ME/CFS and the PACE trial

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Here I review the disastrous trial known as the ‘PACE trial’. This updates a post from several years ago.

Readers may also be interested in seeing the Special Issue on the PACE trial in the Journal of Health Psychology (2017).

Review of the evidence indicates that none of the Wessely School’s hypotheses about the causes of ME/CFS are supported by the science (see here, here and here). Under these circumstances it would be scientifically impossible for ME/CFS treatments based on these incorrect principles to actually work. Only if there is a ‘fix’ and evidence is craftily manipulated by scientific sleight-of-hand could the therapies be made to look effective.

Which is exactly what has happened.

ME/CFS patients have known the truth for donkey’s years. Only the perpetrators of the ‘CBT/GET Illusion’ have claimed otherwise.

I review here the PACE trial and present a few details of an exposure by Carolyn Wilshire, Tom Kindlon, Alem Matthees and Simon McGrath (2017), which reveals the true null effect.

What was the PACE Trial?

Rarely in the history of clinical medicine have doctors and patients been placed so bitterly at loggerheads. The dispute had been a long time coming. Thirty years ago, a few psychiatrists and psychologists offered a hypothesis based on a Psychological Theory in which ME/CFS is constructed as a psychosocial illness. According to the Wessely School, ME/CFS patients have “dysfunctional beliefs” that their symptoms are caused by an organic disease. The ‘Dysfunctional Belief Theory’ (DBT) assumes that no underlying pathology is causing the symptoms; patients are simply being ‘hypervigilant to normal bodily sensations‘ (Wessely et al., 1989; Wessely et al., 1991).

The Wessely School Theory assumes that the physical symptoms of ME/CFS are the result of ‘deconditioning’ or ‘dysregulation’ caused by sedentary behaviour, accompanied by disrupted sleep cycles and stress. Counteracting deconditioning involves normalising sleep cycles, reducing anxiety levels and increasing physical exertion.  Attentional biases also divert the patients towards their symptoms.

To put it bluntly, the DBT asserts that ME/CFS is ‘all in the mind’.  Small wonder that patient groups have been expressing anger and resentment in their droves.

Top-Down Research

‘Top-down research’ uses a hierarchy of personnel, duties and skill-sets. The person at the top sets the agenda and the underlings do the work. The structure is a bit like the social hierarchy of ancient Egypt. Unless carefully managed, this top-down approach risks creating a self-fulfilling prophecy from confirmation biases at multiple levels. At the top of the research pyramid sits the ‘Pharaoh’, Regius Professor Sir Simon Wessely KB, MA, BM BCh, MSc, MD, FRCP, FRCPsych, F Med Sci, FKC, Knight of the Realm, king-pin and originator of the Wessely School. The principal investigators (PIs) for the PACE Trial were Professors White, Chalder and Sharpe, the ‘Inner Circle’ of the Wessely School. Another Inner Circle member, Sir Mansel Aylward, then at the Department for Work and Pensions, was a funder of the trial. The PIs all have or had connections both to the Department for Work and Pensions and to insurance companies.

The investigators obtained close to £5,000,000 of tax payers’ money to run the PACE trial.

The objective of the trial was to demonstrate that two treatments based on the DBT, cognitive behavioural therapy (CBT) and graded exercise therapy (GET), help ME/CFS patients to recover. 

There was a zero chance the PACE researchers would fail to obtain the results they wanted. As the PACE ship left port, it went directly towards its destination. Only when it struck that unfortunate iceberg called “Null Result” did things begin to go seriously wrong.

Groupthink, Conflicts and Manipulation

The PACE trial team were operating within a closed system or groupthink in which they ‘know’ their theory is correct. With every twist and turn, no matter what the actual data show, the investigators are able to confirm their theory. The process is well-known in Psychology. It is a self-indulgent processes of subjective validation and confirmation bias.  Groupthink occurs when a group makes faulty decisions because group pressures lead to a deterioration of “mental efficiency, reality testing, and moral judgment” (Janis, 1972). Given this context, we can see reasons to question the investigators’ impartiality with many potential conflicts of interest (Lubet, 2017). Furthermore, critical analysis suggests that the PACE investigators involved themselves in manipulating protocols midway through the trial, selecting confirming data and omitting disconfirming data, and publishing biased reports of findings which created a catalogue of errors.

‘Travesty of Science’

The PACE Trial has been termed a ‘travesty of science’ while sufferers of ME/CFS continue to be offered unhelpful or harmful treatments and are basically being told to ‘pull themselves together’. One commentator has asserted that the situation for ME patients in the UK is: “The 3 Ts – Travesty of Science; Tragedy for Patients and Tantamount to Fraud” (Professor Malcolm Hooper, quoted by Williams, 2017). Serious errors in the design, the protocol and procedures of the PACE Trial are evident. The catalogue of errors is summarised below. The PACE Trial was loaded towards finding significant treatment effects.

When Disaster Strikes

The claimed benefits of GET and CBT for patient recovery are entirely spurious. The explanation lies in a sequence of serious errors in the design, the changed protocol and procedures of the PACE Trial. The investigators neglected or bypassed accepted scientific procedures for a RCT, as follows:

ErrorCategory of errorDescription of error
1Ethical issue: Applying for ethical approval and funding for a long-term trial when the PIs knew already knew CBT effects on ME/CFS were short-lived.On 3rd November 2000, Sharpe confirmed: “There is a tendency for the difference between those receiving CBT and those receiving the comparison treatment to diminish with time due to a tendency to relapse in the former” (www.cfs.inform/dk). Wessely stated in 2001 that CBT is “not remotely curative” and that: “These interventions are not the answer to CFS” (Editorial: JAMA 19th September 2001:286:11) (Williams, 2016).
2Ethical issue: Failure to declare conflicts of interest to Joint Trial Steering Committee.Undeclared conflicts of interest by the three PIs in the Minutes of the Joint Trial Steering Committee and Data Monitoring Committee held on 27th September 2004.
3Ethical issue: Failure to obtain fully informed consent after non-disclosure of conflicts of interest.Failing to declare their vested financial interests to PACE participants, in particular, that they worked for the PHI industry, advising claims handlers that no payments should be made until applicants had undergone CBT and GET.
4Use of their own discredited “Oxford” criteria for entry to the trial.Patients with ME would have been screened out of the PACE Trial even though ME/CFS has been classified by the WHO as a neurological disease since 1969 (ICD-10 G93.3).
5Inadequate outcome measures.Using only subjective outcome measures.The original protocol included the collection of actigraphy data as an objective outcome measure. However, after the Trial started, the decision was taken that no post-intervention actigraphy data should be obtained.
6Changing the primary outcomes of the trial after receiving the raw data.Altering outcome measures mid-trial in a manner which gave improved outcomes.
7Changing entry criteria midway through the trial.Altering the inclusion criteria for trial entry after the main outcome measures were lowered so that some participants (13%) met recovery criteria at the trial entry point.
8The statistical analysis plan was published two years after selective results had been published.The Re-definition of “recovery” was not specified in the statistical analysis plan.
9Inadequate controlSending participants newsletters promoting one treatment arm over another, thus contaminating the trial.
10Inadequate controlLack of comparable placebo/control groups with inexperienced occupational therapists providing a control treatment and experienced therapists provided CBT.
11Inadequate controlRepeatedly informing participants in the GET and CBT groups that the therapies could help them get better.
12Inadequate controlGiving patients in the CBT and GET arms having more sessions than in the control group.
13Inadequate controlAllowing therapists from different arms to communicate with each other about how patients were doing.
14Lack of transparencyBlocking release of the raw data for five years preventing independent analysis by external experts.

Credit where credit is due

A significant amount of investigation about the PACE trial was carried out in 2015 by David Tuller.

Please see:

Tuller D (2015) TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study. http://www.virology.ws/2015/10/21/trial-by-error-i/

Tuller D (2015) TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study (second installment). http://www.virology.ws/2015/10/22/trial-by-error-ii/

Tuller D (2015) TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue (final installment) http://www.virology.ws/2015/10/23/trial-by-error-iii/

Tuller (2016) http://www.virology.ws/2016/02/01/trial-by-error-continued-a-few-words-about-harassment/

Other significant pieces of exposure were:

Goldin R. PACE: The research that sparked a patient rebellion and challenged medicine. www.stats.org/pace-research-sparked-patient-rebellion-challenged-medicine

This paper by Dr Mark Vink was described in a letter to the Editor of Lancet from Professor Malcolm Hooper as “The final coup de grace“:

The PACE Trial Invalidates the Use of Cognitive Behavioral and Graded Exercise Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Review. J Neurol Neurobiol 2(3).

PACE-Gate: the Cover-Up

Blocking release of the raw data for five years and preventing independent analysis by external experts was tantamount to a cover-up of the true findings. An editorial by Keith Geraghty (2016) was entitled ‘PACE-Gate’. ME/CFS patient associations were rightly suspicious of the recovery claims concerning the GET arm of the trial because of their own experiences of intense fatigue after ordinary levels of activity which were inconsistent with the recovery claims of the PACE Trial reports. For many sufferers, even moderate exercise results in long ‘wipe-outs’ in which they are almost immobilized by muscle weakness and joint pain. In the US, post-exertional relapse has been recognized as the defining criterion of the illness by the Centers for Disease Control, the National Institutes of Health and the Institute of Medicine. For the PACE investigators, however, the announced recovery results validated their conviction that psychotherapy and exercise provided the key to reversing ME/CFS.

Alem Matthees Obtains Data Release

When Alem Matthees, a ME/CFS patient, sought the original data under the Freedom of Information Act and a British Freedom of Information tribunal ordered the PACE team to disclose their raw data, some of the data were re-analysed according to the original protocols. The legal costs of the tribunal at which QMUL were forced to release the data, against their strenuous objections, was over £245,000. The re-analysis of the PACE Trial data revealed that the so-called “recovery” under CBT and GET all but disappeared (Carolyn Wilshire, Tom Kindlon, Alem Matthees and Simon McGrath, 2016). The recovery rate for CBT fell to seven percent and the rate for GET fell to four percent, which were statistically indistinguishable from the three percent rate for the untreated controls. 

Graded exercise and CBT are still being routinely prescribed for ME/CFS in the UK despite patient reports that the treatments can cause intolerable pain and relapse. The analysis of the PACE Trial by independent critics has revealed a catalogue of errors and provides an object lesson in how not to conduct a scientific trial. The trial can be useful to instructors in research design and methodology for that purpose.

