Writing in the time of corona

I’m SO close to the end of my PhD I can almost touch it. But – I don’t know if you’ve heard – there’s something going around. In the past week it feels like the whole world has gone topsy turvy, and whilst I know some people aren’t worried, I am. I’m worried about my family, my friends, everyone who has to work out there still, the economy… the list goes on. And, what should have been the perfect time to sit down and finish my thesis, completely undistracted (no pubs! no brunch! no fun!), is proving to be the opposite. I can’t concentrate at all, and the end seems further away than ever.

I shared my concerns on Twitter earlier and the response has helped me more than I thought it would/ could. I already love Twitter for networking, learning new things, sharing ideas, and, of course, the memes, but the solidarity from people who you’ve never met is amazing. I want to share some of the tips people responded with, in one place, so hopefully it will help other people too.

• Set very, very small goals. Anything you can achieve is something, and that is getting you closer to the finish.
• Celebrate achieving those goals! How we celebrate now will probably have to look quite different – instead of popping to the pub, what else would you find rewarding? A fancy cup of tea? Get some friends together on the House Party app? One person suggested (budget permitting) buying something from an online, independent shop – I love this idea, as you’re also helping someone else.
• Do not beat yourself up if you have an unproductive day. People keep saying that these times are unprecedented because they are.
• Speak to your supervisor, let them know how you’re feeling. Maybe come up with a revised schedule.
• Don’t check the news too often. Ditto group chats.
• Join a virtual writing retreat e.g. https://virtualwritingretreat.co.uk/. Or set one up with others you know in similar stages, so you can all focus together and then take breaks.
• Check in on Twitter regularly for virtual hugs, knowing others are in the same boat.
• Trust that we will get used to this new way of doing things, and your productivity will increase.
• Remember this Haiku by Kobayashi Issa (thank you Dr Elizabeth Evans for sharing):

O snail
Climb Mount Fuji,
But slowly, slowly!

There are lots of other tips out there for working from home (create a nice space separate from where you sleep if possible, make sure you get some fresh air, have a routine etc.) but I think reading the responses from everyone helped me more as they are specific to writing a thesis, which can feel like quite a unique pressure. Of course, there are also other people who are in a much worse situation, and some people have found that perspective helpful – it is just a thesis. I certainly forget that most of the time. But I’ve spent more time speaking to my family and friends this week than I have probably in the last month. And actually, that’s fine. So, write that one sentence, have a cuppa, call your mum, tweak a figure, order a macramé plant holder off of Etsy, and trust that the end is still in sight, even though we can’t see it at the moment.

Original Twitter post is here, and I’ll add any more tips to this blog: https://twitter.com/psychinthecity_/status/1240920043820650496

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SciComm Klaxon!

I’ve written an article for Wonk!, explaining machine learning using fashion! You can read it here.

Wonk! is a new magazine and website that “takes science out of the classroom and onto the catwalk”.  It’s aimed at teenagers aged 13 – 18, but I have to say (as an ‘adult’) I couldn’t put the first issue down. It’s made up of contributions from different writers and academics, so the articles are really varied but super interesting. I love that they’re making science more fun and accessible for young people, which is so important in making sure all genders can thrive in STEMM subjects. Hats off to Wonk!

*Update* Unfortunately Wonk! is no longer running, so I’m pasting my original article here for prosperity.

Machine learning: Your smart personal shopper

You’ve probably heard lots about artificial intelligence (AI) in the news. AI is often painted as a villain, producing robots that will eventually take over the world. But let’s take a look at what it really is. Crucial to AI is machine learning, a set of computer-based tools and rules used to programme machines and help them learn. You will more than likely see examples of machine learning every day, and not even notice it – including in the fashion industry! So, what is machine learning, and how does it work?

Humans are great at spotting patterns. As a child develops, they will start to notice similarities in things, and will instinctively learn to categorise things based on features they possess. Take animals, for example: cats tend to be small, have long tails and meow, whereas dogs are bigger, can have shorter tails, and bark. The more examples we see of each category, the more we learn about them. So, the older we get, the better we become at knowing that a Chihuahua is a type of dog, even if it can fit in a handbag! It turns out that machines are also pretty good at this pattern recognition. They can learn in a similar way, which can be really useful for things you may not have even considered, like online shopping.

Say you wanted a website that will scour the internet and find all different shoes for you, but you want them in groups, such as boots and trainers. You can imagine if a human had to go through ASOS, Topshop and Missguided, finding all the boots and trainers, it would take absolutely ages. They’d then have to start again every couple of weeks when a new collection is released! Not possible. But, with machine learning we can teach an algorithm (a set of instructions used to perform a task) to do this for us.

We start by showing the algorithm some pictures we already have labelled as either boots or trainers (label in this case means the group it belongs in, not the one that tells you which wash cycle to use!). This is the training phase, where the algorithm sees lots of training data and learns what features are important for each group. Look at the pictures below and imagine you’ve never seen a boot or trainer before. What features are different about the two groups? Our algorithm also has these pattern recognition skills, so can learn that both might have laces, trainers come in lots of different colours and sit at the ankle. On the other hand, boots tend to be black or brown and are taller.

