CHIP 24-25 Modern An-Transcript PDF

SPEAKER 0 Some of the things that have happened in psychology post 1950, but also to cover how psychology became used in applied settings. There's a couple of areas I'm going to focus on in in great detail this this week in clinical psychology and in psychometric testing. So I've rejigged this lect...

SPEAKER 0 Some of the things that have happened in psychology post 1950, but also to cover how psychology became used in applied settings. There's a couple of areas I'm going to focus on in in great detail this this week in clinical psychology and in psychometric testing. So I've rejigged this lecture a bit to predominantly focus on these two issues as areas in which psychology very quickly became applied by psychologists. Um, in in situations such as for treating mental health or for administering psychological testing in education. Um, on top of that, there's a few other other bits and bobs that will cover, for instance, about the brain, about the emergence of social psychology and finally how psychology became embedded in work situations. So that's that's going to be, um, the sort of flow and the lecture structure for this week. So there's going to be a break in the middle. Um, the first half we will cover the emergence of clinical psychology. So how psychology became a, a discipline that administered psychotherapy, um, psychological treatment to people with mental health conditions such as depression or anxiety. We'll have a break. Then we'll talk about psychometric testing where that became very heavily used, particularly in America, for selection for various roles, but both at school level and at work. And then finally do a little bit more on the modern history of psychology. So that's that's what we're going to be doing today. So let's click kick off with with clinical psychology. So how psychologists became involved in the treatment of mental health. So the objectives for this section are as follows. First to identify the emergence of professional psychology within a clinical setting. Um, but also then afterwards how that that occurred in in different scenarios, such as the workplace in schools. Um, while I'm talking about both clinical and psychometric testing psychology, there's a couple of things that I want you to keep in mind as I do so. So particularly how psychology ended up influencing public policy. So how did psychology influence public discourses around mental health, around individual differences? Was that good or bad? Did in some ways it, uh, create problems. But also, how is it that those events have influenced psychology as well? So it's not simply that psychology enters the public discourse, but the priorities from that, from policy, from from the news also influence how psychologists, uh, focus their research to, um, in my own research, you see that quite a bit. So my interest is in um, is an addictive behaviours. But I have a sort of a sub area within smartphone use and smartphone addiction where a lot of the pressure for, for researching that has come from the general public has come from policymakers, parents, schools, rather than necessarily from the academic literature. Is this kick off with with psychotherapy? Mostly? This is going to be a bit of a recap from lecture three. So so when when we covered the 19th century, the late 1800s. So in that lecture, you'll have done a little bit on Sigmund Freud and his role, as in many ways like the father of ironic given the theory, the father of psychiatry and psychotherapy. So, um, Freud was was largely innovated. How we think about psychotherapy today that that is sort of the, the catalyst for for that. But Freud was a medical doctor. He wasn't a psychologist, he was a psychiatrist. And that is an important distinction to make, because certainly at the time doctors were very protective of their treatment. So, so for psychiatry they had developed psychotherapies, this treatment approach, and they saw it as a medical treatment that should be administered by licensed professionals. So in the early days, psychologists weren't allowed to conduct psychotherapy on their own. And it was something that had to be done by psychiatrists. And so even though it had become a thing, it was something that was was outside of what was considered psychology. Now, there were some early initiatives that tried to link psychology and psychiatry, that you can start to see some of the beginnings of clinical psychology. So you've got people, um, like Theo Juel Ribot, who was a professor of experimental psychology in, in Paris, in France, who bridged many of those, those sort of gaps between medicine and psychology. So, so he published extensively on a number of different areas of psychology. You can find most of his books online these days. They're quite interesting is a read, I think, in one way, because it lets you see how psychology was conceptualised, but also how it differs in many ways. He wrote about things like like personality disorders, disorders of, well, um, disorders of memory. And the way that those are thought about are in many ways quite different how we do so today. So like often when, when perhaps we think of disorders which involve impaired willpower, We might think of things like perhaps addictive behaviours, whereas the disorders that we focus on are fundamentally very different. So it's interesting in that to get a viewpoint into how those were conceptualised. But he wrote about those, but he wasn't actually allowed to conduct psychological therapy himself. So the way that they got around that in in late 1800s France is that you would have people who did their, their psychological research, their psychology, psychology degrees with Robert and then would go and study medicine under people like Charcot, who were influences on, on a whole range of French, um, sort of psychiatry and psychology, but also