An atheist view on the pope’s speech to congress

I may be an atheist and humanist, but I’m still impressed with Pope Frances. In his speech to congress, he covered a lot of important issues.

On international politics and religious fundamentalism:
“we must especially guard against the simplistic reductionism which sees only good or evil; or, if you will, the righteous and sinners. The contemporary world, with its open wounds which affect so many of our brothers and sisters, demands that we confront every form of polarisation which would divide it into these two camps. We know that in the attempt to be freed of the enemy without, we can be tempted to feed the enemy within. To imitate the hatred and violence of tyrants and murderers is the best way to take their place. That is something which you, as a people, reject. Our response must instead be one of hope and healing, of peace and justice”.

On the responsibility of government being to serve the whole population:
“All political activity must serve and promote the good of the human person and be based on respect for his or her dignity… If politics must truly be at the service of the human person, it follows that it cannot be a slave to the economy and finance”.

In relation to racism and refugees:
“Let us treat others with the same passion and compassion with which we want to be treated. Let us seek for others the same possibilities which we seek for ourselves. Let us help others to grow, as we would like to be helped ourselves. In a word, if we want security, let us give security; if we want life, let us give life; if we want opportunities, let us provide opportunities. The yardstick we use for others will be the yardstick which time will use for us.

On poverty:
“in times of crisis and economic hardship a spirit of global solidarity must not be lost. At the same time I would encourage you to keep in mind all those people around us who are trapped in a cycle of poverty. They too need to be given hope.”

On the arms trade:
“Being at the service of dialogue and peace also means being truly determined to minimize and, in the long term, to end the many armed conflicts throughout our world. Here we have to ask ourselves: Why are deadly weapons being sold to those who plan to inflict untold suffering on individuals and society? Sadly, the answer, as we all know, is simply for money: money that is drenched in blood, often innocent blood. In the face of this shameful and culpable silence, it is our duty to confront the problem and to stop the arms trade”.

He also called for more action on environmental issues, referencing his recent publication on this topic.

Finally, in relation to families:
“I would like to call attention to those family members who are the most vulnerable, the young. For many of them, a future filled with countless possibilities beckons, yet so many others seem disoriented and aimless, trapped in a hopeless maze of violence, abuse and despair. Their problems are our problems. We cannot avoid them. We need to face them together, to talk about them and to seek effective solutions”.

As an atheist, this kind of interpretation of religion resonates with me, despite my lack of belief in a deity. Most of all, I admire anyone who uses their platform to speak for the vulnerable and to advocate for peace and altruism. This is a Pope I can admire. A wise man, and one who leads by example. If only he would overturn the church’s negative approach to homosexuality, I’d feel like he was an all round great man, despite our very different perspectives on the world. This was a fantastic speech, full of insight and compassion. Hopefully his audience, and the world, will take note.

Talking about depression and seeking help

Someone I know emailed me this week, saying he was feeling depressed. He was very self-critical about it because objectively his life was the best it had ever been (after a lot of difficult experiences in his childhood and early adult life he is now employed, in a relationship, with a nice home) and therefore it felt ungrateful to complain about anything (like social anxiety, work stress, sleep disturbance, niggles in the relationship, having to care for a dependent parent) as he should be happy. He felt perpetually exhausted and like therapy and medication was for people with ‘real problems’ and talked about wishing he didn’t exist. This was my answer:

There is no ‘should’ with feelings. They just are what they are. We can learn to challenge our thoughts or change our behaviours, which can have a positive knock on effect, but feelings we have little control over. So just be mindful of them, and try to deal with the stuff that underlies them when you are feeling well-resourced and supported.

I read a rather naff explanation on facebook today, but it has a germ of wisdom in it:

I held up an orange and asked a boy in the audience “If I were to squeeze this orange as hard as I could, what would come out?”

He looked at me like I was a little crazy and said, “Juice, of course.”

“Do you think apple juice could come out of it?”

“No!” he laughed.

“What about grapefruit juice?”

“No!”

“What would come out of it?”

“Orange juice, of course.”

“Why? Why when you squeeze an orange does orange juice come out?”

He may have been getting a little exasperated with me at this point.

“Well, it’s an orange and that’s what’s inside.”