Following the re-analyses of the PACE Trial, the DBT is dead in the water. There is an urgent need for new theoretical approaches and scientifically-based treatments for ME/CFS patients. Meanwhile, there is repair work to be done to rebuild patient trust in the medical profession.

The Final Sinking

Caroline Wilshire, Tom Kindlon, Alem Matthees and Simon McGrath asked a very simple question:

Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy?

These authors gave a critical commentary and preliminary re-analysis of the PACE
trial. I quote their Abstract:

BACKGROUND: Publications from the PACE trial reported that 22%
of chronic fatigue syndrome patients recovered following graded
exercise therapy (GET), and 22% following a specialised form of
CBT. Only 7% recovered in a control, no-therapy group. These
figures were based on a definition of recovery that differed
markedly from that specified in the trial protocol.
PURPOSE: To evaluate whether these recovery claims are justified
by the evidence.
METHODS: Drawing on relevant normative data and other research,
we critically examine the researchers’ definition of recovery, and
whether the late changes they made to this definition were
justified. Finally, we calculate recovery rates based on the original
protocol-specified definition.
RESULTS: None of the changes made to PACE recovery criteria were
adequately justified. Further, the final definition was so lax that on
some criteria, it was possible to score below the level required for
trial entry, yet still be counted as ‘recovered’. When recovery was
defined according to the original protocol, recovery rates in the
GET and CBT groups were low and not significantly higher than in
the control group (4%, 7% and 3%, respectively).
CONCLUSIONS: The claim that patients can recover as a result of
CBT and GET is not justified by the data, and is highly misleading

Implications

  1. The PACE trial is/was/and always will be an unmitigated disaster. I use it in my textbook as an example of how not to do a trial.
  2. The authors and sponsors have done a disservice to science and to patients that will be hard to forget.
  3. An apology is the least that the principal investigators can do to make amends for this dreadful piece of pseudo-science.
  4. The universities involved should return the public funds that were wasted on the PACE trial project.
  5. A government enquiry is necessary to investigate the full facts in relation to the connections between the investigators, the insurance industry and the UK Department of Work and Pensions.

Note: This post is dedicated to Alem Matthees who has dedicated his life to the search for the truth about ME/CFS and was responsible for obtaining the release of the PACE trial data.

Reference:

David F Marks et al. (2020) Health Psychology. Theory, Research & Practice (6th ed.) SAGE Publications Ltd.

A New Depth-Rescaling Illusion

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Most visual illusions are produced using carefully contrived drawings or gadgets to fool the visual system into thinking impossible things.  As described in an earlier post, while waiting at a train station, I encountered an apparently real-life Ponzo illusion. Here I explain why I think the new illusion is more strange and more interesting than the classical Ponzo Illusion.

The Ponzo Illusion

The traditional Ponzo illusion is produced by drawing a pair of receding railway lines. The context suggests different depths in the drawing. An object towards the top of the drawing appears larger than an identical object near the bottom of the drawing.  Using a principle of size constancy, the visual system estimates the size of any object as its retinal size multiplied by the assumed distance. Thus, the ‘most distant’ of the two identical yellow lines appears to be longer than the ‘nearer’ yellow line.

Ponzo_illusion

The Setting for the New Depth-Rescaling Illusion

The setting of this new illusion is a railway station situated at Vitrolles Airport, Marseille (see photo below).  The station has glass panelled shelters on the platforms on each side. The glass panel at the front of each shelter displays two rows of grey rectangles. Apart from their decorative function, one assumes that these rows of rectangles are intended to help prevent people from walking into the glass panel as they move in and around the shelter. The photo below shows the arrangement of the two rows of rectangles on the shelter.

IMG-9407.jpg

The Stimuli

The stimuli for the illusion consist of rectangles that are slightly longer than a credit card, approximately 10.0 cm long x 1.5 cm wide with a separation of about 3.0 cm between successive rectangles. The plate glass window is about 5 mm thick and is marked with rectangles on both sides of the glass in perfect alignment so that a 3-D effect is created indicating a false sense of solidity to these rectangles. This ‘3-D look’ may strengthen the illusory effect illustrated below.

IMG-9426.JPG

An Illusion of Depth and Scaling

The new illusion has two intimately related features: illusory magnification and illusory depth. Looking at the rectangles on the glass, the rectangles appear to be projected into the space behind the glass at a greatly magnified size. The rectangles appear as a set of ‘illusory posts’ on the station platform.

The ‘illusory posts’ appear huge in comparison to the actual size of the rectangles on the shelter window (10 cm). When viewed against the background of the nearby platform, the new illusory size is re-scaled to around 10-15 times the actual size.

The perceived depth of an object or picture is the perceived distance from the nearest to the farthest point. If an object is perceived to be further away, then its magnitude is re-scaled accordingly. The depth and re-scaling are directly proportionate. The further the illusory depth, the greater the illusory magnification. When viewed against the background of the platform on the other side of the railway lines, the rescaling is 40-50 times. The scaling of the lines is driven by the illusory depth.

The Context is Crucial

This new illusion does not occur when the context is incompatible with the existence of ‘rectangular posts’ in the aligned position. When the rectangles appear against incompatible backgrounds, there is no clearly formed illusion, as illustrated below. In the first picture, the rectangles are shown against an incompatible background where ‘posts’ cannot normally float in space above a field of reeds. Hence the two rows of rectangles are perceived in a single plane of a reflecting window.

In the case below, the photograph shows rectangles on the side window of the shelter, which cannot rest as ‘posts’ all the way along the row from the left- to right-hand sides. The illusion does not appear on the left side, but there is a weak magnification effect at the right-hand end of the row, where the platform could be compatible with the existence of ‘posts’.

Conclusion

This powerful new illusion is produced by a combination of illusory depth and illusory rescaling. The illusion is possible when the existence of the projected stimuli is congruent with the observed background. With an incongruent background, the illusion does not occur. The illusion is likely induced by the operation of constancy mechanisms in the visual system of the brain.

Mood Homeostasis in COVID-19 Lockdown

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July 29, 2020

An earlier post suggested that COVID-19 lockdowns create a ‘perfect storm’ of vulnerabilities that huge numbers of people, and services, are ill-prepared to manage. 

I reviewed the science of human needs as they are expected to play out over prolonged periods of domestic confinement. More details were published in our article in the Journal of Health Psychology.

Psychological homeostasis is a natural ability to maintain stability, security and balance, a universal principle in the regulation of behaviour.

A recent Dutch study indicates the role of mood homeostasis before and during the COVID-19 lockdown among students.

Abstract

Maxime Taquet, Jordi Quoidbach, Eiko I. Fried et al. JAMA Psychiatry. Published online July 29, 2020. doi:10.1001/jamapsychiatry.2020.2389

“The impact of lockdowns implemented in response to coronavirus disease 2019 (COVID-19) on mental health has raised concerns. Understanding the mechanisms underlying this impact to mitigate it is a research priority. We hypothesized that one mechanism involves impaired mood homeostasis (i.e., failure to stabilize mood via mood-modifying activities).”

Taquet et al. conclude: “mood homeostasis appeared to decrease during lockdown due to COVID-19, and larger decreases were associated with larger decreases in mood. The association was larger for vulnerable people with a history of mental illness.” Although their conclusion could not be validated with a control condition in which the lockdown did not occur, the reduced range of activity produced by lockdowns is the likely culprit.

Physical activity enhances homeostasis

The disruption of psychological homeostasis in COVID-19 lockdowns degrades the ability to maintain stability, security and balance by a varied range of activities. In our JHP article, we advocate the increased use of physical activity to bolster the natural ability to enhance well-being during periods of lockdown and isolation:

“One underutilized tool that is freely available to almost everyone can bring profound benefits if applied systematically – regular physical exercise. The impact of exercise is one of the most powerful examples of regulation created by homeostasis. Regular physical activity not only has obvious physical benefits but significant psychological benefits also. During COVID-19 isolation, exercise offers the capability to reset body and mind to a state of equilibrium.

“the whole mess started very early in his career”

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Hans Eysenck’s False Claims Began in the 1950s and 60s

Evidence from Joachim Funke of the Psychologisches Institut, Universität Heidelberg shows that Hans Eysenck’s scholarly output was untrustworthy from the very beginning of his career. In the 1950s and 60s Eysenck positioned himself as the ‘enfant terrible’ of psychoanalysis. Eysenck claimed the evidence in support of the therapy was exceedingly poor or non-existent. Critics pointed out that Eysenck had misrepresented the research literature using incorrect statistics and biased summaries. The paper by A. Dührssen and E. Jorswieck states:

The data published by Eysenck do not concur with the original ones of Fenichel, Alexander, Jones and Knight. According to Eysenck psychoanalysts obtained 43% positive results, yet the authors published results that were 80% positive.

In their paper, A. Dührssen and E. Jorswieck attempted to correct the scientific record. However, the correction was less impactful than Hans Eysenck’s inflammatory diatribes. The full reference is as follows:

Dührssen, A., & Jorswieck, E. (1962). Zur Korrektur von EYSENCKs Berichterstattung über psychoanalytische Behandlungsergebniese. Acta Psychotherapeutica et Psychosomatica, 329-342.

The publication contains a summary in English, which is copied below.

Summary

The publications of Eysenck concerning psychoanalytic literature
have been studied and checked. The data published by Eysenck do not
concur with the original ones of Fenichel, Alexander, Jones and
Knight. Since Eysenck himself stated that he had to evaluate the original
data according to certain view points in order to get comparable
results, his data have been rechecked according to his method. It
became apparent that even then other percentages in all details resulted
as Eysenck had published. Even the number of finished cases,
published by the authors, did not concur with number published by
Eysenck. Especially significant is the difference between Eysenck’s
and the original data concerning positive therapeutic results of
psychoanalysis. According to Eysenck psychoanalysts have 43%
positive results, the authors published 80% positive.

It has all gone very quiet on the retractions front. Apparently, the relevant editors and publishers couldn’t care less, such is the poor state of governance in academic publishing. To quote Joachim Funke, the ‘whole mess’ started very early in his career. Sadly, elements of Hans Eysenck’s mythology live on to this very day.

