Tuesday, 10 November 2015

Mental Health Stigma Reduces the Opportunities for 'Success'

Mind, Body and Soul
What do we mean when we imply that people with mental health issues are not successful, as it is often done in some of the psychological literature on the effects of depression on agency? A very powerful talk by Dr Victor Pace (Consultant in Palliative Care at the St Christopher's Hospice) inspired me to think about this question again.

The conference "Mind, Body and Soul: An Update on Psychiatric, Philosophical and Legal Aspects of Care of Patients Nearing the End of Life" was hosted by the Royal Society of Medicine on 10th November. Pace talked about the issues emerging in caring for people with severe mental illness who are also terminal patients. He explained very clearly why people with schizophrenia have a higher mortality rate and die twenty years earlier than if they did not have schizophrenia.

The list of factors he mentioned made me think about one notion of success that is quite implicit in our evaluation of our own lives, and other people's lives. The first factor is unemployment. People who are diagnosed with schizophrenia are unlikely to have stable employment in the ten years following the diagnosis, and unemployment means reduced socialisation, loss of control over one's life, dependence on others, and often poverty.

The second factor that was discussed is lack of close relationships. Being socially integrated matters a lot to people with severe mental illness (they would like to have close relationships) and it predicts reduced risk of suicide. But most of people with a diagnosis of schizophrenia (two thirds) lack social integration, and this causes serious disadvantage.

Thirdly, psychosis is the greatest predictor of premature death, not because of suicide, but because of physical illness, such as high incidence of smoking, diabetes, and metabolic syndromes, which are often made worse by antipsychotic drugs. One reason why physical health deteriorates is that people with psychosis access services late (because they feel they may not be taken seriously and have reduced pain sensitivity or pain expression), and often services are ill-equipped to deal with physical health and mental health as a package.

It seems to me that unemployment, lack of close relationships, and physical illness (and their consequences) are part of our pre-theoretical notion of failure. We see the successful agent as productive, socially integrated, able to determine her own path. What is potentially worrying about this identification is the implicit judgement that the agent is responsible for the consequences of her mental health issues. And this would be mistaken, because as Pace showed in his talk, the three factors he mentioned are due to or made much worse by stigma, that is, by the way society regards and treats people with a diagnosis of schizophrenia. The person with psychosis wants to work, make friends, and be well, but there are fewer opportunities for her to do so because she is marginalised.

The risks of marginalisation and of a "them and us" attitude to mental health are some of the issues I tackle in my latest Birmingham Brief.

Monday, 2 November 2015

Birmingham Heroes for Mental Health

Michael and I, together with post-doctoral researcher Ema Sullivan-Bissett, are taking part in a new campaign launched by the University of Birmingham on research that matters. Our project on the potential benefits of imperfect cognitions (PERFECT) is featured in the Birmingham Heroes website and posters. One of its aims is to challenge the stigma associated with mental illness.

Tuesday, 20 October 2015

Successful People...

This image was published in the wall of a Cognitive Neuroscience group on Facebook, and it seems to come from the website of a rehabilitation clinic in Lahore. It provides excellent motivation for an interdisciplinary group of researchers wanting to study and critically assess the notion of success!

Friday, 25 September 2015

Workshop on Success: A Brief Report

On 18th September at Senate House in London we met some of our collaborators for our proposed research project. It was a great day in which we explored ideas and experiences.

What is success?
We started discussing the meaning of the word "success" (etymologically linked to the Latin word for succession, and thus a term with a strong temporal and causal component) and how the residency would serve as to critically analyse everyday conceptions of success as tied to individual achievement, fame, power and competition. Success demands not just competition but cooperation, and changes our perception of ourselves and the way other perceive us. Any meaningful examination of success requires also a reflection on failure. Our own interest in success comes from its relationship with health: how does doing well relate to being well?

Apart from success and failure, we are interested in character and context, practices and structures, individuals and communities/organisations, internal and external, public and private. How do we achieve success, and what does it do to us once we have it? Several themes emerged from the discussion, including snatching success from the jaws of defeat; experiencing failure after being a success; failing in one domain while succeeding in another; performance anxiety and corporate psychopathy; and failure as necessary, as a useful and important aspect of growth, creativity and innovation.

Tuesday, 15 September 2015

Matthew Syed on Marginal Gains

Here is an extract:

Children are often taught to think that mistakes are bad. They get red lines in their books when they mess up. This is why they fear to put their hands up in class and struggle to take risks. But in an experiment where children were taught to think of weaknesses not as embarrassing, but as opportunities to learn, they became more inquisitive and resilient. They also performed better.

That is the power of the mindset that underpins marginal gains. It might just change the world.

See the whole article here.

Thursday, 10 September 2015

Promotion at Work: A Mark of Success?

Recently, there has been some discussion of the merits and especially the drawbacks of promotion at work. Opinions touch on some of the themes of our project, including creativity, ambition, achievement, satisfaction.

In one piece in Fortune, "Don't let yourself get pushed into a job promotion", the message is that many people accept managerial positions for the money, but then they find that they do not like the new responsibilities and the politics, and eventually would prefer to go back to their previous jobs. One key issue is that people dislike their new positions because of the stress and the long hours associated with them. What is success then? Being promoted and being miserable or not getting a promotion but maintaining a good work-life balance?

In another piece, published a few days ago in the New York Times, Rising to Your Level of Misery at Work, Arthur Brooks writes:
Ambitious, hard-working, well-trained professionals are lifted by superiors to levels of increasing prestige and responsibility. This is fun and exciting — until it isn’t.
People generally have a “bliss zone,” a window of creative work and responsibility to match their skills and passions. But then the problems start. Those who love being part of teams and creative processes are promoted to management. Happy engineers become stressed-out supervisors. Writers find themselves in charge of other writers and haranguing them over deadlines. In my years in academia, I saw happy professors become bitter deans, constantly reminiscing about the old days doing cutting-edge research and teaching the classes they loved.
I am very interested in the relationship between achievement and wellbeing, and Brooks indirectly addresses this. The two factors that seem to increase stress the most are (1) poverty, as it is stressful to lack resources; and (2) wealth, as it is stressful to manage the high pressures of work. There seems to be a blissful zone in the middle, but when people have achieved recognition and power, they do not resign from their positions to go back to their previous jobs, even if those jobs made them happier, because they see the regression as a failure.

