1

But, for researchers who were testing Pfizer’s vaccine at several sites in Texas during that autumn, speed may have come at the cost of data integrity and patient safety. A regional director who was employed at the research organisation Ventavia Research Group has told The BMJ that the company falsified data, unblinded patients, employed inadequately trained vaccinators, and was slow to follow up on adverse events reported in Pfizer’s pivotal phase III trial. Staff who conducted quality control checks were overwhelmed by the volume of problems they were finding. After repeatedly notifying Ventavia of these problems, the regional director, Brook Jackson, emailed a complaint to the US Food and Drug Administration (FDA). Ventavia fired her later the same day. Jackson has provided The BMJ with dozens of internal company documents, photos, audio recordings, and emails.

Poor laboratory management

On its website Ventavia calls itself the largest privately owned clinical research company in Texas and lists many awards it has won for its contract work.2 But Jackson has told The BMJ that, during the two weeks she was employed at Ventavia in September 2020, she repeatedly informed her superiors of poor laboratory management, patient safety concerns, and data integrity issues. Jackson was a trained clinical trial auditor who previously held a director of operations position and came to Ventavia with more than 15 years’ experience in clinical research coordination and management. Exasperated that Ventavia was not dealing with the problems, Jackson documented several matters late one night, taking photos on her mobile phone. One photo, provided to The BMJ, showed needles discarded in a plastic biohazard bag instead of a sharps container box. Another showed vaccine packaging materials with trial participants’ identification numbers written on them left out in the open, potentially unblinding participants. Ventavia executives later questioned Jackson for taking the photos.

Early and inadvertent unblinding may have occurred on a far wider scale. According to the trial’s design, unblinded staff were responsible for preparing and administering the study drug (Pfizer’s vaccine or a placebo). This was to be done to preserve the blinding of trial participants and all other site staff, including the principal investigator. However, at Ventavia, Jackson told The BMJ that drug assignment confirmation printouts were being left in participants’ charts, accessible to blinded personnel. As a corrective action taken in September, two months into trial recruitment and with around 1000 participants already enrolled, quality assurance checklists were updated with instructions for staff to remove drug assignments from charts.

In a recording of a meeting in late September2020 between Jackson and two directors a Ventavia executive can be heard explaining that the company wasn’t able to quantify the types and number of errors they were finding when examining the trial paperwork for quality control. “In my mind, it’s something new every day,” a Ventavia executive says. “We know that it’s significant.”

Ventavia was not keeping up with data entry queries, shows an email sent by ICON, the contract research organisation with which Pfizer partnered on the trial. ICON reminded Ventavia in a September 2020 email: “The expectation for this study is that all queries are addressed within 24hrs.” ICON then highlighted over 100 outstanding queries older than three days in yellow. Examples included two individuals for which “Subject has reported with Severe symptoms/reactions … Per protocol, subjects experiencing Grade 3 local reactions should be contacted. Please confirm if an UNPLANNED CONTACT was made and update the corresponding form as appropriate.” According to the trial protocol a telephone contact should have occurred “to ascertain further details and determine whether a site visit is clinically indicated.”

Worries over FDA inspection

Documents show that problems had been going on for weeks. In a list of “action items” circulated among Ventavia leaders in early August 2020, shortly after the trial began and before Jackson’s hiring, a Ventavia executive identified three site staff members with whom to “Go over e-diary issue/falsifying data, etc.” One of them was “verbally counseled for changing data and not noting late entry,” a note indicates.

At several points during the late September meeting Jackson and the Ventavia executives discussed the possibility of the FDA showing up for an inspection (box 1). “We’re going to get some kind of letter of information at least, when the FDA gets here . . . know it,” an executive stated.Box 1

A history of lax oversight

When it comes to the FDA and clinical trials, Elizabeth Woeckner, president of Citizens for Responsible Care and Research Incorporated (CIRCARE),3 says the agency’s oversight capacity is severely under-resourced. If the FDA receives a complaint about a clinical trial, she says the agency rarely has the staff available to show up and inspect. And sometimes oversight occurs too late.

In one example CIRCARE and the US consumer advocacy organisation Public Citizen, along with dozens of public health experts, filed a detailed complaint in July 2018 with the FDA about a clinical trial that failed to comply with regulations for the protection of human participants.4 Nine months later, in April 2019, an FDA investigator inspected the clinical site. In May this year the FDA sent the triallist a warning letter that substantiated many of the claims in the complaints. It said, “[I]t appears that you did not adhere to the applicable statutory requirements and FDA regulations governing the conduct of clinical investigations and the protection of human subjects.”5

“There’s just a complete lack of oversight of contract research organisations and independent clinical research facilities,” says Jill Fisher, professor of social medicine at the University of North Carolina School of Medicine and author of Medical Research for Hire: The Political Economy of Pharmaceutical Clinical Trials.

Ventavia and the FDA

A former Ventavia employee told The BMJ that the company was nervous and expecting a federal audit of its Pfizer vaccine trial.

“People working in clinical research are terrified of FDA audits,” Jill Fisher told The BMJ, but added that the agency rarely does anything other than inspect paperwork, usually months after a trial has ended. “I don’t know why they’re so afraid of them,” she said. But she said she was surprised that the agency failed to inspect Ventavia after an employee had filed a complaint. “You would think if there’s a specific and credible complaint that they would have to investigate that,” Fisher said.

In 2007 the Department of Health and Human Services’ Office of the Inspector General released a report on FDA’s oversight of clinical trials conducted between 2000 and 2005. The report found that the FDA inspected only 1% of clinical trial sites.6 Inspections carried out by the FDA’s vaccines and biologics branch have been decreasing in recent years, with just 50 conducted in the 2020 fiscal year.7RETURN TO TEXT

The next morning, 25 September 2020, Jackson called the FDA to warn about unsound practices in Pfizer’s clinical trial at Ventavia. She then reported her concerns in an email to the agency. In the afternoon Ventavia fired Jackson—deemed “not a good fit,” according to her separation letter.

Jackson told The BMJ it was the first time she had been fired in her 20 year career in research.

Concerns raised

In her 25 September email to the FDA Jackson wrote that Ventavia had enrolled more than 1000 participants at three sites. The full trial (registered under NCT04368728) enrolled around 44 000 participants across 153 sites that included numerous commercial companies and academic centres. She then listed a dozen concerns she had witnessed, including:

  • Participants placed in a hallway after injection and not being monitored by clinical staff
  • Lack of timely follow-up of patients who experienced adverse events
  • Protocol deviations not being reported
  • Vaccines not being stored at proper temperatures
  • Mislabelled laboratory specimens, and
  • Targeting of Ventavia staff for reporting these types of problems.

Within hours Jackson received an email from the FDA thanking her for her concerns and notifying her that the FDA could not comment on any investigation that might result. A few days later Jackson received a call from an FDA inspector to discuss her report but was told that no further information could be provided. She heard nothing further in relation to her report.

In Pfizer’s briefing document submitted to an FDA advisory committee meeting held on 10 December 2020 to discuss Pfizer’s application for emergency use authorisation of its covid-19 vaccine, the company made no mention of problems at the Ventavia site. The next day the FDA issued the authorisation of the vaccine.8

In August this year, after the full approval of Pfizer’s vaccine, the FDA published a summary of its inspections of the company’s pivotal trial. Nine of the trial’s 153 sites were inspected. Ventavia’s sites were not listed among the nine, and no inspections of sites where adults were recruited took place in the eight months after the December 2020 emergency authorisation. The FDA’s inspection officer noted: “The data integrity and verification portion of the BIMO [bioresearch monitoring] inspections were limited because the study was ongoing, and the data required for verification and comparison were not yet available to the IND [investigational new drug].”

Other employees’ accounts

In recent months Jackson has reconnected with several former Ventavia employees who all left or were fired from the company. One of them was one of the officials who had taken part in the late September meeting. In a text message sent in June the former official apologised, saying that “everything that you complained about was spot on.”

Two former Ventavia employees spoke to The BMJ anonymously for fear of reprisal and loss of job prospects in the tightly knit research community. Both confirmed broad aspects of Jackson’s complaint. One said that she had worked on over four dozen clinical trials in her career, including many large trials, but had never experienced such a “helter skelter” work environment as with Ventavia on Pfizer’s trial.

“I’ve never had to do what they were asking me to do, ever,” she told The BMJ. “It just seemed like something a little different from normal—the things that were allowed and expected.”

She added that during her time at Ventavia the company expected a federal audit but that this never came.

After Jackson left the company problems persisted at Ventavia, this employee said. In several cases Ventavia lacked enough employees to swab all trial participants who reported covid-like symptoms, to test for infection. Laboratory confirmed symptomatic covid-19 was the trial’s primary endpoint, the employee noted. (An FDA review memorandum released in August this year states that across the full trial swabs were not taken from 477 people with suspected cases of symptomatic covid-19.)

“I don’t think it was good clean data,” the employee said of the data Ventavia generated for the Pfizer trial. “It’s a crazy mess.”

A second employee also described an environment at Ventavia unlike any she had experienced in her 20 years doing research. She told The BMJ that, shortly after Ventavia fired Jackson, Pfizer was notified of problems at Ventavia with the vaccine trial and that an audit took place.

Since Jackson reported problems with Ventavia to the FDA in September 2020, Pfizer has hired Ventavia as a research subcontractor on four other vaccine clinical trials (covid-19 vaccine in children and young adults, pregnant women, and a booster dose, as well an RSV vaccine trial; NCT04816643,  NCT04754594,  NCT04955626,  NCT05035212). The advisory committee for the Centers for Disease Control and Prevention is set to discuss the covid-19 paediatric vaccine trial on 2 November.

Footnotes

  • Provenance and peer review: commissioned; externally peer reviewed.
  • Competing interests: PDT has been doubly vaccinated with Pfizer’s vaccine.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage

References

  1. Bourla A. An open letter from Pfizer chairman and CEO Albert Bourla. Pfizer. https://www.pfizer.com/news/hot-topics/an_open_letter_from_pfizer_chairman_and_ceo_albert_bourla.
  2. Ventavia. A leading force in clinical research trials. https://www.ventaviaresearch.com/company.
  3. Citizens for Responsible Care and Research Incorporated (CIRCARE). http://www.circare.org/corp.htm.
  4. Public Citizen. Letter to Scott Gottlieb and Jerry Menikoff. Jul 2018. https://www.citizen.org/wp-content/uploads/2442.pdf.
  5. Food and Drug Administration. Letter to John B Cole MD. MARCS-CMS 611902. May 2021. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/jon-b-cole-md-611902-05052021.
  6. Department of Health and Human Services Office of Inspector General. The Food and Drug Administration’s oversight of clinical trials. Sep 2007. https://www.oig.hhs.gov/oei/reports/oei-01-06-00160.pdf.
  7. Food and Drug Administration. Bioresearch monitoring. https://www.fda.gov/media/145858/download.
  8. FDA takes key action in fight against covid-19 by issuing emergency use authorization for first covid-19 vaccine. Dec 2020. https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19.

Competing interests: DFM has been triply vaccinated with Pfizer’s vaccine.

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Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in 11 European countries

COVID-19 Milestone Series

Panic stations! UK deaths of 750 a day predicted and rising. The paper that threw the entire world into disarray. But were our fears justified? Only history will tell. But the consequences have been severe.

The full report is 35 pages. Here I repost only the Summary, pages 1-2.

Featured

Revisiting the initial COVID-19 pandemic projections

COVID-19 Milestone Series

In previous posts I republished early attempts to project fatalities: here and here. In their milestone paper here, Adam T Biggs and Lanny F Littlejohn explain how interventions to protect the public were founded on exaggerated claims about the likely fatalities from the pandemic. One study from Imperial College, London on 16 March 2020 estimated that in the US there could be 2.35M deaths and in the UK, close to 600,000 deaths. To date, total numbers of deaths in these countries have been 769,769 and 144,433 respectively, 32% and 24% respectively of the projections. Will the projected numbers of deaths ever be reached? Nobody can say. For now the estimates appear pessimistic, some might say, grossly inflated.

The societal, economic and psychological burdens resulting from governmental actions to suppress the pandemic will be felt for decades. Whether the governmental actions will ultimately be viewed as justifiable is for future historians to decide. The jury is still out, but I, for one, remain skeptical.

Authors: Adam T Biggs and Lanny F Littlejohn

Open Access Originally Published: March, 2021

DOI:https://doi.org/10.1016/S2666-5247(21)00029-XPlumX

Early projections of the COVID-19 pandemic prompted federal governments to action. One critical report, published on March 16, 2020, received international attention when it predicted 2 200 000 deaths in the USA and 510 000 deaths in the UK without some kind of coordinated pandemic response.1 This information became foundational in decisions to implement physical distancing and adherence to other public health measures because it established the upper boundary for any worst-case scenarios.However, the authors derived these projections from best available estimates at the time. The evolving nature of empirical knowledge about COVID-19 provides current estimates with more accurate information than what would have been available merely weeks after first discovery of the virus—plus the benefit of hindsight. For example, asymptomatic transmission has been said to be the Achilles’ heel of public health strategies to control the pandemic,2 and several factors about asymptomatic cases remained uncertain during the early days. The report assumed that asymptomatic individuals were 50% as infectious as symptomatic cases,1 whereas the current US Centers for Disease Control and Prevention (CDC) estimates suggest a 75% infectiousness rate for asymptomatic individuals.3 A more important difference is the infection fatality ratio as originally projected in the Imperial College London (London, UK) report1 versus current estimations. A high ratio of asymptomatic individuals might have inflated the perceived mortality of the disease given the limited testing supplies and attention to symptomatic cases.

Age 0–19 yearsAge 20–49 yearsAge 50–69 yearsAge >70 yearsTotal
USA
Population83 267 556126 429 14471 216 11727 832 721308 745 538
Projected deaths
Imperial College London report273389 358725 2321 532 0442 349 367
CDC estimations202320 482288 4251 217 4031 528 333
Seroprevalence135948 638259 2351 070 3811 379 612
UK
Population15 098 00026 193 00014 533 0007 359 00063 183 000
Projected deaths
Imperial College London report49318 744159 069402 318580 624
CDC estimations367424358 859321 883385 351
Seroprevalence25010 18456 653279 548346 637

Data are from the initial Imperial College London report1 and two more recent parameter estimations from the CDC3 and a retrospective study with data from 45 countries (seroprevalence).4 CDC=US Centers for Disease Control and Prevention.

This simplified assessment arrives at a comparable approximation of the original report—2 349 367 projected deaths in the USA and 580 624 deaths in the UK. Applying age-adjusted infection fatality ratio rates to the census population values reveals a striking difference from CDC estimates and seroprevalence reporting. CDC estimates place total deaths at 1 528 333 in the USA and 385 351 deaths in the UK, whereas seroprevalence estimates total deaths at 1 379 612 in the USA and 346 637 deaths in the UK. For the US estimates, the differences produce a 54–70% overestimation of approximately 1 million deaths. For the UK estimates, the differences produce a 51–68% overestimation of approximately 200 000 deaths.Such overestimations remind us of several lessons learned over the course of the pandemic. First, the initial projections were never going to be 100% accurate with a novel coronavirus. Initial projections built worst-case scenarios that would never happen as a means of spurring leadership into action. This upper boundary of possibility then demonstrates a functional value of modelling efforts for unmitigated pandemic progression. Second, asymptomatic cases inflated perceived mortality ratios in addition to complicating any containment challenges. Third, consensus predictions underscore the value of public health coordination—especially early in a novel outbreak. When information is scarce, information sharing from multiple sources becomes crucial to attaining the clearest prediction possible. Last, in democracies, these public health crises will be politicised, and it is incumbent upon guardians of the public trust in health-care institutions and services to remain apolitical—to remain focused on scientific knowledge and the needs of public health, just as the US Department of Defense remains apolitical and focused on the needs of national defence.Ultimately, the relative value of mask wearing and physical distancing, and the economic consequences of lockdowns will be analysed retrospectively. These evaluations will use worst-case scenarios of unmitigated progression as the measuring stick to describe the merit of different public health interventions. Still, initial projections were commendable efforts that brought about public action despite more than 2 million deaths in the USA and more than 500 000 deaths in the UK being a significant overestimation.

We declare no competing interests. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the US Department of the Navy, the US Department of Defense, or the US Government. The authors are military service members or employees of the US Government. This work was prepared as part of their official duties. Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person’s official duties.

References

  1. Ferguson NM et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand.https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf Date: March 16, 2020Date accessed: December 1, 2020View in Article Google Scholar
  2. Gandhi M et al. Asymptomatic transmission, the Achilles’ heel of current strategies to control Covid-19.N Engl J Med. 2020; 382: 2158-2160View in Article Scopus (504)PubMedCrossrefGoogle Scholar
  3. Centers for Disease ControlCOVID-19 pandemic planning scenarios.https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.htmlDate: Sept 10, 2020Date accessed: December 1, 2020View in Article Google Scholar
  4. O’Driscoll M et al. Age-specific mortality and immunity patterns of SARS-CoV-2.Nature. 2020; (published online Nov 2.)https://doi.org/10.1038/s41586-020-2918-0View in Article PubMedGoogle Scholar
  5. Hauser A  et al. Estimation of SARS-CoV-2 mortality during the early stages of an epidemic: a modelling study in Hubei, China and northern Italy.medRxiv. 2020; (published online July 12.) (preprint).https://doi.org/10.1101/2020.03.04.20031104View in Article Google Scholar

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Lessons From the SARS-Cov-2 Pandemic

COVID-19 Repost Series

In a series of republished articles, I recount a catastrophic sequence of errors made in our dealings with the COVID-19 pandemic. In attempting to explain the errors – many of them seeming too obvious to be accidental – it is easy to jump to a conspiracy theory. However, there is a valuable little rule of thumb that states “never attribute to malice that which is adequately explained by stupidity”. In the cases to be presented, stupidity beats conspiracy every time and there are valuable lessons to be learned, if only we pay attention.

Throughout the SARS-Cov-2 pandemic, basic errors have occurred on a regular basis. The analysis of these errors provides a counterweight to what otherwise tends to be captured by a conspiracy narrative. I do not say that we can conclusively disprove all of the many conspiracy theories about the COVID-19 pandemic, but a good place to start is to explore multiple examples of what boils down to human error or plain stupidity. When these examples are taken on board, we can arrive at a more simple account of events. At their best, we humans can be wonderful problem solvers. At our worst, we can say and do some stupid things.

In this first post, Ronald Brown explains how US lawmakers formulated a pandemic control strategy using a ten-fold overestimate of the likely fatalities.

Ronald B Brown (2020): Public health lessons learned from biases in coronavirus mortality overestimation. Disaster medicine and public health preparedness14(3), 364-371. © Society for Disaster Medicine and Public Health, Inc. 2020. I thank the author, the author’s institution and sponsors for placing this article on Open Access.

Public Health Lessons Learned From Biases in Coronavirus Mortality Overestimation

Published online by Cambridge University Press:  12 August 2020

Ronald B. Brown

Abstract

In testimony before US Congress on March 11, 2020, members of the House Oversight and Reform Committee were informed that estimated mortality for the novel coronavirus was 10-times higher than for seasonal influenza. Additional evidence, however, suggests the validity of this estimation could benefit from vetting for biases and miscalculations. The main objective of this article is to critically appraise the coronavirus mortality estimation presented to Congress. Informational texts from the World Health Organization and the Centers for Disease Control and Prevention are compared with coronavirus mortality calculations in Congressional testimony. Results of this critical appraisal reveal information bias and selection bias in coronavirus mortality overestimation, most likely caused by misclassifying an influenza infection fatality rate as a case fatality rate. Public health lessons learned for future infectious disease pandemics include: safeguarding against research biases that may underestimate or overestimate an associated risk of disease and mortality; reassessing the ethics of fear-based public health campaigns; and providing full public disclosure of adverse effects from severe mitigation measures to contain viral transmission.


Keywords

case fatality ratecoronavirus mortality overestimationCOVID-19infection fatality ratesampling bias


TypeConcepts in Disaster MedicineInformationDisaster Medicine and Public Health Preparedness , Volume 14 , Issue 3 , June 2020, pp. 364 – 371DOI: https://doi.org/10.1017/dmp.2020.298[Opens in a new window]Creative Commons

Creative Common License - CC
Creative Common License - BY

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Copyright© Society for Disaster Medicine and Public Health, Inc. 2020

On September 23, 1998, the US National Aeronautics and Space Administration (NASA) permanently lost contact with the $125 million Mars Climate Orbiter. 1 A simple miscalculation, failure to convert English measurements to metric measurements, doomed the Mars space mission. Reference Isbell and Savage2 A later investigation found that backup quality assurance procedures were not in place at NASA to catch and correct this simple miscalculation. Fast forward 22 years to another crisis involving a US government agency: On March 11, 2020, the US Congress House Oversight and Reform Committee received information from the National Institute of Allergy and Infectious Diseases (NIAID) concerning the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and coronavirus-disease 2019 (COVID-19). Reference Fifer3 Based on the data available at the time, Congress was informed that the estimated mortality rate for the coronavirus was 10-times higher than for seasonal influenza, which helped launch a campaign of social distancing, organizational and business lockdowns, and shelter-in-place orders.

Previous to the Congressional hearing, a less severe estimation of coronavirus mortality appeared in a February 28, 2020 editorial released by NIAID and the Centers for Disease Control and Prevention (CDC). Published online in the New England Journal of Medicine (NEJM.org), the editorial stated:

“…the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%).”Reference Fauci, Lane and Redfield4

Almost as a parenthetical afterthought, the NEJM editorial inaccurately stated that 0.1% is the approximate case fatality rate of seasonal influenza. By contrast, the World Health Organization (WHO) reported that 0.1% or lower is the approximate influenza infection fatality rate, 5 not the case fatality rate. To fully appreciate the significance of discrepancies in fatality rate usage by NIAID, the CDC, and the WHO, brief definitions of relevant epidemiological terms follow.

Case fatality rates (CFRs), infection fatality rates (IFRs), and mortality rates are used by epidemiologists to describe deaths during and after an infectious disease outbreak. The CDC defined a mortality rate as the frequency of deaths within a time period relative to the size of a well-defined population. Reference Dicker, Coronado and Koo6 Patients may be classified as having an influenza-like illness (ILI) such as COVID-19 according to standard criteria in a case definition. 7 A CFR is defined as the proportion of deaths among confirmed cases of the disease. CFRs indicate the disease severity, while an IFR is defined as the proportion of deaths relative to the prevalence of infections within a population. Reference Bui, Sanger-Katz and Kliff8 IFRs are estimated following an outbreak, often based on representative samples of blood tests of the immune system in individuals exposed to a virus. Estimation of the IFR in COVID-19 is urgently needed to assess the scale of the coronavirus pandemic. Reference Mallapaty9

Because different types of fatality rates can vary widely, it is imperative to not confuse fatality rates with one another; else misleading calculations with significant consequences could result. As of late spring 2020, a search of the keyword term “infection fatality rate” on the CDC website returned no matching results or similar terms, nor was the epidemiological term located in the 511-page CDC publication, Principles of Epidemiology in Public Health Practice. (The CDC eventually introduced the Infection Fatality Ratio (IFR) on July 10, 2020 “as a new parameter value for disease severity.” 10 ) This terminology omission, in conjunction with questionable use of fatality rate terminology in the NEJM editorial, raises red flags, warning of possible inaccuracies in the coronavirus mortality estimation presented to Congress. Similar to the need to vet for miscalculations that might have rescued NASA’s 1998 Mars mission, vetting the coronavirus mortality estimation for miscalculations and biases may benefit the validity of mortality conclusions. Therefore, the purpose of this article is to present an ad hoc critical appraisal of the coronavirus mortality estimation presented to US Congress on March 11, 2020.

MAIN

Findings from a comparative analysis of selected video and texts are used in this article to critically appraise the validity of coronavirus mortality calculations presented in US Congressional testimony. Critical appraisal is a process that judges the validity of scientific research evidence. Reference Mhaskar, Emmanuel and Mishra11 Comparative analysis is a tool used in a grounded theory methodology to investigate an unexplored area through logical induction of coherent themes and explanations that are grounded in empirical evidence. Reference Chun Tie, Birks and Francis12 Text from the February 2020 NEJM.org editorial and video of Congressional testimony are compared with reliable informational texts from the WHO and CDC. Inconsistencies, inaccuracies, biases, utilization, and consequences of the coronavirus mortality estimation are discussed.

In NIAID testimony before the House Oversight and Reform Committee Hearing on Coronavirus response, Day 1, Reference Fifer3 the Committee learned that mortality from seasonal influenza is 0.1%. Additionally, it was reported to Congress that the overall coronavirus mortality of approximately 2-3% had been reduced to 1% to take into account infected people who are asymptomatic or have mild symptoms. The adjusted mortality rate from coronavirus of 1% was then compared with the 0.1% mortality rate from seasonal influenza, and the conclusion was reported to the House Committee that the coronavirus was 10-times more lethal than seasonal influenza.

In a comparative analysis with WHO and CDC documents, the coronavirus mortality rate of 2-3% that was adjusted to 1% in Congressional testimony is consistent with the coronavirus CFR of 1.8-3.4% (median, 2.6%) reported by the CDC. 13Furthermore, the WHO reported that the CFR of the H1N1 influenza virus (1918) is also 2-3%, 14 similar to the unadjusted 2-3% CFR of the coronavirus reported in Congressional testimony, with no meaningful difference in mortality. As previously mentioned, the WHO also reported that 0.1% is the IFR of seasonal influenza, 5 not the CFR of seasonal influenza as reported in the NEJM editorial.

DISCUSSION

Confusion between CFRs and IFRs may seem trivial, and it is easy to overlook at first, but this confusion may have ultimately led to an unintentional miscalculation in coronavirus mortality estimation. IFRs from samples across the population include undiagnosed, asymptomatic, and mild infections, and are often lower compared with CFRs, which are based exclusively on relatively smaller groups of moderately to severely ill diagnosed cases at the beginning of an outbreak. Due to host defense mechanisms and autoimmunity provided by innate and adaptive immune responses, Reference Aoshi, Koyama and Kobiyama15 asymptomatic infections are often prevalent in influenza. Reference Furuya-Kanamori, Cox and Milinovich16With many asymptomatic infections already identified in COVID-19, Reference Gao, Xu and Sun17 it appears unlikely that the IFR in an ILI like COVID-19 would approximate the disease’s CFR. Presymptomatic infections can also lower the proportion of asymptomatic infections. For example, a CDC report found that asymptomatic individuals identified through reverse transcriptase-polymerase chain reaction (RT-PCR) testing developed symptoms a week later, and those individuals were re-classified as having been presymptomatic at the time of testing. Reference Kimball, Hatfield and Arons18

In Figure 1, 4 cases grouped in the dotted-line box are also included among 7 infections, illustrating that all cases are infections but not all infections are cases, a potential point of confusion in media reports of COVID-19. For example, a high number of coronavirus infections were discovered in US meat-packing plants in Iowa, Reference Leys19 but these infections were reported as cases in the media, Reference Maddow20 potentially causing a type of information bias known as misclassification. Reference Althubaiti21 Misclassification refers to “the erroneous classification of an individual, a value, or an attribute into a category other than that to which it should be assigned.” Reference Porta22 This type of information bias in epidemiological research can lead to underestimates or overestimates of associated disease and mortality risks. Reference Althubaiti21

FIGURE 1 CFR and IFR. 1 fatality / 4 cases = 25% CFR. 1 fatality / 7 infections = 14.28% IFR.

CFRs and IFRs represent different segments of a targeted population and contain widely different proportions of nonfatal infections; therefore, misapplying findings or generalizing inferences between these 2 groups can cause a type of selection bias known as sampling bias Reference Johnson, Beaton and Murphy23 or ascertainment bias. Reference Delgado-Rodriguez and Llorca24 In this type of bias, people do not represent segments of the population to whom findings apply. Furthermore, “…comparisons of the CFR of 1 disease with the IFR of another are mostly useless,” Reference Roth, Clausen and Mueller25 and sampling bias can lead to serious inaccuracies, as when Congress was informed that the coronavirus is 10-times more lethal than seasonal influenza.

A comparison of coronavirus and seasonal influenza CFRs may have been intended during Congressional testimony, but due to misclassifying an IFR as a CFR, the comparison turned out to be between an adjusted coronavirus CFR of 1% and an influenza IFR of 0.1%. Had the adjusted coronavirus mortality rate not been lowered from 3% to 1%, fatality comparisons of the coronavirus to the IFR of seasonal influenza would have increased from 10-times higher to 20- to 30-times higher. By then, epidemiologists might have been alerted to the possibility of a miscalculation in such an alarming estimation.

Quality Assurance

Most people rely on trusted public health experts from organizations like the CDC to disseminate vital information on infectious diseases. Reference Fingerhut26 Unfortunately, even experts can make simple miscalculations that can lead to catastrophic results. In the example of NASA’s lost Mars Climate Orbiter, the NASA board investigating the failed mission recognized that mistakes happen on projects, “However, sufficient processes are usually in place on projects to catch these mistakes before they become critical to mission success.” Reference Isbell and Savage2 The NASA board also recognized the importance of quality assurance procedures to prevent future failures. Of relevance, in 2018, the National Institute of Neurological Disorders and Stroke (NINDS) provided an exemplary definition of quality assurance (QA) in clinical and health sciences:

“The objectives of QA procedures are to assure the accuracy and consistency of study data, from the original observations through the reporting of results and to ensure that study results are considered valid and credible within the scientific and clinical communities.” 27

Similar to NASA’s quality assurance problems in 1998, quality assurance procedures at US national public health organizations in 2020 may benefit from review and revision to prevent crucial mortality miscalculations of infectious diseases in the future. As a safeguard against misuse of fatality rates, and protection in the event of nonstandardized or inter-organizational discrepancies in terminology, every fatality rate should clearly define the denominator of the rate as the specific group to whom fatalities apply, either to the total population in mortality rates, confirmed cases of a disease in CFRs, or individuals exposed to a viral infection in IFRs.

Mitigation Measures

As the campaign to mitigate coronavirus transmission was implemented from March into May, 2020, expected coronavirus mortality totals in the United States appeared much lower than the overestimation reported in Congressional testimony on March 11. Compared with the most recent season of severe influenza A (H3N2) in 2017-2018, 28 with 80,000 US deaths reported by CDC officials, 29 US coronavirus mortality totals had just reached 80,000 on May 9, 2020. 30 By then, relative to the 2017-2018 influenza, it was clear that the coronavirus mortality total for the season would be nowhere near 800,000 deaths inferred from the 10-fold mortality overestimation reported to Congress. Even after adjusting for the effect of successful mitigation measures that may have slowed down the rate of coronavirus transmission, it seems unlikely that so many deaths were completely eliminated by a nonpharmaceutical intervention such as social distancing, which was only intended to contain infection transmission, not suppress infections and related fatalities. Reference Ferguson, Laydon and Nedjati Gilani31 Also in early May, 2020, a New York State survey of 1269 COVID-19 patients recently admitted to 113 hospitals found that most of the patients had been following shelter-in-place orders for 6 wk, which raised state officials’ suspicions about social distancing effectiveness. Reference Matthews, Villeneuve and Hill32 Still, polls showed the public credited social distancing and other mitigation measures for reducing predicted COVID-19 deaths, and for keeping people safe from the coronavirus. Reference Benzie33,Reference Chappell34

Surprisingly, disproportionate mortality increases in Italian and American health-care facilities during the height of the COVID-19 outbreak were not unique; similar health-care facility crises occurred during the 2016-2017 influenza season in Italy, Reference Rosano, Bella and Gesualdo35and during the 2017-2018 influenza season in the United States. Reference Macmillan36 Yet, these earlier outbreaks did not appear to receive the same intensive media coverage as COVID-19. Although media reports of new coronavirus infections reinforced the public’s belief that the virus was continuing to spread, greater levels of testing may have increased detection of infections that were already prevalent throughout the population. In addition, the accuracy of coronavirus tests rushed into production during the pandemic were unknown. Reference Perrone37 RT-PCR testing has been in use since the detection of the A (H5N1) influenza virus in 2005, 38 but a serious limitation of RT-PCR testing is that nucleic acid detection is not capable of determining the difference between infective and noninfective viruses. Reference Joynt and Wu39 Moreover, the CDC modified criteria to record coronavirus mortality by including “probable” and “likely” deaths in the International Classification of Diseases code (ICD) for COVID-19. Reference Schwartz40

By June 21, new daily deaths from the coronavirus dropped to 267 in the United States, a 90% decrease from 2693 daily deaths reported on April 21. 30 However, confirmed cases in some areas increased as lockdowns lifted, Reference Cohen41 and total US infections had reached 1,254,055 by June 21. 30 Several reasons in addition to increased viral transmission could account for case increases. For example, ill people may no longer fear going to hospitals as society reopens, Reference White42 and coronavirus testing may also result in greater differential diagnosis of SARS-CoV-2 infections from other common respiratory viral infections. Reference Singhal43 With more reported cases of COVID-19 in younger people following reopening, Reference Samore44 CFRs could actually decline due to lower associated mortality risk in this age group. Furthermore, country comparisons of coronavirus CFRs are often confounded by numerous factors, Reference James45 including health-care differences in case definitions, access to quality treatment and reliable testing, compliance with mitigation measures, and underlying health conditions; demographic differences in age, race, socioeconomic status, and population density; and geo-political differences including climate, seasonality, environmental pollution, social inequities and unrest, personal liberties, public health policies, reliability in reporting valid government statistics of disease, and lifestyle customs that affect physical and mental health, public sanitation, and personal hygiene. Ultimately, with a myriad of uncontrolled confounding factors, a serosurvey of representative samples of a population is a more reliable method to determine the true prevalence of coronavirus infections.

Emerging confounding factors in the United States have also contributed to a rising mortality trend in ILIs such as COVID-19. For example, each year surviving members of the ageing Baby-Boomer cohort of 76 million people born between 1946 and 1964 enter the high-risk category for ILIs, increasing the burden placed on health-care systems. Reference Henderson, Maniam and Leavell46 Also, research shows that a warming trend in the Artic can lead to more extreme winter weather conditions, especially in the Eastern United States, Reference Cohen, Pfeiffer and Francis47 which may play a role in rising mortality rates from ILIs during the influenza season.

As health authorities responded to the COVID-19 pandemic by implementing lockdowns and other mitigation measures with minimal supporting evidence, scientists warned of “a fiasco in the making,” Reference Ioannidis48 Caution was also raised against violations of fundamental principles of science and logic, such as the mistaken assumption that correlation implies causation. Reference James45 For example, the public’s belief that mitigation measures were responsible for reducing coronavirus mortality may be a post hoc fallacy if lower mortality was actually due to the overestimation of coronavirus deaths. Furthermore, implementing the unconfirmed hypothesis that mitigation measures save lives in vulnerable populations, and rejecting the null hypothesis that assumes no life-saving effect exists, is a type I error in hypothesis testing. Reference Randolph49 The null hypothesis does not assume a priori knowledge. Therefore, before implementing mitigation measures that incur severe costs, the onus is on mitigation proponents to formally reject the null hypothesis by justifying claims of life-saving benefits. Additionally, education in principles of basic research methods is essential for consumers of public health research, and there is a need to increase instruction in the science and logic of research methods in general education curricula. Reference Aguado50 More research of nondrug mitigation interventions is also urgently needed to prevent COVID-19, especially in vulnerable populations. Reference Glasziou, Sanders and Hoffmann51

Scientists also warned of public health decisions made without reliable data of infection prevalence within the population. Reference James45,Reference Ioannidis48 Lacking valid input data due to insufficient testing for disease prevalence, statistical modeling methods often relied on speculative assumptions, producing fearful predictions of increased mortality, which have often proved unreliable. Reference Begley52 A systematic review found that most diagnostic and predictive models for COVID-19 lack rigor, have a high risk of selection bias, and are likely to have lower predictive performance in actual practice compared with optimistic reports published in the research literature. Reference Wynants, Van Calster and Bonten53

A revised version of a non–peer-reviewed study on COVID-19 antibody seroprevalence in Santa Clara County, California, found that infections were many times more prevalent than confirmed cases. Reference Bendavid, Mulaney and Sood54 As more serosurveys are conducted throughout the country, a nationally coordinated COVID-19 serosurvey of a representative sample of the population is urgently needed, Reference McClellan, Gottlieb and Mostashari55 which can determine if the national IFR is low enough to expedite an across-the-board end to restrictive mitigating measures. Plans for a national US serosurvey were announced in April 2020 by the National Institutes of Health, to be conducted by NIAID and the National Institute of Biomedical Imaging and Bioengineering (NIBIB), with the assistance of the National Center for Advancing Translational Sciences (NCATS) and the National Cancer Institute (NCI). 56 Of relevance, nationwide mitigation measures, such as lockdowns, social distancing, and shelter-in-place orders, were not implemented during the 2017-2018 influenza with 45 million US illnesses reported by the CDC. 57 Neither were mitigation measures implemented during the 2009 influenza, with reported estimates adjusted for underreported hospitalizations of approximately 60.8 million US cases, ranging between 43.3 million to 89.3 million cases. Reference Shrestha, Swerdlow and Borse58

Fear and Collateral Damage

Psychological adverse effects, such as anxiety, anger, and posttraumatic stress, have been linked to restrictive public health mitigation measures due to isolation, frustration, financial loss, and fear of infection. Reference Brooks, Webster and Smith59,Reference Hoof60 A June 8, 2020, survey from the Association for Canadian Studies found that fear of contracting the coronavirus affected 51% of the Canadian population, compared with 56% of the US population.61 Venturing out into public during the reopening phase of the lockdown was stressful to 50% of Canadians compared with 56% of Americans. A second wave of the virus was also expected by 76% of Canadians and 64% of Americans. Furthermore, the possibility exists that yet another novel virus could emerge, potentially reigniting a perpetual process of unfounded fear and unnecessary lockdowns if mortality estimations are not properly vetted.