References

  1. Alexander, F.: Critical evaluation of therapeutic results. In: Five-year report
    1932-1937, p. 30-40 (Institute for Psychoanalysis, Chicago).
  2. Eysenck, H.J.: The effects of psychotherapy: An evaluation. J. consulting
    Psychol. 1952, 16:5, 319 ff.
  3. Eysenck, H. J.: Woran krankt die Psychoanalyse? Monat 88: 18 (1955).
  4. Eysenck, H.J.: Wege und Abwege der Psychologie. In: Rowohlts Deutsche
    Enzyklopädie, p. 10 8-1 10 (Rowohlt, Hamburg 1956).
  5. Eysenck, H.J.: The effects of psychotherapy. In: Handbook of abnormal
    psychology, p. 697ff. (New York, 1961).
    6€ Fenichel, O. : Statistischer Bericht über die therapeutische Tätigkeit 1920-1930.
    In: 10 Jahre Berliner Psychoanalytisches Institut, p. 13-19 (Wien, 1930).
  6. Jones, E.: Report of the clinic work 1926-1936. In: The London clinic of
    psycho-analysis. Decennial Report, p. 10-14 (London, 1936).
  7. Knight, R.P.: Evaluation of the results of psychoanalytic therapy. Amer. J.
    Psych. 1941: 434ff.

Institutional Logics, the British Psychological Society and Hans Eysenck

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The Journal of Health Psychology has published a new paper on “Research misconduct complaints and institutional logics: The case of Hans Eysenck and the British Psychological Society” [October 28, 2020].

The paper provides an analysis of the reasons Hans J Eysenck’s misconduct has not been fully investigated by the BPS.

The authors, Russell Craig, Anthony Pelosi, Dennis Tourish, urge the BPS to investigate this complaint afresh. They also support calls for the establishment of an independent National Research Integrity Ombudsperson to deal more effectively with allegations of research misconduct.

This paper is on Open Access and should be widely read.

https://doi.org/10.1177/1359105320963542Article information

The Abstract and key words are copied below followed by the authors’ Press Release.

Abstract

A formal complaint was lodged with the British Psychological Society in 1995 that

alleged serious scientific misconduct by Hans J Eysenck. The complaint referred

to research into the links between personality traits and the causes, prevention

and treatment of cancer and heart disease. Using a framework of institutional logics,

we criticise the Society’s decision not to hear this complaint at a full disciplinary

hearing. We urge the BPS to investigate this complaint afresh. We also support

calls for the establishment of an independent National Research Integrity

Ombudsperson to deal more effectively with allegations of research misconduct.

Keywords

British Psychological Society, personality and fatal diseases, personality and cancer,

personality and ischaemic heart disease, research misconduct, research policy

PRESS RELEASE PREPARED BY THE AUTHORS: Russell Craig, Anthony Pelosi, Dennis Tourish

Cancer and personality

The British Psychological Society should stop dodging research misconduct claims

against Hans Eysenck. Professor Hans Eysenck was a giant in the world of psychology –

the most frequently cited living psychologist at the time of his death in 1997.

But in 2019, a King’s College London inquiry concluded that 26 of Eysenck’s research

papers with Ronald Grossarth-Maticek were ‘unsafe.’


Now, a new paper in the Journal of Health Psychology urges the BPS to properly

investigate a 1995 complaint it received from Glasgow psychiatrist, Tony Pelosi.

This drew attention to Eysenck’s research into the links between personality and

the causes, prevention and treatment of cancer and heart disease. The paper’s

authors, Russell Craig, Tony Pelosi and Dennis Tourish, criticise the BPS’s decision

not to refer the complaint to a full disciplinary hearing. In examining how the

BPS handled the complaint, they highlight how professional societies can be

caught in a bind between preserving the reputation of their field and its

integrity. They say image-management prevailed in 1995, but now urge the

BPS to restore integrity and discharge its duty to the public by agreeing to

a full investigation.

The complaint
Pelosi drew attention to numerous concerns in peer-reviewed articles

about Eysenck’s work, including claims of some data manipulation. He cited

statements by Bernard Fox, the [then] leading authority in biopsychosocial

cancer epidemiology, that the reported results were “simply unbelievable.”

This view was prompted by a conclusion that people with a “cancer-

prone” personality type were 121 times more likely to die from a cancer

than people with a healthy personality. Pelosi’s complaint also mentioned

deficiencies in a clinical experiment in which 41 people with malignant

hypertension, and described as “stressed but healthy,” were included in a

randomised trial. However, the reported clinical features of these

subjects clearly indicated they were far from healthy, and at imminent risk

of stroke, heart failure and kidney failure

The BPS’s investigation
The authors of the Journal of Health Psychology paper use archival

records to explore how the BPS processed the complaint at meetings

of its Investigatory Committee in July and August, 1995. They note the

predicament that professional societies, such as the BPS, face in striving

simultaneously to be “a members’ association” and “an advocate for the public.”

They argue that the complaint’s processing suggests the BPS had abandoned its

“obligation to the public.”

The BPS did not give Pelosi an opportunity to respond to Eysenck’s reply

to his complaint. Nor has the content of Eysenck’s reply been made available.

The BPS’s decision to not fully investigate the complaint was not explained.

Given the public health implications of the disputed research findings, the BPS

should have been highly transparent in its processing

and exercised caution by recommending closer investigation.

There have been several recent calls for the BPS to formally investigate

Eysenck’s wider publications. Although the BPS reaffirms the importance of

ensuring research integrity, it nonetheless seems to consider itself absolved

of any remedial responsibility. It has “passed the buck” by derogating

responsibility for remediation of research misconduct to

“the academic institution which oversees the work carried out by its academics …”

Actions
Professional associations should thoroughly and transparently

investigate complaints they receive alleging research misconduct against

members. They should do so in a way that prioritises integrity over reputation.

The research propriety and reliability of Eysenck’s research on the links

between personality and fatal diseases should be thoroughly investigated.

Specifically, the BPS should reconsider the substance of Pelosi’s 1995 complaint in a way

that accords with best ethical practice.

Media enquiries
Tony Pelosi. E-mail: anthony.pelosi@nhs.net Phone: 07711497617
Dennis Tourish. E-mail: D.J.Tourish@sussex.ac.uk Phone: 07969422365

Hans Eysenck and Carl Sargent’s Dishonesty in Parapsychology

Context

I write this blog as a long-term investigator into psychology and the paranormal. This post concerns a saga of intellectual dishonesty by the late Cambridge University psychologist, Carl Sargent, and his mentor, Professor Hans J Eysenck, of King’s College London. A diary of events weaves a dark story that many wish the world would forget, but the story needs to be told. The parties in this story displayed gullibility, bias and wilful deceit. One of them (CS) was forced to leave his academic post and seek another career. Many years after his death, the other (HJE) stands accused of producing ‘unsafe’ publications on an industrial scale.

Carl Lynwood Sargent (1952 – 2018) was a British parapsychologist and author of several roleplaying game-based products and novels, using the pen name Keith Martin to write Fighting Fantasy gamebooks. Sargent also wrote four books with Hans J Eysenck.  

According to his Wikipedia entry,

Hans Jürgen Eysenck, was born in Berlin onand died in London on, was a British psychologist of German origin known for his work on personality , heritability of intelligence , behavioral therapies and for his critiques of psychoanalysis. At the time of his death, Eysenck was the most frequently cited living psychologist in English-language scientific journals.”

Hans J Eysenck’s intellectual honesty   was recently the focus of renewed controversy after Anthony Pelosi exposed a series of impossible findings published by Eysenck in the field of health psychology (see here, here and here). 26 of Eysenck’s publications were recently considered “unsafe” by an investigation by King’s College London, and many others are also suspected.

Intellectual dishonesty

Richard Smith (personal communication) astutely remarked as follows: “When forensic accountants detect fraud they assume that everything else from that person may well be fraudulent. Scientists tend to do the opposite–assuming that everything is OK until proved to be fraudulent. But as proving fraud is hard lots of highly questionable material remains untouched.”

Smith continues: “I think of the example of R K Chandra, who was eventually found guilty not only of research fraud but also of financial and business fraud. His first paper established to be fraudulent was in 1989. Why, I ask myself, would you start being honest after you’d practised fraud–yet hundreds of his papers are left unremarked, including unfortunately some that have been shown to be fraudulent.”

A reliable source and long-time colleague of Eysenck’s states: “Eysenck was a mendacious charlatan. I base that not so much on his published fiction but his denial of the link between smoking and cancer was pernicious. His espousal of the beliefs of the John Birch Society was egregious…a grant had to be withdrawn and several researchers dismissed.

A profile of Hans Eysenck based on his biography by Rod Buchanan and also his books with Carl Sargent provide insights into Eysenck’s intellectual values as a scientist and scholar. There were four books with Sargent, all with Eysenck as first author:

  1. Explaining the Unexplained: Mysteries of the Paranormal – Weidenfeld & Nicolson, London 01/01/1982 (1982)
  2. Explaining the Unexplained: Mysteries of the Paranormal – (2nd Ed.) – Prion Books Ltd (1993)
  3. Know Your Own Psi-Q – John Wiley (1983)
  4. Are You Psychic? –  Prion Books Ltd (1996).

The collaboration between the two authors began in the early 1980s in Sargent’s heyday at Cambridge and continued until 1996.

A Distorted Account of Parapsychology

These four books present a distorted and strongly biased view that psychic powers are scientifically proven.  The evidence suggests exactly the opposite (Marks, 2020).

Eysenck’s and Sargent’s ‘ naivety and credulity are everywhere apparent. They present a one-sided view of the scientific evidence on psi and affect the naive stance that fraud and trickery do not need to be considered. David Nias and Geoffrey Dean (1986) summarised their criticisms of the Eysenck/Sargent books thus: “the failure of Eysenck and Sargent’s books to cover trickery and credulity is a serious deficiency” (p.368).

In my opinion, these books are among the most distorted and misleading accounts of parapsychological phenomena ever published by academic psychologists. The four books are a total disgrace and how Eysenck had the gall to put his name to them – perhaps only to build his reputation as the fearless contrarian – is beyond imagination.

In addition to the terrible scholarship, there is convincing evidence of scientific fraud by Sargent. How much Hans Eysenck knew about this, we will never know exactly because Eysenck requested that his papers be destroyed after his death. However, Blackmore’s report on Sargent’s fraud became public knowledge several years into the collaboration and years before the third and fourth books with Eysenck were published.

