Presentation by Kate Spiegelhalter at Sociology of Mental Health Study Group symposium: What does sociology need to contribute towards or against the wellbeing agenda? on 10 June 2013.

1. Intersections in Innovation; mindfulnessbased therapies as part of the well-being
agenda
Kate Spiegelhalter
– current doctoral student, University
of Sussex

2. Creative approaches to mental health: a critical analysis of the
mindfulness agenda in Sussex

3. Rationale for PhD:
1) Mindfulness is an innovative therapy and subject of interest in
Sussex.
2) It is debated whether mindfulness therapies are applicable to people
experiencing psychosis (an often marginalised group).
3) Behavioural economics (‘nudge’) agenda is currently popular with an
interesting evidence base.
Collaboration with Sussex Partnership NHS Foundation Trust (SPFT)
study; Mindfulness-based therapy groups for distressing voices
(M4V): A pragmatic randomised controlled trial (RCT).
1.
- M4V aims to evaluate the effectiveness of a new kind of
‘mindfulness- based group therapy’ & seeks to help people learn new
ways of managing and living with distressing voices.

5. Research questions:
Main question:Can mindfulness be used as a specific technique and
made the focus of behavioural interventions in order to increase levels
of well-being for people suffering from psychosis?Sub questions:1.
What is mindfulness and who is promoting and working with it in the
field of mental health?
2. How is mindfulness being used and engaged with in the field of
psychosis, and specifically through on-going research in the area?
3. How is innovation being evaluated and what influences involvement,
acceptability and usability after a formal intervention?
4. Could the mindfulness paradigm be built on by incorporating choice
architecture to increase its value for users and practitioners?
5. What are the lessons for future mental health policy and practice,
both within Sussex and nationally?

6. Relevant sociological literature
Ethical and
methodological issues

7. • Thaler & Sunstein book (2009)
•‘Soft paternalism’
• Choice architecture
• Current government ‘Behavioral Insights
Team’/’nudge’ unit (BIT)
• Problematic as health promotion strategy?
• Medical sociologists would not necessarily
dismiss the relevance of cultural/behavioural
factors

8. Ideas for 'nudges' to apply:

9. UK Wellbeing agenda
•
Happiness Index launched 2011
•
Wellbeing Commission 2012
• 'Mainstreaming' of CAM (mindfulness got own peer reviewed
journal)
•
•
•
Supports retreat of government? Action on inequality needed
on the base of data... (lip service?)
Part of 'New Public Health'
Sociological critiques of health promotion agenda and
healthism

11. Healthism
'Health-related behaviour'
•Increasing demand for
•Development over
medicalisation from lay
past 40 years
public e.g. ADHD, PTSD, (Armstrong 2009)
CFS/ME
•Project of the body:
shift from medicine to
health dominates every
aspect of life (identity,
emotion, behaviour,
appearance)
Healthisation/healthism/
health-facism? (Crawford
•
•Foucauldian theory
•Idiom of ‘behavioural
discourse’
•Rose: ‘bio-citizen’
(1999)
•New modes of
subjectivity

12. The Therapeutic Critique
•‘Happiness gap’ despite increased life
expectancy and relative material wellbeing
•Low self esteem becomes the explanation for
’problem’ groups: teenagers, unemployed,
elderly, mentally ill, lone parents, disabled etc.
•“Society is much more comfortable dealing with
poverty as a mental health problem rather than
a social issue” (Furedi 2004:27)

13. Layard’s ‘Action for Happiness’
http://www.actionforhappiness.org/

14. Accepting the void...
- I believe that the very purpose of our life is to seek happiness. That
is clear. Whether one believes in religion or not, whether one
believes in this religion or that religion, we all are seeking something
better in life. So, I think, the very motion of our life is towards
happiness.
His Holiness the Dalai Lama (Marut 2012: xv)
But...
Case for a parallel acceptance of the void of unknowing
and selflessness.
Sociological writing on happiness: (such as)
Mauss, I., Gruber, J., Tamir, M. (2011) A Dark Side of Happiness?
How, When, and Why Happiness Is Not Always Good. Perspectives
on Psychological Science. Vol. 6 no. 3 222-233
•
•
•
Mindfulness-based interventions (MBIs), with their roots in
Buddhist philosophy, as a way to achieve this balance?

15. Intersections in innovation (and
implementation)
• Possibilities of implementation in Sussex as a case-study:
feeding into the work of Bangor and Exeter (Implementation
Toolkit)
• Still in Kabat-Zinn's words: 'a pimple on an elephants back' in
terms of popular awareness of MBCT as a therapeutic option,
and the cost-effectiveness case being made in order to divert
resources
- Opportunity cost for the NHS, there Is no new funding
• Progress made though, Bangor centre, PhD student there
making a case, Crane and Kuyken upcoming implementation
case-study.
• Jury still out on nudge

16. What biomedicine/psychiatry/wellbeing agenda
can learn from Buddhism
Buddhist themes/teachings
Current policy
applications
Links to MBCT/CBT
Demystifying as a religion: No deity,
creator, or supreme being. No-one to
worship or concept of an immortal
self.
Similarity to focus on the
practical aspects and
thought patterns of CBT.
Focus on Human Dysfunction:
craving causes suffering, people
experience life as unsatisfactory
because it does not correspond to
their expectations
Focus on thought
patterns, viewing
thoughts as clouds in the
sky/trains going through
a station that one can
choose to get onto or not.
Anti-foundational, process
perspective. World in constant flux,
transformation and change.
Phenomena have no independent
essence of their own, they’re ‘empty’
of inherent substance or essence
Role of social networks,
people are not islands,
interdependence
Implications for wider
policy

17. Thank you!
k.l.spiegelhalter@sussex.ac.uk
http://www.sussex.ac.uk/sociology/people/peoplelists
/person/144720