I nodded. “Let’s assume that this orange isn’t an orange, but it’s you. And someone squeezes you, puts pressure on you, says something you don’t like, offends you. And out of you comes anger, hatred, bitterness, fear. Why? The answer, as our young friend has told us, is because that’s what’s inside.”

It’s one of the great lessons of life. What comes out when life squeezes you? When someone hurts or offends you? If anger, pain and fear come out of you, it’s because that’s what’s inside. It doesn’t matter who does the squeezing—your mother, your brother, your children, your boss, the government. If someone says something about you that you don’t like, what comes out of you is what’s inside. And what’s inside is up to you, it’s your choice.

When someone puts the pressure on you and out of you comes anything other than love, it’s because that’s what you’ve allowed to be inside. Once you take away all those negative things you don’t want in your life and replace them with love, you’ll find yourself living a highly functioning life.

Now, I’m not totally on board with filling yourself exclusively with love and light (because I think negative feelings are pretty normal and have their value too), and I’m not sure that anyone can ever respond only positively to life’s pressures, but he is right with one thing – your response under stress reflects what you have learnt and experienced in your life up to that point. If you are filled with the poison of being bullied at school or denigrated by your parents, with the wounds of failed relationships, with traumas and losses, then that becomes your norm. It will tarnish your view of yourself, the world and others, and it has the potential to leak out in unhelpful ways. When you carry that baggage and aren’t buoyed up by positive experiences and relationships it becomes much harder to be resilient to the day to day stressors of life. It becomes harder to feel you deserve a better life and to seek out positive experiences for yourself, and you can instead end up avoiding or sabotaging them.

Therapy is there to help you recognise that skew, and to separate the result of negative experiences from your innate worth as an individual. It can help you to challenge your thinking, to change your behaviour, to give yourself opportunities to test and refine your beliefs about yourself, the world and others. It can help you reflect on the patterns in your relationships, why you keep replaying the ones that are not helpful and how you can begin to change this. And sometimes when you are feeling so hopeless and worn out that even the idea of therapy is too much to manage, medication can help to give you the energy and optimism back to allow change to be possible.

The biggest problem of depression is that people can see it compassionately in others, but we are very critical of ourselves for feeling that way, and unable to recognise that the stuckness and self criticism is part of the depression and – importantly – eminently treatable. If you read back your email to me and imagine someone else made it, I think you’d be a lot more compassionate to that person than you are being to yourself. The problem is that you are trying to measure the objective situation with a subjective (and in fact distorted) tool – yourself. And that distortion increases when you are depressed. So be kind to yourself, and allow others to help you. You don’t have to be stuck with feeling sad just because you can’t pin a reason for it on something specific or because there are other people who have bigger problems in their lives.

You said that you sometimes wish you didn’t exist, but I am very glad you do, and I am sure that there are lots of other people who value you and would miss you if you weren’t around. When you are depressed it is hard (if not impossible) to imagine that life can get better. But it can get better. Not only that, but it does get better for most people with depression. Most people who are depressed or even suicidal go on to happier times and to be glad they didn’t act on those thoughts. So please, seek help and don’t give up. Call the Samaritans if you feel like you might harm yourself, and speak to your GP about medication and/or a referral for psychological therapy. After all, 90% of people who turn up to therapy start to feel better, and you can too.

A note on the two 12 year old girls with “higher IQ than Einstein or Stephen Hawking”

In the news today, two 12 year old girls who have done Mensa assessments have been pronounced to have IQs of 162, and to “already be cleverer than Einstein or Stephen Hawking”. As someone qualified to test IQ in a validated way, this is infuriating, as it compounds public misconceptions about IQ.

Let me start with some basic explanation of how an IQ test works. A proper validated IQ test shows IQ scores in terms of the number of standard deviations that person’s score is from the mean in a normal distribution of other people of their age in their country. So 2.28% of people score above and below 2 standard deviations from the mean. A standard score means that the normal distribution is set up with a mean of 100 and a standard deviation (SD) of 15 points – IQ scores are calculated by using the raw score on the test comparing it to the norm group and then transposing that onto the standard distribution. That means that the average IQ score is 100, and just over two thirds of people have an IQ score between 85 and 115. The further a score is from 100 the more unusual it is in the population. At the lower end, 2.28% of people have an IQ below 70 (considered a Learning Disability) and at the upper end of the range 2.28% have an IQ over 130 (considered “gifted” or “very superior”).