If Sargent had kept his trickery hidden from Eysenck then Eysenck could have been an innocent party.  In a partnership built over 14+ years, surely there would have been a conversation that included a question of the kind, ‘Oh, I hear you left Cambridge, why was that?”  If, as seems likely, Sargent ‘fessed up’ by admitting the occurrence of some kind of experimental ‘error’, then Eysenck could have been party to covering up Sargent’s deceit. Did Eysenck imagine nobody would notice? or perhaps he simply did not care. After all, that great Cambridge genius, Isaac Newton, had done the same kind of thing, and Eysenck saw no problem with a bit of data fudging. According to Eysenck, a ‘genius’ does whatever is necessary to prove their theories, as he had stated in one of his many pot-boilers.

Escaping Early Disaster

1978: Carl Sargent starts playing Dungeons & Dragons and submits an article to Imagine magazine.

1979: The University of Cambridge awards Sargent a PhD, that he claims was the first awarded to a parapsychologist by this university.

1979: The Society for Psychical Research provides a grant to Susan Blackmore (SB) enabling her to visit Sargent’s lab at Cambridge in November.  The original plan was to visit for a month. However, SB was only able to stay eight days from November 22-30 1979.  Blackmore describes her visit to Sargent’s lab as follows:

“[Sargent’s Ganzfeld] research was providing dramatically positive results for ESP in the GF and mine was not, so the idea was for me to learn from his methods in the hope of achieving similarly good results …. After watching several trials and studying the procedures carefully, I concluded that CS’s experimental protocols were so well designed that the spectacular results I saw must either be evidence for ESP or for fraud. I then took various simple precautions and observed further trials during which it became clear that CS had deliberately violated his own protocols and in one trial had almost certainly cheated. I waited several years for him to respond to my claims and eventually they were published along with his denial. (Harley & Matthews, 1987; Sargent, 1987).”

Sargent’s Career Temporarily Blossoms with Eysenck

In this period, Sargent developed his career in parapsychology at Cambridge with Blackmore’s ‘cheating’  report brushed under the carpet.

1980: Sargent writes a monograph, Exploring Psi in the Ganzfeld. Parapsychological Monographs No 17.

Sargent, C. L., Harley, T. A., Lane, J. and Radcliffe, K. publish: ‘Ganzfeld psi optimization in relation to session duration’, Research in Parapsychology 1980, 82-84.

1981: Sargent and Matthews publish ‘Ganzfeld GESP performance in variable duration testing’. Journal of Parapsychology 1981, 159-160

1982: Eysenck and Sargent (1982) publish their first book together, Explaining the unexplained: mysteries of the paranormal. Weidenfeld and Nicolson; First Edition.

1983: Eysenck and Sargent publish their second book, Know Your Own PSI-Q.

Then the Inevitable Downfall

1984: The Parapsychological Association Council asked Martin Johnson to head a committee to investigate SB’s accusation of fraud by Sargent. My book, Psychology and the Paranormal, describes what happened next;

The Parapsychological Association (PA) invited CS to provide an account of the ‘errors’ that SB had reported, but he declined to offer any explanation. The PA President, Stanley Krippner, wrote to CS at four different addresses, but still received no reply. The PA’s ‘Sargent Case Report’ dated 10 December 1986 found that, in spite of strong reservations about CS’s randomisation technique, there was insufficient evidence that CS had used unethical procedures.

CS was ‘reproved’ for failing to respond to the PA’s request for information. However, CS had allowed his PA membership to lapse through non-payment of dues, but he was informed that, should he wish to renew his membership, his application would be considered with ‘extreme prejudice’, I.e. CS would I likely be re-admitted as a member.

The final report of this committee reprimanded Sargent for failing to respond to their request for information within a reasonable time.

1985: Sargent leaves Cambridge University and the parapsychology field [stated in the 2nd edition of Explaining the unexplained: mysteries of the paranormal, 1993].

At some point, Sargent moves into full-time authoring of game-books.

1987: Susan Blackmore’s 1979 report is finally published: ‘A Report of a Visit to Carl Sargent’s Laboratory’, Journal of the Society for Psychical Research, 54, 186-198.

1993: Undeterred by the report of cheating, Eysenck and Sargent publish their third book, Explaining the unexplained: mysteries of the paranormal. (2nd ed.)

1996:  Eysenck and Sargent publish their fourth book, Are You Psychic?: Tests & Games to Measure Your Powers (1996), a revised version of ‘Know your own Psi-Q’.

The Hidden Truth

Two editions of the book by H. J. Eysenck and Sargent (1982, 1993) raise questions about how much Eysenck knew of the fraud accusations against Sargent in Blackmore’s SPR report of 1979. In the 1982 edition of the first book, the procedural problems with Sargent’s GF research are not even mentioned. In the 1993 edition, the authors refer to ‘spirited exchanges on GF research’ between Blackmore, and Sargent and Harley (p. 189).

However, the Ganzfeld evidence of psi is described by them as ‘very, very powerful indeed’. They do not mention the accusations of fraud, CS’s departure from Cambridge University, and his repeated non-cooperation with the Parapsychology Association enquiry.

I obtained an update from Susan Blackmore on her current thinking about her 30-year-old allegation of fraud by CS and on psi research more generally, which I reproduce below. Here are Susan Blackmore’s answers to a few specific questions:

Do you think, in the light of everything that has come to light, CS committed fraud at Cambridge? (Ideally, a yes or a no).

Yes, at least on one specific trial.

Do you think CS knowingly deceived anybody (including possibly himself) or was he simply a victim of confirmation bias/subjective validation?

The former.

Is there anything else you would like to say about research on psi?

In the light of my decades of research on psi, and especially because of my experiences with the GF, I now believe that the possibility of psi existing is vanishingly small, though not zero. I am glad other people continue to study the subject because it would be so important to science if psi did exist. But for myself, I think doing any further psi research would be a complete waste of time. I would not expect to find any phenomena to study, let alone any that could lead us to an explanatory theory. I may yet be proved wrong of course. (Blackmore, personal communication, 1 August 2019)

Summary of facts and conclusions

  1. A consistent pattern of data manipulation in Hans Eysenck’s and at least two collaborators’ research practice is evident over several decades. Yet only recently have journals found it necessary to retract 14 of Hans Eysenck’s papers and to publish 71 expressions of concern. One paper of concern was published by the Proceedings of the Royal Society of Medicine in 1946. 
  2. A reliable source accused Eysenck of cheating with his data analyses in the 1960s and other colleagues and PhD students publicly critiqued Eysenck’s laboratory methods.
  3. In the late 1970s/early 1980s, Eysenck formed a long-term collaboration with a Cambridge academic Carl Sargent in spite of the fact that Carl Sargent had been accused of fraud in 1979.  Eysenck and Sargent’s joint publications, with Eysenck as senior author, occurred over the period 1982-1993.
  4. In 1992 and 1993, Anthony Pelosi, Louis Appleby and others raised serious questions about publications by Eysenck with R Grossarth-Maticek (Pelosi, AJ, Appleby, L (1992Psychological influences on cancer and ischaemic heart disease. British Medical Journal 304: 12951298.Pelosi, AJ, Appleby, L (1993Personality and fatal diseases. British Medical Journal 306: 16661667.) The authorities failed to respond.
  5.  Anthony Pelosi (2019) again voices his concerns. This author’s editorial appealing to Kings College London to open an enquiry finally led to concrete action. 25 publications by H J Eysenck and R Grossarth-Maticek have been deemed by KCL to be unsafe.
  6.  As suspicions strengthened over a 75-year period from the mid-1940s, torpor and complacency in the academic system enabled research malpractice to continue, not only Eysenck’s and Sargent’s, but across the board.
  7.  The currently available systems for regulating research integrity and malpractice are an abject failure. A totally new approach is required. An independent National Research Integrity Ombudsperson needs to be established to significantly improve the governance of academic research.

A New Book with a New Approach to the Investigation of the Paranormal

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From the Preface

[An ESP experiment] “immediately appeals to his [or her] unconscious readiness to witness a miracle, and to the hope, latent in all [people], that such a thing may yet be possible. Primitive superstition lies just below the surface of even the most tough-minded individuals, and it is precisely those who most fight…” 

C.G. Jung, 1952.

It is of natural science to investigate nature, impartially and without prejudice.

J.R. Smythies, 1967.

Anomaly

  • something that defies explanation – adds spice. Beyond spice, anomaly offers hope, the hope that something – whatever it may be – exists beyond the everyday. We humans live in hope eternally. But what exactly is an ‘anomaly’? I do not mean the kind of oddness or peculiarity in human behaviour that is everywhere to be seen. I am referring to things that really should not be so, the weird, the spooky, the face in the mirror that isn’t you. Anomalistic experiences are curious, strange, ‘funny peculiar’.  As we engage with the experience itself, we freely ruminate and craving to understand, we dig to discover something new. The goal here is to do precisely that, to dig below the surface of anomalistic experience, to take a close look at the psychology of the paranormal, to put psi ‘under the microscope’.  One should not be surprised if all is not as it seems and we can expect surprises aplenty here.

I approached the writing of this book with anticipation

wondering where the adventure might lead. I hoped it would lead towards new insights, explanatory theory and nuggets of new knowledge.

In the end, I reached an altogether unexpected conclusion…

How, you may well ask, can that be?  Surely, an ‘expert’ about psychology and the paranormal should already have reached an opinion one way or the other, a strong point of view?

Not so.

I genuinely have no idea where this new investigation will lead.I write as a zetetic.[1] I have a map and a set of place names[2],  but what exists at each place is uncertain. I last visited this field 20 years ago. Now, with ‘new eyes’ and new evidence, one’s understanding could be significantly different compared to 20 years ago.  Unlike previous visits, I am giving the psi hypothesis an initial probability of being a real, authentic and valid experience of 50%.

Please take a minute to consider your own current degree of belief in ESP.  Indicate your current belief with an arrow on the Belief Barometer below.[3]

My objective

is to cut a path through the vast, tangled jungle of publications with a machete that is sharp and decisive. With each new claim, one must reads, reflect, question, reflect some more, and ultimately decide at one particular moment the degree of plausibility that each specific claim possesses. Belief Barometers will be used to mark your and my degree of belief for each individual claim. The amount of variation in one’s degree of belief indicates a sensitivity to evidence.  If somebody simply says ‘0%’’ or ‘100%’ to absolutely everything, that surely indicates intransigence and intolerance of ambiguity.