people like Freud as well. So you would have people who studied psychology and then studied psychiatry and could then administer psychological psychotherapy. So there were these sort of pathways between psychology and medicine that allowed um people with psychology training to administer treatment. A similar case in the UK. So in 1920 the Tavistock Clinic was set up. And that again was was sort of an alliance between doctors, social workers, psychologists to administer psychological treatment. So Tavistock Clinic was the first psychotherapy clinic in the UK. Um got eventually absorbed by the NHS. It's still it's still does um it still does psychotherapy. Um, I think for probably most people here, it's mostly known for one of its clinics that focuses on gender identity. So for many years the Tavistock Clinic in London was the the main clinic that specialised in the UK on on gender identity and gender transition. That's that's now changed, that's been shut down and has been been spread across the country. Um, but you had a similar model in the UK as well. Um, where you have sort of an alliance between psychologists, psychiatrists in order to train people to develop psychological therapy. And before I leave on that, the picture on the right is of the agile rebel wearing the jazzy suit. Um, it was by far the most interesting one I could find. He seems quite harrowed, though, like the look on his face. He doesn't look like he really wants to pose for the camera. Over in America, you have quite a different model that emerges. So, um, psychologist by the name of Lightner Witmer, who was a founding member of the American Psychological Association, came up with the term clinical psychology and set up the first psychology clinics in America at the end of the 1800s, beginning of the 1900s. The way that he did so was quite different to the model in France and the UK though. So, because he couldn't administer psychotherapy himself, instead took a different approach and focussed on the treatment of educational needs in in school children. So quite similar to in many ways quite similar to educational psychology today or particularly to people who work with special educational needs, where he would work with, with, with young students who might have issues such as like dyslexia and try and work with them to, to remediate or to work around those difficulties. So either by changing the environment or changing the way that they learn to, to get overcome the difficulties that they experience. So in order to administer some sort of treatment would do so within a specific educational setting rather than the treatment of mental health per se. And in addition to to setting up these clinics, he was also quite evangelical about the need for psychology to become a clinical discipline. So he wrote extensively on issues of what he thought a clinical psychology should be. And so he wrote a paper which is in the further readings, by the way, if you want to give it a try, it's it's quite an interesting, quite accessible paper that summarises what he thinks clinical psychology should be. B boils down to four key points, um, the first of which is the study of mental development and disability in school children. So again, because the treatment of mental health was largely protected to psychiatrists, um, mental health or mental conditions in school children using a mixture of clinical and statistical methods. So that might be interviewing. That might be psychological testing. The development of clinics. Treat these by treat. That can mean, um, sort of interventions. It can mean changing the environment, but also to offer practical work to teachers, doctors and social workers in affiliated areas in the treatment of these, these, these problems as well. And then finally, and I think the one that that took off the most in America is the training of professional psychologists. So people weren't just trained to have a PhD in psychology and have an academic experience that the specific training of people as, as an expert in, in a professional approach. So like these days you can do a PhD in psychology, but you're not licensed or most probably suitable to give psychotherapy in the way that clinical clinical psychologist is. So so the innovation that he pushed was the specific professional training of psychologists. Um, up until about World War two in America, if you had a PhD in psychology, you you could be considered for, for clinical psychology. But then as the roles that that involved increased, increasingly, just having a strong academic background did not correspond to, to sort of clinical effectiveness. And so he was quite prescient in seeing the need for specific professional training. Also to note for before I move on quickly, um, in many histories of psychology. He's not particularly well represented. And the main reason seems to be that he was a bit of a bastard, not in terms of his professional life, nor in terms of his personal life, but professionally. He managed to really irritate and annoy a lot of people, which meant that his influence was diminished because he couldn't get on with anybody, which is an important life lesson, really. Um, it's not just about the work you do. It is how you treat other people. So that's the status of of clinical psychology. So psychologists couldn't directly administer mental health treatment in America. They, they, they they forged a path by focusing on the treatment of educational needs. And then over about a 30, 40 year period in between World War One and up until probably about the Vietnam War, you saw quite a major change in how psychology and professional psychology was was perceived, which led to psychologists being allowed to administer psychological treatment. Indeed, in America, this talks, I think in some places it has been sort of soft. Uh, put forward the clinical psychologist can now