Unsticking social research through lived experience and citizen control

Having lived experience and knowing people with lived experience are really effective way of researching social conditions—unavoidably, whether or not you want to—and lead to rich theory. I wonder how ideas like sampling, generalisability, and validity can be used to make sense of how this works.

Compare what activist groups do and the purer model of social research in which you have a central institute, running surveys and writing “independent” reports, making policy proposals. The latter leads to flat, superficial theorising if done without lived experience.

In activist groups with rich communication (Facebook groups, WhatsApp chat groups, regular meetings) the “data collection” is continuous and inseparable from day-to-day individual support and activism. But traditional reports can still be important to get media and government attention.

To unstick social research requires holding onto all methodological advances (sometimes getting a good estimate of the population prevalence and correlates of some form of oppression are useful for instance) whilst radically opening up research to citizen control.

Academics without lived experience running convenience sample qualitative studies with small numbers of people and pretentious methodology are fundamentally limited in what they can discover. The same sample from lived experience and lived theory is very different.

There are of course many professional researchers with lived experience, but higher education is a hostile environment now—you couldn’t design a better system to reward junk research and cause burnout if you tried.

Your various identities, privileges and oppressions (“race”, man/woman/non-binary, cis/trans, wealth, monogamous/poly, how valued your labour skills are, property ownership, disabled, etc.) fundamentally constrains who will answer your calls for research participants, what social phenomena you can understand, who will listen to what you discover.

Some research breaks free of the constraints thanks to contradictory locations; for instance, being articulate and well connected is one way to fight against a position of oppression. Though then you can end up being attacked by “your own side” for having helpful privilege.

Ludicrously-large sense-of-self as a way to have free will

Galen Strawson (1994) provides a succinct argument for why we can’t be truly morally responsible for any action. It goes:

(1) Nothing can be causa sui — nothing can be the cause of itself.

(2) In order to be truly morally responsible for one’s actions one would have to be causa sui, at least in certain crucial mental respects.

(3) Therefore nothing can be truly morally responsible.

Intuitively (and arm-waving wildly) this speaks also to the impossibility of free will. This impossibility thesis holds irrespective of whether determinism holds, i.e., whether everything we do “has a cause, and hence an explanation; even if the explanation is inaccessible to us” (Strawson, 1989/2008, p.338).

The gist is that under determinism we and all the actions we take are caused by something outside of us and consequently causa sui fails. Under indeterminism then some randomness — inside or outside our bodies — contributes to an event happening, which doesn’t feel like we are in control either.

This makes a lot of sense to me, and taking it seriously leads to interesting ways of thinking about and coming to terms with the reality in which we find ourselves (if that’s your thing, of course — plenty of people don’t bother). We must find meaning without relying on us being the originator of our actions. Deep curiosity about what happens next seems to be one attribute that runs deep — hence why we watch films even though we know the ending has been predetermined. I’ve recently discovered a Yiddish proverb which goes along these lines: “You should go on living — if only to satisfy your curiosity.” Also if you experience or do something pleasant or important or desirable, accepting that you did not cause it to happen but rather that a universe-old causal chain led to it happening is pretty groovy. This is a potential way to ponder meaning (if you want).

But recently I have been wondering what exactly this something that supposedly cannot be a cause of itself actually is. Intuitively, when I think about whether or not I have free will I think of my Self as encased in a body. The aspects of me of which I am consciously aware feel like me, as do unconscious aspects which I cannot experience but which I know are there: all the gory bodily processes which keep me running like my bladder’s internal sphincter.

Much of what comprises my Self comes from outside me. My genes came from my parents. My experiences come from the world around me. Each of the cause-effect chains stretching back to the beginning of time is clearly outside my body. There is a tradition of pondering where self begins and ends, for instance as popularised by The Extended Mind by Andy Clark and David Chalmers. Consider how much we rely on things in our environment to get things done. Clark and Chalmers discuss a chap called Otto who, like most of us, supplements his skull-based memory with a notebook.

“Most of us already accept that the self outstrips the boundaries of consciousness; my dispositional beliefs, for example, constitute in some deep sense part of who I am. If so, then these boundaries may also fall beyond the skin. The information in Otto’s notebook, for example, is a central part of his identity as a cognitive agent. What this comes to is that Otto himself is best regarded as an extended system, a coupling of biological organism and external resources.”

Kusch (1999, p. 359) also illustrates how stuff going on outside us can get under our skin: “at least some states of the brain might well be called social states. […T]hey predispose us to differ in the intensity, quality, and duration of some of our sensations.” There is a long tradition of this kind of thinking; those of a psychoanalytic persuasion might cite Bion and others.