Monday, 7 September 2015

What's your Epitaph?

Recently I wandered through the wonderful Cimetière de Montmartre in Paris. Although not as famous as Père Lachais it is a special place for me as several of my heroes lie buried in this necropolis, namely Emile Zola and Jean Michael Charcot. 

A cemetery is a useful place to consider success. Our worldly contributions, our imprints on the earth and beyond. I love reading the epitaphs. A life summed up in a few carefully chosen and engraved words. At risk of waffling I hear that great man of very few words whisper in my ear:

The grave of Emile Zola
Don’t try ~ Charles Bukowski

In Montmartre I and other visitors searched for the grave of Edgar Degas. Oddly we couldn't find it. I was looking for a hulking mausoleum or some such tribute, or at least an impressive bust like Zola. In this context size appeared to be a signifier of one’s importance.

Yet, Degas had no great monument. There was a rusting and simple metal surround for a broken and weed ridden gravestone, fallen as flat as the earth around it. I concluded that a talent like Degas doesn't need such frippery when he has left a body of artwork like this.

Team Aura- Lee Valley skate club

Taking inspiration from Degas' wondrous ballerinas I turn to the work of one of my collaborators Hannah Gravestock. Hannah’s recent projects include workshops with synchronised ice skaters. 

She uses theatrical methods to enhance their performance. The ultimate aim is competitive success. I asked Hannah to describe her work. She said nothing but sent me this picture:

Less is more. Collating drawing data

Signing off~ the cemetery cat.

I am looking forward to meeting up with the team this month. Here's to a successful Autumn.

Tuesday, 18 August 2015

Success and the Theatre: Charlotte Gwinner

Charlotte Gwinner
I am really excited to be able to introduce Charlotte Gwinner to the rest of the team!

Charlotte Gwinner is an award winning theatre director and her recent credits include: Sunspots at Hampstead Theatre, Sarah Kane's 4:48 Psychosis and Crave at Sheffield Theatres, The Distance at the Orange Tree Theatre, and A View From The Bridge at the Everyman and Playhouse, Liverpool.

She has directed lots of new and classic plays including: The Knowledge and Our New Girl (Bush Theatre), Benefactors (Sheffield Theatres), and The Uncertainty Project (Paines Plough). 

She was Associate Director for the Bush Theatre, under Josie Rourke in 2006, and was awarded a Quercus award in 2014 by the National Theatre, as well becoming Associate Director for Liverpool Everyman and Playhouse. She is currently an Associate Director at Sheffield Theatres.

It is wonderful news that someone with Charlotte's experience and background is keen to collaborate on a project investigating success, especially as Charlotte herself is interested in the various aspects that make a play successful. Charlotte will help us convert some of our and her ideas on success in a play destined to young children. 

I'm looking forward to discuss the details with Charlotte and the rest of the team in September!

Tuesday, 11 August 2015

Meeting Curious - thinking about failure and vulnerability in the light of success

Last week, at Wellcome Collection, I met with Helen Paris,who together with Leslie Hill form Curious. Curious have already created two artworks with the support of Wellcome Trust. One about ‘gut-feelings’ (The Moment I Saw You I Knew I Could Love You) was a collaboration with gastroenterologists at Barts, London. The other, about smell and memory (On The Scent), involved collaboration with a biologist at the National Centre for Biological Sciences, Bangalore, India.

Helen and I had a wide ranging conversation, but one element stuck in my mind – the possibility of failure and the opportunity to fail. Helen teaches performance at Stanford, USA. In one class she asks students to experience failure by creating ‘bad’ artworks. In order to succeed in the class they have to fail in their art, which Helen says the students find very confusing. What is the role of failure in success?

For artists, learning to take risks is necessary for success. Yet taking risks results in the possibility of failure. Drawing on Nietzsche', the early contemporary choreographer Doris Humphrey described how the modern dancers should always inhabit the ‘arc between two deaths’ - the moment of falling, between standing still and lying down. For Humphrey, lack of risk was the death of the artwork. If you were safely standing, or safely lying down, nothing interesting was happening. To dance, to create 'good' art, you must take the risk - and accept the possibility of failure.

But in healthcare, risk is unacceptable.

In a Lottery-funded project about interpersonal perspectives of suicidality, I was interested to hear service-user and family members discuss how while risk, and risk-assessment was very much part of many suicidal people’s lives, care and humanity was less evident. It seemed to many of our participants, that our risk-averse healthcare culture had reduced care to box-ticking, and that the humanity had all but disappeared. I am reminded of being told about an experience of being an inpatient (partly described in an article by Amy Woods & Neil Springham), when the service-user reported that hearing kind words from the ward cleaner was a standout moment of her mental health inpatient stay.

What is the relationship between risk and care? Trust seems important here, and was lacking for those participants who had been suicidal. I’m very interested in how trust manifests between people, rather than inhabiting any one person. It is neither a cognition, a behaviour nor a feeling, but perhaps a mixture of all these, happening across persons, not inside them - in a distributed way.

Helen Paris told me she thinks of trust in terms of an invitation – the invitation is given to the audience and she awaits the response. For example, in their recent piece Out of Water, Helen holds out her hand to an audience member, who is then led down to the edge of the sea. In making the invitation there is risk and vulnerability. How will the audience member respond? Helen says creating an atmosphere of trust and safety in the artwork is important.