administer medication to. So there was a over that 3040 year period. There were a number of events that led to the role of professional clinical psychologists expanding considerably. Some of those events, particularly were instigated by war and some of the factors that led to a greater need for psychological support. The other is changes in psychiatry as well. So like psychology, as we covered a couple of weeks ago with behaviourism and the cognitive revolution. It wasn't simply that psychiatry was was a single discipline. In fact, it changed quite a lot over that period, too, which created an opportunity for psychologists to administer therapy to, to, um, treat mental health themselves. The first of these was the changes in war, and particularly in war in the West during World War One that created the conditions for severe mental health impact. So World War one, trench warfare. So you had two armies not too far away from each other, heavy use of artillery, machine guns. Later on in the war you saw the introduction of tanks. So you have a number of these industrial weapons that can cause a lot of damage, cause a lot of noise. Um, and their impacts are instantaneous and, and devastating. Understandably, people's response to the prolonged exposure to these was, was that they felt extreme stress. So during World War One, it was noticed that there were many people who experienced what is known as shell shock. Um, so very strong feelings of anxiety, fear, um, responsiveness after exposure to these stressors. Now, although there's there's differing opinions on what shellshock is, generally speaking, it's now considered to be sort of a precursor to post-traumatic stress disorder. Um, so it's a form of PTSD that was caused by the war environment. And what's interesting is, is from different countries across the world, you saw very different responses to this, the emergence of shell shock. So in the USA, I mean, they joined World War One a bit later in 1917. So there wasn't much to talk about in that regard. But they did notice the presence of of shellshock and they responded to it. So in America, they they considered it as a psychological problem that could be either treated or remediated or prevented. And they used psychologists and psychiatrists to do so. So they got psychologists to conduct psychometric testing to assess vulnerability to to Shellshock. To try and identify the people who were at greatest risk of developing it and put them away from situations that might cause it. They also built capacity for psychological treatment as well. So for for people who may experience it, they they tried to develop capacity, recruit psychiatrist to recruit psychologists to, um, to intervene on it when it did occur. Indeed, beyond that, um, psychiatry as a whole responded to war, particularly the Vietnam War, by classifying PTSD as a psychiatric disorder in the 1970s. So in America, the response to it was quite adaptive. In the UK, um, it wasn't. So the British response was was, I think, comparatively quite callous. So in the first step, it was to treat it as a character defect. So it was a sign of weakness, a sign of of cowardice. So first response will be, it's your problem, mate. You need to deal with it. Then, you know, if it was quite, quite severe, they would provide rudimentary care to bed, care to try and get people to recover. The other classic British response was to ban it. So the term shellshock was was banned. It was restricted so that it couldn't be spread through word of mouth through print media. So one way in which they conceptualised it, as well as a character defect, was as like a socially transmitted disease. Um, so historically, there have been certain diseases that don't appear to have a clear organic or psychological cause. So things like, like in historically things like dancing, sicknesses. And the British response was to treat it in the first instance like that as a socially transmitted disease, a social contagion, and try and shut down the spread of it by shutting down means of communication. The other thing they did to approximately 350 soldiers was in cases where they fled the field of battle, is that they shot them. So they were shot for cowardice or for, um, or for sort of, uh, deserting the battlefield. Um, and people who, who, who many of the people who did. So I'm sure there were genuine cases of people fleeing the field of battle, but there were plenty of those where it was purely shellshock. Um, and they were only pardoned, I think it was about 15 years ago. So. So it's relatively recent in our history that that has been acknowledged that that probably wasn't the right thing to do, all things considered. And then in World War two, they banned the term again. So classic British British response really, of just put your head in the sand and hope it goes away. Um, which it didn't really do. The other thing to note on that, though, is especially in America, it meant that psychological problems were taken more seriously. So given that these were sort of healthy, active young men, that they were experiencing these severe psychological problems meant that it was taken a bit more seriously. So if you think back to the way that the Freud's patients, for example, they were sort of, you know, middle class Viennese, um, typically children or women, um, but also the other realm of psychiatric treatment was, was the people being put into asylums. And so it wasn't taken perhaps as seriously as, as cases like shellshock as well. So a number of factors there that that changed how mental health was perceived. The other one I want to mention a bit is in relation to substances that are potentially addictive. So throughout the 1800s through to the 1900s, there was a temperance movement in America, Canada, the UK and Europe that came from a mixture of religious and moral grounds, with a focus on, on, um, raising