Next comes the testing phase. The algorithm is shown boots and trainers that it’s never seen before, and guesses which group they belong in. If it’s shown 100 pictures (say, 50 boots and 50 trainers) and guesses the correct label for 85 pictures, we can say that it’s 85% accurate. This isn’t really good enough – we don’t want any boots appearing when we’re only interested in trainers, and vice versa. So, to improve our algorithm, we go back to the training phase, showing it more examples of each. This time when we test it on 100 brand new pictures, it’s 99% accurate. Just like a child growing up, the better we train our algorithm, the better it is, and can then be used in the real world.

There are some great apps that use this technology, such as SSENSE, where you browse outfits and accessories and select ones that you like. The app then learns your style and will show you items you’re more likely to lust after. My SSENSE has learnt that I’m a leopard print kinda gal, who rarely wears skirts. The more you use it, the better it will be at knowing your taste, because it has more training data to learn from!

So what about that taking over the world thing? Well, an algorithm cannot learn about something that it hasn’t seen during its training. For example, if we showed our boot vs. trainer algorithm a picture of a belt, it would just blow its mind! It will have to guess if it’s a boot or a trainer because it hasn’t learnt the features of a belt. This means, the chance of machines becoming ‘conscious’ and being able to think by themselves is very slim (in the near future at least), because they can only learn from data that they’ve seen before. So, you’re probably safe from a robot apocalypse for now, but machine learning will help you find an awesome new pair of kicks!

A Week in the Life of a PhD Student

I was going to do a ‘day in the life’ type post, but then I thought, why do a day when you can do a week? All manner of exciting things might happen! If you’re considering doing a PhD, just interested, or my supervisor undercover wondering what on earth I’ve been doing, read on.

Monday – participant testing, poster obsessing and a bit of data sharing

I get in at 9am. I know a lot of PhD students prefer to come in later and leave later, but I find I’m much more productive if I’m in at 9. A few colleagues are at the 11th International Conference on Frontotemporal Dementia in Sydney (lucky things) so I check Twitter to see what they have been up to, read a few interesting studies that have been announced, and generally catch up on dementia related news to ease me in to the week. I also have some admin to do – updating the Journal Club schedule (see: 4pm), checking room bookings, sending emails to people to bug them about their presentation titles, etcetera.

10am – I go to Neurology outpatients in St George’s Hospital, attached to the University. Today there is a nurse-led clinic for people who are taking a medication for dementia, to check how they’re doing. One of my projects involves recruiting people with mild Alzheimer’s disease or Mild Cognitive Impairment to a research study, so it’s great that I can be closely involved with the dementia team in the hospital. Usually I sit in with the nurse running the clinic and if a patient is suitable for my study, I ask if they would like to hear about it. If they say yes, I explain what’s involved and answer any immediate questions they might have, then give them some written information to take home and read in their own time. I give them a call in a few days and if they want to take part, arrange a time that suits them to come in.

Today is a bit different because I already know I’m seeing my 50th and final participant this morning – recruitment complete klaxon! It’s a chap I have previously spoken to, who wanted to combine his research visit with his follow-up appointment. He’s not coming until 11:30, so I sit in with the nurse until then. One lady that comes in I know well, as she’s taken part in my research and attends the Young Onset Dementia support group at St George’s, so it’s nice to see her and see how she’s doing.

The patient I’ve arranged to see has his visit with the nurse, and then we complete his research visit which takes around an hour and a half, including collecting consent, which means I know he’s definitely happy to take part and understands what’s involved. I do a general cognitive exam (the Addenbrookes) and some spoken language tasks. He’s brought his daughter with him, and we spend some time chatting. I love this part of my work – getting to know people from all different walks of life, hearing about their careers, lives and families. It also feels like a big milestone to have recruited all 50 participants to my study. There were days when this seemed a distant possibility.

2:00 – lunch. Reliably one of the best parts of the day.

2:30 – It’s the St George’s Research Day soon, and I’ll be presenting a poster of some pilot work I’ve done, so I start designing my poster. For those not in the field, this is very much like the Spice Girls poster you had on your wall, but instead of Sporty, Baby, Scary, Ginger and Posh, it’s Background, Methods, Results, Conclusions. Don’t ask me which one’s which, the analogies gone too far. On the day everyone walks around and can look at your poster, and it means you get to have lots of interesting individual conversations about your work (hopefully). I’m a big believer in posters being eye-catching, easy to follow and full of pictures, so I chuck as many in as possible and have some fun with different colours. While it’s no Jackson Pollock, it’s good to do something a bit creative.

4pm – Every Monday we have a Journal Club, which is my job to organise. I love organising stuff – birthday party? Yes! Weekend away? Sure! Weekly meeting where academics discuss a paper or something they’ve been working on? Sign me up. This week we’re trialling something new – a Data Meeting, where we go around the table and talk about what data sets we’re working on or trying to acquire. We’re a pretty small department but it’s so easy to just work away without really knowing what other people are up to. This turns out to be a really useful hour, with some good ideas thrown around, plus I finally learn what a few acronyms I’ve been hearing mean. We’ll have another one in six weeks and I’m looking forward to hearing people’s updates.

And that’s Monday done! I meet a friend for a cup of tea (hello work life balance), and head home to turn my brain off by watching Made In Chelsea.

Tuesday – BSc student guiding, speech transcribing and review paper writing

9:30 – not quite 9am but who’s counting. I have a bit of ‘admin’ to do again, this time for my study. Every month I send participants a task in the post. They are given instructions like ‘Describe your ideal holiday’, along with some prompts, then they write their response (anything from a few paragraphs to two pages) and send it back to me. So I print out tasks for those still taking part and put them in the post. There can be a lot of admin involved in clinical research, especially getting things like ethical approval. Not that fun, but totally necessary!