Fear, in contrast to moral civic duty and political orientation, was shown to be a more powerful predictor of compliance with mitigating behavior in response to a viral pandemic, but with decreasing well-being and poorer decision-making. Reference Harper, Satchell and Fido62Studies have shown that fear impairs performance of cognitive tasks through debilitating anxiety and worry. Reference Zhuang, Wang and Tang63 Even if a threat ceases to exist, prolonged fearful avoidance of threats is maladaptive and restricts a return to normal social interaction and productivity. Reference Sangha, Diehl and Bergstrom64 For example, after the outbreak of SARS had ended in 2004, avoidance behavior continued to restrict people’s social interactions and prevented people from returning to work. Reference Usher, Bhullar and Jackson65

Exaggerated levels of fear were driven by sensationalist media coverage during the COVID-19 pandemic. Reference James45,Reference Oprysko66,Reference Budrick67 And yet, while the public was ordered to lockdown, overall costs and benefits to society from severe mitigation measures had not been assessed. Reference James45 Fear of infection also prevented people from seeking needed health-care services in hospitals during the pandemic. Reference McFarling68 The ethics of implementing fear-based public health campaigns needs to be reevaluated for the potential harm these strategies can cause. Reference Bayer and Fairchild69 Dissemination of vital health information to the public should use emotionally persuasive messaging without exploiting and encouraging overreactions based on fear.

In addition, legal and ethical violations associated with mitigation of pandemic diseases were previously investigated by the Institute of Medicine in 2007. Reference Gostin and Berkman70 People should have the right to full disclosure of all information pertinent to adverse impacts of mitigation measures during a pandemic, including information on legal and constitutional human rights issues, Reference James45 and the public should be guaranteed a voice in a transparent process as authorities establish public health policy.

Last, severe mitigating measures during the COVID-19 pandemic caused considerable global social and economic disruption. Reference Nicola, Alsafi and Sohrabi71 Enforced lockdowns increased domestic violence, closed businesses and schools, laid off workers, restricted travel, affected capital markets, threatened the security of low-income families, and saddled governments with massive debt. Between February and April 2020, US unemployment rose from 3.5%, the lowest in 50 years, to 14.7%. Reference Davidson72 A recession in the United States was also officially declared in June 2020 by the National Bureau of Economic Research, ending 128 months of historic economic expansion. Of relevance, economic downturns are associated with higher suicide rates compared with times of prosperity, and increased suicide risk may be associated with economic stress as a consequence of severe mitigation measures during a pandemic. Reference Reger, Stanley and Joiner73 Relapses and newly diagnosed cases of alcohol use disorder were also predicted to increase due to social isolation, and harmful drinking in China increased 2-fold following the COVID-19 outbreak. Reference Da, Im and Schiano74 As a global natural experiment, psychological outcomes from restrictive interventions in the COVID-19 pandemic require further investigations. Reference Patrick and Cormier75

Public health lessons learned during the COVID-19 pandemic contribute knowledge and insights that can be applied to prevent future public health crises. Reference Secchi, Ciaschi and Spence76 Figure 2shows a flow chart that summarizes biases and potential effects of viral mortality overestimation observed in a pandemic. Failure to intervene at the source of the problem, at the upstream levels of information bias and sampling bias, can allow fear to rapidly escalate and may cause an overactive response that produces severely harmful collateral damage to society.

FIGURE 2 Biases and Potential Related Effects of Virus Mortality Overestimation.

CONCLUSIONS

Sampling bias in coronavirus mortality calculations led to a 10-fold increased mortality overestimation in March 11, 2020, US Congressional testimony. This bias most likely followed from information bias due to misclassifying a seasonal influenza IFR as a CFR, evident in a NEJM.org editorial. Evidence from the WHO confirmed that the approximate CFR of the coronavirus is generally no higher than that of seasonal influenza. By early May 2020, mortality levels from COVID-19 were considerably below predicted overestimations, a result that the public attributed to successful mitigating measures to contain the spread of the novel coronavirus.

This article presented important public health lessons learned from the COVID-19 pandemic. Reliable safeguards are needed in epidemiological research to prevent seemingly minor miscalculations from developing into disasters. Sufficient organizational quality assurance procedures should be implemented in public health institutions to check, catch, and correct research biases and mistakes that underestimate or overestimate associated risks of disease and mortality. Particularly, the denominator of fatality rates should clearly define the group to whom fatalities apply. Public health campaigns based on fear can have harmful effects, and the ethics of such campaigns should be reevaluated. People need to have a greater voice in a transparent process that influences public health policy during an outbreak, and educational curricula should include basic research methods to teach people how to be better consumers of public health information. The public should also be fully informed of the adverse impacts on psychological well-being, human rights issues, social disruption, and economic costs associated with restrictive public health interventions during a pandemic.

In closing, nations across the globe may fearfully anticipate future waves of the coronavirus pandemic, and look bleakly toward outbreaks of other novel viral infections with a return to severe mitigation measures. However, well-worn advice from a famous aphorism by the poet philosopher George Santayana should be borne in mind, which is relevant to public health lessons learned in this article: “Those who cannot remember the past are condemned to repeat it.” Reference Santayana77

Featured

Smearing MECFS Patients in the Name of Science

A previous post reviewed the SMC’s ‘expert reactions’ concerning MECFS between 2011 and 2017.

Here I review the Science Media Centre’s continued smearing of MECFS patients in a set of carefully curated ‘expert reactions’ to MECFS research between 2017 and 2020,

I expose here further evidence of a deliberate smear campaign of a vulnerable patient group. This campaign has been steered by the director of the SMC, Fiona Bernadette Fox OBE, with the willing assistance of medical and psychological scientists at prestigious institutions such as Oxford University and King’s College London.

The SMC describes itself as: “an independent press office helping to ensure that the public have access to the best scientific evidence and expertise through the news media when science hits the headlines.” Far from being independent, the SMC is funded to well over £500,000 by companies such as: GlaskoSmithKline and Wellcome and Universities such as King’s College London and Oxford.

All for the good of science and humanity, one might expect, but is it really? Not only is this not good science, it is not good journalism either. It is nothing more than pseudoscience verging on a cult. I review the evidence on this in a paper published elsewhere.

Ask a patient with MECFS and you might be surprised that all is not well with the SMC’s view of the condition. The SMC chooses to review a narrow band of researchers allied to a particular, contentious view that MECFS is a psychosomatic disorder based on the unscientific ‘Biopsychosocial Model’.

Curiously for an organisation claiming to represent science, there is almost zero mention of any proper scientific research on the biological basis of the disorders.

What exactly has the SMC been up to? Why has the SMC adopted the peculiar cause of a few researchers from its member institutions at the expense of the wellbeing of patients?

Below, the text of the experts’ reactions on MECFS research is examined with the author’s annotations in [square brackets].

NOVEMBER 10, 2020

expert reaction to NICE draft guideline on diagnosis and management of ME/CFS

Prof Michael Sharpe, Professor of Psychological Medicine, University of Oxford, [WS member, no conflicts of interest declared] said:

“As the NICE report says, it is paramount that patients are listened to and their symptoms and concerns taken seriously. It is also essential that evidence-based rehabilitative treatments (graded activity/exercise and cognitive behaviour therapy) are given only to those patients who want them and then given in a personalized expert fashion in partnership with them. It is to be hoped that these new guidelines improve the quality of delivery of these treatments. It is also to be hoped that the strongly stated concerns about the effect of badly delivered [badly delivered or inappropriate?] treatments do not make it even harder for patients to access the well delivered, evidence-based treatments.” [This statement is distracting spin. The NICE guidelines reject the use of CBT and GET. The issue is not about quality of delivery of treatments, it is about the appropriateness of the treatments in the first place.]

Prof Trudie Chalder, Professor of Cognitive Behavioural Psychotherapy, Institute of Psychiatry Psychology & Neuroscience (IoPPN), King’s College London, [ PACE investigator, no conflicts of interest declared] said:

“Cognitive behaviour therapy (CBT) and graded exercise therapy (GET ) are evidence-based treatments for chronic fatigue syndrome (CFS) in that they facilitate reductions in fatigue [measured by the Chalder Fatigue Scale, with all of its flaws] and improve people’s quality of life if delivered by a qualified therapist. Previous reviews of the science provide the evidence [which the NICE (2020) report finds to be of low or very low quality]. Our clinics are full of patients who are very keen to receive these evidence-based treatments and our patient reported outcomes support their use. My concerns are a) that patients should be offered these treatments to avoid a situation in which their condition stays the same or worsens [which is exactly what the NICE (2020) report suggests happens with GET] b) that health professionals will stop offering evidence-based treatments.” [NICE (2020) recommends against the use of GET and Lightning Process and so if health professionals stopped offering these treatments, that would be a desirable outcome.]

Prof Sir Simon Wessely, Regius Chair of Psychiatry, King’s College London, [no conflicts of interest declared] said:

“As someone who has been treating patients with ME/CFS for over 30 years [e.g.  Ean Proctor] I am in no doubt of the importance of continuing to treat CFS patients with empathy and respect, and offering individualised patient centred care. [Empathy and respect? Dropping them into swimming pools, scaring them on ghost trains and with vigorous wheel chair projection to the amusement of the staff?]  This was in the previous NICE guidelines in 2007, and it is depressing that this still needs to be said today. [Especially for hundreds of thousands of MECFS patients.] If even one patient feels that they are not been taking seriously, there is more work to be done. [There is a huge amount of work to be done because there are hundreds of thousands of MECFS patients who feel that they have not been taken seriously and many attribute this to the BPS psychosomatic approach that claims the symptoms are psychological rather than neurological or immunological.]  13 years ago there were only two treatments with clinical trial support, namely graded exercise therapy (GET) or cognitive behavioural therapy (CBT), and that has not changed over the years. In the new guidelines NICE has again emphasised that these approaches should not be fixed or set in stone, [A gross distortion of what NICE report actually says : the guidance clearly states that GET should not be used and CBT should have only a supportive role] which is already the case for those few centres with proper supervision and expert leadership that do provide such services at present. Such services will agree that “unstructured exercise that is not part of a supervised programme” [forms of GET] should be avoided.  There is a lot of helpful detail as to how such programmes should be implemented, but still some odd inconsistencies.[Innuendo without substance.]  Finally, sufferers should rightly beware any claims of miracle cures from any quarter, [e.g. the Lightning Process which theresearch team has promoted in three publications including a clinical trial] but be reassured that existing programmes that take a cautious, collaborative, clinically supervised approach, backed by evidence from randomised controlled trials, [none of the trials run bythe research team were controlled for placebo or attention effects] the gold standard of assessing effectiveness, offer some hope [to whom? patients?] of meaningful improvement in what remains a complex, little understood and still sometimes misunderstood condition.”

Prof Peter White, Emeritus Professor of Psychological Medicine, Queen Mary University of London, [WS member, no conflicts of interest declared] said:

“NICE is usually commended by being led by the science. It is therefore a great surprise that this guideline proscribes or qualifies treatments for CFS/ME for which there is the best evidence of efficacy, namely graded exercise therapy (GET) and cognitive behaviour therapy. [A great surprise? There has been a huge amount of criticism of GET and CBT for MUS/MECFS patients over the last 10 – 20 years.]

“It is also remarkable that the committee use the symptom of post-exertional fatigue as a reason for not providing GET, when the largest ever trial of GET showed that it significantly reduced this symptom more than staying within one’s energy envelope. [Misleading]. Should this guideline be adopted as suggested, I fear that it will discourage healthcare professionals from offering the two treatments that give patients the best chance to safely improve their health.” [This ‘discouragement’ is based on ‘evidence-based practice’].

APRIL 29, 2019

expert reaction to study investigating a potential biomarker for chronic fatigue syndrome / ME

Prof Sir Simon Wessely, Regius Chair of Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King’s College London (IoPPN), and President, Royal Society of Medicine, [no conflicts of interest declared] said:

“There have been many previous attempts to find a specific biomarker for CFS.  The problem is not differentiating patients with CFS from healthy controls.  The issue is can any biomarker distinguish CFS patients from those with other fatiguing illnesses?  And second, is it measuring the cause, and not the consequence, of illness? This study does not provide any evidence that either has finally been achieved. [Excellent point. However, the same issue applies to the entire research programme of the team at King’s. Multiple occurrences of inappropriate causal language are employed in papers by the King’s team. See Table 2]. It is also regrettable that it is claimed that such a test would give “scientific proof” of the existence of the condition, and prove it is “not imaginary”.  You don’t need a blood test to prove that an illness exists, and nor does the absence of such a test mean that it is “all in the mind”.  Any sub who runs a headline that says ‘new test proves CFS is real and not psychiatric’ should be ashamed of themselves.” [Any sub or Psychiatrist who says CFS is a psychiatric condition and not organic one should be equally ashamed of themselves because this has never been scientifically demonstrated. See section 3.]

MARCH 22, 2018

reanalysis of the PACE trial

Comment from three authors of the original PACE trial

Prof Michael Sharpe, Professor of Psychological Medicine, University of Oxford, Prof Trudie Chalder, Professor of Cognitive Behavioural Psychotherapy, Institute of Psychiatry Psychology & Neuroscience (IoPPN), King’s College London, & Dr Kimberley Goldsmith Senior Lecturer in Medical Statistics, Institute of Psychiatry Psychology & Neuroscience (IoPPN), King’s College London, said:

“Wilshire et al have written a critique of several papers reporting on the PACE trial of treatments for CFS/ME, of which we are authors.  They also report a reanalysis of the PACE trial data.  We note that most of the analyses they report have already been published, either in peer reviewed journals or by ourselves on the PACE trial website (https://www.qmul.ac.uk/wolfson/research-projects-a-z/current-projects/pace-trial/). [At the time of going to press, this website was unavailable. On 25 July 2021 it stated: “Sorry, the page you requested could not be found.”]

“They report different results from the original trial. However this is not surprising as their analyses used only part of the trial dataset and followed a preliminary PACE analysis plan, rather than the final approved and published one. Furthermore they do not refer to the many other trials and meta-analyses that have replicated the findings of the PACE trial. [Misleading criticism: Wilshire et al. (2018) aimed to provide a reanalysis of the PACE trial only, not an entire literature review, which was carried out by NICE (2020).]

“In conclusion we find little of substance in this critique and stand by our original reports. These are all available through the trial website [As noted, at the time of going to press, the trial website was unavailable. On 25 July 2021 it stated: “Sorry, the page you requested could not be found.”] The PACE trial found that CBT and graded exercise therapy are safe and moderately effective treatments; a positive message for people who suffer from this otherwise long-term debilitating illness.”

SEPTEMBER 20, 2017

The Lightning Process – a controversial treatment  for children with chronic fatigue

The Lightning Process is a controversial treatment that is sometimes used for children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME), a disabling illness that means 1% of UK secondary school children miss a day a week or more of school. Describing itself as “a training course that focuses on the science behind how the brain and body interact”. The Lightning Process has been met with scepticism in the scientific community. [Largely because it is a pseudoscientific, pyramid scheme based on Neurolinguistic Programming, strange rituals and osteopathy.]

Researchers decided to test the robustness of this treatment so, despite activists trying to stop them, [An unfounded ad hominem denigration of critics] they ran its first ever trial – an RCT that looked at the effectiveness and cost-effectiveness in children with CFS/ME. The results are published in the Journal of Archives of Disease in Childhood [twice – the second time with major corrections – after the changed endpoints and ethical shortcomings were exposed.]

SEPTEMBER 20, 2017

expert reaction to controversial treatment for CFS/ME

* ‘Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial’ by Crawley et al. published in Journal of Archives of Disease in Childhood on Wednesday 20th September.

Prof. Alastair Sutcliffe, Professor of General Paediatrics, UCL, said:

“A recent systematic review of neurolinguistic programming (NLP) stated “There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. [An interesting distinction.  There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes.” [Br J Gen Pract. 2012 Nov; 62(604): e757–e764. Published online 2012 Oct 29. doi:  10.3399/bjgp12X658287, PMCID: PMC3481516]. But now we have this interesting study by Crawley, a well-conducted single blind clinical trial that suggests NLP, in combination with other therapies and described as the ‘Lightning Process’, is effective for some children with the very hard to treat condition of chronic fatigue syndrome (CFS).

“Although in my view the effects described show some benefit and are therefore to be welcomed, this could be due to placebo which would still be GOOD news. Costs are modest [Costs range between £775 and £2500 per patient] and therefore this study is to be welcomed.

“These press releases are accurate, however, there is no reference to the fact that the effect may be due to placebo as this is a single-blind trial. But in a sense this is not so important [most investigators who run clinical trials would be disappointed if the intervention being trialed was shown to be a placebo effect and nothing more] and as the trial shows convincing evidence of benefit [convincing to whom?] and as placebo is impossible to quantify [yes, in any trial that does not include a placebo control group] we are left with the alternative possibility that these children benefited from the package of care per se, rather than the nebulous placebo effect.[It is impossible to reach this conclusion with an RCT design which lacks a control condition.]

“CFS is a difficult to treat and common disorder, so overall I welcome this step in the direction of evidence-based care as, at present in the UK, there is little agreement about what is the best way to treat this illness.” [The Crawley et al. trial is not a step in the direction of evidence-based care nor can it offer any robust conclusions about the best way to treat MECFS because of its many ethical and design flaws. A flawed trial that allows no advancement in scientific understanding is a waste of public research funds, patient goodwill and time.]

Prof. Dorothy Bishop, Professor of Developmental Neuropsychology, University of Oxford, said:

“The gains for patients in this study do seem solid, however, I am still rather uneasy because while the patient allocation and statistical analysis of the trial appear to be done to a high standard, the intervention that was assessed is commercial and associated with a number of warning signs. The Lightning Process appears based on neurolinguistic programming, which, despite its scientific-sounding name, has long been recognised as pseudoscience. [Valid statement.]

“I am sympathetic to the authors’ decision to evaluate the Lightning Process (LP), given that they had patients who had used it and reported favourably on it, and it could be argued that to fail to do so would indicate a degree of closed-mindedness [Absurd statement. Not anything patients have tried should be evaluated in a clinical trial, for example,  hyperbaric oxygen therapy, “chi deficiency”, acupuncture, naturopathy and chiropractic (invented by D. D. Palmer, who took his instructions from a talking ghost) purely to avoid the appearance of a ‘degree of closed-mindedness’? The potential harms, lack of scientific rationale and the wastage of research resources investigating quack practices cannot be entertained for the sake of ‘open-mindedness’.] But the commercial nature of LP really creates problems. We cannot tell which aspect of LP is responsible for the gains in patients who took part.

“I noticed, for instance, that LP involves group sessions, whereas the comparison group undergoing standard medical care were treated individually. So it may be that the benefits derive from interacting with other children with chronic fatigue syndrome/ME, rather than the specific exercises and training. This is, of course, something that could be investigated in future research [This factor could and should have been controlled in this trial] but meanwhile the concern is that this report will in effect act as positive publicity for a programme that is being proposed for a wide range of physical conditions (including chronic pain, low self-esteem, multiple sclerosis, and depression, to name just a few) and has to date been promoted largely through celebrity endorsements.” [The author previously has said that the technique is based on pseudoscience, yet she is suggesting further research should be carried with improved controls and so she is advocating further research on what she has categorised as a pseudoscientific therapy.]

Dr James Thompson, Honorary Senior Lecturer in Psychology, UCL, said:

“The treatment in this study looks like it had an effect, at least by the standard of most clinical trials. To be extra robust I would have liked to see more objective measures, but unfortunately chronic fatigue syndrome is not an objective diagnosis, it is a leftover category and fatigue is subjective. [Misleading criticism. Not having an objective diagnosis does not prevent objective measurements of improvement, e.g. activity measures.]

“One limitation is that self-report scales can be subject to placebo effects, however if the patients feel better in the experimental condition in which they receive extra help, even if everyone knows it, then that is something and the pupils miss less school, which is an objective measure. In this case it may not have been the CBT element of the treatment, but it looks like it.” [It cannot ‘look like it’ because it is impossible to tell without proper control conditions.]

Prof. Michael Sharpe, Professor of Psychological Medicine, University of Oxford, [WS member, no conflicts of interest declared] said:

“Chronic fatigue syndrome (CFS) is a name for an illness with symptoms of long lasting and disabling fatigue. It affects many young people and can interfere with their education. Whilst some people call it myalgic encephalomyelitis (ME) it is not clear if this is the same or a different condition.

“This trial tests the effectiveness of a commercially available brief intensive talking therapy for CFS called the Lightning Process. The treatment has similarities to cognitive behaviour therapy (CBT) and is given in groups. [The treatment also has differences, e.g. CBT does not require participants to: Tell everyone that you have been healed;  Perform magical rituals such as standing in circles drawn on paper with positive keywords inscribed; etc] The treatment was found to be better than usual care in fatigue, physical function and school attendance, with benefit seen as long as a year later. It was also safe. The study does not tell us how it works however. [The study does not even tells us if it works.]

“This is a robust study because patient were allocated to one of the two treatments at random ensuring that any difference seen in outcome between these treatments, is not due to pre-existing differences in the patients. The main limitation is that, as it is not possible to hide which treatment they received from the patients, their self-ratings of fatigue and functioning could potentially be biased by their views on the treatment they received. [These criticisms are true of all trials run by the BPS school including the PACE trial but the author has never acknowledged this fact.] However, differences in the school attendance a year later were also noted; it seems [un?]likely (sic) that these could be due to such a bias.

“Commercially available treatments like this one that are being used by patients should be rigorously tested. This is especially important for an illness like this one about which much misinformation is spread using social media. [And by medical journals that pass defective trials though peer review and refuse to retract them.] We need more studies and less polemic.” [!]

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The Science Media Centre and MECFS: Best Scientific Evidence or Biased Opinion?

The Science Media Centre describes itself as: “an independent press office helping to ensure that the public have access to the best scientific evidence and expertise through the news media when science hits the headlines.” (https://www.sciencemediacentre.org/)

Here I examine the SMC’s reports on MECFS-related publications relating to the PACE trial, from 2011 when the trial was published until 2017 when the Journal of Health Psychology published a Special Issue critiquing the trial. What the SMC describes as ‘best scientific evidence’ consists of biased opinions from people with strong vested interests.

My personal take on the experts’ opinions is placed [inside square brackets throughout the text].

The recently published revised guidance on MECFS by NICE (2021) recommends that GET should be dropped and CBT only used in a supportive role in the treatment of people with MECFS. How well does the SMC ‘expert opinion’ stand up to scrutiny in light of that new NICE guidance?

I leave this for readers to decide.

JULY 31, 2017

expert reaction to Journal of Health Psychology’s Special Issue on The PACE Trial

The Journal of Healthy Psychology has published a special issue focusing on the PACE trial – originally published in The Lancet (2011). ‘Special Issue on The PACE Trial’ edited by David Marks published in Journal of Health Psychology on Monday 31st July 2017.

Prof. Malcolm Macleod, Professor of Neurology and Translational Neuroscience, University of Edinburgh, said:

“The PACE trial, while not perfect, provides far and away the best evidence for the effectiveness of any intervention for chronic fatigue; and certainly is more robust than any of the other research cited. Reading the criticisms, I was struck by how little actual meat there is in them; and wondered where some of the authors came from. [Ad hominem]. In fact, one of them [a reputable and well-published family doctor in Amsterdam] lists as an institution a research centre (Soerabaja Research Center) which only seems to exist as an affiliation on papers he wrote criticising the PACE trial. [It is normal practice to consider the quality of a critic’s argument not their institution. For the record, affiliations and the alma mater of other PACE trial critics include University College London, City, University of London, Northwestern University, DePaul University, the University of Hertfordshire, Victoria University of Wellington New Zealand, UC Berkeley, and the ME Association.]

“Their main criticisms seem to revolve around the primary outcome was changed halfway through the trial: there are lots of reasons this can happen, some justifiable and others not; the main think is whether it was done without knowledge of the outcomes already accumulated in the trial and before data lock – which is what was done here. [Evidence on this point remains uncertain.]

“So I don’t think there is really a story here, apart from a group of authors, some of doubtful provenance [a family doctor does not have doubtful provenance]  kicking up dust about a study which has a few minor wrinkles (as all do) but still provides information reliable enough to shape practice. If you substitute ‘CFS’ for ‘autism’ and ‘PACE trial’ for ‘vaccination’ you see a familiar pattern…” [This statement is a shameful ad hominem argument that is unbecoming of any reputable academic.] 

A spokesperson for University of Oxford [where a PACE trial investigator is employed, no conflicts of interest declared] said:

“The PACE trial of Chronic Fatigue Syndrome treatments was conducted to the highest scientific standards and scrutiny. This included extensive peer review from the Medical Research Council, ethical approval from a Research Ethics Committee, independent oversight by a Trial Steering Committee and further peer review before publication in high-impact journals such as The Lancet. 

“The allegation that criteria for patient improvement and recovery were changed to increase the reported benefit of some treatments is completely unfounded. As the study authors have repeatedly made clear, the criteria were changed on expert advice and with oversight committee approvals before any of the outcome data was analysed.

“Oxford University considers Professor Sharpe and his colleagues to be highly reputable scientists whose sole aim has been to improve quality of life for patients with ME/CFS. While scientific research should always be open to challenge and debate, this does not justify the unwarranted attacks on professionalism and personal integrity which the PACE trial team have been subjected to.” [It does not justify vilification of patients, citizen scientists and scholars who have criticized very poorly done trials such as the PACE trial.]

OCTOBER 28, 2015

expert reaction to long-term follow-up study from the PACE trial on rehabilitative treatments for CFS/ME, and accompanying comment piece

A paper published in The Lancet Psychiatry reports results of a long-term follow-up study to the PACE trial for CFS/ME. The study has assessed the original trial participants’ health in the long-term, and asks whether their current state of health, two and a half years after entering the trial, has been affected by which treatment they received in the trial.

‘Rehabilitative treatments for chronic fatigue syndrome: long-term follow-up from the PACE trial’ by Michael Sharpe et al. published in the Lancet Psychiatry on Wednesday 28 October 2015.

‘Chronic fatigue syndrome: what is it and how to treat?’ by Steven Moylan et al. published in the Lancet Psychiatry on Wednesday 28 October 2015.

Prof. Rona Moss-Morris, Professor of Psychology as Applied to Medicine, King’s College London, said:

“I think this is a robust study with some limitations that the authors have been clear about. [The authors have not been ‘clear about’ the limitations and refuse to acknowledge the many methodological flaws in the PACE trial. ] The original PACE trial published in 2011 showed that at one year people with CFS/ME who received either graded exercise therapy (GET) or cognitive behavioural therapy (CBT) in addition to standard medical care were significantly less fatigued than those who received standard care alone or those who received adapted pacing therapy. The authors concluded GET and CBT were moderately effective treatments for CFS. Now, moderately effective may not sound all that impressive until you consider that many of our commonly used pharmaceuticals for medical conditions have similar moderate treatment effects. When using pharmaceuticals as treatment, maintaining these effects may mean taking ongoing medicines. This study shows that even two years or more after treatment has completed, patients receiving GET and CBT sustain their clinical benefits. A small percentage of these patients accessed some further treatment, but even so, these sustained effects are impressive. [In light of re-analyses, the effects practically disappear and are fully consistent with a placebo effect].

“Despite these impressive results [hype], this isn’t time for complacency. Some patients do not benefit from the treatment. [The majority of patients do not benefit from the treatment.] We need to do more to understand why. [A critical review of the underlying theory would be a good place to start.]  We also need to develop and tailor existing treatment to get larger effects. It is also important to note that the CBT and GET protocols used in PACE were developed specifically for CFS. They are not the same as CBT for depression and anxiety or the exercise training you may receive at a local gym. The therapies are based on a [non-scientific] biopsychosocial understanding of CFS and the health care professionals in PACE received specific training and supervision in these approaches. This is an important note for commissioners as not all CBT and exercise therapies are equal. Specialist knowledge and competence [and a failure to control for placebo effects] in these therapies is needed to obtain these sustained [contentious and unrecommended by NICE, 2020] treatment effects.”

 Declared interests

Prof. Rona Moss-Morris: “Two authors of this study, Trudie Chalder and Kimberley Goldsmith, are colleagues of mine at King’s College London. I work with Trudie on other CFS work and with Kimberley on different work. I published a small study on GET in 2005. I am a National Advisor for NHS England for improving access to psychological therapies for long-term conditions and medically unexplained symptoms. Peter White (another author of the present study) is Chair of trial steering committee for an HTA NIHR-funded RCT I am working on with people with irritable bowel syndrome.” [Multiple conflicts of interest declared.]

FEBRUARY 17, 2011

expert reaction to Lancet study looking at treatments for Chronic Fatigue Syndrome/ME.

Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial, by Peter White et al, published in the Lancet at 00.01hr UK time Friday 18 February 2011.

The study made the first definitive comparison of various treatments for CFS/ME to deduce the most effective treatments.

Dr Alastair Miller, Consultant Physician at Royal Liverpool University Hospital, Clinical lead for CFS services in Liverpool, Independent assessor of trial safety data for PACE trial and Principal Medical Advisor, Action for ME, [Action for ME was one of the PACE trial sponsors and Dr Miller has an undeclared conflict of interest] said:

“Although NICE have previously recommended graded exercise and CBT as treatments for ME/CFS, this was on the basis of somewhat limited evidence in the form of fairly small clinical trials. This trial represents the highest grade of clinical evidence – a large randomized [uncontrolled] clinical trial, carefully designed, rigorously conducted and scrupulously analysed and reported [A totally false description of the PACE trial which contained 14 design and ethical flaws.] It provides convincing evidence that GET and CBT are safe and effective and should be widely available for our patients with CFS/ME.

“It is clearly vital to continue our research into biological mechanisms for ME/CFS but recent ‘false dawns’ for example, over the role of retroviruses (XMRV) have shown how difficult this can be. In the current absence of a biomedical model for the causation and the absence of any pharmacological intervention, we have a pragmatic approach to therapy that works and we should use it.” [even if it is only a small placebo effect?]

Dr Derick Wade, Consultant and Professor in Neurological Rehabilitation and Clinical Director, Enablement Directorate, Oxford Centre for Enablement, said:

“CFS is common, and it is vital to know whether treatments proposed and/or used are safe and are effective. Randomised controlled trials provide the best and only reliable evidence on safety and effectiveness of any intervention in any condition. The trial design in this study was very good, [but it was not a controlled trial and there are more than a dozen objective flaws] and means that the conclusions drawn can be drawn with confidence. [A patently untrue statement.]

“This is a very significant finding. It identifies that one commonly used intervention is not effective (and therefore should not be used), and it confirms the effectiveness of two treatments, and their safety. The study suggests that everyone with the condition should be offered the treatment, and every patient who wishes to be helped should be willing to try one or both of the treatments. It also means that we can allocate resources to treatments that will benefit patients and, more importantly, stop allocating treatments that do not have proven efficiency. Further research should identify ways that treatments derived from these may deliver greater benefits. [All of this paragraph is spin.]

“Research needs to investigate both treatments and factors that increase the risk of developing CFS. However, it is probably more effective to research treatments, and proving a treatment is effective starts to give clues about causative factors.”

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said:

“We welcome the findings of the PACE trial, which further support cognitive behavioural therapy and graded exercise therapy as safe and effective treatment options for people who have mild or moderate CFS/ME. These findings are in line with our current recommendations on the management of this condition.

“We will now analyse the results of this important trial in more detail before making a final decision on whether there is a clinical need to update our guideline. Until then, healthcare professionals should continue to follow our existing recommendations, especially as this latest research appears to endorse them as best practice for the NHS.”

[NICE, 2021, reported its revised guidance that GET should be dropped and CBT only used in a supportive role.]

Dr Esther Crawley, Consultant Paediatrician and Clinical Lead for the Bath Specialist Paediatrics Chronic Fatigue Syndrome/ME Service, [research associate with no conflicts of interest declared] said:

“All children with chronic fatigue syndrome and their parents are desperate for new research to understand how to treat this condition. The next step is to do a study like this for children to find out if these treatments work.” [Promoting her SMILE trial grant application.]

Prof Willie Hamilton, GP in Exeter and Professor of Primary Care Diagnostics, Peninsula College of Medicine and Dentistry, said:

“At least half of patients improved with CBT or GET. The study also allays fears that CBT or GET may be harmful. [Not among patients who are at the receiving end.] There are a minority of patients who didn’t see improvement so the next step must try and find treatments to help them.

“This study matters: it matters a lot. CFS/ME is common, and causes a lot of suffering. Up until now we have known only that CBT and GET work for some people. We didn’t know if pacing worked. This caused a real dilemma – especially for those in primary care. We didn’t know whether to recommend pacing, or to refer for CBT or GET. Worse still, not all GPs have access to CBT or GET, so ended up suggesting pacing almost by default. This study should solve that dilemma.

“At a patient level, I now know what to suggest to my patients. Almost as important, it sends a powerful message to PCTs – and the soon-to-be-formed GP consortia – that they must fund CBT or GET. NICE proposed that before this study came out – the evidence is even stronger now.”

[With the exception of AfME who sponsored the trial, and later apologised, patient advocacy organisations have not accepted the PACE trial evidence. CBT and GET continue to fail to meet patients’ needs. The NICE (2021) guidance changed recommendations on both GET and CBT and neither therapy is recommended as a treatment for MUS/MECFS.]          

Featured

Think again Dr Paxton. Do your job. Or resign.

In previous posts here, here and here, I have discussed the apparent xenophobia of The Psychologist‘s twitter account.

In a bizarre turn of events, however, it is revealed that any alleged misconduct of psychologists working for the British Psychological Society is not dealt with by the Society’s Ethics Committee. This elite group includes Jon Sutton, the managing editor of The Psychologist, who can apparently tweet to his heart’s content in the name of the British Psychological Society. The majority of the Society’s employed officers are managers, not psychologists. If anybody wishes to complain about the conduct of this elite group, they must do so using an arcane ‘Complains Procedures’ described on the Society’s website.

According to the Complaints Procedures, members are required not to “act in a way that damages, or is likely to damage, the reputation of the British Psychological Society or is contrary to the object of the Society as set out in the Royal Charter.” However, the Chair of the Society’s Ethics Committee, Dr Roger Paxton, informed me that the conduct of staff employees falls under the Complaints Procedures, not the Ethics Committee.

Psychologists employed by the Society apparently have a permanent ‘get out of jail free’ card because cases of alleged misconduct are not dealt with by the Ethics Committee.

What a bizarre system: one set of rules for rank and file members and another set of rules for the elite at head office.

An Email sent on behalf of Dr Roger Paxton dated 10 August 2021 states:

Dear Professor Marks,

Thank you for copying me into your email of 3 August to Diane Ashby.  

Dealing with complaints is not within the terms of reference of the Ethics Committee. If you wish to make a complaint about any BPS staff member the complaints process is readily available on the Society website. 

Kind regards,

Dr Roger Paxton

“Dealing with complaints is not within the terms of reference of the Ethics Committee”

Really?

This is absurd. Jon Sutton is a practising psychologist and member of the BPS. If his conduct is alleged to be unethical, surely this conduct falls under the purview of the BPS Ethics Committee.

Writing in The Guardian on 13 September 2020, Paxton stated:

Morality has been stripped from public life. Here’s a four-step plan to revive it

Moral Wellbeing

Paxton talks about physical, mental and moral well-being. According to Paxton:

For moral wellbeing there is a similar framework that could be useful: the psychological model developed by James Rest, outlining the four components of moral reasoning.

This is a framework for improving thoughtfulness and clarity about moral matters. The first stage is moral sensitivity – recognising when an issue is one of morality, rather than a personal preference or practicality. The second component is moral reasoning. Having identified that a question is one of right and wrong, you then decide what the right thing to do would be. Third comes moral motivation – acknowledging other interests and motives that influence your thinking about the issue, and then weighing up the conflicting motives. The fourth and final stage is moral implementation, which means bringing moral reasoning and moral motivation together to make and act on a decision

Put theory into practice and think again Dr Paxton. Do your job, or resign.

Featured

Xenophobia – What Xenophobia?

Sharing Xenophobia a Collection of Resources

The Little Englander series continues. Following episode 2, ‘Little Englander’: Diane Ashby to the Rescue, we take up the story as Diane Ashby’s Rescue Mission Continues. Her latest email receives a rapid riposte.

Dear Professor Marks

In response to your email of 24 July, I can reassure you that high standards are indeed expected of both staff and members. The purpose of Jon’s tweets around Euro 2020 – including referencing Wales and Scotland when they were in the tournament – was to share a collection of resources on Psychology and football. I believe that, and the spirit in which they were intended, will be apparent to the vast majority of people.

Similarly, I think that an ordinary reasonable person is likely to interpret your ‘Little Englander’ tweet as implying that Jon holds xenophobic attitudes. As noted by Wikipedia, this is a common interpretation of the ‘derogatory’ term. Therefore I must repeat my request that you delete the tweet, by10 August 2021 or we will need to consider further action.

I also kindly request that you refrain from copying Jon in to any reply, as I am aware he has already appealed to you regarding the impact of this. To continue regardless could be interpreted as harassment.

Kind regards

Diane Ashby

Deputy Chief Executive

Dear Diane Ashby,

I acknowledge receipt of today’s email.

Your claim that the purpose of Jon Sutton’s tweets around Euro 2020 “was to share a collection of resources on Psychology and football” appears naive, highly implausible and beside the point. Even if it were true, the impression given by Jon Sutton’s tweet  is of an entirely different nature. 

I refer you to the BPS Guidance on the use of social media where it states: 

■ “Keep your professional and personal life as separate as possible. This may be best achieved by having separate accounts, for example Facebook could be used for personal use and LinkedIn or Twitter used for professional purposes.”

Jon Sutton’s views on ‘football coming home’ etc were personal and should never have been published on the BPS Psychologist Twitter account. Quite clearly, Jon Sutton has broken the rules specified in the social media guidance. By defending Jon Sutton, you are complicit is an unethical, xenophobic and antisocial act against the BPS Code of Ethics and Conduct.

If, as you say, an “ordinary reasonable person is likely to interpret [my] ‘Little Englander’ tweet as implying that Jon holds xenophobic attitudes”, that’s exactly my point. Please note Code of Ethics and Conduct paragraph 3.4 which states: “Integrity Acting with integrity includes being honest, truthful, accurate and consistent in one’s actions, words, decisions, methods and outcomes. It requires setting self-interest to one side and being objective and open to challenge in one’s behaviour in a professional context.”  Also please note paragraph 3.1 which states: “3.1 Respect Respect for the dignity of persons and peoples is one of the most fundamental and universal ethical principles across geographical and cultural boundaries, and across professional disciplines. It provides the philosophical foundation for many of the other ethical Principles. Respect for dignity recognises the inherent worth of all human beings, regardless of perceived or real differences in social status, ethnic origin, gender, capacities, or any other such group-based characteristics. This inherent worth means that all human beings are worthy of equal moral consideration.” Neither Jon Sutton nor you are showing integrity or respect. 