concerns about the use of opioids, alcohol, um, by people and that it was harmful, it was unhealthy, and that it should be reduced or even better yet, stopped completely. So, um, I mean, alcohol has been been sort of around for us going back to ancient history, but but certainly with opioids, um, you know, the UK was the leader in the opioid trade. Um, we, we, instigated several wars to force other countries to accept our opium, um, which didn't go down very well. Um, so you have the use of these substances was pretty prevalent in society, even though there was evidence of harm. And the temperance movement was focussed on trying to raise social awareness about the harms associated with these, to pressure governments to restrict or ban the use of these substances, and also to highlight that there are unhealthy, um, particularly thinking about mental health and thinking about changes in how mental health was perceived, one of the ways in which the temperance movement really pushed this was to frame alcohol opioid use as a potential disease, as an addiction. So alcoholism, they first framed as a nervous system disease, um, which then eventually evolved into what we think of as addictions today. So one of the ways in which they tried to to shift public sentiment and influence people's views was to highlight the dangerousness of these substances and argue that it was a psychiatric and neurological disease. And it worked to some extent. In America, you had prohibition for 13 years, didn't work so well. It didn't really achieve its main goals. It was massively unpopular and was eventually repealed. Um, but it did have influence. It did lead to major, um, societal change. But treating it as a disease, did you know that that does have some implications for how we think about mental health. It's not simply that it's a character defect, a personal failing. Instead, it implies sort of impairments to to control, to willpower. Um, that suggests that for certain things, these aren't things that we can freely choose. The other, the other, um, contribution I want to talk about briefly is that the, the that sort of that movement, that approach created new models of psychological therapy. So in, in America you had, um, Alcoholics Anonymous that was created in 1935 as a peer support mechanism for people with severe alcohol use problems. So, um, the way alcohol Alcoholics Anonymous broadly works is it's the 12 separate steps. Um, you work with a mentor, you're in your in groups, um, sort of like like like, I don't know, discussion groups or sort of like peer groups, um, that work together to help create mutual support to abstain from alcohol. Um, and that approach is still used today. So there are still plenty of those um groups that are present in the UK, America, elsewhere. It's also spread out to to other, other potentially addictive behaviours. You have Gamblers Anonymous, you have Narcotics Anonymous, you even have ones for technology use as well. So it's an approach that's been really, really influential in thinking about treating addiction separate from psychiatric therapy, but also then signals how different approaches started to become, um, prevalent. So as I've mentioned at least a couple of times now, psychotherapy, mental health treatment was largely considered the preserve of psychiatrists in this pre and interwar period. There are a couple of things that fundamentally changed that, though. The most important of those is that psychiatry discovered the brain and particularly discovered its influence, its contribution in mental health. And so sort of in some way, there was there was a there was a shift towards certain things that were originally considered part of neurology, being being married with psychiatry, um, and the role of psychiatry in working with this to try and treat mental health. So particularly throughout the 1920s and 1930s, you have certain innovations in nutritional medical interventions for mental health. Many of these were aimed at psychosis and schizophrenia. Um, the vast majority were originally intended for this purpose and then applied to neurosis, to depression, and to all sorts of other psychiatric conditions as well. Many of them started with schizophrenia or psychosis is their an original target, though? And there's a number of these different treatments that were developed and popularised by psychiatrists. First of which I want to talk about is electroconvulsive therapy. So that is the administration of electric shocks, the frontal cortex to, um, to, to try and almost like, like reset, rewire the brain. So electroconvulsive therapy, um, it's still used today to an extent, um, particularly for treatment resistant depression. Um, but it's designed as a, as a, as a sort of, um, as an intervention to try and treat mental health conditions. And that was developed in Italy by Ugo Leti. You then get a number of more severe, more extreme treatments. So this is still quite an early period in how we think about, um, the treatment of psychiatric illnesses, psychiatric disorders. And so some of them were a bit weird and a bit extreme. The most extreme example is the lobotomy. So the removal of a series. So sort of lesion ING. Um, again the frontal lobe to sever connections to um in most cases designed to intervene again on, on, on psychosis, but also in some cases on hysteria and other neuroses too. So the bottom is were were developed in 1930s. They were popularised through the 1940s and 1950s, um, and used quite a lot as a psychiatric intervention. So you have people, um, you have some members of the Kennedy family that were given lobotomies and it's very it's it's quite an extreme treatment because it tends to be associated with very immediate, rapid personality change, cognitive decline. Um. All sorts of other cognitive difficulties because you're lesions in the frontal lobe. So a lot of