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This blog is to critically introduce, and contextualise, new research findings from developmental research, neuroscience, attachment theory  and other areas of psychology that are topical or are likely to whet the appetite of  anyone interested. The aim is to discuss research which will feel relevant and which might even, if lucky, make a...

This blog is to critically introduce, and contextualise, new research findings from developmental research, neuroscience, attachment theory  and other areas of psychology that are topical or are likely to whet the appetite of  anyone interested. The aim is to discuss research which will feel relevant and which might even, if lucky, make a difference to how we approach our work or other areas of our lives.

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DEEPER THAN SKIN DEEP Black lives matter, racism, evolved capacities for prejudice and finding empathy and compassion

 

 

 A child not embraced by the village will burn it down to feel its warmth.  (African proverb)

 

Quite rightly people are taking to the streets to protest. The shocking murder of George Floyd has awoken a new generation to the extent of racism, prejudice and discrimination, and not before time. His death comes on the back of hundreds of years of racism and violent killings of black people in the USA and elsewhere. Unconscious racial prejudice exists in most contemporary societies and causes unthinkable emotional and physical pain, having repercussions on the minds, bodies spirits and hearts of multiple generations of people of colour.

We must use the most potent methods to diminish and if possible, eradicate discrimination, prejudice and racism. However, I fear that some of the ideology and rage might fuel a superficial political correctness which has too little depth, a bit like patching up a tooth when the root is rotten. I worry about the self-righteousness, and the effects of blaming and shaming.

We all need to get to know and understand the attitudes, beliefs and prejudices we all carry. Only by owning up to these, and thinking about how they arose, can racist attitudes be challenged effectively. Condemning prejudice in others and denying it in ourselves is a classic but unhelpful unconscious ploy, as is self-hating and self-shaming. We need to assertively combat racist behaviours but find a more compassionate approach to the attitudes we can all develop.

The backdrop to all this is the overdetermined set of social forces that gives rise to discrimination, inequality, racist behaviour, discourse, and actions. Such attitudes are kept in place via structural inequality and the way the competitive post-industrial complex works, including how systems around status and social rank play out in most societies. Think of the societies where status and economic advantage is linked with subtle gradations of skin colour, such as in many South American countries. Think of Catholic-Protestant mutual hatred in Ireland linked to the fights for economic ascendancy, or the power of the Serbs, a tiny proportion of Kosovo but holding economic power.  Power and economic gain are often central. It was dominant in slavery and it is in the US prison system, exploiting for profit many more black people than ever were slaves. We need to remain alive to the bigger political questions, and remember that racism and prejudice are about more than individual blame.

I at times am shocked by having a racist or discriminatory thought. My job is to own that, not beat myself up, but see how I can ensure that such unconscious attitudes do not persist, and definitely not translate into actions. I recently did a test I would encourage anyone to do, you can find it here, the  Implicit Association test. This tests our biases, whether on race, gender and a host of other issues.  It gets people to pair pictures (eg white or black faces) with words (eg good bad, violent etc ) and what it is measuring is our response time. If we are slower to pair a black face with positive words, this suggests an unconscious bias. Our unconscious cannot lie. I have done a few of these and have not always liked the results, which are hard to argue with. Even seasoned political campaigners for racial equality and rights, black or white, often find they have unconscious biases they were not aware of and are somewhat ashamed of. People of any race can internalise racist attitudes and not know they have them. It should not mean that anyone who gets a result suggesting non-conscious prejudice is ‘bad’, ‘immoral’ or deserving condemnation. What it does suggest is that we have internalised messages about race from history and wider society, and these have become unconscious beliefs. If such beliefs are revealed we can challenge them, but we certainly cannot challenge them if we deny them.

Some research

Our evolutionary heritage handicaps moves towards a racially less discriminatory world. Predispositions that evolved for sensible evolutionary reasons might now undermine a more equal, less prejudiced world. We evolved in small hunter-gatherer communities where mutual trust, loyalty and identification with one’s in-group were necessary for our very survival. Facing mortal dangers from predators and rival groups meant that in-group loyalty and cohesion were vital. We evolved to distrust the ‘other’.

We see the legacy as early as in infancy. Even babies show preference for adults who look and talk like them and like the same things as them, and they even often like people who harm people who are dissimilar to them [1]. 15 month infants like fairness but when the unfairness is to someone of another race, such preferences disappear [2] This is shocking and suggests that to combat racism we need to work against central aspects of our evolutionary heritage. We evolved to favour people who seem more ‘like us’ [3].

Humans from infancy adapt to survive and fit in, which requires learning cultural expectations and the nuances.  Indeed babies from different cultures  cry differently, with different prosody and gestures, from the first weeks of life [4]. Not fitting in is literally painful, similar pain circuits activating in the brain when ostracised as when feeling physical pain [5]. We like and need to belong, and prefer people in a group we are in, even if the allocation into groups has no objective basis.

Typical is an experiment in which boys were shown pictures painted with dots and asked to estimate how many dots were in each picture. They then were allocated entirely randomly as people who had either over or under-estimated the number of dots, and so were labelled either as ‘over-estimators’ or ‘under-estimators’. Surprisingly they later tended to favour and be more generous to others who were labelled in the same group as them [6].  In another experiment a teacher divided her class into brown and blue eyed pupils and announced that the brown-eyed pupils were better  in various ways [7].  The children then gravitated to playing with those in their own group, and those with the low-status blue eyes showed a marked worsening in performance, while previously well-functioning friendships between blue and brown eyed children deteriorated.

The tendency to divide into groups can have dreadful implications, as seen in the famous if shocking Stanford prison experiment in 1971. Here adults were randomly assigned to play the role of either prisoners or guards. In a very short time the two groups, whose members were indistinguishable in terms of social class, ethnicity and educational level, took on their respective roles. The prisoners became distrustful of and angry with the guards who in turn became surprisingly vindictive to the prisoners [8]. Their over- identification with these roles led to terrifying mutual hostility and violence.

