I just love this stuff

Today I was in Halifax in beautiful W. Yorkshire. It was great.
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I arrived last night and met up with a former colleague for a catch up over a curry (& beer of course).

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Then today was spent with around 20 of Calderdale’s finest mental health & social care workers talking about psychosis and interventions for people who hear voices. It’s amazing what a really enthusiastic group can get through in a single day. We covered basic principles of psychosis, a little philosophy of mental health care, models of understanding and normalisation in the morning. This afternoon was devoted to meaningful activity and validation, socratic dialogue, delusions and perceptions and principles of risk. These people really got their money’s worth today!

The group was great fun to work with and they really seemed to enjoy the day. Hopefully they’ve got some useful new skills to take away too.
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Even better, I think a few of them will be contributing to Care To Share Magazine before too long as well.

All in all it’s been a really successful day. And now it really must be ‘beer O’Clock’!

What a cracking day!

Mental Health and Social Care

Don’t forget about my other book – also available from The Care Guy website.

MH and SC simple lessons meme

This easy to follow book has been written with social care support workers in mind. It’s jargon free and packed with reflection points, tips and exercises to guide you through the social care process from basic principles to support planning and relapse profiling. What’s more – it only costs a tenner. You can download a sampler here.

The author, Stuart Sorensen has many years experience of working in mental health and social care. Drawing on past experience of ‘real world’ care services he boils down the complicated theory of mental health care into the fundamental principles of best practice. The result is an easy to follow book that explains what mental disorder is, what recovery really means and what social care staff can do to help

Fallacies 9: The ‘single cause’ fallacy

Everyone has a place in the world. They don’t always like it – but they have a place none the less. And everyone arrived ‘where they are’ because of a complex combination of circumstances, choices and characteristics that all contribute to whatever it is that makes us who we are.

For example….

I am occasionally asked why I chose to become a mental health nurse. The usual answer I give (the shorthand version, if you like) is that I find mental health work (either as a practitioner or a trainer) both fascinating and rewarding. But actually there’s more to it than that.

To really understand why I drifted in to mental health care you’d need to know how a number of very different causative factors came together to bring me to that point. These include…

Lincoln YMCA

Lincoln YMCA

Volunteering as a teenager in an elderly care day centre (primarily because I was bored);
Not being talented enough to realise my teenage dream of becoming an actor;
Leaving home in search of a theatrical career and becoming homeless;
Living either on the streets or in hostel accommodation during my early twenties;
Eventually finding employment in the hostel I lived in (Lincoln YMCA);
Being ‘thrown in at the deep end’ with a number of mentally disturbed hostel residents;
Witnessing a woman jump to her death from a multi-storey car park near the hostel;
Subsequently taking a series of care assistant jobs in mental health, elderly care and learning disabilities services;
Meeting and becoming engaged to a care assistant who was about to begin nurse training;
Following her into nurse training (to be together);
Entering mental health nursing (mainly because I didn’t fancy adult nursing).

So you see, although the shorthand answer is that I love mental health work the actual answer includes many more causes than that alone. In truth I drifted into this field as much by chance as anything else. I would never have imagined myself doing anything like this when I was at school. And that’s how it is for most people.

There is no single cause!

Of course we all understand this when we think it through. Almost nothing significant happens because of a single event. There are always other underlying conditions that make it possible. Unfortunately though we all tend not to think it through quite so often as we should.

Continuing for the moment with the theme of mental health I’d like to pose a question….

What causes schizophrenia?

If you were to ask 100 people that question you may not get 100 different answers but you’d find that a number of contradictory themes kept cropping up over and over again. Let’s look at two of these themes….

“It’s a biological brain disease”

This means that schizophrenia (the tendency to experience hallucinations, delusions and thought disorders) is caused by something in the person’s body or brain. Different people will offer slightly different versions of this explanation – some will talk about genes and heredity whilst others will attribute schizophrenia to chemical processes resulting from substance use or dietary processes. What brings them all together is the unifying belief that hallucinations, delusions and thought disorders are caused by physical issues and so physical remedies are required. The ‘single cause’ is assumed to be biology.

