Monday, September 19, 2016

This week’s activities (19th September – 27th September, 2016)

I apologise for not updating people as to my activities over the past few weeks – holidays, a hectic timetable, personal issues all conspired to make it difficult.

But this week sees me first (Sunday 18th and Monday 19th) at the Party Conference of the Liberal Democrats in Brighton – networking with colleagues from the charitable sector, and lobbying key politicians on the broad agenda of the British Psychological Society.

I’m then, on Tuesday 20th, at a meeting of a newly-convened (and grandly-named) BPS Presidential Taskforce on the future of applied psychology training in statutory settings. This follows from the recent Government announcement / consultation on changes to the funding of a range of healthcare training, and anticipated threats to commissioned training in psychology. It aims to develop a coherent BPS position on these issues before challenged again on these issues externally.

On Wednesday 21st, I’m meeting senior colleagues from the Department of Health / NHS England to discuss the representation of psychology and psychologists in the senior management of the NHS, and (inevitably, therefore) to raise issues of concern and mutual interest.

I’ll then be travelling up to Edinburgh, because I’m due to open a conference on Thursday 22nd in Perth on how psychology can respond to the challenge of compassion in the NHS, especially highlighted by a number of recent enquiries into failings in health and social care.

That evening, I’ll be travelling back down to London for the free annual joint lecture with the British Academy and the BPS exploring the effects of stress on the brain.

Friday allows me time to return home (and attend to some University work), because on Sunday 25th September, I’ll be off to the Labour Party Conference, for more political fun and games… perhaps spiced, this year, by the leadership contest.

Tuesday, August 2, 2016

BBC interviews on genes and depression

On 2nd August 2016, I was interviewed on two occasions about a research study concerning the genetic basis of depression. Below are very poor quality transcripts of the interviews... poor quality because they are taken from an automated system. But they might give an idea of my comments.

BBC Breakfast on the topic of genes and depression… 2nd August 2016

PRESENTER: Depression can have a huge effect on those who suffer from it, but new research today could provide some more clues about the condition, and how it relates to our DNA. Scientists in America say there are 17 genetic variations linked to depression. The findings came from analysing data, which was crowd-sourced from more than 300,000 people. Depression affects 350 million people worldwide and around one in four people in the UK will experience a mental health problem each year. This is the first time a genetic link has been made for people of European ancestry.
We're joined now by Professor Peter Kinderman, President of the British Psychological Society. Does this mean I suppose that you could in some ways if you have a gene inherent depression?

KINDERMAN: We've known for a long time that a huge range of human traits, including anxiety and depression, and other mental health issues have a genetic component. I guess this research is interesting. It is slightly odd, you mention it being crowd sourced, it's a slightly odd way to go about this kind of genetic science but interesting and it will be interesting to see what these gene areas do biologically. We need to pour a bit of cold water on it in terms of it being a major breakthrough. One of the authors of the paper you're discussing said that this proves depression is now a brain disease and we can move on. I think it is a bit less ground-breaking than that. I think it's interesting to find out what the genetic links might be. But there's a whole load of other issues to do with why people get depressed and how people recover from depression.

PRESENTER: With the cautionary note you put around this, if there is more of a genetic link to depression than we previously thought...

I'm not sure that this research shows that, although we know that there are genetic [] this points to which parts of the human genome might be associated. It doesn't say that the genetics play a larger role.

PRESENTER: How does that help? How useful a tool is that?

In itself it's probably not terribly useful. What would be interesting for me as a psychologist would be looked at it in biological terms what the gene areas do, whether it is to do with how we process information about social comparison, rewards, punishments, relationships, self-esteem, motivation, energy and physical sensations of tiredness and lethargy. All of that would give us some clues as to what's going on. But again, when I was reading the paper there was quite a lot of in terms of it being groundbreaking new research that proves once and for all that depression is a disease. I think it gives us a few small clues about which areas of the genome might be associated. But it raises as many questions as it answers and it doesn't necessarily mean we can now change our view depression.
We know if you're made unemployed, if you're in debt, if you experience social disadvantage or abuse in childhood, all of these factors undeniably make people depressed. It would be interesting to look at the relationship those known factors that lead us to be depressed and the genetic variants and anger about the interaction.