The chances of reaching out to those in other cultures and groups are further compromised as the feeling that one belongs, and group loyalty, increase self-esteem [9], so it is good for us to belong. Prejudice about ethnicity, class or nationality are extreme examples of a double-edged predisposition.

Our group biases can be extremely unsettling. In a typical experiment in America white subjects were shown both black and white faces for 30 milliseconds, too short a time for the conscious mind to register. When shown black faces, in some experiments scans revealed heightened amygdala response, suggesting non-conscious fear, in others it was the fusiform face area. When the pictures were shown for long enough to register consciously, the scans showed activation in brain areas involved with conflict resolution, suggesting that the subjects were grappling with their own racism [10].

A clue as to how to manage our unconscious racism comes from how, when the face was well known and highly thought of, such as Nelson Mandela or Barrack Obama, then the same prejudices were less present in white participants. There are active steps we can all take to challenge our unconscious prejudices but burying our prejudice or projecting it onto others is unhelpful. Mostly our biases are non-conscious and implicit, reflecting societal beliefs and prejudices, often developed early in childhood.

Again, this is all unconscious, and we all can interpret the same sensation differently. I work with children and adults who have been traumatised and they often interpret something is dangerous or a threat that most of us see as ordinary. Their brains have developed to expect and protect them from danger. However many black people are not just wrongly seeing disdain, contempt, suspicion or fear, but they are picking up real signals. It is hard to imagine what it feels like to  be consistently on the receiving end of contempt or suspicion, let alone hatred. I remember 40 years ago reading  ‘Black Like Me’, a shocking account by a journalist who darkened his skin and then travelled to areas he thought he knew. The reactions and experiences he had were as if he was in another planet, attack, revulsion, ostracism, hatred and more, despite being the same person, with the same genes, mind, posture, eye colour, gait and everything else. It is little surprise that even young children can internalise such attitudes, seen when black kids heartbreakingly think that white dolls are better or more good than black dolls (video here).

When shown pictures of people in pain, if the other person is of one’s own ethnic or cultural group, such as African-American or Caucasian American, distinct parts of the brain, those involved in empathy, are active, but less so if the person suffering is from another group [11]. Such dehumanisation, of ‘ some lives not mattering’, seems to be at the heart of many atrocities based on prejudice such as race crimes as well as homophobia, Nazi anti-Semitic murder, or genocides such as between Hutus and Tutsis. It is hard to argue with the idea that there is some innate predisposition for prejudice. Owning that must be the first step to effectively combat it. The next is to transform the ‘other’ into ‘like us’, interestingly something that happened in Rwanda when the government introduced a radio soap opera featuring benign versions of both Hutus and Tutsis.

It is chillingly easy to diminish, dehumanise or ‘other’. In one study an ethnically and socially mixed group were shown images of a range of people, such as a female college student, a male American fire-fighter, a businesswoman and wealthy man, a disabled woman, a female homeless person and male drug addict. They were asked to imagine a day in the life of each of these people, an exercise that generally induces empathy. Strikingly, while the empathy circuits in the volunteers’ brains lit up for all the others, for both the homeless person and the drug addict areas dominant for disgust, such as the insula, were most active [12]. Indeed, very worryingly given the current social trend towards inequality and social divisions, for many brain areas linked with disgust lit up in response to poor people generally. Again, we need to be careful not to condemn too much. We evolved to have suspicion of the ‘other’ who in our evolutionary past could be dangerous or carry pathogens.

Remember, such prejudice is non-conscious and to combat it we have to recognise it, process the fact that we have it, rather than push it under the carpet. Then we can work with these issues, such as, for example, by imagining the lives of someone like a drug-user, possibly the abuse they might have suffered, for example. When we do imagine the lives of black people who receive non-conscious signals of distrust, fear, contempt and dislike day-in day-out it is hard not to feel compassion. It can be no coincidence that black people living in racist areas in the US have higher levels of nearly all bad health related biomarkers, from shorter telomeres to higher allostatic load. [13], [14]

Thus groupness is a mixed blessing. Belonging makes us feel better, and is one of the roots of genuine mutual care and cooperation. However, it can also lead to dehumanisation of others and inhibit cooperating with those we deem different. Surprisingly oxytocin, a hormone central to bonding, mutual trust and cooperation, increases empathy. Yet the same neurochemical  has a darker side. When people are in close-knit and bonded groups, such as the huddles of sportsmen before or close families, oxytocin levels rise. Yet people given oxytocin intranasally become more likely to help those in their own ethnic group, and less likely to aid those from other groups [15], a finding found in Belgium between Walloons and Flemish citixens, and in another study, in Israel between Hassidic orthodox and non-religious Jews [16].

We also know that when times are tough, group identification can be an uncobscious way of bolstering a fragile sense of self by identifying with an in-group, hence gang membership and the increase in racism and xenophobia witnessed so often with economic crises.  People showing a hubristic over-blown pride have higher levels of prejudice than those with ordinary self-confidence [17]. ‘Authentic pride’, which might derive from hard work and a genuine sense of achievement, is more likely to lead to a compassionate and empathic attitude to others. Pride based on hubris, and presumably geared to bolstering fragile self-esteem, is a more arrogant and less genuinely self-confident kind, and suggests attempting to feel better by diminishing others. Such studies back up the psychoanalytic idea that we can cope with bad feelings about ourselves by projecting them onto others. Those with more authentic pride were not only more empathic but they harboured less prejudice. This of course might also make sense of why we see such a rise in far-right and racist groups when there is an economic downturn and economically challenged groups, like some white working class men, can be tempted to more racist attitudes. 

Stress, including poverty, inequality and danger wire our brains for distrust. When the chips are down and danger looms we can’t afford to be open and trusting. Very anxious fearful children, as well as abused and traumatised ones,  are much more anxious, and suspicious of difference [18], and the parts of their brain involved in fear, such as the amygdala, are highly active [19]. People with more social fear tend to be more anti-difference, ant-immigration and, pro-segregation [20]. Some research has suggested that people on the political right have higher activation in fear related brain areas whilst those on the left have more activity in areas involved in curiosity, self reflection and empathy [21].