10:30 – I meet with a BSc Biomedical Sciences student that I’m supervising for a 3^rd year clinical neuroscience project. For his project he’s actually analysing the responses I get back from the tasks mentioned above – he’s finished transcribing the handwriting (a big task), and last week we used some Natural Language Processing tools to extract different features of the language people used – for example, what’s the average number of words per sentence? He shows me some graphs he’s made which is exciting, and we talk about what he could do next. I spend some time brushing up my statistics knowledge because analysing data collected over time (i.e. longitudinal), with lots of missing data (e.g. through people forgetting) is difficult difficult lemon difficult.

1:00 – lunch. I probably won’t carry on including this every day.

1:30 – I transcribe the session from the participant I saw yesterday, which involves typing up everything he said in response to each language task (for example, I asked him to tell me the story of Cinderella). I have conventions to follow, such as adding in things like [=laughs] and ‘..’ for a pause, and I have to be really careful to transcribe every ‘um’ and ‘ah’. Depending on the participant this takes me around an hour, but I find I can only do it in short bursts or I start to make mistakes. Today I started typing a pretend conversation I was having in my head instead of what the participant was saying, which I think is actually quite a skill.

2:30 – I’ve been working on a review paper to hopefully publish in a journal for longer than I care to admit. It’s gone back and forth between my supervisor and I a few times, and now it’s back with me. His comments are super helpful, but I have a lot to re-write and feel a bit disheartened. I think I will have to give myself a deadline for the next draft otherwise it will hang over me like a dark cloud, and decide that Christmas should be achievable. I’ve gone and written it here on the internet where anyone could see now, so I must do it. Spend a few hours writing and feel marginally better about how much I have to do.

4:00 – more transcribing! If I was the PhD student I wished I was, I would have done each session as soon as I collected it. But I am not, and now I have a backlog. I do find that doing them in bulk helps with consistency though, so let’s pretend that was the reason for saving them up.

Over and out, until tomorrow.

Wednesday – some teaching advice, Twitter as a vice, & code to make graphs look nice

Not much to say about today really! I did a lot of bits and pieces – transcribing and more work on the poster. I did learn that if you’re creating graphs in Python using matplotlib, the following line of code will give you print quality files:

plt.savefig('destination_path.eps', format='eps', dpi=1000)

Awesome! Thanks Stack Overflow, I really should give you half my tuition fees.

Tomorrow is my teaching day (or really facilitating day). I facilitate a Year 1 medical student Clinical Based Learning group every week, and a Year 2 Pharmacy group. Each week has a different theme according to what they’re covering in lectures, and we go through a clinical scenario and discuss it. The pharmacy students have to do a quiz and I mark it afterwards. The med students come up with learning objectives for things they don’t know about, and then use the week to research them, before feeding back at the next week. It’s all about self-directed learning and group discussion, and we cover things like communication skills, consent and confidentiality, not just the bare bones (lolz) of medicine. I’ve only just started teaching in my final year, because I always felt like as a Psychology grad I wouldn’t be that useful. But you’re given extensive notes on each case, and I make sure I do a lot of prep. I wish I’d started earlier on in my PhD as it’s a) fun, b) good experience, and c) a bit of extra cash, which helps on  a PhD stipend. I would tell my baby PhD student self to start ASAP. So, I spend some time prepping for tomorrow when I have three sessions: two on heart disease and one on depression.

I also mess about on twitter for a bit, because you never know what you might learn on there! People post interesting papers, things they’ve been doing, conference updates, cool science events, and general motivation/ moaning about PhD life, which I find helpful. I’ve met people at conferences that I feel like I already know because we follow each other and comment on each others tweets. There are some great hashtags to follow – #PhDchat and #PhDlife for example. Get to know your field, there will probably be a virtual place on Twitter where people huddle. It’s easy to get sucked in though and before you know it you’ve lost three hours of your life you’ll never get back, so I generally set myself a limit, like 15 mins in the morning and 15 in the afternoon.

That’s me over the hump, and in to the end of the week!

Thursday – stern words and Brexit distraction

Side bar – ‘A distraction’ would be a really cool name for a group of things, like a murder of crows. A distraction of PhD students maybe? Seems fitting!

So as I mentioned yesterday I had three student groups to facilitate today. The first year medical students had a case about heart disease last week, so this week they fed back what they’d researched in-between. Did you know heart disease is the leading cause of death in women? No, me neither! This week they had a case about pneumonia in a 24 year old due to smoking, which we worked through. They’re given the patient’s symptoms and history and have to guess what might be wrong, discuss what they would do next e.g. which tests, and then they hear the next bit of the case. They’re a few months in now so have settled in and seem to really enjoy the group, which gives me a warm glow inside. I keep meaning to bring them sweets.

Then in the afternoon I had 2^nd year pharmacy students, who also had a case about heart disease, followed by a test on neuroanatomy, and then a session about depression. BIG day for them. I was able to bring a bit more to the table for the depression case, so we talked about Cognitive Behavioural Therapy (CBT), use of different medications, and stigma around mental health. There’s 11 of them so sometimes it feels a bit like herding kittens, but it’s also really fun. Sometimes things don’t get taken seriously enough however, and I had to say a few stern words about respecting people’s experiences of depression. Then I worried I’d been a bit too stern, but better they hear it from me than someone who is actually offended later on I think? It feels like a big responsibility helping the doctors and pharmacists of the future! After a session I often find myself thinking “why on earth did I say that”, but I tell myself we’re all still learning…

I have to admit I didn’t get much else done – I find it hard sometimes when you’re up and down the University stairs like a yoyo, it’s hard to really get in to anything. Plus I was distracted by the omnishambles that is Brexit, as it was raining resignations and seemed like something exciting might happen. Alas, May ploughs on.