According to the principles of Integrity and Respect, Jon Sutton’s public expression of xenophobia is open to challenge as is your defence of his conduct. I defend my right as a Fellow of the BPS and Chartered Psychologist working within the Code to criticise Jon Sutton for what I perceive to be his xenophobia. There have been multiple occasions where xenophobia and racism, codified or overt, have been evident in BPS publications. I am discussing these issues in a book edited by Professor David Pilgrim and will not go into them here. However I am willing to elaborate if called to do so by any investigating organisation such as the Charity Commission.

Xenophobia about England and English football is widely recognised. It is associated with yobbism, violence, nationalism, racism and right wing politics.  Xenophobia is not an attitude that is becoming of an Editor of The Psychologist. It is my considered opinion that Jon Sutton should delete his tweet and apologise, and that you and other BPS officers should distance yourselves from it and other forms of xenophobic behaviour, not defend it with unsubstantiated and implausible speculations. Hence you are as culpable as Jon Sutton for xenophobia which is out of keeping with the Code of Conduct. 

As stated above I will be willing to clarify in more detail why I consider Jon’s conduct and your support of it detrimental to the public standing and reputation of the Society. To give an example, one of the phrases Jon used: “It’s coming home” may not be as innocent as it sounds. I refer you to the paper: “‘Football’s coming home’ but whose home? And do we want it? Nation, football and the politics of exclusion” by Ben Carrington (2002) in A. Brown (Ed.) Fanatics (pp. 121-143). Routledge available at: http://ndl.ethernet.edu.et/bitstream/123456789/34991/1/Adam_Brown.pdf#page=122

The following quotation from Ben Carrington’s paper seems especially apposite:

“Racism manifests itself in plural and complex forms. In this situation the logic of racism needs to be appraised in what we shall call metonymic elaborations. This means that racisms may be expressed through a variety of coded signifiers…. Contemporary racisms have evolved and adapted to new circumstances. The crucial property of these elaborations is that they can produce a racist effect while denying that this effect is the result of racism.” (Solomos and Back 1996:27). 

As a xenophobic, codified signifier of racism, Jon Sutton’s tweet should be removed without further delay and Jon Sutton should be reprimanded and warned not to use the Society’s Psychologist Twiiter account to make personal, xenophobic remarks. For this reason, I am making a formal complaint to the Society Ethics Committee about Jon Sutton’s conduct and your conduct by being complicit with it.

As requested, I have not copied Jon Sutton into this email to avoid what you describe as ‘harassment’. Equally, any further emails from you to me about this matter will also constitute ‘harassment’, by your definition, and I request that you do not write any further emails to me about this matter.

Herewith I am lodging a formal complaint to the Ethics Committee about your and Jon Sutton’s conduct. Any further communication about this matter should be through the offices of the Chair of the BPS Ethics Committee, to whom I am copying this email.

Kind regards,

David F Marks PhD FBPsS  CPsychol

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‘The Martians could land in the car park, and no one would care’

ACADEMIC FREEDOM AND CENSORSHIPFINANCIAL ISSUESGOVERNANCEMEMORY AND THE LAW GROUP

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My friend Dave Pilgrim over at BPSWatch writes:

In 1988, the Board structure agreed by the then leaders of the BPS set the scene for the norms of misgovernance and corruption – which we have reported at length on this blog – to grow and thrive.  Two years later Margaret Thatcher had gone, but neoliberalism and managerialism were finding their symbiotic balance and were being embedded in British public organisations, as they became both more bureaucratized and more marketized (Dalingwater, 2014).  The compromise was the New Public Management approach, which was to find a particularly dysfunctional expression in the BPS, as recent events have demonstrated.

In 1989, Del Amitri released their insistently hypnotic Nothing Ever Happens. Good protest songs are enduring; really good ones can be prophetic, hence the title above, which is one of its many spikey lines. To signal the frenetic passivity of recent times, its chorus repeats its own lament of futile repetition: ‘nothing ever happens, nothing happens at all, the needle returns to the start of the song, and we all sing along like before’.  Good lyricists, like good whistle-blowers, are the canaries in our coalmines.

The BPS AGM on the 26th of July 2021 was rigged to celebrate the oligarchy in a feast of scripted mutual backslapping. Another incipient President was confected, in the wake of the show trial, biased appeal, and public disparagement of the expelled whistle blower, Nigel MacLennan. This illegitimate election symbolised, once more, a contempt for integrity and decency in the BPS. 

The two new Presidents (are they both ‘Elect’ and do these terms actually matter anymore, within this chaotic pretence of democracy?) have got their work cut out. If the SMT say ‘jump’, will they ask, ‘how high?’ Alternatively, will they see what is coming down the line and do their best to hold the cabal to account? When put under pressure to conform obediently, as they will, can they really risk being tarred with the same brush of the old guard? This is the grim context for the newcomers to the party: while the Charity Commission prevaricates, the lawyers and the police are closing in on past crimes and misdemeanours. This is a tricky scenario and so the new duo might do well to seek their own legal advice at this stage. 

Within two days of her ‘election’, Katherine Carpenter was ‘delighted’ to unveil the oven-ready ‘New Strategic Framework’, the goals of which I cite here, with some questions in square brackets; many more come to mind, but these are a sample:

  1. We will promote and advocate for diversity and inclusion within the discipline and profession of Psychology and work to eradicate discriminatory practice. [Will this goal require and permit an open democratic discussion of what is meant by all of these terms and how they will be measured or appraised in practice?]
  2. We will strive to create a vibrant member-centred community with a meaningful membership identity. [Will this mean being open with members and not keeping them in the dark about the workings of the Board and the workings of the SMT, in the light of recent history?]
  3. We will promote the value of and encourage collaboration in interdisciplinary development and engagement. [How will that work in practice in relation to other biological and social sciences and will there be a shared commitment to academic freedom and an unambiguous condemnation of censorship?]
  4. We will be the home for all Psychology and psychologists and uphold the highest standards of education and practice. [Will the ethics and complaints system be overhauled radically in order to turn these fine words into practice, under full compliance with Charity Commission expectations?]
  5. We will increase our influence and impact and advance our work on policy and advocacy [Will this work be inclusive of all policy views and value positions in the Society, rather than those which have been captured contingently by some interest groups in the recent past?]
  6. We will strive to be more innovative, agile, adaptive and sustainable. [Will this include being less secretive and censorious than in the recent past or are these words a form of permission for a continuation of the lack of accountability from those in power in the BPS?]”

All of this Motherhood and Apple Pie stuff is so amorphous that it cannot be gainsaid. It all sounds sensible and progressive, but the devil is in the detail. More importantly, look what has happened in the past, when people have tried to put good intentions into practice. 

A number 7 could have been ‘we will confess to and clear up the scandalous mess the BPS is now in after so many years of misgovernance’. That did not make it into the ‘New Strategic Framework’ for the very reason that the rhetorical line of ‘problem what problem?’ has been held firmly by a defensive cabal, pursuing their own vested interests. However, how can ‘we’, the members, have a better a future without owning the truth of the past?

The broadly good intentions of this document motivated the activity of the President Elect, who note was removed illegitimately and then replaced by Katherine Carpenter. He was concerned to make the Society open, and membership centred. He was concerned to defend a Society that was both learned and learning. He was the one who ensured engagement with the Charity Commission to facilitate such changes, and this was resisted by a reactionary Board hostile to his efforts. 

Earlier attempts at ensuring accountability (for example from another removed President, Peter Kinderman) ended in the same process of systemic resistance, reflecting the norm of misgovernance present since 1988.  And although this is systemic resistance (a description), it has been enacted knowingly at times by a social network that remains shameless and self-congratulatory (a motivational explanation) (McPherson, et al., 2001). If this claim is in doubt, witness the fatuous AGM just held. 

In this context of pretence or bad faith, who does the word ‘We’ actually refer to? Is it the Board, the SMT, the membership, some combination, or other people, such as the non-existent truly independent Trustees? Today, investigative journalists trying to find ‘the BPS’ (and the ‘we’ that supposedly embodies it) are like the perplexed foreign student trying to find ‘the university’, among the Oxford colleges (Ryle, 1949). The convenient imprecision throughout the Framework creates ambiguity and a formula for perpetual unaccountability and political mystification in practice. ‘The needle returns to the start of the song and…… 

‘….we all sing along like before’ – an organisation without a memory

The BPS is the antithesis of a ‘learning organisation’. Indeed, it is an ideal case study in cultural dysfunction and selective amnesia, ripe for teams of researchers, whether historians or from management schools. The very idea of a learning organisation or ‘organisation with a memory’ has proved problematic for the NHS (Pilgrim and Sheaff, 2006) but that does have the excuse of being a vast and complex system, employing around 1.5 million staff (Department of Health, 2000). By contrast, the BPS is a medium-sized charity, with just around a hundred employees and less than 70,000, members. The first is a national treasure but the second is becoming (for those who care about it) a national embarrassment. 

Given the size of the BPS, it does have a fighting chance of being a learning organisation. However, for this to be actualised then a starting responsibility is that those of us who are committed to academic values, including freedom of expression, have to be honest about the mess before us. Evading that empirical picture or pretending that this is merely a passing downturn in the fortunes of an essentially honourable institution, which has been kicking around since 1901, looks like the current tactic of the cabal. They favour the convenient ‘this is has been a challenging year’ rhetorical waffle, in order vaguely to play victim and avoid telling the truth, the whole truth and nothing but the truth about the shambles. (This excuse making was on the pernicious YouTube video from Carol McGuinness about Nigel MacLennan, now belatedly removed by the cabal.)

Who will provide the history of this shameful period?

This blog will be archived in the History of Psychology Centre. However, what will be the story for the record told by the current cabal and the older oligarchy, encouraged in their emergence by the structural false start of 1988?  Will it be the heavily redacted Board minutes of November 2020? Will it describe the policy of censorship operated deliberately in relation to its own publications and how BPS employees were used for that purpose? Will it offer the memo demanding that people should close down discussion? Will there be a silence about the departure of the Finance Director while under investigation? Will it mention non-disclosure agreements and the departures of another CEO and another Finance Director under a cloud before the most recent debacle at the top? Will there be an account of why the current CEO (at the time of writing) is still being paid, while absent from his office, with the membership being offered no transparent proposals about the resolution of this ridiculous impasse? 

The questions keep coming for the very reason that the cabal is secretive, and secrecy provokes curiosity, journalistic and otherwise. And because it is secretive ipso facto it is not inclined to elaborate very much for the historical record. More food for thought for the incoming Presidential duo about how history will judge us all.

Talking of looking back…..

When we sent our dossier to the Charity Commission at the end of 2020, it contained several examples of concern that reflected poor governance in the BPS. One related to the closure of the Memory and Law group announced by the Chair of the Research Board, Daryl O’Connor. At the recent AGM noted above, he was made an Honorary Life Fellow of the BPS. Earlier in the month, the other person involved in the announcement, Lisa Morrison Coulthard (Head of Research and Impact), declared via Twitter that she was leaving the BPS after 25 years of employment to join the NFER. Both were central to the development of the existing and outdated report on memory (British Psychological Society, 2008/2010), which was challenged for a decade by alternative voices in the BPS, particularly those emphasising underreported child sexual abuse and its consequences for adult mental health. 

O’Connor and Morrison Coulthard had a clear vested interest in closing down a much-needed review of the evidence, which note had been agreed publicly and on the record on March 26th 2018, under the watch of the then President Nicola Gale. While public inquiries into child sexual abuse have now published their findings in the Australia and are being released episodically in the UK, the only advice available from the BPS is the 2008/2010 report (now archived). It has a narrow focus on false positive decision making based on closed system methodology and its challenge of extrapolation to open systems. For now, the BPS has permitted no reflection on the public inquiries, the social epidemiology of underreported child abuse, the tendency of sex offenders to glibly deny wrongdoing from private scenarios of the past or the evidence on trauma and dissociation (Pilgrim, 2018; Children’s Commissioner’s Report, 2016). 

This suppression of the production of an agreed new review on this matter of grave public interest is an absolute disgrace. It is (yet) another betrayal of democracy and transparency, to add to the many others we have documented on this blog. What chance the success of the ‘New Strategic Framework’, with these inherited mendacious cultural norms? If, in the future, the BPS is to regain a sense of honourable self-possession as a charity, a membership organisation and a truly learned Society, then people will surely be rewarded for their short-term, not long-term, contributions. Why is hanging around year on year, or being recycled in different leadership roles to exclude new voices, a badge of honour and not of shame in a membership organisation? 

The oligarchy may now be disintegrating by sheer dint of the years passing. This creates the space for a new ethos and for considered reflection on this cultural inertia and its ethically dubious norms of self-perpetuated authority.  After the police, lawyers and Charity Commission have done their work in the coming months, then the BPS still has a fighting chance to regain its credibility and become a learning organisation. 

New people with integrity will be needed for this optimistic scenario. The stitched up and scandalously disparaged ex-President Elect could be their role model. Trustees need to be truly independent to displace the current sham of a Board. The SMT must be accountable to the Board and not dictate to it. Financial matters must be transparent at all times to the Board. The membership must be kept informed, not in the dark. Censorship should have no place in a learned organisation. 

Food for thought indeed for the incoming Presidential duo. I do not envy them their considerable challenge.

References

British Psychological Society (2008/2010) Guidelines on Memory and the Law Recommendations from the Scientific Study of Human Memory.  Leicester: British Psychological Society.

Children’s Commissioner’s Report (2016) Barnahus: Improving The Response to Child Sex Abuse in England London: UK Children’s Commissioner’s Office 

Dalingwater, D. (2014) Post-New Public Management (NPM) and the Reconfiguration of Health Services in England. Observatoire de la Société Britannique, 16, 51-64.

Department of Health (2000) An Organisation With A Memory: Report of an Expert Group on Learning from Adverse Events in the NHS London: Stationery Office.

McPherson, M. Smith-Lovin, L. and Cook, J.M. (2001) Birds of a feather: homophily in social networks. Annual Review of Sociology 27, 1, 415–444. 

Pilgrim, D. (2018) Child Sexual Abuse: Moral Panic or State of Denial? London: Routledge.

Pilgrim, D. and Sheaff, R. (2006) Can learning organisations survive in the newer NHS? Implementation Science 1, 27, 1-11.

Ryle, G. (1949) The Concept of Mind London: Hutchinson.

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THE BPS AND THE FOURTH ESTATE

Re-posting from BPSWatch

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David Pilgrim posts…

Today the relationship between the cabal running the BPS and the press reflects the governance crisis now evident to us all. When it is ‘business as usual’ then the press office of any organisation simply scans for opportunities to maintain a positive public profile and promote its wares. However, the business as usual in the BPS in recent times has been, to say the least, problematic given the evidence of misgovernance and corruption.

Misgovernance in the BPS probably can be traced back to 1988, when the version of Board of Trustees adopted was a sham of a democratic structure, which had an inbuilt lack of independent oversight. By the turn of this century, corruption crept into the culture. In the past few years both misgovernance and corruption have interplayed. Slowly those outside of the current cabal, which is seeking in a rear-guard action to deny this historical reality or mitigate its personal damage for Trustees, are wising up. That critical scrutiny has come from a range of parties. 

The first wave of protest came from disparate members who encountered a broken complaints procedure and a rubber wall of resistance from the centre of the organisation. Some individual members left in disgusted exasperation. Some acted collectively to set up an alternative organisation (the Association of Clinical Psychologists). The second wave came from a reforming President-Elect, who was immediately marginalised, kept in the dark and then expelled in a show trial. In a continuing travesty of justice, he is now the victim of a biased mock appeal process. The third wave came from the Charity Commission in its ongoing attempts to bring the Society into legal and regulatory compliance. The fourth form of critical scrutiny came from the police, with their ongoing inquiries into acts of alleged criminality. 

Earlier pieces on the blog have dealt with this challenging scenario, which is  now a matter of verifiable fact. That grim reality is the context for Trustees jumping ship or clinging to the wreckage. It is also the grim reality, to be examined in bemusement and disappointment, for ordinary members waking up to the mess. Finally, the ‘fourth estate’ has now begun to play its part in reporting aspects of all of the above. 

Impression management during times of crisis

Press officers and advertising executives have a shared concern for what Erving Goffman called ‘impression management’ in relation to the self-presentation of individuals. It was extended by others to political and organisational information control (Peck and Hogue, 2018). How do these gatekeepers of impressions promote good news to advance the interests of their organisation and their current leadership and silence bad news? In the latter regard, in the common parlance of a new management class, with an eye to the training manual of the satire The Thick of It, how do they ensure ‘damage limitation’? 

Given the current crisis in the BPS, a number of tactics have been deployed in relation to the above waves of critical scrutiny. This is what has happened in each case. First, they ignored complaints from members or used the complaints sub-system as a rabbit hole. To reinforce this Kafkaesque obfuscation at the individual level, the whole membership was kept in the dark about what was going so badly wrong. The silence in the pages of The Psychologist (‘the magazine of the BPS’) limited the prospect of membership curiosity. Memos were sent to office holders discouraging frank and open discussion. Here is an example of one sent by a Trustee on behalf of their Board to office holders in sub-systems in December 2020:

Dear all, We are aware that questions are being raised by yourselves and by your colleagues. We are able to share the following BPS statement with you, which we have received today: 

“We are aware of unhelpful speculation and inaccurate information circulating on social media about a confidential staff issue at the society. This relates to a review about internal procedures within the society.  As some of the information that has been shared online is incorrect and potentially defamatory, we have written to the authors of these statements and they have agreed to remove them from their blog and twitter account. As we are sure you will understand, and as the review is ongoing, we have a responsibility to maintain confidentiality and we are unable to comment on this issue further.

We would also like to correct misleading information that states the society is being investigated by the Charity Commission. We are not aware that the Charity Commission has opened an investigation. We take our legal responsibilities as a charity seriously and would always inform our oversight bodies of any relevant issues affecting the society. Several months ago we responded to requests for information from the Charity Commission but we have not received any notification of concerns to date. We would like to assure members that the society continues to operate as normal.”

We hope this is helpful. The statement can be shared with committee members if they are raising questions. Questions can also be directed to the BPS communications team.”

This is a dream memo for those interested in critical discourse analysis. Apart from the overall sub-text, which is ‘please stop asking awkward questions or discussing matters we would rather not talk about’, it is rife with silences about authorial responsibility. If the speculation has been unhelpful then unhelpful to whom and why? If the information is inaccurate then what is the accurate information? Outside of the quotation marks, what does the word ‘we’ refer to? Inside the quotation marks what does the word ‘we’ refer to? Is that the same ‘we’ or a different ‘we’ and how would an ordinary member know the difference? Who exactly is ‘the BPS’? 

Turning to the assurance at the end about the role of the BPS communication team, do they have a vested interest in what is said and what is not said? Were individual members of the BPS communication team implicated in the moves to expel the President Elect or not? Did they confect the ill-advised video on YouTube, disparaging the expelled President Elect in advance of his appeal or not? Have they supported acts of censorship in the Society, thus betraying academic freedom or not? Have they been implicated in controlling what is said, and not said, to the press about concerns of misgovernance and corruption, which now has triggered more than one criminal investigation?

Answering the last question, journalists have been kept at bay with a range of tactics, including threatening them with legal action. There is a difficulty though with impression management when the context is one of dire dysfunction (the current actuality at the centre of the BPS). In a liberal democracy, secrecy in organisations and hostile refusals when approached by the press will tend to further encourage the curiosity of journalists. Not only are they used to evasions (they are experts themselves in impression management), they also are part of highly financed organisations with dedicated legal departments. 

This is especially applicable to The Times and the Daily Telegraph (the largest broadsheet circulation in the UK). David Brown at the former and Hayley Dixon at the latter have run stories which expose the current BPS dysfunction. Stephen Delahunty in the niche online magazine Third Sector has also played his part in exposing current problems in the Society. I understand that soon more will come on board with this scrutiny from the mainstream mass media. Journalists, like writers on this blog, are not going away and the cabal now have that new headache. 

It is one thing for members to be threatened with ‘cease and desist notices’ from the BPS (as applied to this blog in its early days), it is quite another to expect the same tactic to be successful with seasoned journalists and their supportive employers.  The futility of the current BPS tactic is borne of two problems for its communications team. First, newspapers, with the confidence of legal backing, will both investigate rigorously and publish confidently. Second, journalists will take more, not less, interest in the story if they meet evasions or threats from the target of their interest. 

The BPS as a medium-sized charity can eschew internal scrutiny from its members by using threats and evasions or expelling whistle blowers (see above). However, the press will not be cowed so easily. This leaves the BPS communication team with limited options. They can refuse to put journalists in touch with personnel (staff or non-employed volunteers from the membership) and they might defend a position as being reasonable and so not requiring undue scrutiny. They might simply refuse to comment – the preferred tactic, inter alia, of the defensive police suspect or the aloof government department. Here we do find a consistent line of reasoning: whether critics are internal from the membership or external from journalists, a ‘problem what problem?’ approach has become a sort of magical thinking from ‘the BPS’. 

However, members are not stupid (their IQs tend to be well into triple figures) and journalists are certainly not biddable dupes. The waffle in the memo above implies that critics are misrepresenting the truth – what, according to the Trustees, is the truth then? Was the CEO suspended or not? Was there a large fraud being investigated by the police or not? Did the Finance Director leave for employment elsewhere or not while he was under investigation? The distinction between the verifiable material facts, which should be disclosed transparently in the public interest, and the details of any process legitimately warranting confidentiality, in order to protect the fair treatment of individuals, is clear and readily made. 

What the cabal has done regularly recently is elide legitimate confidentiality and self-interested secrecy [see here].  The exact reasons for this secrecy will no doubt come out, in details to be eventually disclosed in court proceedings and any future employment tribunal hearings. At this stage, I can only speculate that the need to shroud the misgovernance in mystification and evasions is that Trustees, past and present, are now fearfully and fully aware of their legacy liability. The Trustees have been party to a lack of oversight about a number of serious matters over a period of time and they know this to be a fact. 

This scenario was evidenced in the concerns expressed by the resigning Deputy President David Murphy, earlier this year, when making vague allusions on Twitter to his concerns about governance and finance. However, note that he too has not given a full and frank elaboration to the membership of the governance wreckage he was now swimming away from. He knows far more than he is saying publicly. 

Secrecy, denials, deflections and evasions, embodied in the strategic ‘problem what problem?’ approach adopted in the communications team’s efforts at impression management, are our starting points for an empirical description of this case study of a dysfunctional organisation. These psycho-social processes have become an irrational collective defence for the cabal against future reckonings. In truth, judgment day will come eventually for those who have resigned, not just for thus who remained. In the eventual history of the BPS, these people will not have covered themselves in glory, to put it charitably. Resignations provide no protection, legally, from legacy liability.

An example of this point, which is already evident, is that to date, with the exception of the expelled President Elect, who repeatedly asked for accountability (and was punished for his efforts), the Trustees have provided no explanation to the membership of the financial cost of misgovernance. If they demanded accountability in this regard, then where might the members read the relevant reports?  Remember members have paid for all these shenanigans and yet the BPS continues to claim hypocritically to value transparency. Basically, the Trustees did not ask for, and so cannot provide the membership with, an account of how much money has been lost to the Society. 

The fraud is one aspect of this scenario, but so too is the Machiavellian spectacle of the Trustees wilfully using Society funds to seek expert legal rationalisations to punish and disparage the one man who blew the whistle on what was going wrong. And then there is the lack of a coherent and transparent business case for the organisational change programme, with its cool £6 million price tag. The press will probably take an avid interest in this and other matters in the near future. For journalists, money is one thing to reflect on, but so is policy distortion.

A Recent Case Study

On this blog we have highlighted that policy capture has occurred in the BPS from partisan interest groups, including the closure of the memory and law group to exclude the evidence of under-reported child abuse and its implications for adult mental health. Another example of ideological capture relates to some gender-affirmative activists driving BPS policy statements about the extension of prescribing rights for psychologists (a Trojan horse for some enthusiasts to prescribe hormones), the controversial gender document (British Psychological Society, 2019) and the manipulation of wording in the Memorandum of Understanding on conversion therapy. 

The latter document shifted from a non-controversial version in 2015, focusing only on homosexuality, to one in which gender identity was bolted on. Logically, sexuality and gender identity are quite separate matters and so should not be conflated in policies. However, that is precisely what activists, including representatives from the BPS, did in their re-writing of the document between 2015 and 2017 [see here and here].

This is a controversial matter, as the difficulties at the GIDS service of the Tavistock Centre have highlighted, with many psychologists who worked there leaving with serious concerns about the ideological capture of service philosophy. The lack of evidence of efficacy for the latter was at the centre of the judicial review, which emerged in December 2020. Despite this clear division within the psychological community about best practice, when responding (or not) to gender non-conformity, in society, the BPS is now linked in its policies to only one side of the argument. This leaves many therapists fearful about exploring options that are not based on routine gender affirmation and referral on for biomedical transition. This story of professional division was then picked up by the press.

A piece from Hayley Dixon in the Daily Telegraph appeared on July 8th 2021, about the clinical freedom of psychological practitioners. The group Thoughtful Therapists recently successfully lobbied the government to proceed with caution and protect clinical freedom about intervention options. Dixon goes on in her piece (cited in full here):

‘They called on ministers “not to criminalise essential, explorative therapy” and warned that there had been a “worrying number of young people de-transitioning and regretting medical treatment”. After the petition reached 10,000 signatures, the Government Equalities Office responded and said that they would ensure the ban on the “abhorrent practice” of conversion therapy does not have “unintended consequences”. “We will protect free speech, uphold the individual freedoms we all hold dear and protect under-18s from irreversible decisions”, the department promised.

“We will ensure parents, teachers and medical professionals are able to safeguard young people from inappropriate interventions and are clear that this ban must not impact on the independence and confidence of clinicians to support those who may be experiencing gender dysphoria.”

They will be holding a consultation to work out the specifics of the new law in the coming months.

But there are fears that even if clinicians are protected under the ban, their work could be impacted by a memorandum of understanding on conversion therapy which has been signed by all the major health, counselling and psychotherapy organisations in the UK.  

Little is known about the Coalition Against Conversion Therapy, which is the steering group for the memorandum, and it has not been revealed whether the document, which is due for review this month, will be looked at again.

The current 2017 document, which included “gender identity” in the definition of conversion therapy for the first time, was written with support of the controversial LGBT charity Stonewall.

The guidelines have widely been interpreted as proposing an affirmative approach and have led to psychotherapists saying that they avoid questioning children as young as six who come to them claiming they wanted to transition.

The Thoughtful Therapists have attempted to contact the signatories – including the NHS, the Royal College of GPs and the UK Council for Psychotherapy – asking to discuss the guidelines as they govern their work with a “vulnerable group of young people with many unknowns and an extremely poor evidence base for significant medical interventions”.

But they have not received a response from any of the members after Dr Igi Moon, chairman of the memorandum and the lead on the document for the British Psychological Society, asked her colleagues “not respond” to the email chain.

Dr Moon, who uses the pronouns they/them and is involved in trans activism, describes those with gender critical views as “terfs”, commonly defined as a feminist who excludes the rights of transgender women from their advocacy of women’s rights, and says that binary gender is inherited “from colonialism”.

In one debate Trans Liberation: What are our demands?, organised by Momentum activists, Dr Moon demanded that more hormones are made available and that GPs offer bridging hormones to those awaiting treatment.

Telling campaigners to lobby the Government, they said that there are “thousands of people who are not receiving treatment” and if it was any other condition that was “killing people” it would be getting more attention because “as we can see from Coronavirus, there are ways to fund health care”. Dr Moon added: “I am not prepared to stand back and watch my community die. It’s not going to happen, not again.” 

A spokesman for Thoughtful Therapists said that they are concerned as the document “seemingly mandates an affirmation-only approach to working with gender dysphoria”.

They added: “We are particularly concerned with the lack of transparency by the Coalition governing the document and its chairman Dr Igi Moon, who on numerous occasions has refused to engage with our professional concerns regarding treatment for gender dysphoria and has instructed signatory organisations not to speak to us. For such an important clinical issue, this stonewalling is shocking.”

Dr Moon and the British Psychological Society failed to respond to a request for comment.’(emphasis added, end cited article)

Note then that on a matter of serious public concern, with empirical claims being made about people being killed unless a particular form of healthcare philosophy is imposed monolithically on the British population, via the NHS, those making the claims refuse point blank to comment to the press or professional colleagues. The BPS refuses to offer a view, tacitly therefore supporting the current policy formation shaped by gender activists. 

Whatever position a reader may take on this topic (which will vary in a community of scholars and practitioners, mirroring their host society divided on the matter), behind this evasion from the BPS is the recurrent failure of governance in relation to policy formation. I would apply this critical claim to policies that I actually agree with, and even have been party to developing, including, for example, the BPS documents on psychosis (https://www.bps.org.uk/what-psychology/understanding-psychosis-and-schizophrenia), as well as the Power Threat Meaning Framework (Johnstone and Boyle, 2018). 

The point here is that if the BPS were functioning properly as a learned society, which routinely set up in advance proper terms of references about any policy and ensured all voices in the Society were then heard, then post hoc protests would be pre-empted, and wasteful publicly enacted divisions avoided. A learned society should be open and transparent about considering evidence, forms of inference and value positions from all parts of the membership academic and applied

However, as both the law and memory debacle and the example just given demonstrate, this inclusive and scholarly approach to policy deliberation, formation and eventual recommendation are not ensured. They are not ensured because the BPS is not a well governed organisation. To make matters worse, a culture of impression management celebrated by those who have no academic background or experience in the values of psychology, as a discipline, now dominates the BPS in the wake of a management coup. 

The press may well continue to play their part in alerting us to what is happening in relation to matters of finance and policy. One thing is certain: that sort of reportage will not be forthcoming from the cabal, nor will it be elaborated in the pages of The Psychologist. The BPS communication team will make that outcome a strategic priority. Meanwhile the world, including journalists, looks on to an organisation that claims to be both transparent and learned. The reader can make their own mind up. But to do so they need access to the story of what has really gone on in the BPS, since the turn of this century. 

This blog and curious journalists will keep fleshing out this story. Historians of the Society and the state of British psychology are now beginning their work. A future empirical sign of integrity and probity in the BPS, if it survives as a charity and credible learned organisation, will be that such historical accounts are published not censored. We should be grateful for the role of a free press in helping secure that preferred outcome.

British Psychological Society (2019) Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity Leicester: British Psychological Society.

Johnstone, L. and Boyle, M. with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J. (2018) The Power Threat Meaning Framework: Towards the Identification of Patterns in Emotional Distress, Unusual Experiences and Troubled or Troubling Behaviour Leicester: British Psychological Society. 

Peck, J. A. and Hogue, M. (2018). Acting with the best of intentions… or not: a typology and model of impression management in leadershipThe Leadership Quarterly29 (1): 123–134.

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Little Englander

Seriously?? – colleagues at BPSWatch tell how that stalwart of fairness and decency, the British Psychological Society, has blocked BPSWatch on twitter.

Tempted though it must be to do likewise, the British Psychological Society hasn’t yet blocked me. It’s only a matter of time because the BPS is sensitive to criticism. Calls for transparency are labelled as ‘bullying’ or ‘abuse’. Telling the truth as we see it is not something the Society appreciates in its members. Fair comment is not appreciated.

What a shambles!

The Society membership is being intimidated by threats, coerced into silence. ‘Pay your fees and shut up’ is the order of the day. Doing or saying anything towards improving the chaotic situation that currently reigns is made almost impossible. Look what happened to the BPS President-Elect, Professor Nigel MacLennan. A man with a mission to make changes, Nigel MacLennan was accused of bullying and summarily dismissed from the Society. A new election is being held, and only a few ‘tame’ members are permitted to stand as candidates. The whole situation is a joke. The BPS is a laughing stock, lacking any credibility as a profession, all bases destroyed.

Dr. Jon Sutton tweets in support of the English football team

The Little Englander mentality of The Psychologist has never been more apparent. Other excellent BRITISH teams of Scotland and Wales at EURO 2020 are not seen as worthy of the BRITISH Psychological Society’s support as England. How more cringeworthy could it get?

The Psychologist tweet is a deafening clanger.

Yet the editor maintains his position. No apology or deletion is offered, Editor Sutton soldiers on, Little Englander to the core. Any non-English BPS member could be appalled and people have already said that they are.

Looking at the bigger picture, one more appalling aspect is the Psychologist’s failure – Jon Sutton’s failure – to ever mention, between the magazine covers, the gross mismanagement, mis-governance and misfeasance within the organisation the Psychologist magazine purports to represent.

The analogy I draw is Nero fiddling while Rome burns.

Nero Fiddling

My response to Dr. Sutton is here together with the BPS response. I speak of ‘popularism’ and ‘a ragbag of a magazine’, both fair comment in my estimation. The BPS calls my tweet ‘personal abuse’ and states: “We’ve received complaints from BPS members that they have found your tweet offensive”. Not Jon Sutton’s tweet, that’s OK, but my tweet which calls out the BPS.

And who exactly is the “We” in “We’ve received complaints from BPS members”? It remains uncertain.

If I make one correction, it would be that it is inappropriate to refer to Dr. Sutton as ‘Nero’. Sutton is not Nero, he’s Nero’s fiddler. Dr Sutton doesn’t call the tune, he plays the tune called by his managers. He is Nero’s fiddler. I can feel empathy for him but his role is largely his own making. If you don’t wish to play the fiddle, don’t pick it up, because if you can’t play well, you won’t please the audience. It might be cringeworthy – and it is. I wrote Dr. Sutton a sympathetic email. In his replies, he played victim and so I won’t give further details to save his blushes.

Sympathetic Email and Retort

The inevitable message came back unsigned. I am seeking the identity of the person(s) claiming to represent the BPS. Who is the ‘we’ behind the implied accusation that I am not operating lawfully. Which law do they think that I have broken? Who is the mystery writer signing off with ” Regards etc”?

Hello Whoever You Are

Blocked!

Twenty-four hours later, no response had been forthcoming. Then the inevitable: my twitter account was blocked by The Psychologist @psychmag.

Conclusion

Only say ‘nice’ things to The Psychologist Editor. Fair comment and honest criticism are called ‘shrill’, ‘condescending’, ‘abusive’, or ‘offensive’.

But always remember, Dr Sutton is only the fiddler, he’s not Nero.

So who is Nero? Nobody knows and nobody’s saying. Presumably Nero is living well on your subs and mine. The time is long overdue for Nero to reveal themselves.

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Seriously??

A couple of recent posts from BPSWatch

AdminBPSWatch

Peter Harvey writes…

We are told every month that our house journal, The Psychologist, aims to fulfil the main object of the Royal Charter, “…to promote the advancement and diffusion of a knowledge of psychology pure and applied.” . I assume that the same laudable and worthy aim applies to its various manifestations on social media. So can someone please explain to me, simply and in words of one syllable, why the following tweet appeared this week…

Apart from the fact that we are the BRITISH Psychological Society (I am not sure how our Scottish, Welsh and Northern Irish colleagues feel about such partisan statements), I cannot for the life of me see how football punditry and simplistic sporting ‘patriotism’ has now become part and parcel of the function of the BPS (I would remind you this is an official BPS outlet). This doesn’t even have the dubious distinction of being a sort of virtue signalling (something that is increasing apparent in some of the BPS social media posts). 

This says nothing about the psychology of sport (about which our sports psychology colleagues may well have something helpful to say), of group identity (ditto for our social psychology colleagues), how mass gatherings might impact on the spread of COVID (ditto our health psychology colleagues) – I will not go on.

This is trivial nonsense, juvenile and unworthy of a society that purports to be the serious face of British psychology. 1 CommentGOVERNANCE

Fear and loathing in the BPS

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David Pilgrim writes…..

On this blog we have rarely attacked individuals, mainly to avoid the inconvenience of libel claims. We would have had a ready fair comment defence, given that we have clear evidence of the actions or inactions of named actors. However, there is another reason to keep our eye on the bigger picture, beyond being cautious about moral attributions in relation to particular people. We have noted the structural problem of the Board of Trustees totally lacking independence and so being disabled from ensuring proper oversight. Even individual Trustees acting in good faith cannot be impartial at present. Also, the problems of managerialism are not limited to recent times but started gradually with the first CEO appointed in 2002. The circumstances of his rapid departure under a cloud were, to say the least, suspicious. They warrant a proper historical investigation, when the time is right.

Today, the overloaded and cautious Charity Commission, still engaged with the cabal trying to negotiate legal and regulatory compliance, could have already brought the BPS into a form of special measures as a failing organisation. This could still happen, but the regulatory weakness of the Commission is part of the story. Then there is the police investigation into both fraud and arson. These pose challenges for us and for journalists under sub judice constraints. This point also applies to the ethical and legal aspects of the show trial of Nigel MacLennan. Another contextualising consideration is the wider political zeitgeist. 

Norms of weak democracy and public passivity

Power play in civil society today reflects recent norms of amoral instrumentality: the powerful frequently do what they like with impunity. They do what they need to do to in order to defend the status quo, save their own skins and evade accountability. The ‘you do you’ mantra of a generation socialised into individualism, within a regime of neoliberalism, has led to political disengagement more widely and this infects the moral order of our current civil society. 

Many of us are now in a state of learned helplessness about shameless politicians and the management class above us, within bureaucracies, private, public or third sector. This ‘whatever it takes to survive’ normative position from the powerful, along with the ‘what is the point in trying to hold them accountable?’ response from below, is not limited to the BPS. 

For example, those working in higher education may be aware of the case of Professor Jane Hutton who was expelled as a UCU-nominated Trustee of USS. (See https://medium.com/ussbriefs/the-insider-jane-hutton-and-uss-d350ba5457ae)  As with Nigel MacLennan, there was no evidence that she was seeking personal gain from her actions but instead was acting in good faith on behalf of members. What they had in common was their persistence in asking necessary questions about governance. In both cases, a self-interested cabal spent much time, and large amounts of members’ money, in order to expel the critic, rather than dealing with the content of their concerns. Cabals enjoy the fruits of their misgovernance and those asking awkward questions may be punished and often they are. After all, shooting the messenger is a lazy option that often works. After her expulsion from the board of USS, it soon became clear that Hutton was vindicated in her analysis of the shambles in the organisation. 