Here is where the Ludicrously-Large Self (LLS) Thesis comes in. Under LLS, whether or not determinism holds, everything causally implicated in who we are and what we do becomes part of the Self. We certainly cannot be consciously aware of the vast majority of this since it extends spatially and temporally back to the beginning of time (hence Ludicrously Large). The consciously aware bit does not bother me — I feel quite attached to my bladder’s internal sphincter, even though I have no awareness of it. Now Strawson’s first proposition, “Nothing can be causa sui“, melts away. With the neatly encased model of Self, external cause-effect chains lead to who we are and what we do, whereas now under LLS we take each of those events as part of us — hence we are causes of ourselves. This is a radical challenge to our sense of identity; e.g., “even the phrase ‘each other’ doesn’t make any sense” (Rumi).

What happens when you write to the Daily Mail about factual inaccuracies

On 23 October 2018 16:18 I used the DM factual inaccuracies contact form to complain about an article on using hot baths to cure depression.

Here’s what happened.

I wrote:

There are several problems with this article.

Firstly, it notes that “The research was published in the journal bioRxiv.” This is misleading. bioRxiv is not a journal; it is “a free online archive and distribution service for unpublished preprints in the life sciences” – it is not yet a published paper.

“Articles are not peer-reviewed,” adds the archive’s About page.

Secondly, this is one study with a small sample size and large dropout in one group. There was no statistically significant difference at 8 weeks – and that’s according to a very weak notion of statistical significance which is relatively easy to achieve (p < .05).

Thirdly, even if taking a bath is better than exercise, is exercise an appropriate control group for a study of treatments for depression? Readers might hope you would consult an expert. What do NICE guidelines currently recommend for patients whose depression is as severe as those in the study?

They replied on 24 Oct 2018 at 16:02:

Thank you for your email.

The following article is a description of the bioRxiv report. We are conveying the results of their report, and many of the issues you raise are ones with the bioRxiv report which we do not claim to endorse or state as unequivocal fact.

It is always good to receive feedback from readers, whether positive or negative. The contents of your email have been noted and have been passed to our editor for review.

I can confirm the article has been updated.

We appreciate you taking the time to get in touch.

I’m not reassured very much by the edit, but sharing details of the process in case helpful…

What is love?

“… romantic love is a syndrome because it is an arational, projected attitude with a plethora of symptoms that vary across cultures and individuals. Some core symptoms have been identified by Tennov’s concept of limerence, including obsessive thinking and idealization.”

“… all norms applicable to romantic love are extrinsic rather than intrinsic to it because romantic love is arational. For this reason, it is up to the lovers to accept, reject, and modify the norms that govern their loves.”

This looks an interesting doctoral thesis, by Arina Pismenny (2018), The Syndrome of Romantic Love.

A psychoanalyst walks into a bar(red subject)

A psychoanalyst walks into a bar with a book on logic and set theory. He orders a whisky. And another. Twelve hours and a lock-in later, all he has to show for the evening is a throbbing headache and some indecipherable nonsense scribbled on a napkin.

That’s the only conceivable explanation for these diagrams from The Subversion of the Subject and the Dialectic of Desire in the Freudian Unconscious, by Jacques Lacan (published in the Écrits collection):

But, I hear you ask, surely this notation means something? After all, Lacan is famous and studied across the world, and f(x) is well-recognised as a function, f, applied to argument x. So the I(A) and s(A) must mean something?

Here is a brief interlude on functions. The Fibonacci sequence, which pops up in all kinds of interesting places in nature, can be defined as following:

f(0) = 0,
f(1) = 1,
f(n) = f(n-1) + f(n-2), for n > 1.

In English, this says that the first two numbers in the sequence are 0 and 1. The numbers following are obtained by summing the previous two: 0, 1, 1, 2, 3, 5, 8, 13, 21, 34, …

If you tell it a number (e.g., 0, 1, 2, …) then it replies with the respective number in the sequence (first, second, third, …). It might look a bit scary if you haven’t seen the notation before, but check out these examples demonstrating how the arithmetic is carried out:

  • f(0)  =  0
  • f(1)  =  1
  • f(2)  =  f(1) + f(0)  =  1 + 0 = 1
  • f(3)  =  f(2) + f(1)  =  1 + 1 = 2
  • f(4)  =  f(3) + f(2)  =  2 + 1 = 3
  • f(5)  =  f(4) + f(3)  =  3 + 5 = 5
  • f(6)  =  f(5) + f(4)  =  5 + 3 = 8

The point here is that the function notation “does something”. It provides a way of defining and referring to (here, mathematical) objects.