That’s why doctors prescribe medications for people diagnosed with schizophrenia. It’s a chemical remedy intended to ‘fix’ or ‘manage’ a chemical problem.

“It’s caused by social exclusion”

People who believe this will not focus upon trying to alter the workings of the brain and/or body. They’ll concentrate their efforts upon more social, cultural and environmental variables and try to solve the problems service-users experience through interaction and coping skills development.

There is extremely good evidence for this sort of intervention and it really can work wonders.

The problem with both of these approaches, at least in my opinion is that they are too superficial and self-limiting. They both fall into the trap of the ‘single cause fallacy’ and because of this they are both essentially inadequate explanations. There is more to schizophrenia than just biomedical (nature) or socio-cultural (nurture) causes in isolation and until we abandon single cause explanations and explore the totality of causes we’re doomed to fail . More significantly we’re also doing our service-users a major disservice. I’ve explained more on this topic in my commercial blog:

Why I’m not ‘anti-psychiatry’

But that’s not really the topic of this entry – it’s just an example. Another example comes from the world of politics and the ‘single cause’ explanations that politicians of all stripes would like us to accept. For example…

A little over a year ago the United Kingdom (or at least England) was blighted by riots in several major cities. The reasons for this seem complex and almost certainly include (among other things):

Poverty and alienation;
Disenchantment;
Opportunism;
An increasing sense of hopelessness;
Disregard for the rights and welfare of others;
Lack of cohesion within the larger community;
The psychological need of desperate people to scapegoat ‘the other’.

Nick cleggThe leader of the Liberal Democrats, Nick Clegg famously predicted that there would inevitably be riots if the Conservatives won the 2010 general election. He understood the link between the ruthless capitalism of Conservative ideology, widespread poverty and the desperation of the masses all too well.

And yet both during and immediately after the riots (and after he’d led his party into coalition with those same Conservatives) he conveniently forgot all that in favour of the party line about ‘lack of respect’ and ‘mindless yobs’. Even when directly asked to comment upon any other possible causative factors he declined to do so.

Whenever someone tries to convince you of a ‘single cause’ for a serious event ask yourself :

What aren’t they considering?

The more we allow ourselves to be drawn into the ‘single cause fallacy’ the more vulnerable we become to manipulative arguments from others, be they politicians, internet bloggers like me (yes I can fall into the same traps as everyone else) or the bloke ‘holding court’ in your local pub.

So the next time someone tells you that disabled people are all benefit scroungers who don’t want to work or that the global economic crisis was caused by the UK’s previous prime minister stop and think for a moment before you fall victim to their particular brand of superficiality.

What aren’t they telling us?

Of course, as another blogger reminded me earlier this week, ‘We don’t know what we don’t know’. It can be difficult to work out just what the other person isn’t telling us because, by definition, we don’t know. But there are a few questions you can ask yourself that may help:

If this was a debate what would the other speaker have said?
If I had to explain this what would I have said?
Does this explanation fit with what I already know about the world?

The trick, as ever, is to think for ourselves. The single cause fallacy isn’t only widespread – it’s dangerous too.

About the ‘Fallacies’ series

The ‘Fallacies’ project was built up from a series of instalments that first appeared online during the summer of 2012. It is republished as part of a larger set of changes intended to rationalise the contents of several different blogs into just 2. The other remaining blog focuses mainly upon social care and mental health related issues. It can be found at http://www.TheCareGuy.com

#TwentalHealth (Twitter) awards

How cool is this? I’m joint runner up in the 2013 #TwentalHealth awards in regard to my Twitter account @StuartSorensen. It’s an honour I share with the wonderful @MrsGracePoole whose twitter feed is well worth following if you’re into mental health and/or nursing.

The winner in the nursing category was @Nurse_W_Glasses, creator of the now extremely famous 20Commandments for mental health workers. I’m especially please to see that NWG won the nursing category award, having interacted with her online for some years now and even collaborated on a longer elaboration of her 20 Commandments a couple of years ago.

So well done to NWG for taking the big credit – an honour she richly deserves. And congratulations to Grace (AKA Alison) who, like myself has the honour of displaying the 2013 runner up badge on our blogs and online profiles.
twental health 2013 runner up

The Care Guy’s back!