Thus the potential for racism and a fear of difference seems to be engrained in human nature, but is exacerbated in the face of fear and uncertainty, which is when most of us tend to cling to the known. This presumably made a lot of sense in terms of increasing our chances of survival in dangerous situations in our evolutionary past. Such an innate fear of the other can be reversed though with exposure to other races, even in infancy [22], and it is probably no coincidence that it was the most multi-racial UK conurbation, London, that came out so strongly against Brexit. When our backs are against the wall, we tend to see threat everywhere and resort to flight/flight responses rather than empathy and care for others.  Fear tends to make us more suspicious and  wary of others [23] . This might explain recent research finding that those who felt most threatened and less ‘safe’ in response to covid were the ones more likely to hoard toilet paper [24], a kind of ‘look after number 1’ threat response.

This might also explain why we see more conservative political views as well as racism in  American gun-owners who tend to be opposed to lenient immigration and other liberal policies. [25]. A state of mind in which fear is prominent often gives rise to more suspicion and less likelihood of caring openness.

In another study  138 men from Cambridge, Massachusetts watched films and then answered questions. Some watched relaxing images such as of beaches and palm trees, or heard soothing music. Others had to watch Sylvester Stallone's rather terrifying film, "Cliffhanger." The latter group not surprisingly had  heightened physiological reactivity after watching two minutes of rope dangling peril. Maybe more worryingly, this led them to have stronger anti-immigration and prejudiced attitudes. A message from this might be that if we make people feel safe, valued, secure and cared for they are less likely to develop such racist attitudes.

 

What much research is suggesting is that when people are suspicious, fearful and  life is going badly, they tend to have more activation in areas of the brain such as the insula, central to disgust, and fear, and less activation in brain areas to do with empathy, curiosity, trust or openness to novelty. Generally, brain areas that are dominant in fear, anxiety, threat or anger work against those that are central to cooperation, empathy or caring for others.

For me, a central lesson is that we all need to look long and hard at our own prejudices, and work to shift these. This can happen in a multitude of ways. For me personally it is often compassion informed practices, opening up to the reality of the lives of those we fear, and finding ways of ensuring I am thinking about their lives, history and past experience. I work with many perpetrators and have yet to meet one who was not also a victim, normally of terrible trauma. We need to understand both sides of this.

Of course, we need to be aware of deeper societal issues. Racism has been central to the maintenance of  contemporary consumerist capitalist society. This includes mass incarceration of black Americans who become effectively slave labour, ghettoization and cheap labour, black people on the lowest social rungs, poverty and suffering the most psychological and health adversity and so much more.

So where does this leave us? It is urgent that we keep in mind that many, if not most, of us, harbour racist and other discriminatory attitudes, unconsciously. These attitudes, often imbibed via the media, perpetuate divisions in our society and suffering in the discriminated against. In any society which is very unequal, ways will be found to justify someone’s power, wealth and status, such as their wealth or status being ‘deserved’, while those ‘others’ are ‘lazy’, ‘unintelligent’ , or worse, subhuman or like animals, as we saw in Nazi Germany and in slavery. Part of the challenge is to extend the boundaries of our empathy, which in some spheres has happened, for example in accepting homosexuality, transgender issues and multiracial living. As Rifkind has pointed out (see video), humans have extended our empathy and trust from small hunter-gatherer groups and blood-ties, to a detribalised feudal new groups, such as religious identification, then to extended ‘families’ within nation states, and now possibly new technology might allow a further extension of empathy, irrespective or race, class, nationality, religion or whatever arbitrary group. to new potential identifications, including with the whole human race, and indeed the planet and other species.

Thus, black, and hopefully all lives, matter, but if we dehumanise another then their lives and lifeblood do not matter to us. We can work against our tendency for prejudice and dehumanisation, which means first owning up to it and not being self-hating. Unconscious bias exists, and not all for bad reasons. We pick up own kids at the school gates, not any old random one, we all have biases, but some seem no longer so helpful. Alongside that we need to support the discriminated against to stand up with authority against acts such as of racism and abuses of power. One of my heroes James Baldwin stood up with courage against racism and also knew and said ‘not everything that is faced can be changed but nothing can be changed unless it is faced’ (video). This applies equally to ‘whitewashing’ structural racism and atrocities but also to facing, with some self-compassion, our own internal prejudices.

 

[1]        J. K. Hamlin, N. Mahajan, Z. Liberman, and K. Wynn, “Not Like Me= Bad Infants Prefer Those Who Harm Dissimilar Others,” Psychol. Sci., vol. 24, no. 4, pp. 589–94, 2013.

[2]        M. P. Burns and J. Sommerville, “‘I pick you’: the impact of fairness and race on infants’ selection of social partners,” Front. Psychol., vol. 5, p. 93, 2014.

[3]        E. J. Van Leuween, R. L. Kendal, C. Tennie, and D. Haun, “Conformity and its look-a-likes,” Anim. Behav., vol. 110, pp. e1–e4, 2016.

[4]        B. Mampe, A. Friederici, A. Christophe, and K. Wermke, “Newborns’ Cry Melody Is Shaped by Their Native Language,” Curr. Biol., vol. 19, no. 23, pp. 1994–1997, Nov. 2009.

[5]        J. T. Cacioppo and S. Cacioppo, “Social Relationships and Health: The Toxic Effects of Perceived Social Isolation,” Soc. Personal. Psychol. Compass, vol. 8, no. 2, pp. 58–72, Feb. 2014, doi: 10.1111/spc3.12087.

[6]        H. Tajfel and J. C. Turner, “An integrative theory of intergroup conflict,” in The Social psychology of intergroup relations, W. Austin and S. Worschel, Eds. Monterey, California: Brooks/Cole, 1979, pp. 33–47.

[7]        W. Peters, A class divided: Then and now. Yale: Yale Univ Pr, 1987.