I hope that Nigel MacLennan soon has the same moral victory after his public disparagement. The early signs of his vindication are good. He was the one person constantly reminding the Board of Trustees of the need for legal and regulatory compliance, being demanded quite properly by a frustrated Charity Commission. He was the one that pointed up the responsibilities of oversight held by the Trustees in general, but also specifically in relation to the unfolding story of the fraud being investigated by the police. He was the one who objected to the suppression of information about the damning NCVO report (see below). At all times he acted with integrity. For his efforts the cabal put him on a show trial and expelled him. They will now delay his appeal until the (illegitimate) election ensures his replacement. The cabal will be hoping that their insider candidate is victorious; we shall see.   

Whether MacLennan is vindicated or not, there are lessons that we can take from how other organisations treat legitimate challenges to the status quo.

Lesson One: self-serving and even corrupt leaders in charities can survive for many years. 

Lesson Two: structurally, leaders of a dysfunctional organization can adapt in various states of reform (actual or rhetorical). In the case of the BPS, the cabal will respond as slowly as it can to the demands being made by the Charity Commission about regulatory compliance. They will defer MacLennan’s appeal long enough to complete his political deletion. 

Lesson Three: individual cabal members will move on to new jobs, maybe even with profitable non-disclosure pay offs. Some members of the Senior Management Team have already bailed out in the past year (with one under investigation at the time). Ordinary members are as clueless today as they were a year ago about how and when the investigation of the CEO will be resolved. Indeed, some members are only just waking up to this simple fact, in light of the complicit silence of The Psychologist

Lesson Four: the short-term survival of careerist managers may or may not be aligned with long term the higher order values of the BPS.  I may have been a member of the BPS for forty years but the here-today-gone-tomorrow members of the Senior Management Team are calling the shots and shaping the future. From football club managers to university VCs and NHS CEOs, we now routinely recognise this pattern of opulent high turnover. This accounts for why, although the BPS website makes claims about transparency and being a learned society, in practice the cabal indulge in information suppression.

Janus-faced professionalism in the charity sector

Most political scandals are about narcissism, power, money or sex (or some permutation). Critics of charities have confirmed this pattern, and this has been at its most obvious in the ‘just giving’ wing. Scandals in Oxfam and Save The Children exemplify this point (See (https://www.gov.uk/government/news/charity-commission-reports-on-inquiry-into-oxfam-gb-no-charity-is-more-important-than-the-people-it-serves-or-the-mission-it-pursues; (https://www.savethechildren.org.uk/news/media-centre/press-releases/save-the-children-response-to-charity-commission-report). 

In the case of quasi-public bodies like the BPS, which have charitable status, there is another dimension needed for our analysis. This is whether professionals are role models for personal integrity and their knowledge is generated unambiguously for the public good. The take-for-granted assumption about the beneficent and socially integrative role of professionals in modernity was promoted by the sociologist Emile Durkheim. However, his conservative and uncritical stance was challenged by Max Weber, who favoured scepticism (Saks, 2010). He saw professionals as being Janus-faced; working for others often but also readily switching to advancing their own narrow interests (cognitive or economic), when and if this was required. This entails sustained political energy to dominate others inside a profession, alongside it (competitors) and outside it, with the public or client groups being the first target for domination.  I return below to Weber and the BPS. 

The legitimation crisis of the charity sector is reflected in its own current soul searching. Stuart Etherington of the National Council for Voluntary Organisations (NCVO) has offered us a critical fundraising review and the use of data by charities has been scrutinised by the Information Commissioner’s Office. Similar doubt casting can also be found in the Public Accounts Committee about the misuse of funds. The level of cynicism about the self-interest of charities is evident in the work of David Craig and his website snoutsinthetrough.com (Craig 2014).

Etherington’s NCVO is of direct relevance to us. It was his organisation that refused to work with the BPS because of its unsafe culture for its own employees. An irony, which has not been lost on journalists, is that a psychological Society has been dubbed psycho-toxic by those sampling its wares. 

Persecuting the righteous

If those asking awkward but fair questions like Hutton and MacLennan are punished, then most ordinary mortals will, quite understandably, keep their heads down and their mouths shut. A few years ago, a colleague had a cartoon on his pin board over his desk, reminding me of this normal diffidence, born of fear. It was in four boxes. Box 1-mother in a restaurant asks her two kids what they want. Box 2-the first kid says, ‘I’ll have the fucking pizza’. Box 3-mother clips the kid around the ear as a punishment. Box 4: (mother to second kid) ‘And what do you want?’ Second kid replies: ‘Definitely not the fucking pizza’.

Whether our metaphor is a ‘poisoned chalice’ about incoming Presidents or a ‘fucking pizza’ for the mystified and anxious ordinary member, the point is clear. Complicit silence will tend to protect the timid and enable the powerful to sit pretty, while fortune may not favour the brave when they try to bring truth to power. Cabals operate successfully at times through their capacity for conscious and deliberate intimidation. They also create an unconscious miasma of dread because we have a primitive need to believe in the protective power of parental structures (Menzies, 1975). The persecutors of Hutton and MacLennan could rely on the silent complicity from the majority, because the history of whistleblowing is one of critics suffering detriment, both financially and emotionally. 

This is where sociological insights are relevant again. Weberian sociologists, as well as being critical of the power play antics of professionals, also respond to the question ‘do organisations have feelings?’, demonstrating that psychologists do not have a monopoly on exploring affect (Albrow, 1997). The answer to the question, as we all know, is that they do. Organisational cultures have an affective dimension and sometimes departments, or even buildings, can feel warm and cosy or chillingly sinister and all stops in between. The NCVO report indicated where the organisational culture of the BPS resides on this spectrum. 

When will we ever learn?

The learning points from the above sketch are as follows. 

  • First, we should expect those in power to act in their own self-interest. 
  • Second, they may use a mixture of secrecy and emotional pressure to ensure compliance with their goals. If needs be, whistle blowers will be persecuted and expelled. 
  • Third, those with less power will be limited in their understanding of actual events and processes, compared to the cabal in control at the centre. 
  • Fourth, the less powerful will anxiously err on the side of caution, when expressing doubts or criticisms about their organisation; they keep their heads down and their mouths shut. Alternatively, they may retain a naïve faith in their concerns being taken seriously by appealing for truth and justice from the very people who are in power over them. They may be sorely disappointed. 
  • Fifth, some in power may leave, out of fear, if the game is up about their complicit role in misgovernance. If they are employees, they will try to switch employers. If they are volunteers (such as Trustees), a mixture of guilt, fear and denial may well persist about their legacy liability. 

On this blog we have drawn these conclusions about the BPS by collating and observing evidence about a range of players and their conduct, without naming them. In their case, we can say to them, ‘if the cap fits wear it’.  

An implication of the above emotional field is that transparency and democracy will be constrained or eliminated in the organisation. When secrecy is a priority, the cabal turn that into the faux virtue of confidentiality and (amongst other tactics) set about redacting their own minutes. They want pretence to triumph over honesty, and members to be kept in the dark. This mendacity is less likely if the executive wing of the organisation fails to capture control of the Board of Trustees and if the latter is truly independent. The BPS can still survive but, as a logical precondition, the current cabal and its carpetbaggers and beneficiaries will need to depart. If they stay, the organisational agony will continue and amplify. The cabal, not we as its critics, are bringing the BPS into disrepute and wrecking its future prospects. We, like the expelled President Elect, are asking legitimate questions and so supporting, not jeopardising, the survival of the BPS.  We have explored all of these points in previous entries to the blog and will continue to do so.  Given the evidence we have, we could write a book. That is what we are now doing, and it will be published later this year.  

Albrow, M. (1997) Do Organizations Have Feelings?  London: Routledge

Craig, D. (2014) The Great Charity Scandal London: Original Book Company

Menzies, I.E.P. (1975). A case study in the functioning of social systems as a defense against anxiety. In A.D. Colman & W.H. Bexton (Eds), Group Relations Reader 1 Jupiter, FL: A.K. Rice Institute.

Saks, M (2010) Analyzing the professions: The case for the neo-Weberian approach. Comparative Sociology 9(6): 887–915.Leave a comment

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Perceptual Control Theory

In this post, I review a single excerpt from page 1 of the above book. The entire book is freely available online. On the basis of page 1, William T Powers’ ‘Perceptual Control Theory’ (PCT) cannot be correct. Dag Forssell explains the provenance of this piece as follows:

I have annotated the text to indicate my initial thoughts:

’10 Minutes’ from Forssell, 2016, p. 1.

I cannot believe William Powers could have been serious in writing these words. If so, he was a seriously deluded man. Note the following, manifestly untrue assertions:

It (PCT) explains why one organism cannot control another without physical violence. There is a long list of counter-examples: honey bees, murmuration, bird song, classroom teaching, coaching, managing, leadership, being a guru, altruism, pacifism, non-violent protest, laws, the justice system, social cohesion, sports such as cricket, tennis and baseball, international treaties, the European Union, etc.

It explains why people deprived of any minor part of their ability to control soon become disfunctional (sic), lose interest in life, pine away and die. Steven Hawking, people with sensory impairments, pw motor impairments, people living in torture or concentration camps, the vast majority of people living without enough food, water or money, patients with cancer or other fatal illnesses, patients infected with the SARS-CoV-2 pandemic, the list goes on and on.

It explains why it is so hard for groups of people to work together even on something they all agree is important. Another very long list of counter-examples: scientific discoveries, e.g. the Double Helix, the Curies – radiation, the war effort in WWI and WWII, space travel, the First Person on the Moon, July 20, 1969, the International Space Station, the production of SARS-CoV-2 vaccines in less than one year 2020-1, etc, etc.

What planet was William T Powers living on?

I had read the first couple of chapters of one Powers’ books on PCT a few decades ago and found it unconvincing.

Recently I received a recommendation from a proponent of the approach and had been looking forward to taking another look at PCT. Sadly, my initial reaction to page 1 is disappointment. Under normal circumstances, I would put this book down and never pick it up again. However I find the ‘guru’ status of Powers among his supporters somewhat intriguing. I note that many are engineers.

It is said that one must never judge a book by its cover. Never judge a book by what is says on page 1 either? Or what?

I will soldier on to see if Powers begins to make sense. Any graphologists out there might gain insights by looking at his handwriting.

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Science is Beautiful

Science is beautiful when it makes simple explanations of phenomena or connections between different observations. Examples include the double helix in biology and the fundamental equations of physics.

Steven Hawking

I have something beautiful to offer, not in Biology or in Physics, but in Psychology:

A General Theory of Behaviour.

It’s got harmony, synchrony and zing, and it’s closely linked to the natural world. To be perfectly honest – it’s got me a little excited.

A General Theory of Behaviour is a whole new perspective on the Science of Psychology. The focus is psychological homeostasis, a seemingly ‘magical’ principle of revolutionary significance. This new focus has the potential to unify the disparate field of Psychological Science under a single umbrella. No theory did that before, which is why I’m a little excited.

Any theory that can make novel predictions that are confirmed by data is along the right lines. The original formulation of the theory includes 20 principles and 80 empirical propositions, all receiving strong empirical support (Marks, 2018). There is also huge potential to test many more novel predictions. That is rather beautiful! Independent commentators appear to agree:

Stevan Hobfoll, Rush University Medical Centre, himself a significant theorist, states:

Marks brings exceptional insights and a driving logic to bear to navigate through many fragmented theories of behaviour that are by their nature partial and limited.  It is not that these more fragmented theories are not often important, but that we need the grander theory to hold disparate ideas together.  Marks does so convincingly and in a way that is testable, refutable, and often even entertaining.

Henderikus J. Stam, Professor of Psychology at the University of Calgary, Founder & Editor Emeritus of the leading journal, Theory & Psychology, wrote:

A General Theory of Behavior is an innovative and promising new theory that integrates the long tradition of investigations on homeostasis with contemporary research in such diverse areas as emotion, addiction and sleep. A truly original and wide-ranging study of human nature, this book will be foundational for anyone who considers the importance of theory for modern psychology.

Amedeo D’Angiulli, Department of Neuroscience, Carleton University, Ottawa, Editor-in-Chief, of the main journal for studies on the human imagination, Imagination, Cognition and Personality, wrote:

Dear Professor Marks (David if I may) I re-read your paper on Brain Sciences I Am Conscious, Therefore, I Am: Imagery, Affect, Action, and a General Theory of Behavior, in the May 2019, issue of Brain Sciences and then I discovered your book on your General Theory through it, which I read just afterwards. Both are major contributions to psychology, but they also read like classics to me. They have a guiding vision forwardCongratulations.

Janine Crosbie, Psychology Lecturer, University of Salford, commented:

This inspiring book applies the seemingly simple biological concept of homeostasis to human behaviour.  There is beautiful historic detail about key researchers, whilst considering modern issues such as stress, lack of sleep and addiction. A compelling read, which feels like an engaging lecture, by a passionate and considered speaker.

David A Holmes, Senior Lecturer in Psychology, Founder of the Forensic Research Group, Manchester, wrote:

In A General Theory of Behaviour, David Marks has applied scientifically established theory to conceptualize disparate areas of Psychology in a manner that both unifies and brings greater insight, establishing this book as a milestone text of the 21st century.

Scott Barry Kaufman, University of Pennsylvania, opined:

The field of psychology has many theories, but no General Theory. The unifying theory David Marks presents, along with the 20 principles, provide rich soil for further testing and opens up exciting avenues for psychology.

The General Theory appears to these independent experts be an inspiring milestone with a guiding vision forward. These comments are most encouraging and help to motivate me to persevere with the work. Thanks to all of the experts named above for your positive comments.

Life is short and there is a lot more work still to be done. I need many more hands on deck.

Thank you for your attention.

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The British Psychological Society

This series of posts examines the current situation of crisis that exists within the British Psychological Society (BPS). The series is a collaboration with the team at BPSWatch. I am reposting here content originally published at BPSWatch. Readers may also be interested in the posts here, here and here.

How much does the future of the BPS actually matter to you?

AdminBPSWatch

We began this blog and the associated Twitter feed because we were all extremely concerned about what we see as the misgoverance of an organisation that we gave our time and energy to over many years because we believed in what it stood for. What we have seen in recent years is an increasing distancing of those that run the BPS from its membership – as our posts and out tweets demonstrate. The recent expulsion of the President Elect exemplifies the parlous state of the BPS. 

We have had some feedback from people who are of a similar opinion to us, some of which has appeared here, and it’s helpful to know that our concerns are shared by others. We have also had many informal comments of support either applauding our efforts or telling us of similar experiences with this failing organisation. Disturbingly, we have been told of those who, after working hard on behalf of the Society, have left feeling betrayed and traumatised by their experiences. More evidence that change is needed urgently.

But, and it is a big but, we are retired from practice and at are a distance from active involvement in the BPS. Frankly, whether it survives or not will have little practical impact on our lives professionally although its demise would cause us great sadness. But its continued existence as a thriving, member-led organisation which represents the best of UK psychological thinking and practice matters, perhaps never more so than now. Over the half-century that we have been psychologists we have seen such enormous strides made in how psychological practice has grown in maturity and relevance. Psychologist of all sorts and conditions are listened to with respect and can speak with authority. When we started out it was psychiatry that was seen as the ‘go-to’ source of expertise in matters psychological – no more. Psychologists can be proud of the strides that it have made over the years. And that process is almost entirely due to those psychologists, members of the BPS by-and-large, who were willing to spend time and energy to build the discipline, the profession and the BPS. That psychology has got to where it is today is due almost entirely to the hard work – often against the odds – of those who cared deeply and passionately about their discipline. They were not professional, go-anywhere managers – they were psychologists who believed in what psychology could do.

So this is a plea to all those of you who want to be represented by an organisation of which you can be proud. An organisation that reflects and promotes psychology to the benefit of all and of which membership can be seen as badge of honour. The BPS can be this – it is clearly not this right now. Its future cannot depend on the likes of us old codgers alone. It must involve those of you who are still out there, working as psychologists, on whose future the health of a thriving BPS is dependent. It is your responsibility more than ours. 

This is a critical time for the BPS. The current ‘leadership’ is engaged in highly unprofessional actions for which they are not being held accountable. The BPS has no senior member-elected officers. The fact that the Charity Commission is heavily involved is a serious warning sign. There is a commitment of £6 million (yes, £6 million of your money) to an ill-specified and inadequately scrutinised change project. There is a £2 million loan (securitised against two BPS-owned properties) with no CFO or CEO in post to manage or oversee these vast financial commitments. 

This needs you (yes, you) to act now. Be prepared to be rebuffed and ignored or accused of harassment if you express you concerns to the current BPS officials. Write to the Charity Commission with your comments. Read and contribute to the blog. Email the blog – BPSWatch@btinternet.com. Read and forward the Tweets  – @psychsocwatchuk. Share your experience with others.

It’s your Society – and your responsibility to rescue it.

Peter Harvey2 CommentsEXPULSION OF PRESIDENT-ELECT

A challenge to the BPS narrative.

AdminBPSWatch

From the BPSWatch Editorial Collective…..

Since the inception of this blog we have had intermittent contact with the now expelled President Elect around matters of concern regarding what we believed were clearly signs of organisational misgovernance, irregularities and toxic culture at the BPS. These had been separately signposted to us individually when we had dealings with senior staff about a range of policy issues. We had become increasingly alarmed by the way we were ignored, brushed off, rebuked, and, as one of the recent threads on @psychsocwatchuk https://twitter.com/psychsocwatchuk/status/1401165572436602884?s=20  demonstrated, we had our correspondence closed down with implications, explicit or veiled, that we were harassing or bullying staff. During our exchanges with Dr. MacLennan over months, he indicated his growing belief that he would never be allowed to become President and that there were moves afoot to prevent that. Latterly he told us he was sure he would be suspended or expelled for persisting with challenging the current governance process and practice. This was, of course, his stated reason for standing to be elected. Members gave him their backing.

His appeal against expulsion remains unheard and there is another legal matter that remains sub judice so he cannot yet speak out in his own defence, despite all that has been said in print and on a Youtube video that he is a “bully”, deserving only expulsion.

We can say, without hesitation, that in the contacts the three of us have separately had with Dr. MacLennan, we have detected no signs in his manner or his expressed attitudes that he is disrespectful, aggressive or demeaning. And despite all the slights and insults he has received, he remains passionate in his commitment to making the BPS a better organisation.  All three of us have had long careers as clinical psychologists, two of us with very significant forensic experience. We do not just take things at face value when there are conflicting views and narratives about individual behaviour.

Taken in that context, and with Dr. MacLennan unable to defend himself publicly at this stage, we are publishing verbatim a communication that we received from a friend and long-term colleague and collaborator of Dr. MacLennan. We have permission of the author who is happy to be named, and of Dr. MacLennan.

Good Morning,

I have recently been following your articles about Dr MacLennan on BPS Watch and feel your concerns.

I am not a member of the BPS and feel it would be inappropriate for me to pass comment on recent events, but I am a close friend of Nigel and have been horrified at his very public vilification because this is not the Nigel I recognise. While I have my own views, I recognise that there are two sides to every story and I only have one side, but I feel that I must tell you about my relationship with him and, in a sense, to defend him.

But first, a little bit about myself. I served for 30 years as a police officer with Surrey Police. Towards the end of my career I was seconded to the National Leadership Academy for Policing at Bramshill as a Programme Director to deliver programmes on the High Potential Development Scheme and the Senior Leadership Development Programme. While I have delivered all types of Leadership programmes and consultancy services across England, Wales and Northern Ireland (and to every public service) my core programmes were Managing Finance and Resources, Media Strategy (I developed the National Police Media Strategy in conjunction with the highly respected journalist Brian Morris), and Strategic Community Relations. I retired in 2005 and was retained as a consultant until 2015.

In 2012 I became the Honorary Secretary of the British Academy of Management Special Interest Group on Corporate Governance with a special interest in ethics and, in 2013, I became an Honorary Visiting Professor at London Metropolitan University Business School. This is when I met Nigel. With him, I have delivered talks to four Advances in Leadership Conferences, been a judge and Chairman of judges at national leadership awards, and have even delivered a talk at the last BPS conference. I have also worked with Nigel on a 9 month Leadership Development Programme for BAME officers in the Metropolitan Police Service. In my opinion, his skills and talents are without doubt.

As a former police officer, I tend to view people with suspicion until I can understand their motivations and I have never doubted Nigel’s motivations. As you are probably aware, he has had a glittering career working for blue chip companies and organisations such as the Chartered Management Institute and I have found his honesty and integrity beyond reproach. What I particularly liked about him was his assertiveness – he was not afraid to tell you how it is – and this is an in-demand skill for effective leaders. I have learnt many things from Nigel and have been quite happy when he has pointed out that I am wrong and, I hasten to add, vice versa.  In my experience he has never strayed into aggressiveness – forceful yes, aggressive no. However, like me, he does struggle with obfuscation, and this can become a barrier to communication with certain people.

In short, I have always found Nigel to be competent, conscientious, a supreme coach and, above all, honest.

Kindest regards.

Graham Buchanan, BSc(Hons), NdipM, PGCE, CMgr FCMI, FRSALeave a comment“THE PSYCHOLOGIST”BOARD OF TRUSTEESEXPULSION OF PRESIDENT-ELECTGOVERNANCE

The legitimation crisis and a membership denied answers

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David Pilgrim posts….

Today, the concept of a ‘legitimation crisis’ can be applied clearly to the BPS. Although explored at length in a book with that title by Habermas (1974), many other social and political scientists have returned to the theme. This is about leadership regimes, which may notionally still retain power, but their strained credibility reflects an imminent or current breakdown in their actual authority. The cabal currently at the centre of the BPS is still in power but its credibility is in rapid decline. It lacks what Eric Fromm, in his book The Sane Society, called ‘rational authority’ and, instead, exercises power on its own terms in order to ward off the stream of criticism warranted. For Fromm this would be an expression of ‘irrational authority’.

On this blog we have been reporting the character and history of this crisis in recent months and each entry, such as this one, is a new take on an unprecedented state of affairs for the Society. The occasional flurry of criticism of rogue celebrity researchers, such as Cyril Burt (Joynson, 1988) or Hans Eysenck (Marks, 2018), barely dented the reputation of the BPS. Similarly, the spat between the Maudsley methodological behaviourists and their scorned psychodynamic colleagues from north of the Thames, in a struggle to control the Medical Section and its journal, led to a temporary closure of its business in 1958 (Pilgrim and Treacher, 1991). These small eruptions of doubt, that all was well in the BPS, pale into insignificance today. We have never seen anything like this, either in living memory or in the literature on the history of British psychology. Those past examples, looked at in the current context, are like comparing a bar room brawl with a military coup. 

In meetings of the Board of Trustees today all of the Presidential triumvirate have gone, so it contains nobody elected from the general membership. Unelected Senior Management Team members now outnumber Trustees from the sub-systems. This trend is now amplified by the Board preventing members electing a replacement for the radically reforming President Elect, after expulsion from the Society, a cue for the next main point.

The public disparagement of Nigel MacLennan

The video released, vilifying the President Elect in advance of his appeal being submitted and heard, is a complete outrage. It offends our normal understanding of natural justice and leaves the Board of Trustees, who planned its production and dissemination on YouTube, open to the charge of unethical and possibly illegal activity. Are the Trustees so determined to crush this man’s reputation that they will simply ‘do anything that it takes’? 

It is officially the position of the BPS (according to its own website for all to read) not to investigate individual members. However, does that claim fail to apply only when it is politically expedient for the interests of the incumbent leadership? Are the members seriously expected to believe that this has been anything but a ‘stitch up’ from start to finish? Was the investigation panel hand-picked by the Board of Trustees or not? How many on that panel were truly independent and without their own vested interest in the current regime of power? Were membership funds used liberally by the Board to hire legal advice in order to justify the scapegoating of a reformer, turned whistle blower? The questions go on and on. Some of them ultimately may be resolved in court but what is clear already is that Nigel MacLennan has not been treated in a fair manner, if we use everyday criteria of common sense and decency.

If the stitch up hypothesis is in doubt, look at how Carol McGuinness, in a follow-up document to that unedifying and ill-advised video, made it quite clear that even if Nigel MacLennan were to be re-instated on appeal, as a member of the Society, he would still not be permitted back to his role as the President Elect. This nothing-left-to-chance approach, reflecting the persecutory intent of the Board, sticks out like a sore thumb in this planned and vindictive attack on a man whose career has now suffered immediate detriment. 

I can find no justification for this pre-emptive strike from McGuinness, on behalf the Board, within the Statutes and Rules. Does she offer no rule-based rationale in the script she is reading because one simply does not exist? This brings us back to Fromm’s notion of ‘irrational authority’. Those in power often do and say things, simply because they can. But do we have to believe this travesty of justice? And given that under Statute 20 of the Society, the Board should have been chaired on an interim basis by MacLennan not McGuinness, is there an Alice in Wonderland feel to this whole scenario? 

We know that such a surreal quality can indeed emerge from group think, especially when it leads to scapegoating in order to create an illusion of homeostasis and harmony (Baron, 2005; Leyens et al. 2000). The warring factions of the SMT and the Trustees could take temporary comfort in a common enemy to be eliminated, but the facts of the crisis are still there, with or without the removal of MacLennan. Facts do not disappear because they are ignored conveniently by displacement activity or an ostrich stance.

Keeping the membership in the dark

If a making-the-rules-up-as-you-go-along approach to governance now characterises the workings of the cabal, then another supportive tactic has been information control. Nowhere has this been more obvious than in the silence in the pages of The Psychologist. An exception has been the printing of the statement about the expulsion of MacLennan from McGuinness (giving the BPS a free noticeboard posting without editorial comment or analysis), as well as the link to her video. No right of reply was offered to MacLennan. If this were a normal magazine it would reflect the normal rules of journalism and both sides of a story would have been offered, or at least taken into account.

However, this is not a normal magazine. For example, the political turbulence in the Society, should have warranted some commentary but none has been evident. Its inside cover reminds us every month that it is ‘…the magazine of the British Psychological Society…’. If this means that it obeys the contingent expectations of those running the BPS, then this is actually a fair and valid description. However, maybe members of the Society have broader expectations (such as it being a forum for free debate about the current legitimation crisis). Such expectations are indeed raised, conveniently, by the subsequent cover description ‘…It provides a forum for communication, discussion and controversy among all members of the Society…’. Has there been any actual sign of the latter, in practice, in the past turbulent year? Why are ordinary members still playing catch up about the financial scandal in the Society, the fat file of complaints being held by the Charity Commission and the expensive legal shenanigans to expel Nigel MacLennan?

During the crisis, the monthly column of the Chief Executive Officer suddenly disappeared without editorial comment, and we slowly became aware that he was ‘not in his office’ and his function was then taken on by his Deputy, Diane Ashby. And before the President, Hazel McLoughlin, also disappeared from the pages because she had resigned, citing family reasons, the content of her column revealed nothing to the membership of the chaos and tensions, which led to the resignation of the Vice President David Murphy. He explained on Twitter that this was because of his concerns about both governance and finance.  

However, the role of this ‘magazine’ has not gone unquestioned. For example, here is a reply to Pat Harvey from the editor (12.12.20) responding to her criticism of The Psychologist failing to provide information of legitimate concern to the BPS membership:

We are not a ‘house journal’, we are a magazine. Our responsibility is not to speak for the Society or to align with any documents it might publish; it is to provide a forum for communication, discussion and controversy among members and beyond.

This restatement of the confusing and contradictory blurb, cited earlier from the inside cover of The Psychologist, does not cease to be confusing and contradictory simply because it is robotically restated. Does the membership deserve a better journalistic service, during the current legitimation crisis of the BPS, than this sort of vacuous rhetorical gambit? The supine post-it-board role offered by The Psychologist on behalf of the current BPS leadership, reminds us of one of many of Orwell’s dire warnings about democracy: ‘Journalism is printing what someone else does not want printed. Everything else is public relations.’

The exchange between Pat Harvey and the editor of The Psychologist, Jon Sutton, did not end with the above restated confusion. She also wrote to the Chair of the Editorial Advisory Committee, Richard Stephens, starting with a complaint about the narrow and prejudicial role of The Psychologist, when being biddable and posting the offensive video. She made other criticisms of the magazine as well. This was the response she received from Stephens:

Thanks for your letter and for raising these concerns. I plan to table these for discussion at the next meeting of the Psychologist and Digest Editorial Advisory Committee on 24th June. I felt that your first raised point warranted some urgency of response so I discussed it today with our editor, Jon Sutton. Jon’s view was that while the video featuring Professor Carol McGuinness as Interim Chair of the Board of Trustee has been widely disseminated among BPS members, it is unlisted on YouTube. Given that The Psychologist has a much wider audience, Jon reflected that it’s inclusion in the piece “‘The Society is at a crossroads’” was not appropriate. On that basis the video has been removed. I will feedback in due course following our meeting on the 24th

This is a small sign of good sense and fairness from Richard Stephens, although at the time of writing the video is still available on YouTube.  Will this be the start of a period of genuine honest reflection from the Advisory Committee? Would the video have been removed had it not been for these critical questions from Pat Harvey? In my view, it seems as though those below the cabal level in the Society are very slowly waking up to the serious challenges that the legitimation crisis is posing for freedom of expression and balanced and open journalism in the future pages of The Psychologist. Elsewhere on the blog I have addressed the matter of censorship in the Society.

The ethical and legal culpability of the Trustees

The Charity Commission continues to work with the Society to bring it into ‘regulatory compliance’. This raises questions about the role of the Trustees in the recent past. How many of them (other than Nigel MacLennan), out of public interest, took their concerns about poor governance and financial irregularities to the Charity Commission or the press? 

Many resignations have been evident in recent months, including the President and Vice President. Are they now prepared to offer a full and frank account to the membership of what happened in the Board, which went so badly wrong? This could be a starting point for the ‘root and branch’ reform now required, to reverse the demise of the organisation. 

Will they admit that the conflicts of interest inherent to the current definition of a Board (which date back to a lack of specificity in the Royal Charter arrangements in 1988) have been routinely out of sync with current expectations of properly independent trustees in charities today? The current Board of Trustees is a sham because its members all have conflicts of interest and there are no outsiders from the Society to offer impartial oversight. Given the legitimation crisis, should the current Trustees at least own up to this basic fact, resign and insist on a properly constituted Board in line with Charity Commission expectations?  

And if it turns out that the negligence, or worse, of some Trustees has cost the BPS dearly, will they be held liable for these costs, as Charity Commission regulations allow? Will BPS members now seek to hold Trustees liable for the seeming losses incurred to the Society, by their apparent lack of oversight? Will that liability also extend to those who resigned but were in place during that period of apparent lack of oversight (in legal terms this is called ‘legacy liability’)?

This particular legitimation crisis, like all others, never stops posing questions for democracy. We all (not just a few pushy malcontents) need to keep asking them. The passivity in our current zeitgeist about trying to influence events around us does not have to lead to fatalism. We can still challenge the cabal and the current shambles in the BPS, as this blog and Nigel MacLennan have already demonstrated. The more of us taking up this challenge, the less likely that victimisation will be seen and the more likely that the Society will be saved from its own self-inflicted wounds. 

Baron, R. (2005). So right it’s wrong: Groupthink and the ubiquitous nature of polarized group decision making. Advances in Experimental Social Psychology. 37: 35.

Habermas, J. (1974) Legitimation Crisis Boston: Beacon Press. 

Joynson, R. B. (1989). The Burt Affair. New York: Routledge

Leyens, J. Ph., Paladino, M. P., Rodriguez, R. T., Vaes, J., Demoulin, S., Rodriguez, A. P., & Gaunt, R. (2000) The emotional side of prejudice: The attribution of secondary emotions to ingroups and outgroups. Personality and Social Psychology Review. 4, 2, 186–97.

Marks,D.F  (2019) The Hans Eysenck affair: time to correct the scientific record Journal of Health Psychology 24, 4, 409–42.

Pilgrim, D. and Treacher, A. (1991) Clinical Psychology Observed London: Routledge.3 CommentsEXPULSION OF PRESIDENT-ELECT

Questioning the Expulsion – Part 3

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Was the evidence sound?

As psychologists, from our very earliest years as bright-eyed, bushy-tailed undergraduates, we are used to dealing with evidence. We learn how to evaluate it, how to contextualise data, how to look in detail at the hypotheses, the method, the analyses. We are used to defining behavioural referents for concepts. Professional researchers carry on and refine this whilst practitioners hone their evidence-gathering skills through the interview rather than controlled trial and have to remain alert to their own biases as well as to the inevitable and understandable one-person perspective of their client. Perhaps we could characterise all these approaches as one of benign scepticism, always open to correction the face of new data.  We are assured the BPS commissioned external investigations (presumably at the expense of member subscriptions – will the total cost of all this appear in the audited accounts?) into the allegations and their findings were a central part of the case against Dr MacLennan. All well and good and superficially follows due process. But it raises an important set of questions. As outlined in Part 2, we suggest that Dr MacLennan’s arrival may have heralded an unwelcome intrusion for some in the organisation. Perhaps they had already formed an opinion of him and his reformist zeal and put the shutters up in advance. They were, perhaps, primed to view him as the ‘enemy’. Perhaps Dr MacLennan’s enthusiasm and energy was seen as ‘over the top’. Perhaps he felt he had to be assertive in the face of what he saw, rightly or wrongly, as intransigence and unhelpfulness – and, of course, assertion is not the same as bullying.  We ourselves have been subject to veiled accusations of harassment and bullying, simply because we refused to stop asking questions when legitimate requests for information or clarification were denied (an experience not unique to us). So we would ask how many respondents in the data-gathering exercise actually used the word ‘bullying’? What overt, identifiable behaviours of ‘bullying’ did Dr MacLennan show? And, most importantly, what was the criterion used by any of those involved into what constituted ‘bullying’, especially as there are well-documented definitions available? These interactions presumably took place during the COVID epidemic and in many cases could not have involved an intimidating physical presence. How did the Panel account for the potentially distorting effects of conversations being mediated by technology?

Was the sanction proportionate?

The BPS is clear on the three sanctions available to the Responsible Person (and note here that in the long and highly detailed justification issued by the BPS it contradicts itself saying that the Panel recommended the sanction in one place and that the Responsible Person made the decision, acting on the evidence provided by the Panel in another passage – which was it BPS?). He chose the most serious of the three – immediate expulsion. We have no information as to how he reached that decision other than that it is stated that he was presented with the Panel’s findings – minus, of course, any input from Dr MacLennan. That last point raises the question as to whether, in the light of the possible consequences, he might have thought it advisable, at the very least, to check with Dr MacLennan that he had nothing to contribute. The relevant paragraph of the BPS statement is this

The member conduct process involved a careful review of sanctions applied in other similar cases and in relation to the conduct that might reasonably be expected of a member of this standing and experience.

We are in uncharted territory here as we, as mere members, don’t have access to any data about the outcome of any disciplinary process (which may or may not exist) since part of it was outsourced to the HCPC. In the days when the BPS did take this responsibility seriously, the outcome of investigations was published in The Psychologist. Looking at the statement above, we have no idea as to how many similar cases there have been and we have no idea of how many members have been expelled – and, of crucial importance, for what offences were they deprived of society membership. We have already noted the ‘proportionality’ of sanctions in the light of previous cases and we really do need to know what offences committed by (now ex-) members resulted in expulsion. We are left with the highly general and completely subjective judgement (made by one person) as to what he might reasonably expect of a member of standing. And as we have already noted, he is the Chair of a Standing Committee of the Board of Trustees.

We would also ask how he judged the possible consequences of his decisions on all those involved – particularly on the person who is most affected – Dr MacLennan. We understand that he runs his own business and is more dependent than many psychologists on being able to attract clients – they do pay his income quite directly. He has not only been deprived of his BPS membership – this action, compounded and magnified by the subsequent barrage of publicity will cause enormous reputational damage and may well cost him his livelihood. Did the RP take this into account at all?

In a final act of this grossly public humiliation, we are told by ‘the BPS’

If Professor MacLennan has his membership reinstated on appeal, he would not automatically reassume his role as trustee and President Elect, although he would be eligible for re-election to the Board in line with its usual procedures. The BPS constitution provides mechanisms for filling vacancies on the board and these must be followed. These procedures do not include an option for the board to choose to reinstate Professor MacLennan (as President or President Elect) if his appeal is successful.

This is saying that the BPS can overturn the democratic process ‘just because it can’ – and we are sure that many members would value a sight of the rules that allow this. Should Dr MacLennan be cleared of all charges, then how can the BPS justify not reinstating him to his democratically elected post? He has been expelled from membership the Society, the consequence of which is the loss of his position. Reinstatement of his membership should, therefore, mean being able to take up the post to which he is entitled. This looks very much like a small group within the BPS doing its absolute utmost to ensure that Dr MacLennan never becomes President.

Was the video absolutely necessary? 

Many of you, like us, will have been shocked by the lengths to which the BPS has gone to justify itself and to ensure the widest possible coverage of this unfortunate affair – before the appeal has even been heard. Five closely typed pages, one video (now on YouTube), all going into the grisly and hurtful accusations of a case that has yet to reach its lawful conclusion. This stands in complete contradistinction to the following; the fact that the CEO is out of his office about which the members have been told nothing (not even the fact of it); the police investigation about which the members have been told nothing (not even the fact of it); that the Charity Commission is engaged with the Society about which it needed a bunch of “malcontents” and the resignation of the Vice-President for the BPS to even acknowledge.  These are critical issues for the membership as a whole and could have easily been communicated to us in a way that did not prejudice any legal investigations. So what’s the difference, BPS? Why go in to the sort of supposed detail that is career-wrecking when a simple holding statement would have sufficed? Looks a lot like the actions of a bully to us.

Where from here?

We hope that our highlighting of the issues that we think to be of importance has, at the least, piqued your interest. Perhaps we could encourage you to look further into the workings of your Society – the minutes of the Board of Trustees is a good place to start as much for what it doesn’t say as to what it does. If you are a member of the Senate (a body, as far as we can tell, without Terms of Reference) or know one of the Trustees, perhaps you could ask some questions – and be prepared to fobbed off or accused of harassment. If you have social media links to other colleagues who care about our Society’s future then get involved by spreading the word.

We will do our best to keep you up to speed as far as we are able. 

Peter Harvey, Pat Harvey and David Pilgrim

BPSWatch Editorial Collective.1 CommentEXPULSION OF PRESIDENT-ELECT

Questioning the Expulsion – Part 2

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Were both sides heard fairly?