There is risk and vulnerability in mental health care too. For service-users, who have perhaps been let down or hurt many times before, there is huge risk in approaching services for help, and allowing themselves to become vulnerable in the moment of trust. But for the staff too there is risk and vulnerability. (And I am thinking of my own experience here, as a trainee psychotherapist). If we make ourselves vulnerable by showing care for a service-user/client, what will happen? There is risk in creating attachments with the people we ‘care’ for (and this also goes for informal carers and wider friends and family of those with mental health problems). There is risk in acknowledging that as healthcare providers we often do not have adequate methods to ease suffering, and that we, sadly, sometimes fail to keep people safe or help them become well.

In thinking about success, failure, vulnerability and risk are all implicated. This seems to be the case in both artist endeavours and in healthcare.

Monday, 10 August 2015

Mental Health and Success in the News

Almost every week we read about the "unexpected benefits" of mental distress: people with depression are more accurate in their judgements, people with mania are more creative, people with anxiety are perfectionists. How should we interpret this literature, and is it a good thing to associate diagnostic labels to general patterns of behaviour that are viewed as positive?

Dianne Harris, Wellcome Images
This is a question I asked myself a lot recently, facing the reactions that my work on project PERFECT provokes in people with lived experience of mental distress, academics and the general public. PERFECT is about the potential benefits of imperfect cognitions (delusions, confabulations, distorted memories) and thus it often emphasises such benefits in the context of the behaviour of people with a psychiatric diagnosis.

One reaction is the Enthusiasts'. They believe it is wonderful to battle stigma by talking about people with mental distress in a more balanced way, highlighting the positives as well as acknowledging the negatives. The opposite reaction is the Sceptics'. They are wary of sweeping claims romanticising what by many is experienced as pain, distress, isolation, failure.

What should we think when we are told that anxiety makes us more successful performers and depression makes us more knowledgeable about ourselves? (Links are to popularised versions of these claims in the media, not to research articles in academic journals). I think we should first distinguish between the more and less severe form symptoms can take. A pinch of anxiety might make us more excited before an important performance, keeping us on edge and motivating us to prepare better. A depressive mood may be a powerful antidote to the overwhelming optimism we generally experience when we assess ourselves and our prospects. But crippling anxiety and major depressive episodes are no fun, and seem to deliver no benefits at all, rather than maybe develop resilience in the people who survive them.

This is a message we get clearly from the first-person accounts we publish in Imperfect Cognitions (see Emily Troscianko on anorexia): sadly, some situations have no silver-lining.

To explore these issues in the context of our interest in "striving and thriving" will help us map the relationship between mental health and success. This task will be partly empirical as it will require to collect information about how people behave and how their mental distress affects their behaviour, and partly conceptual as one will have to have a pretty good idea of what success entails in order to collect data that are relevant. Michael's last post helps with clarifying what the conceptual questions may be like: Is the successful person the one who finds meaning in what she does, or the one whose measurable achievements exceed expectations? Is there a notion of success that can capture both aspects?

Friday, 7 August 2015

Navigators, Long-distance Runners, and Unreal Children

There's a lot of relevant discussion to enjoy in this interview with Ian Mackaye.

The Winner-Take-All Economy

The Second Machine Age
I've just read "The Second Machine Age", by Brynjolfsson and McAfee, and I thought I would share some thoughts relevant to our project with you.

The authors explain the concept of a winner-take-all economy. This is an economy where the company or individual that produces the best product or the best performance gets huge rewards and all the competitors get relatively little, even when the quality of their product or performance is only slightly lower than the quality of the product or performance of the top company or individual. The authors also explain how technology (and digitisation in particular) and globalisation are pushing contemporary society more and more towards a winner-take-all economy.

Digitisation means that many goods (those that can be digitised) can be reproduced at a very low cost and can thereby invade global markets very easily. The same applies to goods that have a low marginal cost of reproduction. So, within any particular niche of the market, the best version of one product can generate huge profits for its producer leaving only crumbs to the producers of second-best versions. As the Nike ad put it "you don't win silver, you lose gold".

Winner-take-all systems for the distribution of rewards can be useful for some purposes: they can spur excellence and innovation (in some circumstances, when they don't give rise to monopolies, etc.) But they obviously result in huge inequalities. If there is no mechanism to redistribute the rewards of the winner so that the whole of society can benefit, the inequalities accumulate and become entrenched. 

This is bad in all sorts of ways and for all sorts of things, including health. The epidemiological literature on the social determinants of health has shown how significant the impact of inequalities on health are. In the decades to come, the shift towards a winner-take-all economy generated by digitisation and globalisation will make those impacts even more significant and problematic than they already are. 

Why I Keep Thinking about Collections...

Reading Room, Wellcome Collection

Last night I braved the tube strike to visit the Wellcome Collection, and I spent some time in the Reading Room. I’ve always loved libraries and bookshops, so it’s perhaps no surprise that I feel very at home there, but there’s something more going on. Ever since early in this project I’ve become hooked on this idea of collections, archives, libraries – there’s something here for me, but what? I have proposed that as part of the project we create a digital archive of all the ‘Stories of Success’ we come across during our residency – these may be oral stories, videos, texts, or other media; drawings, photographs, objects etc. They may be collected from members of the public (perhaps with the help of storytellers, SparkLondon), from our empirical work, or from our collaborators themselves. But my interest in collection seems to even go beyond that.

Is it to do with memories? Helen Paris, from Curious, (see separate post to follow) told me about a collaborator of hers, a dancer, who made a piece about how our memories for places can be held in a bodily library. I’m interested in the intersection between bodily memory and narrative memory, and wrote about this in my PhD research on guilt. I know some of our collaborators will be working with dementia, and that Victoria has done a lot of work in this area, so there are links here. Perhaps memory and memorialising are becoming more important to me as I get older. Do I see this project as such a precious opportunity that it must not be forgotten? Am I keen to remember? And to ‘re-member’; to embody this conceptual work and make it real, tangible.