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So what about people who are super-bright? How accurately can we measure their ability?

Given that IQ tests are normed on only a few thousand people, the sample and thus the knowledge we have about the distribution of IQ in those ranges is pretty limited. By the time we look at the sample 3 SDs above the mean at 145+ we are studying 0.03% of the population (three people in every ten thousand) and that means that the normative sample will probably contain only two or three of those people at best. Of course most of the tests are normed in the USA, and the UK sample used to ensure it transfers to this country was only hundreds of people, so it probably didn’t contain any.

We then have the variable of error in measurement, which increases as you get to the edges of the distribution. You get a noise in the background during one item or a moment of misunderstanding and it can change the score by one or two points, and in these ranges that could make a huge difference. How valid can it be to stratify people in these extremes according to individual items of knowledge?

So, you would typically give either a confidence interval (the range at which the person is 95% likely to score if re-tested, according to the statistical properties of the test, usually the individual IQ score plus or minus 4-6 points) or a percentile. And the general practise is to say “the top 0.5%” for all scores above 140 and be no more specific than that. So the answer to my question is that we know fairly little about the distribution of IQ scores above 130 and the tests are not very good at reliably differentiating between scores in that range. That means I’d be sceptical about anyone claiming “genius” who cites a specific IQ score, as they clearly aren’t enough of a genius to understand the statistics or science of IQ measurement!

Does someone with a high IQ as a child keep getting higher?

No, cognitive assessments are designed to measure ability relative to your age peers, so that it is likely to remain a similar score as you get older. A child with an IQ of 130 is likely to become an adult with an IQ of 130, give or take the error of measurement, unless there is a significant head injury or some other explanation for the change. If someone under-performs on the test for some reason (for example because their attention is very poor) their score might improve if that reason is addressed (if their attention is improved by medication, change in their environment or practise at similar tasks). You can practise the specific tasks used in IQ tests and learn general knowledge and vocabulary deliberately to improve your score, and the score is not normally considered valid if the same test is used again within 24 months because of practise effects.

The norms for IQ tests are gathered for each language and country, so although they are meant to be “culture free” you also need to be mindful of cultural or language barriers to performance. And of course, in the end IQ scores measure how good you are at IQ tests, which may not reflect how “intelligent” you are in real life, where social skills, emotional intelligence, interests, ability to use executive functions to concentrate, self-monitor, learn from feedback and many other factors affect the degree to which you can succeed or appear exceptional. In fact it is often the people with the narrowest focus in their skill-set who are able to make the most impact in that area, and they may often not have the breadth of skills to appear that intelligent in other contexts. Of course there are some genuine polymaths, but it isn’t clear that IQ scores reflect functional skills beyond being reasonably predictive of academic attainments.

So what about these scores cited in the media of IQs of 162? Are they cleverer than Stephen Hawking or Einstein?

Many high IQ societies don’t use the cognitive assessment tools that Clinical Psychologists use (like the Wechsler tests, or the Stanford Binet). Mensa for example use the Cattell which is not widely accepted as a valid test of IQ and has relatively low correlation with the standardised tests I mentioned. This test has a completely different scoring system, with a standard deviation of 24 points. This makes the highs look higher and the lows look lower, and it seems it is popular amongst high IQ societies because it is cheap to administer and pleasing to their members as it gives nice high numbers. On this test a standard IQ score of 130 (achieved by that top 2.28% I mentioned earlier) would be a score of 148 – a higher number, but still designed to indicate the same level of ability (a score in the top 2.28%) – and a score of 145 on a standard test (achieved by the top 0.03% of the population) would be a score of 172.

So those published scores of 162 are high, but statistically we’d expect 3 in every ten thousand people to score over 170 on that scoring system – and simple multiplication tells us that across the population of the UK we’d expect there to be 18,000 people with that level of ability – whilst the error of measurement in that range must be enormous. In fact, we can say little about their IQ beyond “it is above 130 on a standardised test” due to the confidence intervals being very wide. To differentiate amongst super high ability people we would not only need a test that is able to be sufficiently granular at that ability range, we would have to norm it on representative samples of higher ability people studied in sufficient numbers to see what happens to the distribution as raw scores go up.

