The Complex Process of Profiling & Diagnosing Autism

According to the NHS (2019), ‘being autistic does not mean you have an illness or disease. It means your brain works in a different way from other people’. The core characteristics of autism are: (1) poor social communication; (2) poor social interaction; (3) sensory processing differences; (4) sensory sensitivity; (5) repetitive behaviours; and (6) obsessions and fixations on special interests. These characteristics can vary, and some individuals show two or three, whilst others might be more severely affected (Lincoln College, 2022). This blog post will explore these core characteristics, the unofficial subtypes of autism, and the complex process of diagnosis.

Individuals experiencing the behavioural abnormalities, will show a fixation on specific activities, tools, toys, etc. They may use these objects in particular ways. Furthermore, they may engage in repetitive behaviours such as hand flapping or spinning around, might become upset if their routine is disrupted, and will insist on maintaining consistency. Moreover, they might have unusual sensory interests, either a high or low tolerance to pain, unpredictable verbal outbursts, and might become upset at sensory intrusions. Finally, they might also engage in risky or self-injurious behaviour. 

Individuals experiencing communication difficulties might have a delayed language development, speech difficulties and/or reliance on alternative communication methods, high levels of articulation, literal interpretation of words (i.e. lack of understanding of jokes or sarcasm), problems starting and maintaining conversations, stereotyped and repetitive use of phrases, a monotonous voice tone, and poor interpretation of body language or other forms of non-verbal communication. 

Individuals experiencing social difficulties might struggle to form and sustain friendships, might show a lack of interest in social activities, might engage in inappropriate social responses, might have a lack of awareness of boundaries, might reject expressions of affection such as hugging, might prefer to role play,  and might be naive, suggestible and overly trusty of others. 

The Unofficial Subtypes of Autism

Due to current diagnostic manuals such as the DSM-V (American Psychiatric Association, 2013) and ICD-11 (World Health Organisation, 2019), individuals are generally given a diagnosis of Autism Spectrum Disorder (ASD) regardless of their profiles. Yet, there are unofficial categories used by the autistic community to understand differences better.

Individuals categorised as having Asperger’s syndrome tend to have a higher than average I.Q., and unlike other forms of autism, no speech or cognitive difficulties. However, interpersonal difficulties are prevalent for them, as they struggle to communicate and interact with others. Yet, the symptoms are invisible and difficult to spot. They may also have pathologies which affect their day to day life (Lincoln College, 2022). Asperger’s syndrome is no longer diagnosed (McCrimmon, 2018) but it is still generally seen as a subtype of autism. It is also believed that Asperger’s syndrome is a form of high-functioning autism (HFA) which according to Lincoln College (2022) entails a delay in development, an inability to read facial expressions, a hypersensitivity to light and noise, and a desire for socialisation without understanding how to effectively do it. Nevertheless, HFA is not diagnosable, although it is also recognised by autistic populations. 

Individuals categorised as having Pathological Demand Avoidance (PDA) tend to have intersubjective difficulties and to avoid the demands of everyday life. This profile is not an universally recognised form of autism by healthcare professionals, however, it is still generally used by autistic populations. According to the National Autistic Society (n.d.), an individual with this profile ‘(a) resists and avoids the ordinary demands of life; (b) uses social strategies as part of avoidance, for example, distracting, giving excuses; (c) appears sociable, but lacks some understanding; (d) experiences excessive mood swings and impulsivity; (e) appears comfortable in role play and pretence; and (f) displays obsessive behaviour that is often focused on other people’. Furthermore, Lincoln College (2022) states that these individuals have an anxiety-based desire to remain in control all the time, and can become aggressive if they feel they are not in control. They also seem to get stressed out if anything is expected of them. However, if they feel comfortable, they seem normal. 

Individuals labelled as having Kanner’s Autism also known as ‘Classic Autism’ are described as having impairments in communication, and a fixation on activities with restrictive or repetitive behaviour such as hand flapping. The criteria for this autism profile is: (1) an impairment in the use of non-verbal skills, poor eye contact, and an inability to interpret body language; (2) inability to make and maintain friendships; (3) inability to enjoy interests or share activities; (4) inability to respond appropriately to emotion in others; (5) delay in, or complete lack of language development; (6) repetitive use of language; (7) fixation on a particular interest; (8) inflexibility to change routines; and (9) repetitive physical movements (Lincoln College, 2022). However, this is not diagnosable. 

Individuals diagnosed as having atypical autism are those whose pattern of behaviour fits most but not all of the criteria for other forms of autism. It can often be undiagnosed for many years as individuals tend to be given this label later in life. 

Finally, individuals categorised as having Savant syndrome have skills which are uncommon to most people, as well as having the general characteristics of autism. Among the extraordinary abilities seen in savant autism are being able to mentally solve complex mathematical problems, having great memory for specific details of something, high quality artistic skills, and outstanding musical talent. 

Diagnosing Autism

The advantage  of diagnosing Autistic Spectrum Disorder (ASD) is that individuals and their families can find as much information as possible about the condition and engage in psychoeducation, which can foster a sense of relief. The diagnosis might help the individuals have more clarity about their difficulties, and might give them more insight into potential comorbidities or wrong diagnoses. Moreover, a personalised care plan with strategies can be devised for ongoing support in all sectors. Nevertheless, a disadvantage of diagnosis is that individuals have to live with the stigma (i.e. negative stereotyping) associated with psychiatric labels, and how the label can affect their relationships and lead to prejudice and discrimination. Furthermore, another disadvantage is that individuals might become depressed with the fact that autism has no cure. They might also experience more adverse circumstances as a result of having a diagnosed disability, and all these negative variables might lead the individual to internalise the label and to embrace the maladaptive behaviours associated with the label which shapes their identity (Lincoln College, 2022). 

Diagnosis is usually done through a person’s GP; however, a paediatrician, a speech and language therapist, an educational psychologist, and/or a specialist psychologist might also need to be involved; and sometimes this multidisciplinary approach can take years before a diagnosis is given (Lincoln College, 2022). Moreover, information for diagnosis is also gathered from relatives, teachers and friends of the individual presenting with symptoms. The individual might be observed as he or she conducts activities and skills might be tested. Furthermore, professionals working with people with autism must take on board the National Institute for Health and Care Excellence (NICE; n.d.) guidelines. These specifically state that anyone working with autism should be skilled and competent and have tactful communication skills (Lincoln College, 2022). 

There are several factors that influence the diagnosis of autism: (1) culture— behaviours classed as ‘abnormal’ by a society might bring attention and concern to others. Some countries might perceive different behaviours as ‘symptomatic’, whilst others might see the same behaviours as completely ‘normal’. Also, stigma might become a barrier to diagnosis; (2) age— even though the symptoms of autism can be spotted when the individual is 2-3 years old, many professionals refuse to make a diagnosis until later on. However, some professionals are also reluctant to diagnose adults; (3) sex— males tend to get a diagnosis of autism more than females. Some believe that this is due to how different the characteristics manifest, with girls being more able to hide the symptoms; (4) parental attitudes— some children might not get diagnosed because their parents cannot effectively spot the symptoms, or they might ignore these manifestations out of fear of being judged. Alternatively, parents might insist to the family GP that the child has a problem even if such is not the case; (5) coexisting conditions— autism often has mental and physical comorbidities, making it more difficult to pinpoint the exact cause for specific behaviours, and making diagnosis more complicated; and (6) genetic factors— autism has a genetic link that runs in families. 

Furthermore, there are also barriers to diagnosing autism such as a lack of local services for autistic people, which means that a formal diagnosis with the necessary multidisciplinary specialists is not always possible as a GP might have limited knowledge of the condition. This might subsequently lead to individuals not being diagnosed for a long time, which might prevent them from wanting a diagnosis in the future. It can also lead to individuals not having a documented developmental history, which can affect the process of diagnosis.  Moreover, another barrier to diagnosing autism is how subtle some of the symptoms can be, and how subjective the interpretation of these symptoms also is (Lincoln College, 2022).  