The statements from the BPS make the observation that Dr MacLennan declined to present evidence to support his case despite repeated requests. We are at a loss understand this as it is presented. We could speculate that Dr MacLennan might chose to distance himself from a process that he might believe to be illegitimate and be biased against him and that, by co-operating, he would add spurious validity to it. However, it is a surprise that, in view of the seriousness of the issue for him on a personal and professional level, it is implied that he made no efforts to defend himself robustly. We would ask, therefore, whether he was given due time to collect together all the evidence he might need? Was he able to access all available material that would be necessary, such as privileged communications to which he as an office-holder, would be entitled? What efforts were made by either the Panel or the Responsible Person to find our why he would choose to take this course of action? Was the RP able to satisfy himself that Dr MacLennan did not wish to defend himself in the dock?

Was it a level playing field from the outset?

We can have some idea of how the BPS views complaints from this extract from the Minutes of the Board of Trustees meeting in December 2020

“This year has seen a trend for the potential misuse of the complaints process, where it has been used to express a difference of opinion or dissatisfaction with a consultation outcome.The volume of complaints is a strategic risk for the Society and was considered at the Risk Committee.”

Clearly, complaints about the running of the Society are unwelcoming intrusions rather than a learning experience, a risk to be managed. Whilst is it easy to fob off the ordinary member with tactics such as simply not responding, not answering questions or crudely cutting off debate, when an elected officer, who will be an integral part of the organisation arrives, different tactics will be required.

It was very clear from his election statement that Dr MacLennan was a man on a mission – a mission to overhaul the BPS. His successful election (44% of votes cast) must have given him some confidence that he was doing the right thing. His experience, and that of others who he canvassed and supported him, was enough for him to believe that reform was an absolute necessity. We have no doubt that this energy translated into an enthusiasm and diligence to find out, in greater detail, about the mechanics of how the BPS worked (or, more importantly, how it didn’t work). We have no doubt that for some in the organisation this was a significant threat. We have already noted that the BPS had serious problems well before his election and that many people who were meant to have formal oversight of the organisation had – at the very least – taken their individual and collective eyes off the ball (including the Trustees). To support this assertion we can do no more than to quote part of the resignation tweet of Professor David Murphy, lately Vice-President (and therefore a Trustee during his period as President-Elect and President) which identified 

“…governance oversight, escalating expenditure and lack of openness and transparency…”

as one trigger for his leaving. And that of Past President, Professor Peter Kinderman

“…When I was President, I was routinely excluded from key decisions, was threatened with legal action over ‘fraud’ (I was completely exonerated, of course) and forced to resign (as Vice-President) for advocating for what is now effectively BPS policy…”

So we know, from two very senior past office holders, that there were significant problems well before Dr MacLennan was propelled into the scene. And remember that Professor Kinderman was in post for the two years 2015-2017 (until his forced resignation) and Professor Murphy for the years 2018 – 2021.  We also know, from the minutes of the Board of Trustees meeting in December 2020, that some Trustees themselves were anxious enough about the Society to support

“…a wider discussion in relation to a governance review and stressed the urgency of moving forward with this action…”

Bear in mind also that the Leicestershire police are investigating an allegation of a major financial fraud within the Society.  So we have a picture of an organisation that is clearly dysfunctional and under scrutiny and had been so for some considerable period of time. Is it any wonder that some within the organisation, both staff and volunteers, may have felt more than a twinge of anxiety at the arrival of an avowed new broom? We would suggest that in the light of all this, the BPS bureaucracy was on the defensive. This not only might have influenced the trigger for the investigation, it may have influenced its course.

The third and final post will appear tomorrow, Saturday 22 May 2021.

Peter Harvey, Pat Harvey and David Pilgrim

BPSWatch Editorial Collective.Leave a commentEXPULSION OF PRESIDENT-ELECT

Questioning the Expulsion – Part 1

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This is the first of three posts looking closely at the recent expulsion of the Present-Elect.  We will be asking a series of questions about both the process and outcome, identifying what we see as major deficiencies which highlight, in stark detail, the issues which we have been raising about the sorry state of our organisation. Much of this is speculation and informed guesswork, some generalising from our own experiences because, despite the mass of defensive information coming from the BPS there are many serious omissions and obfuscations.

So, to begin at the beginning.

Can we trust the overall process?

Before we get into the fine detail, let’s step back and cast an eye over the disciplinary process itself.  We would remind you that in the Complaints FAQs on the BPS website there is the following statement

The Society does not have a function to investigate complaints against its members…

This, of course, is in complete contradiction to the various statements in the Member Conduct Rules which do outline such a function. If it were sentient, the complaints process would be in a serious existential crisis. 

We must also remember that we have been told, by the Acting CEO, that the Society is undertaking a root-and-branch review of the whole of the complaints procedure. To put it at its mildest, this suggests that all is not well with the process, whether it actually exists or not.

In addition, we must also ask who actually made the decision to pursue this complaint against the President-Elect. Again, to remind you, the CEO is still ‘out of the office’; there is no CFO; the President has resigned; the Vice-President has also resigned citing failures of governance amongst his reasons for going; we have an “Interim Chair” of the Board of Trustees (presumably this same Board that is accused of the aforementioned governance failures); an acting CEO who is, presumably, involved in the issues raised by the President-Elect. So the question remains, who decided? Was it the full Board of Trustees or some select subgroup of the willing? Was the complete (if depleted, of course, due to resignations) Board given full and unredacted information about the reasons for this course of action and its possible consequences? Who chose the Panel members and the Responsible Person? Did the Board as a whole and unanimously sign all this off?

In view of the serious and unusual nature of this whole business – disciplining the only remaining elected senior officer of the Society must surely rate as out-of-the-ordinary – and the fact that this would be subject to more than the usual degree of scrutiny from the membership and the outside world, one might hope (perhaps, vainly, expect) that the BPS would go to some lengths to show that justice would not only be done, but would be seen to be done.  It should be a shining example of how to do things right. This takes on a particular relevance in the light of the current application to the Professional Standards Authority where matters of monitoring and managing professional standards (the clue is in the name) are paramount.

We argue and will, we hope, show that the whole process, from start to finish, is fatally flawed and itself brings the BPS into disrepute. 

How “independent” is independent?

The various self-exculpatory outpourings of the BPS make great play of the ‘independence’ of the investigation. What does that mean to you? To us it suggests – at the very least – that whoever is carrying out the investigation is as far removed from both the current and past history of the BPS as possible. This is not just a matter of not being a Trustee or a member of the SMT. Many of the problems and issues identified by us and by others pre-date the election of Dr MacLennan by many years. Indeed, as we will see later, at least one past President identified serious problems as did the now-resigned Vice-President who had been in post (President-Elect, President) for two years prior to his abandonment of the sinking ship. So any properly constituted investigatory panel should comprise people untainted by previous appointments as Trustees or as senior post-holders with the BPS. This seems to be particularly important in the light of the fact that this may be, to our knowledge, a unique event in BPS history.  Ideally, the panel should be made up of people from outside of the organisation completely. After all, the allegations against Dr MacLennan were of ‘bullying’ – this is a generic, non-organisation-specific behaviour. You don’t need to know about the arcane intricacies of the BPS to recognise bullying when you see it. Again, given the importance of being seen to do this correctly, it would be sensible to have someone who has considerable HR experience. Was this the case?  No, it was formed of some (number unstated) of ‘…our most senior experienced colleagues…’. The fact is, however worthy and experienced,  they are not independent of the BPS. This failure is also shown by asking the Chair of the Ethics Committee to act as the Responsible Person –  who is accountable to and appointed by the Board. As an officer holder of a Standing Committee of the Board of Trustees, he is neither independent of the Board nor of the BPS. We assume (again, lack of detail makes this suppositional on our part) that he was completely distant from the everyday work of the Panel for otherwise he would be unable evaluate the evidence presented with fresh and neutral eyes.

It is stated by the BPS that 

The process was also conducted throughout with the benefit of independent legal advice to give additional assurance that it was being carried out with propriety and fairness.

This could mean all manner of things. Given that the whole complaints process is muddled and inconsistent and would need an awful lot of (expensive) lawyers’ and consultants’ time to sort through and make sense of, we can only hope that the BPS see this is a good use of your subscriptions. But the point we are making is that even if the letter of law was followed to the last dotted i and crossed t this is not the same as ensuring that the overall process was seen to be just. In our view, it could not be.

We will continue to raise questions in Part 2, to be posted tomorrow (21 May 2021).

Peter Harvey, Pat Harvey and David Pilgrim

BPSWatch Editorial Collective.1 CommentBOARD OF TRUSTEESEXPULSION OF PRESIDENT-ELECTGOVERNANCE

The End of Membership Democracy in the BPS?

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The campaign in the self-serving bunker at the centre of the BPS continues unabated. Its main character, which we have documented in our posts in the past few months, includes a number of strands. Some reflect the tactics of evasion and secrecy. They include complaints being ignored, as well as concerns (that are not complaints) being turned into complaints and sent into a rabbit hole.  The complicit non-reporting of the crisis in ‘the magazine of the British Psychological Society’ has been a trusted management mechanism to keep members in the dark. Dictates have been sent out by ‘Trustees’ to Senate members to demand their silence in a comical pantomime of control freakery.

Other tactics have involved clear projection: a bullying and high-handed culture of management has accused its critics of being the bullies. The power asymmetry here between the parties is ignored but that acknowledgment would require a capacity for honest reflectiveness. Journalists just doing their job in a democracy have been threatened with legal action. By any standards of common sense and fair judgement, this precarious regime of power has had a probity bypass. 

The most egregious example of this has been the ‘investigation’ and subsequent expulsion of the President Elect. His sin was to be open from the beginning about reforming the governance arrangements in an organisation which, for years, had flouted the normal expectations of charity law and good practice guidelines offered by the Charity Commission.

What price membership democracy?

The literal price of being in the BPS is known to its membership. For now, some of those fees are maintaining the high salary of a CEO who is still ‘out of the office’, so remains unable to fulfil his duties. Those in the bunker have told us nothing, so members are left to speculate. 

In the few days that have elapsed since the expulsion of the President Elect was announced (in a scripted account – crafted by whom?), matters have deteriorated further. The unprecedented video from the ‘Interim Chair’ of the Board of Trustees was a callous public disparagement of the President Elect. Speaking from an office and role that, under Statute 20 of the Society, she still has no right to hold, her personalised career-threatening attack upon him remains on Youtube for the world to see.

This scandal now has worsened.  A rapid election is to be held to replace the summarily deposed President-Elect before his appeal has even been heard. From well before he took office there were overt intentions to obstruct him wherever possible. We believe that there is evidence to support this that will be made public. Like the ‘investigation’ of the allegations against him this is a travesty. History will judge those responsible for deposing him, so this faux process of justice will peter out to its discreditable conclusion.

In case members are getting too excited about choosing someone new and untainted by what has gone before, they need to be prepared for a disappointment. This is the score. Only candidates from the current Board of Trustees or Senate members will be permitted to stand. This is the very group under whose ‘oversight’ the Charity Commission has become involved on an ongoing basis. There is an active police investigation into an alleged major fraud (watch this space next month). The self-same group from which the Vice-President resigned,  citing issues about “…governance oversight, escalating expenditure and lack of openness and transparency…”, which he communicated to the Charity Commission.  Former President, Professor Peter Kinderman, informs us that several years ago “…When I was President, I was routinely excluded from key decisions, was threatened with legal action over ‘fraud’ (I was completely exonerated, of course) and forced to resign (as Vice-President) for advocating for what is now effectively BPS policy…” .

What sort of real choice are members now given?   

The candidate will be drawn from a pool of complicit individuals. They assume that everything in the garden is rosy and the much-vaunted £6 million Change Programme will supercharge the BPS, when the membership to date have been shown no substantive evidence to support this wishful thinking. 

Meanwhile, for now, any vestige of membership democracy has been placed on indefinite hold. We can only hope that needed legal proceedings, active media interest and decisive action from the Charity Commission will, between them, resolve this sinister and shameful demise of the public face of psychology in the UK once and for all. 

BPSWatch – Editorial CollectiveLeave a comment‘FALSE MEMORY SYNDROME’MEMORY AND THE LAW GROUP

On memories of abuse….

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The BBC websitethe Daily Telegraph and the Daily Mail are all reporting on the trial of an alleged sexual abuser, the widow of a former High Court judge. All quote the following statement by the prosecuting QC

“He tried to bury away the memories and not to think about them”.

As is her right, we have no doubt every effort will be put into her defence, perhaps even involving the British False Memory Society.

How will any witnesses for the prosecution or the barristers involved be able to rely on a balanced, empirically based set of guidelines to argue against any claims that the accuser’s memories may be ‘recovered or false’? The short answer is that they won’t because ‘The BPS’, in its wisdom, has given up on any pretence to take this matter with the seriousness that it deserves by abandoning the revision of its Memory and The Law guidelines (see here).

We can only hope that the court is able to hear from a balanced and fully informed range of expert witnesses. It is shameful than none of the psychologists who may be in that position will be able to call on the backing and support of their professional society.

The BPSWatch Editorial CollectiveLeave a commentGOVERNANCE

The BPS is unfit for purpose

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This was originally sent as a comment to our post ‘The Crisis deepens…’ We felt that it was important enough to stand on its own as a separate post.

TheBPSWatch Editorial Collective.

I am Professor David Marks, membership number 3829, a Chartered Member with FBPsS, currently a member of the Division of Health Psychology, previously a member of other groups and networks. I joined the BPS as a student in 1963. After completing a BSc and PhD I worked in universities in the UK and overseas carrying out teaching administration and research. I have practiced as a psychologist and worked as a consultant to multiple organisations within the NHS, industry and voluntary sectors. I served as Head of Department at two large Psychology Departments, firstly at Middlesex University, where I worked from 1986 to 2000, and then at City, University of London from 2000 to 2010. I founded two scholarly journals and, for 26 years, have served as Editor-in-Chief of the Journal of Health Psychology

Based on my research publications, I was appointed to a BPS Fellowship in 1984. In the early 1990s, I was elected chair of the BPS Health Psychology Section, which was taken into Special Group status and subsequently to a Division. I was actively involved in the BPS accreditation of the first MSc awards in health psychology and the first Stage 2/doctoral training provision in the UK. I sat on various BPS boards and represented the BPS on international bodies. Over many years multiple elected and unelected BPS officers were well known to me and I counted many as personal friends. 

It with sadness and regret that I believe that I must state my concerns about the Society, its organization, working practices and public outputs. 

I am writing this comment in support of the recent blog postings on ‘BPSWatch’. I do not know and have never met any of the three authors. However I have read their postings and find myself in total agreement with the points they have been making. Rather than resign from the Society, which has crossed my mind on numerous occasions, I had always hoped that change could come from within. Now, seeing the total chaos that reigns, and the complete lack of transparency, accountability and honesty with members, I am strongly doubtful.

I can summarise my current thoughts on the BPS in four sentences: 

1) The BPS is grossly failing the public good, its members, and the discipline of Psychology.
2) The current problems of the BPS cannot and will not be solved by tinkering with the system, as has been tried unsuccessfully on a frequent basis over several decades.
3) Only root-and-branch restructuring would be able to make the necessary changes to achieve the objects of its charter.
4) Sadly, I do not believe the BPS has the wherewithal to achieve the necessary structural reorganization that is called for.

The BPS website (https://www.bps.org.uk/about-us/who-we-are) states:
“The British Psychological Society is a registered charity responsible for the development, promotion and application of psychology for the public good.
Through our Royal Charter we are charged with overseeing psychology and psychologists in the UK, and we are governed by a number of democratically-elected boards and committees.”

My nearly 60-year long association with the BPS indicates to me that the BPS is woefully unfit for purpose. The BPS fails to meet its obligations as a registered charity. This fact is evidenced by the Society’s:

Ineffective governance
Lack of accountability
Lack of transparency
Institutional racism
Improper complaints procedures
Willful neglect of fraud and/or malpractice

In due course, unless I resign first, I will address each point on this and/or my own blog site at: https://davidfmarks.com/

David F Marks
5 May 20211 CommentBOARD OF TRUSTEESFINANCIAL ISSUESGOVERNANCE

Twenty Tough Questions for ‘the BPS’

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Questions are coming thick and fast from colleagues new to the story of the crisis in the BPS. Of course, they are new to it because, amongst other things, the Board of Trustees (BoT) and Senior Management Team (SMT) have been secretive about the facts. In the past year nothing has appeared in The Psychologist (relevant note: ‘the magazine of the British Psychological Society’) to give the slightest hint of any organisational problems. The CEO’s monthly homilies petered out with no editorial explanation. The President, who has recently resigned, made absolutely no mention of the troubled state of the organisation in her final ‘reports’.

This blog and an increasing number of reputable journalists are now bringing into public gaze the extent of organisational dysfunction in the Society. We have been trying our best to do what the BPS has palpably failed to do in relation to transparency. However, we are not private detectives or forensic accountants and nor do we have the investigatory powers of the Charity Commission. The latter is hovering nearby, but to date it has not fully disclosed its intentions in relation to its ongoing ‘engagement’ with the BoT. Given the very large file of complaints against the Society, we are left wondering what will be the tipping point for them to announce a Statutory Inquiry.

The 20 questions that require answers

Here we raise some questions crossing our minds and those put to us by perplexed colleagues. Ipso facto, we cannot answer them definitively but we can pose them in good faith on behalf of the membership.

  1. Why is the CEO still in post and being paid (from membership fees) but ‘not in his office’?

2. The Finance Director left the Society abruptly just before Christmas last – what were the circumstances surrounding that departure?

3. Was the expelled President Elect genuinely allowed to conduct his duties and was he given access to information appropriate for that task?

4. Was there a deliberate strategy on the part of the BoT and SMT to marginalise and disempower him, given his election pledges to rectify governance problems in the Society?

5. Was there a large fraud conducted in the Society that is still being investigated by the police? 

6. What recruitment checks were conducted on the person who was alleged to have committed the fraud?

7. Who appointed this person?

8. Was the arson attack on the Leicester office during this period of turmoil (unreported to the membership) linked in any way to the alleged fraud investigation?

9. Did the BPS report the arson to the Charity Commission, as it is supposed to do under their guidance?

10. Why did the SMT refuse to give the BoT access to critical information, about the £6 million ‘change programme’?

11. What oversight was the BoT providing of the SMT and how was the effectiveness or otherwise of that oversight assessed? 

12. Did the BoT consider that its culture of information restriction, which we have experienced directly ourselves, reasonable for a membership organisation professing a value of openness and transparency?

13. Why did the BoT make public the alleged grounds for the expulsion of the President Elect in advance of his appeal?

14. How can the President Elect have a fair appeal, when it appears to have been already prejudiced?

15. In light of answers to the above questions, has the President Elect been subjected to a ‘kangaroo court’ or ‘show trial’?

16. Was there a planned and wilful campaign to remove the President Elect by the BoT and SMT, as both a radical reformer and a whistle blower, as soon as he was elected?

17. Have journalists making legitimate enquiries, about all of the above matters, been threatened with legal action by the BPS?   

18. Had the Vice-President, who resigned citing concerns about finance and governance, already ensured that those concerns were reported fully to the Charity Commission?

19. The ACAS definition of bullying is this: “Offensive, intimidating, malicious or insulting behaviour, involving an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient.”  Accordingly, does the action of broadcasting a video denouncing the President Elect constitute bullying by the BPS? 

20. Finally, does the BoT now knowingly have a policy to ward off legitimate questions from members about governance matters, by alleging that the questioning, in of itself, constitutes bullying and harassment of BPS staff? 

The final question is rhetorical; as victims of this tactic we can vouch that the answer is in the affirmative. Some of the questions on the list relate to criminal matters and others to aspects of due diligence and common decency. Ordinary members not only pose them now on reasonable grounds, but they deserve reasonable answers. The BoT have warded off the inconvenient truth surrounding the questions, using a mixture of silence, glib evasions, bureaucratic obfuscation and legal threats. 

Is this how we expect a properly functioning learned organisation to operate, with its rhetorical adherence to the principle of openness and transparency? We ask readers to please send us any other questions that come to mind, which we might have missed from the above list. If we cannot answer them we can at least share them.

We will be posting some more detailed analyses of these questions over the course of the next couple of weeks.

The BPSWatch Editorial Collective

How much does the future of the BPS actually matter to you?

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We began this blog and the associated Twitter feed because we were all extremely concerned about what we see as the misgoverance of an organisation that we gave our time and energy to over many years because we believed in what it stood for. What we have seen in recent years is an increasing distancing of those that run the BPS from its membership – as our posts and out tweets demonstrate. The recent expulsion of the President Elect exemplifies the parlous state of the BPS. 

We have had some feedback from people who are of a similar opinion to us, some of which has appeared here, and it’s helpful to know that our concerns are shared by others. We have also had many informal comments of support either applauding our efforts or telling us of similar experiences with this failing organisation. Disturbingly, we have been told of those who, after working hard on behalf of the Society, have left feeling betrayed and traumatised by their experiences. More evidence that change is needed urgently.

But, and it is a big but, we are retired from practice and at are a distance from active involvement in the BPS. Frankly, whether it survives or not will have little practical impact on our lives professionally although its demise would cause us great sadness. But its continued existence as a thriving, member-led organisation which represents the best of UK psychological thinking and practice matters, perhaps never more so than now. Over the half-century that we have been psychologists we have seen such enormous strides made in how psychological practice has grown in maturity and relevance. Psychologist of all sorts and conditions are listened to with respect and can speak with authority. When we started out it was psychiatry that was seen as the ‘go-to’ source of expertise in matters psychological – no more. Psychologists can be proud of the strides that it have made over the years. And that process is almost entirely due to those psychologists, members of the BPS by-and-large, who were willing to spend time and energy to build the discipline, the profession and the BPS. That psychology has got to where it is today is due almost entirely to the hard work – often against the odds – of those who cared deeply and passionately about their discipline. They were not professional, go-anywhere managers – they were psychologists who believed in what psychology could do.

So this is a plea to all those of you who want to be represented by an organisation of which you can be proud. An organisation that reflects and promotes psychology to the benefit of all and of which membership can be seen as badge of honour. The BPS can be this – it is clearly not this right now. Its future cannot depend on the likes of us old codgers alone. It must involve those of you who are still out there, working as psychologists, on whose future the health of a thriving BPS is dependent. It is your responsibility more than ours. 

This is a critical time for the BPS. The current ‘leadership’ is engaged in highly unprofessional actions for which they are not being held accountable. The BPS has no senior member-elected officers. The fact that the Charity Commission is heavily involved is a serious warning sign. There is a commitment of £6 million (yes, £6 million of your money) to an ill-specified and inadequately scrutinised change project. There is a £2 million loan (securitised against two BPS-owned properties) with no CFO or CEO in post to manage or oversee these vast financial commitments. 

This needs you (yes, you) to act now. Be prepared to be rebuffed and ignored or accused of harassment if you express you concerns to the current BPS officials. Write to the Charity Commission with your comments. Read and contribute to the blog. Email the blog – BPSWatch@btinternet.com. Read and forward the Tweets  – @psychsocwatchuk. Share your experience with others.

It’s your Society – and your responsibility to rescue it.

Peter Harvey2 CommentsEXPULSION OF PRESIDENT-ELECT

A challenge to the BPS narrative.

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From the BPSWatch Editorial Collective…..

Since the inception of this blog we have had intermittent contact with the now expelled President Elect around matters of concern regarding what we believed were clearly signs of organisational misgovernance, irregularities and toxic culture at the BPS. These had been separately signposted to us individually when we had dealings with senior staff about a range of policy issues. We had become increasingly alarmed by the way we were ignored, brushed off, rebuked, and, as one of the recent threads on @psychsocwatchuk https://twitter.com/psychsocwatchuk/status/1401165572436602884?s=20  demonstrated, we had our correspondence closed down with implications, explicit or veiled, that we were harassing or bullying staff. During our exchanges with Dr. MacLennan over months, he indicated his growing belief that he would never be allowed to become President and that there were moves afoot to prevent that. Latterly he told us he was sure he would be suspended or expelled for persisting with challenging the current governance process and practice. This was, of course, his stated reason for standing to be elected. Members gave him their backing.

His appeal against expulsion remains unheard and there is another legal matter that remains sub judice so he cannot yet speak out in his own defence, despite all that has been said in print and on a Youtube video that he is a “bully”, deserving only expulsion.

We can say, without hesitation, that in the contacts the three of us have separately had with Dr. MacLennan, we have detected no signs in his manner or his expressed attitudes that he is disrespectful, aggressive or demeaning. And despite all the slights and insults he has received, he remains passionate in his commitment to making the BPS a better organisation.  All three of us have had long careers as clinical psychologists, two of us with very significant forensic experience. We do not just take things at face value when there are conflicting views and narratives about individual behaviour.

Taken in that context, and with Dr. MacLennan unable to defend himself publicly at this stage, we are publishing verbatim a communication that we received from a friend and long-term colleague and collaborator of Dr. MacLennan. We have permission of the author who is happy to be named, and of Dr. MacLennan.

Good Morning,

I have recently been following your articles about Dr MacLennan on BPS Watch and feel your concerns.

I am not a member of the BPS and feel it would be inappropriate for me to pass comment on recent events, but I am a close friend of Nigel and have been horrified at his very public vilification because this is not the Nigel I recognise. While I have my own views, I recognise that there are two sides to every story and I only have one side, but I feel that I must tell you about my relationship with him and, in a sense, to defend him.

But first, a little bit about myself. I served for 30 years as a police officer with Surrey Police. Towards the end of my career I was seconded to the National Leadership Academy for Policing at Bramshill as a Programme Director to deliver programmes on the High Potential Development Scheme and the Senior Leadership Development Programme. While I have delivered all types of Leadership programmes and consultancy services across England, Wales and Northern Ireland (and to every public service) my core programmes were Managing Finance and Resources, Media Strategy (I developed the National Police Media Strategy in conjunction with the highly respected journalist Brian Morris), and Strategic Community Relations. I retired in 2005 and was retained as a consultant until 2015.

In 2012 I became the Honorary Secretary of the British Academy of Management Special Interest Group on Corporate Governance with a special interest in ethics and, in 2013, I became an Honorary Visiting Professor at London Metropolitan University Business School. This is when I met Nigel. With him, I have delivered talks to four Advances in Leadership Conferences, been a judge and Chairman of judges at national leadership awards, and have even delivered a talk at the last BPS conference. I have also worked with Nigel on a 9 month Leadership Development Programme for BAME officers in the Metropolitan Police Service. In my opinion, his skills and talents are without doubt.

As a former police officer, I tend to view people with suspicion until I can understand their motivations and I have never doubted Nigel’s motivations. As you are probably aware, he has had a glittering career working for blue chip companies and organisations such as the Chartered Management Institute and I have found his honesty and integrity beyond reproach. What I particularly liked about him was his assertiveness – he was not afraid to tell you how it is – and this is an in-demand skill for effective leaders. I have learnt many things from Nigel and have been quite happy when he has pointed out that I am wrong and, I hasten to add, vice versa.  In my experience he has never strayed into aggressiveness – forceful yes, aggressive no. However, like me, he does struggle with obfuscation, and this can become a barrier to communication with certain people.

In short, I have always found Nigel to be competent, conscientious, a supreme coach and, above all, honest.

Kindest regards.

Graham Buchanan, BSc(Hons), NdipM, PGCE, CMgr FCMI, FRSALeave a comment“THE PSYCHOLOGIST”BOARD OF TRUSTEESEXPULSION OF PRESIDENT-ELECTGOVERNANCE

The legitimation crisis and a membership denied answers

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David Pilgrim posts….

Today, the concept of a ‘legitimation crisis’ can be applied clearly to the BPS. Although explored at length in a book with that title by Habermas (1974), many other social and political scientists have returned to the theme. This is about leadership regimes, which may notionally still retain power, but their strained credibility reflects an imminent or current breakdown in their actual authority. The cabal currently at the centre of the BPS is still in power but its credibility is in rapid decline. It lacks what Eric Fromm, in his book The Sane Society, called ‘rational authority’ and, instead, exercises power on its own terms in order to ward off the stream of criticism warranted. For Fromm this would be an expression of ‘irrational authority’.

On this blog we have been reporting the character and history of this crisis in recent months and each entry, such as this one, is a new take on an unprecedented state of affairs for the Society. The occasional flurry of criticism of rogue celebrity researchers, such as Cyril Burt (Joynson, 1988) or Hans Eysenck (Marks, 2018), barely dented the reputation of the BPS. Similarly, the spat between the Maudsley methodological behaviourists and their scorned psychodynamic colleagues from north of the Thames, in a struggle to control the Medical Section and its journal, led to a temporary closure of its business in 1958 (Pilgrim and Treacher, 1991). These small eruptions of doubt, that all was well in the BPS, pale into insignificance today. We have never seen anything like this, either in living memory or in the literature on the history of British psychology. Those past examples, looked at in the current context, are like comparing a bar room brawl with a military coup. 

In meetings of the Board of Trustees today all of the Presidential triumvirate have gone, so it contains nobody elected from the general membership. Unelected Senior Management Team members now outnumber Trustees from the sub-systems. This trend is now amplified by the Board preventing members electing a replacement for the radically reforming President Elect, after expulsion from the Society, a cue for the next main point.

The public disparagement of Nigel MacLennan

The video released, vilifying the President Elect in advance of his appeal being submitted and heard, is a complete outrage. It offends our normal understanding of natural justice and leaves the Board of Trustees, who planned its production and dissemination on YouTube, open to the charge of unethical and possibly illegal activity. Are the Trustees so determined to crush this man’s reputation that they will simply ‘do anything that it takes’? 

It is officially the position of the BPS (according to its own website for all to read) not to investigate individual members. However, does that claim fail to apply only when it is politically expedient for the interests of the incumbent leadership? Are the members seriously expected to believe that this has been anything but a ‘stitch up’ from start to finish? Was the investigation panel hand-picked by the Board of Trustees or not? How many on that panel were truly independent and without their own vested interest in the current regime of power? Were membership funds used liberally by the Board to hire legal advice in order to justify the scapegoating of a reformer, turned whistle blower? The questions go on and on. Some of them ultimately may be resolved in court but what is clear already is that Nigel MacLennan has not been treated in a fair manner, if we use everyday criteria of common sense and decency.

If the stitch up hypothesis is in doubt, look at how Carol McGuinness, in a follow-up document to that unedifying and ill-advised video, made it quite clear that even if Nigel MacLennan were to be re-instated on appeal, as a member of the Society, he would still not be permitted back to his role as the President Elect. This nothing-left-to-chance approach, reflecting the persecutory intent of the Board, sticks out like a sore thumb in this planned and vindictive attack on a man whose career has now suffered immediate detriment. 

I can find no justification for this pre-emptive strike from McGuinness, on behalf the Board, within the Statutes and Rules. Does she offer no rule-based rationale in the script she is reading because one simply does not exist? This brings us back to Fromm’s notion of ‘irrational authority’. Those in power often do and say things, simply because they can. But do we have to believe this travesty of justice? And given that under Statute 20 of the Society, the Board should have been chaired on an interim basis by MacLennan not McGuinness, is there an Alice in Wonderland feel to this whole scenario? 

We know that such a surreal quality can indeed emerge from group think, especially when it leads to scapegoating in order to create an illusion of homeostasis and harmony (Baron, 2005; Leyens et al. 2000). The warring factions of the SMT and the Trustees could take temporary comfort in a common enemy to be eliminated, but the facts of the crisis are still there, with or without the removal of MacLennan. Facts do not disappear because they are ignored conveniently by displacement activity or an ostrich stance.

Keeping the membership in the dark

If a making-the-rules-up-as-you-go-along approach to governance now characterises the workings of the cabal, then another supportive tactic has been information control. Nowhere has this been more obvious than in the silence in the pages of The Psychologist. An exception has been the printing of the statement about the expulsion of MacLennan from McGuinness (giving the BPS a free noticeboard posting without editorial comment or analysis), as well as the link to her video. No right of reply was offered to MacLennan. If this were a normal magazine it would reflect the normal rules of journalism and both sides of a story would have been offered, or at least taken into account.

However, this is not a normal magazine. For example, the political turbulence in the Society, should have warranted some commentary but none has been evident. Its inside cover reminds us every month that it is ‘…the magazine of the British Psychological Society…’. If this means that it obeys the contingent expectations of those running the BPS, then this is actually a fair and valid description. However, maybe members of the Society have broader expectations (such as it being a forum for free debate about the current legitimation crisis). Such expectations are indeed raised, conveniently, by the subsequent cover description ‘…It provides a forum for communication, discussion and controversy among all members of the Society…’. Has there been any actual sign of the latter, in practice, in the past turbulent year? Why are ordinary members still playing catch up about the financial scandal in the Society, the fat file of complaints being held by the Charity Commission and the expensive legal shenanigans to expel Nigel MacLennan?

During the crisis, the monthly column of the Chief Executive Officer suddenly disappeared without editorial comment, and we slowly became aware that he was ‘not in his office’ and his function was then taken on by his Deputy, Diane Ashby. And before the President, Hazel McLoughlin, also disappeared from the pages because she had resigned, citing family reasons, the content of her column revealed nothing to the membership of the chaos and tensions, which led to the resignation of the Vice President David Murphy. He explained on Twitter that this was because of his concerns about both governance and finance.  

However, the role of this ‘magazine’ has not gone unquestioned. For example, here is a reply to Pat Harvey from the editor (12.12.20) responding to her criticism of The Psychologist failing to provide information of legitimate concern to the BPS membership:

We are not a ‘house journal’, we are a magazine. Our responsibility is not to speak for the Society or to align with any documents it might publish; it is to provide a forum for communication, discussion and controversy among members and beyond.

This restatement of the confusing and contradictory blurb, cited earlier from the inside cover of The Psychologist, does not cease to be confusing and contradictory simply because it is robotically restated. Does the membership deserve a better journalistic service, during the current legitimation crisis of the BPS, than this sort of vacuous rhetorical gambit? The supine post-it-board role offered by The Psychologist on behalf of the current BPS leadership, reminds us of one of many of Orwell’s dire warnings about democracy: ‘Journalism is printing what someone else does not want printed. Everything else is public relations.’

The exchange between Pat Harvey and the editor of The Psychologist, Jon Sutton, did not end with the above restated confusion. She also wrote to the Chair of the Editorial Advisory Committee, Richard Stephens, starting with a complaint about the narrow and prejudicial role of The Psychologist, when being biddable and posting the offensive video. She made other criticisms of the magazine as well. This was the response she received from Stephens:

Thanks for your letter and for raising these concerns. I plan to table these for discussion at the next meeting of the Psychologist and Digest Editorial Advisory Committee on 24th June. I felt that your first raised point warranted some urgency of response so I discussed it today with our editor, Jon Sutton. Jon’s view was that while the video featuring Professor Carol McGuinness as Interim Chair of the Board of Trustee has been widely disseminated among BPS members, it is unlisted on YouTube. Given that The Psychologist has a much wider audience, Jon reflected that it’s inclusion in the piece “‘The Society is at a crossroads’” was not appropriate. On that basis the video has been removed. I will feedback in due course following our meeting on the 24th

This is a small sign of good sense and fairness from Richard Stephens, although at the time of writing the video is still available on YouTube.  Will this be the start of a period of genuine honest reflection from the Advisory Committee? Would the video have been removed had it not been for these critical questions from Pat Harvey? In my view, it seems as though those below the cabal level in the Society are very slowly waking up to the serious challenges that the legitimation crisis is posing for freedom of expression and balanced and open journalism in the future pages of The Psychologist. Elsewhere on the blog I have addressed the matter of censorship in the Society.

The ethical and legal culpability of the Trustees

The Charity Commission continues to work with the Society to bring it into ‘regulatory compliance’. This raises questions about the role of the Trustees in the recent past. How many of them (other than Nigel MacLennan), out of public interest, took their concerns about poor governance and financial irregularities to the Charity Commission or the press? 

Many resignations have been evident in recent months, including the President and Vice President. Are they now prepared to offer a full and frank account to the membership of what happened in the Board, which went so badly wrong? This could be a starting point for the ‘root and branch’ reform now required, to reverse the demise of the organisation. 

Will they admit that the conflicts of interest inherent to the current definition of a Board (which date back to a lack of specificity in the Royal Charter arrangements in 1988) have been routinely out of sync with current expectations of properly independent trustees in charities today? The current Board of Trustees is a sham because its members all have conflicts of interest and there are no outsiders from the Society to offer impartial oversight. Given the legitimation crisis, should the current Trustees at least own up to this basic fact, resign and insist on a properly constituted Board in line with Charity Commission expectations?  

And if it turns out that the negligence, or worse, of some Trustees has cost the BPS dearly, will they be held liable for these costs, as Charity Commission regulations allow? Will BPS members now seek to hold Trustees liable for the seeming losses incurred to the Society, by their apparent lack of oversight? Will that liability also extend to those who resigned but were in place during that period of apparent lack of oversight (in legal terms this is called ‘legacy liability’)?

This particular legitimation crisis, like all others, never stops posing questions for democracy. We all (not just a few pushy malcontents) need to keep asking them. The passivity in our current zeitgeist about trying to influence events around us does not have to lead to fatalism. We can still challenge the cabal and the current shambles in the BPS, as this blog and Nigel MacLennan have already demonstrated. The more of us taking up this challenge, the less likely that victimisation will be seen and the more likely that the Society will be saved from its own self-inflicted wounds. 

Baron, R. (2005). So right it’s wrong: Groupthink and the ubiquitous nature of polarized group decision making. Advances in Experimental Social Psychology. 37: 35.

Habermas, J. (1974) Legitimation Crisis Boston: Beacon Press. 

Joynson, R. B. (1989). The Burt Affair. New York: Routledge

Leyens, J. Ph., Paladino, M. P., Rodriguez, R. T., Vaes, J., Demoulin, S., Rodriguez, A. P., & Gaunt, R. (2000) The emotional side of prejudice: The attribution of secondary emotions to ingroups and outgroups. Personality and Social Psychology Review. 4, 2, 186–97.

Marks,D.F  (2019) The Hans Eysenck affair: time to correct the scientific record Journal of Health Psychology 24, 4, 409–42.

Pilgrim, D. and Treacher, A. (1991) Clinical Psychology Observed London: Routledge.3 CommentsEXPULSION OF PRESIDENT-ELECT

Questioning the Expulsion – Part 3

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Was the evidence sound?