As to scores higher than Stephen Hawking or Einstein, that’s purely speculation. Neither of these two people have done comparable IQ tests, and the norms change year by year. Plus people can be brilliant at some things and less good at others, and there is not a perfect relationship between IQ and ‘intelligence’ let alone IQ predicting who will be a “genius” and increase the boundaries of current knowledge.

I’ll leave the last word to Stephen Hawking, when asked what his IQ was by the New York Times:

“I have no idea. People who boast about their I.Q. are losers”.

To Patreon or not to Patreon, that is the question

Over the summer the interest in the personal development group waned, and I had a lot going on (see previous entry) so I closed the Patreon service. I have a really strong ethical stance about doing things properly or not doing them at all, and I felt like I wasn’t giving good value for money.

But now I’m feeling a bit better, and applications have opened for 2016 entry, I need to figure out whether to re-open the Patreon account and/or whether to offer any kind of professional development support this year. As I said on the forum, it has always been a bit of a thorny issue to navigate:

clinpsy has done a lot to make advice available to all and to undermine the market for paid for services, but it is unrealistic to expect an endless supply of personalised advice for free to be provided by just a few individuals (I do 20+ form reviews every year, and often 2-3 days of helping people prepare for interview).

Historically we’ve only ever had charges that are below half of the market rates, and they have mainly gone to charitable causes that are nothing to do with the person providing the service (eg I’ve asked people to donate to big noise/systema scotland and to the little lives appeal to refurb the neonatal unit at my local hospital, bluecat asked for donations to a school – average donation under £10) and I did personal and professional development days which went to our social enterprise therapy subsidy fund to allow people to access low cost therapy if they couldn’t get an NHS service (£24 per person for up to 15 people, whilst I lost £800/day of other income by putting them on, and spent £70+ on catering).

But now I’m self-employed this has been more and more difficult to do (don’t forget I’m a single individual clinician supporting a family who is already making a loss by providing clinpsy.org.uk out of my own pocket without any charges to users) so I then moved to testing a model in which we asked people to subscribe via patreon and offered to have regular discussions and blogs, which some people used to get their applications reviewed. That was money for my time, but it was time I used to blog, and make a couple of videos, and run online discussions and workshops as well as to do individual advice.

It is a very difficult balance for me to find a comfortable solution to. I get paid several hundred pounds to speak at conferences these days, and yet here I am criticised for asking for £5 per person per month for workshops; likewise I have to turn down work paying £100 in the time it takes for reviewing a form, but there are lots of negative judgements about the tier of patreon subscription for that costing £20 or so. So at the moment I have turned this off again.

I don’t mean to sound defensive about it. In an ideal world it would be free. But in an ideal world, we’d have enough adverts on here to cover the costs and/or I’d not have a mortgage to pay!

So, what is the right path here? Do I just keep the blog as but stop doing the personal development stuff and keep the Patreon account off? Or do I revert to offering form reviews for a donation to our therapy subsidy fund, and/or doing some workshops on a similar basis. Or do I use Patreon to fund my time and trust that people only subscribe if they think it is worth it to them?

Bump!

Its been a while since I wrote a blog entry, so this is a catch-up to the little chain of events that took up my summer.

On 24th June I was driving from work to do an assessment in the community, when I gave way at a roundabout. Unfortunately the lorry behind me didn’t stop, and went into the back of me. I got jolted forward in my seatbelt, but walked out physically unscathed to find that you could hardly see the impact on the car either. Thankfully the lorry driver was lovely about it; concerned and apologetic and we exchanged details. I was right near the VW dealership where I bought the car, so I got them to check it was roadworthy and went on to my appointment about an hour late. The garage explained that cars are very well protected against straight on collisions, and the bumper would have absorbed most of the impact by crumpling inside, so it was later replaced by my insurance. Likewise I was fine on the outside, but things on the inside started to show the impact in unexpected ways, both physically and psychologically.