References

American Psychiatric Association (2013a) Diagnostic Statistical Manual of Mental Disorders, 5th ed.

Lincoln College (2022) ‘The diagnosis and characteristics of autism’, TQUK Level 3 Certificate in Understanding Autism [Online]. Available at https://lincolncollege.equal-online.com/courseplayer/autisml3/?ls=8663048&cpid=223390  (accessed 22 February 2022). 

McCrimmon, A. (2018 ‘What happened to Asperger’s syndrome?’, The Conversation, 8 March [Online]. Available at https://theconversation.com/what-happened-to-aspergers-syndrome-89836 (accessed 22 February 2022). 

National Autistic Society (n.d.) ‘PDA — a guide for parents and carers’ [Online]. Available at https://www.autism.org.uk/advice-and-guidance/topics/diagnosis/pda/parents-and-carers (accessed 22 February 2022). 

National Institute for Health and Care Excellence (n.d.) ‘Autism’ [Online]. Available at https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions/autism (accessed 23 February 2022). 

NHS (2019) ‘What is autism?’, 18 April [Online]. Available at https://www.nhs.uk/conditions/autism/what-is-autism/ (accessed 10 March 2022). 

World Health Organisation (2019) ‘International Classification of Diseases – 11th Revision’ [Online]. Available at https://icd.who.int/en (accessed 22 February 2022). 

Photo by Polina Kovaleva

The Health Impacts of Domestic Abuse

Domestic abuse takes a toll on victims, and they experience all sorts of maladies as a result of the abuse they were put through, both in the short term and in the long term. This blog post will inform the reader about the health impacts that domestic abuse can have on adults and children. 

Impacts on Adults

Individuals affected by domestic abuse often present with depression, and are more susceptible to suicidal ideation, post-traumatic stress disorder (PTSD), other stress and anxiety disorders, insomnia, and eating disorders. They also have low self-esteem and confidence levels. Furthermore, domestic abuse can change the victim’s behavioural temperament permanently, especially when the victim is a child. Research shows that when children are abused, as early as adolescence they can engage in hypersexual, promiscuous, or disinhibited behaviours, as well as risky behaviours such as using illicit drugs, drinking heavily, and/or smoking. 

Moreover, women who were sexually abused as children find it particularly difficult to connect in appropriate or safe ways, and are more prone to allowing abusive relationships to enter their lives. It is believed that this happens because these traumatised women cannot distinguish between men who show affection, and men who make sexual advances. For instance, they may think that expressions of affection or support are sexual advances and might respond sexually, and/or might think that expressions of sexual desire are ‘love’ and respond romantically.  What this tells us is that individuals already affected by mental health problems as a result of their traumas are more vulnerable to being domestically abused, and likewise those experiencing domestic abuse are more likely to get mental health problems. 

Domestic abuse can cause physical illness whether as a result of actual bodily harm (ABH), the stress associated with the abuse, and/or risky behaviours. ABH includes cuts, bruises, burns, bites, broken bones or teeth, as well as severe head injuries and damage to the eyes, ears, chest and abdomen. All these forms of ABH can consequently lead to long-term illness, disability, and/or death. If the victim is pregnant, domestic abuse can trigger a miscarriage or harm the fetus. Furthermore, sexual abuse can damage the genital, pelvic, and urinary areas whether through brute force or the transmission of infections. Risky behaviour can also lead to sexually transmitted diseases, self-injury, as well as other health problems associated with substance abuse. 

Physical symptoms worsen mental health problems, and mental health problems also worsen physical symptoms. This is why people who already have disabilities-especially women- are more likely to be abused than non-disabled individuals due to their vulnerability regardless of whether the disability is motor, mental, or intellectual (SafeLives, n.d.). Perpetrators see vulnerability as an opportunity, and seek to exploit this deliberately. 

All this is without mentioning yet the health impacts of female genital mutilation (FGM) which are devastating. Not only can FGM lead to all of the above mental health symptoms, it can also lead to tremendous physical impairments such as severe and long-term pain, infections, difficulty in walking or having sex; bleeding, cysts and abscesses from the wounds; difficulty urinating or experiencing incontinence, life-threatening complications during pregnancy and childbirth, infertility, and/or death. 

Impacts on Children

Children are very vulnerable to distress, and this is why experiencing and/or witnessing domestic abuse can be severely traumatising for them. They might develop symptoms of anxiety and depression, have nightmares or intrusive flashbacks, clinical fear, behaviour that challenges, regression, aggression, withdrawal or lack of engagement, low self-esteem, self-harm, suicidal ideation, risky behaviours, and eating disorders. Indeed, when children are made to feel scared, confused and powerless; this can be introjected and a reaction formation can happen leading children to behave in similar ways to the perpetrator. 

Children also experience physical symptoms when they have been exposed to domestic abuse. They might experience similar symptoms to adults such as injuries that can cause concussion or brain damage. They undergo epigenetic changes with every adverse experience, and they might become neglected, underfed, and unwashed if they are in an abusive environment. Moreover, they may present with bed-wetting difficulties, stomach and headaches, and a disrupted circadian rhythm. They might also present with self-injury, or injury obtained through risky behaviours.  

Finally, children go through very intense transitions after domestic abuse has been exposed. They might have to move home, and away from friends. They might also experience a disruption to their education. They might develop an attachment trauma after they lose the abusive family member who they might not have perceived as abusive. They might find the conviction of the abusive relative traumatic. They may experience a change in quality of life, and in the worst case scenarios they might be separated from their parents and placed in foster care. All these factors increase the chances of developing health problems. 

References

SafeLives (n.d.) ‘Spotlight #2: Disabled people and domestic abuse’ [Online]. Available at https://safelives.org.uk/knowledge-hub/spotlights/spotlight-2-disabled-people-and-domestic-abuse (accessed 21 February 2022). 

Acquired Traumatic & Traumatised Narcissism

Adults who experienced domestic abuse when they were children have more potential to suffer from long-term health impacts such as diabetes, obesity, and heart disease. They might also experience mental health problems which involve low levels of resilience, and higher levels of anxiety and depression, among other health complications. Those who endured severe physical violence as children at times carry their injuries into adulthood in the form of disabilities; intellectual, social, and emotional difficulties can arise, and individuals might perform poorly occupationally as a result of the abuse they’ve been through. Furthermore, their perceptions of a ‘normal’ relationship can also be affected (e.g. women who cannot differentiate between affection and a sexual advance), and the traumas can also lead to shallow object relations, where those who survived are unable to form a meaningful connection with others. Yet, the most concerning aspect of childhood domestic abuse is that in some cases these children can grow to imitate the behaviour of their perpetrators and subjugate others. This is what acquired narcissism is, a relational system where the person exposed to domestic abuse goes on to introject such patterns of behaviours and to abuse other innocent victims, displacing the trauma. This article will focus on this potential consequence of domestic abuse, and what happens when a victim becomes a perpetrator drawing from Shaw (2014).

Some narcissists are born with this predisposition (e.g. psychopaths), whilst others acquire the predisposition through trauma (e.g. sociopaths), getting absorbed in a generational and social cycle of abuse. This is how acquired narcissism works. That is, the individual is not born with it, but rather he acquires it through adverse experiences. Shaw (2014) defined traumatic narcissism as ‘the action of subjugation. In the traumatizing narcissist’s relational system, the narcissist fortifies himself by diminishing the other. The other is then conquered, controlled, or enslaved at worst—and exploited’. In other words, traumatic narcissism can be described as the narcissism that can consciously traumatise other people through behaviours. Similarly, traumatised narcissism happens when someone who has already been narcissistically abused, unconsciously behaves in ways that resemble their perpetrator. Traumatised narcissism— which is also traumatising— can be acquired in adulthood, is often temporary, and recovery depends on the individual’s ability to heal trauma; whereas traumatic narcissism as described by Shaw (2014) is acquired through childhood trauma, is often long-term and constitutes a pathology that is consistent with an individual’s personality and trajectory. Moreover, in some cases victims of narcissistic abuse go on to become traumatised narcissists. In rare cases, adults go on to become traumatic narcissists; especially when they are subjected to adverse epigenetic changes or traumatic brain injury resulting from their circumstances.