As psychologists, from our very earliest years as bright-eyed, bushy-tailed undergraduates, we are used to dealing with evidence. We learn how to evaluate it, how to contextualise data, how to look in detail at the hypotheses, the method, the analyses. We are used to defining behavioural referents for concepts. Professional researchers carry on and refine this whilst practitioners hone their evidence-gathering skills through the interview rather than controlled trial and have to remain alert to their own biases as well as to the inevitable and understandable one-person perspective of their client. Perhaps we could characterise all these approaches as one of benign scepticism, always open to correction the face of new data.  We are assured the BPS commissioned external investigations (presumably at the expense of member subscriptions – will the total cost of all this appear in the audited accounts?) into the allegations and their findings were a central part of the case against Dr MacLennan. All well and good and superficially follows due process. But it raises an important set of questions. As outlined in Part 2, we suggest that Dr MacLennan’s arrival may have heralded an unwelcome intrusion for some in the organisation. Perhaps they had already formed an opinion of him and his reformist zeal and put the shutters up in advance. They were, perhaps, primed to view him as the ‘enemy’. Perhaps Dr MacLennan’s enthusiasm and energy was seen as ‘over the top’. Perhaps he felt he had to be assertive in the face of what he saw, rightly or wrongly, as intransigence and unhelpfulness – and, of course, assertion is not the same as bullying.  We ourselves have been subject to veiled accusations of harassment and bullying, simply because we refused to stop asking questions when legitimate requests for information or clarification were denied (an experience not unique to us). So we would ask how many respondents in the data-gathering exercise actually used the word ‘bullying’? What overt, identifiable behaviours of ‘bullying’ did Dr MacLennan show? And, most importantly, what was the criterion used by any of those involved into what constituted ‘bullying’, especially as there are well-documented definitions available? These interactions presumably took place during the COVID epidemic and in many cases could not have involved an intimidating physical presence. How did the Panel account for the potentially distorting effects of conversations being mediated by technology?

Was the sanction proportionate?

The BPS is clear on the three sanctions available to the Responsible Person (and note here that in the long and highly detailed justification issued by the BPS it contradicts itself saying that the Panel recommended the sanction in one place and that the Responsible Person made the decision, acting on the evidence provided by the Panel in another passage – which was it BPS?). He chose the most serious of the three – immediate expulsion. We have no information as to how he reached that decision other than that it is stated that he was presented with the Panel’s findings – minus, of course, any input from Dr MacLennan. That last point raises the question as to whether, in the light of the possible consequences, he might have thought it advisable, at the very least, to check with Dr MacLennan that he had nothing to contribute. The relevant paragraph of the BPS statement is this

The member conduct process involved a careful review of sanctions applied in other similar cases and in relation to the conduct that might reasonably be expected of a member of this standing and experience.

We are in uncharted territory here as we, as mere members, don’t have access to any data about the outcome of any disciplinary process (which may or may not exist) since part of it was outsourced to the HCPC. In the days when the BPS did take this responsibility seriously, the outcome of investigations was published in The Psychologist. Looking at the statement above, we have no idea as to how many similar cases there have been and we have no idea of how many members have been expelled – and, of crucial importance, for what offences were they deprived of society membership. We have already noted the ‘proportionality’ of sanctions in the light of previous cases and we really do need to know what offences committed by (now ex-) members resulted in expulsion. We are left with the highly general and completely subjective judgement (made by one person) as to what he might reasonably expect of a member of standing. And as we have already noted, he is the Chair of a Standing Committee of the Board of Trustees.

We would also ask how he judged the possible consequences of his decisions on all those involved – particularly on the person who is most affected – Dr MacLennan. We understand that he runs his own business and is more dependent than many psychologists on being able to attract clients – they do pay his income quite directly. He has not only been deprived of his BPS membership – this action, compounded and magnified by the subsequent barrage of publicity will cause enormous reputational damage and may well cost him his livelihood. Did the RP take this into account at all?

In a final act of this grossly public humiliation, we are told by ‘the BPS’

If Professor MacLennan has his membership reinstated on appeal, he would not automatically reassume his role as trustee and President Elect, although he would be eligible for re-election to the Board in line with its usual procedures. The BPS constitution provides mechanisms for filling vacancies on the board and these must be followed. These procedures do not include an option for the board to choose to reinstate Professor MacLennan (as President or President Elect) if his appeal is successful.

This is saying that the BPS can overturn the democratic process ‘just because it can’ – and we are sure that many members would value a sight of the rules that allow this. Should Dr MacLennan be cleared of all charges, then how can the BPS justify not reinstating him to his democratically elected post? He has been expelled from membership the Society, the consequence of which is the loss of his position. Reinstatement of his membership should, therefore, mean being able to take up the post to which he is entitled. This looks very much like a small group within the BPS doing its absolute utmost to ensure that Dr MacLennan never becomes President.

Was the video absolutely necessary? 

Many of you, like us, will have been shocked by the lengths to which the BPS has gone to justify itself and to ensure the widest possible coverage of this unfortunate affair – before the appeal has even been heard. Five closely typed pages, one video (now on YouTube), all going into the grisly and hurtful accusations of a case that has yet to reach its lawful conclusion. This stands in complete contradistinction to the following; the fact that the CEO is out of his office about which the members have been told nothing (not even the fact of it); the police investigation about which the members have been told nothing (not even the fact of it); that the Charity Commission is engaged with the Society about which it needed a bunch of “malcontents” and the resignation of the Vice-President for the BPS to even acknowledge.  These are critical issues for the membership as a whole and could have easily been communicated to us in a way that did not prejudice any legal investigations. So what’s the difference, BPS? Why go in to the sort of supposed detail that is career-wrecking when a simple holding statement would have sufficed? Looks a lot like the actions of a bully to us.

Where from here?

We hope that our highlighting of the issues that we think to be of importance has, at the least, piqued your interest. Perhaps we could encourage you to look further into the workings of your Society – the minutes of the Board of Trustees is a good place to start as much for what it doesn’t say as to what it does. If you are a member of the Senate (a body, as far as we can tell, without Terms of Reference) or know one of the Trustees, perhaps you could ask some questions – and be prepared to fobbed off or accused of harassment. If you have social media links to other colleagues who care about our Society’s future then get involved by spreading the word.

We will do our best to keep you up to speed as far as we are able. 

Peter Harvey, Pat Harvey and David Pilgrim

BPSWatch Editorial Collective.1 CommentEXPULSION OF PRESIDENT-ELECT

Questioning the Expulsion – Part 2

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Were both sides heard fairly?

The statements from the BPS make the observation that Dr MacLennan declined to present evidence to support his case despite repeated requests. We are at a loss understand this as it is presented. We could speculate that Dr MacLennan might chose to distance himself from a process that he might believe to be illegitimate and be biased against him and that, by co-operating, he would add spurious validity to it. However, it is a surprise that, in view of the seriousness of the issue for him on a personal and professional level, it is implied that he made no efforts to defend himself robustly. We would ask, therefore, whether he was given due time to collect together all the evidence he might need? Was he able to access all available material that would be necessary, such as privileged communications to which he as an office-holder, would be entitled? What efforts were made by either the Panel or the Responsible Person to find our why he would choose to take this course of action? Was the RP able to satisfy himself that Dr MacLennan did not wish to defend himself in the dock?

Was it a level playing field from the outset?

We can have some idea of how the BPS views complaints from this extract from the Minutes of the Board of Trustees meeting in December 2020

“This year has seen a trend for the potential misuse of the complaints process, where it has been used to express a difference of opinion or dissatisfaction with a consultation outcome.The volume of complaints is a strategic risk for the Society and was considered at the Risk Committee.”

Clearly, complaints about the running of the Society are unwelcoming intrusions rather than a learning experience, a risk to be managed. Whilst is it easy to fob off the ordinary member with tactics such as simply not responding, not answering questions or crudely cutting off debate, when an elected officer, who will be an integral part of the organisation arrives, different tactics will be required.

It was very clear from his election statement that Dr MacLennan was a man on a mission – a mission to overhaul the BPS. His successful election (44% of votes cast) must have given him some confidence that he was doing the right thing. His experience, and that of others who he canvassed and supported him, was enough for him to believe that reform was an absolute necessity. We have no doubt that this energy translated into an enthusiasm and diligence to find out, in greater detail, about the mechanics of how the BPS worked (or, more importantly, how it didn’t work). We have no doubt that for some in the organisation this was a significant threat. We have already noted that the BPS had serious problems well before his election and that many people who were meant to have formal oversight of the organisation had – at the very least – taken their individual and collective eyes off the ball (including the Trustees). To support this assertion we can do no more than to quote part of the resignation tweet of Professor David Murphy, lately Vice-President (and therefore a Trustee during his period as President-Elect and President) which identified 

“…governance oversight, escalating expenditure and lack of openness and transparency…”

as one trigger for his leaving. And that of Past President, Professor Peter Kinderman

“…When I was President, I was routinely excluded from key decisions, was threatened with legal action over ‘fraud’ (I was completely exonerated, of course) and forced to resign (as Vice-President) for advocating for what is now effectively BPS policy…”

So we know, from two very senior past office holders, that there were significant problems well before Dr MacLennan was propelled into the scene. And remember that Professor Kinderman was in post for the two years 2015-2017 (until his forced resignation) and Professor Murphy for the years 2018 – 2021.  We also know, from the minutes of the Board of Trustees meeting in December 2020, that some Trustees themselves were anxious enough about the Society to support

“…a wider discussion in relation to a governance review and stressed the urgency of moving forward with this action…”

Bear in mind also that the Leicestershire police are investigating an allegation of a major financial fraud within the Society.  So we have a picture of an organisation that is clearly dysfunctional and under scrutiny and had been so for some considerable period of time. Is it any wonder that some within the organisation, both staff and volunteers, may have felt more than a twinge of anxiety at the arrival of an avowed new broom? We would suggest that in the light of all this, the BPS bureaucracy was on the defensive. This not only might have influenced the trigger for the investigation, it may have influenced its course.

The third and final post will appear tomorrow, Saturday 22 May 2021.

Peter Harvey, Pat Harvey and David Pilgrim

BPSWatch Editorial Collective.Leave a commentEXPULSION OF PRESIDENT-ELECT

Questioning the Expulsion – Part 1

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This is the first of three posts looking closely at the recent expulsion of the Present-Elect.  We will be asking a series of questions about both the process and outcome, identifying what we see as major deficiencies which highlight, in stark detail, the issues which we have been raising about the sorry state of our organisation. Much of this is speculation and informed guesswork, some generalising from our own experiences because, despite the mass of defensive information coming from the BPS there are many serious omissions and obfuscations.

So, to begin at the beginning.

Can we trust the overall process?

Before we get into the fine detail, let’s step back and cast an eye over the disciplinary process itself.  We would remind you that in the Complaints FAQs on the BPS website there is the following statement

The Society does not have a function to investigate complaints against its members…

This, of course, is in complete contradiction to the various statements in the Member Conduct Rules which do outline such a function. If it were sentient, the complaints process would be in a serious existential crisis. 

We must also remember that we have been told, by the Acting CEO, that the Society is undertaking a root-and-branch review of the whole of the complaints procedure. To put it at its mildest, this suggests that all is not well with the process, whether it actually exists or not.

In addition, we must also ask who actually made the decision to pursue this complaint against the President-Elect. Again, to remind you, the CEO is still ‘out of the office’; there is no CFO; the President has resigned; the Vice-President has also resigned citing failures of governance amongst his reasons for going; we have an “Interim Chair” of the Board of Trustees (presumably this same Board that is accused of the aforementioned governance failures); an acting CEO who is, presumably, involved in the issues raised by the President-Elect. So the question remains, who decided? Was it the full Board of Trustees or some select subgroup of the willing? Was the complete (if depleted, of course, due to resignations) Board given full and unredacted information about the reasons for this course of action and its possible consequences? Who chose the Panel members and the Responsible Person? Did the Board as a whole and unanimously sign all this off?

In view of the serious and unusual nature of this whole business – disciplining the only remaining elected senior officer of the Society must surely rate as out-of-the-ordinary – and the fact that this would be subject to more than the usual degree of scrutiny from the membership and the outside world, one might hope (perhaps, vainly, expect) that the BPS would go to some lengths to show that justice would not only be done, but would be seen to be done.  It should be a shining example of how to do things right. This takes on a particular relevance in the light of the current application to the Professional Standards Authority where matters of monitoring and managing professional standards (the clue is in the name) are paramount.

We argue and will, we hope, show that the whole process, from start to finish, is fatally flawed and itself brings the BPS into disrepute. 

How “independent” is independent?

The various self-exculpatory outpourings of the BPS make great play of the ‘independence’ of the investigation. What does that mean to you? To us it suggests – at the very least – that whoever is carrying out the investigation is as far removed from both the current and past history of the BPS as possible. This is not just a matter of not being a Trustee or a member of the SMT. Many of the problems and issues identified by us and by others pre-date the election of Dr MacLennan by many years. Indeed, as we will see later, at least one past President identified serious problems as did the now-resigned Vice-President who had been in post (President-Elect, President) for two years prior to his abandonment of the sinking ship. So any properly constituted investigatory panel should comprise people untainted by previous appointments as Trustees or as senior post-holders with the BPS. This seems to be particularly important in the light of the fact that this may be, to our knowledge, a unique event in BPS history.  Ideally, the panel should be made up of people from outside of the organisation completely. After all, the allegations against Dr MacLennan were of ‘bullying’ – this is a generic, non-organisation-specific behaviour. You don’t need to know about the arcane intricacies of the BPS to recognise bullying when you see it. Again, given the importance of being seen to do this correctly, it would be sensible to have someone who has considerable HR experience. Was this the case?  No, it was formed of some (number unstated) of ‘…our most senior experienced colleagues…’. The fact is, however worthy and experienced,  they are not independent of the BPS. This failure is also shown by asking the Chair of the Ethics Committee to act as the Responsible Person –  who is accountable to and appointed by the Board. As an officer holder of a Standing Committee of the Board of Trustees, he is neither independent of the Board nor of the BPS. We assume (again, lack of detail makes this suppositional on our part) that he was completely distant from the everyday work of the Panel for otherwise he would be unable evaluate the evidence presented with fresh and neutral eyes.

It is stated by the BPS that 

The process was also conducted throughout with the benefit of independent legal advice to give additional assurance that it was being carried out with propriety and fairness.

This could mean all manner of things. Given that the whole complaints process is muddled and inconsistent and would need an awful lot of (expensive) lawyers’ and consultants’ time to sort through and make sense of, we can only hope that the BPS see this is a good use of your subscriptions. But the point we are making is that even if the letter of law was followed to the last dotted i and crossed t this is not the same as ensuring that the overall process was seen to be just. In our view, it could not be.

We will continue to raise questions in Part 2, to be posted tomorrow (21 May 2021).

Peter Harvey, Pat Harvey and David Pilgrim

BPSWatch Editorial Collective.1 CommentBOARD OF TRUSTEESEXPULSION OF PRESIDENT-ELECTGOVERNANCE

The End of Membership Democracy in the BPS?

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The campaign in the self-serving bunker at the centre of the BPS continues unabated. Its main character, which we have documented in our posts in the past few months, includes a number of strands. Some reflect the tactics of evasion and secrecy. They include complaints being ignored, as well as concerns (that are not complaints) being turned into complaints and sent into a rabbit hole.  The complicit non-reporting of the crisis in ‘the magazine of the British Psychological Society’ has been a trusted management mechanism to keep members in the dark. Dictates have been sent out by ‘Trustees’ to Senate members to demand their silence in a comical pantomime of control freakery.

Other tactics have involved clear projection: a bullying and high-handed culture of management has accused its critics of being the bullies. The power asymmetry here between the parties is ignored but that acknowledgment would require a capacity for honest reflectiveness. Journalists just doing their job in a democracy have been threatened with legal action. By any standards of common sense and fair judgement, this precarious regime of power has had a probity bypass. 

The most egregious example of this has been the ‘investigation’ and subsequent expulsion of the President Elect. His sin was to be open from the beginning about reforming the governance arrangements in an organisation which, for years, had flouted the normal expectations of charity law and good practice guidelines offered by the Charity Commission.

What price membership democracy?

The literal price of being in the BPS is known to its membership. For now, some of those fees are maintaining the high salary of a CEO who is still ‘out of the office’, so remains unable to fulfil his duties. Those in the bunker have told us nothing, so members are left to speculate. 

In the few days that have elapsed since the expulsion of the President Elect was announced (in a scripted account – crafted by whom?), matters have deteriorated further. The unprecedented video from the ‘Interim Chair’ of the Board of Trustees was a callous public disparagement of the President Elect. Speaking from an office and role that, under Statute 20 of the Society, she still has no right to hold, her personalised career-threatening attack upon him remains on Youtube for the world to see.

This scandal now has worsened.  A rapid election is to be held to replace the summarily deposed President-Elect before his appeal has even been heard. From well before he took office there were overt intentions to obstruct him wherever possible. We believe that there is evidence to support this that will be made public. Like the ‘investigation’ of the allegations against him this is a travesty. History will judge those responsible for deposing him, so this faux process of justice will peter out to its discreditable conclusion.

In case members are getting too excited about choosing someone new and untainted by what has gone before, they need to be prepared for a disappointment. This is the score. Only candidates from the current Board of Trustees or Senate members will be permitted to stand. This is the very group under whose ‘oversight’ the Charity Commission has become involved on an ongoing basis. There is an active police investigation into an alleged major fraud (watch this space next month). The self-same group from which the Vice-President resigned,  citing issues about “…governance oversight, escalating expenditure and lack of openness and transparency…”, which he communicated to the Charity Commission.  Former President, Professor Peter Kinderman, informs us that several years ago “…When I was President, I was routinely excluded from key decisions, was threatened with legal action over ‘fraud’ (I was completely exonerated, of course) and forced to resign (as Vice-President) for advocating for what is now effectively BPS policy…” .

What sort of real choice are members now given?   

The candidate will be drawn from a pool of complicit individuals. They assume that everything in the garden is rosy and the much-vaunted £6 million Change Programme will supercharge the BPS, when the membership to date have been shown no substantive evidence to support this wishful thinking. 

Meanwhile, for now, any vestige of membership democracy has been placed on indefinite hold. We can only hope that needed legal proceedings, active media interest and decisive action from the Charity Commission will, between them, resolve this sinister and shameful demise of the public face of psychology in the UK once and for all. 

BPSWatch – Editorial CollectiveLeave a comment‘FALSE MEMORY SYNDROME’MEMORY AND THE LAW GROUP

On memories of abuse….

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The BBC websitethe Daily Telegraph and the Daily Mail are all reporting on the trial of an alleged sexual abuser, the widow of a former High Court judge. All quote the following statement by the prosecuting QC

“He tried to bury away the memories and not to think about them”.

As is her right, we have no doubt every effort will be put into her defence, perhaps even involving the British False Memory Society.

How will any witnesses for the prosecution or the barristers involved be able to rely on a balanced, empirically based set of guidelines to argue against any claims that the accuser’s memories may be ‘recovered or false’? The short answer is that they won’t because ‘The BPS’, in its wisdom, has given up on any pretence to take this matter with the seriousness that it deserves by abandoning the revision of its Memory and The Law guidelines (see here).

We can only hope that the court is able to hear from a balanced and fully informed range of expert witnesses. It is shameful than none of the psychologists who may be in that position will be able to call on the backing and support of their professional society.

The BPSWatch Editorial CollectiveLeave a commentGOVERNANCE

The BPS is unfit for purpose

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This was originally sent as a comment to our post ‘The Crisis deepens…’ We felt that it was important enough to stand on its own as a separate post.

TheBPSWatch Editorial Collective.

I am Professor David Marks, membership number 3829, a Chartered Member with FBPsS, currently a member of the Division of Health Psychology, previously a member of other groups and networks. I joined the BPS as a student in 1963. After completing a BSc and PhD I worked in universities in the UK and overseas carrying out teaching administration and research. I have practiced as a psychologist and worked as a consultant to multiple organisations within the NHS, industry and voluntary sectors. I served as Head of Department at two large Psychology Departments, firstly at Middlesex University, where I worked from 1986 to 2000, and then at City, University of London from 2000 to 2010. I founded two scholarly journals and, for 26 years, have served as Editor-in-Chief of the Journal of Health Psychology

Based on my research publications, I was appointed to a BPS Fellowship in 1984. In the early 1990s, I was elected chair of the BPS Health Psychology Section, which was taken into Special Group status and subsequently to a Division. I was actively involved in the BPS accreditation of the first MSc awards in health psychology and the first Stage 2/doctoral training provision in the UK. I sat on various BPS boards and represented the BPS on international bodies. Over many years multiple elected and unelected BPS officers were well known to me and I counted many as personal friends. 

It with sadness and regret that I believe that I must state my concerns about the Society, its organization, working practices and public outputs. 

I am writing this comment in support of the recent blog postings on ‘BPSWatch’. I do not know and have never met any of the three authors. However I have read their postings and find myself in total agreement with the points they have been making. Rather than resign from the Society, which has crossed my mind on numerous occasions, I had always hoped that change could come from within. Now, seeing the total chaos that reigns, and the complete lack of transparency, accountability and honesty with members, I am strongly doubtful.

I can summarise my current thoughts on the BPS in four sentences: 

1) The BPS is grossly failing the public good, its members, and the discipline of Psychology.
2) The current problems of the BPS cannot and will not be solved by tinkering with the system, as has been tried unsuccessfully on a frequent basis over several decades.
3) Only root-and-branch restructuring would be able to make the necessary changes to achieve the objects of its charter.
4) Sadly, I do not believe the BPS has the wherewithal to achieve the necessary structural reorganization that is called for.

The BPS website (https://www.bps.org.uk/about-us/who-we-are) states:
“The British Psychological Society is a registered charity responsible for the development, promotion and application of psychology for the public good.
Through our Royal Charter we are charged with overseeing psychology and psychologists in the UK, and we are governed by a number of democratically-elected boards and committees.”

My nearly 60-year long association with the BPS indicates to me that the BPS is woefully unfit for purpose. The BPS fails to meet its obligations as a registered charity. This fact is evidenced by the Society’s:

Ineffective governance
Lack of accountability
Lack of transparency
Institutional racism
Improper complaints procedures
Willful neglect of fraud and/or malpractice

In due course, unless I resign first, I will address each point on this and/or my own blog site at: https://davidfmarks.com/

David F Marks
5 May 20211 CommentBOARD OF TRUSTEESFINANCIAL ISSUESGOVERNANCE

Twenty Tough Questions for ‘the BPS’

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Questions are coming thick and fast from colleagues new to the story of the crisis in the BPS. Of course, they are new to it because, amongst other things, the Board of Trustees (BoT) and Senior Management Team (SMT) have been secretive about the facts. In the past year nothing has appeared in The Psychologist (relevant note: ‘the magazine of the British Psychological Society’) to give the slightest hint of any organisational problems. The CEO’s monthly homilies petered out with no editorial explanation. The President, who has recently resigned, made absolutely no mention of the troubled state of the organisation in her final ‘reports’.

This blog and an increasing number of reputable journalists are now bringing into public gaze the extent of organisational dysfunction in the Society. We have been trying our best to do what the BPS has palpably failed to do in relation to transparency. However, we are not private detectives or forensic accountants and nor do we have the investigatory powers of the Charity Commission. The latter is hovering nearby, but to date it has not fully disclosed its intentions in relation to its ongoing ‘engagement’ with the BoT. Given the very large file of complaints against the Society, we are left wondering what will be the tipping point for them to announce a Statutory Inquiry.

The 20 questions that require answers

Here we raise some questions crossing our minds and those put to us by perplexed colleagues. Ipso facto, we cannot answer them definitively but we can pose them in good faith on behalf of the membership.

  1. Why is the CEO still in post and being paid (from membership fees) but ‘not in his office’?

2. The Finance Director left the Society abruptly just before Christmas last – what were the circumstances surrounding that departure?

3. Was the expelled President Elect genuinely allowed to conduct his duties and was he given access to information appropriate for that task?

4. Was there a deliberate strategy on the part of the BoT and SMT to marginalise and disempower him, given his election pledges to rectify governance problems in the Society?

5. Was there a large fraud conducted in the Society that is still being investigated by the police? 

6. What recruitment checks were conducted on the person who was alleged to have committed the fraud?

7. Who appointed this person?

8. Was the arson attack on the Leicester office during this period of turmoil (unreported to the membership) linked in any way to the alleged fraud investigation?

9. Did the BPS report the arson to the Charity Commission, as it is supposed to do under their guidance?

10. Why did the SMT refuse to give the BoT access to critical information, about the £6 million ‘change programme’?

11. What oversight was the BoT providing of the SMT and how was the effectiveness or otherwise of that oversight assessed? 

12. Did the BoT consider that its culture of information restriction, which we have experienced directly ourselves, reasonable for a membership organisation professing a value of openness and transparency?

13. Why did the BoT make public the alleged grounds for the expulsion of the President Elect in advance of his appeal?

14. How can the President Elect have a fair appeal, when it appears to have been already prejudiced?

15. In light of answers to the above questions, has the President Elect been subjected to a ‘kangaroo court’ or ‘show trial’?

16. Was there a planned and wilful campaign to remove the President Elect by the BoT and SMT, as both a radical reformer and a whistle blower, as soon as he was elected?

17. Have journalists making legitimate enquiries, about all of the above matters, been threatened with legal action by the BPS?   

18. Had the Vice-President, who resigned citing concerns about finance and governance, already ensured that those concerns were reported fully to the Charity Commission?

19. The ACAS definition of bullying is this: “Offensive, intimidating, malicious or insulting behaviour, involving an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient.”  Accordingly, does the action of broadcasting a video denouncing the President Elect constitute bullying by the BPS? 

20. Finally, does the BoT now knowingly have a policy to ward off legitimate questions from members about governance matters, by alleging that the questioning, in of itself, constitutes bullying and harassment of BPS staff? 

The final question is rhetorical; as victims of this tactic we can vouch that the answer is in the affirmative. Some of the questions on the list relate to criminal matters and others to aspects of due diligence and common decency. Ordinary members not only pose them now on reasonable grounds, but they deserve reasonable answers. The BoT have warded off the inconvenient truth surrounding the questions, using a mixture of silence, glib evasions, bureaucratic obfuscation and legal threats. 

Is this how we expect a properly functioning learned organisation to operate, with its rhetorical adherence to the principle of openness and transparency? We ask readers to please send us any other questions that come to mind, which we might have missed from the above list. If we cannot answer them we can at least share them.

We will be posting some more detailed analyses of these questions over the course of the next couple of weeks.

The BPSWatch Editorial Collective

Featured

Insights from ME/CFS May Help Unravel the Pathogenesis of Post-Acute COVID-19 Syndrome

New paper by:

Anthony L. Komaroff 1 and W. Ian Lipkin 2

1 Division of General Medicine, Department of Medicine, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA
2 Center for Infection and Immunity, Mailman School of Public Health, Columbia
University, New York, NY

Available here from 7 June 2021

Journal Pre-proof
DOI: https://doi.org/10.1016/j.molmed.2021.06.002

Citation: A.L. Komaroff and W.I. Lipkin, Insights from Myalgic
Encephalomyelitis/Chronic Fatigue Syndrome May Help Unravel the Pathogenesis of
Post-Acute COVID-19 Syndrome, Trends in Molecular Medicine (2021),

https://doi.org/10.1016/j.molmed.2021.06.002

Keywords: myalgic encephalomyelitis/chronic fatigue syndrome, SARS-CoV-2, COVID19, post-acute sequelae of SARS-CoV-2, post-COVID-19 syndrome, long COVID

Abstract


SARS-CoV-2 can cause chronic and acute disease. Post-Acute Sequelae of SARSCoV-2 infection (PASC) include injury to the lungs, heart, kidneys and brain, that may produce a variety of symptoms. PASC also includes a post-COVID-19 syndrome (“long COVID”) with features that can follow other acute infectious diseases as well as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Here we summarize what is known about the pathogenesis of ME/CFS and of acute COVID-19, and speculate that
the pathogenesis of post-COVID-19 syndrome in some people may be similar to that of
ME/CFS. We propose molecular mechanisms that might explain the fatigue and related
symptoms in both illnesses, and suggest a research agenda for both ME/CFS and postCOVID-19 syndrome.

Highlights

In some people, the aftermath of acute COVID-19 is a lingering illness with fatigue and cognitive defects, known as post-COVID-19 syndrome or “long COVID”.

Post-COVID-19 syndrome is similar to post-infectious fatigue syndromes triggered by other infectious agents, and to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a condition that patients often report is preceded by an infectious-like illness.

ME/CFS is associated with underlying abnormalities of the central and autonomic nervous system, immune dysregulation, disordered energy metabolism and redox imbalance. It is currently unclear if the same abnormalities will be identified in post-COVID-19 syndrome.

The US and other developed nations have committed considerable support for research on post-COVID illnesses.

A.L. Komaroff and W.I. Lipkin, (2021)
Featured

The Rise and Fall of the Wessely School

New preprint available here

ABSTRACT

The Wessely School’s (WS) approach to medically unexplained symptoms, myalgic encephalomyelitis and chronic fatigue syndrome (MUS/MECFS) is critically reviewed using scientific criteria. Based on the ‘Biopsychosocial Model’, the WS proposes that patients’ dysfunctional beliefs, deconditioning and attentional biases cause illness, disrupt therapies, and lead to preventable deaths. The evidence reviewed here suggests that none of the WS hypotheses is empirically supported. The lack of robust supportive evidence, fallacious causal assumptions, inappropriate and harmful therapies, broken scientific principles, repeated methodological flaws and unwillingness to share data all give the appearance of cargo cult science. The WS approach needs to be replaced by an evidence-based, biologically-grounded, scientific approach to MUS/MECFS.

Featured

Psyche in Mythology and the British Psychological Society of Today

Psyche/ˈsʌɪki/the human soul, mind, or spirit

“their childhood made them want to understand the human psyche and to help others”

Similar: soul spirit(inner) self innermost self(inner) ego true being essential nature life force vital force inner man/woman persona identity personality individuality make-up subconscious mind intellect anima pneuma

Opposite: body

Wikipedia

the fountain of knowledge in the contemporary world, states :

Psyche (mythology)

Psyche (/ˈsaɪkiː/;[2]Greek: Ψυχή, romanizedPsukhḗ) is the Greek goddess of the soul. She was born a mortal woman, with beauty that rivaled Aphrodite. Psyche is known from the story called The Golden Ass, written by Lucius Apuleius in the 2nd century. See Cupid and Psyche.

The following text is extracted directly from Wikipedia and adapted to the world of the British Psychological Society, which uses Psyche as its figurehead and logo image. Readers can make their own comparisons to recent events within the Society, such as these may be discerned by interested parties.

Early life

Psyche was the youngest child of a Greek king and queen. She had two elder sisters. She was the most beautiful among her siblings and she looked like a goddess among mortals. She was so beautiful that people, including priests, compared her to Aphrodite, the Greek goddess of love and beauty. Many went to the extent of saying that she was even more beautiful than the goddess. When Aphrodite’s temples were deserted because people started worshiping Psyche, the goddess was outraged. As a punishment, she sent their son, Eros, to make Psyche fall in love with a vile and hideous person. However, Eros fell in love when he saw her and decided to spare her from his mother’s wrath.

Both of her elder sisters were jealous of her beauty. Her sisters eventually got married with kings and left to be with their partners. Nobody asked Psyche’s hand for marriage; people would rather admire her beauty. She was left alone. Desperate, her father decided to consult the oracle of Delphi to get answers.

Wikipedia

Marriage to Eros

The story continues:

[Psyche’s] father, the king, consulted the Oracle of Delphi for the solution of this problem. From inside the priestess, Apollo himself spoke. He said, “Despair, king. Your daughter will marry a beast even the gods fear. Dress her in funeral clothes and take her to the tallest rock spire in the kingdom. There, she shall meet her doom.” Hearing this, the king was heartbroken. But since he had got direct orders from Apollo, he did as he was ordered.

He took her in funeral clothes to the tallest rock spire in the kingdom. Psyche waited for the beast to come, but when it did not come, she took matters in her own hands. She jumped off the spire. Everyone in the kingdom thought she was dead.

[This is precisely how some members view recent events within the British Psychological Society.]

But Zephyrus the Greek lord of west wind, had saved her from death. He had taken her to Eros‘s palace where she waited until night for Eros to return. There, she saw that the palace was very large and each cupboard was filled with gold. When Eros returned, he said to Psyche in utter darkness that she must not see him. She must not try to see him and he can’t tell her his name or it would ruin everything. 

The first few weeks of Psyche’s life in the palace were great, but soon she heard her sisters calling out her name. Her two sisters convinced her to see her husband’s true form, in case he was tricking her.

Psyche eventually listened to what they told her. She snuck into her husband’s room with an oil lamp and a knife. Psyche shone the light on her husband’s face, and a small drop of hot oil fell onto his shoulder, awakening him and burning him.

Betrayed by his wife’s actions, Eros ran off to his mother, Aphrodite. After learning what she had done, Psyche was miserable and depressed.

Aphrodite found Psyche and made her face four trials. 

Wikipedia

Trial Number One

According to the myth, Psyche’s first trial was to sort a huge mount of seeds. With the help of an empathetic ant colony, Psyche completed this task.

Wikipedia

Translating ‘seeds’ as ‘data’ and ‘ants’ as ‘BPS members’ creates a simile for the current organisation of the British Psychological Society.

Let me explain.

Recently I contacted Neil Baker, the Society’s Diversity and Inclusion Manager seeking any existing sociodemographic data held by the Society on the diversity of the BPS membership and workforce including gender, ethnicity and age. Neil responded as follows:

“the BPS declaration on equality, diversity and inclusion has formed the basis of all work relating to EDI (Electronic Data Interchange) over the past five years, including our commitment to anti-racist practice and decolonising the curriculum. The declaration will be replaced later this year by a brand new 18 month strategy incorporating EDI outcomes...

“In terms of demographic data BPS has been working hard to ensure demographic and diversity data form a core part of all membership systems. This work will lead to roll out of a brand new CRM system for membership over the next six months…

Our commitment to capturing data is embedded in our core belief that membership data can help the society actively challenge prejudice and discrimination, while promoting equity, social mobility and inclusion. While at the same time, allowing us to explore potential gaps, barriers and/or concerns for members as they undertake their membership journey.”

In spite of all its professed, good intentions, the BPS is yet to collect any sociodemographic data on its membership and so does not have the foggiest idea about this issue.

It is notable that Neil Baker has neglected to provide any information on the socio-demographics of the BPS workforce. Surely the Society must have this information in its HR department but, seemingly, prefers not to reveal it. One can only imagine why this might be the case.

The Society’s official policy and its actual practice could not be more different. I can illustrate this fact with an account of a personal experience of what can happen when one attempts to “actively challenge prejudice and discrimination, while promoting equity, social mobility and inclusion.

[Health warning: expect to be insulted, attacked and canceled if you should ever have the audacity to attempt this.]

In July 2017, I tweeted about The Psychologist‘s penchant for ‘white’ people on its covers and in its content of its publications. Editor Sutton responded that I was being “shrill and condescending” and he would “continue the discussion today with others who might have more constructive stuff to say”.

Sutton later accused me of trolling him, something he (wisely) later retracted.

Jon Sutton states his mantra that his team believe they are “doing good things”.

Then comes a very curious statement: “over those four years we’ve repeatedly been criticised on here in the opposite direction…”

What could this possibly mean – that the Psychologist editor has been repeatedly criticised by BPS members for being too non-racist?

If so, that is extremely alarming. Because there has been an objective, racist bias within BPS publications over the entire history of the organisation aided and abetted by its appointed editors. There are multiple examples.

The Society’s deletion of members’ comments does not pass unnoticed:

So much for the ability of concerned members to challenge the Society’s publication practices and policies.

The BPS needs to establish an anti-racist policy which is supported by a statistical database of the sociodemographic diversity of its membership that can be tracked over time.

It is unacceptable in the third decade of the 21st century that the BPS is playing catch up on a process that has been standard in reputable institutions of higher learning for years.

Psyche, wake up from your slumbers. Wake up, or you will die.

Trial Number Two

[Psyche’s] next task was to gather wool from a notoriously dangerous sheep. Psyche was saddened but helped by a river god, who taught her to collect pieces of wool from bushes.

Let’s translate ‘wool’ as ‘criticism’ , ‘dangerous sheep’ as ‘critics’ and the ‘river god’ as the recently deposed President-Elect. The latter had been elected on an explicit platform to transform the Society’s out-dated and ineffective structure and governance.

It is current practice of the Society’s unelected officers to not respond to, cancel or delete all forms of criticism. Witness this example. I submitted the following (abbreviated) critical comment on The Psychologist website on 2nd June 2021. As predicted, it got deleted five days later, but not before it had been archived:

Pravda-esque

Permalink Submitted by David F Marks on Wed, 06/02/2021 – 10:25

If the issues affecting the BPS and its membership had never been more serious and dire, I would think this article on “Power Posing” must be an embarrassing joke…

Readers interested in how their membership fees are being squandered can get up to speed by reading “The legitimation crisis and a membership denied answers” available at: https://bpswatch.com/. You will not find any of the most essential information here in the Psychologist. It has all been embargoed by the unelected management.

Instead of doing a genuine job as a forum for “communication, discussion and controversy”, this magazine hides behind the coattails of senior management and drags its readers through the pseudoscientific depths of topics such as ‘power posing’.  

Contrary to its published statement to “provide a forum…among all members of the society” and “to promote the advancement and diffusion of a knowledge of psychology pure and applied”, the Psychologist’s editor, Jon Sutton, serves as a minion of the unelected officers of the BPS Psychologist. BPS members are treated with contempt by the Society and its magazine. This un-peer-reviewed magazine claims to promote advancement of knowledge; on the contrary it promotes a regress to the lowest common denominator of  content that aims to be ‘popular’. Unfortuntaely, ‘Pop Psychology’ tends to be ‘Pseudopsychology’, as Mr Loncar’s article demonstrates. 

The Psychologist fails to address the most relevant truth: the BPS has reached a nadir in its reputation as a professional society and has no credible governance. In parallel, a nadir has been reached by the Psychologist in the art of bullshitting as eloquently explained in the May issue by Emma Young: “people who bullshit more often in a bid to impress or persuade others are also more susceptible to bullshit themselves”. 