Physically I got a typical pattern of whiplash injury – pain in my neck and left shoulder, tightness in my left arm and a restricted range of movement, stiffness in my back, headaches and disrupted sleep. I also got bruxism, the tendency to clench or grind your teeth, particularly during sleep. I’ve had similar physical symptoms from previous road traffic accidents (I’ve been hit several times before, 3 of which caused whiplash, but I’ve never had an at fault accident in 200,000+ miles since I bought my first car at age 20). But the psychological symptoms were new.

The first thing I noticed was that my concentration was completely shot. I couldn’t sequence tasks into the right order, sustain my attention or gather my thoughts enough to write coherently. I more anxious, had an increased startle reaction to loud noises and weird scary dreams. I had to work hard to keep my mind on mundane tasks like driving, so I didn’t wander out of my lane on a quiet motorway and was attentive to the speed limit (although driving was limited anyway due to the pain in my shoulder and arm). I couldn’t draw together and reflect on the different information in my court reports, feel confident about my conclusions and present them effectively in a report, so I had to be signed off sick for a month – something I have never done before. However the weighty nature of doing expert witness work for the family court means that I had no other option, it wouldn’t have been ethical to have submitted poor work to inform the court’s decisions on such life-changing matters.

To compound things I started getting severe pain in my tooth and jaw. The dentist was initially unable to identify the source, but eventually found a crack in my wisdom tooth. He tried to fill this, but it caused me levels of pain that I have never experienced before (even in childbirth). A few days later they tried to remove the tooth but had to abort the attempt midway, due to an infection in my jaw. I spent the following week on antibiotics and analgesics, wavering between debilitating pain and a pleasant but unproductive codeine-induced haze. I was reminded how debilitating chronic pain can be, especially as I became more tolerant to codeine and had to alternate with ibuprofen to gain relief. I also found out that dental pain falls in the gaps between the out of hours services (the emergency dentist said “see your dentist on Monday, nothing we can do except let the antibiotics do their stuff, but see your GP if over the counter painkillers are not enough” whilst the walk in clinic said they couldn’t prescribe for dental pain). And to add insult to injury I got a speeding ticket for doing 36 mph on my way to the clinic. The tooth was removed the day before we flew to Scotland for our good friends’ wedding, and once there, I immediately started to feel better. On my return I was able to complete the delayed court reports and start to catch up with my email, albeit with limited intervals on the computer.

Now I feel like I’m getting back to normal. I can’t go weightlifting at the gym, my sleep isn’t 100% and I’m still very stiff on waking or if I do anything physical like playing with the kids or trying to pull a few weeds in the garden, but I feel like myself again psychologically. I can concentrate and plan to levels typical for me, and it has been an interesting experience to reflect upon. Taking time out of work was difficult for me, because it challenges both my expectations of myself as a perfectionist and workaholic, the level of input/control I’ve been able to have over my business, and my reputation as a reliable provider of services. The up side has been spending more time at home with the kids over the summer holidays, taking time to relax and being forced to think about self-care a bit more than usual. I am very lucky that my husband had just left his job and was able to postpone his freelance work and take on a lot of the domestic tasks, otherwise I don’t think that I’d have managed nearly as well.

As a self employed person, taking time off work also lost me a lot of money, but it was difficult to see this as a loss I had no control over rather than me being self-indulgent. Even though I was told that I could claim from the lorry driver’s insurance for lost earnings I was still loathe to make a claim. Of course I had to contact my insurer, as the car bumper was structurally compromised and needed replacement, and my insurance company in turn set other wheels in motion. I genuinely loathe the personal injury claim industry from the speculative cold-calls and TV marketing to drum up trade to the impact on premiums and the motivation to malinger. I hate to be part of it. Yet I watch helplessly from the sidelines as the leaches of the insurance industry cream off maximum profit to take forward my claim, from the hire car whilst mine was in for repair (for more than twice the price of just walking into the local hire shop), to the paralegals at the ambulance-chasing law firm charging an obscene hourly rate for their cut-and-paste letters and calls. Yesterday I had my medical interview/examination with a very nice doctor who took 16 minutes to complete his assessment. Certainly an interesting contrast to the detailed day of interviews and assessments of each person I do for the family court!

So, its been an interesting summer. Despite the hiatus there is a lot I want to write about.