those executive functions are sort of located, um, or have white matter pathways through that, that, that area. It's been lesions. So it leads to, to very severe detriments, um, creates very strong feelings of lethargy. Almost so and sort of stupor. So in terms of it looking like it's treated the problem or the thing that's being intervened on, it's superficially appears to be effective, but also causes a ton of damage at the same time. You then have insulin shock therapy, which again, was designed as an intervention for psychosis, which was to induce a diabetic coma in people to try and reset their brain. So again, like electroconvulsive therapy, it was designed to, um, almost like, you know, turning it off and turning it on again. Um, with people's brains as a way of trying, intervening on on their conditions. Um, didn't work was wasn't very helpful. Um, the final one was, was deep sleep therapy, which was designed to be a nicer, gentler version of electroconvulsive therapy, um, in which what doctors did, what psychiatrists did was administer barbiturates to to a patient to put them into a state of very deep sleep, for in some cases, a very long period of time up to a month. Now, the problem with barbiturates is that if you give people too many, they die. So barbiturates are quite often used as as a form of euthanasia. So in Switzerland, in Canada, they are used as one of the methods for administering euthanasia. And what happened in Australia, um, during that period is there was there was a clinic that did that and, and killed 25 people. So it it was supposed to be sort of a gentler, friendlier treatment, but actually was was highly lethal. So, um, don't recommend it. So you have these these treatments that became very popular. And the key point with them is it highlights how psychiatrists thought about the brain as the locus of, of mental health and so changing how they think about it from administering talking therapies towards active intervention. After World War Two, then there was a explosion in new drugs coming on board that, at least to some extent, could deliver psychiatric treatment that was at least mildly effective, in some cases very effective, but also quite dangerous. So you have the first sort of generation of antidepressants. You have early antipsychotics like La Gasol. You have amphetamines, um, which have been used for a number of different treatments. So like for instance, for ADHD in the 1950s, they were used for weight gain, all sorts of different uses. Um, and these became rapidly very popularised because they could be delivered at scale, they could be delivered easily to people. So you didn't have to go through a course of treatment of psychotherapy. You could just give them the drugs, um, which meant that psychiatry became very popular, um, in American society in particular during that period. And in particular, it started to highlight a shift in psychiatry because you can deliver this treatment at scale, at speed, whereas you can't necessarily with psychotherapy. And what this meant that is, is that psychotherapy, psychological treatments were no longer as indispensable. They weren't as important to psychiatrists because they could they had other options that were faster. They were cheaper. In many cases, they were more effective too. And so instead, you see a shift in how psychiatrists conceptualised their, their, their their treatment and its abandoned Freudian models. So what you see is in that period, particularly from about 1940 to 1960, is that whereas at the beginning most departments, most psychiatry departments were Freudian, by the end of it, almost none of them were so a very rapid disposal of Freud and his therapeutic approaches. The other contribution from psychology that helped um, bring this about was increasing evidence that certainly Freudian psychotherapy, but also early early therapy in general wasn't particularly effective either. So as a paper I've put in the in the further readings, I recommend you give it a read. It's, I think maybe 7 or 8 pages long by hands, eyes ink in 1952 that just critiques the literature on psychotherapy and looks at actually does it deliver therapeutic benefit. And so what you did essentially was it was almost like an early, early systematic review. So he explored the literature. He identified relevant papers that looked at psychotherapy in neurosis and looked at the the evidence of treatment effectiveness. So did people get better when they were given treatment? And what he did is he compared it not just improvement against no improvement. It compared it against a baseline. In this case, the proportion of people that were taken out of state psychiatric institutes because they had been they didn't need that, that level of intervention anymore. So he was comparing psychotherapy against, um, treatment completion rates. And what he found is that there was no evidence of benefit for eclectic or sort of unspecified broader psychotherapy. It performed about the same rate of effectiveness as, as, um, sort of like sort of. I'm trying to think of the right word for form. So it's with state hospital treatment in the US, it tended to be quite low level. It wasn't the same as being institutionalised, but it's not how we think about perhaps being institutionalised today where that comes with adjunct therapy. Instead, it more or less essentially bed care. So quite low level of intervention. And what you found is that that eclectic psychotherapy didn't do any better than that. Indeed Freudian psychoanalysis did worse. Um, the improvement rate after two years was about 20% less than than for for hospital treatment. And so pointing out that that so Freudian analysis in particular doesn't seem to have really any evidence of treatment efficacy. In fact, in some cases it might make people worse because it slows down the rate at which they improve. And