[8]        P. G. Zimbardo, C. Maslach, and C. Haney, “Reflections on the Stanford prison experiment: Genesis, transformations, consequences,” in Obedience to authority: Current perspectives on the Milgram paradigm, T. Blass, Ed. New Jersey: Laurence Erlbaum, 2000, pp. 193–237.

[9]        M. Hewstone, M. Rubin, and H. Willis, “Intergroup Bias,” Annu. Rev. Psychol., vol. 53, no. 1, pp. 575–604, 2002.

[10]      W. A. Cunningham, M. K. Johnson, C. L. Raye, J. C. Gatenby, J. C. Gore, and M. R. Banaji, “Separable neural components in the processing of black and white faces,” Psychol. Sci., vol. 15, no. 12, pp. 806–13, 2004.

[11]      V. A. Mathur, T. Harada, T. Lipke, and J. Y. Chiao, “Neural basis of extraordinary empathy and altruistic motivation,” NeuroImage, vol. 51, no. 4, pp. 1468–1475, Jul. 2010, doi: 10.1016/j.neuroimage.2010.03.025.

[12]      L. T. Harris and S. T. Fiske, “Dehumanized perception: A psychological means to facilitate atrocities, torture, and genocide?,” Z. Für Psychol. Psychol., vol. 219, no. 3, pp. 175–181, 2011.

[13]      S. Y. Liu and I. Kawachi, “Discrimination and Telomere Length Among Older Adults in the United States: Does the Association Vary by Race and Type of Discrimination?,” Public Health Rep., vol. 132, no. 2, pp. 220–230, Mar. 2017, doi: 10.1177/0033354916689613.

[14]      K. K. Ridout, M. Khan, and S. J. Ridout, “Adverse childhood experiences run deep: toxic early life stress, telomeres, and mitochondrial DNA copy number, the biological markers of cumulative stress,” Bioessays, vol. 40, no. 9, p. 1800077, 2018.

[15]      C. K. W. De Dreu, L. L. Greer, G. A. Van Kleef, S. Shalvi, and M. J. J. Handgraaf, “Oxytocin promotes human ethnocentrism,” Proc. Natl. Acad. Sci., vol. 108, no. 4, pp. 1262–1266, Jan. 2011, doi: 10.1073/pnas.1015316108.

[16]      C. Fershtman and U. Gneezy, “Discrimination in a Segmented Society: An Experimental Approach*,” Q. J. Econ., vol. 116, no. 1, pp. 351–377, Oct. 2011, doi: i: 10.1162/003355301556338</p>.

[17]      C. E. Ashton-James and J. L. Tracy, “Pride and Prejudice: How Feelings About the Self Influence Judgments of Others,” Pers. Soc. Psychol. Bull., 2011.

[18]      L. E. Williams et al., “Fear of the Unknown: Uncertain Anticipation Reveals Amygdala Alterations in Childhood Anxiety Disorders,” Neuropsychopharmacology, vol. 40, no. 6, pp. 1428–1435, May 2015, doi: 10.1038/npp.2014.328.

[19]      K. Ohashi, C. M. Anderson, A. Polcari, A. Khan, and M. H. Teicher, “Psychopathology and Impaired Brain Network Architecture: The Importance of Childhood Maltreatment,” in BIOLOGICAL PSYCHIATRY, 2014, vol. 75, pp. 88S-88S.

[20]      P. K. Hatemi, R. McDermott, L. J. Eaves, K. S. Kendler, and M. C. Neale, “Fear as a Disposition and an Emotional State: A Genetic and Environmental Approach to Out-Group Political Preferences,” Am. J. Polit. Sci., vol. 57, no. 2, pp. 279–293, Apr. 2013, doi: 10.1111/ajps.12016.

[21]      R. Kanai, T. Feilden, C. Firth, and G. Rees, “Political orientations are correlated with brain structure in young adults,” Curr. Biol., vol. 21, no. 8, pp. 677–680, 2011.

[22]      G. Anzures et al., “Brief daily exposures to Asian females reverses perceptual narrowing for Asian faces in Caucasian infants,” J. Exp. Child Psychol., vol. 112, no. 4, pp. 484–495, 2012.

[23]      J. Renshon, J. J. Lee, and D. Tingley, “Physiological Arousal and Political Beliefs,” Export BibTex Tagged XML Immigrationanxiety Pdf, vol. 559, 2013.

[24]      L. Garbe, R. Rau, and T. Toppe, “Influence of perceived threat of Covid-19 and HEXACO personality traits on toilet paper stockpiling,” 2020.

[25]      K. O’Brien, W. Forrest, D. Lynott, and M. Daly, “Racism, Gun Ownership and Gun Control: Biased Attitudes in US Whites May Influence Policy Decisions,” PLoS ONE, vol. 8, no. 10, p. e77552, Oct. 2013, doi: 10.1371/journal.pone.0077552.

 

 

 

 

 

 

 

 

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Covid-19, Disproportionate BAME deaths, inequality and adverse childhood experience. A serious plague

 

As too often, the poorest and most discriminated against are suffering most, and bearing the brunt of an unequal neoliberal agenda.  This is a serious political issue, literally deadly serious

 

One of the extremely shocking features of the current epidemic is the disproportionate number of people from Black, Asian and Minority Ethnic Groups who have become ill and died. For example, many US cities report that 70% of the deaths have been from minority groups, even when these groups make up only 30% of the population. In the UK it looks like about 35%  are from non-white populations who in fact make up only 13% of the population, although, possibly as a cover-up, the government seems to not even be recording race and ethnicity formally.

There is a lot to unpick here, some speculative. The disproportionate illness levels are linked clearly to who is bearing the brunt on the front-line. Those designated as keyworkers, such as nurses, doctors, and equally those who work on public transport, in supermarkets, in refuse collection and many other ‘essential’ services, are at most risk of exposure to the virus. Many also have zero-hours contracts, work in poor conditions and are struggling to keep bread on the table and pay bills. A disproportionate number of people from BAME groups work in poorly paid insecure roles such as those above.  Similarly nursing in this country is shockingly under paid and a disproportionate proportion of nurses come from BAME backgrounds, and indeed vast numbers are imported from abroad due to worrying staff shortages.