One cannot profess definite explanations in advance because that would be blinkered. If we already KNEW the answers, we would cease to investigate, I would not be writing, and you would not be reading. The truth would already be out and we would be picking at the flesh of dead learning like vultures at a dead elephant.

No true zetetic starts from a fixed position. She/he suspends judgement while seeking and exploring with an open mind. In any science, all ideas are provisional, pending further investigation. Those who assert a fixed point of view before looking at the evidence break the ‘Golden Rule of Science’, which is to let conclusions follow the evidence.

Anomalistic psychology

includes the entire spectrum of conscious experience in all of its glorious splendour. By examining in-depth the evidence both pro and con any particular claim, one gains an entitlement to offer conclusions. Even then, the conclusions are tentative, pending further investigation by independent investigators. I am also minded to recall Heraclitus’ well-known dictum, “You cannot step into the same river twice, for other waters are continually flowing on.”  Having stepped into the paranormal river on a few occasions, it was each time a different river.

It is impossible here to include everything in Anomalistic Psychology. The selected exemplify phenomena that have received significant attention from researchers over the last 50 years.  Fun though they may be: Big Foot, the Loch Ness Monster, Clever Hans, mediums, Ouija boards, and stage mentalists didn’t make the cut. See them in the ‘red tops’ and on YouTube.

Returning to the world of psi

after a 20-year respite, I am curious to see what has changed. Anomalistic Psychology is now the battle-ground of psi (Luke, 2011) and there is a growing stockpile of sophisticated methods and findings that can be considered to be supportive of paranormal interpretation.

My return to the field is not without some amount of trepidation, for now I risk being the target for pot-shots from both sides!

However, a strongly partisan view is unhelpful to making any progress in this, or any other part, of science.  Progress requires a dialogue between advocates of differing positions. I wish to put down a marker that says: “Peace. Nobody won. Stop fighting.” That’s not to say there won’t be criticism; there must be, otherwise there can never be progress.

To establish a dialogue, I invited seven *stars* of the field to respond to my criticisms and questions: Daryl Bem, Susan Blackmore, Stanley Krippner, Dean Radin, Hal Puthoff, Rupert Sheldrake, and Adrian Parker. Warm thanks to one and all.

Evidence, critique, new theories

In this book, I present evidence, critique, and new theories. Whenever possible, I use verbatim quotations of advocates concerning specific claims. Nobody can ever legitimately say that a claim has been ‘disproved’; if the truth of a claim is undecided, it is only possible to say that it is neither confirmed nor disconfirmed.

Whatever one thinks, the world is always independent of how we might wish it to be. There is nothing wrong about believing in psi if one chooses to, and scientists have no place disparaging such beliefs. Belief in the paranormal is normal.

Sociologist Andrew Greeley (1991) put it this way:

“The paranormal is normal. Psychic and mystic experiences are frequent even in modern urban industrial society. The majority of the population has had some such experience, a substantial minority has had more than just an occasional experience, and a respectable proportion of the population has such experiences frequently. Any phenomenon with incidence as widespread as the paranormal deserves more careful and intensive research than it has received up to now….People who have paranormal experiences, even frequent such experiences, are not kooks. They are not sick, they are not deviants, they are not social misfits, they are not schizophrenics. In fact, they may be more emotionally healthy than those who do not have such experiences.” (Greeley 1975: 7)

Scientists should be agnostic about the ontological status of paranormal experience and examine the circumstances that constrain or facilitate exceptional experiences.  In approaching each claim, I maintain a zetetic viewpoint, neither believing nor disbelieving,  attending to the evidence. Only after one has completed a thorough survey of evidence is one entitled to an informed opinion. A zetetic must not be naïve, however.

Master zetetic, Marcello Truzzi (1987):

Marcellotruzzi

“The ground rules of science are conservative, and in so far as these place the burden of proof on the claimants and require stronger evidence the more extraordinary the claim, they are not neutral. But, we also need to remember, evidence always varies by degree, and inadequate evidence requires a tolerant reply which requests better evidence, not a dogmatic denial that behaves as though inadequate evidence were no evidence” (p. 73).

Astronomer, Carl Sagan (1995) also offers wise advice:

260px-Carl_Sagan_Planetary_Society

“It seems to me what is called for is an exquisite balance between two conflicting needs: the most skeptical scrutiny of all hypotheses that are served up to us and at the same time a great openness to new ideas. Obviously those two modes of thought are in some tension. But if you are able to exercise only one of these modes, whichever one it is, you’re in deep trouble.If you are only skeptical, then no new ideas make it through to you. You never learn anything new. You become a crotchety old person convinced that nonsense is ruling the world. (There is, of course, much data to support you.) But every now and then, maybe once in a hundred cases, a new idea turns out to be on the mark, valid and wonderful. If you are too much in the habit of being skeptical about everything, you are going to miss or resent it, and either way you will be standing in the way of understanding and progress. On the other hand, if you are open to the point of gullibility and have not an ounce of skeptical sense in you, then you cannot distinguish the useful as from the worthless ones.” (Sagan, 1995, p 25).

The first 20 years of the 21st century

brought many astonishing scientific discoveries: the first draft of the Human Genome, graphene, grid cells in the brain, the first self-replicating, synthetic bacterial cells, the Higgs boson, liquid water on Mars and gravitational waves. Not bad going in such a short time!  During this same period, Anomalistic Psychology has grown at an enormous pace with increased numbers of investigators and publications (Figure P2).  Disappointingly, however, new discoveries or theories are few and far between. If there has been one discovery, it might be stated thus: The science of anomalistic experience is more complex and obscure then most psychologists ever imagined. When we are at the beginning of new venture like this, we must not be deterred by having no real answer to two of the hardest questions in science: What is consciousness and what is it for? [5]

Screen Shot 2020-06-19 at 10.38.01

One of the greatest scientific minds of the last century, Stephen Hawking, stated:

Stephen_Hawking.StarChild

“Science is beautiful when it makes simple explanations of phenomena or connections between different observations” (Sample, 2011).

It has also been said that advances in science come not from empiricism but from new theories.

Parapsychology, like its ‘big sister’ Psychology, has always been heavily empirical and short on theory. The rapid growth is indexed by multitudes of empirical studies in the absence of notable theoretical developments.

By becoming more theory-driven, the field of ‘Psychology + Parapsychology’ as an integrated whole seems likely to make faster progress.

It seems counterproductive to treat Parapsychology and Psychology as separate fields.

Bringing the ‘Para’ part back into mainstream Psychology helps to integrate the discipline. This book takes a step in that direction. Parapsychology and Psychology contain myriads of variables, A,B,C…N…X,Y,Z.  An established strategy for developing new research in Psychology and Parapsychology is for the investigator to identity ‘gaps’ in the field and to set about filling those gaps with correlational and experimental studies with almost every possible permutation and combination of variables.  The gap filling approach is one strategy for keeping productivity high but, often, it is at the expense of developing new theories. As already noted, the academic world is based on quantitative measures of performance[6] and the number of publications a researcher can claim matters. This drive towards publications leads to what I call ‘Polyfilla Science’.

Polyfilla Science

For every ‘hole’ investigators can fill, they are almost guaranteed a peer-reviewed publication. ‘Polyfilla Science’ exists on an industrial scale, keeping hundreds of thousands of scientists busily occupied in hot competition. The ‘winners’ of the Polyfilla competition are the ones who tick the highest number of boxes and harvest the most citations.[7]

‘Polyfilla Science’ can be represented as a multidimensional matrix of cells where the task of science is viewed as filling every last cell in the matrix (Figure P3).  This method of doing science is more akin to a fairground shooting gallery than to theory-driven science.  In the absence of theory, many researchers use a Polyfilla ‘shotgun’ by testing a dozen or more “hypotheses” in one shot. Popular though it is, ‘Polyfilla Science’ isn’t the only game in town, and a theory-driven approach is also available.  Theory is used to identify the principles behind questions that need answering in a process of confirmation and disconfirmation of predictions. When one considers the fact that there are one hundred thousand psychology majors in the US alone, all needing a research project, it is no wonder the Polyfilla approach is so popular.[8]

Screen Shot 2020-06-19 at 10.39.15

The book is geared towards the needs of teachers, researchers and students interested in Anomalistic Experience, Parapsychology and Consciousness Studies.

In comparison to the scientific discoveries in other fields, Psychology or Parapsychology have made no world-changing discoveries in the last 50 years. By this, I mean discoveries that are worth telling your grandchildren. In my opinion, the lack of significant theoretical developments, and the Polyfilla Approach, are two of the main reasons for this lack of progress.  All this needs to change.

Avoiding the drunkard’s search

One must beware – and avoid – the drunkard’s search principle – searching only where it is easiest to look. You probably already know the parable:

A policeman sees a drunk man searching for something under a streetlight and asks what the drunk has lost. He says he lost his wallet and they both look under the streetlight together. After a few minutes the policeman asks if he is sure he lost it here, and the drunk replies, no, and that he lost it in the park. The policeman asks why he is searching here, and the drunk replies, “this is where the light is”.

lost_in_the_dark

We must look wherever psi could be found, not only where it is easiest to look.

The search for psi is a complex, winding trail of traps and pitfalls. When we observe evidence, we must not,  a priori, rule it out as subjective validation or confirmation bias. An openness to being wrong may cause uncomfortable feelings, but knowledge and truth are never givens. When we are lucky enough to discover something new, this is hard-won treasure.

I present here new theories in the spirit of open inquiry. There’s a saying that ‘today’s theories make tomorrow’s fish-n-chip paper’. Possibly, probably, these theories are wrong.  So be it. If possible, falsify my theories, throw them out, and develop better ones. By testing and falsifying existing theories, newer, better theories can be obtained and so on indefinitely. As I share thoughts and conclusions, the reader will be able to contest and challenge  and contrary evidence.

We’ve walked on the Moon and are heading to Mars, but we still don’t yet know the function of consciousness. One of the starting points must be to separate fact from fiction in anomalistic psychology.

Notes

[1] Zetetic from the Greek zçtçtikos, from zçteô [ζητέω (zéteó) — to seek] “to seek to proceed by inquiry”.

[2] [2] Tópos, the Greek name for “place” (τόπος); ‘topic’ in English.

