Tuesday 24 June 2014

Psychological Resilience in Birmingham

It’s not often I blog about events I go to, but occasionally one sparks some thoughts that I think are worth committing to virtual paper.  Today I attended a seminar as part of an ESRC-funded series on behaviour change and psychological governance.  This session had a focus on ‘resilience’.  There was a range of speakers, including a practitioner from Action for Happiness.  As often happens with these sort of events, I came away feeling like a bit of a dilettante when confronted with the ridiculous levels of scholarship of some the people in the room – yet with an ambivalence about the worth of the sort of analysis being presented (it’s interesting and impressive, but does it have any real potential application to change the things that are being critiqued?).  Happily, Will Leggett put my discomfort into more coherent and polite form, and got something approaching an answer from some of the academics present.

I don’t want to offer a blow-by-blow account of the day, and you won’t get a full understanding of what the speakers said from this post.  What I’d like to do instead is just note some points that made me think, in the hope that they’re also interesting to other people.  If you want something approaching a running commentary, Mark Whitehead’s Twitter feed would be invaluable.

Jan de Vos had some interesting, critical points to make about neuroscience and its popular understanding – one of which was that the idea of the ‘self’ has now taken a back seat in favour of the idea that we are subject to various processes of mind/brain.  According to this view of the world, the brain isn’t a ‘mirror’ of the self, with neuroscience enabling us to ‘see’ things like happiness.  Rather, it’s a ‘medium’ that forms humans.  This means that the old adage ‘be yourself’ no longer really applies – it would be a better reflection of understandings to say ‘be your brain’ – or rather, you have to be your brain.  In presenting this analysis, there were all sorts of references that go beyond my understanding, with detail on Lacan, Baudrillard and many more.

Erica Burman offered a fascinating critique of the recent report of the APPG on Social Mobility entitled ‘Character and Resilience Manifesto’, in conjunction with Centre Forum and Character Counts (and with material from Richard Reeves of Demos).  I found her critique persuasive, but this was the point when I wondered how it would change or add to current policy.  This doesn’t mean that critique isn’t necessary, but it did make me feel that if practitioners were in the room they might be wondering why we were bothering with this sort of thing.

One interesting point made by Erica was that the importance of emotional awareness and work has been acknowledged by the Coalition, but reframed from previous understandings to be discussed in terms of ‘skills’ and ‘learning’.  In her words, ‘New Labour emotional talk has acquired austerity hardness’ – and there’s something masculinising about this formerly feminised field.

Mark Duffield made an interesting point from the floor, noting how resilience is asymmetrical between aid workers and those receiving aid: the workers are increasingly separated from local communities, retreating to what Mark called ‘bunkers’, where they can perform ‘care for the self’ (to use a phrase from Foucault, to keep the idea academic).  That means that those who live in these communities require a higher level of resilience than the aid workers.  He wondered aloud whether the same could apply to the implementation of such policies (or rhetoric) in the UK: those who are advocating resilience are precisely those who need it least, because they are insulated in their ‘bunkers’.

This chimed well with John Cromby’s critique of an academic article that took similar themes to resilience to suggest that people with particular personality traits were more likely to report wellbeing.  Although he successfully attacked much of the methodology underpinning the article, the point that caught my eye was the way in which the findings were divided by socio-demographics.  The relationship between personality and wellbeing was only evident amongst those from deprived areas; those from more affluent areas didn’t show any such pattern.  That is, resilience as a strategy is only really relevant to those facing structural hardship.  This need to be aware of structures and environments around people is crucial – and highlights a possible tension between resilience and nudging.

This brings me onto the thought from Kathryn Ecclestone’s talk that got me thinking the most.  She contrasted the idea that individual citizens should do work to make themselves resilient at an individual cognitive level – suggesting that we can individually think and make ourselves happier – and the prominence of ‘nudge’ approaches, which are sold on the basis that it’s possible to change behaviour without changing minds.  Resilience is all about changing minds.

Of course it could be that there’s horses for courses, and policymakers should have a range of techniques at their disposal, but it certainly highlights the ongoing tensions in policymaking frameworks.

And that brings me back to my scepticism about some of these analyses (though, revealingly, prompted by one of them).  It’s sometimes too easy to see policymakers as a monolith, or when analysing policy to look for a coherent underlying philosophy (such as neoliberalism, perhaps).  The reality (and this is no new insight) is disappointingly messy and ramshackle.  And, as Will Leggett pointed out, if we wanted to change policymaking we might need to think about these references to Foucault, Lacan and the like are translated into language to persuade politicians and civil servants resulting in practical policy programmes.

Sometimes we should stop analysing, and think about alternatives.  I was asked at lunch what I thought the regulatory system for drugs should be, and I was reminded of Virginia Berridge’s comment in Demons that she was asked this once and wasn’t sure how to reply.*  I should spend my time thinking what good alcohol and drug policy would look like if I’m going to criticise the current government approach.  And maybe I will – though for the moment I’m going to bask in the consolation that I’ll be taking decisions about local substance misuse treatment policy when I’m back in the office on Tuesday.