Less well-known, but appearing in university philosophy courses, is the lozenge symbol, ◊, which means “possible” in a particular kind of logic called modal logic. It seems plausible that there is something meaningful here in Lacan’s use of the symbol too.

Here is Lacan, “explaining” his notation for non-mathematicians:

Huh?

Lacan doesn’t try to explain what the notion means; he doesn’t seem to want readers to understand. Maybe he is just too clever and if only we persevered we would get what he means. However, elsewhere in the same text Lacan uses arithmetic to argue that “the erectile organ can be equated with √(-1)”. Personally, I am unconvinced.

Alan Sokal and Jean Bricmont have written a book-length critique of Lacan’s maths and others’ similar use of natural science concepts. Having read lots of mathematical texts and seen how authors make an effort to introduce their notation, I think it’s entirely possible Lacan is a fraud. That might sound harsh, but just look at how he writes. I reckon anyone can see for themselves that Lacan is writing nonsense if they take a look and forget for a moment how famous he is.

 

Lightly edited 18 Sept 2018, hopefully making clearer!

NHS England mental health clustering implementation “disappointing”

A document is circulating from NHS England and NHS Improvement (13 Aug 2018) on the current state of payment systems and clustering in mental health services in England.

It cites “local pricing rule 7” from the 2017/18 and 2018/19 National Tariff Payment System (NTPS) and reports on a survey of progress towards implementing the rule.

Here is what rule 7 said (p. 114):

Rule 7: Local prices for mental health services for working age adults and older people
a. Providers and commissioners must link prices for mental health services for working age adults and older people to locally agreed quality and outcome measures and the delivery of access and wait standards.
b. Providers and commissioners must adopt one of the following payment approaches in relation to mental health services for working age adults and older people:

i. episode of care based on care cluster currencies
ii. capitation, having regard to the care cluster currencies and any other relevant information, in accordance with the requirements of Rule 4(b) to (e)
iii. an alternative payment approach agreed in accordance with the
requirements of Rule 4 (b) to (e).

Commissioners and providers (233 in total) were asked, “What payment approach do you have in place with your contracts for working age adults and older people in 2017/18?”

Here are the results:

So only 14 out of 223 responses (6%) reported a move away from block contracts – the whole point of the new payment systems! The report notes, “The results were disappointing.”

Reasons given by respondents for the poor implementation included:

  • “limited local capacity to implement a new payment approach”
  • “lack of shared confidence in cost and activity data”
  • “uncertainty about how the proposed payment approaches would relate to the new operating models that would develop as part of integrated care systems.”

Services are supposed to be “clustering” the patients they see, irrespective of whether the clusters are used for payment. Rule 6 (p. 114):

Rule 6: Using the mental healthcare clusters
All providers of services covered by the care cluster currencies (see Annex B3) must record and submit the cluster data to NHS Digital as part of the Mental Health Services Dataset, whether or not they have used the care clusters as the basis of payment. This should be completed in line with the mental health clustering tool (Annex B3) and mental health clustering booklet to assign a care cluster classification to patients.

The research on clusters is damning. A recent study (Jacobs, et al., 2018) found that clusters were not very good at characterising the costs of different kinds of treatment and support (p. 7):

“Clusters are therefore not performing very well as a classification system to capture similarities and differences between patients. The categories of the current classification system appear to be neither case-mix nor resource homogeneous. We find evidence of large variation in terms of activity and costs within clusters and between providers.”

Surprisingly, the authors argue that clustering should continue (p. 7):

“… any payment approach needs to be underpinned by a solid classification system and to abandon the clustering approach now will thwart all progress. The clustering approach is already relatively well-established among most providers. Scrapping it all and starting from scratch risks putting mental health services back a decade in terms of developing a more transparent and fair funding system.”

Given the survey results above, it’s unclear how much progress would actually be thwarted by ditching clusters.

 

If you enjoy this sort of thing, you might also be interested in:

Mr Justice Mostyn vs. vague, rhetorical applications of theory

A court case (GM v Carmarthenshire County Council [2018] EWFC 36) has ruled that a social worker’s “generalised statements, or tropes” based on attachment theory are not admissible evidence.

The full judgement by Mr Justice Mostyn has interesting thoughts on the valid application of theory and balance between theory and observation.