As the complaints mount up, the Charity Commission is investigating. One fears that the ending of the BPS story will not be a good one. 

The BPS needs to stop debarring, deposing, canceling and deleting those who are critical of its policies, practices and governance, start listening to its members and to radically transform at root-and-branch level its current processes of communication, governance and decision making. Or it will die.

Trial Number Three

[Psyche’s] next task was to collect water from the underworld. Psyche was now assisted by the eagle of Zeus, who collected the water for her.

Translate ‘water’ as ‘evidence’, the ‘underworld’ as ‘malpractice’, and the ‘eagle of Zeus’ as ‘ethics procedures’ and the simile is pertinent to the recent practice of the Society.

In my capacity as Editor of the Journal of Health Psychology, an independent, non-BPS journal, and as a BPS Fellow, I wrote an Open letter to the Chief Executive of the BPS about the malpractice of a major figure within British Psychology, the late Professor H J Eysenck:

Dear Mr Bajwa,

I am writing about a serious matter concerning the research integrity of a person who one can presume was a member of the British Psychological Society. In the interests of openness and transparency, this is an Open Letter. If left unresolved this is a matter that can be expected to produce potential harm to patients, to biomedicine and science, to your institution, to its members and students. Although Professor Hans Eysenck died in 1997, the issue of alleged falsified science committed by the late Professor remains current to the present day.

To give a few examples, the 2017 edition of Eysenck’s autobiography published by Springer, in relation to the causal link between smoking and cancer, states, ‘On a purely statistical basis the causal efficacy of smoking – if this can be deduced at all from a simple correlation – is very much less than that of psychosocial factors; about one-sixth in fact’ (Eysenck, 2017Rebel with a Cause. Kindle Locations 3759–3761). Is the claim that psychosocial factors are six times more important than smoking something that the British Psychological Society is content to endorse or is it a claim that the BPS would like to see corrected? Or consider where Eysenck describes the effectiveness of psychotherapy in preventing cancer: ‘The total number of deaths in the control group was 83 per cent, in the placebo group 81 per cent, and in the therapy group 32 per cent, again demonstrating the efficacy of the method in preventing death from cancer and coronary heart disease’ (Eysenck, 2017, Kindle Location 3804–3806). Or the section where Eysenck claims that ‘there is some evidence that behaviour therapy may be useful in prolonging life, as well as in preventing disease’ (Eysenck, 2017, Kindle Locations 3821–3822).

I hope that the Society will add its voice to those who are requesting that the relevant publishers and journals should correct or retract Eysenck’s publications wherever they can be shown to contain questionable data-sets or claims that are known to be false.

The case is fully documented in Dr. Anthony Pelosi’s peer-reviewed article: ‘Personality and fatal diseases: revisiting a scientific scandal’. As the Editor responsible for the peer review and publication of Dr. Pelosi’s article, I have every confidence that Dr. Pelosi’s evidence and conclusions are reliable and true. In light of the policies and statutes of the British Psychological Society concerning research integrity I bring this case to your attention for investigation. A full and thorough investigation would be good for Psychology, for the research integrity of the BPS as a professional society and for the welfare of patients and the general public.

I look forward to your response.

Kind regards, David F Marks BSc PhD CPsychol FBPsS
Editor, Journal of Health Psychology

The letter was sent two-and-a-half years ago (in October 2018) and no reply has ever been received. This lack of response is discourteous and unprofessional. Some might say plain rude.

The BPS needs to stop prevaricating, formulate a clear, unambiguous ethics policy and implement that policy without fear or favour. Or it will die.

Trial Number Four

The myth continues:

Psyche’s last task was the most difficult; she had to bring back some of Persephone’s beauty for Aphrodite. Persephone willingly gave Psyche some of her beauty. When she was near Olympus, Psyche opened the box of Persephone’s beauty, but the only thing inside was the essence of death.

Psyche died, but her husband, Eros, who had forgiven her, saved Psyche’s life and took her to Olympus.

Psyche was made the goddess of the soul.

Task four requires no translation.

Conclusion

What will be the fate of Psyche? Will she be saved, or will she forever remain a myth of a bygone age?

Featured

Can Long-Covid be Cured with the Mind: Expert Patient or Nutty Professor?

Guest authored by Dr. Keith Geraghty
I am a research fellow working from the University of Manchester Centre for Primary Care. A major focus of my work is on medically unexplained symptoms and illness. I promote evidence-based medicine and psychology, so like a detective, I spend a lot of my time discerning ‘good’ and ‘bad’ data and science, particularly in the field of health psychology. I am currently researching ‘Long-Covid’, the name giving to a syndrome of lingering symptoms post-Covid infection. The Office of National Statistics recently reported an alarming figure that 1.1 million people in the UK may be experiencing Long-Covid, with symptoms lasting anything from a few weeks to a year or more.

‘Weird as Hell’: From Near Death to Diving

Perhaps the most famous of all Long-Covid patients is Professor Paul Garner at Liverpool School of Tropical Medicine and a founding member of the Cochrane Collaboration, a group that seeks to provide credible answers to the many questions impacting modern medicine. Garner began blogging about his struggle with Covid that he contracted on the 19th March 2020 in the British Medical Journal website. His blogs continued through until January 2021, whereby he details his experience of suffering Long-Covid for 7 months. Garner has done considerable amounts of media engagements, an interview on BBC Newsnight, live interviews on BBC Breakfast, interviews for radio and TV in Australia, CNN, media in the US, Europe and beyond, newspaper articles, blogs and live zoom meetings with senior NHS clinicians, regaling of his personal story. Garner has done more media on his Covid experience than most academics might do over the course of their entire careers.

Garner’s story resonated with many doctors and health professionals suffering from Long-Covid, many of whom had to stop working due to lasting symptoms like extreme fatigue, pain, breathlessness and cognitive complaints. What a great story, a doctor and professor going out there telling the world that Long-Covid is real and that recovery takes time – only problem, my fact detector hit high alert when a patient sent me a picture of Professor Garner on a diving holiday in Grenada in November 2020 during the midst of the pandemic and around the time of the UK travel lockdown, and smack bang in the middle of his media stream.

Stepping into a ‘Parallel Universe’: From Near Death to Diving in Grenada

Wow I said: “what a remarkable recovery story, to go from near death’s door to diving in the Caribbean sea”? I had listened to the professor on BBC Breakfast in January 2021 and he made no mention of his trip abroad, and even more curiously, I had listened to a BBC Radio Leeds interview he gave on 5th of October 2020 where he stated he had ‘only started to feel a bit better in the last week or two’. Could someone with Long-Covid, who said they could hardly get out of bed for many months, go from that level of poor health to being able to dive in the Caribbean within the space of a month? I wanted to know more

Piecing the Garner story together required a notepad, a pen, and some of the type of head scratching you might see on an old episode of the Columbo detective show.

He Could Control His Brain, he said

I don’t doubt the veracity of Professor Garner’s Covid story, his symptom profile fits the classic presentation, but he does admit that he has never had an actual positive Covid test. This is not unusual – many Covid sufferers do not get tested or attend hospital. My interest in the Garner story peaked when I read a number of interviews with him where he said he put his recovery down to being able to ‘control his brain and stop fatigue and alarm signals to his body’. Essentially, Garner now claims that be cured his Long-Covid using the power of his mind. In his Sept 4, 2020 BMJ blog, Garner wrote:

“Has covid-19 gone?” My first thought every morning for six months. A few weeks ago, I was jubilant. The muscle aches had evaporated, my head was clear. I announced this to Rachael, a friend who knows chronic fatigue well. “Fantastic, Paul. You have found your baseline.” Crestfallen, I realised this was not the end; it was the end of the beginning.

Garner often uses metaphors to describe Long-Covid, such as ‘like a cricket bat that hits you over the head’ – an apt but perhaps ornate wording to use for a professor of infectious diseases who must have seen many hundreds of patients with similar post-infectious symptoms over the years. So, by early Sept 2020 Garner had a dramatic fall in symptoms but some lingering issues. Like detective Columbo, I noted the importance of the timeline.

He recounts doing a 10-minute bike ride prior and having some symptom flare. This is commonly known as post-exertional malaise and is often seen in post-infectious illnesses, such as chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS) – and illness I research. At this point, Garner talks about his illness resembling ME/CFS. His concern about this would be well-founded, many ME/CFS patients report that their illness started after an infection, and while some recover relatively quickly, a large percentage go on to suffer debilitating symptoms for years.

So, how does Garner go from Long-Covid and possible ME/CFS in September to full recovery in October and diving in November?

He Receives a ‘Magical’ Phone Call

The answer, according to Garner, lies in a mysterious phone call he received from a psychology coach in Norway, whom he claims helped him overcome his fear of exercise. He writes in one interview 12 March 2021:

Later, she asked what I most feared. I said payback and relapse from exercise, which was making me sad as I love exercise. So she suggested we both went for (separate) bike rides, and left the video call running then meeting back at the computer. She would help me deal with any side effects from the cycle ride. I went out on my bike, a gentle 20 minutes, and I was just overjoyed. I was suddenly out doing what I love which I’d stopped myself doing because of all this fear and there was absolutely no kickback. Then I used graded exercise therapy, which is often recommended for chronic fatigue. I started with 20 minutes a day for a week, then up to 30 minutes in the second week. After two weeks, I was back at my military fitness class in the park.

So, Garner’s symptoms had subsided in September and he was doing 10-minute bike rides and sometime in October he was able to have no symptoms after a 20-min bike ride and a magical phone call from his coach. Within 2 weeks he was back doing full military exercises in the park – a truly remarkable tale. Garner writes that he was a fitness fanatic pre-Covid infection, thus he was delighted to be back at his local park doing regular exercise.

Can the Conscious Mind Heal the Body?

Garner says in his January 2021 BMJ blog that,

I was asked, “are you open to the idea that you can have an impact on your symptoms with your conscious mind?” and that “This opened the door that led to my recovery”.

I returned to my notebook: Garner had written to an ME/CFS patient in early October 2020 stating that he did not have the classic ME/CFS symptom of orthostatic intolerance (difficulty standing) and that he was doing 5km walks daily, but was fearful of increasing the distance. In a TV interview Garner gave to Channel 5 news aired 23rd of September, Garner can be seen walking relatively long distances around Liverpool docklands and getting a local ferry, yet in the same interview Garner reported that he still felt ‘disabled by Long-Covid’. Garner’s perception of his disability is not in question, my only observation concerns the fact a person doing 5km walks daily would not generally meet any criteria for ME/CFS, as Garner claimed, and the physical improvements around Sept-Oct appear to have occurred prior to his meeting with the mysterious Norwegian psychology coach that led to his statements that he overcame Long-Covid using his mind.

Garner’s claims about the power of mind to heal illness are not new in my field of research; the only question is what evidence do we have for such claims. In this case, we have the personal account of one patient’s story, albeit a very influential and prominent patient who holds centre-stage in many media reports on Long-Covid and a doctor who seems to be at the epicentre of professional forums with NHS leaders about how best to treat Long-Covid patients. Garner has come out in favour of a controversial treatment called Graded Exercise Therapy (GET), a treatment that the National Institute of Health and Care Excellence (NICE) UK plans to drop as a recommended treatment for ME/CFS. Garner has been critical of this decision.

Healing over Time – Naturally

What is most remarkable to me as an evidence-based medicine and health psychology researcher is the fact a professor of infectious diseases and expert in evidence-based medicine, makes scant mention of the fact that the vast majority of Covid sufferers will recover in time, even those who suffer Long-Covid. Research by Kings College London suggests that around 10-15% will suffer lingering symptoms lasting longer than 6 weeks, but again by the end of year 1 this percentage will be vastly lower.

The human body takes time to recover from infections, people recover at different rates and humans experience illness and symptoms in different ways. Covid-19 is a novel human disease, and we do not fully understand how it impacts health, but early data suggest the majority of people will recover. However a significant but smaller percentage of patients may well continue to suffer longer term health complications. Eventually most people recover simply by the body’s own healing powers of homeostasis.

So, why does Garner put his recovery down to the power of his mind, rather than the power of his body and cells, which operate largely outside of his conscious control?

Believing the mind can cure Covid is perfectly fine as a belief, some people believe crystals can help heal illness, others believe in the power of prayer. I make no disparaging comment on anyone’s beliefs, but Professor Garner is not a lay person. Since his miraculous recovery he has sat on high-level medical meetings with NHS clinicians regarding the best way to manage patients with Long-Covid. Garner’s story and position carry weight – he is no ordinary patient, hence why media outlets chose his story above that of many other sufferers. Therefore the details of his personal case-study and beliefs are of importance.

Mistories

Garner, like all of us, is at the mercy of one of the strongest biases in everyday experience: ‘subjective validation’. The mind-body connection is a fascinating and complex research topic, but the brain is also part of ‘the body’ – such a distinction is often missed. Being ill causes anxiety, and a global pandemic that has killed many people impacts collective anxiety. Being struck down by a mysterious virus, must be a terrifying experience, many people will require medical and psychological support, but it’s important that personal anecdote does not become factual dogma – that is why ‘evidence-based medicine exists’.  

In Garner’s January blog he uses yet another metaphorical soundbite when he says he ‘stared down the barrel of ME/CFS and disarmed it’. Garner claims he met the Canadian Consensus Criteria for ME/CFS. This Criteria requires at least 6 months unexplained fatigue and 5 other symptoms that are not associated with an acute or linked illness. Garner was suffering from Covid, this explained his symptoms, and he recovered within 6-7 months, so he either never had ME/CFS or met the criteria for 1 month before full recovery. This point exemplifies the potential harm of taking one person’s story as ‘credible evidence’ – evidence-based medicine exists to overcome such bias. Yet, Garner continues to tell media outlets and health care officials that exercise is a good treatment for both ME/CFS and Long-Covid and he continues to promote his story of mind-over-matter. In a November interview Garner did with Swedish TV, a reporter asked him how get got out of bed to do military exercises in the park, he states he ‘Got up out of bed, relaxed, thought about nice things and jumped on my bicycle and went off to fittness class…and felt better that evening’

Symptoms ‘Evaporated’ Overnight

The implicit message Garner promotes is that others with ME/CFS and Long-Covid, many being health professionals like doctors and nurses who’ve been unable to recover fully since contracting Covid working on the frontline of the NHS, should just stop being afraid of exercise, relax and get outside. Such a narrative grossly distorts the reality of the diseases ME/CFS and Long-Covid, minimises the role of immune and other physiological dysfunction in these disorders, and stigmatises sufferers as anxious hypochondriacs – symptoms are real, but not related to anything biological. His underlying claim is that symptoms are manifestations of fearful thoughts that can be overcome with the mind. This is not a scientific explanation, it’s one man’s story, it won’t fit all patients, it may be dangerous for some patients to ignore symptoms and head to the park for exercise, it’s also insulting to many others, both ME/CFS and Long-Covid patients, doctors and health care staff, health care assistants in nursing homes and so on, who remain unwell after putting themselves in harms-way. Professor Garner states that he has the support of his employer during his months of convalescence, many Long-Covid sufferers aren’t so lucky and will suffer ongoing physical, mental and economic challenges.

Conclusions

Paul Garner’s recovery may have had very little to do with his mind, yet his mind now tells him it was the most important factor. That is perhaps the true power of the mind. The mind subjectively validates the stories one tells about oneself.

In his early media posts Garner said pacing helped, and also diet, sleep, rest, accommodating to the virus and setting up a self-help support group, all before the magical mind guru entered his Long-Covid tale.

This researcher wishes Professor Garner continued good health, but remains concerned that Long-Covid NHS care planning could be influenced by anecdotal stories; we must listen to all patients and be evidence-led.

text © Keith Geraghty, 2021

Featured

Myalgic encephalomyelitis/ chronic fatigue syndrome as a breakdown of homeostasis

David F Marks published on 31 May 2021 here

Abstract

Homeostasis is a fundamental physiological principle that ensures equilibrium, stability and safety of the organism in a continuously changing and potentially life-threatening environment. This article introduces a new theory of the aetiology of ME/CFS that hypothesises that ME/CFS is caused by a breakdown of homeostasis that produces an aberrant state of disequilibrium with endocrinological and immunological changes.  The current hypothesis is that ME/CFS involves a changed set point such that homeostasis persistently pushes the organism towards a pathological dysfunctional state because the disequilibrium fails to reset. To use an analogy of a thermostat, if the ‘off switch’ of a thermostat stops working,  the house would become warmer and warmer without limit. Here I summarise the evidence in support of the theory. Clinical trials to investigate the role of suggested biological mediators such as thyrotropin-releasing hormone in ME/CFS would appear to be helpful.

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Neural mechanisms of social homeostasis

Annals of the New York Academy of Sciences

Gillian A. Matthews and Kay M. Tye First published: 15 March 2019 

https://doi.org/10.1111/nyas.14016

Originally published as a REVIEW

Open Access Article

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Abstract

Social connections are vital to survival throughout the animal kingdom and are dynamic across the life span. There are debilitating consequences of social isolation and loneliness, and social support is increasingly a primary consideration in health care, disease prevention, and recovery. Considering social connection as an “innate need,” it is hypothesized that evolutionarily conserved neural systems underlie the maintenance of social connections: alerting the individual to their absence and coordinating effector mechanisms to restore social contact. This is reminiscent of a homeostatic system designed to maintain social connection. Here, we explore the identity of neural systems regulating “social homeostasis.” We review findings from rodent studies evaluating the rapid response to social deficit (in the form of acute social isolation) and propose that parallel, overlapping circuits are engaged to adapt to the vulnerabilities of isolation and restore social connection. By considering the neural systems regulating other homeostatic needs, such as energy and fluid balance, we discuss the potential attributes of social homeostatic circuitry. We reason that uncovering the identity of these circuits/mechanisms will facilitate our understanding of how loneliness perpetuates long‐term disease states, which we speculate may result from sustained recruitment of social homeostatic circuits.

Introduction

The twenty‐first century has unleashed a tsunami of opportunities for social engagement and accelerated the flow of social information. Yet as our outlets for social sustenance proliferate, along with the global population,1 there is a paradoxical increase in social isolation within society.2 The proportion of the population who live alone has risen3 and an increasing number of people experience loneliness.45 Social isolation presents itself in multiple forms including social rejection, exclusion, ostracism, discrimination, social loss, or neglect—all of which have a significant negative impact on emotional state. Across the animal kingdom, social isolation can threaten survival—individuals lack protection from predators, assistance foraging, support raising offspring, opportunities for social play, and mating prospects. Similarly, in humans, deficits in objective quantity and/or subjective quality of social relationships can compromise longevity.6 Lower social integration (assessed by network size/participation, living arrangements, and frequency of close social contact) is predictive of elevated mortality,69 and even just the perception of isolation (colloquially referred to as loneliness) is associated with poor physical and mental health1011 and higher mortality rates.1213

However, beyond just constituting an unwelcome emotional side effect of social isolation, loneliness is theorized to represent an “adaptive predisposition” providing the motivational drive to maintain social contact and prevent the aversive consequences of isolation.1415 This adaptive response to deviation from an expected quantity/quality of social connections is reminiscent of negative feedback mechanisms triggered by challenges to physiological homeostasis, such as energy balance or thermoregulation.

In our review, we introduce the idea that coordinated adaptations across discrete neural circuits function to maintain “social homeostasis.” The term social homeostasis has previously been applied to the maintenance of stable organization within a large group of animals, typically social insects, such as ants, termites, and bees. This “supraorganismal” structure requires tight regulation to maintain stable social organization when met with changes in the environment or internal composition.1617 Here, we propose to extend this concept to the individual level in order to encourage a mechanistic understanding of how deficiencies in social connection are detected and evaluated, and how effector systems are activated to compensate for perturbations.

Social homeostasis: a widespread phenomenon

Homeostasis classically refers to physiological processes wherein stable states are maintained through compensatory mechanisms.18 Homeostatic systems are known to exist for a number of physiological needs essential to survival such as thermoregulation, energy balance, and osmoregulation. These rely upon detection of a deviation from a defined homeostatic “set point,” followed by central coordination of a response in a “control center,” and the recruitment of “effector systems” that interact with the environment to correct the deviation (Fig. 1). Challenges to physiological homeostasis can also elicit motivated behaviors associated with strong negative “drive” states, such as overheating, thirst, and hunger, designed to appropriately adapt/direct behavior.1921

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Figure 1Open in figure viewerPowerPointProposed model for social homeostasis. Based on Cannon’s classic model for homeostatic regulation,18 we propose that a social homeostatic system consists of a detector to sense a change in overall quantity/quality of social contact, a control center to compare this deviation to the individual’s set point, and effector systems to correct the change. (A) Detection of social signals (both their quantity and quality) would require social recognition in order to facilitate recall of previous social encounters and determine the expectation for interaction. Information relevant to the identity of the social agent (recognizing that individual as such) as well as estimation of their relative social rank would be required for appropriate evaluation of a deviation. Integration of this information may occur at the level of the detector (model A) or the control center (model B) stage of processing. Identity and rank information may be represented in an overlapping or nonoverlapping fashion (callout box). For a familiar animal, both these variables may be incorporated to set social expectation, but for an unfamiliar animal, only rank perception would be available. (B) Deviations from the set point would be evaluated within the control center by comparing the current social input to the homeostatic set point for quantity and/or quality of social contact. The social control center may integrate information pertinent to other homeostatic needs (e.g., energy balance, fluid balance, and thermoregulation) in a “hub and spoke” fashion (model A), or the social control center may be subservient to other homeostatic control systems (model B). Alternatively, integration of homeostatic needs may occur in a convergent arrangement onto shared effector systems (model C), with interconnections between control centers (model D). (C) If a deviation from set point is determined, effector systems may be engaged to correct the change. This process could include activation of “external” effectors to promote behavioral adaptation (e.g., social approach/avoidance) along with “internal” effectors to adjust internal/emotional state (model A). Alternatively, engagement of internal effector systems, and a change in emotional state, may itself promote behavioral adaptation (model B).

While a change in social connection may not appear to constitute an immediate challenge to internal stability, individuals on the social perimeter are vulnerable and becoming isolated can threaten survival. Even in controlled laboratory environments (where external threats to survival are absent), the presence of social contact is associated with increased life span across a range of social species including honeybees, ants, Drosophila melanogaster,2223 mice,2425 and rats,2628 as well as in free‐ranging groups of macaques29 and baboons.30 Therefore, an emerging social neuroscience model posits that evolutionarily conserved neurophysiological mechanisms underlie the adaptive, short‐term, self‐preservation mode triggered by a lack of social connections/mutual protection.1431 This model proposes that loneliness operates as an aversive signal designed to promote adaptation to the vulnerabilities of being alone and motivate reconnection.32 Thus, the long‐term disease states perpetuated by chronic loneliness may result from the prolonged engagement of neural systems that were intended for short‐term preservation.

To begin unraveling how the chronic state of loneliness emerges, it is necessary to first understand the neural response to social deficit. Conceptualizing this as the response of a homeostatic system would apply certain defined principles (Fig. 1). A social homeostatic system would be required to (1) monitor social conditions; (2) detect deviation from a homeostatic “set point” in control centers; and (3) activate effector systems to elicit an appropriate response (e.g., strategies to promote social contact). A deficit in social connections (whether perceived or actual) would be predicted to engage this system. In animals, one way to create a social deficit is to remove social contact entirely. While this only captures the objective component of social isolation, it offers controlled conditions for assessing rapid neurophysiological adaptations. Chronic social isolation, particularly in rodents, has been used as a developmental model of early life stress since many of the long‐term maladaptive changes resemble features of human neuropsychiatric disease.33 This rich body of work has been comprehensively reviewed elsewhere for both rodents3337 and nonhuman primates.3840

Alternatively, here we examine the response to acute social isolation (using under 1 week as an arbitrary operational definition of “acute” for the purpose of the review) in order to identify candidate neural circuits involved in the rapid response to social deficit. We focus primarily on experiments in social rodents, including laboratory mice (Mus musculus), rats (Rattus norvegicus), and prairie voles (Microtus ochrogaster), which are social species, adapted to group living, but with different styles of social behavior. The wild species of mice and rats from which laboratory strains were derived are promiscuous and territorial, but show greater social tolerance in high‐density living environments and adopt linear dominance hierarchies that promote group stability.41 In a laboratory setting, mice and rats prefer social company (even that of other males) over a solitary existence.4243 They show conditioned preference for regions previously associated with social contact,44 make nests in close proximity to conspecifics when partially separated,4345 and will actively work to obtain social contact.4647 Alternatively, prairie voles are socially monogamous and form an enduring, selective bond with their partner following mating. They show biparental care toward offspring, tend to live in extended families,4849 and are well utilized in the study of social bonding and isolation.

Here, we evaluate social isolation–induced adaptations in these rodents, in light of the phenotype of human loneliness, which may also represent a state of activation of “social homeostatic systems.” We have categorized the behavioral and neural adaptations into three broad themes: (1) hypervigilance/arousal; (2) social motivation; and (3) passive coping. We propose that parallel, overlapping circuits mediate the response to social deficit (the output of homeostatic “effector” systems) in an effort to heighten attention to environmental stimuli, motivate social reconnection, and limit emotional distress (Fig. 2). While we can only speculate as to the neural identity of the detector, control, and effector systems in a social homeostatic network, we anticipate that a cohesive understanding of the response to social deficit will help unmask candidate neural substrates.

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Figure 2Open in figure viewerPowerPointNeural circuit components implicated in the response to social deficit. Pathways, neuromodulators, neuropeptides, and receptors showing modifications following acute social isolation in rodents. Circuit components are colored based on their involvement in hypervigilance, social motivation, and passive coping. Other prominent projections/connections are shown in gray. Coordinated activity across these parallel, overlapping circuits may function to maintain social homeostasis by heightening attention to environmental stimuli, motivating social reconnection, and limiting emotional distress. 5‐HT, 5‐hydroxytryptamine (serotonin); ACTH, adrenocorticotropic hormone; AT1, angiotensin II receptor 1; BNST, bed nucleus of the stria terminalis; CeA, central amygdala; CRF, corticotropin‐releasing factor; CRFR1/2, corticotropin‐releasing factor receptor 1/2; DA, dopamine; D1/2, dopamine D1/2 receptor; DRN, dorsal raphe nucleus; Hp, hippocampus; KOR, ĸ‐opioid receptor; LC, locus coeruleus; MeA, medial amygdala; MOR, μ‐opioid receptor; NAc, nucleus accumbens; NE, norepinephrine; OT, oxytocin; PFC, prefrontal cortex; PVN, paraventricular hypothalamic nucleus; VMH, ventromedial hypothalamus; VTA, ventral tegmental area.

Homeostatic response to social deficit: promoting hypervigilance

An evolutionary perspective on the origins of loneliness proposes that the vulnerabilities of isolation promote hypervigilance to guard against potential threats.50 Lonely individuals often show high levels of anxiety,5152 and hypervigilant responses to negative social stimuli, suggesting heightened recruitment of attentional and self‐preservation mechanisms.53 In rodents, acute isolation can promote behaviors that indicate enhanced arousal and heightened vigilance. For example, adult rats show an increase in escape‐related behaviors over 1–7 days of isolation,54 along with a reduction in exploratory behavior and an increase in self‐grooming.5557 Targeted manipulations in rodents have unveiled that anxiety‐related behaviors arise from activity across distributed, interconnected corticolimbic circuitry, which interpret and evaluate incoming environmental stimuli (reviewed in Ref. 58). One major output system is the hypothalamic–pituitary–adrenocortical (HPA) axis, which regulates arousal, vigilance, and attention, in concert with central arousal circuits including the lateral hypothalamic (LH) orexin/hypocretin system, locus coeruleus (LC) noradrenergic neurons, basal forebrain cholinergic neurons, dorsal raphe nucleus (DRN) serotonergic neurons, and midbrain dopaminergic neurons.5960 Several of these neural circuits exhibit rapid adaptations following acute social isolation. Here, we briefly outline the nature of these changes and their potential role in the response of a social homeostatic system.

HPA axis

Glucocorticoid production is initiated by paraventricular hypothalamic nucleus (PVN) secretion of corticotropin‐releasing factor (CRF) into the hypophyseal portal system, triggering adrenocorticotropic hormone (ACTH) release by the anterior pituitary that in turn acts on the adrenal cortex to secrete glucocorticoids. The HPA axis is regulated by a negative feedback loop, wherein glucocorticoids bind to receptors in the pituitary and other brain regions including the hippocampus, which subsequently inhibits CRF and ACTH production. While acute activation of the HPA axis can be an adaptive physiological response to salient events, chronic activation of this system, particularly by continued psychosocial stressors, is implicated in the progression of multiple disease states and psychopathologies.61 Consistent with this, high self‐reported loneliness in humans has been associated with elevated daily cortisol output6266 and a flattening of diurnal cortisol rhythm,65 suggesting poor regulation of the HPA axis.67

Heightened HPA axis activity (evidenced by a robust increase in circulating corticosterone and ACTH) is observed after 1–5 days of social isolation in juvenile (3–5 weeks old)6869 or pair‐bonded adult7072 prairie voles. Peripheral corticosterone levels are also reportedly increased in male mice isolated for 12 h,73 and both pituitary ACTH and adrenal corticosterone are increased in male rats isolated for 24 h in a novel environment.7475 This recruitment of the HPA axis during acute periods of isolation may reflect the increased need for vigilance and attention to salient stimuli.

CRF signaling

CRF pathways are a prominent point of convergence for isolation‐induced adaptations. Aside from their role in initiating the neuroendocrine response to stress, PVN CRF neurons are pivotal in orchestrating the rapid, complex behavioral adaptations that occur following acute stress (potentially via glutamate coreleasing projections to neighboring hypothalamic regions).76 CRF‐producing neurons are also widely distributed in extrahypothalamic regions, including the bed nucleus of the stria terminalis (BNST), central amygdala (CeA), nucleus accumbens (NAc), and hippocampus,7779 which have, likewise, been implicated in the behavioral and physiological responses to stress. Isolation of preadolescent female (but not male) mice for <24 h decreased the excitability of PVN CRF neurons in a glucocorticoid‐dependent manner.80 This finding may reflect glucocorticoid feedback–induced suppression of CRF activity. Consistent with this interpretation, a 24‐h isolation of adult rats decreased CRF mRNA and protein in the PVN75 and decreased cortical CRF1 receptor levels.81 Moreover, these changes in CRF were accompanied by enhanced angiotensin II (ATII) AT1 receptor expression in the PVN.74 ATII is a circulating endocrine factor that can trigger CRF production in response to stress.82 This factor may be necessary for isolation‐induced adaptations within the hypothalamic CRF system, as the isolation‐induced decrease in CRF mRNA in male rats could be prevented by an AT1 receptor antagonist.75 Conversely, a shorter period (1 h) of social isolation in adult male and female prairie voles housed with same‐sex siblings, resulted in increased hypothalamic and hippocampal CRF mRNA.83 This discrepancy may reflect the shorter duration of isolation or the different species under study. However, it highlights the growing need for a thorough understanding of the timeline of adaptations following social isolation.

LC noradrenergic system

The LC is the sole source of noradrenergic innervation to the central nervous system, best known for its role in arousal and vigilance, but more broadly thought to be recruited to combat environmental challenges.8485 In adult rats, a 24‐h isolation increased tyrosine hydroxylase (TH; the rate‐limiting enzyme in catecholamine synthesis) mRNA in the LC, an effect that could be blocked by an AT1 receptor antagonist.81 Thus, the acute response to isolation involves coordination across both peripheral and central neuromodulatory systems.

Homeostatic response to social deficit: engaging social motivational systems

In humans, a deficit in social connections is conceptualized to engage the “social monitoring system”86 with the purpose of directing attention toward socially relevant information. Accordingly, individuals that either self‐identified as lonely or expected a lonely future showed enhanced sensitivity to social cues and increased socially affiliative motivation.8690 Enhanced social motivation is similarly evident in acutely isolated rodents: when given the opportunity, previously isolated (2‐ to 48‐h duration) juvenile and adult rodents spend more time engaged in social behaviors.9198 It is suggested that up to 7 days of isolation promotes affiliative social behavior and social interest in rats,5792 whereas in adult mice, a significant increase in aggressive behavior was observed after 48 h, but not 24 h of social isolation.99

For many social species, the inherently rewarding nature of social interactions is a major driving force for social contact. In rodents, one method to evaluate the positive reinforcing properties of social interaction is the social conditioned place preference (social CPP) assay—an adaptation of a test traditionally employed to measure the rewarding properties of drugs of abuse.44 In this task, animals typically demonstrate preference for a place previously paired with social housing over one paired with isolate housing (∼24‐h duration44). Notably, therefore, the conditioned approach to a socially conditioned context may be a product of both “social reward” and “isolation aversion.”44 Several neuromodulatory systems (including dopamine, oxytocin, and opioid circuits) are posited to underlie the motivation for social reward. These circuits are also prominent sites of rapid adaptation following social isolation, which we discuss below. The degree to which neural circuits for “social reward” and “isolation aversion” overlap and diverge remains to be determined.

Ventral tegmental area dopamine system

The midbrain dopamine system has a long‐standing role in reward processing100 and affiliative social behavior,101 and is frequently reported as a site of isolation‐induced adaptation. The ventral tegmental area (VTA) dopamine neurons project to multiple regions including the striatum, prefrontal cortex (PFC), and basolateral amygdala (BLA), with the VTA–NAc pathway being particularly well associated with social reward.102103 In juvenile rats, isolation‐induced social play was suppressed by D1‐ or D2‐receptor blockade in the NAc,104 while in adult rats, 24 h or 4 days of isolation decreased striatal D2‐receptor density105 and increased mesostriatal TH activity,106 respectively. Isolation‐induced changes do not appear to be limited to the mesostriatal pathway, however, as adolescent mice isolated for 1–7 days showed an increase in cortical dopamine metabolism.107 Additionally, in the PFC, decreased GABAA‐stimulated chloride influx was evident in a membrane preparation from 24‐h isolated rats108 along with reduced benzodiazepine binding,81 indicating a decrease in cortical GABAA expression and/or function. Given the functional diversity of dopamine input to striatal subregions109110 and dopamine’s divergent effects on cortical projector populations,111 further work is necessary to elucidate precisely how these rapid isolation‐induced changes to dopamine neurotransmission influence downstream activity.

DRN dopamine system

Another component of the midbrain dopamine system—the DRN dopamine neurons—also exhibits acute isolation‐induced adaptations. These dopamine neurons were historically considered a caudal extension of the VTA, but accumulating evidence has revealed distinct downstream projections and functional roles.112118 In adult male mice, 24‐h social isolation potentiated glutamatergic synapses onto DRN dopamine neurons, and also heightened their activity in vivo in response to a novel mouse.118 Artificially enhancing activity of DRN dopamine neurons with optogenetic stimulation was sufficient to increase social preference. However, in the absence of a social stimulus, mice chose to avoid receiving stimulation of DRN dopamine neurons (demonstrated by real‐time and conditioned place avoidance), which suggests the induction of a negative affective state.118 DRN dopamine neurons may, therefore, be recruited following acute isolation to elicit “negative drive”–induced social motivation, in a manner distinct from the reward‐related social motivation mediated by the VTA–NAc dopaminergic pathway.103 Consistent with this assertion, optogenetic inhibition of the DRN dopamine population had no effect on sociability in group‐housed animals, but it suppressed social preference following 24 h of isolation.118

The DRN dopamine neurons lie directly upstream of several regions, most notably the BNST and CeA.116118 While the explicit role of dopamine in these regions in social behavior remains to be determined, dopamine receptor signaling can modulate synaptic transmission and activity in both the BNST and CeA.115118120 Specifically, in the dorsolateral BNST blunting of long‐term potentiation (LTP) is evident after 24 h of social isolation in male mice.121 Given that dopamine in the BNST can facilitate glutamatergic transmission, via a CRF‐dependent process,119 it is tempting to speculate that increased dopamine neurotransmission following acute isolation may occlude LTP.

Interestingly, it was recently revealed that an intermediate duration of isolation in mice (2 weeks) is associated with upregulation of the neuropeptide tachykinin 2 (TAC2; also known as neurokinin B) in several regions including the anterodorsal BNST (adBNST), CeA, and dorsomedial hypothalamus (DMH), with levels gradually increasing from just 30 min post‐isolation.122 Behavioral changes observed following 2 weeks of isolation appeared to be mediated by TAC2 upregulation in discrete sites, as chemogenetic silencing of TAC2‐expressing neurons in the adBNST, CeA, or DMH selectively prevented persistent freezing, acute freezing, or aggression, respectively.122 Notably, ∼50% of TAC2‐expressing neurons in the adBNST and CeA co‐expressed CRF,122 which again highlights the involvement of CRF circuits in isolation‐induced adaptation. A substantial body of work supports a role for the BNST in mediating sustained responses, and the CeA in mediating rapid responses, to potential/unpredictable threats.123 This behavioral control is enabled by the far‐reaching connections of the BNST and CeA, particularly with hypothalamic and brainstem structures, which underlies their ability to influence autonomic and neuroendocrine functions.124125 These regions are therefore well positioned to drive isolation‐induced adaptive responses, under modulatory control from upstream regions, including the DRN dopamine neurons.

This collection of findings compels the hypothesis that dopaminergic signaling may be involved in the initial response to social isolation, but that downstream regions (including the BNST and CeA) might exhibit longer term remodeling/plasticity following chronic isolation. Indeed, there is considerable evidence to support a similar model for the stages of drug‐evoked plasticity in the mesocorticolimbic dopamine system. Specifically, a single dose of cocaine is sufficient to potentiate glutamatergic transmission onto VTA dopamine neurons after 24 hours.126 Synaptic strength returns to baseline levels within a week, however, this VTA plasticity is required for the persistent changes that occur downstream in the NAc following prolonged cocaine exposure127 (reviewed in Ref. 128). This permissive role of synaptic plasticity in VTA dopamine neurons could similarly be a feature of DRN dopamine neurons in the response to social isolation. Such a feature would predict that acute isolation‐induced synaptic changes in DRN dopamine neurons precede, and are necessary for, chronic isolation‐induced adaptations in downstream regions. In this way, the myriad of maladaptive behavioral changes associated with long‐term social isolation37 might result from chronic engagement of neural circuits mediating the acute response to social isolation and persistent remodeling in downstream regions.