Viral load, the sheer amount of exposure to the virus, is obviously an important causative factor, and explains some of the deaths of front-line health workers, but it is hard to square the pictures of the first 10 doctors who died in the UK all being from BAME groups. While some have hypothesised genetic predispositions, other research has talked about certain blood-types conferring resistance, and others talked of vitamin D deficiency, the jury is still out on these factors. Dietary factors linked to culture and social class/poverty might also be an issue (e.g. high fat, salty, sugary and especially processed foods). In addition, there likely is also unconscious racism, with certain groups possibly prodded to take on the riskier tasks, but we do not know for sure.

 However, what is incontrovertible is that a disproportionate number of people dying and having serious symptoms have what has euphemistically been called underlying health conditions. Those who seem particularly at risk are people who have well above average obesity levels, diabetes, heart and lung conditions and a range of metabolic syndrome disorders, as well as those who are immuno-suppressed. For the under 60’s for example, being obese seems to at least double the risk of hospital admission and indeed, mortality, and this has been seen in many countries, including the USA, UK and France.

This is by no means just bad luck and needs urgently to be linked to other findings out there about the effects of inequality, discrimination and particularly the long-term lifetime effects of Adverse Childhood Experiences (ACE’s). The data we have seen linking obesity and Covid-19 illness severity is crude, based primarily on Body Mass Index (BMI) measures, but we know that BMI is just one of many biomarkers linked with ACE’s .

What we know for certain is that, generally, more adverse life experiences, especially earlier on, are linked with worse health outcomes later, and to earlier death, and Covid-19 is not about to make an exception to this.

Multiple detailed studies show how, using basic measures of ACE’s, the more ACE’s someone has experienced, the worse the physical as well as mental health outcomes. While obesity is one marker, we see the same link and trajectory with, for example,  hypertension, heart disease, strokes, cancer, diabetes, arthritis,  lung disease, insulin resistance, inflammatory disorders, to name a few, and that is without mentioning the host of psychological effects, from depression,  anxiety disorders, eating disorders, a list too long to write. Typical, and hugely relevant for Covid-19,  is the clear link between ACE’s and COPD, Chronic Obstructive Pulmonary Disease, a huge cause of death anyway in the western world, and about 2.6% higher in those with 5 or more ACE’s.

It is important to note a few things here. While adverse experiences might increase the likelihood of behaviours which are risky, including smoking, poor diet, addictive behaviours, still, the pathways to such ill-health and the links between psychological and physiological states are multi-layered and overdetermined. Yet, seems clear that important genetic pathways are turned on or off by adverse experiences, one example being the glucocorticoid receptor, very linked to many serious psychiatric disorders. Being under stress and thereat lowers our immune responses, and anyone’s immediate survival needs in the face of danger will trump the body’s desire to look after long-term immunity. Indeed cortisol, often seen as the ‘stress hormone’, is a steroid with immune dampening effects.

Similarly, more Adverse Childhood Experiences equates with a range of effects on the nervous system, and the brain (eg on the hippocampus, amygdala, PFC and so much more). Constantly being on ‘red-alert’ for danger or stress has powerful effects on immune functioning and the ability of the body to relax and recover, the healthy parasympathetic ‘rest-and-digest system barely getting a look-in while we are under threat.

How does this link to BAME morbidity and risk in the current crisis? People from minority ethnic groups are grossly over-represented in the population struggling with poverty, economic stressors, scary neighbourhoods, psychiatric problems and so much more.  We are seeing the effects of structural inequality at a society-wide level. Of course, as scholars such as Wilkinson and Marmot have shown unequivocally, inequality itself in a society has profound health effects. The more unequal societies have much worse health outcomes than more egalitarian ones.,

This is without taking account of the effects of, for example racism. Racial discrimination alone has an effect at a biological and cellular level. Those from minority groups in areas of the US with more discrimination have been found  to have higher levels of the stress hormone, cortisol, and also show faster biological ageing, as measured by telomere length. This is mediated by oxidative stress and is linked, for example with type-2 diabetes and obesity.  The over-determining factors pile up. More stress increases the propensity for addictive behaviours, for having raised blood sugars (needed in fight/flight responses), for eating the /sugar/salt infused food peddled by fast food companies, to conserve fat more, to affect sleep, needed for immune responses, and so it goes, on and on and on. This is the tip of the iceberg.

We might add to this the effects of lockdown. While the privileged, like myself, can manage to pay bills and buy food and have a home with internal and external space, many families lack this pressure valve, and were already experiencing huge emotional challenges pre-Covid. As children’s charities are warning, such serious chronic stressors are being exacerbated in the current crisis. We have seen an increase in domestic violence reported and we might surmise that there is also likely to be an increase in child maltreatment.  People in such families are already suffering, especially the children perhaps, but the chickens will certainly come home to roost in terms of poor health outcomes later in life, and indeed intergenerationally.

We need to begin to take this research very seriously. As Marmot’s recent report showed, health inequalities, even pre-covid, had worsened in the last decade, Life expectancy has stalled in the UK, inequality has widened, and more people are predicted to be in worse health as they get older.  Perhaps most worrying of all, wealth inequalities have grown hugely, and of course on average those from BAME groups tend to suffer the worst effects of this.

Thus while it is true that there are links, for example, between obesity and COVID morbidity, the obesity factor is just one piece of the puzzle. Without doubt, racism and discrimination needs to be taken very seriously, and fought against, but it also needs to be linked to structural inequalities. Obesity is just one of multiple biomarkers that we might use and there is host of other measurable markers one could point to.

This is a serious political issue, literally deadly serious, and as often the poorest and most discriminated against are suffering most and bearing the brunt of an unequal neoliberal agenda. This is not just about the level of NHS resources, and who has access to them, although it is as well. This issue of who is ill and dying and why, goes to the root of how we have organised society, and the effects of this are showing up at a biological and cellular level as well as psychologically. While we all applaud the amazing courage and generosity of our NHS frontline workers, this might also be a moment to stand up and be heard campaigning about racial and other inequalities.