“… the local authority’s evidence in opposition to the mother’s application was contained in an extremely long, 44-page, witness statement made by the social worker […]. This witness statement was very long on rhetoric and generalised criticism but very short indeed on any concrete examples of where and how the mother’s parenting had been deficient. Indeed, it was very hard to pin down within the swathes of text what exactly was being said against the mother. […] [The social worker] was asked to identify her best example of the mother failing to meet L’s emotional needs. Her response was that until prompted by the local authority mother had not spent sufficient one-to-one time with L and had failed on one occasion to take him out for an ice cream. […] A further criticism in this vein was that the mother had failed to arrange for L’s hair to be cut in the way that he liked.”

There is also a detailed section on attachment theory:

“… the theory is only a theory. It might be regarded as a statement of the obvious, namely that primate infants develop attachments to familiar caregivers as a result of evolutionary pressures, since attachment behaviour would facilitate the infant’s survival in the face of dangers such as predation or exposure to the elements. Certainly, this was the view of John Bowlby, the psychologist, psychiatrist, and psychoanalyst and originator of the theory in the 1960s. It might be thought to be obvious that the better the quality of the care given by the primary caregiver the better the chance of the recipient of that care forming stable relationships later in life. However, it must also be recognised that some people who have received highly abusive care in childhood have developed into completely well-adjusted adults. Further, the central premise of the theory – that quality attachments depend on quality care from a primary caregiver – begins to fall down when you consider that plenty of children are brought up collectively (whether in a boarding school, a kibbutz or a village in Africa) and yet develop into perfectly normal and well-adjusted adults.”

Much to discuss!

On evidence in psychological therapy

It sometimes feels that the demand for evidence for psychological therapies is seen as offensive. How dare researchers, commissioners, and policymakers reduce therapeutic relationships to tickbox questionnaires and symptom reduction! Therapy is something larger, broader, more holistic than that.

There are clearly problems with using short questionnaires consisting of a handful of closed-questions, and then summing these to a distress score before and after care. But the other extreme, trusting the professionals who are paid to provide therapy to say how effective their therapy is, doesn’t sound convincing either – especially for therapists in private practice who charge by the session. If a therapist depends on long-term therapy for their income, it might be challenging for them to think through different perspectives on how helpful their brand of therapy actually is.

Improving Access to Psychological Therapy (IAPT) is criticised for being heavily manualised, too brief, and offering only a narrow range of therapeutic approaches. However, perhaps IAPT is helpful for some people; for instance people experiencing panic attacks triggered by certain situations or specific phobia, in the context of an otherwise typically but not unusually bumpy life. The research evidence and testimony seems to lend support to this.

I am particularly suspicious of wealthy “woke” psychoanalysts arguing passionately for their Freudian or Lacanian approach. People can need long-term – in some cases life-long – and frequent support, especially for conditions and predicaments which have complex causes and in the context of brutal cuts to social security (welfare “benefits”). It is not obvious that this support needs to be steeped in psychoanalytic jargon.

Having someone there who is kind, listens, and is trustworthy might make all the difference to someone’s quality of life and ability to survive a harsh world. There is no need to run a multi-million pound clinical study to demonstrate the efficacy of kindness. However, therapeutic relationships need to foreground honesty concerning their limits. A paid professional who is there for us each week is not the same as a friend, and that needs to be clear before a relationship begins.

How to find money to save the NHS

This morning was the launch of the Resolution Foundation report, Healthy finances? Options for funding an NHS spending increase – a response to the rumoured government “birthday present” for the NHS as it turns 70 on 5 July 2018.

The audience included party advisers (I spotted a Whatsapp group chat for a party’s comms team), people from various think-tanks, academics (including an Emeritus Professor from Imperial who had a lot to say), and a representative from at least one (non-militant, at least in the room) campaigning group.

The line up:

  • Sarah Wollaston MP, Chair of the Health Select Committee and medic who worked as a GP up until 2010. (Given her generally sensible views, I keep having to remind myself that she’s a Tory).
  • Jon Ashworth MP, Shadow Secretary of State for Health, who has a long history as a Labour professional, including as Special Adviser in the Treasury for Gordon Brown.
  • Ben Page, Chief Executive of Ipsos MORI and fellow of the Academy of Social Sciences.
  • Matt Whittaker, Deputy Director at the Resolution Foundation, who previously worked for the House of Commons Library where he provided stats and economics advice.

The event was chaired by Torsten Bell, Director of the Resolution Foundation, former adviser to Ed Miliband (and, incidentally, architect of the Ed Stone).

Interlude: What is the Resolution Foundation?

The launch was set at Resolution HQ in a bright, wide room, with cosy luxurious seats which wouldn’t be out of place in an up-market indie cinema, so I was curious who they are and how it’s all funded.