What do freelancers do when they’re not trading?

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I have long believed that for a trainer or consultant to stay relevant he or she must keep their practical skills up to date. I know from experience that my clients think so too. From learners in training sessions to managers in consultancy you want the person you’re talking with to understand the real world of practice. You want him or her to understand your world and the challenges you face. You want him or her to ‘know’.

That’s why the best freelancers make a point of staying in touch. But spending time in practice is only half the battle. How that time is used is just as important.

Freelancers in practice need to take note of changes and understand new challenges. We need to think strategically and come up with practical ways to meet the demands of the real world. And we need to use that experience when we return to work with our clients.

There have been some changes to my services

For almost a year now I’ve been working as Quality Development Lead for a large UK social care provider. During this time I’ve come to grips with a range of real world challenges and worked with staff at all levels to meet them. It’s been a remarkable and illuminating year.

The net result of all this is a bigger range of services based upon the most up to date principles of social care, organisational strategy and personal development.

Click the links below to see what’s new.

Training
Support for organisations
Personal development and coaching

It’s good to be back!

I’m in the top 10!

Now that was a surprise. The Cision UK top 10 UK health blog index has this blog at number 8. How cool is that?

In fairness I strongly suspect that it’s more in recognition for my archived mental health and social care material than for my current stuff. But hey, who’s complaining?

It’s good to know that people still remember the old blog. For those new to my stuff you can find most of the old archived stuff in downloadable PDF and other formats here.

Enjoy and do please let me know what you think of my work.

Cheers

Stuart

A request

Hi,

I have a problem to solve. Some colleagues need advice on the interface between autism spectrum disorders and mental health problems. In particular they are trying to find reliable guidance on dual diagnosis regarding autism spectrum disorders and cluster B (emotionally unstable) personality disorders.

I am very familiar with the cluster B stuff but I need to source reliable (preferably evidence based) information both on autism and on any correlation. I’m aware of a couple of interesting Swedish studies both of which seem to suggest links with clusters A and C (not surprisingly) but not cluster B.

I also need a good primer on autism that I can use to create a syllabus for further study into the autism spectrum.

Can anyone help?

Please get in touch either via this blog (just comment on this post) or Email
stuart.sorensen@googlemail.com
if you can point me in the right direction.

Cheers,

Stuart

Hard wired 12: Heuristics

Heuristics – the amazing mental shortcuts that lead us into trouble

“A heuristic is a mental shortcut that allows people to solve problems and make judgements quickly and efficiently. These rule-of-thumb strategies shorten decision-making time and allow people to function without constantly stopping to think about the next course of action.”

Making teaWe all use heuristics. We have to. The alternative would be ‘paralysis by analysis’. We’d be too busy thinking through our every action actually to do anything. From a smile or a handshake to how to cross the road or even boil a kettle. Without heuristics life would be exhausting and probably very short. After all – by the time you’d thought through how to respond to the speeding car hurtling toward you, you’d probably be dead. Heuristics are the psychological shortcuts that keep us going in a complex world.

Some of our heuristics are learned. That’s why experts are so good at what they do. Years of experience has taught them the heuristics of their work.

In my own field for example, I remember as a novice psychiatric nurse spending hour upon hour wondering how to approach each individual, trying to be aware of their every characteristic as though all that information, somehow would tell me what to do. With experience I learned that not every piece of information is important in every situation. I can ‘cut out the irrelevant’ and take appropriate action based upon only the important things. In a very real sense the study of ‘heuristics’ is the study of ‘the relevant’.

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So I know that depressed people need motivation; I know that anxious people need a way to problem solve; and I know that psychotic people need a way to assess their perceptions and beliefs. These are the shortcuts, the heuristics that allow me to be effective. But they’re not foolproof.

In choosing to ignore irrelevant information and act according to pre-conceived patterns of need psychiatric nurses run the very real risk of ignoring ‘the individual behind the distress’. By focussing only upon the depression and working to motivate a service-user I might fail to notice their suicidal ideation. That would be a serious omission and working too hard on motivation without addressing the underlying desire to die could result in the person actually killing themselves rather than just thinking about it.