Is it about storage and legacy, or a need to create something tangible for posterity? Something that can be shared, and that can transcend time? Am I feeling the urge to hoard ideas, less then become suddenly scarce? Maybe I want to create a perfect collection, tracking down every possible variation until I have a complete set... I do feel that if we were given two years to explore success we should create something that endures; that has duration; that lasts beyond the two years. On Tuesday, Michael and I noticed that we need to think about the sustainability and the legacy of this project for the new application form – but it’s more than this. It feels almost like a moral responsibility or an compulsion for me. We (Michael and I) were discussing how having a significant piece (actually several linked pieces) of empirical work gives us a strong grounding for our work, from a disciplinary perspective, but will also provide us with material that we can revisit well beyond the life of this project. And that hopefully others in our group, and beyond, can explore too.

Or is this interest in collections actually more about multiplicity? This feels most likely. The reading room contains many different perspectives on mental health, for example, some from the service-user movement, some critical psychology, some mainstream, some from psychiatry etc. etc. Voices that wouldn’t normally be heard together. All these multiple voices are allowed to coexist in a library. In an exhibition (and also in the reading room), exhibits in different media are allowed to rest next to one another. Objects from different centuries, continents, peoples, and of different ‘values’ can sit together. The audience/reader/viewer is treated as an intelligent and curious individual who has the capacity to take on board multiple viewpoints and to stitch them together in their own, unique ways. It feels like there are increasingly few spaces in our world where such multiplicity is celebrated.

I think it is this – the multiplicity – that specifically interests me about the idea of collections, libraries and archives. Perhaps too often I surround myself with people who think like me – providing the familiar, the comfortable. In my discipline, my view of the world is fairly marginalised, so it’s perhaps no wonder that I find others like me, and we club together to create a safe ‘home’ for ourselves. However, this intellectual ghettoisation is very limiting. I feel more inspired by the conversations I’ve had with artists this summer, than by any journal article I’ve read. I’ve suddenly remembered how reading non-scientific literature, looking at artwork, and going to the theatre is more than just an enjoyable activity, but can feed directly into my research.

Perhaps with this project we can 1) create a collection of people. Perhaps this is the very special and unusual thing - a chance for people who wouldn’t normally share space to meet, talk and create. I strongly believe that if you put interesting people together in a room, interesting things will happen. Of course, we need some structure, outcomes and milestones, but we must allow for flexibility and spontaneity too. And so then 2), through cross-pollination, and sparking off each other, we can generate a collection of ideas. Maybe one equal to any library or museum collection.

Wednesday, 5 August 2015

Metrics and Meaning; Technique and Content.

I've been busy moving house this last few weeks, which has presented its own modest opportunities to 'thrive in the face of adversity.' Luckily for me, the adversity is only of the inconvenient and transitory form, but it has meant that I've felt a little out-of-step with our plans here this month.

Yesterday, Zoë and I had a day blocked out to catch up on this stuff, and alongside a lot of very practical planning stuff, we also managed to begin think through a few more interesting angles on the meaning of succeeding. One of these - which really resonated with me - was the observation that 'default,' everyday understandings of success are very often situated at one end of a polarity, with metrics and technique at one end of succeeding (how much money, how many skills, etc.) and meaning and content (defining success in our own terms, for its intrinsic value, or in terms of what it permits us to communicate).

I think this is brilliantly illustrated in these two contrasting clips from the BBC's 'Listening project.' In one, Miguel and John discuss the financial implications of their transition to what seems to be construed as a 'state of success' (albeit a vulnerable one).

In the other, which is misleadingly billed as the story of two musicians who have 'not known success,' Duncan and Paul describe how - on their own terms - they consider their musical work to have been rewarding and successful.

This led us to thinking about competency (artistic technique; professional skills in healthcare; leadership and its qualities; the collaborative 'joint action' aspect of skilled enactment; evidence-based training and change) as a dimension of success, and as one which links the interests of several of our proposed collaborators for the theme. I experience a bit of 'de-skilling' when I think about this. I find the topic fascinating, but will need to rely heavily on the expertise of collaborators in order to explore it meaningfully. It seems to be the nature of this scheme that its interdisciplinary and interconnected nature takes one seemlessly into the realms of topics which are *just outside* of one's comfort zone. I expect that this is a good thing, really, but it will be good to deal with this in a team context. A little bit of time and space for reflection goes a long towards coping with the twin perils of Discomfort and Complacency!

The other thing I wanted to post, because of Matteo's interests in Lord Owen's ideas about character, leadership and hubris, does link - tenuously perhaps - to this idea of knowing your limits, and extending them cautiously. David Owen gave a very interesting interview to Radio 4's Reflections programme, last week. I was struck by a few things: the non-partisan nature of his judgements about important people in his career; the strength of feeling still evident in Owen's account of his departure from the Labour party, and the difficulty that Owen had in responding to his interviewer's question about the consequences of that departure for his own political career.

I wonder if there is some merit in thinking about the motif of the 'road not taken,' in relation to the meaning of success. Thinking back to those two co-constructed narratives from the Listening Project, I notice that some of the more emotive content settles around the 'what if?' and 'if only?' moments. There's a sense of precariousness and transience to many of our experiences of 'doing well.'

Thursday, 16 July 2015

Stories of Success at the Heart of the Project

Logo of SparkLondon
I just had a great call with the director of one of our newly confirmed collaborators, SparkLondon. Joanna Yates started out as a Occupational Psychologist, but now runs London's storytelling events organisation, as well as working directly with companies thinking about the stories they tell.