With the smell of the weekend in the air, that’s Thursday!

Friday – working from home capers, reading papers

I find it hard to dip in and out of reading so I tend to try and do it in blocks, and I’d earmarked today as my reading day. I try and read three papers a week minimum, but I don’t know if that’s ‘enough’. I often feel like I’m struggling to keep up with the literature in my field (one thing that massively helped was writing a literature review, and I’d highly recommend doing this in your first year – I did not). This seems to be the pervading sense on Twitter as well – there’s a lot of people chatting about never doing enough reading. But then I think, what if these people are reading ten papers a week, and a book? Or they’re reading one paper? WHO SHOULD BE WORRIED. Anyway, you can only do so much and I guess while there’s other things that need to be done (seeing participants, meeting BSc students), you won’t do as much reading, and at other times you’ll do a lot more. I’d be interested to hear other students thoughts on this.

Personally I find I read better literally anywhere other than in the office, so I might work from home. I did that this morning, and also because I knew I was getting a train up north in the afternoon, so could do more on the train. PhD’s are great for that kind of flexibility, but obviously you can’t take the Michael.

So not much to report for today, but I had a few thoughts through writing this whole post which I wanted to share:

My Final Thoughts

1) This was not a normal week, in that I left on time every day. I mentioned work life balance on Monday, and while this week was good, others it goes totally out the window and I start to forget what my family look like. This is another thing that I hear a lot about, and I think people can get quite competitive/ humble braggy – “Can’t believe I’ve been working on my thesis ten days straight! #god #hero”. I jest, but really, don’t do that to yourself. If you’re on a roll, feel like you’re being really productive or have lots of deadlines coming up, you will find yourself putting in a lot of hours, and that can be really rewarding. But if you’re too stressed, knackered or just really need a pint, stop! ‘It’s a marathon not a sprint’ is my favourite PhD one liner, coming just before ‘if you don’t write it down, you won’t remember it’. Although I am aware anyone reading this who’s actually completed their PhD will be thinking “PAH! Let’s see how much yoga she does when it’s write up time”…

2) If you make yourself think about (or even write down) everything you do in a week, it makes you VERY productive! I also found it useful for thinking about what parts of my week I really enjoy, and what parts I don’t enjoy so much. Useful, as every other person I meet seems to ask me “what are you going to do when you finish?” at the moment.

3) There are so many things that didn’t come up this week. Writing code, doing data analysis, giving talks, writing up results for (hopefully) publication, attending training, to name a few. I can’t speak for all PhD students but my time so far has been incredibly varied and I love that.

That’s a wrap! Hope you found something useful or interesting in all that.

Would you Adam and believe it

I won an award! The Max Perutz Science Writing Award, a competition run each year by the Medical Research Council. Entrants write 800 words on their PhD research, explaining what it involves and why it’s important, aimed at the public.

Out of over 120 entries, 10 of us were short listed (yes, that noise you can hear is me blowing my own trumpet*). We got to attend a science writing masterclass with science journalist Claire Ainsworth which was brilliant, and then trotted off to The Royal Institution for the awards evening. Professor Robin Perutz, son of Nobel prize winner and legendary science communicator Professor Max Perutz, gave an inspiring speech, and we even got to see a hand-written draft of one of Max’s articles, complete with crossings out and re-writes – Robin assured us that even after a lifelong career, writing is still hard!

I had already got myself all nervous about walking across a room – something I do successfully most days – in front of lots of people, so by the time Robin came to announcing the top three I was nearly hyperventilating. Then the runner up was announced, and I knew I had won! I managed to walk all the way to have my photo taken with Professor Fiona Watt, MRC’s Executive Chair and Chair of the judging panel (girl power!), along with the biggest cheque I have ever received, both in value and size. Matched only by the size of my grin, evidenced here:

“I don’t think you can actually cash it!” – Professor Fiona Watts (Image credit: the Medical Research Council)

Robin read my essay out loud, which was surreal and awesome, before we were whisked off for photos. We spent the rest of the evening celebrating science communication, and eating some of the most delicious gnocchi I’ve ever had. It was great too to spend an evening with my supervisors, who are really supportive – there was audible whooping when my name was called out.

My PhD supervisors, Prof Peter Garrard and Dr Tom Barrick, and me with my giant cheque again

You can read my winning essay, ‘How artificial intelligence, and a cup of tea, could help diagnose Alzheimer’s disease’, here (still feels weird typing that!) and all of the short listed articles here. There’s also more info on the award and Max Perutz on the Science Museum blog here, written by one of the judges Roger Highfield.

With the other writers (Image credit: the Medical Research Council)

I think every day since I’ve started my PhD I’ve said to myself “really should re-start that blog!”. Well there’s really no excuse now. If you’re interested please keep your eyes peeled as I’ll be revamping, and in the mean time check out the archives!