Opioid system

The opioid system exerts a broad influence on neural activity through widespread expression of opioid peptides and receptors, most notably within regions connected to positive reinforcement (reviewed in Ref. 129). Opioid signaling plays well‐documented roles in regulating pain/analgesia,130 reward processing,129 and social bonding,131 and has also been implicated in isolation‐induced social behavior. In vivo autoradiography revealed changes to opioid receptor binding, with 7 days of isolation in juvenile rats associated with upregulation of opioid receptor number or affinity in the PFC.57 Additionally, isolation‐induced social play in juvenile rats was attenuated by systemic administration of a μ‐opioid receptor (MOR) antagonist97132 or a ĸ‐opioid receptor (KOR) agonist,132 but enhanced by administration of a MOR agonist.97 Furthermore, in the CeA, infusion of an ACTH analog suppressed isolation‐enhanced social interest in 7‐day isolated rats, but this was prevented by administration of naltrexone (a MOR and KOR antagonist).56133 Therefore, both opioid and dopamine receptor signaling may be necessary for the heightened sociability evoked by acute isolation.

Hypothalamic oxytocin system

Oxytocin‐producing neurons of the PVN, along with the closely related vasopressin (AVP) neurons, are intimately involved in the regulation of social affiliation134 and have been particularly well studied in the monogamous prairie vole, as they play a pivotal role in pair bonding.135 Oxytocin neurons project not only to the posterior pituitary where they release oxytocin into the bloodstream but also to distinct targets within the brain for direct modulation of neuronal activity. One important site for oxytocin action is the NAc, which is a critical hub for the integration of motivationally relevant information and relays information to elicit motor responses.136 In male prairie voles, 3 days of isolation from a bonded female partner, but not a male sibling, decreased oxytocin mRNA in the PVN and oxytocin receptor binding in the NAc shell.137 Notably, oxytocin signaling in the NAc is reportedly essential for the expression of social CPP in adult male mice.138 Specifically, it was elegantly demonstrated that social CPP required activation of oxytocin receptors on presynaptic terminals in the NAc arising from DRN serotonergic neurons—facilitating serotonin release.138 Social CPP was further shown to be dependent on the PVN oxytocin projection to the VTA.139 Either suppressing activity in the PVN–VTA pathway or VTA dopamine–specific knockout of oxytocin receptors prevented social CPP in male mice.139 Collectively, these findings illustrate the dynamic balancing of dopamine, oxytocin, and serotonin signaling that is required for the reinforcing properties of social interactions.

Acute isolation has also been demonstrated to disrupt social recognition memory.140 Rodents possess an innate tendency to investigate novel rather than familiar social stimuli and typically reduce their investigation of a familiar conspecific on repeated exposure.141 This effect is absent in mice isolated for 24 h or 7 days, who display equivalent investigation of a familiar juvenile compared with the first exposure.142143 This lack of social recognition memory is associated with a suppression of oxytocin‐dependent synaptic plasticity in the medial amygdala (MeA) following 7 days of isolation in rats.144 Impaired social recognition memory may also result from elevated hippocampal Rac1 (a small GTPase), which is evident in male mice isolated for 24 h or 7 days.145 Thus, isolation‐induced modifications to oxytocin signaling, in a pathway‐specific manner, may contribute to changes in both social motivation and social recognition memory.

Homeostatic response to social deficit: a self‐protective coping strategy?

Individuals that self‐identify as lonely frequently exhibit features of negative affective state or depression.1050146149 Furthermore, individuals swayed toward feelings of future loneliness (by receipt of false feedback following a questionnaire) show a reduction in physical pain sensitivity and emotional sensitivity.89 This suggests the adoption of self‐protective strategies to minimize further emotional distress. While we cannot directly measure emotional state in rodents, we can assay motivated behavior as a proxy.58150 In rodents, immobility in the forced swim and tail suspension tests is thought to reflect passive coping and/or behavioral despair151152 (but see Ref. 153). There is a general lack of agreement over whether acute isolation alters immobility in these assays in mice.5573154 However, more consistent results have been obtained in monogamous prairie voles, wherein females or males isolated from their bonded partner for 3–5 days show an increase in immobility time.7071137

There is also evidence for disruption of reward‐related behavior in acutely isolated rodents, specifically in the response to addictive drugs. In rats, a 24‐h social isolation increased preference for ethanol and opioid intake, which was reversed with social housing.155156 Reduced pain sensitivity has also been reported, with male mice and juvenile rats exhibiting higher thermal and mechanical pain thresholds following 2–7 days of social isolation.157158 The prominent role of dopamine and opioid signaling in mediating the effects of drugs of abuse159 and analgesia130160 makes them strong contenders for underlying these adaptations. In particular, chemogenetic activation of ventrolateral periaqueductal gray (vlPAG)/DRN dopamine neurons can promote antinociception,117 while lesion of these neurons suppresses both the antinociceptive161162 and rewarding163 properties of exogenous opioids. Furthermore, inhibition of VTA dopamine signaling in mice can induce depression‐related behaviors,164 while KOR antagonists are proposed to have antidepressive effects in rodents (see Refs. 165167). In this way, interaction between the dopamine and opioid systems may underlie isolation‐induced changes to reward processing, pain sensitivity, and emotional affect.

In addition to dopaminergic and opioidergic mechanisms, isolation‐induced depressive‐like behavior may result from changes in the balance of CRF and oxytocin neurotransmission. Specifically, the passive coping behavior observed in pair‐bonded prairie voles isolated for 3 days was prevented by NAc shell infusion of a CRF2 receptor antagonist, or oxytocin, throughout the period of isolation.137 Microdialysis experiments suggest a mechanism by which this effect is mediated via presynaptic CRF2 receptor activation on oxytocin terminals in the NAc, which serves to reduce oxytocin release.137 These findings point toward a confluence of isolation‐induced adaptations in the NAc. The NAc receives strong glutamatergic input from thalamic and cortical regions, enabling it to integrate motivationally relevant information from neuromodulatory nuclei with higher cognitive and sensory input.168 Thus, this region is aptly poised to adapt goal‐directed behavior in response to social deficit.

Proposed attributes of components within a social homeostatic system

Flexibility

Animals are frequently faced with conflicting signals in the environment, which can elicit competing motivational drives. To ensure survival, animals must appropriately weigh environmental cues and evaluate them in light of current homeostatic need state. Selecting the appropriate behavioral response under these conditions requires dynamic coordination of neural activity.169 Thus, a key requirement for a social homeostatic system is its capacity for flexibility. Specifically, a change in environmental conditions and/or need state (e.g., hunger and thirst) may require a shift in the “set point” for social contact in the control center (Figs. 1B and 3). This will be heavily influenced by dynamic factors, such as resource availability, predator threat, mating prospects, and the presence of offspring.

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Figure 3Open in figure viewerPowerPointLong‐term integration of social experience within a homeostatic system. (A) Under normal conditions, appropriate functioning of a social homeostatic system would maintain social contact quantity/quantity within an acceptable dynamic range. Experienced social interactions may be assimilated and assessed (compared with set point) in a sliding window fashion across time (e.g., days/months). Social quality and quantity information might be weighted differently depending on the individual (traits) and current environmental conditions. The set point could be determined by a combination of factors including age, sex, species‐typical behavior, and past history of social encounters. (B) Failure of homeostatic system to correct deviations in social contact quantity/quality might result in a chronic deficit. This deficit (whether perceived or actual) may be associated with chronic engagement of homeostatic effector systems, and experienced as a state of loneliness. (C) Major life or environmental changes, such as moving away from home, or switching jobs, might provoke the need for a shift in set point. A stable shift in set point, and acceptance of a new expected quantity/quality for social contact, could represent an adaptive change. This shift may prevent social homeostatic effector systems from being chronically recruited and promote continued balance.

For example, in a state of hypernatremia (elevated plasma sodium, which is associated with the perception of thirst), rats exhibit greater social investigation of a novel intruder.170 This effect is proposed to have evolved to suppress anxiety in social situations, such as those encountered at a communal source of water, in order to promote social approach and allow drinking behavior.170 This observation suggests that social motivation can be altered by other physiological needs. Intriguingly, acute hypernatremia in rats is associated with increased plasma oxytocin, increased c‐Fos expression in magnocellular PVN oxytocin neurons, and suppression of ATII production.170 Given that ATII signaling can drive HPA axis activity, these data suggest that hypernatremia concomitantly suppresses activity within stress‐related circuitry, while promoting activity in social reward‐related oxytocin pathways, thereby inhibiting stress/anxiety‐related behavior and facilitating social interaction. This relationship illustrates overlap and coordination across homeostatic systems and also demonstrates the flexibility of effector systems.

The motivational state of hunger is another essential homeostatic drive that promotes rapid neural adaptations.171172 Specifically, the agouti‐related protein (AgRP) neurons in the arcuate nucleus of the hypothalamus are essential in the maintenance of energy balance, and increasing their activity can rapidly drive feeding behavior.173 Interestingly, in isolated mice, optical stimulation of AgRP neurons, or physiological hunger, provoked feeding, even in the presence of a novel male or female mouse.171 This finding suggests that AgRP activity in a state of hunger is sufficient to override a competing social motivational drive. Conceptually, it is possible that competing homeostatic drives are integrated into a social homeostatic system at the level of the control center in a “hub‐and‐spoke” fashion, or they may form an interconnected hierarchical arrangement that converges on effector systems (Fig. 1B). While it is possible that one homeostatic system may be subservient to another, an interconnected network would permit flexible control in a state of motivational need competition, prior to convergence on effector systems. Precisely how these homeostatic systems interface with one another remains to be elucidated.

Maintaining physiological variables, such as core body temperature and energy levels, within an appropriate dynamic range relies heavily upon a functioning immune system. Inflammation is theorized to be a unifying feature of homeostatic perturbation: providing a protective response to extreme deviations from the homeostatic set point.174175 Adverse conditions, including social isolation, can provoke a shift in immune function: enhancing expression of proinflammatory genes and reducing expression of antiviral/antibody‐related genes in circulating leukocytes.176 Social isolation may recruit this response to appropriately prepare an individual for the susceptibilities of being alone, which might include an increased need for a rapid inflammatory response to combat bacterial infections sustained through physical injury, but reduced need for protection against socially transmitted viral infections.15176 This immune response also appears to be recruited in a state of perceived isolation—humans with high self‐reported loneliness show enhanced proinflammatory activity but reduced antiviral response.66177179 Immune system changes can also predict subsequent loneliness, suggesting a reciprocal relationship between these two phenomena.64 Remarkably, classifying rhesus macaques as putatively high in loneliness (by sociability levels and social initiation attempts)180 revealed leukocyte gene expression changes similar to those observed in lonely human subjects.64 The recruitment of inflammatory processes under conditions of actual or perceived social isolation31 suggests that this state is recognized as a threat to an essential variable. As such, this supports the assertion that social contact may be regulated in a homeostatic manner.

Mixed selectivity

Considering the neural processing of “social homeostatic” information, one possibility is the existence of dedicated neural circuitry. An alternative model would feature overlap between neural systems governing social homeostasis and other highly conserved neural circuitry. This scenario would predict that certain nodes in a social homeostatic network display “mixed selectivity,” similar to neurons underlying other complex cognitive processes.181 In particular, this is conceivably a feature of “effector” regions in a homeostatic system. The disinhibition of VTA dopamine neurons, for example, has been shown to enhance motivation toward a variety of stimuli ranging from social stimuli to novel objects.182183 Furthermore, activation of BLA input to the ventral hippocampus or medial PFC (mPFC) not only induces robust anxiety‐like behavior in exploratory assays but also suppresses social investigation in the resident–intruder assay.184186 Perturbations in social behavior are often, but not always, co‐expressed with anxiety‐related behaviors, and there is significant overlap in their neural correlates, which suggests a tight relationship between these two forms of behavioral expression.58187

The DRN dopamine system is another prime example of overlapping circuit function. Monitoring fluorescent calcium activity in vivo revealed that these neurons are active in response to social stimuli, and this activity is heightened following acute isolation.118 However, these neurons are also responsive to other salient stimuli, including palatable food and unexpected foot shock, and show greater activity during wakefulness compared with sleep, suggesting an arousal‐promoting function.112115188 This diversity of sensitivities is consistent with the notion that neural circuits regulating social homeostasis may promote attention to a variety of salient stimuli, in an effort to scan the environment for potential threats or opportunities for social engagement. It was also recently reported that optogenetic or chemogenetic inhibition of DRN dopamine neurons during fear conditioning suppressed freezing in response to a footshock‐predictive cue, suggesting an additional role in aversive responding.115 Taken together, these findings illustrate the existence of multiple mechanisms through which DRN dopamine neurons may limit the vulnerabilities of being alone: increasing social motivation, promoting vigilance/arousal, and enhancing responsivity to aversive stimuli.

Considering the potential for mixed selectivity, the recent observation that activation of DRN dopamine neurons not only increases social preference118 but can promote antinociception117 could be reconciled in a number of ways. One possibility is that functional heterogeneity exists within this cell population. Another possibility is biological convergence in the representation of emotional pain and nociceptive pain in DRN dopamine neurons. In accordance with this notion, an emerging hypothesis posits that social pain and physical pain are processed by overlapping neural circuitry.189 This is supported by human imaging studies revealing that social disconnection engages brain regions including the dorsal anterior cingulate cortex and anterior insula cortex,190 which also process the affective component of physical pain.191 This dual role of DRN dopamine neurons also points toward a potential mechanism through which acute isolation reduces pain perception.157158 It is also interesting to note that inflammatory pain is suppressed by activation of AgRP neurons, suggesting a general reduction of chronic pain perception by strong motivational drive states.192 Mixed selectivity may, therefore, be a common feature within neural circuits regulating homeostatic needs, and cross talk between these systems might facilitate the activation or suppression of appropriate “effector” systems (Fig. 1).

Subjective nature of social experience

A third element in conceptualizing a social homeostatic system is the integration of subjective experience. There is mounting support for the notion that subjective or “perceived” isolation (the quality of social relationships) is a stronger predictor of poor health and emotional state in humans than objective isolation (the number/frequency of social contacts).1162146 Consistent with this, loneliness—independent of social network size—is associated with higher mortality13193 increased blood pressure,11194 higher rate of diabetes, hypertension, arthritis, emphysema,195 and Alzheimer’s disease,196 along with poor health habits stemming from a lack of self‐control.197198 Thus, in evaluating social needs, a homeostatic system would need to incorporate a subjective assessment of social experience, in addition to its overall objective nature), which may be heavily influenced by interoceptive signals and internal state (Figs. 1 and 3).

There is an ongoing debate as to whether animals experience emotions in the same way as humans.150199 However, it has been reasoned that emotions constitute an internal state, encoded by specific neural circuits, which can give rise to externally observable behaviors.150 These internal brain states may be subjectively perceived as feelings by the individual.150 Although the traditional concept of homeostasis refers to a purely automatic physiological control system, motivational drive states (guided by “homeostatic feelings”) play a significant role in maintaining homeostasis.200 Homeostatic feelings act as “informative regulatory interfaces”—providing means for an animal to sense its physiological state and guaranteeing attention to relevant stimuli.200 While this process can be adaptive and introduces greater flexibility into homeostatic regulation, it also passes an element of control to the individual, taking homeostatic regulation beyond purely automatic mechanisms.200

In order to understand the neural mechanisms of social homeostasis, a major hurdle lies in the ability to infer subjective social experience in animals.14 Although we can never truly know the emotional experience of a rodent, one method of differentiating between individuals is by exploiting the natural variability introduced by social hierarchy. Grouped living can lead to the establishment of social hierarchies in multiple species including fish, birds, rodents, and primates.201204 Hierarchies create a scenario in which grouped individuals might have divergent perceptions of their social experience. Social rank can influence access to essential resources including food, territory, and mates,205 and thus a more dominant rank is often a coveted position associated with higher quality of life. Although subordination in animal societies is not always directly related to low social connectedness or unmet social needs, social rank bestows variability in subjective social experience without removing support structure for safety, warmth and other nonsocial benefits of a group.

Strikingly, studies on social hierarchy in mice and rats have revealed underlying neural correlates in the same circuits implicated in the response to social deficit (Fig. 2). These findings include differences between subordinates and dominants in CRF expression in the BNST, CeA, MeA, and medial preoptic area;206 mitochondrial function and dopamine signaling in the NAc;207208 and glutamatergic synaptic strength in the mPFC.209 The mPFC, in particular, is frequently implicated in the representation of social rank. Most recently, “winning”‐induced plasticity in the tube test was localized to a mediodorsal thalamic (MDT) projection to the dorsomedial PFC (dmPFC), as phasic optogenetic stimulation of the dmPFC, or the MDT–dmPFC projection, immediately induced winning against a previously dominant cagemate.210 Notably, social rank also predicted the magnitude of behavioral effects elicited upon DRN dopamine manipulations in mice.118 Optogenetic activation of these neurons promoted social preference and real‐time place avoidance, whereas inhibition reduced isolation‐induced social preference. However, the behavioral change observed in these assays was greater in dominant animals relative to subordinates.118 This observation suggests that prior social experience may influence the ability of the DRN dopamine neurons to modulate behavior. Collectively, these findings illustrate that rank‐related information may be integrated into multiple neural circuits that respond to social deficit (Fig. 1A). This organization would permit flexible control over homeostatic regulation and adjustment of goal‐directed behavior depending on the social opportunities available.

Moving forward, several questions remain in elucidating how social information might be processed through a homeostatic system. For example, is the individual’s “expectation” for social contact encoded upstream in detector regions, or at the level of the control center? And how are different categories of social contact represented? To speculate on this last point, one possibility is that a social homeostatic system is category blind. Another potential arrangement would involve separate processing streams for the regulation of different social relationships, such as same‐sex, opposite sex, mother–offspring, or unfamiliar conspecifics. Indeed, specialized circuits, within discrete hypothalamic nuclei, underlie the expression of parental behavior,211 aggression,212 male intruder–specific behavior,213 opposite‐sex approach,214 and mating.212 If we conceptualize these as discrete “effector systems,” then this raises the possibility that decentralized processing of different social “needs” may occur in separable nodes.215 However, the precise organization of social homeostatic elements remains a topic of conjecture.

Valence of motivational drive

A fourth consideration is the valence of motivational drives that direct social interaction.216 Motivated behaviors regulating food intake are often distinguished as homeostatic (essential for maintaining energy balance and survival) or hedonic (driven by sensory perception or pleasure in the absence of a need state).217 Feeding behavior, therefore, is directed by motivational drives of opposing valence: the negative sensation of hunger and the positive hedonic value of palatable food. In extrapolating to social behavior, equivalent opposing motivational drives may promote social interaction: the aversive state of isolation and the hedonic value of social reward. However, while mechanistic differences exist, the neural systems mediating homeostatic and hedonic feeding are proposed to be intertwined, and highly overlapping with reward circuitry.217218 Similarly, social reward circuitry is heavily recruited in isolated animals. Engagement of reward circuitry in situations of social deficit may enhance the rewarding value of social contact—potentially similar to how food deprivation enhances the rewarding properties of food.219222 In support of this concept, functional magnetic resonance imaging (fMRI) in humans has revealed that more lonely individuals show greater activation of the ventral striatum in response to familiar social cues,223 but contrastingly reduced activation in response to unfamiliar social cues.224 Similarly, ventral striatal activity is initially high in response to palatable food but diminishes as individuals consume beyond satiety.225

The coordination of social behavior to meet homeostatic needs may, therefore, recruit both positive and negative motivational processes. The DRN dopamine system might be one source of negative motivational drive in response to social deficit.118 Recruitment of this system aligns with the “drive reduction” hypothesis, in which internal state elicits goal‐directed behaviors in order to reduce the intensity of an aversive/negative motivational drive (e.g., hunger and thirst)226 (Fig. 1C). A potentially similar function has been described for arcuate nucleus AgRP neurons and nitric oxide synthase 1 (NOS1) neurons in the subfornical organ (SFO). These neurons show heightened activity during hunger (AgRP) and thirst (NOS1), their activity elicits an aversive state (place avoidance), and they are essential for driving feeding and drinking behaviors, respectively.21227

However, the role of valence processing in homeostatic feeding behavior is complex. AgRP neurons are activated in a state of energy deficit,228 and their optical stimulation can voraciously promote food consumption, but also elicits real‐time place avoidance (indicative of an aversive state) in the absence of food.173227229 However, AgRP activity is rapidly suppressed on sensory detection of food,227228230 which, surprisingly, suggests that ongoing AgRP activity is dispensable for food consumption. This paradox is potentially reconciled by the observation that brief optical stimulation, as little as 1 min, prior to food availability was sufficient to promote robust, sustained feeding in well‐fed mice once food was made available.231 Furthermore, mice performed operant responses to stimulate AgRP neurons in the presence, but not the absence of food, suggesting that AgRP activity can be positively reinforcing.231 Therefore, an alternative hypothesis proposes that AgRP activity provides a sustained positive valence signal that potentiates the incentive value of food, and supports transition from foraging to feeding behavior via persistent changes in downstream circuitry.231 Intriguingly, this is not a feature of SFO NOS1 neurons, as prestimulation was insufficient to drive drinking behavior when water was subsequently made available.231 Therefore, the relationship between neuronal activity and behavioral regulation may depend on the specific homeostatic need.

While the precise role of DRN dopamine activity in social motivation and valence processing remains to be fully elucidated, drawing insight from other neural circuits that participate in maintaining homeostatic balance provides mechanistic clues into their mode of operation. However, an important consideration for social behavior is that (unlike food detection) initial social contact does not necessarily guarantee a rewarding social experience. Therefore, immediate suppression of neural activity on social contact may be inappropriate for DRN dopamine neurons, and activity might persist until a stable relationship has been achieved. Moving forward, it will be important to determine the temporal dynamics of activity within and across neural circuits during the response to social deficit and to understand how valence is represented in these systems.

Outlook

Moving forward, we propose that improving the evaluation of subjective social experience, and standardizing parameters used in studies of social behavior (Table 1), will accelerate the assembly of a cohesive model for social homeostasis. Studies in rodents are continuing to move toward approaches that capture larger, more naturalistic group living,206 and the incorporation of automated tracking is permitting a deeper longitudinal analysis of complex social interaction dynamics.232 Great promise has arisen from detailed behavioral observations on groups of nonhuman primates, facilitating classification of social relationship quality in females chacma baboons30 and putative loneliness in male rhesus macaques.180 Across the animal kingdom, we may see conservation in neuromodulatory systems for social behavior all the way to invertebrate systems, as recent groundbreaking work in the octopus demonstrates.233Table 1. Experimental conditions to report in the methodology of studies on social behavior and/or social isolation to facilitate informative interpretation and reproducibility

Grouped/Control AnimalsIsolated Animals
Housing conditions
Number of cage matesPrior number of cage mates
Cage mate relationship (siblings/age‐matched etc.)Cage mate relationship (siblings/age‐matched etc.)
Sexual experienceSexual experience
Age at isolation
Duration of isolation
Extent of experimenter handlingExtent of experimenter handling
Housing type (size, bedding material etc.)Housing type (size, bedding material etc.)
Social rank (if known)Social rank (if known)
Environmental enrichmentEnvironmental enrichment
Proximity of other animals
Normal or reverse light/dark cycleNormal or reverse light/dark cycle
Measurement of behavioral/neurophysiological parameters
Time of testing
Age at testing
Conditions of behavioral assays
Stress exposure
Food/water restriction
Timeline of conducted experiments

Current technological approaches in rodents now provide unprecedented temporal and spatial resolution with which to scrutinize neural circuits and have already yielded fascinating results identifying discrete systems mediating specific social behaviors including parental behavior,211 social reward,103138139 and social observational learning.234 The new millennium has brought with it a rapid rise in opportunities for social nourishment together with a growing prevalence of loneliness and social isolation. Given the protective effects of social contact on a vast array of physical and mental health measures, there has never been a more important time to understand the neural mechanisms underlying the need for social connection.

Acknowledgments

This article was prepared by invitation of the New York Academy of Sciences for publication in a special issue of Ann. N.Y. Acad. Sci. presenting work from winners and finalists of the Innovators in Science Award; K.M.T. was an Early‐Career Scientist finalist in 2017. Takeda Pharmaceutical Company Limited sponsors the Innovators in Science Award, as well as open access of this paper.

We thank Gwendolyn G. Calhoon and Ruihan Zhang for comments on the manuscript and all members of the Tye Lab for helpful discussion. K.M.T. is a New York Stem Cell Foundation–Robertson Investigator and McKnight Scholar and supported by funding from the JPB Foundation, the Picower Institute Innovation Fund (PIIF), the Picower Neurological Disorder Research Grant, the Picower Junior Faculty Development Program, the Alfred P. Sloan Foundation, the New York Stem Cell Foundation, the McKnight Foundation, and by the following Grants from the National Institutes of Health: NIMH R01‐MH102441‐01, NIMH R01‐MH115920, NIA RF1‐AG047661‐01, the NIH Director’s New Innovator Award DP2‐DK‐102256‐01 (NIDDK), and the NIH Director’s Pioneer Award DP1‐AT009925 (NCCIH). G.A.M. was supported by a fellowship from the Charles A. King Trust Postdoctoral Research Fellowship Program, Bank of America, N.A., cotrustees.

Competing interests

The authors declare no competing interests.

Featured

Consciousness as a Delusion

In Chasing the Rainbow: The Non-conscious Nature of Being, David Oakley and Peter Halligan (2017) present the theory that consciousness is a delusion.

At the time of publication, the paper in Frontiers has received 107,012 views.

According to their theory, consciousness is a specially engineered delusion; let’s call it the ‘CAD theory’. Because, to them at least, consciousness is only a delusion, O&H place the word inside scare quotes, as ‘consciousness’. Here, I leave the word as it should be left: consciousness it is and consciousness it stays.

According to the CAD theory, the ‘epiphenomenon’ of consciousness evolved to provide humans a false belief that they are actors with agency. In reality, so O&H claim, all psychologically meaningful and functional processes occur within an unconscious ‘Central Executive Structure’ (CES).

The CES is an amazing cortical device that craftily creates a fake experience of consciousness to deceive naïve humans into the false belief that they have the power to voluntarily control their individual destinies with agency and selfhood. All other psychological products are manifested in Personal Awareness a brief ‘Libet’ unit of time after their production by the CES. Consciousness does not control any behavior. It serves a passive, narrative function as an excrescence. Humans are simply automatons. In 1999, the editor of an American Psychologist special issue entitled “Behavior— It’s Involuntary” wrote: “We perceive ourselves to have far more control over our everyday behavior than we actually do. . . . [T]he source of behavioral control comes not from active awareness but from . . . mental activations of which we are unaware and environmental cues to which we are not consciously attending that have a profound effect on our behavior (Park, 1999, p. 461). The CAD theory is illustrated in Figure 1.

The CAD Theory

Figure 1. The Oakley-Halligan CAD model. The schematic diagram shows all current CES functions and other psychological activities as non-conscious processes and their products. The most task-relevant of these psychological products are selected by a Central Executive Structure (CES) to create an ongoing personal narrative via the process of Internal Broadcasting. This personal narrative is passively accompanied by personal awareness – a by-product of Internal Broadcasting. Some components of this narrative are selected by the CES for further transmission (External Broadcasting) via spoken or written language, music, and art to other individuals. The recipients in turn transmit (internally then externally) their own narrative information, which may contain, or be influenced by, the narrative information they have received. The CES also selects some contents of the current personal narrative for storage in autobiographical memory. The contents of external broadcasts contribute (via Cultural Broadcasting) to an autonomous pool of images, ideas, facts, customs, and beliefs contained in folklore, books, artworks, and electronic storage systems (identified as “Culture” in the Figure) that is accessible to others in the extended social group but is not necessarily dependent on direct interpersonal contact. The availability of culturally based resources is a major adaptive advantage to the social group and ultimately to the species as a whole. The CES has access to self- and other-generated externally broadcast content as well as to cultural information and resources, all of which have the potential to provide information that supports the adaptedness of the individual and to be reflected in the contents of their personal narrative. As a passive phenomenon, personal awareness exerts no influence over the CES, the contents of the personal narrative or on the processes of External and Cultural Broadcasting. In the Figure non-conscious process are identified in green and personal awareness (subjective experience) in blue. (From Oakley & Halligan, Front. Psychol., 14 November 2017).

The simplistic automaton of the epiphenomenonalist view, in this reviewer’s opinion, is an inadequate and flawed scientific theory, which, ultimately, offers a false doctrine. Alternative positions that warrant more serious consideration include the emergence theory that views phenomenal ‘consciousness’ as a naturally emergent feature of life and complex brains (e.g. Sperry, 1990; Feinberg & Mallatt, 2020). IMHO, in spite of its rhetorical merits, this interesting and provocative paper does not ‘unmask consciousness’ but manages to conceal and obscure its true nature in obfuscation.

Merits and Demerits of the CAD Theory


Overall, the paper provides a clear statement of a well-known epiphenomenonalist view of consciousness, namely that consciousness is a superfluous carbuncle in the scientific analysis of behavior. The paper is concise and mainly internally consistent but it presents a highly incomplete and misleading analysis of consciousness and the associated cortical structures.

If it is to be given serious attention as a scientific theory, the authors need to specify not only (A), the axiomatic assumptions and ancillary propositions of the theory, but also (B), refutable and novel predictions evaluated with robust empirical evidence. However, to date they have only succeeded in producing A, the ‘pudding’, but there is no B, ‘proof of the pudding’. Unless refutable predictions can be added, this paper and theory will remain a flight of fancy about what might be so that is lacking any defined empirical tests to assess its veracity one way or the other. The current iteration of the theory, crafted and polished over several decades, remains a scientifically weak, descriptive theory of consciousness.


Unless the claims sketched out by O&H can be substantiated with hard evidence, the theory will remain a quaint ‘straw man’ on the hinterlands of the scientific study of consciousness. To be fair, the authors do mention in passing a few speculative hypotheses about brain mechanisms but they are vague (e.g. Figure 3) and I can find no substantive hypotheses that can be tested in non-brain-damaged subjects. The Casarotto et al. (2016) study described by the authors appears to this reviewer to have questionable relevance and should perhaps be removed.

There have already been several criticisms of the CAD paper. How are these known criticisms to be rebutted? What new research will follow from the claim that consciousness is a delusion? Does the CAD claim not have a stultifying impact on new investigation if there is nothing worth discovering about the consciousness delusion?

There are some well-known limitations and shortcomings of the CAD theory that need to be addressed.

Consciousness as an Unnecessary Epiphenomenon

As the authors must be aware, there are established objections to their type of epiphenomenalist account of consciousness that they have not addressed. For example, Meese (2018) raises the first technical objection with these words: “…the simple fact is, we can talk about consciousness. This is not trivial; it means the thing we call consciousness can influence the underlying system (by causing it to speak), and in philosophy of mind, epiphenomena do not have causal feedback (e.g., Megill, 2013), so consciousness cannot be epiphenomenal (Blackmore, 2004; Bailey, 2006; Robinson, 2015)”. So how do O&H answer this objection? To date, they have given no answer.


O&H believe that consciousness is not required. Yet, they write about consciousness throughout the article as (a) process(es) that they and readers all perfectly understand as universally available phenomenal consciousness. However, different people often mean different ‘things’ when they talk about consiousness. Also following Meese (2018): “we can envisage a machine that is programmed to store only some of its internal operations in memory, and call that a personal narrative, but it does not follow that this will imbue the machine with consciousness.”


A significant point overlooked in O&H’s manuscript is the fact that, in one or more of its different states, consciousness has demonstrable adaptive value. Consciousness convincingly delivers selfhood to ‘actors’ who set global, behavioral priorities and goals, life choices, career, country and region of residence, sexual preferences, gender assignment and choice of mate, beliefs, values, opinions, and significant communication, social, artistic and cultural functions. According to O&H’s theory, these ‘choices’ are all delusory products of an unconscious CES. Yet, in delegating all of developmental, personal, social and behavioral adaptations to the CES with a stroke of the pen, gaping holes are evident, straining the theory with severe limitations.


First Missing-Link: Motivation


According to O&H’s theory, the unconscious CES is responsible for the ‘what’ and ‘when’ of behavior – thinking, choosing, planning, remembering, problem solving, acting – in their entirety. However, the all-important ‘how’ and ‘why’ and associated ‘feelings’, emotions, drives and cravings that underly behavior are in another department of unconscious processing not considered relevant in the theory. Motivation, needs, wants are nowhere to be found. If ‘free will’ really is a delusion, then surely it remains necessary to formulate how and why the CES decides which actions are momentarily beneficial to survival and need to be prioritized? The authors do not say. Perhaps O&H could consider the following sources:

Maslow (1943): “”Thus man is a perpetually wanting animal.” Thwarting, actual or imminent, of these basic needs provides a psychological threat that leads to psychopathy”;

Rogers (2008): “The directional tendency in every living organism of maintaining, enhancing, and reproducing itself is seen as fundamental to the question of motivation. This “actualizing” tendency involves development toward autonomy and away from heteronomy, or control by external forces”;

Fanselow (2018):”Fear has the ability to overwhelm consciousness so that that nothing but phylogenetically selected action occurs. By filling consciousness fear prevents flexible behaviors and that is one reason why anxiety disorders can be so debilitating. Anxiety, fear and panic are states within the emotion that correspond to different levels of threat.”

If consciousness as a delusion is overwhelmed by fear, then the feeling of fear itself must be a delusion. Yet this ‘fear delusion’ is necessary for survival. In which case, consciousness is necessary for survival. QED.


Second Missing Link: Arousal, the Waking State, and Sleep


The well-known circadian alterations in consciousness that fall under the ‘arousal’ umbrella range from the fully awake state through intermediate states of inattention and drowsiness to sleep are all missing from O&H’s theory of consciousness. Self-evidently, these dramatically different, scientifically well-established states of conscious awareness are not delusory, nor are they figments of the CES ‘broadcasting station’. They exist. They are real. They are universal across many species apart from humans.


Third Missing Link: Mental Imagery/Imagination


Another notable absentee from the CAD theory is mental imagery/imagination. In this respect, O&H differ from Jorion (1999), who equated the alleged ‘consciousness delusion’ with ‘imagination’. O&H talk instead about ‘internal broadcasting’, the scripted narrative provided by the CES, serving the function of keeping the deluded and unconsciously controlled human content with their little lot by listening to especially scripted messages broadcast by an all-powerful inner structure. Thus, the internal broadcasting is like a ‘mental radio station’. O&H appear to have missed a trick here. They could just as easily have inserted a ‘multi-channel mental TV’ into the CES which could include fantasy fiction, travel, series, horror, thrillers, erotica/’adult’ material for instant replay whenever required by waking daydreams, dreams and nightmares, and even a ‘playstation’ for hypnotic and hypnagogic mental games such as counting sheep as people are drifting off to sleep. This ‘modernisation’ of the CES would make it immensely more powerful by enabling ‘broadcasting’ of a vast range of imaginative material into what the lay person calls the ‘mind’s eye’ unavailable on steam radio. Other sensory modalities could be added to the broadcasting of the CES to bring it into line with the quasi-perceptual qualities of taste, olfaction, touch, somatic sensations and synaesthesia. The current version allows only narratives ‘propaganda’ conjured up for innocents who believe the delusion that they are fully conscious with agency, selfhood, integrity, and a moral compass.

Figure 2 mentions the right cortex having ‘visuo-spatial ability’ so a rudimentary ‘mind’s eye’ is present in the theory but needs to be elaborated if the full range of known ‘internal broadcasting’ is to be captured by the theory. A more minor point: Figure 2 suggests a division of the two cortical hemispheres (‘verbal’ vs ‘visuo-spatial ability) in line with 1960s and 1970s neuropsychology with ‘sequential’ processing on the left side and ‘simultaneous’ processing on the right side. Is this classification still viable? Also, the arrow at the top of Figure 2 labelled “suppresses” requires clarification.


Fourth Missing Link: Adaptive Benefits of Consciousness


O&H’s proposition that consciousness should be abolished from science would gain more credence if there did not exist multiple, well-established, demonstrable evolutionary benefits of consciousness. Evidence of biologically adaptive benefits of consciousness has been reviewed in several articles (e.g. see Earl, 2014, 2019; Feinberg & Mallatt, 2020).

Consider these 12 categories of evidence :


1) The complexity and enormous range of altered states of consciousness need to be explained. O&H lump all of the processes and states of consciousness together as a single entity yet this is manifestly incorrect, viz. sleep, dreams, hypnagogic/hypnopompic state, hypnotic state, hypnotic analgesia, meditation, trance, trance logic, dissociative states, etc. Why do these empirically identifiable ASCs all exist and why are they necessary? Are these states all delusional? Do none have beneficial advantages to survival? Why does sleep and/or dream deprivation have such strongly detrimental effects on wellbeing? Lacking any consideration or acknowledgement of the complexity of consciousness, the O&H theory falls at the first post.


2) It is known that ancillary systems have evolved in association with consciousness, e.g. two perceptual systems, two memory systems, explicit vs implicit memory. In each case, why would two systems be necessary? Are both systems delusory – in spite of decades of supportive empirical evidence that they have functional relevance?


3) Whenever one is actively involved with events, one experiences representations of them, which aids selection of pleasurable vs non-pleasurable stimuli. If consciousness had no effect on behaviour, then it could indicate something quite different to what was actually happening, and it wouldn’t actually matter because, according to the theory, the CES would still control all human actions, so ‘consciousness’ must be adaptive.


4) Clearly, pleasure and pain are not delusory, yet they are an essential part of conscious experience. Consciousness ranks sensed stimuli by importance, enabling decisions on how to respond (Cabanac, 1996).


5) Self-related information, very relevant to survival, is treated differently from non-self-related information. This consciously experienced ‘personal self’ appears to be anything but a delusion. The selfhood/identity of a person is associated with a unique life history, kith and kin relationships, legal identity and set of morals, values and beliefs. The sense of selfhood is palpable and real.Self-protective behaviors in the face of danger trigger near-instantaneous “freeze, flight, fight, or fright” (4 F’s) behaviors with millisecond rapidity. A dog walks towards me barking aggressively. I freeze before moving away rapidly. It is me the dog approaches not the person on the other side of the road. I take preventive action accordingly. No internal broadcast here, just an instantaneous physiological and conscious choice.


6) Consciousness can directly influence behavior. Feelings and perceptions re-direct one from one activity to another without any significant delay. One can make immediate ‘changes of mind’ with fast adjustments to new stimuli. The few 2-300ms delay suggested by LibetR