Resolution Foundation’s website describes it as “a non-partisan and award-winning think-tank that works to improve the living standards of those in Britain on low to middle incomes.” In their most recent annual report, they defined “low to middle” as those in income deciles 2 to 5, whom they say are overlooked in policy debates. Their focus is on working households.

They receive most of their funding via donations from Resolution Trust, founded by Clive Cowdery with a £50m donation, “believed to be one of the largest endowments for public policy research made in the UK”.

Cowdery made his wealth from “sponsoring insurance vehicles” (an FT article says more) and is also founder of financial services investment firm called (again) Resolution.

Resolution Trust backs Prospect Magazine and, intriguingly, WorkerTech, which seems to be about encouraging alternatives to trade unions for the precarious world of Uberified work. (Here are slides from its launch.)

What did they say on health funding?

All agreed that the NHS needs more funding, so the question is how much more funding and where the money is coming from. The issue was framed as a tug-of-war between Treasury and Jeremy Hunt (with Hunt wanting more money, in case not clear – it’s not always obvious), constrained by a complex parliament and a wish to keep voters happy.

Matt Whitaker took us through some headlines from the Resolution report, emphasising that it was a prediction of what the government was likely to announce rather than what it should do. (Though it sounded very much like advice.)

Borrowing was seen as likely necessary, so long as the total was below 2% of the projected GDP in 2020-21 (to meet a Tory fiscal target). But borrowing alone would not suffice, so some sort of tax raise is almost certainly on the cards – the problem is how to keep keep Tory voters and donors on side, whilst getting it through parliament.

One possibility is increasing National Insurance contributions (or NICs, pronounced “nicks”), which Gordon Brown did when he was chancellor. This is a progressive tax for workers; however, increased NICs was seen by the report authors as “unfair from a generational perspective” since older people who rely more on healthcare don’t pay national insurance (this generational perspective might need some analysis). A solution proposed was to extend NICs to include those above state pension age who are still working.

Increasing income tax could be another way to get the money. LibDems and SNP might support this, and Scotland recently introduced a change to its tax bands meaning some pay more and others pay less tax. Labour, the authors argue, would likely oppose increases for anyone earning under £80k and some Tory MPs might oppose too.

Another approach suggested was to adjust thresholds for (i) when income tax is payable and (ii) the higher rate of payment. Threshold changes were Tory manifesto promises, but the authors suggest a fiddle (p. 24):

“An alternative approach would be to lift the Income Tax thresholds to those pledged in the manifesto in 2020-21, but to freeze both them and the NICs thresholds in the final two years of the parliament. This would of course cost money in 2020-21, but by 2022-23 it would raise £3.7 billion relative to the default of uprating in line with inflation every year.”

Another promising source of funding would come from reversing George Osborne’s 2016 pledge to cut corporation tax by 2020. This tax uncut could provide £5.2 billion in 2020-21 and £5.7 billion by 2022-23. Other political parties would likely support the move and the authors argue (p. 27):

“The Chancellor might also feel emboldened to act given the way in which the estimated costings of the move from 19 per cent to 17 per cent have shifted since George Osborne first announced it.”

Remarkably little was said about Brexit. Will it torpedo all the projections and render the suggestions (sorry, predictions?) unimplementable? The exception was Sarah Wollaston, who noted that she never believed the infamous £350m bus claim; she expressed reasonable worries about the effects Brexit would have.

What might more money mean for mental health?

Although the focus was very much top-level – where’s the money? – speakers did say a little about how it should be spent. For instance, Jon Ashworth quoted numbers on additional doctors and nurses required (it’s thousands), citing a report from IFS – also cited by Sarah Wollaston.

Reassuringly, mental healthcare was mentioned a few times as being important and in need of improvement (though note the history of “warm words”). Ben Page cited public support for increased spending, with mental health being second on the list in an April Ipsos MORI survey of priorities, after Accident and Emergency. Jon Ashworth mentioned improving support for addictions, in particular.

Sarah Wollaston cited the Health and Social Care Committee’s report into integrated care, published yesterday, which discusses detailed contractual changes needed to improve how, e.g., mental healthcare integrates with other services, including discussion of accountable care organisations (ACOs). (Perusing this report just now highlights how difficult it is to have public debates on these issues – it’s technical stuff.)

The coming weeks as we approach July 5th would be a good time to campaign for key specifics on how much money mental healthcare should receive and what it should be spent on. If the NHS received £20 billion more in 2022-23, how much should go to mental health and where?