SparkLondon hosts two types of events at present - 'SparkLondon Open Mic' nights, where anyone can tell a story based on the theme of the night. The next events on on 'Adventures in Business Gaffes' (30th July) and 'Glory' (10th August). They also host 'SparkLondon Stories' which are specially produced events with story-tellers from particular groups. The next event, produced in collaboration with Open University, focuses on the stories of sex workers.

Every event is recorded and turned into a podcast. Their podcast now has 30,000 listeners. You can listen to them here.

Speaking to Joanna was fanstastic - she completely understood the complexity of the theme 'success' and had many personal and professional insights into the idea of 'success against the odds', or in 'times of adversity'. She's passionate about learning from what works and uses storytelling to help companies negotiate periods of change. For this reason, I think she'll make a great contribution to the work of collaborator Dr Leah Tomkins on organisational success and our thinking about interpersonal and systems successes.

Joanna is going away to discuss our conversation with her team and come up with some more refined ideas for events and workshops that we can interweave into our residency. She's also going to look at some costings. We'll meet again later this month at one of their events, and Joanna is hoping to come to the collaborators' event on 18th September.

I'm feeling very inspired and am coming to find that stories are at the centre of the research I want to do as well. As a phenomenological psychologist stories hold a tenuous place, but in my PhD I incorporated narrative because I see it as such a pervasive part of being human. I think the stories that we tell as individuals, couples and families, especially at times of adversity, are part of what holds us together (anchors us), and helps us be successful. I am really excited about the prospect of moving forward with these research ideas!

Next meeting is with performance poet, Luke Wright...

Tuesday, 30 June 2015

Success and Mental Health: the Case of Delusions

Credit: Wellcome Library, London
With Michael I attended today a lunchtime seminar on delusions, hosted by the School of Psychology at Birmingham (as part of the Neurocognition of Aberrant Experience and Belief Research Theme), organised by the Philosophy Department, and sponsored by our team at project PERFECT. The seminar was interdisciplinary, as most of the events I promote, featuring psychologists and philosophers.

The focus of the talks by Phil Corlett (School of Medicine, Yale University, US) and Kengo Miyazono (Philosophy, Keio University, Japan) was the relative merits of theories of delusion formation (prediction-error theories versus two-factor theories), but I kept thinking about how interesting the case of delusions is for understanding the relationship between mental health and success, and indeed this was a recurrent theme in the discussion following the talks.

When we think about delusions, we tend to think about the most distinctive mark of madness, and about their disruptive effect on people's lives. And although it would be a mistake to construct delusions as radically discontinuous from the irrational beliefs we all have, their adverse impact on wellbeing should not be underestimated. Thanks to the talks at today's seminar, we reflected on how delusions come about and this led us to realise that delusions may be a response (some would even say: an adaptive response) to a crisis. If we believe the prediction-error theory of delusion formation, in the prodromal stage of psychosis (before delusions develop) people experience hyper-salience. Their experience becomes salient: noises are louder, colours are brighter, apparently random events assume special significance, and there is no explanation available for this change that is overwhelming and distressing.

When the delusion emerges, it presents itself as an explanation for the change. Things become less mysterious and unpredictable, the person seems to gain some sort of control by imposing meaning over previously puzzling events. For a short time then delusions provide a relief, they allow the person to engage with the physical and social environment that had become so difficult to predict and interpret, and can be seen as psychologically and epistemically beneficial (see this paper for a more detailed account). Such benefits do not last long, as the delusion may be distressing in its own right, due to its content, and may become a new source of anxiety by creating a gulf between the person and others who do not share the delusion. Moreover, it can give rise to further beliefs that are consistent with it, and prevent the person from accessing a shared reality.

Interestingly, when a strange belief is shared (where we want to call it delusional or not will depend on whether we believe that the term 'delusion' should be reserved to clinical cases) the adverse effects seem to be mitigated. The example of bizarre religious beliefs in small communities was mentioned today, and evidence suggests that such  beliefs do not impact negatively on the functioning of the people who live by them. Thus, at its adoption stage the delusion can be seen as adaptive by helping a person overcome hyper-salience and reconnect with the surrounding environment, but at its maintenance stage the delusion can become a serious threat to wellbeing and good functioning, especially when it prevents socialisation.

The distinction between different stages of the development of the delusion can be clinically relevant to the choice of treatment options, and contribute to a better understanding of the intricate relationship between mental health and success. What if, as Roberts (1991) suggested, the delusion were the first step towards remission?

Wednesday, 17 June 2015

Success, Rationality, and Optimism: an Update

My own parallel projects have made progress lately and I feel confident that they will interface very nicely with the preparation for our project on success. My current ERC funded project, PERFECT, is entering its second year and articles describing some of our first results are being published. This week a paper in which I argue (with Kengo Miyazono) that delusional beliefs can have psychological and epistemic benefits (as well as obvious costs) has appeared in Erkenntnis, and I am curious to see what reactions it will provoke. It is the basis for a talk I will give later this month at the Royal College of Psychiatrists International Congress in Birmingham, where with Richard Bentall and Phil Corlett I will be examining the function of delusions. The fact that something so obviously detrimental and upsetting as a delusional belief may be found to play a useful role in some circumstances speaks to the complexity of the relationship between success and mental health.

Thursday, 11 June 2015

Matthew Syed on the Surprising Truth about Success

Black Box Thinking
by Matthew Syed
One of our proposed collaborators, Matthew Syed, elite sportsperson and now journalist and broadcaster, has a new book on success coming out this October, entitled Black Box Thinking.

In the book Matthew argues that the key to success is a positive attitude towards failure. What is especially interesting for our project is that the book proposed to examine success in different fields from sport to business, and from education to health.

Wednesday, 3 June 2015

John Doran on the Many Levels of Successful Recovery

Jolly Lad by John Doran
One of our proposed collaborators, John Doran, has been out and about this month giving readings from his book Jolly Lad.

This morning, he published this piece in the Telegraph, with a lovely extended metaphor about a drained lake.