[3] Belief Barometers appear throughout this book.

[4] The majority of so-called ‘skeptics’ are disbelievers and/or deniers who have adopted the label ‘skeptic’ for its more temperate connotations. The late Marcello Truzzi was one of two co-founding chairman of the leading US skeptical organisation CSICOP (the Committee for the Scientific Investigation of Claims of the Paranormal). Truzzi became disillusioned with the organization, saying they “tend to block honest inquiry, in my opinion… Most of them are not agnostic toward claims of the paranormal; they are out to knock them.” Using the title of ‘skeptic’, Truzzi claimed that this association of debunkers could claim an authority to which they were not entitled: “critics who take the negative rather than an agnostic position but still call themselves ‘skeptics’ are actually pseudo-skeptics and have, I believed, gained a false advantage by usurping that label.” Genuine or ‘classical’ skepticism is the zetetic view to suspend judgement and enter into a genuine inquiry that assumes any claim requires justification. Maintaining a zetetic position of open inquiry requires a steady hand and a critical mind. There is no room for naivety but a touch of Socratic irony may at times be helpful. A protracted correspondence between Martin Gardner and Marcello Truzzi , indicating their two contrasting viewpoints, has been published by Richards (2017).

[5] Nagel (2013) and Strawson (2006), among others, argue for the ancient philosophy of pan-psychism, in which all physical objects from atoms to the cosmos all have conscious experience.  Elsewhere, I have described Consciousness  as “a direct emergent property of cerebral activity” (Marks, 2019)..

[6] Numbers of publications, citations, grant monies, prizes, promotions and awards.

[7] One of the world’s most published and ambitious ‘Polyfilla’ psychologists told me a self-effacing story about the occasion he went for an interview at the University of Oxford. A member of the panel asked: “Dr X, you have a huge number of publications. But what does it all mean?” He didn’t know the answer and got rejected for the post.

[8] Polycell Multi-Purpose Polyfilla Ready Mixed, 1 Kg, i#1 best seller on Amazon.co.uk, 16 May 2019.

[9] The history of the field is adequately reviewed by others e.g. John Beloff (1993) or Caroline Watt (2017).

Homeostasis, Exercise, and COVID-19 Isolation

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The Value of Exercise

A recent post explored human needs during COVID-19 isolation. The success of social isolation policies will depend on minimizing long-term depreciation of mental health. In this post, I explain the benefits of developing a system of daily exercise to bolster well-being.

Exercise is an under-utilised resource that is freely available to almost everyone, which can bring profound benefits if applied systematically. The impact of exercise is one of the most powerful examples of regulation created by homeostasis. Regular physical activity not only has obvious physical benefits but significant psychological benefits also. During COVID-19 isolation, exercise offers the capability to reset body and mind to a more optimum state of equilibrium.

Hawley et al. (2014) state: “Exercise represents a major challenge to whole-body homeostasis, and in an attempt to meet this challenge, myriad acute and adaptive responses take place at the cellular and systemic levels that function to minimize these widespread disruptions.”

template_cell

The Physiological Responses to Voluntary, Dynamic Exercise. Multiple organ systems are affected by exercise, initiating diverse homeostatic responses. Reproduced from ‘Integrative Biology of Exercise’ by Hawley et al. (2014).

Note of caution

Apart from its general ability to challenge homeostasis to reset the body’s biological equilibrium, exercise has a role in two domains of well-being:

(1) the immune system is strengthened through regular physical activity (Campbell and Turner, 2018; Simpson et al., 2020)

(2) psychological well-being is enhanced (Mandolesi et al., 2018).

However, exercise is no panacea.

Exercise must be applied with caution especially by people with chronic conditions. If a person has a heart condition, strenuous physical exercise may put them at risk (Keteyian et al., 2016).

In some chronic conditions such as ME/CFS, exercise tends to make many patients feel much worse (Geraghty et al., 2019).

However, if used safely and appropriately, the majority of people can quickly feel physical and mental benefits from regular exercise.

Physiological Mechanisms

Some significant effects of physical activity can be explained by physiological mechanisms (Lopresti et al., 2013). Exercise within the context of psychological health promotion has also been an active research area (Chekroud et al., 2018; Curioni and Lourenco, 2005; Mikkelsen et al., 2017; Tiggemann and Zaccardo, 2018). Some researchers have focused on neurophysiological mechanisms, which aim to identify the positive outcomes of the relationship between exercise and mental health (Eyre and Baune, 2012). Exercise is understood as a relationship between intensity and frequency, and positive outcomes are mostly based on which exercise protocol will determine a better neurophysiological response (Lopresti et al., 2013). Exercise is recognized as a mediator of primary monoamine neurotransmitters, namely, serotonin, noradrenaline and dopamine. These three neurotransmitters receive reciprocal regulation, while exercise intensity modulates the stimulation of monoamine system (Lin and Kuo, 2013). However, it is also important to recognize the affective responses of physical activities and psychological variables are likely to mediate the relationship between exercise and mental health (Rodrigues et al., 2019). There is a sound empirical basis for an integrated account of the emotional effects of exercise. A recent study with a representative US sample of 1.2 million individuals linked exercise to mental health and exercising was associated with reduced self-reported mental health burden. Furthermore, motivation and mindfulness-based techniques act as mediators for these relationships, which seem to account for the strongest effect of the exercise on fewer days of poor mental health (Chekroud et al., 2018).

Joy and Happiness

young-people-jumping_23-2148299823

In the context of social isolation, exercise can be an inherently rewarding activity that contributes joy, happiness and satisfaction (Ryan and Deci, 2017; Standage and Ryan, 2012). The positive outcomes also appear as a function of affective consequences of exercise or anticipation of its affective response – the hedonic principle of the law of effect (Marks, 2018). In general, the expected pleasure versus displeasure is a determining principle of the motivation to repeat behaviour (Kwasnicka et al., 2016; Williams, 2008).

Isolation and quarantine are a disagreeable experience, which may lead to sadness and even impose dramatic mental illness for those who undergo it (Brooks et al., 2020). In this context, a daily exercise routine can be crucial to modulating pleasurable situations at some point during the day. People can feel more deeply satisfied through the experience of choice and volition, reinforce their sense of autonomy and competence, and renew a sense of joy (Lubans et al., 2017; Ryan and Deci, 2017; Standage and Ryan, 2012).

The benefits of exercise depend on the degree of internalization of the behaviour. In our daily lives, exercises are normally performed in order to achieve goals, such as social aesthetic standards (Sperandei et al., 2016). These goals are separable from the purpose of the exercise (a person may not enjoy exercising, but will do it to obtain a result); and therefore, people are generally not ‘authentic’. The lack of authenticity represents a person doing an activity for contingent reward or punishment, feeling tense and pressured, lacking intentionality and being oriented to avoid guilt, angst and social judgement or to protect contingent self-worth. Contrarily, people are authentic when exercise choice is aligned with personal goals, interest and is assimilated with the individual’s characteristics, ability and identity (Deci and Flaste, 1995). Identity is associated with ongoing positive experiences attendant on the behaviour (Kwasnicka et al., 2016), such as exercising at home.

Notably, the COVID-19 pandemic causes fear and the lockdown imposes limits on people’s movement (Brooks et al., 2020; Xiang et al., 2020).

The rationale for the positive side of exercising at home is that exercise can be experienced without any strong social pressure, having a totally internal source of inspiration. The behaviour might be accompanied by higher self-esteem and lower psychological ill-being, since we are free to choose the:

  • types of exercise
  • schedule
  • frequency
  • intensity

The fulfilment of basic psychological needs appear within this context.

Authenticity and Self-Compassion

the-scientific-benefits-of-self-compassion-emma-seppala-clip

Another helpful process is that of self-compassion – the ability to treat oneself with the same concern and support in distressing situations; it is related to self-kindness, common humanity and mindfulness. In fact, it is associated with self-regulation when performing health-promotion behaviours (Holden et al., 2020; Semenchuk et al., 2018). Exercising at home, in a crisis situation, can be performed without self-criticism, which could hinder the process by increasing pressure and self-judgement, which in turn may provide adaptive coping, problem-solving and psychological well-being.

Research has provided empirical evidence on the positive relationship between self-compassion and exercise in providing exercise maintenance and enhancing positive emotions (Holden et al., 2020; Semenchuk et al., 2018).

Mastery and Self-control

Exercising at home can increase the individual’s sense of control. Research suggests that self-mastery is a crucial criterion for promoting positive effects on psychological outcomes (Mikkelsen et al., 2017; Ryan and Deci, 2017). In the face of this pandemic, we have seen many examples across the world showing that exercise can create a social arena in which individuals learn social skills and build social networks by adhering to exercise challenges, exercising in condominiums and encouraging others. These virtual social connections enhance feelings of autonomy and being fully alive. When autonomous forms of regulation guide behaviour, positive affective responses are expected (Ryan and Deci, 2017; Standage and Ryan, 2012). One example is the QuaranTrain launched at HAN University of Applied Sciences in the Netherlands, an online fitness programme promoting evidence-based information on exercise and resources to stay active during COVID-19 pandemic through blogs and videos (HAN University of Applied Sciences, 2020). They provide daily online support, according to World Health Organization advice on physical activity. Users post their workouts routines in social media using the trending hashtags #quarantrain and #quarantraining, with more than 5000 posts worldwide.

Self-efficacy and Self-esteem

Being engaged in exercise may result in higher levels of self-efficacy (Bandura, 1997) which can have the knock-on effect of improving one’s ability to carry out other activities (Mikkelsen et al., 2017). The relationship between changes in the ability to perform activities successfully and increased self-efficacy is fundamental, considering the observed association between depression and low self-efficacy (White et al., 2009). In the context of social isolation, physical activity may be one key to enhancing people’s feeling of competence. In addition, achievement of internal goals and satisfaction has been related to greater psychological wellness (Ryan and Deci, 2017; Standage and Ryan, 2012). This hypothesis has been confirmed by an experimental protocol in which mindfulness self-efficacy appeared to mediate the indirect effects of exercise on mental health and perceived stress (Goldstein et al., 2018), reinforcing the positive account of emotion for a better quality of life (Joseph et al., 2014).

