Is Mental Illness All in the Brain?

In an open letter to Stephen Fry, who in a recent BBC programme argued that bipolar disorder is a brain condition to which some people are vulnerable because of genetic predisposition, Richard Bentall argues that mental illness is not all in the brain. He talks about some "unhappy experiences" he had in a public school for boys, the same Stephen Fry went to, and speculates that their interest in mental health may be an effect of those experiences.

MRI of the brain overlaid with "pain".

Here is an extract of the letter:

[R]ecent epidemiological studies have pointed to a wide range of social and environmental factors that increase the risk of mental ill health [...]. These include poverty in childhood and early exposure to urban environments; migration and belonging to an ethnic minority (probably not problems encountered by most public school boys in the early 1970s) but also early separation from parents; childhood sexual, physical and emotional abuse; and bullying in schools. In each of these cases, the evidence of link with future psychiatric disorder is very strong indeed – at least as strong as the genetic evidence. Moreover, there is now good evidence that these kinds of experiences can affect brain structure, explaining the abnormal neuroimaging findings that have been reported for psychiatric patients, and that they lead to stress sensitivity and extreme mood fluctuations in adulthood.

In this excellent letter, one of the themes of our research group is illustrated very clearly: almost everything that happens in our lives has an impact on our health, and traumatic events early in life affect our brains. So, when we say that instances of mental distress are caused by brain disorders, we are not telling the whole story.

The view Richard Bentall defends in the letter, and in his research, is also discussed in a recent podcast, episode 5 of The Philosofa, where Richard and I are asked: Is there a clear line between madness and sanity?

Individuals, Society and Success: How does national mood infiltrate personal mood?

Our collaborator, performance poet Luke Wright, writes:

Performance poet, writer and broadcaster
Luke Wright

 

"I used to knock around with a bunch of poets and creatives in Liverpool. This was over ten years ago, just after Liverpool won its bid to become the European Capital of Culture. Suddenly there was a lot of money floating around and my pals were as keen as anyone to get a little bit of it to help them run their poetry events. 

Over the next few years they got increasingly exasperated as the powers that be spent the cash on projects that didn’t feel very cultural at all. “Future generations will marvel at the great paved spaces we have created!” the poet Nathan Jones drawled sarcastically.

We’re frequently told that public money sunk into big urban projects will not only generate billions of pounds but be good for public morale. But just how true is that? Can we ever really quantify public morale? Are these “great paved spaces” there for the happiness of the people that pass through them everyday or the glory of the leaders who put them there?

How far does national mood infiltrate personal mood? I remember walking through Chelsea after England beat Argentina in the 2002 World Cup. It would be fair to say the result was unexpected and strangers were high-fiving and beeping their horns at one another. The mood of the whole day lifted but across the city bills laid unpaid, friends fell ill, relationships ended. When it comes to personal success is there such a thing as society? 

I don’t have the answers to all these questions, probably nobody does. But I’m looking forward to working with some people whose answers will be a lot better informed than mine. I want to take these ideas and use them to inform the story of three teenagers living in East London when the Olympics were ‘won’ by Britain. How did Britain’s success in its bid to win the Olympics and then our athletes success in the games themselves affect their own successes and failures in life?"

                                                                        

 ***

Luke is currently on tour with his most recent solo show 'What I Learned From Johnny Bevan', which won the Fringe First award for new writing at Edinburgh last year: http://www.lukewright.co.uk/

Why Rugby Players Turn to Aristotle

For the past two years, I’ve been running a philosophy group at Saracens rugby club, the current champions of the rugby Premiership. Once a month, I go to Saracens’ training ground in St Albans and give a brief talk about an idea from ancient philosophy that can be applied to our lives today. Then the group – usually around 10 players and staff – use that as a starting point to discuss how to live well.

We’ve covered everything from “accepting adversity” to “what makes a good friend”, and have explored ideas from many wisdom traditions – Epicurus, the Stoics, Taoism, Buddhism – as well as looking at how these have been revived in modern psychotherapy.

It all came from a project I’m working on at Queen Mary, University of London, to see if philosophy can be useful beyond academia. I have run philosophy clubs in a mental health charity and a Glasgow prison, as well as the current one at Saracens.

I went in to the rugby club with zero expectations, and still find it strange to sit in a circle with Jim Hamilton, Owen Farrell and others, discussing Aristotle’s idea of the Golden Mean. But it’s been good fun for all of us. It was “the most popular thing we did last season,” says defence coach Paul Gustard, who is now defence coach for England.

Why do rugby players need to sit around talking about wisdom when they could be doing star jumps? Aren’t they living the dream already? Yes and no. A career in professional sport comes with some incredible highs. “Winning a big game is an ecstatic experience,” one player said in the philosophy club this week. “I don’t think people outside sport ever feel like that.” But there are some real lows too.

We might think of athletes as supermen, but it turns out that a lot of their lives are beyond their control. Are they fit? Does the coach pick them? How do the media treat them? How does the rest of the team play? When those external factors are in their favour, they’re gods. When fortune shifts, suddenly they’re a nobody. The transition to life after sport is particularly hard. How will you get that high again?