Of course experienced nurses know this and work hard not to limit their attention only to motivation without understanding what might come next but the point is clear. Mental shortcuts are useful but they are also, by definition, superficial. They make us prone to mistakes.

The good news is that we can learn to take account of these pitfalls. The bad news is that most of the time heuristics just take hold of us and we carry on in our own sweet, superficial way because that’s what we evolved to do.

Like all evolved tendencies, heuristics favoured survival of the fittest in the Environment of Evolutionary Adaptation (EEA). They are so embedded in our evolutionary journey that they are a universal trait among humans. We act without thinking. That’s what kept our ancestors alive. It’s also what keeps us alive today. Whether the threat was a predatory tiger in the Pleistocene or a speeding car in the present we act instantly to keep ourselves safe. Natural selection kept the gene pool viable and the evolution of heuristics was assured.

Instinct

neonateWhen we talk about ‘instinct’ we often really mean heuristics. A newborn human has only two instinctive responses:

1. Suckling;
2. Fear of falling.

Everything else has to be learned. The more effective the heuristic shortcut the more likely it is that we confuse the lesson with instinct. But it’s not instinct. The tendency to develop learned heuristics is an evolutionary trait but often the heuristics themselves are the products of experience and of culture. They develop as we learn from experience and, as we have seen, they can lead us astray.

In a sense, evolutionary psychology might be thought of as the study of heuristics. It’s the study of those ingrained mental shortcuts that mould our basic drives even (although not necessarily our specific behaviours). Protection of children, for example or a general commitment to justice (at least justice so far as other people are concerned) seem more hard wired than a healthy respect for road safety. That’s because although the need to survive is hard wired the rules governing traffic have to be learned.

As already noted, one of the aims of this blog series is to understand the role of determinism in our evolutionary make up. I suspect that if we are to embrace free will (the opposite of determinism) in any meaningful way then attention to heuristics will be the way forward.

Hard wired 6: The meaning of human nature

Disclaimer: As I made clear at the beginning of this series I’m writing this blog because I want to learn. I don’t profess to be an expert in evolutionary psychology and I don’t pretend to have an absolute understanding of human nature either. So if you read something here that strikes you as really, really, silly, pretentious or just downright inaccurate – please tell me. And please tell me why you think I’m mistaken – that’s how I’ll learn.

wpid-nuremberg_party_rallies_gallery_main_2.jpegThroughout my career I’ve met all sorts of people from many different ‘walks of life’, some with serious mental health problems and some who swore that their mental state was nothing short of perfection. I’ve met people with money and also those who struggle to find the next meal – actually I’ve met many more of the latter than the former.

But no matter what their circumstances, class or lifestyle many, and quite possibly ‘all’ of them, have a tendency to justify their ingrained behaviours by describing them as ‘human nature’. They spoke as though everyone behaves that way and there really isn’t any option. Interestingly the same argument about ‘universal’ behaviour is made by the ‘dog eat dog’ con artist who sells his second-hand car without declaring the fact that it’s good only for scrap and the sympathetic nurse who seems to live only to help others in need. Both would tell you with equal certainty that their behaviour is the result of universal human nature.

But if human nature means anything at all it must be consistent – it must hold true for all people. Otherwise it’s just a collection of preferences that people justify by claiming that they’re more widespread than they are.

One of the most important issues addressed by evolutionary psychology is this very question – what exactly is ‘human nature’? What are its components and why, if such a thing as human nature exists at all, do we see such widely differing behaviours from human beings ‘in the wild’, so to speak?

I confess that for many years this concept confused me. It seems that whatever aspect of ‘human nature’ I came across there was a contradiction waiting in the wings to knock it down again. It was as though human nature became nothing more than a myth – a widespread illusion that people use to justify whatever they like without so much as a grain of truth behind it. And then, just within the last few months, I read ‘The Moral Animal’ by Robert Wright (1994) – a fascinating book that suddenly helped me to make sense of the whole notion of human nature. You can get hold of the book here

Wright describes the way that human nature, far from being a collection of hard and fast, inflexible rules, is much more like a set of choices, alternatives that are turned on or off in response to opportunity and circumstance. To illustrate this I’ll take only one of these alternatives – the dichotomy between dominance and submission.