For those with acquired traumatic narcissism, narcissistic trauma is often relational or developmental, and relational trauma happens when there is a constant disruption of a child’s sense of feeling loved and safe (Monroe, 2017). There might be a form of physical or emotional neglect and abandonment, a violation of boundaries, and/or abuse. In other words, relational trauma happens when a child’s needs are not met by their caregivers, and where the child ends up feeling betrayed by their parents. All this can affect a child epigenetically, and alter their biological make-up in the long-term. For instance, Shaw (2014, pp. 7-8) states: ‘these people typically experience significant depressive symptoms, which are actually post-traumatic symptoms of cumulative developmental, or relational, trauma—symptoms that are often expressed in the form of painful lifelong longing for love that can never be requited. In development, to be recognized primarily as object—in other words, to be rigidly objectified—is to be cumulatively traumatized in one’s efforts to consolidate the sense of subjectivity’. 

Furthermore, the American Psychological Association (n.d.) defines subjectivity as ‘the tendency to interpret data or make judgements in the light of personal feelings, beliefs, or experiences’. Stripping someone off their subjective can lead to problems with intersubjectivity, which Oxford Reference (n.d.) describes as ‘the mutual construction of relationships through shared subjectivity’. Indeed, those with acquired narcissism struggle to maintain stable relationships with others precisely because of their many relational traumas. According to Shaw (2014, p. xv) ‘the traumatizing narcissist seeks to abolish intersubjectivity, and to freeze a complementary dynamic in the relationship, allowing recognition in one direction only—toward himself’.

This is why narcissists are extremely talented at hiding and protecting their vulnerabilities always wary of the world around them, a world that betrayed their trust. They seek to impress others through what seems like a normal demeanour. Yet, covertly, a narcissist will display the following behaviours: 

  1. Passive aggression: they may say things that are not directly offensive but that are still hurtful. 
  2. Introversion: they might be more reclusive but still need narcissistic supply from others. 
  3. Sulky behaviours: they may act in sullen ways when they do not get their way. 
  4. Constant dissatisfaction: they chronically blame the world for their circumstances, and constantly complain. 
  5. Grandiosity: they secretly think they are superior to others, and will only associate with those they deem to be superior. 
  6. Sense of entitlement: they always want to take what they desire, often crossing boundaries. 
  7. Playing as the victim: they always say that the world is doing something to them, and do not take responsibility for the harm they cause. 
  8. Hypersensitivity to criticism: they might rage if criticised and might feel hurt at the slightest comment. 

Morever, Shaw (2014, p. 13) states that ‘the heightened sadistic tendencies of the traumatizing narcissist may be masked in some cases by charisma and seductive charm. She has successfully dissociated the need to depend on idealized others by achieving a complete super-idealization of herself. She is overt in her need for superiority and domination, successful in seducing others into dependence on her, and cruel and exploitative as she arranges to keep the other in a subjugated position’. A common misconception is to think that the narcissist’s grandiose overcompensation is somewhat rooted in high self-esteem. I would argue it is more rooted in egocentrism. The truth is that narcissists are hypersensitive to their own impression management. That is, the facade they show to the world is their vulnerability because deep down they do not love who they are. Overtly, the malignant narcissist will exhibit the following behaviours:

  1. Pathological jealousy: they may experience feelings of envy and anger at the slightest disadvantage.
  2. Psychopathic behaviours: callous, cold-blooded, and instrumental harmful actions.
  3. Persecutory delusions: excessive paranoia based on false beliefs that the world is out to get them.
  4. Cruelty: having no remorse for engaging in sadistic behaviours.
  5. Coercive control: manipulating, threatening or controlling the victim.
  6. Pathological lying: not being able to tell the truth.
  7. Distress-based responses: things that hurt his self-esteem or self-image might trigger his dangerous behaviours.
  8. Sexual promiscuity: having more than one sexual partner.
  9. Hypersensitivity to criticism: always on guard for real or imagined criticism.
  10. Aggression: an inability for self-restraint when raging.

The individual with acquired narcissism is essentially looking for the love that he or she did not receive in childhood. According to Shaw (2014, p. 10) ‘patients described as pathologically narcissistic are often those whose self-esteem is terribly fragile; who easily feel insulted, attacked, and humiliated […] someone who in development has suffered severe damage to their self-esteem system, and whose self-esteem regulation is therefore inconsistent and precarious, subject to the internal persecution of the split-off protector self’. Furthermore, according to Mahendran (2015, p. 179) there are five main cognitive biases used by narcissists in order to maintain their self-esteem: (1) misremembering, which is a particular way in which people tend to remember past events in ways that are self-serving; (2) self-serving attribution, which consists in attributing blame to external events for failures, and attributing credit to the self for successes; (3) false consensus effect, which consists in assuming that other people will make the same choices one does, and behave in similar ways to one; (4) sour grapes effect, which consists in devaluing unattainable goals and rewards; and (5) unrealistic optimism which consists in attributing a positive expectation or outcome to something, even if the evidence and standards contradict it. 

In conclusion, acquired narcissism can be severely detrimental and is often a result of domestic abuse. Acquired narcissism can be conscious or unconscious, temporary (traumatised narcissism) or long-term (traumatic narcissism), and has many biases reinforcing an unstable sense of image.

References

American Psychological Association (n.d.) ‘Subjectivity’, APA Dictionary of Psychology [Online]. Available at https://dictionary.apa.org/subjectivity (accessed 17 December 2021). 

Mahendran, K. (2015) ‘Self-esteem’, in Turner, J., Hewson, C., Mahendran, K. and Stevens, P. (eds) Living Psychology: From the Everyday to the Extraordinary 1, Milton Keynes, The Open University. 

Monroe, H. S. (2017) ‘How Relational Trauma Affects Teen Mental Health, Relationships, and Self-Esteem’, Newport Academy, 1 September [Online]. Available at https://www.newportacademy.com/resources/mental-health/relational-trauma/ (accessed 16 December 2021). 

Oxford Reference (n.d.) ‘Intersubjectivity’ [Online]. Available at https://www.oxfordreference.com/view/10.1093/oi/authority.20110803100008603 (accessed 16 December 2021). 

Shaw, D. (2014), Traumatic Narcissism: Relational Systems of Subjugation, New York, Routledge [Online]. Available at https://www.routledge.com/Traumatic-Narcissism-Relational-Systems-of-Subjugation/Shaw/p/book/9780415510257# (accessed 16 December, 2021). 

Domestic Abuse: Situational Factors

The following common situational factors tend to contribute to the risk of domestic abuse, and tend to be elements that victims report. Some of these aspects, we already have talked about in this blog

  • When individuals are experiencing the close monitoring that comes with coercive control, there is a higher likelihood of other forms of domestic abuse occurring such as physical and economic abuse. 
  • When individuals experience adverse family circumstances where elements of financial problems, unemployment, alcohol or substance use disorder are present, there is a higher likelihood of domestic abuse occurring. 
  • When individuals are connected to adverse cultural traditions such as female genital mutilation (FGM), forced marriage, or honour-based abuse; there is a higher likelihood for other forms of domestic abuse to take place. The more patriarchal the culture, the more risks there are. 
  • When individuals are connected to adverse community circumstances such as community aggression, violence, fear of others, a distrust of authority figures (e.g. police), poor housing, low socio-economic status, low education levels, and poor access to support services and facilities; there is a higher likelihood of domestic abuse occurring and individuals might have no option to turn to in the case of domestic abuse taking place.  
  • When there are individuals who are traumatised and display behaviour that challenges such as risky behaviour, this might lead to an escalation of domestic abuse at home and other interpersonal conflict. Sadly, the risk is also increased by these situational factors.
  • When there are people who have financial constraints, they are more likely to stay stuck in an abusive environment or relationship, and more likely to depend on a perpetrator. Therefore, financial problems increase the likelihood of domestic abuse occurring. 
  • When there are individuals who are isolated from their social networks, they become more vulnerable, suggestible, and the risk of domestic abuse increases. 

