This blog is to critically introduce, and contextualise, new research findings from developmental research, neuroscience, attachment theory  and other areas of psychology that are topical or are likely to whet the appetite of  anyone interested. The aim is to discuss research which will feel relevant and which might even, if lucky, make a...

This blog is to critically introduce, and contextualise, new research findings from developmental research, neuroscience, attachment theory  and other areas of psychology that are topical or are likely to whet the appetite of  anyone interested. The aim is to discuss research which will feel relevant and which might even, if lucky, make a difference to how we approach our work or other areas of our lives.


COVID, stress, trauma and why we need to prioritise children’s mental health


This appeared (with nicer pictures plus some advertising of courses ) recently on the Tavistock website here


We are living through precarious times which are a challenge to us all, but more of a challenge to those who are vulnerable.

Children’s mental health is at serious risk from this crisis, and children’s mental health issues today translate into adult mental health issues in the decades to come. This makes it all the more imperative to understand how vital – and literally lifesaving – it is to prioritise good childhood experiences, which in turn means really understanding the effects of early experiences.

We know that both good and bad early experiences can have a lifelong impact on our psychological states. We know that good early caregiving predicts a range of outcomes years later, including career success, good relationships, health outcomes and much more. Research shows clearly that the best predictor we have of wellbeing in adulthood is secure early relationships in childhood and adolescence, and that such early relationships in fact program the ‘life-course’, psychologically but also physiologically.


The impact of stress and trauma

This, in part, is why the current crisis is so worrying. Data shows that, for example, suicides have increased, as has the use of antidepressants; many charities are reporting higher levels of domestic abuse, child abuse and neglect, and these are all things that increase when people are facing stress. Many of us are experiencing new anxieties associated with isolation, bereavement, and potential loss of income, or even poverty.

Stressed parents simply cannot care for their children in the sensitive, attuned way that gives rise to emotional ease, confidence and the capacity to take in information and learn. Stressed, traumatic and unhappy childhoods have been shown to have a very negative effect on later health outcomes. Stress is linked to lower or worryingly-heightened sympathetic nervous systems – as seen in vigilant, tense bodily responses to threat, shallow breathing, heightened blood pressure, lowered immune functioning and much more. In many traumatised children, such responses move from being one-off states to ongoing traits and become their default way of experiencing the world.


Current challenges

The challenges we face are many and varied, but some of the most current and urgent include:

  • Parents who are triggered and in crisis badly need more support and help from the kind of interventions which experienced, well-trained and supported mental health professionals, such as psychotherapists and psychologists, can deliver. A parent’s mental state will transmit to a child who will pick up on the mood and atmosphere in a household, and will be profoundly affected by more serious experiences, such as domestic violence.


  • Other professionals such as teachers and social workers, as well as doctors, need support in understanding the kind of symptoms they might be seeing. The effects of psychological challenges, such as trauma and neglect, can manifest in unlikely ways, such as acting out aggressive behaviours, psychosomatic symptoms, self-harm, or children or young people withdrawing. This all requires a depth of understanding, rather than superficial tinkering with simplistic or brief manualised interventions.


  • Children need to be given space and time to communicate what is going on for them. For some, this will be through talking, such as in child psychotherapy, for others, this might be through expressing their inner states of mind via play.


  • People in poverty, or subject to discrimination, are the ones who need the help most of all. It can be all too easy to blame parents or to criticise children, whereas in fact they all need support, care and reflective, compassionate help.


There are many more challenges, but the help that we can offer all depends on being able to provide and receive thoughtful, reflective and empathic care, in which good, healthy relationships are at the centre. This is what will give rise to better outcomes, this is what the research in areas such as attachment theory has long shown, and this is central to what we at the Tavistock and Portman NHS Foundation Trust have long taught to the professionals we train, and tried to offer to the children and families with whom we work.


What can we do?

We absolutely know that change is possible, and interventions can really affect children’s futures. There is increasing evidence that good, early help can have a long-lasting effect on children’s psychological and social wellbeing that extends right into adulthood. Good psychological help can affect the minds, brains, nervous systems and physiology of those who receive it. Such help can be at the level of community or national interventions – for parents, families, the individual child or supporting professionals. Many readers of this blog will be undertaking activities with children and families that most definitely change their trajectory.

In my experience, it is always relationships that make the most difference – relationships in which empathy, mind-mindedness, compassion and sensitivity to another’s feelings are at the centre. The psychological attitude and skills of parents and how they interact with children makes a big difference, as do the attitudes and capacities of professionals such as therapists, teachers and social workers. We need to build a psychological legacy for future generations and that is just what is being challenged at the moment.

Would you like to learn more?

If you work with children and young people, and want to better understand the factors that affect how they behave, think and feel, our Digital Academy courses may be for you. Developed by Consultant Child and Adolescent Psychotherapist ​​​​​​​Dr Graham Music, the courses explore the most significant influences on the developing child, key developmental stages, and topics such as trauma, neglect and resilience:

Children’s Brain and Emotional Development: What people working with children really need to know

This five-hour mini course introduces new research into the brain and nervous system – highlighting important insights into the effects of early experiences, which can directly inform your work with children and young people.

Understanding and Nurturing Troubled Children

This 20-hour short course takes a more in-depth look at significant influences on the developing child – drawing on the latest neurobiological science and tried-and-tested clinical ideas to unpack children’s psychological states.

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neglecting neglect

A version of this blog can also be seen on the MindinMind website where there is also a video interview with MindinMind founder Jane O'Rourke  and also a free downloadable pdf of the below

It is really worth checking out the website, as it has great content on it


Why Neglect?

Emotional neglect as a therapeutic challenge is too little understood – and neglected. Neglect is different from abuse and overt trauma as it is about the good experiences which are not received, not the bad ones that are suffered, about omission not commission, about the effects of not receiving the growth inducing experiences that help minds grow, emotional lives thrive and hearts come alive. It is being held in mind, understood, thought about, cherished and enjoyed which gives rise to emotional growth. This is just what neglected children do not get.

In Nurturing Children I use clinical stories to illustrate essential elements of good therapeutic work. Ultimately therapeutic success depends on a good alliance, empathy, compassion and mutual resonance, alongside carefully gleaned skills and understanding. Yet some patients leave us feeling de-skilled, hopeless, even dreading sessions. I find this especially when working with people with histories of neglect, who have experienced insufficient growth-inducing experiences. This is different to those who are victims of, for example overt abuse or violence, who tend to be more reactive and challenging,

The feelings stirred up in us can be hard to own up to if our personal narratives include being ‘caring’, ’interested’ and ‘empathic’.

  • With such clients we often feel flat, bored and dulled-down.
  • They appear ’empty’, inhibited, passive, self-contained, with minimal capacity for mentalizing.
  • They show little pleasure, rarely inspiring hope, affection or passion.
  • They can be thought of as ‘under-looked’ or ‘unenjoyed’, or after Alvarez, ‘undrawn’ rather than ‘withdrawn’.
  • They slip out of minds, stirring up little interest or worry.

Spectrum of neglect

  • From extremely deprived orphans to milder forms,
  • such as those with very emotionally avoidant, or depressed parents.

True I risk conflating symptoms and causes, as similar histories do not necessarily lead to the same symptoms, but there are sufficient commonalities to describe a common clinical experience.