rather than simply saying that, you know, psychotherapy is nonsense, we should get rid of it. What he argued instead is that we should move towards better treatments informed by psychology. So instead of just saying we shouldn't administer psychological therapy at all. Instead, you need to go back to the academic literature and identify potential approaches that may be more effective than Freudian ones, which led to the development of behavioural therapy, cognitive therapies, cognitive behavioural therapy, so that the number of different um, approaches that are now used in, in clinical psychology, in psychotherapy, um, were as a result of this work. The other thing to note on that as well is that there was also a change in not just in the the content of the psychotherapy, but the broader overall relationship between sort of the client and the, the, the therapist. So rather than it being sort of very top down expert versus patient model, you have figures like Carl Rogers arguing instead that we should go for a client centric approach based on, um, based on the client's needs, the the client's goals being non-judgmental and allowing them to to express their feelings in that way, which fundamentally changes the relationship and the power dynamic between the patient and and therapist in many ways, sort of started to, um, create new opportunities for ways that psychology could be incorporated into the therapeutic role. And I recommend giving giving Isaac's paper a read. There are some things that I want to highlight both as strengths and weaknesses in critically evaluating the the importance of this paper. So, um. one thing to be aware of is that although it reviews a number of psychoanalytic, um, therapy papers, they are quite biased in, in terms of, um, actually how it's weighted. So, so it doesn't weight the, the, the sort of studies in any particular way just counts them up, um, or counts up the number of cases. And the problem is that on the psychoanalytic side, there is one study of, I think, sort of like the 5 or 6 that he includes that makes up the majority of the cases. The data is quite biased. There is one study that is overwhelmingly influencing that conclusion. And so in that case, you know, it might be that because that study shows quite a low success rate, the conclusions are sort of biased towards being quite negative. The second is in the selection of cases. So this is like a pre pre-modern psychology. A lot of the papers are sort of from the 40s and the 50s. So it's before really how psychiatrists diagnose and categorise psychiatric conditions today. And so his his topic of focus was just just neurosis, with that being a very broad swathe of, of sort of mental health difficulties. So, um, there's not any necessarily there's not much specificity in the groups that he's looking at, which means that the it's, it's lumping across a very broad swathe of, of conditions. And so you can't tell whether it's equally effective or ineffective in those. Um, and it might be that in some cases actually psychotherapy might be quite effective. But, but the data doesn't allow that, that um, analysis to be made. Moreover that, that works on the other side too because he also excluded certain studies that focussed on specific conditions or ones that focussed on psychosis on on bipolar disorder were removed from from the analysis. So it's not clear whether there's a difference there. Um, and to an extent, given that the neurosis is such a broad. Unspecific category, it's not clear whether that that sort of demarcation is appropriate or not. Another issue is, is the equivalence of the samples. So given that he's comparing as a baseline psychiatric hospital, um, completion rate, is that equivalent to the people who are going into these psychotherapy studies are being reported on? Um, and that's that's not really clear. He does explain the rationale for this in the paper, but it's not actually demonstrated that these are equivalent points. So it might be the baseline is set. Is either quite high or quite low. And finally the other issue with the paper is that in terms of looking at the effectiveness of psychotherapy, the measurement that he uses is reports of improved versus not improved. And these are based off the the judgements of the paper authors that the judgements of the clinicians, they're not based on an improvement say in a psychometric test. So it's not that you see an improvement in depression scores for example. So it's not clear how those improvements relate to some sort of quantitative index of change. It might be that, that clinical, um, it might be that the clinicians judgement is biased. It might be that the notes they make only capture sort of a part of the, the judgement. And in those cases, you know, it is left up to the clinicians judgement. And we know from about 60 years of research that clinical judgement, although in many ways is brilliant, does have known biases and known flaws. And so that might bias those, those those judgements as well. But given the state of the literature at the time, there's not much that he could have done about that. So I recommend giving it a read. It's a really interesting paper. Um, apart from that, Hans, I think was he was an interesting figure, um, massively influential on psychology. Um, one of the fathers of modern personality psychology. But towards the end of his life, he started to get a bit weird, so ended up with a lot of money from the smoking lobby, or at least with his co co researchers to try and demonstrate that smoking didn't cause cancer. So he published a number of papers in the 80s and the 90s. Towards the end of his life, with a guy by the name of gross matter, check that. Try to argue that personality caused cancer instead of smoking and and that his his personality treatments could cure cancer or they could prevent it. So published a