DID YOU KNOW? 

When a perpetrator has a history of being domestically abusive, sadistic, and/or controlling; there is a potential for recidivism to occur. This is why since 2014, victims have a right to make a request to the police for a disclosure of any history of domestic abuse from their partner. This is to prevent the perpetrator from reoffending by giving potential victims a heads up about what could happen in their relationship, as it is known that perpetrators of domestic violence rarely change. According to the Home Office (2022), ‘The Domestic Violence Disclosure Scheme (DVDS), also known as “Clare’s Law” enables the police to disclose information to a victim or potential victim of domestic abuse about their partner’s or ex-partner’s previous abusive or violent offending’. This was implemented in 2014 across all police forces in England and Wales after 36 year old Clare Wood was murdered in 2009 (BBC News, 2014). Clare was strangled and set on fire by her obsessive exboyfriend George Appleton at Salford, and it was concluded that she received no support from the local authorities even though George had a history of violence against women (VAW; BBC News, 2011). 

References

BBC News (2011) ‘Salford murder victim Clare Wood “was not protected”’, 23 May [Online]. Available at https://www.bbc.co.uk/news/uk-england-manchester-13506721 (accessed 17 February 2022). 

BBC News (2014) ‘“Clare’s Law” introduced to tackle domestic violence’, 8 March [Online]. Available at https://www.bbc.co.uk/news/uk-politics-26488011 (accessed 17 February 2022). 

Home Office (2022) ‘Domestic Violence Disclosure Scheme Factsheet’, GOV.UK, 31 January [Online]. Available at https://www.gov.uk/government/publications/domestic-abuse-bill-2020-factsheets/domestic-violence-disclosure-scheme-factsheet (accessed 17 February 2022). 

The Controversial History of Autism

According to Lincoln College (2022), autism as a word was first used to describe those who suffered from schizophrenia and who were also ‘withdrawn and self-absorbed’. In 1943, the word was first used to describe a condition of its own and individuals seemed perplexing to clinicians and were scrutinised heavily (Kanner, 1943); followed by the creation of Asperger’s disease in 1944. Later in the 1950s, it was believed that autism was a result of developmental trauma, and mothers of autistic children were heavily criticised as ‘refrigerator mothers’, indicating that they had no emotional warmth. 

Eventually, during the 60s and 70s there were changes initiated by parents coming together (and forming the National Autistic Society), and by scientists recognising the disease as biological. This recognition led to segregation schools being implemented for autistic children before a genetic link was discovered in 1974. Yet, it was not until 1979 that a psychological model called ‘the triad of impairments’ was proposed which highlighted difficulties in social interaction, communication, and imagination skills. Then, in 1980 the DSM first recognised Autism Spectrum Disorder,  and in 1989 the diagnostic criteria for Aspergers was created before being recognised in 1994. From there on there were national scientific and governmental initiatives to improve practice on understanding and working with autism. Finally, since 2009 World Autism Day has been celebrated. 

Currently, there are still people who think that autism happens only to children, or that it is not a disability. Furthermore, only a minority of people understand that autism has no cure. This shows that even though there have been a lot of developments in the history of autism, many misconceptions still persist. 

Theories

Initially, it was believed that autism was a form of schizophrenia. Furthermore, the way clinicians used to relate to autistic individuals was very derogatory and subjugating throughout history. Individuals with autism were labelled as ‘mentally retarded’, ‘idiotic’, ‘feeble-minded’, ‘slow or backwards’, or ‘autistic schizoid’ (Lincoln College, 2022). Now individuals are known to have a neurodevelopmental condition which they live with, and which has unique individual needs and no cure. Moreover, autism was considered to be a matter of moral degeneration until the genetic link was discovered and its biological construct was explored. 

Kanner (1943) cited in Lincoln College (2022) was the first to propose that autism was a condition of itself and that it was not schizophrenia. This was a major breakthrough. Later on, Aspergers (1944) cited in Lincoln College (2022) proposed that ‘autistic psychopathy’ was the cluster of symptoms now known as ‘Asperger’s syndrome’. He believed that these individuals could not change because autism had no cure. He identified symptoms such as ‘lack of empathy’, and poor ability to make friends, among others. This was another breakthrough. However, autism is not the same as psychopathy, and this should be emphasised. 

Moreover, Lincoln College (2022) also states that Wing’s and Gould’s (1979) theory was the first one to mention Aspergers syndrome in a research paper challenging Kanner’s theory and they introduced the model of the ‘triad of impairments’  (social interaction, communication, and imagination). Furthermore, Baron-Cohen et al. (1980) proposed the theory of mind (ToM) theory indicating that individuals with autism struggled to understand the mental states of others. It was stated that this impairment affected most or all aspects of the individual’s life. 

Another theory was the ‘extreme male brain theory’  which states that autistic individuals have been exposed to higher levels of testosterone than the average population. This might explain why most autistic individuals are male. Furthermore, Baron-Cohen also proposed the ‘empathising-systemising theory’ which states that autistic individuals can only be empathic by imitating the behaviours of others without really understanding the subjective states of mind of others. This is because autistic individuals are more systematic than empathetic and adapt based on organisational, structural, normative, and routine schemas. This might explain why these individuals have interpersonal difficulties. Finally, the ‘autism spectrum  condition’ theory states that individuals with autism have a life-long condition which can vary based on where they are in the spectrum which can range from interpersonal difficulties to verbal communication difficulties (Lincoln College, 2022). 

Treatments & Interventions

Electroshock therapy was often used to treat autism in the past and treatments heavily relied on the use of medication. Autistic individuals were placed in asylums and separated from their families during treatment even though a cure does not exist. Nowadays, treatment takes place in the community most of the time, medication is only used where necessary,  and psychotherapy is offered in order to help build coping and distress tolerance skills. Furthermore, in the past autistic individuals were segregated from society and placed in special schools. This is now known to have detrimental effects. Hence why nowadays autistic individuals are integrated into mainstream schools with extra support for their needs.  Finally, in the past autistic individuals had little or no autonomy and were passive receivers of interventions; whereas now person-centred approaches are the norm, and individuals are encouraged to be autonomous and to live meaningful lives (Lincoln College, 2022) even though the mental health industry still has a lot to improve when it comes to co-production of care plans in general. 

Furthermore, Lincoln College (2022) states that in the past autism was treated with medication on a trial and error basis, sometimes having dangerous and now-illicit substances administered such as LSD. Of course, this was harmful. Moreover, aversion therapy was used to operationally condition unwanted responses using punishment as the reinforcing method. Individuals were slapped on the wrist, splashed with cold water, and given electric shocks every time they displayed unwanted behaviours. This was done with the intention of extinguishing such behaviours, and was inhumane. Nowadays, this would be classed as unethical and degrading. 

Needless to say, in the past individuals were excessively put through electro-convulsive therapies which consisted of electrocuting the individual’s head in order to forcefully and drastically alter the biological make-up of the brain. This practice is known to induce seizures,  memory loss, and other effects. Sadly, this type of torture is still used as treatment in many countries, including the UK. There are several human rights movements such as the Citizens Commission on Human Rights (n.d.) which have made documentaries advocating against this form of therapy due to its many harmful effects. However, among the positive services offered to autistic individuals nowadays are community care (i.e. ensuring individuals are not hospitalised), speech and language therapy, occupational therapy, family therapy, behavioural therapy, medication, parent education, psychosocial treatments, and counselling (Lincoln College, 2022). 