* I’ve realised I’ve done a lot of “oh it’s nothing!” and “such a fluke!” type expressions since winning. I can genuinely say I didn’t expect to win, especially having read the other short listed articles. I’m the first to tell my friends to believe in themselves and celebrate their achievements, but for some reason it’s quite hard when it’s you! There is a lot of talk about Imposter Syndrome at the moment, something I definitely struggle with and know lots of other people do too. So I’m trying to be better at just saying “thank you!” to any congratulations or compliments on my work, without adding the bit after that detracts from it, out loud or in my head. And blowing my own trumpet too.

Climate Change March

Yesterday I had a fun old time at the London climate change march, moonlighting as official photographer for the East Mendip branch of the Green Party. It was heartening to see so many people, of all shapes, sizes, and walks of life, turnout not just to raise awareness of Climate Change, but to show solidarity with those in Paris, whose march was cancelled.

A lot less psych, but a bit more city – a few of my favourite snaps below.

A policeman reads a leaflet about climate change.

Natalie Bennett, leader of the Green Party, leads their section of the march.

…before East Mendip spot a photo opportunity.

Well done Dad.

 

“I love cuts, cuts cuts cuts.”*

*Not a direct quote from Iain Duncan Smith, but this is what I imagine him saying a la Ron Burgundy, as he eats his £39 breakfast that he’ll later claim on expenses.

A newly published piece of research prompted me to write this post about how the recent government cuts to welfare have impacted some of the most vulnerable people in this country. I’ll summarise the paper (which you can read in full here) later on but I first just wanted to chuck in my own observations.

In 2012 I was working as a Psychologist at a Dementia charity. Part of my job was to see people who had been referred to the Memory Clinic with suspected memory or other cognitive problems and decide whether they needed to see a dementia specialist, were ‘worried-well’, or were experiencing problems due to a different cause. In that year, myself and the other Psychologist started to notice how many people we were now taking referrals for who were going to their GP complaining of problems such as not being able to remember things, forgetting words, unable to follow conversations – and were also under scrutiny from the DWP about their fitness for work or eligibility for benefits. This was honestly something I can say we hadn’t really seen before, and neither had the doctors. It was a worrying trend, that got worse until I left in 2013, with these patients (/service users/ clients – that’s a conversation for another time) highly anxious, often depressed and with other serious health problems to contend with every day.

I remember one lady in particular who was in her 50s. It’s not impossible to have dementia in your 50s, but it is rare. She spent the hour long appointment crying, as she told me how degrading her interview with Atos was, how ashamed she felt at being made to feel like she was claiming benefits when she didn’t need them, and how scared she was she would lose her home, because she couldn’t afford to pay the bedroom tax on her ‘spare bedroom’, where her small son slept when he visited. She wasn’t sleeping, she wasn’t eating properly, and she constantly had these thoughts on her mind. A while ago they’d sent her a form to fill in that was umpteen pages long, filled with complicated questions, and she couldn’t understand it – this was the first time she thought maybe she was getting Alzheimer’s Disease.

People often don’t realise how much things like emotions impact on our ability to use our cognitive functions. It’s not at all ridiculous that anxiety, depression, lack of sleep and everything else that comes with these kind of problems made this person scared she was experiencing some kind of degenerative disease. And imagine how scary that must be, on top of losing your home and your benefits. It becomes a vicious cycle of worry and cognitive dysfunction. I was able to reassure her she was OK, due to the nature of the problems she reported and her performance on sensitive assessments, and referred her for some therapy. This was just one in a long line of appointments like this; men who lost everything in the recession and had since been spiralling into depression; carers now themselves thinking they had memory problems, terrified of how they would look after their loved ones with both of their benefits cut, on top of cuts to social care services and things like day care adding to the immense strain. The list went on.

So I welcome this paper, from two leading Universities. It’s times like this when we need cold hard research to really show the knock on effects of policy change to society. To summarise (skip to the bit in bold for the results):

• Previous research suggests mental health in the UK is declining, with suicides reaching a 13-year high in 2013. The recession was found to lead to increased rates of suicide.
• Since 2010 over 1 million people have had their benefits eligibility re-assessed with a new checklist, the Work Capability Assessment (WCA), with doctors and other groups raising concerns about the effects of this process on the mental health of those in the system.
• Five independent reviews have raised concerns over the effectiveness and fairness of this process, labelling it ‘impersonal’, ‘mechanistic’, and not inadequate at capturing the impact of chronic health conditions.
• The authors looked at three outcomes: suicide, anti-depressant prescribing and self-reported mental health problems in England between 2004 and 2013, as well as the amount of people having a WCA year on year, and compared numbers across different local authorities.
• They used fancy stats to take in to account things like how much each local authority was spending, and any possible trends already going on before the Government started the re-assessments, so we don’t need to worry about those.
• They found that: from 2010 to 2013 there were an extra 590 suicides, 279,000 extra cases of mental health problems, and an extra 725,000 anti-depressant prescriptions than there would have been if people hadn’t had a WCA.
• This is equivalent to: 5% of all suicides over that time, 11% of all new mental health problems reported, and 0.5% of all anti-depressant prescriptions.
• These increases were not found when looking at the same data for people over the age of 65, who did not have to undergo WCA.