(I haven’t covered all the speakers here, but that’s no slight on those I’ve missed.  It’s more about trying to keep some kind of coherence in my thoughts.  Will Davies, for example, gave a presentation full of interesting thoughts – but in my interpretation more relevant to my thinking on neoliberalism, so I’d bunch it with that.  He noted how pre-20th Century thinkers such as Bentham and Jevons saw money as a potentially useful way for people to quantify and prioritise their preferences.  Indeed, this is the foundation of classical economics (I think).  However, in neoliberal economics, Davies suggested, price moves beyond a way of quantifying something of the pleasure associated with consumption to being the only thing of interest, in and of itself.  An interesting though – and quite possibly one I’ve misrepresented and oversimplified.  All will no doubt be made clear in his forthcoming book…)

*I had that terrible realisation afterwards that I’d told John Cromby that I’d been told this by someone recently.  No, Will, you just read a popular, brilliant book. 

Friday 20 June 2014

Does Total Consumption matter?

It’s always nice when I get an opportunity to write about something on this blog that actually fits with my original aspirations for it: to discuss clarity of thinking around policy.  On the negative side, as usual I’m writing about something inspired by Chris Snowdon and/or James Nicholls rather than writing on my own initiative.

In this case, it’s a response to an exchange between the two of them, where they discussed the Total Consumption Model and alcohol policy.  I felt there was a lack of clarity in the exchange (though I wasn’t able to listen to the original LBC audio).  James accused the original IEA report that prompted the debate as being misleading in characterising the Total Consumption Model as being the ‘cornerstone’ of government alcohol policy.  I don’t want to go into the rights and wrongs of this debate here – there’s plenty of that on Twitter and Chris’ blog.

More than this, though, Chris seemed to be inconsistent in terms of considering problems and solutions.  There isn’t any necessary link between the Total Consumption Model and whole population approaches to alcohol policy.  There are all sorts of reasons for identifying a whole population solution even if you know the problems are caused by individuals.

Sometimes this might be about the ease of administering a policy.  For example, we place fixed age limits on alcohol consumption, even though potential drinkers mature physically and mentally at different rates, and won’t all be equally well prepared to deal with alcohol at the same age.

Sometimes this might be about equality.  There’s something attractive about the idea that all units of alcohol should be treated (and taxed) in the same way, rather than differentiating on the basis that more problems are associated with a particular drink.

Finally, support for a whole population approach might be political (or perhaps more accurately moral).  Kettil Bruun supported a population-wide approach partly because he felt it might avoid stigmatising dependent drinkers.

That is, population-level approaches needn’t have the Total Consumption Model as their cornerstone.  More importantly, though, population-wide policies aren’t the ‘cornerstone’ of the Total Consumption Model, as Chris also seems to suggest on his blog.  The TCM might prop those policies up, but it would be back-to-front thinking to have the solutions explaining a problem.

This is all a bit reminiscent of the industry objections to MUP dressed up as concerns regarding its effectiveness.  Chris’ problem with the Total Consumption Model is that it (apparently) supports population-wide policies, which he says are likely to be ineffective, but we haven’t even agreed on how that potential efficacy might be judged.  I’m sticking my neck out here, because this isn’t quite the reasoning he offers on the blog, but I have a suspicion that the reason he doesn’t like population-wide policies is because they might affect people whose drinking impinges on no-one but themselves.  However, as I’ve noted, there are lots of other arguments in favour of population-wide policies other than the TCM.

Moreover, MUP may affect the majority of drinkers, but it wouldn’t ‘target’ them (as Chris put it on his blog).  All drinkers might all be somewhat affected by MUP, but there’s no doubt that people wouldn’t be equally affected by the policy.  One good way of seeing this is to watch Nick Sheron’s presentation about the drinking habits of the people he sees with serious liver conditions: they drink a disproportionate amount of cheap alcohol, and would be disproportionately affected by MUP – whether that would reduce their consumption or simply lead to a financial hit.

There’s also something misleading in Chris’ discussion of risk and health in the context of population-wide policies.  It’s perfectly correct to point out that an individual won’t be much affected by a small reduction in their consumption, particularly if they’re not at the top end of the consumption spectrum.  However, this is to misunderstand how population-level policies work: they don’t aim to make everyone necessarily live longer by a day or so; they aim to make an average population live longer, and affect some individuals significantly.  The nature of the prevention paradox is that an individual won’t be noticeably affected by the small reduction in risk their change in consumption habits produces.  These small reductions in risk, though, when aggregated across a whole population, can produce a notable reduction in overall mortality.

Of course it can perfectly reasonably be argued that pushing (not quite nudging) people towards certain choices is no business of the state – and that’s fundamentally where the disagreement here lies.  The IEA isn’t an expert in the effectiveness of health interventions; it’s a bit more clued up on political philosophy.

The real policy debate should be a clear discussion of what the problem is, and what an appropriate solution might be – which may not necessarily be the most effective solution, as that might not be acceptable for practical or moral reasons.

Whole population policies might or might not be a sensible approach to alcohol, but it’s misleading to focus on the idea that ‘The 'cornerstone policies' of the Total Consumption Model involve raising taxes, restricting advertising and limiting availability’, since these policies can be justified in a number of other ways.

If this is a debate about liberty and fairness, let’s have it.