References

Citizens Commission on Human Rights (n.d.) ‘Therapy or Torture? The Truth About Electroshock [Online]. Available at https://www.cchr.org/ban-ect/watch/therapy-or-torture-the-truth-about-electroshock.html (accessed 22 February 2022). 

Kanner, L. (1943) ‘Autistic Disturbances of Affective Contact’, Pathology [Online]. Available at https://neurodiversity.com/library_kanner_1943.pdf (accessed 22 February 2022). 

Lincoln College (2022) ‘The historical context of autism’, TQUK Level 3 Certificate in Understanding Autism [Online]. Available at https://lincolncollege.equal-online.com/courseplayer/autisml3/?ls=8663048&s=23416 (accessed 22 February 2022). 

Domestic Abuse: Subjective Risk Factors of Identity

A perpetrator can isolate a victim from family and friends in order to have control over her mind. He may do this to ensure that the victim receives no external support from her network, and is therefore more suggestible and vulnerable to his tactics. Even if the perpetrator is unreliable in many ways, he wants the victim to feel that she needs him, and that she has to depend on him. Victims affected by this form of coercive control often gradually lose touch with their networks as the perpetrator’s demands for time and attention increase. This perpetrator wants to jail his victim, and will use manipulative techniques to make the victim feel guilty for not meeting his needs. This jailer wants to take over the victim’s life and wants the victim to leave her studies and/or job. The isolated victim loses touch with herself, and experiences low levels of self-esteem and confidence. Eventually, the victim can also lose all ability to make her own decisions, and will do as the perpetrator wants. Due to these interpersonal experiences of coercive abuse, the victim might develop social anxiety and might become further alienated into the perpetrator’s world. Therefore, isolation is one of the many risk factors for domestic abuse. 

So what other risk factors are there? Even though domestic abuse can happen to anyone, protected characteristics under the Equality Act 2010 are also risk factors when it comes to domestic abuse. All these characteristics can increase the the likelihood of isolation, and can place victims at serious risk. Depending on the intersectionality of characteristics, some people might be more at risk of being abused than others. For instance, the evidence suggests that women are more at risk of being domestically abused than men, and that transgender and non-binary individuals also experience experience higher rates of domestic abuse. Therefore, it can be said that gender is a risk factor. 

Furthermore, having mental health problems makes individuals more vulnerable and suggestible. Perpetrators of domestic violence look to exploit a victim’s vulnerabilities, and will prey on those who are either depressed or anxious. Individuals affected by this type of abuse tend to become isolated as a result of coercive control, and might find it more difficult to access support. Therefore, it can be said that mental illness is a risk factor. 

Moreover, many perpetrators use religious beliefs as an excuse to engage in domestic abuse. For example, the perpetrator might tell the victim that the Bible says that women should be submissive to men, or that Dharma requires constant hedonism and sexual exploitation  (e.g. cult leaders). Whatever the beliefs, perpetrators can sometimes make it difficult for the victims to reclaim their subjectivity, and will subjugate the victims based on these beliefs. The victim might also have different beliefs to her perpetrator, and this might escalate the abuse. Therefore, religion is a risk factor. 

Also, a lot of perpetrators are homophobic and will abuse anyone who deviates from heterosexuality, at times even using punishment against the LGBTQ+ victim. The evidence shows that LGBTQ+ individuals experience higher rates of abuse due to their vulnerabilities, with bisexual women being the most affected group. Therefore, sexual orientation is a risk factor. 

What’s more, many perpetrators abuse those whose age means they are more vulnerable, and indefensible, such as children and elderly people. These predators may get children or young people to commit acts to which they cannot give consent to as a result of immaturity (e.g. child sexual abuse). Therefore, age is a risk factor. 

Furthermore, when people are ill or disabled, they are more vulnerable to harm. Perpetrators can at times exploit this vulnerability. The victim might feel like they are a burden to the perpetrator and might find it difficult to leave due to dependencies (e.g. financial factors). Therefore, disability is a risk factor when it comes to domestic abuse, and victims are more likely to experience such abuse for a prolonged period of time. 

Finally, perpetrators at times exploit the vulnerabilities of those with a different ethnicity. For instance, if a person’s immigration status is uncertain, they might stay in a relationship out of fear of losing their visa. Also, those who do not speak English might find it harder to communicate their ordeals. Moreover, some cultures practise disturbing traditions such as female genital mutilation (FGM) and women with these cultural connections are more likely to experience abuse, including forced marriage and honour-based abuse. When it comes to forced marriage, children from specific cultures are more likely to experience childhood sexual abuse as a result of forced child marriage. Therefore, ethnicity is a major risk factor when it comes to domestic abuse. 

In conclusion, the protected characteristics of the Equality Act 2010 can each be risk factors to potential domestic abuse, and it is important now more than ever that these characteristics are taken into account when safeguarding human beings. Furthermore, isolation is a major risk factor and a common trait which intersects with protected characteristics of identity.

Categories
Forensic Psychology

Signs, Symptoms and Indicators of Domestic Abuse

This blog post will educate the reader about the signs of domestic abuse, and how to identify it in every day life. It also touches on the specific symptoms and indicators of female genital mutilation, forced marriage, honour-based abuse, and digital domestic abuse; as well as who is most at risk from experiencing these.

Physical Abuse

Individuals affected by physical violence present with recurrent physical injuries such as black eyes, bruises, split lips, marks on the neck, or sprained wrists. Moreover, the explanations given for these injuries might be inconsistent, and might be obviously a cover-up for something else. Finally, they might also wince when making motor movements as if in pain and trying to avoid pressure on a specific part of the body. However, it must be noted that perpetrators tend to be wary of where they leave marks, so as to avoid getting caught. So in many cases, physical abuse is hidden from the public eye and the victim is manipulated into keeping things secret. Physical signs of domestic abuse might not always be visible because the perpetrator might be ensuring that they leave no evidence that could incriminate them. This might mean that they will attack the victim in specific hidden places such as the head, the stomach, or breasts, among other places. Furthermore, they might have manipulated the victim to hide the marks, or to keep silent; and the victim might actually be using clothing, make-up, and accessories to actively cover the injury. 

Emotional & Psychological Abuse

Individuals affected by emotional abuse present with symptoms of agitation and anxiety, chronic tiredness and insomnia, substance or alcohol use disorder, submissiveness (e.g. apologising all of the time), anhedonia, low self-esteem, low self-confidence, fear or wariness, depression, and/or suicidal ideation. Whilst these symptoms might not always be caused by domestic abuse, these are commonly experienced by people who are in abusive relationships. Therefore, it is important to take into account these indicators when safeguarding adults from potential abuse which might be hidden. Emotional signs of domestic abuse are inherently invisible and can only be detected by observation. If the victim does not have a support network who knows them well, it might be more difficult for anyone to notice any differences in behaviour. Furthermore, not everyone is equipped with the knowledge to correctly identify signs of emotional abuse. Moreover, victims might actually avoid disclosing anything, especially if the perpetrator has manipulated them to keep things to themselves through blame and/or threats. 

Individuals affected by domestic abuse present with behavioural markers that could reveal their ordeal such as drastic behaviour or personality changes, unjustified self-isolation, being unable to attend scheduled meetings, avoidance of social gatherings, the sudden reluctance to engage in activities once enjoyed, and/or secretive behaviours. Furthermore, the individual might appear anxious and/or fearful, and their behaviour might seem extremely ‘well-behaved’ when around their perpetrator. These individuals may try to cover up the abuse they are being put through by giving excuses that are unrelated to what is actually happening. Behavioural signs of domestic abuse are difficult to pinpoint if the victim is not known to the witness very well, and therefore the witness cannot notice a change in usual behaviour. This means that unless someone notices the situation, a bystander intervention is unlikely, especially when the victim makes excuses for apparent unusual incidents which no one can recognise as an inconsistency. 