So, that all seems quite convincing to me. And it’s not just cuts to benefits where policy decisions are having such a big impact. This article in the Guardian last week is a real eye-opener, detailing cuts to legal aid budgets and the knock on effects this has had on people’s mental health, who are now attempting to represent themselves whilst dealing with all the horrible mess that comes with a court case, as well as on the courts. Cases that would previously been heard in less than a day are taking three days. Coincidentally, they’re already under further strain from the benefits palaver because around 40% of those refused benefits after their WCA appealed in court (and 40% of those people won their appeal), with courts having to open on Saturdays and hire new Judges just to get through all the extra cases. From trying to save money, knock on effects on services may end up costing more, particularly for the NHS which is already under strain. And, that’s not even going in to the human cost, which evidently is much, much higher.

 

Get this down your lug ‘oles! – Part 1

I’ve listened to a fair few interesting and informative podcasts recently that I would highly recommend, so I thought I would start a little series of posts with Tears of a Clown, from Robin Ince.

Robin Ince, for those who don’t know, is a comedian and one half of The Infinite Monkey Cage. Last year I saw him interview Professor Bruce Hood, and learnt more from Ince’s questions than Hood’s answers – he’s a very clever chap. This podcast is framed in the aftermath of Robin William’s suicide; punctured with hilarious snippets from comedy greats, which in the context seem incredibly sad, and beautifully honest interviews with people including Josie Long, Simon Amstell and Jo Brand. Brand in particular gives some great insights about Bi-Polar disorder, backed up by her years of experience as a mental-health nurse.

I was also pleased to hear an interview with a researcher who has looked in to the personality of comedians and correlations with psychotic traits, with the view that these traits run along a continuum through the ‘normal’ population, to pathological or clinical manifestations. (The scale he talks about sounds suspiciously like the one I used to investigate hallucinations a non-clinical population – quick overview here https://psychinthecity.wordpress.com/2011/10/10/putting-it-all-in-context if you’re interested, full paper here http://www.sciencedirect.com/science/article/pii/S0165178114000420 if you’re REALLY interested).

The ‘cliché of a sad clown’ is something I’ve often thought about. It has always seemed to me that the most funny, outwardly confident and happy individuals are, behind closed doors, the most plagued by insecurities or the Black Dog of depression. I wonder if each hypothetical Black Dog is accompanied by an equally sized Rainbow Unicorn, battling for a winner, or at least to exist in harmony. (If you’re wondering what the hell I’m on about: http://www.jameshalltherapy.com/5). One ex-boyfriend in particular was the life and soul of any party, forever having people in stitches, but away from the laughing crowds was a very different story. It was like a switch was flipped (and no, I don’t think it was just because he was stuck with me…), and I think that’s something a lot of us have seen in close friends or can identify with. While this is quite different from the idea of professional comedians, there is a quote in the podcast that I think describes this idea of the intelligent, tormented soul, perhaps using humour as a mask or way to cope with a world that is just too much sometimes – “Better to be an unfulfilled Socrates than a fulfilled fool.”

Coming back to the research side, I got to thinking, what would we be gaining through researching this area? Ways to identify ‘at risk’ populations, and thus better target awareness and interventions, which is often the aim of research? Or, is it some kind of morbid fascination? I think in a lot of ways the media focus on Robin William’s suicide did some good for mental health. It highlighted that anyone can have bad mental health, even the most unlikely of personalities. But it also made stark some of the misconceptions that somehow still pervade society- that depression is ‘feeling sad’ and that people should be able to ‘snap out of it’. People seemed shocked that someone who gave so much laughter to others could be anything but happy themselves, and I do think that’s something people find hard to reconcile – and desperately want to try and understand. This is also discussed in the podcast, in the idea that the public are naïve in thinking that comedians are immune from the troubles the rest of us may face.

One problem is that comedy is so subjective. It would be interesting to recruit groups of friends, have each person rate how funny the others were, and then each individual to complete standard measures of depression, anxiety, how funny they think other people find them etc. Looking at the correlations you may find that those perceived as most funny by their friends are also the most prone to depression and anxiety, and may also think they’re the least funny. This could even be done online to get the large numbers needed. My cogs are whirring…

I hope I haven’t given away too many spoilers, but enticed you enough to set aside an hour and listen to the podcast in full – because you won’t regret it. Here’s the link: http://www.bbc.co.uk/programmes/b04n20v4

Money Makes the NHS Go Round

A story in the news today has caused quite a stir – GP’s in England will be given £55 for each patient they diagnose with dementia (full article here: http://www.bbc.co.uk/news/health-29718618). On the face of it you can see why there has been some outrage amongst the public and patient groups. I do think it’s a ridiculous idea – not because it seems as if the NHS are incentivising and rewarding GPs for making diagnoses, which people feel they should be doing anyway – but for different reasons. Before addressing these I’ll do a whistlestop tour of dementia and services.

Dementia is an incredibly complicated disease area, and far from being one single diagnosis covers a whole multitude. The three common factors that must be present in all dementias are:

1) A downward change in cognition (aka thinking, e.g memory, attention, reasoning or processing information).
2) This change is progressing over-time…
3) …and is enough to exert effect on the persons everyday life.

There are a few key points here. Firstly, we’re talking about a relative change, so in a time when GPs rarely know their patients, this can be difficult to figure out. A reliable ‘informant’ such as family member, friend or carer can help, as can neuropsychological testing that can help estimate something called ‘pre-morbid’ ability, or how well the person would have performed before they started having problems.

Secondly, to assess the rate and nature of change over time, you will likely need to see the person a number of times over a period of months or even years. Over this time symptoms can express themselves in different ways at different times.

Some cases are fairly clear cut, but there are also different types of dementia, some of which are rare. So it’s a complicated picture that can make dementia difficult to diagnose for GPs, often requiring lots of resources and that precious commodity in medicine – time.