I thought you might enjoy it!

Friday, 1 May 2015

Success Map 3

Here's our revised schematic - thanks for all the suggestions!

Connecting and Relating

Credit: Anthea Sieveking, Wellcome Images
For the project so far I have nominated two collaborators, who are both keen to take part:

Dr Leah Tomkins has a background in classics, then worked in industry for 20 years, including as Director of Change at the Cabinet Office. Like me, she retrained in psychology at Birkbeck and then completed her PhD. She now works in the field of Organisational Studies. I invited Leah because of her understanding of how organisations succeed, and particularly because of her work around the notion of the 'caring leader' and the Heideggerian idea of 'care'. I am also currently collaborating with Leah on a project about experiences of happiness. One area of interest is how achievement and happiness can be bound together - but can involve experiences of anxiety and shame as well. I see Leah's interests fitting well with Michael's and my work on relationships (Leah is also an expert in the IPA method and the phenomenological psychology approaches we use) and foresee her being involved the 'relationships and connectedness' stream, but also she will contribute to our stream on 'individuals and hierarches' as well.

Dr Andreas Aresti and the British Convict Criminology group are committed to developing critical insider perspectives on prison and the experiences of prisoners. Andreas is both an ex-prisoner and an academic. As such, he researches with communities and individuals who are impacted by the prison experience and co-founded the British Convict Criminology movement, which is an emerging theoretical perspective (originating in the US) led by ex-convict/non-convict academics. The group takes a critical perspective to existing criminal justice issues. In particular he has looked at resettlement. I am keen to work with Andreas and other members of British Convict Criminology on the 'relationships and connectedness' stream, to explore further how relationships succeed during time inside, and during the difficult resettlement period. Andy also shares expertise in the IPA methodology, but also works in more collaborative participatory ways with groups and individuals. As well as working academically, he is involved in shaping policy and doing community work, such as mentoring. With his personal and academic experience I also think Andy will be a great contribution towards the 'social contexts and alternative cultures'.

Wednesday, 29 April 2015

A Hub of Success

I've been thinking, dreaming, contemplating and moving towards action, in this case writing. The evolution of this project already represents success for me. It's almost ready. A group of people have come together (thank you Lisa and Michael) and developed something novel, each contributing unique insights and skills. Through a series of exchanges and interactions, many virtual, a programme of work has emerged. The discussions, (re) connections and interactions have reminded me of the importance of relational factors in achieving success. So, what are my plans for the project and who will I bring in to collaborate with?

My focus will be on creativity as a route to successful recovery from mental health problems. This addresses the Wellcome challenge of understanding the brain and how integrating humanities, arts and science approaches can contribute to this.

I will draw on my research focussing on engagement in creative activities and mental illness. Specifically my work on dementia that addresses another Wellcome challenge, that of investigating development, aging and chronic disease. This work is building evidence on how to provide and encourage supporting skills and resources in older people.

Success as an Outsider
I plan to engage with my colleagues and creators in the outsider art field to explore how creative endeavor can lead to success within the art world and the costs and benefits associated with this. Some, even those with severe and chronic mental health problems, have achieved considerable success as recognised artists. The current popularity of the ‘outsider’ art field is testimony to this. ‘Outsider’ art, a term coined by Roger Cardinal in 1972, defines artists as those outsider or peripheral to mainstream art training and infrastructure. It is now a contested term as it serves to reinforce differences between individuals within and outside the art world, and, implicitly, those with and without mental health issues or other challenges to social and cultural inclusion. Despite this, in 2013 there were at least 5 major exhibitions of outsider art in Europe alone which demonstrate success in the art world. The movement has its own dedicated art magazine: Raw Vision. There are now 2 commercial outsider art fairs in NYC and Paris each year where art made by untrained artists, many of whom have mental health or learning difficulties, exchange hands for substantial sums of money.

Whilst exhibitions, press coverage, and fairs increase the profile of artists and their work, it could be suggested that those benefiting are the art dealers rather than the artists themselves. Some artists indicate that commercial exposure can be exploitative and even damaging to mental health. I would like to explore relationships in this context, which would link to Zoe’s work stream. I will work with John Maizels, the editor of Raw Vision magazine. Coverage of artists and events in this publication represent an important marker of artistic success and wider recognition.

Outputs: John has agreed to work with us to develop an article or series of articles in his publication focussing on notions of success within the outsider art field. This will enable findings from our residency to reach an international audience in the specialist art field, a marker of artistic achievement (success).

Both the work on creativity and aging (dementia) and outsider art lead to many opportunities for public engagement. I plan multi art form activities working with Errol Francis. Errol is an artist, curator and researcher. He has recently established the research and creative consultancy –PSY- based at London College of Communication (I am a member of this group). Errol has a string track record of curating and directing festivals with mental health themes. Most recently the acclaimed ACE-funded Anxiety Festival 2014 and 'Acting Out' (2015) http://www.actingout2015.org (I am a curatorial consultant on ‘acting out’).

Outputs: An art exhibition and/or festival, across multi art forms and featuring new commissions on the themes emerging from the residency.

Success and Performance
I plan to explore creative expression through a phenomenological framework, informed by positive psychology. In particular I plan to look at artistic activity as a form of ‘flow’ state and one which results in enhanced wellbeing but also production of valuable aesthetic artifacts. Also, artistic activity may be viewed as a component of posttraumatic growth (PTG), that is a way that one’s life is enhanced as a result of traumatic experiences such as mental illness and events preceding it. I would also aim to explore how artwork made by those with mental illness may be used to successfully connect them to significant others and to the wider community. Here I plan a collaboration with the filmmaker David Bickerstaff. David has enjoyed considerable success with films on artistic, mental health and environmental themes. He has collaborated with the Wellcome Trust on numerous occasions e.g. Madness and Modernity and is working with them currently on a future exhibition that focuses on mindfulness.