Double deprivation

Neglected children initially receive scant attention, and later further deprive themselves by barely recognising life-enhancing relationship opportunities. While born with the same preconceptions of lively interpersonal exchanges as anyone, the lack of good experiences leads to lifeless internal objects, with little hope of introjecting anything good. They seem to project little too, having surprisingly little effect on others. [Watch Gianna William’s on this theory]

Nervous systems and brains

Inadequate early experience leads to ‘dampened down’ nervous systems, the opposite of hyperactive aroused people. Emotional deprivation profoundly affects brain architecture, and programs our neurochemical system. (eg releasing less oxytocin).  Many develop autistic-like symptoms, lacking empathy and avoiding intimacy. We see deficits in right orbitalfrontal region, central to attachment patterns and emotional regulation, and less prefrontal left brain activation, central to agency and pleasure.


Such people evoke less interest than those with better developed autobiographical and emotional capacities. Our words and gestures, given with meaning, can feel denuded of life. It is in one’s countertransference that one really learns about these clients, and what it is like to be them, but our attuned resonance can lead us to feel as dead as them. We can say things in therapy just to escape their lifeless worlds.

Clinical technique

We must sustain an empathic stance without being drawn too far into such lifelessness, to stay psychologically animated enough to breathe life back into their psyches, while avoiding the trap of a ‘going-through-the-motions’  faux  psychotherapy. Research even shows that anyone interacting with avoidant people becomes less interested in people generally!

With such patients we need a more ‘active’ technique. They often know little about positive emotional experiences such as enjoyment, excitement, attunement, playfulness or joy. To develop an interest in oneself and others, someone must have been interested in us. In therapy we tend to work a lot with clients’ defensive and fear systems, helping to manage difficult feelings. However, with these patients we also need to build their ‘appetitive’ seeking systems, via mutually enjoyable interactions, allowing aliveness to flourish.


Humans are born ‘experience expectant’, primed for interpersonal interaction, but emotional development is stymied without growth-inducing relationships. In therapy we need to find a way to encourage agency and positive affect, and paradoxically, step back from lifeless encounters to empathically be in touch with such lifelessness. With them we walk a delicate tightrope between amplifying aliveness, agency and enjoyment while not being too intrusive, manic or seductive.

This blog describes children and adults I feel particularly worried about, who rarely inspire passion and therapeutic zeal, who have been neglected emotionally in their early lives, and often then evoke further neglect. The long-term sequelae of such neglect can be ‘deadly’ serious, probably more harmful, yet less noticed, than more visible trauma. Neglected children and adults I have worked with often ‘warm up’, get livelier and more real, given sufficient adaptation to our practice, and the courage of emotional honesty.


I am giving talks on similar themes in the near future at

Confer  5/2/21 with Anne Alvarez

The Sunflower Project January 23rd


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This blog is on the fantastic new MindinMind website

A brief snippet below but please click on this link to read the whole thing  and explore the site which has just launched

“There has been a shocking redirection of responsibilities onto individuals and away from the real culprits including poverty, childhood trauma, inequality, stressful environments and of course the powerful food industry”.

According to one recent report 1 in 5 children are obese when they start primary school and one in 3 by the time they begin secondary school.  Obesity is increasingly recognised as a major health issue and clear links exist between early obesity and a frightening range of health problems, such as heart disease, diabetes, even cancer and of course it has also been linked with serious cases of covid-19, especially fatal ones. ...........obesity, including in childhood, has in most countries increased significantly in recent decades. Its increase in childhood is especially worrying, given how adipocyte numbers remain throughout the lifespan. A major worry for me is the links between obesity and cognitive deficits, not only on the elderly, which link to poorer attention, worse executive functioning and suboptimal verbal learning,  This is on top of the cascade of serious physiological problems linked to obesity as life proceeds, from diabetes heart-disease and even cancer. This is really and truly deadly serious. Incredibly a recent government report suggested that obesity costs the NHS more than the police, fire-services and judicial systems combined.  Given the clear link between obesity, covid mortality and a range of health issues, we cannot afford not to act.

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Obesity, Immunity, Trauma, Covid-19: Science and Avoiding Fat Shaming


Interventions and policy must take seriously how adverse early experiences, stress and anxiety, alongside poverty, inequality and an exploitative food industry, contribute to obesity and metabolic issues in children and adults.


Obesity is increasingly recognised as a major health issue and clear links exist between it and serious cases of covid-19, especially fatal ones.

 We need a rethink of our understanding and attitudes to fat, large bodies and linked health issues, and become more aware of how obesity is linked to socio-political issues, stress and childhood trauma. There is real danger that discourses about food and obesity become another way of blaming the poor for their poverty and its effects. The overweight are often criticised for being lazy, greedy, lacking control or selfish, yet often what drives eating is far outside consciousness and developed for sensible evolutionary reasons.

 Obesity is often described in alarmist language, such as ‘an 'epidemic' or ‘public health crisis’. Prejudice against fat is endemic, with common narratives often evoking fear, disgust and blame [1] , attitudes often overlaid with social class and ethnic prejudice [2]. Prejudice against fat is one of the last remaining allowable ones, and most of us have feelings about food, fat and weight that we do not want to admit to. There are thankfully some alternative discourses, such as the Health At Any Size [3] and Fat Studies  [4] movements, which critique many poor quality scientific claims, such as those which automatically equate bodyfat and ill-health. Such movements have highlighted the overt discrimination in many health narratives about fat, including discrimination against large black female bodies [5].

 Fat shaming and fat blaming is of course pernicious, and indeed shame cycles are common contributors to unhealthy food issues such as binge eating. Over the decades I have seen too many clients full of self-blame, wracked with self-hate, feeling awful about their bodies and indulging in solutions which simply don’t work,  issues that many, such as Orbach [6] have brought to our attention over recent decades.


Science, biology, evolution and why diets don’t work

The recent science about body set-points and how bodies fight hard to protect fat stores, explains why diets don’t work in the long-term [7]. Dieting only gives short-term gains as the human body strives for homeostasis, so as we consume less calories, our body responds by using less energy, hence in time feeling tired, weak and ‘hangry’, and nearly always, reverting to old eating patterns.  In fact, nothing in our evolutionary history prepared us for living in an environment where calorie rich food was so abundantly on-tap. Our bodies evolved to conserve energy via storing fat, and our adipose tissue (fat cells), are packed with masses of important goodies set aside for future use, such as vitamins and minerals. Fat cells are alive, communicating and signalling, and have been a brilliant survival-aiding resource of millions of years [8], although they can also give rise to more worrying inflammatory processes [9].

 Such science is partly why I despair about much policy discourse and health advice, which is simplistic and prosaic, and centred on behavioural advice, like ‘consume less,' 'eat healthier', and 'move more'. Such an approach shows little understanding of basic biological processes, let alone the social, psychological, political and biological complexities of increased obesity levels. Shifting of responsibility onto individuals anyway reinforces dominant medical individualistic models [10], giving rise to worryingly pathologizing discourses, blaming the obese, and also, the parents of obese children. 

 Adverse Experiences and Obesity

The area of science which I think is too often missed is the link between obesity and adverse early life experiences, and how life-histories and our socio/political/economic contexts are expressed and ‘lived’ through our bodies, brains, minds and behaviours.  There is a growing literature on the relationship between obesity and both stress and trauma, with childhood trauma associated not only with obesity but also with a hugely increased likelihood of diseases loosely grouped under the heading of metabolic syndrome, including heart disease, diabetes and strokes [11]. The links between ACE’s (Adverse Childhood Experiences) and health issues such as obesity, diabetes, heart-disease and metabolic syndrome, is staggeringly clear, as highlighted for example in this radio 4 program. Stress and anxiety of course have many other worrying psychobiological effects, including increasing the chances of almost every kind of illness, physical and psychological, and indeed of early death [12], [13].

One study, analysing 112,000 subjects, found a very clear link between early childhood trauma and adult obesity [14], [15]. How might this happen? It seems that high stress levels disrupt our metabolisms, having an effect on our body chemistry and on weight-regulating hormones such as leptin and adiponectin, particularly in people who suffered abuse or trauma [16].  We also know that obesity also profoundly affects autoimmunity [17], hence  the possible link between obesity and covid-19 mortality. To dive into the science, in diabetes low insulin signalling undermines glutathione production which is central to antiviral action. Fructose, especially high-fructose corn syrup but also even table sugar, reduces antiviral activity, and indeed whether glucose is controlled or not is very linked to covid outcomes [18].

There is much new science about  the obesogenic effects of stress [19], poor sleep [20], and  the cascade of endocrinological and other effects of stress, including links to poor sleep which in turn links to higher body mass index, less healthy eating [21] and greater risk for obesity [22]. In addition, when stressed, anxious or traumatised a range of things happen to our bodies and brains, including less ability to self-regulate, as well as a drive towards more sweet, fatty and salty ‘obesogenic’ foods, which would have aided survival in our human ancestral past.  In experiments, those induced into stressful states of mind  are much more likely to go for fatty and sugary foods than those in a calm state [23], including even generally restrained eaters [24]. 

We can blame people for being ‘weak-willed’ or lazy, but it is ‘our evolution what done it’, for sensible survival-based reasons. We know from decades of developmental and evolutionary research [25] how extraordinarily adaptable humans are to their contexts, especially the earliest ones. Our brains, bodies and minds mould to fit into our environments, both in the physical world, where we can survive in artic cold and Saharan heat, and also in emotional worlds where we adapt to violent or abusive or loving or cut-off families and communities. Obesity is in many ways another example of our adaptability, as we see if we look at the research. Indeed childhood obesity is linked to increased numbers of fat cells that remain stable throughout the lifespan [26], as if messages about food, such as likely shortages, predispose to conserving fat stores. The more adipocytes the more desire to  consume calories, and the long-term effect is that childhood obesity is predictive of later health issues [27].

Storing Fat when times are tough

Food insecurity and other stressors lead to increased fat storage, as bodies naturally try to insure against future risks [28]. Stress. including facing an uncertain future, makes us attracted to fattening foods [29]. Linked to this, poverty and inequality induce a propensity to seek high calorie foods  [30]. If you subliminally give people messages suggesting that harsh economic times are around the corner and then you offer them both high and low-calorie food, they tend to choose more fattening food than those given more hopeful messages. Indeed, when both groups are offered the same food, but some are told that this food is high calorie, those receiving messages of economic trouble or hard times consume considerably more of the supposedly high rather than food designated low calorie.

Extraordinarily, if we have a stressful or depressing event 6 hours before eating a high fat meal, then our metabolism slows down and we are more likely to put on weight than someone not experiencing stressors. This can translate to around an 11kg weight difference over a year for stressed or depressed people compared to a non-stressed control groups [31]. Stress and anxiety actually alter the bodies inflammatory responses, which in turn effects how we metabolise foods, which is one way in which stress increases the propensity for obesity [32], again presumably for good evolutionary reasons.

Life-history here makes a surprising difference. Extraordinarily the same meal in the same fast-food outlet has a different effect on disadvantaged populations to the affluent [33], allostatic load and its likely effects on the microbiome seeming to be central in this process. The way our bodies respond to a food is in part determined by people’s whole lived experience, including both long-term lifetime and environmental stressors. This is another reason why just legislating about fast or processed food sales is not enough, we must also look at stress and life-history.

Linked to this, parents with an insecure attachment style who struggle to regulate their own emotions are more likely to have kids who indulge in foods that are less healthy, and who are likely to become obese [34]. This is partly due to using food as a comforter to compensate for unhappy feelings, but the stress is likely to drive both children and adults to not only comfort eat but also to store fat.

This all makes sense from an evolutionary perspective. In our hunter-gatherer pasts when the environment and food sources were uncertain and there was little sustenance available, our bodies pushed to stock up on calories and fat. These are not conscious decisions but bodily-led non-conscious instinctual ones.

Benefits of psychological wellbeing

On the other hand, feeling good about our lives will lead to consuming less. In fact people who do the same activity, such as running a race, and find it pleasurable are less likely to eat high calorie foods than those who are dissatisfied or unhappy about the same run [35]. If you get people to do exercise and tell some it is a pleasurable, relaxing activity while others are told it is exercise, the latter afterwards tend to consume more calories and less healthy foods. Feeling good helps you to eat healthily, creating a virtuous cycle for those without stressors. Clinical experience adds plenty of important angles to these issues. The push to eat when stressed and anxious often of course leads to ‘eating down’ feelings, and self-punishment linked to high levels of self-disgust about body-shape in both obese and non-obese people.

Given all this it seems imperative to challenge belief systems replete with blame and factually dubious assumptions. Current discourse has remained primarily at the level of individual responsibility. The British Prime Minister,  Boris Johnson, whose covid-linked scrape with mortality was probably diabetes/obesity linked, has naively exhorted us to, Tebbit-like, get on our bikes to exercise as well as eat better. This is not enough, especially when factors such as early adversity and its relationship to biological mechanisms are not considered, let alone the power of the food industry.

 Addiction and Big-Food

Important here is the ‘addictive’ nature of eating and cravings, powerfully fuelled by the addictive nature of much processed food. Our biological and psychological systems drive us towards pleasurable experiences which aid species reproduction, such as sex and food, such drives being linked to the dopaminergic system,  and centrally involved in all addictive processes. While in some clients we see too low a drive and ‘appetitive’ system, in others we see a very high one, and more often one which has lost touch with ‘real’ needs, such as in drug, alcohol, and other addictions. We can add food addiction to this list, and following high stress, we see worse poor interoceptive abilities, ie less capacity to read bodily signals and know if one is hungry. The propensity for both worse interoception and heightened addictive states is massively increased in trauma, stress and abuse.

 Particularly worrying are the obesogenic effects of easy to access high sugar/fat/salty foods designed to stimulate reward pathways. Food companies invest huge sums into researching exactly what quantities of, especially, sugar, fat and salt, and also which tastes, stimulate addictive food urges and the likelihood of customers returning for more.  Alongside this supermarkets invest vast sums in not only marketing but also product placement, such as where exactly to place, at what height etc , the  high profit, less healthy more addictive processed foods.  Calling for a ‘sin tax’ is a wrong-sighted redirection of responsibilities onto individuals and away from culprits such as poverty, childhood trauma, inequality, stressful environments and of course the powerful food industry.


What are some of the lessons from this kind of research? Firstly, it does not mean that we should not continue to campaign against advertising which suggests that skinny prepubescent looking bodies are what is attractive. Nor should we let up on arguing that companies who basically sell addictive products should be brought to rights. Such practices are as pernicious and dangerous as selling cigarettes and other addictive health damaging substances. Indeed, it might well be the combination of the fairly recent availability of high calorie, high fat foods with the biological predisposition to consume these in times of stress that has given rise to such an obesity epidemic.

This kind of research could be used to try to halt the tendency of certain already marginalised sectors of society to be blamed for what are basically the effects of stress, fear, unhappiness, inequality, poverty and bad luck, plus a manipulative food industry. Such issues need addressing on a macro-socio-political level, but also with community interventions, improving neighbourhoods. We also do need interventions to help individuals feel better about their lives through wellbeing enhancing help, whether therapy, mindfulness, yoga, exercise, dietary advice and the like. These can make a huge difference but will be but a drop in the ocean if we don’t address the wider, macro socio-political issues such as poverty, inequality, poor economic prospects for so many, degraded neighbourhoods, the lack of hope for increasing numbers of our population and the power of Big Food.

We know that the current climate is particularly dangerous given  how economic downturns gives rise to a reduction of food spending,  buying foods higher in calories and fats [36], and our bodies retaining more fat when stressed. In the face of what is being described as an obesity epidemic we must avoid simplistic and judgmental solutions, many of which blame sufferers. Instead we badly need scientifically valid yet potentially liberating understandings, with the blame, guilt and judgement stripped out, allowing for macro-social, community, family and individual level responses that might lead to better overall mental and physical health, including the reduction in obesity.​  

This is truly deadly serious. Obesity has been shown to increase death by covid-19 by nearly 50%, hospital admissions by 113% and ICU admission by 74%  [37]. Incredibly a recent government report  [38] suggested that obesity costs the NHS more than the police, fire-services and judicial systems combined.  Given the clear link between obesity, covid mortality and a range of health issues, we cannot afford not to act.


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[2]        C. L. Hoyt, J. L. Burnette, L. Auster-Gussman, A. Blodorn, and B. Major, “The obesity stigma asymmetry model: The indirect and divergent effects of blame and changeability beliefs on antifat prejudice.,” Stigma Health, vol. 2, no. 1, p. 53, 2017.

[3]        A. N. Taylor, “Fat Cyborgs: Body Positive Activism, Shifting Rhetorics and Identity Politics in the Fatosphere,” Bowling Green State University, 2016.

[4]        E. Rothblum and S. Solovay, The Fat Studies Reader. New York: NYU Press, 2009.

[5]        S. Strings, Fearing the black body: The racial origins of fat phobia. NYU Press, 2019.

[6]        S. Orbach, Fat is a feminist issue. Random House, 2010.

[7]        J. Fung, The obesity code: Unlocking the secrets of weight loss. Greystone Books, 2016.

[8]        C. A. Wagner, P. H. I. Silva, and I. Rubio-Aliaga, “And the fat lady sings about phosphate and calcium,” Kidney Int., vol. 91, no. 2, pp. 270–272, 2017.

[9]        L. Boutens, G. J. Hooiveld, S. Dhingra, R. A. Cramer, M. G. Netea, and R. Stienstra, “Unique metabolic activation of adipose tissue macrophages in obesity promotes inflammatory responses,” Diabetologia, vol. 61, no. 4, pp. 942–953, 2018.

[10]      V. McFarland, “Neoliberal bodies: ideology and obesity,” Laurentian University of Sudbury, 2020.

[11]      O. M. Farr, D. M. Sloan, T. M. Keane, and C. S. Mantzoros, “Stress-and PTSD-associated obesity and metabolic dysfunction: A growing problem requiring further research and novel treatments,” Metab.-Clin. Exp., 2014.

[12]      C. Van Niel, L. M. Pachter, R. Wade Jr, V. J. Felitti, and M. T. Stein, “Adverse Events in Children: Predictors of Adult Physical and Mental Conditions.,” J. Dev. Behav. Pediatr. JDBP, vol. 35, no. 8, pp. 549–551, 2014.

[13]      S. R. Dube, V. J. Felitti, M. Dong, W. H. Giles, and R. F. Anda, “The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900,” Prev. Med., vol. 37, no. 3, pp. 268–277, 2003.

[14]      E. Hemmingsson, K. Johansson, and S. Reynisdottir, “Effects of childhood abuse on adult obesity: a systematic review and meta‐analysis,” Obes. Rev., vol. 15, no. 11, pp. 882–893, 2014.

[15]      R. Cox, H. Skouteris, E. Hemmingsson, M. Fuller-Tyszkiewicz, and L. L. Hardy, “4.1 Narrative Review,” ACCESS THESIS-A, p. 53, 2015.

[16]      M. Dalamaga, S. H. Chou, K. Shields, P. Papageorgiou, S. A. Polyzos, and C. S. Mantzoros, “Leptin at the intersection of neuroendocrinology and metabolism: current evidence and therapeutic perspectives,” Cell Metab., vol. 18, no. 1, pp. 29–42, 2013.

[17]      C. Tsigalou, N. Vallianou, and M. Dalamaga, “Autoantibody Production in Obesity: Is There Evidence for a Link Between Obesity and Autoimmunity?,” Curr. Obes. Rep., pp. 1–10, 2020.

[18]      L. Zhu et al., “Association of blood glucose control and outcomes in patients with COVID-19 and pre-existing type 2 diabetes,” Cell Metab., 2020.

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[20]      M.-P. St‐Onge, “Sleep–obesity relation: underlying mechanisms and consequences for treatment,” Obes. Rev., vol. 18, pp. 34–39, 2017.

[21]      J. S. Kjeldsen et al., “Short sleep duration and large variability in sleep duration are independently associated with dietary risk factors for obesity in Danish school children,” Int. J. Obes., 2013.

[22]      J. S. Dweck, S. M. Jenkins, and L. J. Nolan, “The role of emotional eating and stress in the influence of short sleep on food consumption,” Appetite, vol. 72, pp. 106–113, 2014.

[23]      G. Oliver, J. Wardle, and E. L. Gibson, “Stress and food choice: a laboratory study,” Psychosom. Med., vol. 62, no. 6, pp. 853–865, 2000.

[24]      C. Evers, A. Dingemans, A. F. Junghans, and A. Boevé, “Feeling bad or feeling good, does emotion affect your consumption of food? A meta-analysis of the experimental evidence,” Neurosci. Biobehav. Rev., vol. 92, pp. 195–208, 2018.

[25]      G. Music, Nurturing Natures: Attachment and Children’s Emotional, Social and Brain Development. London: Psychology Press, 2016.

[26]      K. L. Spalding et al., “Dynamics of fat cell turnover in humans,” Nature, vol. 453, no. 7196, pp. 783–787, 2008.

[27]      S. Kumar and A. S. Kelly, “Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment,” Mayo Clin. Proc., vol. 92, no. 2, pp. 251–265, Feb. 2017, doi: 10.1016/j.mayocp.2016.09.017.

[28]      D. Nettle, C. Andrews, and M. Bateson, “Food insecurity as a driver of obesity in humans: The insurance hypothesis,” Behav. Brain Sci., vol. 40, 2017.

[29]      J. Laran and A. Salerno, “Life-history strategy, food choice, and caloric consumption,” Psychol. Sci., vol. 24, no. 2, pp. 167–173, 2013.

[30]      B. Bratanova, S. Loughnan, O. Klein, A. Claassen, and R. Wood, “Poverty, inequality, and increased consumption of high calorie food: Experimental evidence for a causal link,” Appetite, vol. 100, pp. 162–171, May 2016.

[31]      J. K. Kiecolt-Glaser et al., “Daily Stressors, Past Depression, and Metabolic Responses to High-Fat Meals: A Novel Path to Obesity,” Biol. Psychiatry, 2014.

[32]      J. K. Kiecolt-Glaser et al., “Depression, daily stressors and inflammatory responses to high-fat meals: when stress overrides healthier food choices,” Mol. Psychiatry, vol. 22, no. 3, pp. 476–482, 2017.

[33]      S. L. Prescott and A. C. Logan, “Each meal matters in the exposome: Biological and community considerations in fast-food-socioeconomic associations,” Econ. Hum. Biol., vol. 27, pp. 328–335, 2017.

[34]      B. H. Fiese and K. K. Bost, “Family Ecologies and Child Risk for Obesity: Focus on Regulatory Processes,” Fam. Relat., vol. 65, no. 1, pp. 94–107, Feb. 2016, doi: 10.1111/fare.12170.

[35]      C. O. Werle, B. Wansink, and C. R. Payne, “Is it fun or exercise? The framing of physical activity biases subsequent snacking,” Mark. Lett., pp. 1–12, 2014.

[36]      R. Griffith, M. O’Connell, and K. Smith, “Shopping around? Households’ ability to maintain nutritional quality over the Great Recession,” 2014.

[37]      S. B. H. editor, “Obesity increases risk of Covid-19 death by 48%, study finds,” The Guardian, Aug. 26, 2020.

[38]      “Health matters: obesity and the food environment,” GOV.UK, 2017. (accessed Dec. 30, 2019).


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DEEPER THAN SKIN DEEP Black lives matter, racism, evolved capacities for prejudice and finding empathy and compassion



 A child not embraced by the village will burn it down to feel its warmth.  (African proverb)


Quite rightly people are taking to the streets to protest. The shocking murder of George Floyd has awoken a new generation to the extent of racism, prejudice and discrimination, and not before time. His death comes on the back of hundreds of years of racism and violent killings of black people in the USA and elsewhere. Unconscious racial prejudice exists in most contemporary societies and causes unthinkable emotional and physical pain, having repercussions on the minds, bodies spirits and hearts of multiple generations of people of colour.

We must use the most potent methods to diminish and if possible, eradicate discrimination, prejudice and racism. However, I fear that some of the ideology and rage might fuel a superficial political correctness which has too little depth, a bit like patching up a tooth when the root is rotten. I worry about the self-righteousness, and the effects of blaming and shaming.

We all need to get to know and understand the attitudes, beliefs and prejudices we all carry. Only by owning up to these, and thinking about how they arose, can racist attitudes be challenged effectively. Condemning prejudice in others and denying it in ourselves is a classic but unhelpful unconscious ploy, as is self-hating and self-shaming. We need to assertively combat racist behaviours but find a more compassionate approach to the attitudes we can all develop.

The backdrop to all this is the overdetermined set of social forces that gives rise to discrimination, inequality, racist behaviour, discourse, and actions. Such attitudes are kept in place via structural inequality and the way the competitive post-industrial complex works, including how systems around status and social rank play out in most societies. Think of the societies where status and economic advantage is linked with subtle gradations of skin colour, such as in many South American countries. Think of Catholic-Protestant mutual hatred in Ireland linked to the fights for economic ascendancy, or the power of the Serbs, a tiny proportion of Kosovo but holding economic power.  Power and economic gain are often central. It was dominant in slavery and it is in the US prison system, exploiting for profit many more black people than ever were slaves. We need to remain alive to the bigger political questions, and remember that racism and prejudice are about more than individual blame.

I at times am shocked by having a racist or discriminatory thought. My job is to own that, not beat myself up, but see how I can ensure that such unconscious attitudes do not persist, and definitely not translate into actions. I recently did a test I would encourage anyone to do, you can find it here, the  Implicit Association test. This tests our biases, whether on race, gender and a host of other issues.  It gets people to pair pictures (eg white or black faces) with words (eg good bad, violent etc ) and what it is measuring is our response time. If we are slower to pair a black face with positive words, this suggests an unconscious bias. Our unconscious cannot lie. I have done a few of these and have not always liked the results, which are hard to argue with. Even seasoned political campaigners for racial equality and rights, black or white, often find they have unconscious biases they were not aware of and are somewhat ashamed of. People of any race can internalise racist attitudes and not know they have them. It should not mean that anyone who gets a result suggesting non-conscious prejudice is ‘bad’, ‘immoral’ or deserving condemnation. What it does suggest is that we have internalised messages about race from history and wider society, and these have become unconscious beliefs. If such beliefs are revealed we can challenge them, but we certainly cannot challenge them if we deny them.

Some research

Our evolutionary heritage handicaps moves towards a racially less discriminatory world. Predispositions that evolved for sensible evolutionary reasons might now undermine a more equal, less prejudiced world. We evolved in small hunter-gatherer communities where mutual trust, loyalty and identification with one’s in-group were necessary for our very survival. Facing mortal dangers from predators and rival groups meant that in-group loyalty and cohesion were vital. We evolved to distrust the ‘other’.

We see the legacy as early as in infancy. Even babies show preference for adults who look and talk like them and like the same things as them, and they even often like people who harm people who are dissimilar to them [1]. 15 month infants like fairness but when the unfairness is to someone of another race, such preferences disappear [2] This is shocking and suggests that to combat racism we need to work against central aspects of our evolutionary heritage. We evolved to favour people who seem more ‘like us’ [3].

Humans from infancy adapt to survive and fit in, which requires learning cultural expectations and the nuances.  Indeed babies from different cultures  cry differently, with different prosody and gestures, from the first weeks of life [4]. Not fitting in is literally painful, similar pain circuits activating in the brain when ostracised as when feeling physical pain [5]. We like and need to belong, and prefer people in a group we are in, even if the allocation into groups has no objective basis.

Typical is an experiment in which boys were shown pictures painted with dots and asked to estimate how many dots were in each picture. They then were allocated entirely randomly as people who had either over or under-estimated the number of dots, and so were labelled either as ‘over-estimators’ or ‘under-estimators’. Surprisingly they later tended to favour and be more generous to others who were labelled in the same group as them [6].  In another experiment a teacher divided her class into brown and blue eyed pupils and announced that the brown-eyed pupils were better  in various ways [7].  The children then gravitated to playing with those in their own group, and those with the low-status blue eyes showed a marked worsening in performance, while previously well-functioning friendships between blue and brown eyed children deteriorated.

The tendency to divide into groups can have dreadful implications, as seen in the famous if shocking Stanford prison experiment in 1971. Here adults were randomly assigned to play the role of either prisoners or guards. In a very short time the two groups, whose members were indistinguishable in terms of social class, ethnicity and educational level, took on their respective roles. The prisoners became distrustful of and angry with the guards who in turn became surprisingly vindictive to the prisoners [8]. Their over- identification with these roles led to terrifying mutual hostility and violence.

The chances of reaching out to those in other cultures and groups are further compromised as the feeling that one belongs, and group loyalty, increase self-esteem [9], so it is good for us to belong. Prejudice about ethnicity, class or nationality are extreme examples of a double-edged predisposition.

Our group biases can be extremely unsettling. In a typical experiment in America white subjects were shown both black and white faces for 30 milliseconds, too short a time for the conscious mind to register. When shown black faces, in some experiments scans revealed heightened amygdala response, suggesting non-conscious fear, in others it was the fusiform face area. When the pictures were shown for long enough to register consciously, the scans showed activation in brain areas involved with conflict resolution, suggesting that the subjects were grappling with their own racism [10].

A clue as to how to manage our unconscious racism comes from how, when the face was well known and highly thought of, such as Nelson Mandela or Barrack Obama, then the same prejudices were less present in white participants. There are active steps we can all take to challenge our unconscious prejudices but burying our prejudice or projecting it onto others is unhelpful. Mostly our biases are non-conscious and implicit, reflecting societal beliefs and prejudices, often developed early in childhood.

Again, this is all unconscious, and we all can interpret the same sensation differently. I work with children and adults who have been traumatised and they often interpret something is dangerous or a threat that most of us see as ordinary. Their brains have developed to expect and protect them from danger. However many black people are not just wrongly seeing disdain, contempt, suspicion or fear, but they are picking up real signals. It is hard to imagine what it feels like to  be consistently on the receiving end of contempt or suspicion, let alone hatred. I remember 40 years ago reading  ‘Black Like Me’, a shocking account by a journalist who darkened his skin and then travelled to areas he thought he knew. The reactions and experiences he had were as if he was in another planet, attack, revulsion, ostracism, hatred and more, despite being the same person, with the same genes, mind, posture, eye colour, gait and everything else. It is little surprise that even young children can internalise such attitudes, seen when black kids heartbreakingly think that white dolls are better or more good than black dolls (video here).

When shown pictures of people in pain, if the other person is of one’s own ethnic or cultural group, such as African-American or Caucasian American, distinct parts of the brain, those involved in empathy, are active, but less so if the person suffering is from another group [11]. Such dehumanisation, of ‘ some lives not mattering’, seems to be at the heart of many atrocities based on prejudice such as race crimes as well as homophobia, Nazi anti-Semitic murder, or genocides such as between Hutus and Tutsis. It is hard to argue with the idea that there is some innate predisposition for prejudice. Owning that must be the first step to effectively combat it. The next is to transform the ‘other’ into ‘like us’, interestingly something that happened in Rwanda when the government introduced a radio soap opera featuring benign versions of both Hutus and Tutsis.

It is chillingly easy to diminish, dehumanise or ‘other’. In one study an ethnically and socially mixed group were shown images of a range of people, such as a female college student, a male American fire-fighter, a businesswoman and wealthy man, a disabled woman, a female homeless person and male drug addict. They were asked to imagine a day in the life of each of these people, an exercise that generally induces empathy. Strikingly, while the empathy circuits in the volunteers’ brains lit up for all the others, for both the homeless person and the drug addict areas dominant for disgust, such as the insula, were most active [12]. Indeed, very worryingly given the current social trend towards inequality and social divisions, for many brain areas linked with disgust lit up in response to poor people generally. Again, we need to be careful not to condemn too much. We evolved to have suspicion of the ‘other’ who in our evolutionary past could be dangerous or carry pathogens.

Remember, such prejudice is non-conscious and to combat it we have to recognise it, process the fact that we have it, rather than push it under the carpet. Then we can work with these issues, such as, for example, by imagining the lives of someone like a drug-user, possibly the abuse they might have suffered, for example. When we do imagine the lives of black people who receive non-conscious signals of distrust, fear, contempt and dislike day-in day-out it is hard not to feel compassion. It can be no coincidence that black people living in racist areas in the US have higher levels of nearly all bad health related biomarkers, from shorter telomeres to higher allostatic load. [13], [14]

Thus groupness is a mixed blessing. Belonging makes us feel better, and is one of the roots of genuine mutual care and cooperation. However, it can also lead to dehumanisation of others and inhibit cooperating with those we deem different. Surprisingly oxytocin, a hormone central to bonding, mutual trust and cooperation, increases empathy. Yet the same neurochemical  has a darker side. When people are in close-knit and bonded groups, such as the huddles of sportsmen before or close families, oxytocin levels rise. Yet people given oxytocin intranasally become more likely to help those in their own ethnic group, and less likely to aid those from other groups [15], a finding found in Belgium between Walloons and Flemish citixens, and in another study, in Israel between Hassidic orthodox and non-religious Jews [16].

We also know that when times are tough, group identification can be an uncobscious way of bolstering a fragile sense of self by identifying with an in-group, hence gang membership and the increase in racism and xenophobia witnessed so often with economic crises.  People showing a hubristic over-blown pride have higher levels of prejudice than those with ordinary self-confidence [17]. ‘Authentic pride’, which might derive from hard work and a genuine sense of achievement, is more likely to lead to a compassionate and empathic attitude to others. Pride based on hubris, and presumably geared to bolstering fragile self-esteem, is a more arrogant and less genuinely self-confident kind, and suggests attempting to feel better by diminishing others. Such studies back up the psychoanalytic idea that we can cope with bad feelings about ourselves by projecting them onto others. Those with more authentic pride were not only more empathic but they harboured less prejudice. This of course might also make sense of why we see such a rise in far-right and racist groups when there is an economic downturn and economically challenged groups, like some white working class men, can be tempted to more racist attitudes. 

Stress, including poverty, inequality and danger wire our brains for distrust. When the chips are down and danger looms we can’t afford to be open and trusting. Very anxious fearful children, as well as abused and traumatised ones,  are much more anxious, and suspicious of difference [18], and the parts of their brain involved in fear, such as the amygdala, are highly active [19]. People with more social fear tend to be more anti-difference, ant-immigration and, pro-segregation [20]. Some research has suggested that people on the political right have higher activation in fear related brain areas whilst those on the left have more activity in areas involved in curiosity, self reflection and empathy [21].

Thus the potential for racism and a fear of difference seems to be engrained in human nature, but is exacerbated in the face of fear and uncertainty, which is when most of us tend to cling to the known. This presumably made a lot of sense in terms of increasing our chances of survival in dangerous situations in our evolutionary past. Such an innate fear of the other can be reversed though with exposure to other races, even in infancy [22], and it is probably no coincidence that it was the most multi-racial UK conurbation, London, that came out so strongly against Brexit. When our backs are against the wall, we tend to see threat everywhere and resort to flight/flight responses rather than empathy and care for others.  Fear tends to make us more suspicious and  wary of others [23] . This might explain recent research finding that those who felt most threatened and less ‘safe’ in response to covid were the ones more likely to hoard toilet paper [24], a kind of ‘look after number 1’ threat response.

This might also explain why we see more conservative political views as well as racism in  American gun-owners who tend to be opposed to lenient immigration and other liberal policies. [25]. A state of mind in which fear is prominent often gives rise to more suspicion and less likelihood of caring openness.

In another study  138 men from Cambridge, Massachusetts watched films and then answered questions. Some watched relaxing images such as of beaches and palm trees, or heard soothing music. Others had to watch Sylvester Stallone's rather terrifying film, "Cliffhanger." The latter group not surprisingly had  heightened physiological reactivity after watching two minutes of rope dangling peril. Maybe more worryingly, this led them to have stronger anti-immigration and prejudiced attitudes. A message from this might be that if we make people feel safe, valued, secure and cared for they are less likely to develop such racist attitudes.


What much research is suggesting is that when people are suspicious, fearful and  life is going badly, they tend to have more activation in areas of the brain such as the insula, central to disgust, and fear, and less activation in brain areas to do with empathy, curiosity, trust or openness to novelty. Generally, brain areas that are dominant in fear, anxiety, threat or anger work against those that are central to cooperation, empathy or caring for others.

For me, a central lesson is that we all need to look long and hard at our own prejudices, and work to shift these. This can happen in a multitude of ways. For me personally it is often compassion informed practices, opening up to the reality of the lives of those we fear, and finding ways of ensuring I am thinking about their lives, history and past experience. I work with many perpetrators and have yet to meet one who was not also a victim, normally of terrible trauma. We need to understand both sides of this.

Of course, we need to be aware of deeper societal issues. Racism has been central to the maintenance of  contemporary consumerist capitalist society. This includes mass incarceration of black Americans who become effectively slave labour, ghettoization and cheap labour, black people on the lowest social rungs, poverty and suffering the most psychological and health adversity and so much more.

So where does this leave us? It is urgent that we keep in mind that many, if not most, of us, harbour racist and other discriminatory attitudes, unconsciously. These attitudes, often imbibed via the media, perpetuate divisions in our society and suffering in the discriminated against. In any society which is very unequal, ways will be found to justify someone’s power, wealth and status, such as their wealth or status being ‘deserved’, while those ‘others’ are ‘lazy’, ‘unintelligent’ , or worse, subhuman or like animals, as we saw in Nazi Germany and in slavery. Part of the challenge is to extend the boundaries of our empathy, which in some spheres has happened, for example in accepting homosexuality, transgender issues and multiracial living. As Rifkind has pointed out (see video), humans have extended our empathy and trust from small hunter-gatherer groups and blood-ties, to a detribalised feudal new groups, such as religious identification, then to extended ‘families’ within nation states, and now possibly new technology might allow a further extension of empathy, irrespective or race, class, nationality, religion or whatever arbitrary group. to new potential identifications, including with the whole human race, and indeed the planet and other species.

Thus, black, and hopefully all lives, matter, but if we dehumanise another then their lives and lifeblood do not matter to us. We can work against our tendency for prejudice and dehumanisation, which means first owning up to it and not being self-hating. Unconscious bias exists, and not all for bad reasons. We pick up own kids at the school gates, not any old random one, we all have biases, but some seem no longer so helpful. Alongside that we need to support the discriminated against to stand up with authority against acts such as of racism and abuses of power. One of my heroes James Baldwin stood up with courage against racism and also knew and said ‘not everything that is faced can be changed but nothing can be changed unless it is faced’ (video). This applies equally to ‘whitewashing’ structural racism and atrocities but also to facing, with some self-compassion, our own internal prejudices.


[1]        J. K. Hamlin, N. Mahajan, Z. Liberman, and K. Wynn, “Not Like Me= Bad Infants Prefer Those Who Harm Dissimilar Others,” Psychol. Sci., vol. 24, no. 4, pp. 589–94, 2013.

[2]        M. P. Burns and J. Sommerville, “‘I pick you’: the impact of fairness and race on infants’ selection of social partners,” Front. Psychol., vol. 5, p. 93, 2014.

[3]        E. J. Van Leuween, R. L. Kendal, C. Tennie, and D. Haun, “Conformity and its look-a-likes,” Anim. Behav., vol. 110, pp. e1–e4, 2016.

[4]        B. Mampe, A. Friederici, A. Christophe, and K. Wermke, “Newborns’ Cry Melody Is Shaped by Their Native Language,” Curr. Biol., vol. 19, no. 23, pp. 1994–1997, Nov. 2009.

[5]        J. T. Cacioppo and S. Cacioppo, “Social Relationships and Health: The Toxic Effects of Perceived Social Isolation,” Soc. Personal. Psychol. Compass, vol. 8, no. 2, pp. 58–72, Feb. 2014, doi: 10.1111/spc3.12087.

[6]        H. Tajfel and J. C. Turner, “An integrative theory of intergroup conflict,” in The Social psychology of intergroup relations, W. Austin and S. Worschel, Eds. Monterey, California: Brooks/Cole, 1979, pp. 33–47.

[7]        W. Peters, A class divided: Then and now. Yale: Yale Univ Pr, 1987.

[8]        P. G. Zimbardo, C. Maslach, and C. Haney, “Reflections on the Stanford prison experiment: Genesis, transformations, consequences,” in Obedience to authority: Current perspectives on the Milgram paradigm, T. Blass, Ed. New Jersey: Laurence Erlbaum, 2000, pp. 193–237.

[9]        M. Hewstone, M. Rubin, and H. Willis, “Intergroup Bias,” Annu. Rev. Psychol., vol. 53, no. 1, pp. 575–604, 2002.

[10]      W. A. Cunningham, M. K. Johnson, C. L. Raye, J. C. Gatenby, J. C. Gore, and M. R. Banaji, “Separable neural components in the processing of black and white faces,” Psychol. Sci., vol. 15, no. 12, pp. 806–13, 2004.

[11]      V. A. Mathur, T. Harada, T. Lipke, and J. Y. Chiao, “Neural basis of extraordinary empathy and altruistic motivation,” NeuroImage, vol. 51, no. 4, pp. 1468–1475, Jul. 2010, doi: 10.1016/j.neuroimage.2010.03.025.

[12]      L. T. Harris and S. T. Fiske, “Dehumanized perception: A psychological means to facilitate atrocities, torture, and genocide?,” Z. Für Psychol. Psychol., vol. 219, no. 3, pp. 175–181, 2011.

[13]      S. Y. Liu and I. Kawachi, “Discrimination and Telomere Length Among Older Adults in the United States: Does the Association Vary by Race and Type of Discrimination?,” Public Health Rep., vol. 132, no. 2, pp. 220–230, Mar. 2017, doi: 10.1177/0033354916689613.

[14]      K. K. Ridout, M. Khan, and S. J. Ridout, “Adverse childhood experiences run deep: toxic early life stress, telomeres, and mitochondrial DNA copy number, the biological markers of cumulative stress,” Bioessays, vol. 40, no. 9, p. 1800077, 2018.

[15]      C. K. W. De Dreu, L. L. Greer, G. A. Van Kleef, S. Shalvi, and M. J. J. Handgraaf, “Oxytocin promotes human ethnocentrism,” Proc. Natl. Acad. Sci., vol. 108, no. 4, pp. 1262–1266, Jan. 2011, doi: 10.1073/pnas.1015316108.

[16]      C. Fershtman and U. Gneezy, “Discrimination in a Segmented Society: An Experimental Approach*,” Q. J. Econ., vol. 116, no. 1, pp. 351–377, Oct. 2011, doi: i: 10.1162/003355301556338</p>.

[17]      C. E. Ashton-James and J. L. Tracy, “Pride and Prejudice: How Feelings About the Self Influence Judgments of Others,” Pers. Soc. Psychol. Bull., 2011.

[18]      L. E. Williams et al., “Fear of the Unknown: Uncertain Anticipation Reveals Amygdala Alterations in Childhood Anxiety Disorders,” Neuropsychopharmacology, vol. 40, no. 6, pp. 1428–1435, May 2015, doi: 10.1038/npp.2014.328.

[19]      K. Ohashi, C. M. Anderson, A. Polcari, A. Khan, and M. H. Teicher, “Psychopathology and Impaired Brain Network Architecture: The Importance of Childhood Maltreatment,” in BIOLOGICAL PSYCHIATRY, 2014, vol. 75, pp. 88S-88S.

[20]      P. K. Hatemi, R. McDermott, L. J. Eaves, K. S. Kendler, and M. C. Neale, “Fear as a Disposition and an Emotional State: A Genetic and Environmental Approach to Out-Group Political Preferences,” Am. J. Polit. Sci., vol. 57, no. 2, pp. 279–293, Apr. 2013, doi: 10.1111/ajps.12016.

[21]      R. Kanai, T. Feilden, C. Firth, and G. Rees, “Political orientations are correlated with brain structure in young adults,” Curr. Biol., vol. 21, no. 8, pp. 677–680, 2011.

[22]      G. Anzures et al., “Brief daily exposures to Asian females reverses perceptual narrowing for Asian faces in Caucasian infants,” J. Exp. Child Psychol., vol. 112, no. 4, pp. 484–495, 2012.

[23]      J. Renshon, J. J. Lee, and D. Tingley, “Physiological Arousal and Political Beliefs,” Export BibTex Tagged XML Immigrationanxiety Pdf, vol. 559, 2013.

[24]      L. Garbe, R. Rau, and T. Toppe, “Influence of perceived threat of Covid-19 and HEXACO personality traits on toilet paper stockpiling,” 2020.

[25]      K. O’Brien, W. Forrest, D. Lynott, and M. Daly, “Racism, Gun Ownership and Gun Control: Biased Attitudes in US Whites May Influence Policy Decisions,” PLoS ONE, vol. 8, no. 10, p. e77552, Oct. 2013, doi: 10.1371/journal.pone.0077552.









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Covid-19, Disproportionate BAME deaths, inequality and adverse childhood experience. A serious plague


As too often, the poorest and most discriminated against are suffering most, and bearing the brunt of an unequal neoliberal agenda.  This is a serious political issue, literally deadly serious


One of the extremely shocking features of the current epidemic is the disproportionate number of people from Black, Asian and Minority Ethnic Groups who have become ill and died. For example, many US cities report that 70% of the deaths have been from minority groups, even when these groups make up only 30% of the population. In the UK it looks like about 35%  are from non-white populations who in fact make up only 13% of the population, although, possibly as a cover-up, the government seems to not even be recording race and ethnicity formally.

There is a lot to unpick here, some speculative. The disproportionate illness levels are linked clearly to who is bearing the brunt on the front-line. Those designated as keyworkers, such as nurses, doctors, and equally those who work on public transport, in supermarkets, in refuse collection and many other ‘essential’ services, are at most risk of exposure to the virus. Many also have zero-hours contracts, work in poor conditions and are struggling to keep bread on the table and pay bills. A disproportionate number of people from BAME groups work in poorly paid insecure roles such as those above.  Similarly nursing in this country is shockingly under paid and a disproportionate proportion of nurses come from BAME backgrounds, and indeed vast numbers are imported from abroad due to worrying staff shortages.

Viral load, the sheer amount of exposure to the virus, is obviously an important causative factor, and explains some of the deaths of front-line health workers, but it is hard to square the pictures of the first 10 doctors who died in the UK all being from BAME groups. While some have hypothesised genetic predispositions, other research has talked about certain blood-types conferring resistance, and others talked of vitamin D deficiency, the jury is still out on these factors. Dietary factors linked to culture and social class/poverty might also be an issue (e.g. high fat, salty, sugary and especially processed foods). In addition, there likely is also unconscious racism, with certain groups possibly prodded to take on the riskier tasks, but we do not know for sure.

 However, what is incontrovertible is that a disproportionate number of people dying and having serious symptoms have what has euphemistically been called underlying health conditions. Those who seem particularly at risk are people who have well above average obesity levels, diabetes, heart and lung conditions and a range of metabolic syndrome disorders, as well as those who are immuno-suppressed. For the under 60’s for example, being obese seems to at least double the risk of hospital admission and indeed, mortality, and this has been seen in many countries, including the USA, UK and France.

This is by no means just bad luck and needs urgently to be linked to other findings out there about the effects of inequality, discrimination and particularly the long-term lifetime effects of Adverse Childhood Experiences (ACE’s). The data we have seen linking obesity and Covid-19 illness severity is crude, based primarily on Body Mass Index (BMI) measures, but we know that BMI is just one of many biomarkers linked with ACE’s .

What we know for certain is that, generally, more adverse life experiences, especially earlier on, are linked with worse health outcomes later, and to earlier death, and Covid-19 is not about to make an exception to this.

Multiple detailed studies show how, using basic measures of ACE’s, the more ACE’s someone has experienced, the worse the physical as well as mental health outcomes. While obesity is one marker, we see the same link and trajectory with, for example,  hypertension, heart disease, strokes, cancer, diabetes, arthritis,  lung disease, insulin resistance, inflammatory disorders, to name a few, and that is without mentioning the host of psychological effects, from depression,  anxiety disorders, eating disorders, a list too long to write. Typical, and hugely relevant for Covid-19,  is the clear link between ACE’s and COPD, Chronic Obstructive Pulmonary Disease, a huge cause of death anyway in the western world, and about 2.6% higher in those with 5 or more ACE’s.

It is important to note a few things here. While adverse experiences might increase the likelihood of behaviours which are risky, including smoking, poor diet, addictive behaviours, still, the pathways to such ill-health and the links between psychological and physiological states are multi-layered and overdetermined. Yet, seems clear that important genetic pathways are turned on or off by adverse experiences, one example being the glucocorticoid receptor, very linked to many serious psychiatric disorders. Being under stress and thereat lowers our immune responses, and anyone’s immediate survival needs in the face of danger will trump the body’s desire to look after long-term immunity. Indeed cortisol, often seen as the ‘stress hormone’, is a steroid with immune dampening effects.

Similarly, more Adverse Childhood Experiences equates with a range of effects on the nervous system, and the brain (eg on the hippocampus, amygdala, PFC and so much more). Constantly being on ‘red-alert’ for danger or stress has powerful effects on immune functioning and the ability of the body to relax and recover, the healthy parasympathetic ‘rest-and-digest system barely getting a look-in while we are under threat.

How does this link to BAME morbidity and risk in the current crisis? People from minority ethnic groups are grossly over-represented in the population struggling with poverty, economic stressors, scary neighbourhoods, psychiatric problems and so much more.  We are seeing the effects of structural inequality at a society-wide level. Of course, as scholars such as Wilkinson and Marmot have shown unequivocally, inequality itself in a society has profound health effects. The more unequal societies have much worse health outcomes than more egalitarian ones.,

This is without taking account of the effects of, for example racism. Racial discrimination alone has an effect at a biological and cellular level. Those from minority groups in areas of the US with more discrimination have been found  to have higher levels of the stress hormone, cortisol, and also show faster biological ageing, as measured by telomere length. This is mediated by oxidative stress and is linked, for example with type-2 diabetes and obesity.  The over-determining factors pile up. More stress increases the propensity for addictive behaviours, for having raised blood sugars (needed in fight/flight responses), for eating the /sugar/salt infused food peddled by fast food companies, to conserve fat more, to affect sleep, needed for immune responses, and so it goes, on and on and on. This is the tip of the iceberg.

We might add to this the effects of lockdown. While the privileged, like myself, can manage to pay bills and buy food and have a home with internal and external space, many families lack this pressure valve, and were already experiencing huge emotional challenges pre-Covid. As children’s charities are warning, such serious chronic stressors are being exacerbated in the current crisis. We have seen an increase in domestic violence reported and we might surmise that there is also likely to be an increase in child maltreatment.  People in such families are already suffering, especially the children perhaps, but the chickens will certainly come home to roost in terms of poor health outcomes later in life, and indeed intergenerationally.

We need to begin to take this research very seriously. As Marmot’s recent report showed, health inequalities, even pre-covid, had worsened in the last decade, Life expectancy has stalled in the UK, inequality has widened, and more people are predicted to be in worse health as they get older.  Perhaps most worrying of all, wealth inequalities have grown hugely, and of course on average those from BAME groups tend to suffer the worst effects of this.

Thus while it is true that there are links, for example, between obesity and COVID morbidity, the obesity factor is just one piece of the puzzle. Without doubt, racism and discrimination needs to be taken very seriously, and fought against, but it also needs to be linked to structural inequalities. Obesity is just one of multiple biomarkers that we might use and there is host of other measurable markers one could point to.

This is a serious political issue, literally deadly serious, and as often the poorest and most discriminated against are suffering most and bearing the brunt of an unequal neoliberal agenda. This is not just about the level of NHS resources, and who has access to them, although it is as well. This issue of who is ill and dying and why, goes to the root of how we have organised society, and the effects of this are showing up at a biological and cellular level as well as psychologically. While we all applaud the amazing courage and generosity of our NHS frontline workers, this might also be a moment to stand up and be heard campaigning about racial and other inequalities.


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Recent Comments
Guest — Melinda Elson
Thank you for this Graham, a very important piece. Perhaps you can get this into one of the national papers? It needs to be read, ... Read More
Monday, 20 April 2020 19:13
Guest — Emily
I agree, I’d like to see this information being distributed more widely as the ramifications of this crisis are going to be far re... Read More
Tuesday, 21 April 2020 20:19
Guest — Deirdre Fay
This is an important link you're making, Graham. As you say, "literally deadly serious" ...."goes to the root of how we have org... Read More
Saturday, 25 April 2020 15:08
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