Coercive Control

Individuals affected by coercive control present with signs and indicators such as asking their perpetrator for permission to socialise with others, receiving numerous texts and/or calls from their perpetrator, having no money or access to it, having no car and being picked up by their perpetrator all the time, and/or needing to be home at specific times. These individuals might also keep these patterns secret, and might actually feel shame related to their ordeal. Signs of coercive control are often quite hidden from everyday life because the victim might appear to be respectful rather than fearful of her perpetrator. Others might not pick up on the abusive flood of texts and/or calls, or might not understand that all of these communications come from the perpetrator. Furthermore, victims might feel embarrassed to disclose their financial situation and/or dependencies, and might avoid answering truthfully when questioned about details. 

Female Genital Mutilation (FGM)

Women who have been genitally mutilated present with difficulty walking, sitting, or standing; they show signs of being in pain, and may spend longer in the toilet than usual. They might be anxious, depressed, and/or might be self-isolating without a justification. They might present with drastic changes of behaviour and personality, may engage in truancy at school/college/university, might become absent from work and/or might withdraw from social activities. Furthermore, the Home Office has a list of countries flagged as ‘risky’ when it comes to female genital mutilation. These are Somalia, Kenya, Ethiopia, Sierra Leone, Sudan, Egypt, Nigeria, Eritrea, Yemen, Kurdistan, and Indonesia. Women and girls at risk of female genital mutilation are those who speak about special ceremonies or rituals about womanhood in their culture, those who say that they are going on holiday outside the UK, those who say that a ‘special’ relative is coming to visit them, and those have family members who have been already mutilated. This means that when women and girls present with any of the above indicators, and especially when they have connections to any of the blacklisted countries, they should be safeguarded through bystander intervention.

Forced Marriage

Forced marriage happens here in the UK and also abroad. Sometimes only the woman is forced, and other times both parties are forced. Individuals affected by forced marriage present with truancy or absence from work, fearfulness and anxiety about holidays, failure to return to occupational life after a holiday, not being allowed to study or work, having excessive parental control,  depression or isolation, and/or attempts to escape their ordeal at home. Furthermore, those at risk of being forced into marriage include those who have connections to those who have already been forced to marry, and those whose culture promotes early marriage. Countries known to have child marriage include Nigeria, Central African Republic, Chad, Bangladesh, Mali, South Sudan, Burkina Faso, Guinea, Mozambique and India (Reid, 2018); as well as Pakistan (Ijaz, 2018). 

Honour-based Abuse

In some cultures, the family or community might attempt to protect or defend their shared values through abusive means and/or threats of abusive means such as harassment, assault, imprisonment, murder and rape. This is what is known as honour-based abuse and it is directly linked to beliefs, and attitudes. Individuals affected by this type of abuse present with drastic changes in behaviour or personality, anxiety, demotivation, poor performance, excessive control by others, self-isolation which cannot be justified, confrontational and argumentative behaviours, truancy or absence from work, attempts to escape their ordeal, self-harm, depression, substance or alcohol use disorders, suicidal ideation, and/or actual bodily harm (ABH). Furthermore, individuals at risk of honour-based abuse include those who have relatives who have been forced into early marriage, and those who come from cultures where honour-based abuse is perceived as normal. Countries flagged as risky when it comes to this type of abuse include Turkey, Kurdistan, Afghanistan, South Asia, Africa, the Middle East, South and Eastern Europe, and traveller communities. This means that people from these cultures are particularly at risk of being abused. 

Digital Domestic Abuse

Digital domestic abuse entails harassment, bullying, and/or stalking through an online platform, and/or the restriction of someone from  accessing technology. Individuals affected by digital domestic abuse present with an excessive number of texts/calls, appear visibly upset or distressed after texts/calls, online attacks against their integrity, and online embarrassing media involving them. Furthermore, individuals who are being coercively controlled through technology present with a monitored access to social media, emails, and/or the internet by their perpetrators,  signs that others have access to their personal digital accounts, a controlled access to technology by the perpetrators, a recurrent pattern of asking for permission from their perpetrator before connecting digitally with the people in their lives, an excessive guardedness about what is said in emails or other digital platforms, and/or a recurrent pattern of borrowing other people’s technology for access to the internet. Moreover, an individual can be both abused digitally, and also face to face, with punishments, reprimands and other negative consequences used by the perpetrator to intimidate the victim into obeying. 

References

Ijaz, S. (2018) ‘Time to End Child Marriage in Pakistan’, Human Rights Watch, 9 November [Online]. Available at https://www.hrw.org/news/2018/11/09/time-end-child-marriage-pakistan (accessed 14 February, 2022). 

Reid, K. (2018) ‘Untying the knot: 10 worst places for child marriage’, World Vision, 6 July [Online]. Available at https://www.worldvision.org/child-protection-news-stories/10-worst-places-child-marriage (accessed 14th February, 2022).  

Categories
Journalism

Women Who Are Mad

De facto and de jure social injustices are an expression of the id quo. These impulses have a detrimental effect on women’s daily lives, making it a lot more difficult for them to enjoy their human rights. This document has shared data particles of knowledge about current injustices occurring to ‘mad’ and ‘intersectional’ women in the UK, the psychological impact of these injustices (e.g. Borderline Personality Disorder), and the legal framework of international law, which the UK is subject to. De jure and de facto injustices exacerbate mental health problems, and lead to the introjection of maladaptive behaviours, and can corrupt the individual superego. Furthermore, UN Women (2016) recommends that  all countries take on board the Istanbul Convention, and the UK is a country member of the UN Security Council. The UK’s Domestic Abuse Act 2021 does not fully cover all the criteria necessary for the prevention and protection of women’s rights, as well as the prosecution of perpetrators of violence against women. Similarly, the Equality Act 2010 only protects some of the many characteristics that elicit discrimination against human beings, and the word ‘dignity’ does not appear once in the Human Rights Act 1998. This seemingly innocuous semantic exception is a malpraxis. All these technical legislative failures lead to very costly consequences for the least advantaged in the status quo. The facts and figures have shown that women in the mental health sector are the most affected group, out of which patients with BPD tend to struggle the most with daily attitudinal obstacles, intersectional discrimination, and de facto impediments.

Categories
Opinion

Authoritarianism in Mental Health Settings

When I began this journey in Forensic Psychology, I did not expect to learn as much as I have. The main tenet of this career consists in understanding psychopathy, and psychopathology.

It does make me question authoritarianism and the ways in which it can manifest. For instance, Milgram and Adorno et al. studied the psychology of obedience under pressure, and how following orders led to the holocaust. An aspect that has been questioned little is how scarcity or the fear of scarcity has led to similar phenomena due to how people have been conditioned to see money as an enabler of everyday behaviour. For instance, when Milgram conducted his obedience experiments during the 60s, he monetarily rewarded his participants for taking part in the studies. Modern psychologists have attempted to re-examine the dynamics at Yale’s laboratory and what might have led the participants to show that they were capable of being sadistic under such conditions. An example is Gibson’s (2013) work which meticulously examines the prods given by the experimenter. In a way, Gibson seeked to understand how the orders and requests given by the authority figure contributed to the decision-making processes of the participants. However, I have not come across much research highlighting the role of the monetary incentive in everyday behaviour; or how being given a monetary incentive places a subconscious obligation on individuals to comply with requests, even if such requests at times make them feel uncomfortable.

The c/s/x movement, also known as ‘the psychiatric survivors movement‘ (Wikipedia, n.d.) explores how a large number of individuals report feeling or having felt dehumanised by the mental health system. For the unstigmatised person, it is often more common to assume that all these people expressing dissatisfaction with the system are crazy, than to understand the nature of what it means to respect a person’s dignity and human rights. It is quite a complex situation, because it is unclear what reinforces and keeps some mental health settings from actively listening to their patients’ concerns.