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Mikkelsen et al. (2017) observed that exercise influences self-esteem through self-efficacy or mastery, and mood, distracting individuals from negative and worrying thoughts and rumination, improving the retrieval of positive thoughts and allowing time away from negative or stressful aspects of everyday life, and especially, the COVID-19 pandemic itself. These moderating factors might also explain the protection effect of exercise on mental health (Mikkelsen et al., 2017).

Physical activity programmes to improve self-esteem to people of all ages can be effectively delivered at home by DVD (e.g. see Awick et al., 2017) or by You Tube (e.g. PE with Joe).

Peer Support

Moreover, people in social isolation should try to create peer support through social networking services by involving friends and relatives in their exercise routines or challenges.

Resources

 

The negative impacts of COVID-19 lockdown on mental health can be ameliorated by the use of exercise, which should be as vigorously promoted as social distancing itself.

In this context, keeping moving seems to be the key.

Reference:

Thiago Matia, Fabio H Dominski and David F Marks (2020)

Human Needs in COVID-19 Isolation

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A Perfect Storm

These are extraordinary times. Throughout history there have been plenty of pandemics but the human response to COVID-19 is unprecedented. The world will never be the same again. It is estimated that close to four billion people are living in social isolation during this mother of all pandemics (Sandford, 2020). Unless there is a revolt, policies of social isolation in one form or another are expected to continue until a vaccine is available 6, 12 or 24 months from now.  The cumulative impacts of social distancing will be truly profound.

COVID-19 lockdown has created a perfect storm’ of vulnerabilities that huge numbers of people, and services, are ill-prepared to manage. This post reviews the science of human needs as they are expected to play out over a prolonged period of domestic confinement.

The COVID-19 pandemic involves a novel coronavirus characterized by a respiratory illness that results from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (Centers of Disease Control and Prevention, 2020). The disease was first reported in Wuhan, China, in December 2019 and symptomatic patients frequently present with a dry cough, fever and shortness of breath within 2 to 14 days after exposure. The coronavirus disease (COVID-19) pandemic is receiving intensive interest at all levels: political, economic, social, scientific and in health care.  The epicenter of the COVID-19 outbreak moved from China to Europe and a few weeks later to the US. As of 22 April 2020, there were 2,564,038 confirmed cases and 177,424 deaths reported worldwide, affecting at least 201 countries, areas or territories (Johns Hopkins University, 2020). Most cases are in the USA (823,786 cases), followed by Spain (204,178) and Italy (183,957) (Johns Hopkins University, 2020).

Isolation

Owing to the absence of a vaccine, official control measures have been implemented to reduce the spread of COVID-19, such as restrictions on people’s movements, including social distancing, closing of gyms and parks, travel restrictions, quarantines and stayathome guidance. The policy of confinement has significant health, economic, environmental and social consequences. In the psychological sphere, recent evidence shows that similar pandemics increased the prevalence of symptoms of post-traumatic stress disorder, as well as confusion, feeling of loneliness, boredom and anger during and after quarantine (Brooks, Webster, Smith, Woodland, Wessely, Greenberg, et al. 2020). 

Stressors during this critical period include fear of infection, fear of death, uncertainty, loss of social contacts, confinement, inadequate information, conflicting advice, loss of outdoor activities, disconnection from nature, loneliness, depression, helplessness, anger, low self-esteem, financial loss and obstacles to supplies of food and water (Brooks et al., 2020; Jiménez-Pavón, Carbonell-Baeza & Lavie, et al., 2020; Xiang, Yang, Li, Zhang, Zhang, Cheung, et al., 2020). A survey in China during the initial outbreak of COVID-19 found that 54% of respondents rated the psychological impact of the outbreak as moderate or severe; 17% reported moderate to severe depressive symptoms; 29% reported moderate to severe anxiety symptoms, and 8% reported moderate to severe stress levels (Wang, Pan, Wan, Tan, Xu, Ho et al., 2020). Given that a significant proportion of the population live alone or are vulnerable to mental health problems, the impacts of the COVID-19 pandemic on mental wellbeing are only now just beginning to be felt.  

 

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In light of these issues, systematic psychological self-care must be given a high priority in coping with the detrimental impacts of COVID-19 and social distancing. Here we discuss one of the most fundamental tools of self-care for health enhancement: increased physical activity. Governmental recognition of the benefits of exercise is evidenced by permitting exercise outdoors during social isolation for indefinite periods of weeks or months. Yet rarely is the issue adequately addressed; an International Task Force of experts to review and advise on psychological and physical self-care would be a welcome initiative.

During the COVID-19 pandemic special attention to systematic psychological health care is required (Zaka, Shamloo, Fiorente & Tafuri, 2020; Zandifar and Badrfam, 2020). Interventions to deal with the pressing psychological needs of individuals during the pandemic are being investigated but in most parts of the world seriously lacking (Xiang et al., 2020; Wang, Zhao, Fen, Liu, Yao, & Shi, et al., 2020). 

One example is physical exercise, which is one of the most important tools to prevent mental illness and improve well-being (Mandolesi, Polverino, Montuori, Foti, Ferraioli, Sorrentino et al., 2018). However, few public health guidelines include daily physical exercise routines for people living in varying degrees of isolation during the pandemic (Chen et al., 2020; Jiménez-Pavón et al., 2020).  The role of physical exercise in psychological wellbeing during the pandemic is discussed in a later post.

Here I introduce concepts that help to enable effective self-care measures for COVID-19 isolation. These concepts are part of A General Theory of Behaviour.

 Psychological Homeostasis

At every level of existence, from the cell to the organism, from the individual to the population, and from the local ecosystem to the entire planet, homeostasis is a drive towards stability, security and adaptation to change.  In a general theory of behaviour claims that striving for balance and equilibrium is a primary guiding force in all that we do, think and feel.  A behavioural type of homeostasis has been given the descriptive term: “Reset Equilibrium Function” (or ‘REF; Marks, 2018). The REF is thought to be omnipresent, whatever we are doing and wherever we are doing it, which includes the monotony of COVID-19 isolation. When we are in isolation, the REF stays with us, considers how to restore equilibrium and reduce feelings of unrest. The REF’s monitoring is not normally attended to, but the REF’s products are: feelings of distress, boredom, loneliness and instability can all be a focus for concern. Competing drives, conflicts, and inconsistencies all pull the flow of thought and feeling ‘off balance’, triggering an innate striving to restore equilibrium. Individuals resort to a variety of methods to restore a sense of balance and equilibrium.

Body and mind continuously regulate and control many domains and levels simultaneously, with multiple adjustments to voluntary and involuntary behaviour guided by two types of homeostasis: Type I – inwardly striving or physiological homeostasis, H[Φ], and Type II – outwardly striving or psychological homeostasis, H[Ψ]. Physiological regulation involves drives such as hunger, thirst, sex, elimination and sleep. The ‘Reset Equilibrium Function’ (REF) operates across all behavioural systems that are investigated by psychological science. 

The Reset Equilibrium Function is a general control function that automatically restores psychological processes to equilibrium and stability. The REF is triggered when any processes within a system strays outside of its set range. The REF is innate and exists in conscious organisms, which all have Type I and II homeostasis. The two types of homeostasis work in synergy. Psychological and physiological processes operate in tandem to maximize equilibrium for each particular set of functions. 

These include cognition, affect, chronic stress, and subjective well-being, and also out-of-control conditions such as isolation, boredom, addiction or insomnia that are in need of self-care. When there is goal to make a behavior change, conscious awareness of the goal and full engagement of one’s personal resources are necessary preconditions for purposeful striving, e.g. the need to reduce boredom and instability in COVID-19 isolation.

The Needs Hierarchy

Human experience is controlled by needs and behaviours to satisfy needs. A general theory of behaviour includes Maslow’s (1943) influential statement about human needs(with a few minor modifications). It is assumed that needs occupy a hierarchy of seven overlapping levels (Figure 1). Like any hierarchical structure, the stability of the system relies on the strength of its foundation level.  The first level  Immediate Physiological Needs  incorporates physiological homeostasis (Type I) and the sustenance of all physiological needs.  Higher level needs from level 2 upwards are served by psychological homeostasis (Type II). There is a progression in developmental priority as the individual matures.  The motivational hierarchy reflects evolutionary function, developmental sequencing, and current cognitive priority. Individuals who are unable to meet their immediate physiological needs at level 1 are at a disadvantage in meeting higher-level needs. Think of a building with seven storeys. If level 1 of the building is not strong, then the higher levels will be vulnerable to collapse.

NEW Needs Pyramid 

Figure 1. The Hierarchy of Human Needs. Homeostasis operates at all seven levels. Physiological, or Type I homeostasis operates at level 1. Psychological, Type II, homeostasis operates at level 2 (Self-protection) and above. Reproductive goals are in the order they are likely to appear developmentally. Later developing needs are overlapping with earlier developing needs. Once a need develops, its activation is triggered whenever relevant environmental cues are salient. Adapted from Kenrick, Griskevicius, Neuberg and Schaller (2010) with permission.

 

I consider next the likely impact of COVID-19 social distancing in light of the needs hierarchy. Four needs most directly impacted by social distancing at levels 1 to 4 are discussed in turn.

Immediate Physiological Needs (Level 1)

Physiological regulation involves the drives of hunger, thirst, sex, elimination and sleep. Level 1 is a bedrock for all higher levels. We consider first food, drink and other necessary products, which have been an issue from the very start of the pandemic with panic buying and stockpiling reported everywhere causing supermarkets and stores to run out of supplies. In the UK, in packaged food and beverages, the highest growth has been evident in cereals (38%), vegetables (37%), cocoa (25%), rice (22%) and pasta (19%). There has also been an increase in bottled water and indulgence foods, such as chocolate (23%), olives (68%) and beer (20%) (Kantar, 2020).Comfort eating and drinking is a common strategy of individuals seeking ways to ameliorate anxiety and distress associated with lockdown. Comfort eating and drinking is associated with weight gain and the development of obesity and eating disorders, especially in conditions of isolation and boredom (Crockett, Myhre & Rokke, 2015; Marks, 2015; Figure 2). Sadly, there is likely to be an acceleration in the already high prevalence of obesity over the lockdown period. As the lockdown period is indefinitely extended, with increasing joblessness and poverty, food insecurity is likely to become a major concern for many people. 

 

FIG 2

 

Figure 2.  Panel A shows the homeostasis system linking low self-esteem with negative affect, comfort eating and overweight. Intervention to alter the dynamics of the system towards that shown in Panel B replaces comfort eating with exercise designed to increase self-esteem and control weight gain (Marks, 2015).