What has surprised me, talking to various coaches over the past year, is how little attention most clubs pay to the mental and emotional well-being of players. Considering how big a factor the mind is in sport, you’d expect top teams to invest as much in mental wellbeing as they do in physical fitness. In fact, it’s more or less ignored.

This reflects the attitudes of wider society. If you get cancer, you can expect all the care and sympathy in the world. If you get mental illness, no one wants to talk about it. That’s particularly true of male culture. Men are not good at taking care of themselves or each other, and numb their pain with booze. As a result, suicide is the biggest killer of men under 50.

The values of professional sports teams can also be quite toxic. “It’s a fear-driven industry, focused on short-term success,” says Neil Burns, a mentor who’s worked with top cricketers. “Athletes often get used up and tossed aside. Values and wellbeing don’t usually get a look in.”

Saracens are trying to do things differently. When new management arrived, in 2009, they insisted that the character, values and wellbeing of the players were the top priority, and results would follow from that. They launched something called the Personal Development Programme, to support all the players in their lives and their careers after sport. They duly invited various people in to talk to the players, including mindfulness experts, a yoga teacher, even a philosopher (me).

image: www.saracens.com

The “Saracens revolution” has created a unique culture. Alex Goode, the 26-year-old Saracens and England fullback, says: “The old Saracens was not a particularly friendly place. There’d be quite brutal banter. Now, there’s much more of a feeling of togetherness.”

The esprit de corps has made the team stronger and better. Saracens won the Premiership in 2011, and broke the record in the 2014 season for most tries scored and most league points won, reaching the European cup final and Premiership play-off final, both of which they sadly lost. Last season, they had their most successful season ever, winning the Premiership and the AV Cup. They’re currently top of the league, and many of their young players are playing for England in the Six Nations.

Other teams are following their lead. The head of the Personal Development Programme, David Priestley, moved to Arsenal last season to develop a programme there, and I’ve done a couple of philosophy sessions with the players. In cricket, after some high-profile burnouts, the ECB is beginning to recognise that “inner fitness is the foundation for long-term success”, as former England coach Andy Flower puts it. In the United States, the enlightened coach Phil “Zen Master” Jackson is putting values and wisdom at the centre of his basketball team culture. In American football, the New England Patriots, winners of the 2014 Superbowl, have also been incorporating ancient Stoic philosophy into their team ethic, via a book by Ryan Holiday called The Obstacle Is the Way.

It’s interesting to consider whether this focus on wellbeing could be transferred to other industries. Poor mental health costs the UK economy roughly £23 billion a year through absenteeism and low morale, according to the Centre for Mental Health. Yet, according to the Chartered Institute of Personnel and Development (CIPD), only a third of British companies offer any stress management or resilience training, which usually means one half-day session a year.

That’s not enough. What impresses me at Saracens is that it’s not a once-a-year workshop. It’s a values-driven culture, sustained every day in every interaction (or not). Just as importantly, it’s a pluralist approach, exploring various ways to live well rather than forcing employees down one path. There is space for players to discuss ideas and share their own experience. This helps create a culture of peer support, which is more powerful than a one-off workshop.

There is not one philosophical or scientific answer to the question of how to live well. But some philosophies have survived for two millennia because there is wisdom in them. The challenge for organisations is to offer useful ideas and techniques, while enabling employees to find what works for them. And if that sounds soft and fluffy to you, go and watch Saracens this season.

This post is by our collaborator Jules Evans, a Wellcome Trust Research Fellow and Policy Director at the Centre for the History of the Emotions at Queen Mary University of London.

Agential Success and False Beliefs

On 4th and 5th February the project I current lead, PERFECT, hosted a two-day workshop in central London, called "False but Useful Beliefs". The idea was to discuss the costs and benefits of those beliefs that do not correspond to reality or that are not constrained by evidence, but that in one way or another benefit agents. They might increase self-esteem, help support motivation, enhance wellbeing, be biologically adaptive, and so on.

Several talks addressed the relationship of success with rationality and truth. It is not always the case that true and rational beliefs are conducive to agential success, whereas false and irrational beliefs are conducive to agential failure.

For instance, Lubomira Radoilska (University of Kent), in her talk "Could False Beliefs Be Non-Accidentally Conducive to Agential Success?", argued that some false beliefs are useful, not because of their falsity, but because they lead people to act and increase their chances to fulfil their goals in the future. It is their practical dimension that makes such beliefs useful.

Jesse Summers (Duke University), in his talk "Post Hoc Ergo Propter Hoc: Some Benefits of Rationalisation", was concerned with false explanations or justifications for actions and choices. Although such explanations and justification do not help agents understand why they acted and chose as they did, they still have benefits, as they allow agents to see themselves as providing coherent reasons.

