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?

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".

Ode to the Monument of Failure

One of our collaborators, the author and journalist Oliver Burkeman, explores the counter-intuitive notion of a negative path to happiness and success that involves embracing failure, pessimism, insecurity and uncertainty. The following is an excerpt from his 2013 book The Antidote: Happiness for People Who Can't Stand Positive Thinking.

"In an unremarkable business park outside the city of Ann Arbor, in Michigan, stands a poignant memorial to humanity's shattered dreams. It doesn't look like that from the outside, though. Even when you get inside – which members of the public rarely do – it takes a few moments for your eyes to adjust to what you're seeing. It appears to be a vast and haphazardly organised supermarket; along every aisle, grey metal shelves are crammed with thousands of packages of food and household products. There is something unusually cacophonous about the displays, and soon enough you work out the reason: unlike in a real supermarket, there is only one of each item. And you won't find many of them in a real supermarket anyway: they are failures, products withdrawn from sale after a few weeks or months, because almost nobody wanted to buy them. In the product-design business, the storehouse – operated by a company called GfK Custom Research North America – has acquired a nickname: the Museum of Failed Products.

This is consumer capitalism's graveyard – the shadow side to the relentlessly upbeat, success-focused culture of modern marketing. Or to put it less grandly: it's almost certainly the only place on the planet where you'll find Clairol's A Touch of Yogurt shampoo alongside Gillette's equally unpopular For Oily Hair Only, a few feet from a now-empty bottle of Pepsi AM Breakfast Cola (born 1989; died 1990). The museum is home to discontinued brands of caffeinated beer; to TV dinners branded with the logo of the toothpaste manufacturer Colgate; to self-heating soup cans that had a regrettable tendency to explode in customers' faces; and to packets of breath mints that had to be withdrawn from sale because they looked like the tiny packages of crack cocaine dispensed by America's street drug dealers. It is where microwaveable scrambled eggs – pre-scrambled and sold in a cardboard tube with a pop-
up mechanism for easier consumption in the car – go to die.

The Museum of Failed Products was itself a kind of accident, albeit a happier one. Its creator, a now-retired marketing man named Robert McMath, merely intended to accumulate a "reference library" of consumer products, not failures per se. And so, starting in the 1960s, he began purchasing and preserving a sample of every new item he could find. Soon, the collection outgrew his office in upstate New York and he was forced to move into a converted granary to accommodate it; later, GfK bought him out, moving the whole lot to Michigan. What McMath hadn't taken into account was the three-word truth that was to prove the making of his career: "Most products fail." According to some estimates, the failure rate is as high as 90%. Simply by collecting new products indiscriminately, McMath had ensured that his hoard would come to consist overwhelmingly of unsuccessful ones.

By far the most striking thing about the museum, though, is that it should exist as a viable, profit-making business in the first place. You might have assumed that any consumer product manufacturer worthy of the name would have its own such collection – a carefully stewarded resource to help it avoid making errors its rivals had already made. Yet the executives who arrive every week at Sherry's door are evidence of how rarely this happens. Product developers are so focused on their next hoped-for success – so unwilling to invest time or energy thinking about their industry's past failures – that they only belatedly realise how much they need to access GfK's collection. Most surprising of all is that many of the designers who have found their way to the museum have come there to examine – or been surprised to discover – products that their own companies had created, then abandoned. They were apparently so averse to dwelling on the unpleasant business of failure that they had neglected even to keep samples of their own disasters."

This piece raises issues that we plan to explore in the Hub. A failure may seem just that until you reframe and repackage it, in this case by making a collection of consumer flops, resulting in a novel, useful and successful project - the Museum of Failed Products.

Human failures of mind, body and circumstance, such as mental health problems, physical illness, and relationship breakdown can also be harnessed positively. Artists regularly draw on trauma and distress creatively, resulting in inspirational and aesthetically stimulating works of art. An exhibition of light boxes in East London is testament to this. Letting in the Light showcases the work of 35 artists, all of whom have experienced mental health issues. Located in a neglected section of fast-regenerating Stratford, an area marked for ambitious growth post 2012, the work illuminates a strip of the High St that includes ubiquitous betting, fried chicken and pound shops.

Letting in the Light. Image: Andrew Whittuck (c) 

The most recent project by Bobby Baker's Daily Life Ltd, at first glance Letting in the Light appears simply a pop-up exhibition of interesting and colourful artwork, until you read the text accompanying each piece, for example:

'In recovering from the depths of depression, I experienced 
a spontaneous outpouring of creativity, resulting in over 3000 abstract digital paintings to date'.

'This piece symbolises that there is a way out of the depth of despair into the world above, where there is light and hope'.

Oliver's piece is also a reminder that by focussing on the future and obsessing on past successes or failures, we neglect the present. This is surely a reason for the surge in popularity of mindfulness-promoting activities such as adult colouring-in and meditation.

The huge potential of complex and often messy human experience, socially constructed as success or failure, lies at the heart of what our project will explore. I declare our intention to build a monument to failure - by learning from what works.

The Drive to Succeed and Young People's Mental Health

Jasmine Parker - Wellcome Images

Today Vicki Abeles on the New York Times reports on a new study by Stuart Slavin showing that one in three young people in the States experience anxiety or depression due to school-related stress.

This does not apply only to teenagers, but to children aged 5 to 7 as well. The article suggests that the drive to succeed creates stress, and paradoxically undermines academic success.

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.

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.

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.

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?

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?

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.

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.

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.

Transformation and Success

me on the couch

I am writing this at a time that I am emerging from a period of intense personal and professional challenge. The themes of striving and thriving therefore resonate with me on many levels. Having explored the concept of Post Traumatic Growth (PTG) during my doctoral research I now have gained experiential as well as empirical knowledge of the concept. Indeed, at a time of striving to overcome difficulties I find myself in a position where I have a greater sense of gratitude for my family and friends, I have gained new insights, knowledge and compassion, and I have developed different and, I'd argue, enhanced future priorities. It wasn't an easy process however I do feel transformed. I hope that the Hub residency is part of that future and that we are 'the dream team'!

On re-reading the blog posts to date I am filled with anticipation and a sense of the possibilities that Zoë articulated. Like all of you I am in awe of the Wellcome space and the opportunities it presents. What a space in which to develop, debate, and transform. See me above on 'Freud's' couch in the new Reading Room, striving in a straightjacket, my daughter laced me into it, she thought it hilarious...

I'd like to explicitly link planned work to positive psychology, where PTG is a core concept as is the idea of 'flow' both of which relate to thriving. I've explored the flow state in athletes a creative way previously. When I read Michael's description of the Hub event in March it struck me that the experience shared elements of flow:

an unusual rhythm, alternating between periods of quiet reflection (or stunned silence - gloss as you prefer!) where we all tried to process the overwhelming surge of ideas and possibilities, and other periods of intense discussion where we worked together to give these ideas some shape