 

A well-known and, to many, surprising COVID-19 phenomenon has been the prevalence of toilet-tissue stockpiling (TTS). In the UK, for the week ending 8 March 2020 the sales of toilet tissues rose by 60% year-on-year (Kantar, 2020). Why should this be?  In fact, this behaviour is perfectly logical and in line with the needs hierarchy where utmost priority is given to needs at level 1. TTS provides long-term hygienic support to the necessary act of elimination, which, during isolation, is more frequent at home because people are unable to do itat the workplace. Thus, TTS is consistent with level 1 of the hierarchy of needs.

 

Level 1 needs are automatically more complex in cases of addiction to drugs, alcohol, tobacco and other substances. If any of these addictions are present, the entire needs structure can be placed in jeopardy. In any case, disruption of sleep patterns is one prevalent consequence of pandemic distress. A European task force concluded: “In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships” (Altena, Baglioni, Espie, Ellis, Gavriloff, Holzinger, et al., 2020, p. 1). It has been established that physical exercise improves sleep for people of all ages (Flausino, Da Silva Prado, de Queiroz, Tufik, & de Mello, 2012; Reid, Baron, Lu, Naylor, Wolfe & Zee, 2010;  Yang, Ho, Chen, & Chien, 2012). We return to this later.  

Need for Self-Protection (Level 2)

Self-protection needs during the COVID-19 pandemic are paramount. The World Health Organisation (WHO, 2020) and national governments have required a lockdown of the population with social distancing and ‘stay-at-home’ isolation. These policies have stoked fear of death and infection while incentivizing individuals to carry out frequent handwashing, wearing masks along with social isolation. The advice to stay at home has been the main topic of messaging from health authorities during the pandemic.  

An individual’s responses to COVID-19 lockdown is shown in Figure 3. In lockdown, unmet self-protection needs become ‘normal’ and individuals experience systematic frustration of a deep-seated need to ensure protection of self and their family. This high level of frustration causes fear, anxiety and distress as individuals feel incompetent to guarantee the safety and protection of loved ones, family and self. Fear, anxiety and distress are also associated with insomnia, irritability and aggression. Especially if an  individual uses alcohol or drugs to assuage their fears, aggression may turn into physical violence to family members, women, children and pets(Peterman, Potts, O’Donnell, Thompson, Shah, Oertelt-Prigione, et al., 2020). There are increases in the incidence of  homicides and suicides (e.g. Campbell, 2020).

 

FIG 3

 

Figure 3. Behavioural systems at level 2 of the needs hierarchy in COVID-19 lockdown. In panel A, fear and frustration are accompanied by heightened surveillance of the external environment via TV news channels and social media. In panel B, fear and frustration are replaced by self-compassion and empathy and surveillance is replaced by reaching out to others.

Need for Affiliation (Level 3)

The almost total cessation of full frontal face-to-face affiliation outside of one’s domestic bubble is mandated by policies of home confinement and “social distancing”. Connecting with others normally helps individuals to regulate their emotions, cope with stress, and remain resilient (Williams, Morelli, Ong & Zaki, 2018).  Loneliness and social isolation, on the other hand, worsen the burden of stress, and often produce deleterious effects on mental, cardiovascular, and immune health (Haslam, Jetten, Cruwys, Dingle, & Haslam, 2018). Older adults, at the greatest risk of severe symptoms from COVID-19, are also most susceptible to isolation (Luo, Hawkley, Waite, & Cacioppo, 2012). Intergenerational social support, self-esteem, and loneliness are all strongly associated with subjective well-being (Tian, 2016). 

 

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These effects are not peculiar to older people. Even among adolescents, loneliness  is associated with physical inactivity (Pinto, Oppong Asante, Puga Barbosa, Nahas, Dias and Pelegrini, 2019). Thus distancing threatens to aggravate feelings of loneliness that likely will produce negative long-term health consequences in many vulnerable people. During the COVID-19 pandemic, the population of people at risk is enormous. After the lockdown period ceases, sadly mental health services are expected to be overwhelmed.

People with unmet needs for affiliation at level 3 are also at risk of failing to meet needs for status and self-esteem at level 4.

Need for Status/Self-esteem (Level 4)

As noted, status and self-esteem needs are vulnerable if needs at levels 1 – 3 are unmet. Failure at levels 1-3 accumulates with larger knock-on effects as cumulative failure develops. Furthermore, the pandemic is producing huge increases in  unemployment and poverty, vulnerability factors for lowered self-esteem and social status (e.g. Goldsmith, Veum & Darity, 1997). Self‐esteem is associated with responses to success and failure (Baumeister & Tice, 1985). Low self-esteem also creates a vulnerability to depression (Sowislo & Orth, 2013) and to drinking alcohol (Hull & Young, 1983)  if affordable. Self-esteem moderates the associations between body-related self-esteem, conscious emotions and depressive symptoms (Brunet, Pila, Solomon-Krakus, Sabiston & O’Loughlin, 2019).  Self-esteem also appears to be an important antecedent of the development of self-compassion (Dona, Parker, Sahdra, Marshall, & Guo, 2018).  

 

Conclusion

COVID-19 lockdown has created a perfect storm’ of vulnerabilities that huge numbers of people, and services, are ill-prepared to manage. The success of social isolation policies will depend on minimizing long term depreciation of mental health. 

 

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COM-B System Fatally Flawed

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The COM-B System

In 2011, three psychologists, Susan Michie, Maartje M van Stralen and Robert West (MSW, 2011), proposed “a ‘behaviour system’ involving three essential conditions: capability, opportunity, and motivation…This forms the hub of a ‘behaviour change wheel’ (BCW).”

MSW mention two sources for the idea of the COM-B:

“a US consensus meeting of behavioural theorists in 1991 [see this], and a principle of US criminal law dating back many centuries…Under US criminal law, in order to prove that someone is guilty of a crime one has to show three things: means or capability, opportunity, and motive.”

They continue:

“This suggested a potentially elegant way of representing the necessary conditions for a volitional behaviour to occur…We have built on this to add nonvolitional mechanisms involved in motivation (e.g., habits) and to conceptualise causal associations between the components in an interacting system.”

However, the hub of the COM-B is incomplete and doesn’t work  Here I explain why. Screen Shot 2020-04-03 at 10.34.04.png

In the COM-B system, Capability, Opportunity, and Motivation ‘interact’ to generate Behaviour. C, O and M are claimed to be sufficient and necessary conditions for B.

I show below that this claim is incomplete …but first we need some definitions:

Definitions

MSW give the following definitions:

‘Capability’ is defined as the individual’s psychological and physical capacity to engage in the activity concerned. This includes having the necessary knowledge and skills. In plain language – what I call ‘plang’ – ‘capability’ equates with ‘fit to’. 

‘Motivation’ is defined as all those brain processes that energize and direct behaviour, not just goals and conscious decision-making, e.g. habitual processes, emotional responding, as well as analytical decision-making.  In plang, motivation equates with ‘need to’.  

‘Opportunity’ is defined as all of the factors that ‘lie outside the individual that make the behaviour possible or prompt it’. In plang, opportunity means ‘can do’. 

Robbing a Bank

According to the COM-B, capability and opportunity cause changes in motivation and changes in behaviour.  I refer to that well-know character Joe Blow (pronouns: him/her/their). 

According to the COM-B:

Joe Blow (JB) would (X rob a bank, Y kiss the queen, Z fly to the moon, whatever) if JB is fit to, needs to, and can do X, Y or Z.

Yet this account is plainly incomplete. A key element is missing from the COM-B. JB must want to carry out X, Y or Z.  If JB doesn’t want to, he/she/they simply won’t do it, no matter what.

Imagine the following:

1) JB is fit to rob a bank because he/she/they is physically strong and has a jemmy and a set of tools for breaking open doors and safes – (fit to).

2)  JB is hugely in debt (to a bank, as it happens) so he/she/they need(s) money very badly, and so they have a strong motive to rob a bank – (needs to).

3) JB knows there is a back alley and a back door with an alarm that a friend who works in the bank will leave switched off on any night of their choosing – (can do).

JB ticks all three boxes but  JB chooses not to rob a bank. Why? There could be a million and one  reasons, e.g.  JB believes that he should not rob the bank because:

robbing the bank would be wrong,

it would be risky – i.e if he is found out he would go to prison,

it would look bad in front of the neighbours,

it would upset the bank manager who he drinks beers with in the local pub,

it would be an unreasonable and unfair act , etc.

For a host of different reasons, JB may desperately need money but does not want to rob the bank to get it.

In spite of JB ticking all three of COM-B boxes, the COM-B fails to correctly predict JB’s behaviour. There is a hidden barrier. In multiple situations people do not do something, even something they need to do, because they simply do not want to do it.

Another quite similar individual who ticks all three COM-B boxes might actually proceed to commit the bank robbery. Imagine: Joe Blow has a twin, Les Blow (LB/him/her/their) who lives on the other side of town. JB tells LB about the bank, the back alley and the dodgy security guard,  LB meets all three criteria – LB is fit to, needs to, and can do the bank robbery. Significantly, however, LB has none of the moral and social scruples held by JB and LB proceeds to rob the bank.

The twins act differently under essentially similar circumstances.  JB didn’t want to rob the bank but  LB wanted to – so LB did – revealing a crucial difference between the twins.

The COMA-B Reformulation

I have suggested that the COM-B requires reformulation because there is a crucial process missing. Also four of the so-called ‘interactions’ do not exist and none of the interactions work in both directions.

Only one ‘interaction’ in the COM-B diagram is anywhere near causal.  In order to do something, a person also has to want to do it more than they want not to do it. This is a delicate balancing act that goes on when we make decisions every day of our lives.

The reformulated ‘COMA-B’ is shown below.

(A = ‘Agrees to’, which makes a better acronym than using W for Wants : COMW-B).

amended COM-B model.png

Adding a box for wants, COM-B is converted into COMA-B.  A further change is the removal of arrows for imaginary interactions. In removing arrows, it is necessary to distinguish enablers from causes. Fit-to capability and can-do opportunity are both enablers of need-to motivation .

Conclusion

All together there are four necessary and sufficient conditions for any action X:

  1. needing to do X
  2. having the capability to do X
  3. having the opportunity to do X
  4. wanting to do X