PRESENTER: One of the many questions is you may have the gene but that might not mean you have depression.

The gene won't be for depression, I'm reasonably confident, the genes are likely to be for energy levels or how you respond to times of stress. Whether you're a particularly likely person to respond to life events in a slightly more extreme way than others.

PRESENTER: If we did know that and you say there's lots of questions to be asked... If we did know this was the case and these were these particular genes, would it make it easier to treat and help people?

It might make a small difference; it would make it easier. For me as a clinical psychologist, I work with people to try and work out what's going on; why these problems might have emerged and what they can do. Knowing what particular traits you're exposed to as a person; what particular vulnerabilities you have as a person, is useful. It doesn't necessarily mean if you know your genetic vulnerability that therefore the intervention will biological. The good example is if you knew for certain that because of your parents' genetic make up you were prone to alcohol problems, the obvious thing to do is to make lifestyle choice to avoid alcohol. You wouldn't necessarily take a pill to reduce the genetics. If you are prone to big mood swings, a job as a transatlantic cabin crew on an airline isn't the job for you. It doesn't follow that even if you know what traits you are slightly more likely to inherit than other people - and these tendencies tend to be small - it doesn't mean you found the gene for depression you should cure it with a gene editing technique. You might know more about what your traits are like and therefore you can make lifestyle choices to counteract. For instance taking regular exercise, a damn good thing.

PRESENTER: We were talking about that earlier in the programme. Thank you for mentioning it...

BBC Radio 4 on the topic of genes and depression… 2nd August 2016

PRESENTER: Researchers in the United States say they have found 17 genetic variations linked to major depressive disorder including for the 1st time among people with European ancestry - the previous DNA evidence was the people of Asian descent. Peter Kingdom is Professor of clinical psychology at the University of Liverpool and president of the British psychological society. He's in our Salford studio and we're also joined by Dr Jerome Green from the Institute of psychiatry psychology and neuroscience at King's College London. Good morning to both. Dr Green what do you make of this study?

GREEN: I think it's very important study overall. It shows us that like other complex disorders that once we can achieve a large enough sample for life […] that we can discover interesting things about the genetic basis of the biological basis for a risk for depression. Using studies that integrate those risk factors. […] This particular study makes it clear that it is not just the case in in people of Haitian descent so I think we know that depression is a prolonged time proof from family studies the twin studies study recently even had to leave women but that and for two variants that there is a very rare and people with European percentage what the study does is identified variants that are common in people of European descent and showed that […] with 17 regions associated with that […].

PRESENTER: Professor Kinderman and do you agree that this adds to our knowledge and understanding of the causes of depression?

I think it's useful. I think it potentially adds a little bit more to the jigsaw but I think we need to pour few buckets of cold water on here. Just from the start is a slightly odd study because it's opportunistic; it's looking at people who signed up to a commercial gene testing company rather than a hypothesis driven scientific work. That said, I certainly wouldn’t argue that the findings are untrue… Just something that Jerome said which I think we just need to be cautious about. I'm sure it was a slip of the tongue but he said depression is genetic. Well, depression like many other traits in human life has a genetic and inherited element. It's interesting that Jerome’s own institution, the Institute of Psychology, Psychiatry and Neuroscience, published a paper yesterday showing that there were defined gene regions associated with people's spatial awareness that people's ability to make sense of 3D objects. Lots of traits in our human experience have genetic elements, but I think that’s a long way from saying simply that depression is genetic. 

PRESENTER: Don't you mean depression can be genetic? 