Support the dominant maleI know many very successful people who claim that the drive to dominate, to be in charge, to have authority over others is something that exists in all of us. They justify their behaviour, their often cruel and uncaring behaviour, by asserting that if they didn’t take charge of others, others would take charge of them. In the past I’ve dismissed this reasoning as just so much posturing intended to excuse their abuse of those around them. But now I’m not so sure.

To make sense of this I’ll begin with an assumption:

In evolutionary terms, dominance is preferable to submission!

This is because dominance is likely to result in more opportunities for procreation. Remember that the driving force of evolutionary adaptation is to get your genes into the next generation and the only way to do that, at least for primates like ourselves, is via sex.

Yes, of course, it’s possible in the modern world to produce offspring without sexual intercourse but that wasn’t the situation in the evolutionary environment. For most of our history (human and pre-human) sexual intercourse was vital to genetic survival.

So – the default is to strive for dominance. Our nearest relatives on the evolutionary family tree, chimpanzees and bonobos demonstrate this correlation remarkably well. The dominant males get most (if not all) of the sex. Their genes make it into the next generation. The submissive males are much less likely to procreate and so their genetic lineage dies out. Usually.

There is then, a great drive to dominate others, especially for males. But what of those who find themselves lower down in the ‘pecking order’ – the hierarchy of sexual opportunity? What choices do they have.

Well essentially they have only three choices….

 1. They can risk injury or death (often amounting to the same thing) by challenging the dominant male;
 2. They can support the dominant male in the hope that they will be allowed some limited access to females (this really happens);
 3. They can accept submission and stay alive with the possibility of the odd sneaky liaison when the dominant male isn’t looking.

Bonobo dominantIf the male in question has realistic designs on dominance (or supporting the dominant male) they are likely to bide their time and make their own ‘power play’ when they’re mature enough to do so.

If the male in question is weak they tend to accept submission and the occasional liaison because this affords their genes a greater chance to be transported into the next generation. After all – there’s no evolutionary prospects at all if you’re dead. Staying alive by submission at least gives your genes a slight chance of making it through.

We can see then that dominance isn’t an ‘all or nothing’ strategy. It’s a sliding scale that prompts individuals to assume more or less dominant roles depending upon the circumstances that they find themselves in. In short it’s a hard wired, genetically determined, psychological ‘module’ that helps us to ‘play the odds’. We’ll hear more about psychological ‘modules’ as the series progresses.

For now let’s compare this principle to human behaviour…..

We all play different roles depending upon our circumstances:

Prison milieu1. The bullying office manager is dominant when surrounded by underlings but assumes a submissive role when called to explain the accounts to the chairman of the board.
 2. The pompous professor is less domineering when surrounded by more respected academics;
 3. The violent criminal may be quite prepared to assault his (weaker) victims but assumes a much more submissive role when sent to a prison populated by real ‘hard men’.

Of course – in the modern world these choices about dominance don’t always relate directly to opportunities to procreate but that’s not the point. They did during the Environment of Evolutionary Adaptation (EEA) and so the tendency to be dominant when we can and to submit as a form of self-preservation when we must is hard wired. That’s why ‘human nature’ seems so variable. It depends upon complex social and circumstantial cues to fine tune behaviour.

As we go through this series the theme of circumstantial adaptation will be integral. Nothing about human nature is quite so ‘cut and dry’, so ‘black and white’ as many of us – myself included – used to believe.

I wonder if this is true

Faith healing GP Accusations have come forward that a Staffordshire Dr. told his patient God would heal her & to stop taking her psychiatric medication. The GP denies any wrongdoing and claims that the allegations represent an attack on his Christian faith.

Whether or not this particular GP is guilty of such serious misconduct is a question yet to be answered. However it wouldn’t be the first time such medieval recommendations have been made in UK. The last few years have seen UK psychiatrists like Rob Waller refer psychotic patients for exorcism, several deaths resulting from exorcism worldwide and an Archbishop calling for exorcism of ‘the mentally ill’ in the House of Lords.

It’ll be interesting to see how this plays out.

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