According to Turner (2015), signal detection theory (SDT) “describes processes whereby information that is important to the perceiver (known as the ‘signal’) is distinguished from other information that is unimportant and potentially distracting (known as the ‘noise’)”. It is my hypothesis that some of the inherently dehumanising behaviours occurring in the mental health system happen as a result of the hyper-normalisation of object-relations with patients. As I mentioned on my post Investigating the neuropsychopathology of prejudice‘, people can at times perceive those with stereotyped and stigmatised characteristics as non-human objects. This would of course increase the chance of mental health settings staff processing signals coming from clients as background noise, rather than as worth-listening-to human signals. Such established conscious and unconscious behaviours leading to the dehumanisation of many clients are reinforced through monetary incentives, and through an intragroup, mob-like co-validation of such unconscious biases. Like Eichmann, many live their lives constantly affirming to themselves that they were just following procedures and orders, or just doing their job; and therefore they believe it is not their responsibility to reflect on how clients are impacted by this. But the signals coming from mental health patients often stand in stark contrast to the common belief that these dehumanising, and at times non-empathic methods are appropriate, or even de facto acceptable.

I do think everyone deserves to be paid for their labour, and that having access to a basic form of income is an important foundation in any society; and I also think that mental health settings need to be encouraged or trained appropriately to detect clients’ signals as more than just background noise (i.e. as more than non-human objects signals) in order to reduce risk outcomes. The situation is problematic, persistent, and pervasive with these manifestations of authoritarianism in mental health settings. It would indeed be arrogant to assume that all the patients/clients expressing dissatisfaction with the service are wrong, or to culturally pathologise reasonable dissent. It would also be irresponsible and de jure unacceptable to fail to take steps towards alleviating feelings of ‘being dehumanised’ in civil society, especially if such feelings of dehumanisation have the potential to lead to never events, such as suicide.

References

Gibson, S. (2013) ‘Milgram’s obedience experiments: A rhetorical analysis’, British Journal of Social Psychology, vol. 52, York, The British Psychological Society/York University, pp. 290-309 [Online]. Available at https://pmt-eu.hosted.exlibrisgroup.com/permalink/f/gvehrt/TN_cdi_gale_infotracacademiconefile_A332152211 (accessed 11 October 2020).

Turner, J. (2015) ‘Making sense of the world’, in Turner, J. and Barker, M. J. (eds) Living Psychology: From the Everyday to the Extraordinary, Milton Keynes, The Open University, pp. 7-45.

Wikipedia (n.d.) ‘Psychiatric survivors movement’ [Online]. Available at https://en.wikipedia.org/wiki/Psychiatric_survivors_movement (accessed 11 October 2020).

Categories
Journalism Videos

Psychological Survival Through the Coronavirus Pandemic

This is a short video answering some questions in relation to how to cope with the intensity of the coronavirus pandemic by focusing on psychological survival and wellbeing at home.

Categories
Journalism Science

COVID-19: Situation Report, Administrative Challenges, and What Psychologists can do to Help the Crisis

UK-specific numbers

As of 10 April 2020:

CONFIRMED CASES: 73,758

PATIENTS DISCHARGED: 344

PATIENTS WHO DIED: 8,958

Worldometers (2020)

Are the numbers to be trusted?

There is a certain ‘mystery’ with the numbers. For instance, the GOV.UK’s (2020a) dashboard has not been updating the recovery section of its spreadsheet since the 22nd March. This has led to much confusion, and many people are suspicious of the numbers being provided. For instance, the media (Merrick, 2020) announced that health secretary Matt Hancock tested positive for coronavirus on the 27th March, 2020. Then on the 2nd April, 2020 he was back to work (Matt Hancock gives first coronavirus briefing since coming out of isolation, 2020) and was looking healthy. Nevertheless, the historic record spreadsheet did not register his recovery, indicating that maybe only those admitted to hospital are being registered in the records.

Another odd discrepancy is the fact that even though Worldometers (2020) updated for the first time this month the number of recovered patients yesterday to 344, the historic record document mentioned above- which is available on the GOV.UK’s (2020a) dashboard- continues to show 135 as the number of recoveries. This is worrisome as it gives an impression of misinformation and it elicits uncertainty. No wonder many people are having a gut feeling of ‘deception’ at the hands of the GOV.

What is the government’s plan?

As of the date of this writing, the GOV.UK’s (2020b) coronavirus action plan is full of misinformation and inaccuracies. I wrote to the Department of Health & Social Care (GOV.UK, 2020c) on the 1st April in order to communicate my concerns in regards to their published document and to request more frequent reviews of it. Nevertheless, nothing has been done about it, and the file continues to create feelings of confusion and uncertainty. Here you can download the analysis I conducted. You will be able to understand the discrepancies better after reading it.

What is the WHO saying?

I attended the World Health Organization’s (2020) press briefing yesterday (10th April). Dr. Tedros Adhanom Ghebreyesus, Director-General stated: “When health workers are at risk, we are all at risk”. There were many important calls to action, such as ensuring that medical staff are able to have adequate rest periods instead of long, exploitative shifts; the development of an immune response; and the clarification of the severity of the disease. For instance, so far we have heard about patients who are in mild, and critical conditions. It was mentioned in the conference that an explanation of the moderate condition would be helpful, as there are confirmed cases of pneumonia which have not required hospitalization.

Another important point discussed was that the death of health workers has become a ‘tragic’ stimulus to action. The health environment was spoken about as a double-edged sword. It was also raised that personal protective equipment (PPE) is therefore a must have in hospitals in order to reduce the exposure of health workers to infectious hazards. This reminds us of the importance of staying at home and protecting the NHS. Furthermore, it was also suggested that psychosocial support for front-line and health workers should be made readily available, and reasonable adjustments should also be made by administrative staff in order to prevent doctors and nurses from developing fatigue as a result of extremely long shifts.

What can psychologists do to help the coronavirus crisis?

The coronavirus (COVID-2019) impacts on different people in different ways. Psychologically speaking, this requires an ongoing decision-making process based on the likelihood of catching the virus, and the perceived severity of the consequences.

“The barriers component may comprise both physical limitations on performing a behaviour (e.g. expense) and psychological costs associated with its performance (e.g. distress)”.

Abraham and Sheeran (1996, p. 33)

The outbreak is by all means a stress-generative situation. Exploring the psychopathology of the coronavirus pandemic, such as the negative and positive symptoms it causes (e.g. confusion, neurosis, and psychosis) would help both, professionals and students to feel more efficient in their preparedness for what is to come next. For example, the concept of normal distribution and the curve as illustrated by The Visual and Data Journalism Team (2020) would help people understand what is meant by “the peak” of the outbreak that so many sources are expecting and talking about.

Psychologists are also encouraged to help people understand the serious challenge at hand, and the levels of vulnerability in individual differences. Moreover, it would also be helpful to stimulate the GOV so they respond quicker without the need for the tragic stimulus of death explained above. Furthermore, exploring the cycle of panic and neglect that manifests as response to the threat would help soothe emotionally vulnerable human beings. Advice about how to strengthen the system is welcome. When it comes to forensic psychologists, it would be useful to elucidate how data formulates policy, and why it is important to have accurate data in order to prevent confusion at subnational levels, including criminal justice settings.

How can I check the coronavirus numbers for myself?

There are two ways you can check the coronavirus statistics. For global numbers go to Worldometers.info/coronavirus.

For UK-specific numbers:

  1. Go to the GOV.UK’s (2020a) Dashboard.
  2. Click on the ‘About’ tab at the bottom of the page.
  3. Click on the ‘Access historic data from the dashboard (xlsx)’ link.
  4. Save the file on your device.
  5. Open the file with a spreadsheet software such as Google Sheets (n.d.), Microsoft Office Excel (n.d.), or LibreOffice Calc (n.d.).