number of these studies where the data was completely and totally made up. And it's only fairly recently people have twigged this and have started to retract those papers because they were fraudulent. Um, apart from that, on the top there's a photo of Hans and his wife, Sybil. Sybil was also a prominent academic in personality psychology, too. And so, given the state of psychiatry as it was, particularly with these new emerging treatments and then becoming extremely popular. You ended up with a bit of a backlash. So particularly during the 1960s, there was a movement known as anti-psychiatry that railed against the way in which people were treated by psychiatrists. So psychiatry, sort of at the peak of its popularity, then entered into a period of reaction because of these problems. Now we've already went over psychotherapy, but but the treatments that I mentioned a couple of slides ago have abysmal success rates as well. By far and away, the most effective of them is electroconvulsive therapy that is still used today in some cases, um, particularly for depression. But even then, the way in which it was used for everything willy nilly, um, wasn't appropriate. And it wasn't particularly effective either. Um, so the way in which it's used is, is very restricted compared to the way it was in, in sort of the 50s, the 60s, it was used very extensively for all sorts of treatment. That is no longer the case, and that's the best one. So, so psycho surgeries like lobotomies, um, other forms of lesions to the brain have minimal to zero evidence of support in their favour. They lead to to to neurological changes, lead to behavioural changes, but they aren't effective psychiatric treatments, particularly with lobotomies. The evidence for them is basically zero. And they were completely stopped as a result of controversy over it. And the the evidence for for insulin shock and deep sleep is even low is literally zero. So those those are pseudo treatments. They're pseudoscience or at least they considered so today. The other thing to note is that early psychiatric medication was quite severe in its side effects. So these these drugs have quite major Impacts and you have to be careful with when you use them. So, um, early antidepressants like mono and mono amines take inhibitors. I think that's right. Get the words that eventually, um, they can lead to very severe side effects if they are taken with certain foods. So if you're on those drugs you can't eat cheese, which which I think is criminal. Um, you also can't have red wine either. So, um, not very fun at a wine tasting session because you'll probably end up in the hospital. Similarly, things like early antipsychotics, although had some um, and in some cases are used today, have therapeutic benefit. They also have extreme side effects that are deeply unpleasant as well. So things like um, other other other sort of um, other behavioural changes, um, cognitive effects that meant that the, the impact of them, although they treated the problem at hand, they created new problems too. Otherwise, you're still in a period with institutionalisation as well. And so a lot of the treatments being used are pretty harsh. They're quite extreme by our standards. On top of that, you had questions about how reliable psychiatric diagnosis was. So because often it was based on clinical judgement. It wasn't necessarily, um, wasn't necessarily perfectly accurate. This is a time before standardised classification schemes like the DSM, like the, uh, the ICD, which are used today. And so you get significant variation between practitioners in their diagnosis. Um, and this this led to a study in the 1960s by Rosenheim and colleagues who essentially got a bunch of volunteers to pretend that they had psychosis, put themselves forward for psychiatric treatment and got themselves institutionalised and then struggled to get out. And the point there was that, especially within the context of of an asylum, of an institution acting normal, was then seen as weird. And so they found it much more difficult to get out. The problem with Rosenthal study is that, by and large, it was was mostly made up. So there's a lot of controversy over actually what they did. Um, but in terms of, I suppose, exploring this point in terms of as the demonstration highlights some of those issues with psychiatric diagnosis in turn, that led to reform. So that led to the development of new drugs. It led to standardised classification. It led to the abandonment of certain treatments. It led to institutions being shut down and moved towards a community care model instead of putting people into. Into asylums. So you have this period of of reform and development and evolution afterwards. And so on. Clinical psychology. Then there's a number of themes that I want to pull back from all of what I just said. Basically, at the start, you have a number of events that changed how we think about mental health. So in particular either destigmatizing certain aspects of it, but also that in some cases it wasn't of personal responsibility. So so making that more acceptable across the population, which created the conditions in order for governments to provide the resources and the frameworks to to act. So it meant that that it meant the resources were placed on the treatment of psychological conditions in a way that perhaps wasn't beforehand. Changes in psychiatry then created this opportunity for psychologists to to conduct psychological therapy and for it to be be licensed to do so. And so they did. And so, particularly from 1945 onwards, um, most psychologists now are allowed to perform psychotherapy in, in, in, in a number of different contexts. Um, but also how the nature of that therapy changed as well and how that was influenced by psychology. The other thing to note on that is, is that the creation of these professional roles meant