Outputs: a short film on themes emerging from the residency and a peer-revised publication in Arts and Health.

I would like to broaden this work stream to include performance within sport and other arenas such as theatre working with Jules Evans and Hannah Gravestock.

Jules Evans is an author, philosopher and is policy director at the centre for the study of emotions at QMUL. He is also a broadcaster e.g. he recently presented a piece on flourishing on BBC Radio 3. He has been a BBC 'new generation thinker'. He is co-organiser of the London Philosophy Club and has been working with businesses, elite sportspeople e.g. Saracens football club and in prisons teaching flourishing and 'the good life'. His book Philosophy for life and other dangerous situations has been published in 19 countries. It has been #1 in Amazon.co.uk’s philosophy chart, a Guardian Books bestseller, and a Times book of the year. His next text (due 2016) focusses upon ecstatic experiences.

Output: Jules will develop a seminar series on flourishing and success in a variety of public, clinical and community settings.

Hannah Gravestock is a former elite ice skater. She provides performance coaching in theatrical and sporting arenas. She has established innovative training modalities e.g. drawing, to enhance success in the theatre and in sporting venues. She has worked with people with dementia in residential care settings.

Output: Development of performance and drawing based interactive training programmes.

My Collaborators (and what I want to do with them)

Here are those who have agreed collaborate if the project is successful:

The Rt Hon Lord David Owen and the Daedalus Trust

Lord Owen is a prominent British politician. He has agreed to be a collaborator both individually and as Chairman and Founder of the Daedalus Trust.

He is a doctor by training and has a long-standing interest in the interrelationship between politics and medicine. Among many other things, he is the proponent of the hypothesis according to which people who exercise power often develop a distinctive psychiatric condition, what he calls the Hubris Syndrome, a personality disorder that leads to impulsive and irrational decision-making. When powerful people make bad decisions, many suffer and the wellbeing of many is at risk.

The Daedalus Trust is a registered charity funded by Lord Owen with the aim to raise awareness of the existence and the threats generated by Hubris Syndrome in public and business life.

The website of Lord Owen:

The website of the Daedalus Trust:

Professor Sir Michael Marmot and the Institute of Health Equity

Sir Marmot is Professor of Epidemiology and Public Health at UCL. He is most famous for his work on the social determinants of health and for what is known as the Marmot Review. He has agreed to be a collaborator both individually and as Director of the UCL Institute of Health Equity.

Among many other things, he is the proponent of the hypothesis, known as the Status Syndrome, that differences in socioeconomic and occupational status are responsible for differences in health (because lower status is more likely to give rise to chronic stress). 

The UCL Institute of Health Equity is supported by the UCL Department of Health and by the British Medical Association. Its aim is to study the social determinants of health in order to increase health equity both at a national and at a global level.

The webpage of Sir Marmot:

The website of the Institute of Health Equity at UCL:

Success and Inequalities: Impact on Freedom, Health, and Happiness

Success is often conceived in terms of hierarchies: there are those who are at the top, and get big rewards from being at the top, and those who are the bottom, and get little or nothing. It is also often conceived in terms of domination: those further up the hierarchy directly or indirectly have power/impact over or at least constrain the actions and lives of those who are below them. My plan for the project would be to develop a philosophical reflection on hierarchies and domination and on how the widespread striving for power, domination, wealth and fame can negatively affect the thriving of individuals and communities, including their physical and mental health. This reflection will have two starting points: the existing empirical literature and the classic ideas developed on this issues by some past philosophers.

Social epidemiologists have accumulated evidence on the harm on individuals and societies generated by inequalities in wealth and in socio-economic and occupational status. Inequality has negative effects on the life expectancy, the physical health and the mental health of individuals. Social epidemiologist Michael Marmot and other social epidemiologists have uncovered evidence strongly indicating that the lower one’s socio-economic and occupational status, the worse one’s health (as measured for example in terms of life expectancy and risk of suffering from cardiovascular disease). One important causal pathway according to Marmot has to do with the level of control that people have other their lives: the lower one’s SES status is, the lower one’s level of control, and thereby the higher one’s levels of chronic stress, with all the negative implications for health that this means. Psychological studies have confirmed that lower social class is linked to a reduced sense of personal control.

These data and hypotheses are philosophically interesting. For example, philosopher Philip Pettit has developed a notion of domination according to which one is free from domination to the extent that one is able to interact with others without reason for fear or reference. One could argue that the lower one SES status is, the more one’s interactions with other human beings are characterised by fear and deference.

Successful Ways of Relating

Two types of relating have been on my mind with regard to success...

Last week I was presenting some work on trust and suicidality at the British Sociological Association conference and it led me to thinking about Lisa's ideas on the politics of interdisciplinarity. I feel most comfortable working in the hinterlands between psychology, sociology and philosophy, but as a trained psychologist, I still experience myself as somewhat of a fraud outside of the psychology discipline. My 'outsider' status could be a fertile place of creativity, but the actuality of inhabiting material spaces across disciplines leaves me uncertain. I feel most 'at home' at those events that set themselves up explicitly as interdisciplinary.

But isn't there a problem here? If interdisciplinary-ism becomes a space in its own right, hasn't its project essentially failed? How can interdisciplinary work genuinely mesh and tether the disciplines together, in a way that opens out one field for those in another, if we silo ourselves off in special, private spaces? Working out how to work in a genuinely interdiciplinary way while maintaining connections to our various disciplines seems important. Perhaps because several of us see ourselves as having 'several hats' or 'past lives' where we do/did something different, we will be able to find news ways to straddle disciplines and negotiate the politics involved in these processes.

Credit: Wellcome Library London
Secondly, Michael and I have just been awarded a grant from the Independent Social Research Foundation for a small project on Relatedness and Relationships in Mental Health. The project will bring together psychologists, philosophers (including Lisa), sociologists, a social policy researcher and a psychiatrist to think conceptually about the roles of relating in experiencing and recovering from mental health difficulties.