Sidebar for a bit of background on GP services that I find geekily interesting. Every GP practice must log their diagnoses on the Quality & Outcomes Framework system (QOF – pronounced kwoff). Each diagnosis has a ‘read code’ (named after the person who invented the codes, Dr Read). This is what the NHS uses, along with an algorithm, to decide the number of cases that should be diagnosed in each area. Then, you can measure the gap between this number, and the number of people who have actually received a diagnosis. Using this method, it’s estimated that in London the diagnosis gap is 52%, meaning only 48% of people who should have a dementia diagnosis have one. For now we’ll assume that the algorithm is correct (although some health professionals believe it is not properly adjusted according to area, for example some towns will have a higher number of older people, or more people with diabetes – both of which increase your chances of getting dementia). You can see why the NHS might want to close such a large diagnosis gap. The Alzheimer’s Society have recently focused their campaign efforts on the need for a diagnosis, so people can access services, plan for the future and know what they’re dealing with.

GPs will only see on average between 2-4 new cases of dementia every year, which isn’t very many. Given this you can see that GPs don’t get that much practice diagnosing an already complicated problem. At my old place of work we ran a GP survey to try and establish gaps in knowledge surrounding dementia that we could try and fill. There were some worrying responses, one of the most prevalent being the view that dementia isn’t curable, so why ‘waste’ our budget on dementia drugs? But for some people, drugs can improve cognition to the extent that they have a few more years at work, being able to play with their grandchildren, live at home or recognise their wife.

I don’t have a problem incentivising diagnosing in principle. As the BBC article states, GPs are often given money for different things and for different reasons. Dr Hope says in the clip, a doctor is hardly likely to misdiagnose a patient for the sake of 55 quid (or £220 a year), and in reality this money will go back in to the practice. But together, this six month scheme is costing FIVE MILLION pounds. Just my personal opinion – and I would really welcome some discussion on this – but I would rather see this money spent on 1) training for GPs to better understand and diagnose dementia, 2) specialist memory nurses, 3) services that anyone with a cognitive problem (e.g. memory, language) can access, regardless of diagnosis, or 4) help for unpaid family carers saving the government millions of pounds, who could do with a break. This new scheme seems a little like a short term solution to try and solve a problem, without looking at the overall long-term picture.

That awkward moment when you write a blog and no one reads it.

‘Awkward moments’ seem to be going through some sort of cultural renaissance. There was  a time not long ago when you couldn’t log on to facebook without seeing some sort of “That awkward moment when someone says ‘Hello!’ and you say ‘Good thanks!'” related status (although, that one did make me laugh). And whilst there has been a fair bit of research in to embarrassment, there has been a lot less on the wider, more wishy-washy (that’s not an official psychological term) social phenomenon of awkwardness.  One researcher in America called Clegg (not the PM – awkward), has been trying to find out exactly what makes a moment awkward.

He asked three participants to sit in a room together, on three chairs facing each other in a triangle. Also in the room was a table with a microphone and some biscuits on it, and participants were aware they were being filmed through a two-way mirror. For three minutes they were given no instructions on what to do. Then a confederate (someone posing as a fellow participant, but working for Clegg) entered and sat with them. After three more minutes of doing nothing in particular, a researcher entered and gave them an ice-breaker task, at which point the confederate left. After three minutes of this task, the participants were asked to introduce themselves to each other. It’s not clear at what point the biscuits came in to the whole thing.

After this, participants watched the footage back (on their own), and used a slider box to show how awkward they were feeling during the interaction, moment by moment.

Clegg then analysed these ratings of awkwardness together with what was happening during the interaction at that time. He found that moments of feeling awkward occurred during different distinct social categories of interaction, which can theoretically be generalised to why we feel awkward in the ‘real world’:

• When people did not know what was expected of them, or what the social rules were (e.g. when the participants first sat down)
• When a social norm was broken (e.g. someone interrupting somebody else or infringing on personal space)
• A social ‘standard’ wasn’t obtained (e.g. no one spoke for a while)
• When negative social judgements were made about a person (e.g. someone pulling a face)
• When someone forgot somebody elses name
• When social processes were made explicit (e.g. the ice breaker task)
• When norms around eating were broken (e.g. crumbys – so that’s where the biscuits came in)

From that quite extensive list it appears that participants found the whole thing pretty awkward, for one reason or another. But it is interesting so see exactly when a dramatic increase occurred – and there were also moments when the awkwardness significantly dropped. These moments occurred when:

• People were sharing common interests
• One person helped another
• One person was positive about another
• Humour was used – a lot of the humour involved talking about the social awkwardness, which then relieved it.

Perhaps these ways to alleviate awkwardness could be used when we come across awkward situations in everyday life? Apparently, the top of the top 10 list of awkward moments is being stuck in a lift with someone. So next time you’re stuck in a lift, maybe give the person next to you a compliment. Crack a joke when you walk in on someone in the bathroom (number three on the list). Actually… maybe use with caution!

I do think this research is interesting (plus I love a ‘confederate’ in a study – I was suspicious of everyone when taking part in studies at Uni), with some potential avenues. Some people are, unfortunately, just more socially awkward than others. It would be interesting to find out exactly what this comes down to, for example whether they are more likely to be the culprit of awkward-inducing faux-pas, or whether they are less likely to employ the above tools to alleviate social awkwardness – or both. Maybe there’s a personality trait that makes you more likely to call your teacher “mum” (number four on the list).