 

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Guest — Melinda Elson
Thank you for this Graham, a very important piece. Perhaps you can get this into one of the national papers? It needs to be read, ... Read More
Monday, 20 April 2020 19:13
Guest — Emily
I agree, I’d like to see this information being distributed more widely as the ramifications of this crisis are going to be far re... Read More
Tuesday, 21 April 2020 20:19
Guest — Deirdre Fay
This is an important link you're making, Graham. As you say, "literally deadly serious" ...."goes to the root of how we have org... Read More
Saturday, 25 April 2020 15:08
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Brief briefings from isolation. Zooming in or zoomed out? Tech use and small silver linings

We are all experiencing different forms of discombobulation in the current crisis and finding our own ways to manage our situations.  This is not a life or death matter, but I have been thinking about our use of technology and web-based interactions in the crisis and lockdown.  I, like many, have made friends with technology in a surprising way and have been developing a newfound gratitude for it!

Pre-covid many of us felt like slaves to our devices, being addicted, despite ourselves, to a range of media, twitter, Instagram, emails, Whatsapp and flicking through news. For others it was gaming, shopping, gambling and for many it was more worrying media such as pornography. What we had been learning from research on the brain was that high use of such media was correlated with higher activity in brain areas also involved in addiction and the dopaminergic system, such as the nucleus accumbens and ventral striatum.

This was no coincidence. The most senior executives of tech companies have admitted how they aim to keep us online by stimulating little dopamine surges, and of course the more they keep us online, the more advertising they can sell. Many such senior executives, such as Tim Cook of Apple, have been quoted as saying that they do not let children in their lives use social media or smartphones. Interestingly Mark Zuckenberg does not use facebook, and the same is true of executives at twitter and other  Big Tech  companies who are fully aware of the addictive patterns  tech use creates. They seem to be guided by the old dealer’s mantra ‘never get high on your own supply’.

For many the effect of high levels of screen-time has been a buzzy mindset, our minds jumping around even more, less capacity to be still and concentrate, less activity in parts of the brain central to executive functioning as well as empathy and emotional regulation, and what some have called ‘hypo-frontality’, the downegulation of the prefrontal cortex. Seemingly concentration spans had been diminishing in most western countries, some have suggested we are at risk of falling behind goldfish in our capacity to attend! This is alongside falls in empathy, and presumably compassion.

So what now, in the midst of this crisis? This is purely personal and anecdotal, but I have found that, whilst I still spend too long fiddling on my phone and flicking around for news, such as for death rates or politicians’ announcements or yet another daft meme, I have noticed something new.

I can now have longer conversations on a screen without jumping around between websites and computer windows, probably to the chagrin of google and others who depend on our jumpy attention to sell advertising . Most days I will have long chats, with friends, or family, over video, where we can concentrate on each other and give each other time. Like many I have had several dinner dates, bookclubs and other  fulfilling interactions. I am seeing patients over similar media, and often the work is deep, people feeling reached, heard, empathised with; surprisingly genuine compassion seems possible via screens.  Similarly I have been doing some teaching, as well as giving and receiving meditation spaces, and partaking in yoga and pilates classes and personal fitness training sessions.

Whether or not these activities are as fulfilling as doing them ‘in the flesh’ is a moot point, and for me I don’t feel they are, some feeling more satisfactory than others. I particularly miss whole body awareness, the cues from body language that are harder to get, the clues from other senses such as smell. Nonetheless these new forms of interaction are changing how  we might experience the computer screen. Some of this is pure Pavlovian behaviorial association. For example, while I have worried about seeing patients online who use the very same screen to meet with me and to view worrying images, a shift seems already to be occurring. Research by people like Valerie Voon had found that for a porn ‘addict’ just seeing a computer screen could give rise to activation in brain areas central to the dopaminergic system, such as the ventral striatum, the exact same areas that we see light up when an alcoholic, for example, walks past a bottle of their tipple of choice. My hope is that this association will change for  tech addicts such as our porn user patients, as they increasingly use screens to communicate in more meaningful ways. Again, only anecdotally, I am noticing my body being in a less buzzy state as I sit by my screen in anticipation of a 50 minute session or family chat. Earlier research showed that waiting for our email inbox to open gave rise to spikes of stress-induced sympathetic nervous system activity, but I don’t notice that when I am about to have a therapy session or meet an old friend online, even if it is not really the same.

Of course it is not the technology that has ever been the problem but rather, how it is manipulated by the companies that harvest data and make unthinkable sums of money via advertising and the like. There always have been countervailing forces thankfully, even before new tech experiences arising from lockdown. For example,  I have become increasingly interested in uses of tech such as in neurofeedback, which can support the development of a range of skills such as concentration, mindfulness, executive-functioning and many other hopeful developments, including ameliorating symptoms such as ADHD, depression, trauma-symptomatology and much more.

Like so much in these dark times,  we must face the awful reality of what so many are experiencing, but there might also be some silver linings, whether working less, being less frantic, being less materialistic, less polluted, and possibly we might add a new way of being with and harnessing tech, taming it so it does what we want it for, for us to feel more human, to make it helpful for us,  a resource we can use for the good,  rather than our too common knee-jerk reactivity to Big-Tech puppet masters pull their powerfully addictive  strings.

 

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Coronavirus, moral panic, psychic and physical threat, danger and social immunity

 

We are in the grip of huge physical and psychological threat from the coronavirus. Like all species, humans have clearly evolved mechanisms for both responding to, and avoiding, pathogens. There are similarities between the fear response, as seen for example when there is danger of being confronted by an aggressor or predator, and the fear of pathogens. Both give rise to distrust, anxiety, fear of the ‘other’, ‘disgust’, and autoimmune inflammatory reactions.