This work which will run from July 2015-July 2016 will be an excellent platform for the work I am planning for this project around relational success in adversity - especially in mental health and addictions contexts. I hope to be able to develop some of the ideas we will explore here, particularly, around the relational factors that contribute to successful recovery, and the recovery factors that facilitate successful relationships, particularly in a context that privileges individualism and independence.

Monday, 27 April 2015

Agential Success

Credit John Wildgoose, Wellcome Images
My idea for the project focuses on agential success. We need to better understand the notion of agential success which is often upheld as a worthy goal without being fully understood or critically examined in the philosophical, psychological, or mental health literature. The notion of agential success is usually explained in terms of an agent’s capacity to pursue and sometimes achieve her goals. My research goal is to identify the psychological factors contributing to agential success and explore the costs and benefits of those factors for human agency broadly conceived. In particular, I am interested in the relationship between success and rationality, and in the relationship between success and wellbeing.

Rationality and success

As I am starting to explore via Project PERFECT and I hopefully will explore as part of a new fellowship supported by the Templeton Foundation, positive illusions and unrealistic optimism (i.e., the tendency to have a higher opinion of oneself than is warranted by the evidence and to predict one’s own future in a rosier way than statistical evidence would recommend) seem to support successful agency. This would mean that some forms of irrationality (false beliefs and inaccurate predictions) are good for agents. But it is not clear whether optimism is beneficial and conductive to success across contexts and populations. In what way does optimism promote engagement with the social and physical environment surrounding the agent? Moreover, it is not clear that the best way to understand the literature is in terms of a trade-off between rationality and success. Cannot optimistic beliefs enhance rationality as well as success in some context, and compromise both in other contexts?

Success and wellbeing

The identification between agential success and mental health has a long history. Some of the criteria for mental health (such as good functioning) seem to be other ways to capture agential success. But it is not obvious that agents with compromised mental health are less successful as agents or that agential success intended as goal satisfaction contributes to psychological wellbeing. We can all think of cases where mental distress and creativity go together, and similarly of cases where highly successful agents present symptoms of mental distress, often related to their prioritising their goals over other aspects of their lives.

Responding to negative feedback

Once the notion of success and its relationships with other values are critically examined, the recent empirical literature on agential success can be taken to suggest that the key feature is the capacity to respond positively to negative feedback and other challenges (psychologists talk about ‘hardiness’ and ‘preparedness’ in that context, in the popular culture we talk about ‘bouncing back’, and in the mental health literature the word ‘resilience’ is used to denote some of these phenomena). Are successful people in different domains hardy and prepared for set-backs? How do they overcome disillusionment and maintain motivation in the face of failure?

In the proposed project, I see my role as analysing some features of agential success that can help us understand in what contexts and to what extent success is something that agents should aim to achieve. This requires the study of case studies: success in elite sport (which will be explored in collaboration with Silvia Camporesi), success in the arts and fashion (Victoria Tischler’s focus), success in relationships (Zoe Boden’s focus), success and mental health (Michael Larkin’s focus), success and political or social power (Matteo Mameli’s focus), and at a more methodological level, success in interdisciplinary research (which concerns all of us!). Such cases will illustrate the complexities of measuring or assessing success: elite sportspeople, successful managers, and even top academics often give up long term health prospects or happiness in their relational and family lives to achieve career objectives in their field; self-harm, psychotic symptoms, or eating disorders involve actions and experiences that are at the same time bad and good for the agent. They may bring relief and some sense of achievement or accomplishment, maybe in the short-term, but they also cause pain or suffering, and are responsible for broken relationships or ill-health down the line. And many more examples sping to mind where assumptions about success are challenged.

My own research goal is to try and understand the significance of the single case studies for the general context of any agent’s success. The framework I would like to propose rests on the notion of success criteria for engaged agency. The proposal I would like to test is that the successful agent is the agent who engages with the physical and social environment in a way that allows her to give meaning and direction to her life. This is possibly one sense of success that is central to mental health. We often identify long-term wellbeing and mental health with the agent’s capacity to effectively pursue and ultimately achieve at least some of her goals, forgetting that the agent needs to be engaged to do so: she needs the capacity to interact successfully with her physical and social environment, to feel motivated and supported, and to develop creative responses to inevitable failures and set-backs.

My dream collaborators

Charlotte Gwinner – theatre director who would assist us in producing a play on success for families, to be performed on weekends at the Wellcome Trust.

Matthew Syed – successful sportsperson and now author and media who would feature in a podcast on the residency and deliver a public lecture on what elite sports can teach us about success in more general terms.

Anne Khazam – producer for the radio programme BBC Forum (World Service) who provisionally agreed to work on one or  two episodes of the Forum with core members and collaborators on success, to be aired worldwide and available as a podcast on the BBC website. She has confirmed that her editor is keen to pursue the project.

Amy Hardy – research clinical psychologist interested in the role of imagery in mental health who will deliver a series of lectures on positive and negative aspects of imagery and its role in ‘success’ (including a critical perspective of the recovery framework in mental health).

Some outputs and activities

  • Preparation of two research articles on agential success
  • Organization of a series of interviews, lectures and debates with experts from different backgrounds (podcasted)
  • Book: Bortolotti and Larkin, Health and Happiness, Routledge (contracted)
  • Contribution to set up an open access journal: Journal of Human Experience
  • Co-editing a collection on success with papers from Core Members and their collaborators
  • One or two episodes of BBC Forum (World Service) for each year of residency: (1) on individual vs. society and (2) on success in sport and performance art.
  • Play for families on success to be performed at weekends at the Wellcome Collection.
  • Two informal exhibitions in the Hub or Reading Room contributing to the two themes, success and rationality, and success and mental health.