Please note that GOV staff have neglected the recovery section in the official spreadsheet since 22nd March, 2020. If you are concerned about the numbers, please contact the Department of Health & Social Care on https://contactus.dhsc.gov.uk/ and explain to them your concerns.

References

Abraham, C. and Sheeran, P. (1996) ‘The health belief model’, in Conner, M. and Norman, P. (eds) Predicting Health Behaviour, Buckingham, Open University Press, pp. 23-61.

Google (n.d.) ‘Google Sheets’ [Online]. Available at https://www.google.co.uk/sheets/about/ (Accessed 11 April 2020).

GOV.UK (2020a) ‘Total UK COVID-19 cases’, 4th April [Online]. Available at https://www.arcgis.com/apps/opsdashboard/index.html#/ae5dda8f86814ae99dde905d2a9070ae (Accessed 11 April 2020).

GOV.UK (2020b) ‘Coronavirus action plan: a guide to what you can expect across the UK’, 3 March [Online]. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/869827/Coronavirus_action_plan_-_a_guide_to_what_you_can_expect_across_the_UK.pdf (Accessed 11 April 2020).

GOV.UK (2020c) ‘Department of Health & Social Care’ [Online]. Available at https://www.gov.uk/government/organisations/department-of-health-and-social-care (Accessed 11 April 2020).

LibreOffice (n.d.) ‘Calc’ [Online]. Available at https://www.libreoffice.org/discover/calc/ (Accessed 11 April 2020).

Matt Hancock gives first coronavirus briefing since coming out of isolation (2020), Youtube video, added by The Sun [Online]. Available at https://www.youtube.com/watch?v=qrF6Z8s5dmw (Accessed 10 April 2020).

Merrick, R. (2020) ‘Coronavirus: Health secretary Matt Hancock tests positive’, The Independent, 27 March [Online]. Available at https://www.independent.co.uk/news/uk/politics/coronavirus-matt-hancock-boris-johnson-test-positive-covid-19-symptoms-a9430031.html (Accessed 10 April 2020).

Microsoft (n.d.) ‘Office Excel’ [Online]. Available at https://products.office.com/en-gb/excel (Accessed 11 April 2020).

The Visual and Data Journalism Team (2020) ‘Coronavirus pandemic: tracking the global outbreak’, BBC News, 10 April [Online]. Available at https://www.bbc.co.uk/news/world-51235105 (Accessed 11 April 2020).

World Health Organization (2020) ‘Coronavirus Disease (COVID-2019) press briefings’ [Online]. Available at  https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/press-briefings (Accessed 10 April 2020).

World Health Organization (n.d.) ‘Biography of Dr. Tedros Adhanom Ghebreyesus, Director-General’ [Online]. Available at https://www.who.int/antimicrobial-resistance/interagency-coordination-group/dg_who_bio/en/ (Accessed 11 April 2020).

Worldometers (2020) ‘COVID-19 coronavirus pandemic’ [Online]. Available at https://www.worldometers.info/coronavirus/ (Accessed 11 April 2020).

Categories
Journalism

Coronavirus (COVID-19): Understanding the New Status Quo, Following Governmental Advice, and Interpreting the Numbers

We have heard the advice, but how can we interpret the information? Why follow the lockdown protocols? This article will clarify the coronavirus’ status quo.

UK-specific numbers:

CONFIRMED CASES: 47,806.

PATIENTS DISCHARGED: 135.

PATIENTS WHO DIED: 4,934.

(GOV.UK, 2020b)

What’s the difference between the coronavirus and COVID-19?

The coronavirus is what people catch, and the COVID-19 is the respiratory disease that can develop. A good analogy for understanding the differences between the two terms is HIV and AIDS. Whilst not all people who test positive for HIV develop AIDS, those who do develop it become severely ill. Similarly, not everyone testing positive for the coronavirus develops COVID-19, but those who do develop it are hospitalised and become severely ill. This is why preventing catching the coronavirus is just as important as preventing catching HIV.

What is the likelihood of catching the coronavirus?

As of the date of this writing, and according to Worldometers (2020a), there have been 47,806 confirmed cases in the UK, which has a population of 67,802,457 (Worldometers, 2020b). This means that the total number of hospital admissions per 1 million population is approximately 704, and the number of deaths per 1 million population is 73. Furthermore, Plymouth (the city where I live) had a population of 264,200 as of February (World Population Review, 2020), and as of the date of this writing it has had a total of 102 hospital admissions (GOV.UK, 2020b), out of which 13 (approximately 12.8%) patients have died (O’Leary, 2020); which means that even though there is a low risk of catching the virus, those who do catch it and develop COVID-19 are at high risk of dying.

Why should I stay at home?

Because you do not know whether you are infected or not, and if you are coronavirus positive but you have not developed COVID-19; you could still pass the virus onto other people who might be more vulnerable than you and who might develop COVID-19. Alternatively, you could catch the virus and in the worst case scenario die.

How is staying at home protecting the NHS?

When you prevent catching the coronavirus, you also prevent spreading it around. This means that you are doing everything you can to make sure that the NHS does not become overwhelmed with patients.

What preventive action can be taken?

  • You could self-educate on the topic in order to feel confident that you know what’s going on, and how to survive the crisis.
  • You could stay home in order to prevent becoming a patient, or spreading the virus (creating patients). This means that the NHS will have more supplies to deal with the overwhelming number of cases, and those severely ill will have a higher chance of getting the medical attention and equipment that they need.
  • You could share the information with your friends and family.

What reliable advice is available?

  • The World Health Organization (WHO; 2020a) has a section dedicated to the coronavirus pandemic with all available scientific information.
  • The NHS.UK (2020) has a section also dedicated to the disease.
  • The GOV.UK (2020a) also has a section dedicated to the lockdown in relation to the pandemic.

How is the virus transmitted?

According the World Health Organization (WHO; 2020b) “COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes […] transmission of the COVID-19 virus can occur by direct contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on the infected person […] Airborne transmission is different from droplet transmission […]can remain in the air for long periods of time and be transmitted to others over distances greater than 1 m”.

References

GOV.UK (2020a) ‘Coronavirus (COVID-19): what you need to do’ [Online]. Available at https://www.gov.uk/coronavirus (Accessed 5 April 2020).

GOV.UK (2020b) ‘Total UK COVID-19 cases’, 4th April [Online]. Available at https://www.arcgis.com/apps/opsdashboard/index.html#/ae5dda8f86814ae99dde905d2a9070ae (Accessed 5 April 2020).

NHS.UK (2020) ‘Advice for everyone’, 3 April [Online]. Available at https://www.nhs.uk/conditions/coronavirus-covid-19/ (Accessed 4 April 2020).

O’Leary, M. (2020) ‘Ten coronavirus deaths confirmed in past 24 hours across Devon and Cornwall’, Plymouth Herald, 5 April [Online]. Available at https://www.plymouthherald.co.uk/news/uk-world-news/coronavirus-death-toll-uk-risen-4021937 (Accessed 5 April 2020).

World Health Organization (2020a) ‘Coronavirus disease (COVID-19) pandemic’ [Online]. Available at https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (Accessed 5 April 2020).

World Health Organization (2020b) ‘Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations’, 29 March [Online]. Available at https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations (Accessed 5 April 2020).

World Population Review (2020) ‘Plymouth population 2020’, 17 February [Online]. Available at https://worldpopulationreview.com/world-cities/plymouth-population/ (Accessed 5 April 2020).

Worldometers (2020a) ‘COVID-19 coronavirus pandemic’, 5 April [Online]. Available at https://www.worldometers.info/coronavirus/ (Accessed 5 April 2020).

Worldometers (2020b) ‘U.K. Population’, 5 April [Online]. Available at https://www.worldometers.info/world-population/uk-population/ (Accessed 5 April 2020).