In my talk, on "The Epistemic Innocence of Self-enhancing Beliefs", I related some of the themes from the previous two talks to the phenomenon of positive illusions, when people adopt excessively optimistic beliefs about their own worth and their own capacity to control external events, and make excessively optimistic predictions about their own future. Although such beliefs and predictions are not well supported by evidence, they help people form a sense of themselves as coherent and competent agents, and they support socialisation. The absence of a coherent and competent sense of oneself as an agent and social isolation or withdrawal are symptoms of mental distress and cause the person to lose the motivation to act, making it harder for her to achieve her goals.

The Power of Personal Narratives: the Successful Potato Farmer

sites.google.com/site/goblinpotato/potatoes

It is a classic triumph over adversity tale. A humble potato farmer from Herefordshire, dismayed that supermarkets rejected potatoes that were not 'cosmetically perfect', finds a lucrative niche in the market for posh crisps and high-end gin. The serial entrepreneur is now a multi-millionaire but it wasn't always so.

In a narrative that storytellers would salivate over, the engaging elements of local hero William Chase's tale include: a versatile vegetable, a messy divorce, bankruptcy, running far far away to exotic lands (well Australia), and a triumphant return.

The underdog then risked all in the form of a substantial bank loan, took on an evil giant (aka Tesco), and won- a la David and Goliath, and now his gin and crisp businesses reach towards the stratosphere.

Such stories can have a powerful motivating impact on others. Referred to as recovery narratives in mental health care, personal stories convey hope by demonstrating how individuals can move from trauma and despair towards their goals.

One of our goals is to assemble a multi-dimensional, multi-media repository of 'success' narratives that will illuminate the concept, explore what works for whom, and involve the public in telling their own stories. 

As Mr Chase says 'People love stories, the real stories behind things'. 

www.chasedistillery.co.uk/gin/

Success and Mental Health: Too much pressure?

This interesting article in the New York Times attempts to put the suicide of Chef Benoit Violier into context by highlighting that this is not an isolated episode: many highly successful chefs have recently ended their lives. Violier was most certainly a high achiever: his restaurant, Restaurant de l’Hôtel de Ville, had been awarded three Michelin stars and in December was judged the No. 1 in La Liste, France’s ranking of 1,000 restaurants in 48 countries.

“It can’t keep happening; it just can’t,” the food writer Kat Kinsman said on Monday. In January she started Chefs With Issues, a project aimed at illuminating the job-related stresses and mental illnesses afflicting many people in the food industry. Depression, anxiety, addiction and eating disorders are common.

Is this a pattern in the world of high cuisine only or is it a widespread phenomenon among high achievers in different fields? It is surely something that needs to be explored as part of the "dark side of success".

Thinking like the Traceur

This post is by Hannah Gravestock, scenographer and sportswoman.

Founder and managing director of Parkour Generations, co-creator of the A.D.A.P.T™ courses, coach and author, Dan Edwardes writes of success:

‘Why is being strong better than being weak?  Is it at all?

Or is the process of becoming strong just a vehicle, a path for us to focus our own understanding of ourselves, our world, our lives, and our place in the order of things?’

For the Parkour participant, also known as Traceur, an on-going commitment to self awareness is certainly part of the route to success. Only when a Traceur understands how and why they move can they find the flow of movement required to move in and around obstacles in their path. Whilst Parkour requires a skill set specific to the discipline it also offers a valuable insight into what can be achieved when focus is given to knowledge and understanding embodied by each individual participant.

In contrast, figure skating, like many other sporting activities measures success through a more externally visible and universally accepted approach. An international marking system turns success into a mathematical calculation and makes the identification of a successful skating performance easy. But does it really? The answer is both yes and no. Whilst computer systems enable judges to assess technical performance it is less clear how to judge a skater’s interpretation and artistic expression of a piece of music. Whilst it’s a common belief that the art of skating has been lost to the technical development of the sport, it is more likely that it’s become harder to understand, and therefore judge, how to synthesise new technical skills with advanced artistic ones.

For a synchronised skating team these problems are multiplied since success is located through many interlocking performances. Improving the success of a team therefore requires an understanding of how to assess and effectively combine the technical and artistic skills of each individual. To understand how this can be achieved it’s worth considering the Traceur’s attitude towards failure as well as individual success. Whilst Parkour training generally centres on personal goals and experiences, the focus on mental strength is relevant and applicable to a team. For example, for the Traceur failure to move smoothly from one object to another is not a negative outcome, but an inevitable part of a journey that leads to self awareness. To fail is to locate a weakness, better understand why it exists and make appropriate changes to a performance so that it doesn’t happen again. From this perspective the synchronised skater might do well to consider how and why they move, how well these perceptions relate to interpretations made by a third party and what new pathways can be taken to develop a performance as a result of this understanding.

This leads me to the area I hope to investigate as part of my proposed collaboration with the Hub Residency Team and the development of my investigations into training and performance practices. In this project drawing is used as a research method to access and explore embodied experiences of a UK synchronised skating team as they develop their performance. I have already conducted some initial drawing work with the team, but hope to continue the drawing and movement workshops through a competitive season to examine and challenge how skaters perceive success both individually and as a team.

drawing from synchronised skating workshop 

For more about Hannah see www.hannah-gravestock.co.uk