I have been watching my own and others’ reactions on the streets. Fear, anxiety and distrust are powerfully present. It feels strange to shirk proximity, move away from strangers and avoid close contact. I particularly feel for children now, as they, as potential ‘spreaders’, are eliciting fear and disgust reactions in many which could have a psychic effect. The brain circuits involved in physical pain are equally active in social ostracism, and children particularly tend to interpret the world through adult eyes, and as Winnicott said, gain their sense of self that way. Who wants to be viewed as a social leper, a dangerous potential pathogen inducer to be avoided?

Avoiding danger is of course is what most species do,  moving away from pathogens, whether avoiding infected foods, forming colonies near plants that pathogens don’t like, or developing internal group hygiene, such as bees clearing out worrying larvae and ants at times doing the equivalent of ‘deep-cleaning’.  Many species do what we are doing now, and actively become more isolated.

When we smell something putrid or ‘off’ we tend to feel, and indeed signal, disgust, and whole areas of the brain, particularly the insula, are activated. Smell is possibly the most powerful sense-organ, but sight (eg awareness of other’s worrying bodily  such as boils or pox) and touch also are used to detect threat. Indeed, trauma victims so often seem to have highly developed sense of smell, especially when the abuse happens at a very young age. Decisions such as what to eat, who to mate with, are influenced by such subtle non-conscious factors.

What we know is that when in a state of stress or when sensing danger, we all tend to be more suspicious and less welcoming of others generally, in psychoanalytic language we have heightened paranoid-schizoid responses. Humans anyway have an innately constituted fear of  those we see as ‘other’. Even babies prefer others who look like them, talk like them, and act like the trusted adults in their circles, but that exacerbates in times of fear and danger, when borders are all but closed.

Social safeness and safeness from pathogens are linked. A classic example is grooming within groups of conspecifics, like primates., Those who are groomed and groom have been shown to harbour less infection-inducing tics and parasites. The additional benefit is feeling good. Higher status chimps get groomed more, especially by low status ones, for example, and grooming fosters a sense of social harmony in which neurochemicals such as oxytocin are released. In humans we have other mechanisms which foster the same things. Singing, dancing, social and family gatherings, which all heighten oxytocin and immune responses, lower inflammatory ones, and are linked with feeling good. Social outcasts, whether primates or humans, tend to have lower serotonin, for example, and higher cortisol. This is a  real danger at the moment when isolation and lack of community is a threat to mental health and especially the psychologically vulnerable..

I had always assumed that in-group loyalty and out-group suspicion, even in babies,  had a good evolutionary rationale as a main predator of infants and children was often males from another social group who might, for example, kill offspring spawned by other men and indeed, kill those other men too. What I had not sufficiently considered is the powerful fear of the ‘other’ carrying genuinely dangerous pathogens. We know this all too well from the accounts of the genocide of indigenous populations in Australia and the Americas, decimated by viruses carried by Europeans.

Fascinatingly of course oxytocin fosters not only in-group trust and cohesion but also distrust of those in out-groups. I again had always assumed this also to be linked to the dangers of attacks from rival groups, but it makes sense that fear of viruses and pathogens is central here too.

It is no coincidence that Trump, in characteristic xenophobic fashion, attacks a ‘foreign’ virus. Pathogens of course are always ‘foreign’ but this conflation of fear of a pathogen and fear of the other is worryingly common. Certainly, anecdotally it is my non-white clients, particularly Asian ones, who have felt most shunned in the last few weeks. We know from social neuroscience that we can non-consciously demonise certain others, such as the homeless and drug-addicts,  and despite what we consciously avow, often our brains, when looking at drug--addicts, or even those of other ethnicities, show less activity in networks involved in empathy and recognising the other as human, such as areas in the medial prefrontal cortex. Instead we often see increase activity in areas of the insula which are linked with disgust signals as well as in amygdala-linked fear and aggressive reactions. Both also are often activated with a threat of pathogens. The worry is that dehumanisation can kick in, the other (e.g the infected, but also the rival shopper) becoming ‘subhuman’. Similar brain mechanisms are thus involved in both Trump-like xenophobia, and in fear of pathogens.

A major health concern is the rise in inflammatory conditions. Inflammation of course is an appropriate response to heal an injury, wound or danger. We need inflammation when we have an injury or when eating toxic food. Our immune antibody army then generally does a great job sending inflammatory cytokines like IL-6, TNF-alpha, CRP, and multiple macrophages etc  in to fight dangerous intruders. However, such immune responses go into overdrive in disorders such as lupus, fibromyalgia and so much more, and cannot tell the difference between the benign and the dangerous. The same happens with trauma, high levels of stress and competition threats, including this virus. It is no coincidence that stress, trauma in childhood is linked to higher levels of most pro-inflammatory cytokines in adulthood. 

High inflammation is also central in depression, and inflammation might have had a specific evolutionarily important role in managing pathogens and disease, fevers and hot temperatures often vital for dealing with viruses and other diseases. High inflammation is also linked to social aversion as well as stress, depressive symptomatology, anhedonia, lethargy, possibly because social isolation decreases infection risk. High cytokine activity comes with threat responses, hypervigilance and much else seen in stress, anxiety and psychological trauma. The same genes are involved in both depression and defence against pathogens, genes that are less present in societies where there is less risk of physical infection, and where there is also less depression.

What we seem to be uncovering is an extraordinary synergy between fear of the other, fear of pathogens, expectation of danger or threat and links with the rise of xenophobia, racism and ‘othering’, and links also between these and depressive and other metal health symptomatology.

Anyway of course, in danger and major stress brain circuits involved in empathy and rational thought go into abeyance as survival-based responses kick in, including panic and aversion, and that is in large part what we are seeing in the panic-buying and hoarding. It is interesting that in more socialised  European countries, those less in the grip of neoliberal competitive ideologies,  there is plentiful food on shelves, unlike in our increasingly competitive one with decimated services, massively cut hospital beds and our main drivers increasingly being individualism, profit and greed.

