Thursday, 17 October 2013

Talk : Who's afraid of groups and why?

Fascinating Cafe Sci talk recently entitled "Who's afraid of groups and why?" presented by Psychoanalyst and devout cyclist Prof Chris Evens (University of Nottingham, Institute of Group Analysis and Nottinghamshire Healthcare NHS Trust)

The Good in Groups
The talk examined the way in which humans are an intensely social species and how social groups have a role to play in promoting mental health.

To start with, Dr Evans tossed a small foam ball at a member of the audience and smiled at them. They smiled back and threw the ball back at him - which Dr Evans used as a demonstration of how people would almost instinctively react to others in a group and interact with them. It also demonstrated how much we expect to see certain reactions from others in a group, people returning a smile for example.Dr Evans explained that these social interactions were a key part of mental health.

The Cafe Sci Group in the interval between the talk and the Q&A

Dr Evans also mentioned how this needs for interaction meant that ostracism (a practice that oringinates with the greeks) is such a powerful threat

He pointed out that humans depend on groups for their very survival, noting that he would not be alive today were it not for his immediate family, farmers growing the food he ate, doctors treatinghim if he fell ill etc

As an example of how people turn out if they do not interact with human groups as a child, Dr Evans mentioned the strange case of Casper Hauser, who was allegedly kept in a cellar during his entire childhood

[BFTF does rather wonder about this story, struggling to see how a kid kept in those conditions would be able to walk up stairs, draw beautifully, see long distances etc as was the case for Casper]

Another example of how powerful and instincive human interactions can be was that of a ward of patients that Dr Evans had been involved with, and which contained patients with severe mental health issues such as believing they were dead, that they had no guts or that all the evil in the world was their fault. Sometimes toddlers were on the ward, as visitors, and it was fascinating to see how the faces of patients who were severely depressed and reluctant to engage with adults would light up as the small children approached them. To Dr Evans, this indicated that a very profound and basic interaction was happening here.

Dr Evans felt that we now engaged less in groups than used to be the case and were now "in a consumerist economy where we are purchasers of our own healthcare"

The Bad in Groups
On the other hand, as aspect of group behaviour that gave Dr Evans cause for concern was their ability to fall into mob behaviour patterns and violent behaviour. Dr Evans also referred to comments in a previous talk (by similarly soft spoken friend Prof Greg Hadley) on how the effects of war span multiple generations. Here is the relevant section of the BFTF report on Prof Hadley's talk :
"Prof Hadley explained that, in the case of Japan, the returning Japanese soldiers had not wanted to talk about their experiences overseas. This left the national narrative as being the one experienced by the women and children who stayed behind, a narrative of hunger, bombing and defeat.

The fact that the US lost the Vietnam war is one reason why many US police dramas of the 70s and 80s had a Vietnam vet with a tortured past as one of the characters.

Most troubling of all was the way in which returning soldiers who began to suffer PTSD (often several years after the end of the conflict) cause terrible stress in their families, and that their children can often grow up to show the same problems that their soldier parents had (e.g anger control, alcohol abuse) - thus repeating the cycle through multiple generations. One of the daughters of a Jordan crew member commented to Prof Hadley how she had felt that there was “a huge invisible B29 in the living room” throughout her childhood"

Prof Evans wondered whether we, in the UK, had yet truly dealt with the carpet bombing that was done in our name in WW2, often with little military justification.

Guernica, an example of what happens when groups go bad.

Another area that Dr Evans covered was that of measuring outcomes, as he had been part of the team that developed the CORE for scoring mental health treatment outcomes. Dr Evans felt this was important as, previously, highly paid professionals had been working behind closed doors without systmatic evaluation of whether they were always having a positive effect - and there had been a number of cases where the treatment given had not been harmful.

Prof Evans again voiced his concern that we were a society that it could "buy mental health an that mental health professionals can deliver mental health" and that the increase in individualism had meant that it was almost abnormal to be part of an organised group, adding that perhaps our "aspirations were very carefully fostered to be consumerist" and that the aspirations people used to give to the church or the football team, they now give to the TV. He referred to a famous study called "Bowling Alone: America's Declining Social Capital" which looked at the post-war decline in civil participation in the US.

Prof Evans felt that the factors that had caused this were the revolutions in computer and monetary systems,increased social mobility - and perhaps also a wish to move away from the kinds of groups that had been the cause of two world wars.

He also commented on the fact that, whilst there was also a great deal of advertising in the 1940's, it had been was more stratified, there was not the mass marketing that we see today where Porsches are advertised to those who can afford them as well as those who will never be able to afford them.


The Armadillo way?
Dr Evans gave an insight into the kind of "out-of-the-box" thought experiments that academics sometimes consider by wondering how people might view groups if, like armadillos, they always gave birth to multiple, identical, young.

An Armadillo

Open Dialogue
The really eye opening part of the talk was the description of the "open dialogue" movement from Finland. This approach to treatment emphasises seeing the patients in their own home, a prompt start to treatment reduced medication/hospitalisation and respect for the individual.

In some respects this is similar to the pragmatic approach taken in the developing world where a community might take the view that "yes, you have a psychosis, but we still have to get the harvest in" and give a person with mental health issues a role in society, rather than shutting them out - and where outcomes for patients with psychotic disorders are much better than in the West.

A fascinating article by filmmaker Daniel Mackler on his visit to a hospital that practiced Open Dialogue can be found here. Frankly, it is more important that you read that than reading the rest of this blog post.

To close this report, it's perhaps worth mentioning Dr Evans comments on the how different countries view groups. In his experience, groups such as villages are viewed much more positively in countries such as Greece than they are in the UK, although some aspects of village life were cut off for those perceived as outsiders (such as those of a different faith). And village life in Scandinavia was different again

And lastly, Prof Evans also talked about how creatures such as starlings clearly have a very strong group behavious built into them when they flock and that it felt as though human mob behaviour worked in a similar way, with people reacting to the behaviour of the few people directly surrounding them.

Flocking Starlings

Image Sources: