Click to edit Master subtitle style Preliminary development and evaluation of an instrument to measure ‘subjective communality’ Kerr, Abernathy et al

Click to edit Master subtitle style

Preliminary development and evaluation of an instrument to

measure ‘subjective communality’

Kerr, Abernathy et al.NHS Lanarkshire et al.

‘Subjective communality’

Abundant evidence implicating social and cultural factors in origins and outcome of ‘individual’ mental disorders.

Various sociological and social psychiatric measures available to evaluate these.

Plethora of measures of individual psychological distress and function.


Sociological/social psychiatric measures e.g. social capital, ‘anomie’, Warwick-Edinburgh Scale, SF36, EQ5 etc etc.

Individual psychological distress and function e.g. BDI, HAD, GAF, BPRS, CORE, SCL90, PSQ etc etc.


Impression from clinical practice that internalised socio-cultural factors relating to sense of ‘communality’ are identifiable and important.

Need for measure of something like ‘subjective communality’ in local project involving NHS Lanarkshire and Prato, Tuscany (Prof Sashidharan and Pino Pini). This aims to evaluate and promote ‘joint (collaborative) experiences’ between services and community.


Arneil, B. (2006). Diverse Communities: The Problem with Social Capital, Cambridge, England, Cambridge University Press.

Bruce, M.L., Takeuchi, D.T. and Leaf, P.J. (1991). Poverty and psychiatric status. Longitudinal evidence from the New Haven Epidemiologic Catchment Area Study.. Archives of General Psychiatry, 48, 470-474.

Harris, T. (2001). The psychosocial origins of depression. James, O. (2007) Affluenza. London, Random House Publishing. Marmot, M & Wilkinson, R. (2006). Social Determinants of Health. (2nd

Ed) Oxford, Oxford University Press. Putnam, R. (2000). Bowling Alone: The Collapse and Revival of American

Community, New York, Touchstone. Read, J., Van Os, J., Morrison, A., Ross, C.A. (2005). Childhood trauma,

psychosis and schizophrenia. A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330-350.


Rutter, M. (2000). Psychosocial influences: critiques, findings and research needs. Development and Psychopathology, 12, 375-405.

Warner, R. (1994). Recovery from Schizophrenia: Psychiatry and Political Economy. (2nd Ed) London, Routledge.

Weich, S. & Lewis, G (1998). Poverty, unemployment and the common mental disorders. A population based study. British Medical Journal, 317, 115-119.

Whitley, R. & Mackenzie, K. (2005). Social capital and psychiatry: review of the literature. Harvard Review of Psychiatry, 13, 71-84.

Wilkinson, R. and Pickett, K. (2009). The Spirit Level. Why More Equal Societies Almost Always Do Better. London, Allen Lane, Penguin Books.


Conceptualisations of ‘socially-constituted’ self currently inadequate and poorly developed in mental health field.

‘Subjective communality’ Brown, D & Zinkin, L. (1994. The Psyche and the Social World -

Developments in Group Analytic Theory. London, Routledge. Leiman, M. (2004) Dialogical sequence analysis. In, The Dialogical Self in

Psychotherapy. Hermans, H, and Dimaggio,G. (Eds). Hove, Brunner-Routledge.

Meares, R. (1998) The self in conversation: on narratives, chronicles and scripts. Psychoanalytic Dialogues, 8:875-891.

Mitchell, S.A. (2000). Relationality: From Attachment to Intersubjectivity. Hillsdale NJ, The Analytic Press.

Rogoff, B. (2003). The Cultural Nature of Human Development. Oxford: OUP.

Shweder, R.A. & Bourne, E.J. (1982) ‘Does the concept of the person vary cross-culturally?’. In, A.J.Marsella & G.M.White (Eds) Cultural Conceptions of Mental Health and Therapy, Dordrecht, Reidel.

Stacey, R. (2003). Complexity and Group Processes: A Radically Social Understanding of Individuals. Hove, Brunner Routledge.

Stiles, W. (1997) Signs and voices: joining a conversation in progress. British Journal of Medical Psychotherapy, 70, 169-176.


Paucity of means of assessing significance of internalisation of socio-cultural factors in contributing to morbidity and outcome (including treatment outcome) of mental disorders.


“…Any function in a child’s cultural development appears twice, or on two planes. First it appears on the social plane and then on the psychological plane. First it appears between people as an interpsychological category and then within the child as an intra psychological category. This is equally true with regard to voluntary attention, logical memory, the formation of concepts and the development of volition. We may consider this position as a law in the full sense of he word, but it goes without saying that internalisation transforms the process itself and changes its structure and functions. Social relations or relations among people genetically underlie all higher functions and their relationships...” (Lev Vygotsky)


Stern, D.N. (2000). The Interpersonal World of the Infant ; A View from Psychoanalysis and Developmental Psychology. (2nd Ed.) New York, Basic Books.

Reddy, V. (2008). How Infants Know Minds, Cambridge, Mass, Harvard University Press.

Rizzolatti G., & Craighero L. (2004). The mirror neuron system. Ann Rev Neurosci 27: 169-192.

Trevarthen, C., and Aitken K.J. Infant intersubjectivity: research, theory and clinical applications. Journal of Child Psychology and Psychiatry 2001; 42: 3-48.

Vygotsky, L.S. (1978). Mind in Society; The Development of Higher Psychological Processes. Cambridge, Mass.; Harvard University Press.


Bruner, J. (2005). Homo sapiens, a localised sub-species. Behavioral and Brain Sciences, 28, 694-695.

‘Human beings are biologically predisposed to be socially formed’. A. Ryle.


CAT - based on a radically social model of self which is seen as fundamentally constituted by internalised, socially-meaningful, interpersonal experience and is described in terms of a repertoire of ‘reciprocal roles’ and their procedural enactments.

(Ryle, A. & Kerr, I.B. (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. John Wiley and Sons, Chichester, New York.)


From this perspective it can be argued that there can be no such thing as purely individual psychopathology - but only ever socio-psychopathology.


‘internalised sense of common identity, meaning and purpose, in conjunction with a sense of mutual support and trust, and sense of mutual acknowledgement and appreciation of personal experience and narrative.’

(‘Addressing the socially-constituted self through a common language for mental health and social services: a cognitive analytic perspective’.Kerr, I.B. (2009). In, Forbes, J. & Watson, C. (eds). Confluences of Identity, Knowledge and Practice: Building Interprofessional Social Capital. ESRC Seminar Proc., (4), 20, 21-38, Aberdeen , University of Aberdeen.)

‘Subjective communality’- initial short version: feedback from focus groups and selected others.

Identification and explication of the core hypothesised domains/facets and the generation of corresponding items.

Questionnaire circulated and discussed by focus groups (mixed colleagues and service user groups) and by selected colleagues and acquaintances. Further verbal and written feed back subsequent to meetings also obtained.

‘Subjective communality’: initial short version (1)

1) I feel that if something bad happened to me (e.g. serious financial difficulties

or an illness) I would be able to rely on those around me for help and support.

2) I feel that I share the same values with most of the people around me.

3) I feel that I share a sense of common purpose with most of the people around me.

4) I feel that together with the people around me I have considerable power

to affect important issues in life.

5) I feel that I am effectively alone with any difficulties I have in life.

6) I feel that my involvement with other people around me day to day

contributes to a sense of meaning in my life.


7) I feel that I am able to contribute helpfully to the lives of others around me.

8) I feel that if I had any serious anxieties there would be plenty of people

around who would help me cope with them.

9) I feel that my involvement with other people around me day to day

contributes to a sense of meaning in my life.

10) I feel that I am able to contribute helpfully to the lives of others around me.

11) I feel that if I had any serious anxieties there would be plenty of people

around who would help me cope with them.

12) I feel that no-one around me knows my life story well enough to give it

a sense of meaning.


13) I feel that in some after life there may be some redemption or a making sense

of my present life.

14) I feel that certain religious beliefs which I hold contribute to a sense of

connectedness with other people around me.

15) I feel that there is a strong sense of trust between me and other people living

around me.

16) I feel that there is considerable respect between me and other people

living around me.

17) I do not feel any sense of belonging to the group of people around me.

18) I feel that my sense of connectedness with other people is constant from day

to day.

‘Subjective communality’- initial short version: feedback from focus groups and selected others.

Focus groups and others asked to direct attention towards conceptual issues, clarity of wording and cohesion with consideration of the face /content validity of the instrument. This led to modification of some items and creation of some additional items.

‘Subjective communality’- initial short version: themes from discussion and feedback.

General agreement that questions touched on some important issues not normally overtly addressed in discussions of mental health and well being nor by mental health practitioners in routine practice.

Some questions felt to be over wordy or abstract. Recurrent difficulty in identifying or being sure of

who or what ‘others’ or ‘community’ were exactly.

‘Subjective communality’- initial short version: themes from discussion and feedback.

Questions about relevance of religious beliefs in discussing the issues described as subjective communality.

Poignant description and agreement from service users about experience and effects of e.g. aloneness, stigma, damaging effects of contact with any ‘community’.

‘Subjective communality’- extended version

1) I feel that if something bad happened to me I would be able to rely on others for help and support.

2) I feel that I share the same values with most people.

3) I feel that I have considerable control over important things in my life. 4) I feel that I am alone in life. 5) I often feel that people in the community around me do not think I belong there. 6) I do not feel that I share any sense of purpose in life with other people. 7) I feel that my involvement with other people helps to give a sense of fulfilment to my life. 8) I often wish I felt more like I belonged to the community around me. 9) I feel that I am able to contribute helpfully to the lives of others. 10) I often feel low due to a lack of connection with other people.


11) I feel that the community around me is helpless to affect important issues in life. 12) I feel that if I had any serious psychological worries there would be people around with whom I could share them. 13) I feel that I have some influence over things that affect my community. 14) I feel that no-one really knows my life story. 15) I feel I would be able to ask people for help with any practical problems I had.16) I feel there is no real community around me. 17) I feel that the needs of the community around me is more important than my own needs. 18) People in the community around me often feel fearful about things. 19) I feel that I have a shared history with other people. 20) I feel that the community around me has damaged the quality of my life.


21) I feel that there is a strong sense of trust between me and other people. 22) I feel that having a sense of belonging to a community is important in life. 23) I feel that there is little respect between me and other people. 24) I do not feel any sense of belonging to other people. 25) I often wish I could move somewhere where I felt I belonged more to a community.26) I feel that my sense of connectedness with other people is constant from day to day. 27) I wish I could live in a community where I fitted I better. 28) I find it difficult to give to other people. 29) I feel that the community I live in would help me if I needed it. 30) I feel I would be able ask people for financial help if I needed it.


31) I feel isolated in life. 32) I feel there are people who would help with legal problems if I needed it. 33) I often feel fearful about things.34) I feel that I can make a meaningful contribution to decisions which affect my community. 35) I feel there are people around me who would help with any physical problems I had. 36) I feel there is a sense of hopelessness in the community around me.37) I often feel ashamed in relation to other people. 38) I feel there are people around me who would help with any medical problems I had. 39) I feel that the community around me carries a sense of shame. 40) I feel that I belong to the community around me.


41) I feel there is a strong sense of community spirit where I live. 42) I often wish I could contribute more to the community around me.43) The support I get from other people is important to me. 44) I feel left out of the community around me. 45) Religious beliefs are important to me. 46) I feel that certain religious beliefs which I hold contribute to a sense of connectedness with other people. 47) I have religious beliefs which I feel are shared with many others in my community. 48) I feel that in an after-life there may be some redemption or making sense of my present life.

‘Subjective communality’- next steps

Initial testing of 48 items with opportunity sample comprising mental health professionals, trainees, acquaintances and others with wide geographical distribution throughout UK.

Data to be evaluated using PCA/FA to explore the uni- or multi-dimensionality of the factors, hypothesised domains and internal consistency assessed with Cronbach’s alpha reliability analysis, all with a view to reduction of items.

‘Subjective communality’- next steps

Further testing with clinical and general populations in various localities in the UK.

On this basis further assessment of content validity (e.g. item response frequencies), normative data for specific groups, and convergent/discriminant validity in relation to other instruments (e.g. Warwick–Edinburgh Mental Well Being Scale, CORE). Assessment of test-retest reliability.



and then?? – further suggestions welcome!!

thank you!

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Click to edit Master subtitle style Preliminary development and evaluation of an instrument to measure ‘subjective communality’ Kerr, Abernathy et al