Assuming that lock-down, isolation and banning foreigners is the right approach for covid-19 ,  we still need to recognise that this comes with dangers to us as a society, such as discrimination, vigilant distrust, depression and much more. There are also real risks in social isolation, and taking away the main sources of emotional wellbeing, which are community and cherished others. In response we need to keep alive influences that combat this, whether friendships, family, forms of self-care. I have noticed myself giving really nice looking people a wide birth, and but if I catch myself I can take a deep breath,  thank them for moving away from me rather than feeling threatened, and while keeping a distance, make sure I have a slightly more open face, smile (heart) as I walk through the places I can still walk.

We can and should, for our own and others’ good, keep alive our capacity to reach out compassionately and kindly to others at a time when such pathways are endangered by heightened threat, fear and disgust reactions, alongside social withdrawal. So, if we need to self-isolate to protect self or others, or if we have to work on the front-line, at the risk of being Polyanna-ish, let’s try to keep hold of compassion, for ourselves and others.

 

 

 

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Guest — Sarah Hartley
Thank you for this Graham!
Saturday, 14 March 2020 13:31
Guest — Gabriela
Thank you graham! So well spoken! Kindly Gabriela Jones
Sunday, 15 March 2020 08:55
Guest — KeiraLianne
Very interesting- thank you for sharing!
Monday, 16 March 2020 23:04
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Neglecting Neglect: Why Therapists Do It & How We Can Break the Cycle 

A version of this blog recently appeared on the Psychotherapy Execellence Website  here  

 

Why Neglect?

In Nurturing Children I use clinical stories to illustrate essential elements of good therapeutic work. Ultimately therapeutic success depends on a good alliance, empathy, compassion and mutual resonance, alongside carefully gleaned skills and understanding. Yet some patients leave us feeling de-skilled, hopeless, even dreading sessions. I find this especially when working with people with histories of neglect, who have experienced insufficient growth-inducing experiences. This is different to those who are victims of, for example overt abuse or violence, who tend to be more reactive and challenging,

 

The feelings stirred up in us can be hard to own up to if our personal narratives include being ‘caring’, ’interested’ and ‘empathic’.

  • With such clients we often feel flat, bored and dulled-down.
  • They appear 'empty', inhibited, passive, self-contained, with minimal capacity for mentalizing.
  • They show little pleasure, rarely inspiring hope, affection or passion.
  • They can be thought of as 'under-looked' or 'unenjoyed', or after Alvarez, ‘undrawn’ rather than ‘withdrawn’.
  • They slip out of minds, stirring up little interest or worry.

 

Spectrum of neglect

  • from extremely deprived orphans to milder forms,
  • such as those with very emotionally avoidant, or depressed parents.

True I risk conflating symptoms and causes, as similar histories do not necessarily lead to the same symptoms, but there are sufficient commonalities to describe a common clinical experience.

 

Double deprivation

Neglected children initially receive scant attention, and later further deprive themselves by barely recognising life-enhancing relationship opportunities. While born with the same preconceptions of lively interpersonal exchanges as anyone, the lack of good experiences leads to lifeless internal objects, with little hope of introjecting anything good. They seem to project little too, having surprisingly little effect on others.

 

Nervous systems and brains

Inadequate early experience leads to ‘dampened down' nervous systems, the opposite of hyperactive aroused people. Emotional deprivation profoundly affects brain architecture, and programs our neurochemical system. (eg releasing less oxytocin).  Many develop autistic-like symptoms, lacking empathy and avoiding intimacy. We see deficits in right orbitalfrontal region, central to attachment patterns and emotional regulation, and less prefrontal left brain activation, central to agency and pleasure.

 

Countertransference

Such people evoke less interest than those with better developed autobiographical and emotional capacities. Our words and gestures, given with meaning, can feel denuded of life. It is in one’s countertransference that one really learns about these clients, and what it is like to be them, but our attuned resonance can lead us to feel as dead as them. We can say things in therapy just to escape their lifeless worlds.

 

Clinical technique

We must sustain an empathic stance without being drawn too far into such lifelessness, to stay psychologically animated enough to breathe life back into their psyches, while avoiding the trap of a 'going-through-the-motions'  faux  psychotherapy. Research even shows that anyone interacting with avoidant people becomes less interested in people generally!

 

With such patients we need a more ‘active’ technique. They often know little about positive emotional experiences such as enjoyment, excitement, attunement, playfulness or joy. To develop an interest in oneself and others, someone must have been interested in us. In therapy we tend to work a lot with clients’ defensive and fear systems, helping to manage difficult feelings. However, with these patients we also need to build their ‘appetitive’ seeking systems, via mutually enjoyable interactions, allowing aliveness to flourish.

 

Summary

Humans are born ‘experience expectant’, primed for interpersonal interaction, but emotional development is stymied without growth-inducing relationships. In therapy we need to find a way to encourage agency and positive affect, and the paradoxically, step back from lifeless encounters to empathically be in touch with such lifelessness. With them we walk a delicate tightrope between amplifying aliveness, agency and enjoyment while not being too intrusive, manic or seductive.

 

This blog describes children and adults I feel particularly worried about, who rarely inspire passion and therapeutic zeal, who have been neglected emotionally in their early lives, and often then evoke further neglect. The long-term sequelae of such neglect can be 'deadly' serious, probably more harmful, yet less noticed, than more visible trauma. Neglected children and adults I have worked with often ‘warm up’, get livelier and more real, given sufficient adaptation to our practice, and the courage of emotional honesty.

 

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Joining forces; Telomeres, social, psychological and political challenges

 

In the last few days I came across yet another interesting article [1] showing that prenatal stress is linked with  shorter telomeres. Telomeres are those caps on the end of chromosomes that can fray and shorten with stress and age [3], are a classic biomarker for health. Shorter telomeres are bad news, heralding ill health, and indeed, early death, or in other words early stress might program the body to develop a faster metabolism, which also leads to faster ageing and more physical and mental illness. One recent meta-analysis looking at over 40 papers corroborated how early adversity, such as abuse or neglect, links with shorter telomere length [2].

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