GREEN: No, I mean that component of the risk for depression it genetic a we have to recognise that the proportion of the risk is that it may be time to progression maybe 30 40 % and other risk factors if account for the rest. I see the genetic risks operated alone and operate in concert with other at risk factors thing as very important that nothing is agreement what as opposed to cold water is that both the people promoting research such as this and sometimes big bold including have to say journalists looking for a straightforward and simple stories say we have found the genetic basis of depression or indeed we know that depression is a genetic disease which is one of a brain disease which one of the authors of this study shows and what they would not disagree with which you but I would absolutely agree with this they are genetic and neuro-biological elements to depression just as with many other human traits. 

PRESENTER: Let me ask you then; what difference it would make […] if you end up with depression, that you are able to get a targeted treatment have with a better chance of working ?

KINDERMAN: Well again I think that I need to put some cold water on this which is - we already have a very very successful therapies […] for instance regular physical exercise is hugely important in helping people who are at risk of developing low mood or other mental health problems and helping people when they are depressed […]

PRESENTER: [What about…] targeted biological agents with all of the side-effects all of the possible adverse consequences?

KINDERMAN: Yes I can see the theoretical possibility but again I think you're leaping towards [saying that] we found some magic bullet that would allow some biological treatment. […] We have other reasons why people get […] unemployment makes people ….

PRESENTER: Jerome green and Professor Peter Kinderman thank you both 

Thursday, May 19, 2016

Making Sense of the World - Nature, Nurture and Beyond

This was first published on the Huffington Post on Thursday 19th May 2016.

Our mental health reflects a complex and turbulent dance between nature and nurture. But we are not merely passive slaves to these forces, we actively learn about, make sense of and respond to the world. The essential added element in the 'nature-nurture' debate, too often overlooked, is human psychology itself.
We are biological creatures. It is an undeniable fact that neural activity and chemical processes in the brain lie behind all human experiences. It is therefore very common to assume that our distressing emotions or inexplicable behaviour must stem from illnesses or disorders of the brain. And, from that perspective, individual differences in mental health outcomes (why some of us experience psychological problems while others are more fortunate) are best explained in terms of individual differences in biology or genetics.
It's undoubtedly helpful to understand more about how the human brain works. But the human brain is not only a complex biological structure, it is also a fantastically elegant learning engine. We learn as a result of the events that happen to us, and there is increasing evidence that our mental health problems are not merely the result simply of faulty genes or brain chemicals. They are also a result of learning: a natural and normal response to the terrible things that can happen to us and that shape our view of the world.
There is very powerful evidence that even serious problems as hallucinations and delusional beliefs are associated with traumatic childhood experiences (poverty, abuse, etc.). And it is important to remember that the recent economic recession has had a direct impact on suicide rates - a rather dramatic (and sad) example of how social factors impact on our mental health.
Fundamentally, our mental health depends on how we understand our world, our thoughts about ourselves, other people, and the future. Biological factors, social factors, circumstantial factors - our learning as human beings - affect us as those external factors impact on the key psychological processes that help us build up our sense of who we are and the way the world works.
This means we should think differently about the 'nature - nurture' argument, and add a third factor; human psychology. It's absolutely true that biological factors are important in mental health, and that biological differences can partially explain individual differences in mental health. But that happens if those biological factors affect the way in which we think - how we make sense of ourselves and the world. And that is equally true for environmental factors. The events we experience in our lives also affect our psychological make up and how we make sense of the world around us. In rather more technical language, the effects of nature and nurture are mediated by psychological factors.
This approach to psychological wellbeing is diametrically opposed to the traditional 'disease-model' of mental illness, and should change how we help people in distress. We should replace diagnoses with straightforward descriptions of people's problems, radically reduce use of medication, and use it pragmatically rather than presenting it as a 'cure'. Instead, we need to understand how each person has learned to make sense of the world, and tailor help to their unique and complex needs. We need to offer care rather than coercion, to fight for social justice, and to establish the social prerequisites for genuine mental health and wellbeing.
These ideas form the basis for the free, online course I'm leading on - Psychology and Mental Health: Beyond Nature and Nurture, which is available on FutureLearn, starting on the 13th June.