Music, Alzheimer’s Disease, and The Shining….

I think I may have found the coolest person in the world. His name is James Leyland Kirby, a British composer based in Berlin who goes by the name of ‘The Caretaker’, due to his original inspiration of the the haunted ballroom scene in Kubrick’s The Shining. The score for The Shining, with it’s layers of ghostly vocals, electronica and 30’s ballroom, came to represent a type of music referred to by critics as ‘hauntological’, which I don’t think sounds like a real word, but it caught on nevertheless. And his work is inspired by Alheimer’s disease.

The Caretaker’s first album was titled Selected Memories From The Haunted Ballroom, released in 1999. Since then, he started to become interested in memory, and the links and similarities between music and memory, and this has become the focus of his work. In 2005 he released Theoretically Pure Anterograde Amnesia. Anterograde Amnesia is a condition whereby the person affected can remember everything up to the point of trauma (this could be trauma in the medical sense of a head injury or drug reaction, or, more rarely and controversially, a point in their life where they develop amnesia in response to some massive psychological trauma), but they are unable to form new memories. ‘Pure’ anterograde amnesia is just that – complete inability to form new memories, as opposed to partial anterograde amnesia. It’s also the opposite (kind of) to retrograde amnesia, where the person can still form new memories but can’t remember anything (pure) or bits (partial) that happened before the trauma.

So this does have a psychological link! Not just an excuse to listen to some weird, beautiful music.

This was followed by Deleted Scenes/ Forgotten Dreams in 2007 and Persistent Repetition of Phrases in 2008, where Kirby loops degraded and ‘glitched’ electronics to try and mimic the effect of diseases of the brain such as amnesia. Tracks are given titles like ‘Von Restorff Effect’, a theory that things which ‘stick out’ are more likely to be remembered, and named after the psychiatrist who first studied it. This is also called ‘Distinctive Encoding’, and can be used to aid remembering basically due to the brain’s bias to remember unusual things.

Another track is called ‘Lacunar Amnesia’, a type of amnesia that effects one specific event, leaving a ‘lacunar’, or gap, in memory. Film buffs might recognise the word Lacunar from the film Eternal Sunshine of  the Spotless Mind – it’s the name of the company that offers to erase someone from your life by getting rid of all of your memories of them. Apparently the idea behind the album was to play on the idea of the brain being ‘trapped’ inside a moment in the past.

But it’s The Caretakers most recent release that I find most intriguing. In 2011 he was inspired by the work of Brandon Ally, a neurologist with a background in cognitive disorders and Alzheimer’s. He published a paper called ‘Music as a memory enhancer in patient’s with Alzheimer’s disease’, which is itself a very interesting read. In that paper he discussed the (previously mostly anecdotal) link between music and Alzheimer’s, and the effect it can have on patients. Even in the severe stages of the disease, when people appear to be no longer able to communicate or understand what is going on around them, music can lead to pockets of lucidity, even a glimpse of what that person used to be like. It reminds me of this video (although it does watch a bit like an advert for i-pods, but maybe that’s just the skeptic in me): http://www.youtube.com/watch?v=fyZQf0p73QM

I’ve heard accounts of people who no longer recognise their family members, but put them in front of a piano and they can play a whole Bach back-catalogue. Other case studies have shown that individuals with moderate Alzheimer’s disease, where the brain areas specifically required for learning have deteriorated to a massive degree, can learn new songs despite not being able to re-learn other ‘rote’ skills, like making a cup of tea.

In his 2011 paper Ally found that Alzheimer’s patients were more likely to remember information that was sung to them than the same information being spoken to them, while healthy controls didn’t display an advantage in either. His theory for this is two-fold: firstly, music leads to a state of ‘heightened arousal’ for patients, meaning they are more likely to take in information, and secondly, brain areas involved in music are specifically spared in the disease process.

Ok, back to The Caretaker. Inspired by Ally’s work, his 2011 album was called An Empty Bliss Beyond This World, and made entirely from layered samples of pre-war records, with the same ballroom ‘hauntological’ sound as his earlier work. Throughout the album songs are often incomplete; degraded, then suddenly crisp and clear; missing gaps, with some even repeated again but slightly different, much like memories. Tracks include ‘I Feel As If I Might Be Vanishing’ and ‘Moments of Sufficient Lucidity.’ He has said in one interview that a lot of the titles were taken from books about Alzheimer’s sufferers.

I think music can have an incredible effect on memory, often more so than pictures, sights, or stories. It has the power to instantly transfer you to the first time you heard a certain song, or emotional times that can make all those emotions come back as if they were happening all over again. I love the idea that this impact of music on people with dementia has inspired someone to make music  – it feels like it’s coming full circle.

One review I found sums it up incredibly well: “It’s as though the album is trying to recall the originals, but is failing. For anyone who’s witnessed the frustrating effects of Alzheimer’s in real life, it’s hard not to be touched by Kirby’s drive to understand the emotions that accompany the deterioration of the brain– not only the part of the patient, but also that of the observer. The result is one of the most devastatingly tender electronic albums of the year.” (Unfortunately the reviewer is nameless). You can listen here: https://thecaretaker.bandcamp.com/.

And I’ll leave you with this quote from The Caretaker himself “We are our memories, and the saddest thing and big fear we all have is of losing our ability to remember as then really we are nothing, only a shell.”