that we, the psychologists, needed bodies to represent them. So you have groups like the APA and the BSS that were created during this period to represent and advocate for psychology as a whole. And interestingly, over time, the sort of the rationale for their existence has changed quite a lot. So certainly at the beginning both were focussed on the the advocacy and the development of academic psychology. So encouraging psychology departments to be set up to, to encourage people to do psychology degrees and then, particularly in the latter half of the 20th century, focussed instead on the representation of professional psychologists. So as they became the majority of psychologists. So most, most psychologists in the UK are professionals. So they're not academics like me. They're people who administer therapy, they work in organisations, they, um, they conduct psychometric testing, um, they work in prisons. The nature of those societies shifted to represent their, their needs, um, which meant that it created some tension, like at the very beginning, um, you know, sort of social butterfly extraordinaire. Lightner Whitman left the APA that he founded in February because he couldn't get them to represent freshman psychologists properly. And then at the end of the 1980s, you have the opposite happen, where a number of psychologists left the APA to form the Association for Psychological Science, including people like B.F. Skinner, because they felt that they weren't represented properly. So you have this this shift in how these professional bodies represent psychologists and. Apart from that. UNKNOWN Is that all right? SPEAKER 0 Sorry. I've got a screen on the other side and it's just randomly dyed. So I was a bit surprised by that back in the room. So although so far we've covered and this is, this is sort of the last couple of bits before we get to the break. Um, as it's been an intense session, um, feels it to me at least. I just want to riff on a couple of. I just want to focus on a couple of sort of outcroppings, a couple of issues related to psychology. From the content I've talked about so far, so talked a bit about the role of the brain in psychiatry, but it's also important to understand that it's also become really important in psychology, too, that that's that's a shift that has occurred in both disciplines. So last time we covered a bit about the computational model of mind. We covered the Turing machine and how that had been used as the basis, um, for thinking about the mind, um, as software to the hardware of the brain. And one of the major developments over this period has been the study of the brain in relation to psychological processes, the study of that hardware itself. And there's a number of different ways in which is that that has been done. But you can see that occurring very soon after McCulloch and Pitts proposed the computational model. So you have Hibbs rule, which which tried to operationalise a neural model of learning to try and explain learning at the level of neural firing, to try and have a biological basis, a neural neurobiological basis for learning. Otherwise, over this period and through up to the 1990s, loads of different ways in which the brain was explored and its impact on psychology. So in particular, you have a number of lesion studies go all the way back to like like Phineas gauge on how lesions affected people's psychological processes. Um, in particular, the presence of of a large number of lobotomies meant that being able to study the frontal lobe was possible. Um, you also have people like Roger Sperry that looked at split brain studies, so he sever the corpus callosum, um, between between the two hemispheres and the effect that that had on people's perceptual and psychological processes. So a number of different ways in which the brain was explored and its relation to our psychological processes, um, particularly the impairment of them as the result of brain lesions increasingly recently, that's also looked at plasticity. So how, um, function is restored after lesions like a stroke. So how people might redevelop abilities with speech, um, how people who, who have, uh, blindness from birth then develop other perceptual capacities to accommodate for that a number of different ways in which our neurones reorganise. Around these sort of circumstances. And what these did was, was really emphasised the role of the brain in psychology. So it's not just that, um, it's the hardware it runs on. But but the nature of that hardware matters to us. And that's not just for behaviour. It's for, um, for the mind, it's for our social processes, how we internalise those. So a number of different ways in which neuroscience has become integrated, which has also been helped by the fact that it's much, much easier to measure the brain than it used to be. So if you go back all the way back to like the 1930s and 1920s, you'd have to remove the skull to measure the brain properly. So early EEG was done on people who were having brain surgery whose skull had been removed. Um, thankfully, it's it's a bit more. It's a bit more. participant friendly these days. You can use like nets to to that can pick up on the activity using sensors. But you also have magnetic resonance imaging that can measure blood flow and other matter in the brain, and can image that at a very quick temporal resolution. And that means that people's brain activity can be measured when they're doing psychology experiments. And so, particularly since the 1990s, there's been loads and loads of research using these methods, not just to look at our psychological processes, but how how our, our behaviours, how our cognitive processes are related to our brain, um, brain function, brain structure, um, electromagnetic electrical activity in the brain, all sorts of stuff like that. And with that, I'll give us all a bit of a break.