Historian looks to the future
Interview: Professor Matthew Smith (University of Strathclyde)…
Historian looks to the future
Professor Matthew Smith is the Co-Director of the Centre for the Social History of Health and Healthcare (CSHHH), Director of Research for History and Deputy Head of the School of Humanities at the University of Strathclyde. He came to Scotland in 2011 after four years at the University of Exeter's Centre for Medical History, where he gained his PhD. His research interests focus on the history of mental health and psychiatry, allergy and immunology, and food and nutrition. He has also written books and published papers on the history of food additives, ADHD (Attention Deficit Hyperactivity Disorder) and food allergy, and has done research on social psychiatry in the US, investigating how psychiatrists and social scientists viewed the connection between mental illness and social deprivation after the Second World War. In 2015, he also played a key role in the launch of an innovative project at Pinkie St Peter’s Primary School in Musselburgh “to increase child resilience and wellbeing” in future generations...
After finishing high school in Canada, Matt Smith flipped a coin to decide if he would study maths or history. Twenty years later, as Senior Lecturer in History at the University of Strathclyde, he was visiting a primary school in Musselburgh, East Lothian to watch a group of pre-school children talking to puppets, as part of a project to improve educational attainment and reduce the number of referrals to child and adolescent mental health services in Scottish schools.
Smith's history as an historian makes colourful reading, and his own experience at high school, combined with his later professional work as a youth counsellor and careers advisor, has had a big impact on his attitude to education and what school is for.
As well as focusing on controversial topics in research such as mental health, ADHD and food allergy, Smith has always been concerned with how we measure educational success and prepare young people for their future lives and adult careers. He is also concerned that parents and the educational system in general have unrealistic expectations which put too much pressure on children, and may even be a factor in the emergence of ADHD in recent decades. Expectations change as each new generation is born, but children do not change, says Smith. The main objective of education should be to ensure every student leaves school with a thirst for education, not just academic qualifications. Everyone should also be able to choose different options – too many people end up doing jobs that make them unhappy. “Having an appetite for lifelong learning is much more important than passing some tests,” he continues. “We should be aiming to empower every student.” Smith also draws attention to his own university's mission – to be “a place of useful learning” – and says this is consistent with his personal views.
These ideas also come from Smith’s professional experience in Canada, where part of his job was to identify adolescents with ADHD and refer them for treatment, as well as work with children from dysfunctional backgrounds who had dropped out of school. They are also the issues which fuelled his later academic career, focusing on medical history, including the history of ADHD, the modern name for hyperkinesis or hyperactive impulse disorder.
Smith himself also admits that he is not immune to career doubts. Even in his late thirties, as an established post-doctoral researcher, he wondered if he would have a future in history or academia. For students with ADHD, the problem can prevent them even finding a career in the first place, but Smith has learned that cause and effect can be complex – involving brain development as well as school environment and social factors. He also believes that a lot of the problem is “less to do with children and what they need and more about what adults need,” and that being diagnosed with the disorder can depend more on where you live than on medical science.
Smith’s other specialist topic is the history of food additives, which may also be associated with ADHD and other psychological disorders. For example, food dyes have been blamed for causing hyperactivity and Smith says this is based on historical fact – the food dyes used in industry were based on by-products of coal tar which were also used to develop the first generation of antibiotics as well as early anti-psychotics. “Researchers noticed that the coal-tar dye-based drugs calmed rats down,” says Smith. “And it's historians who make these links – the history of medical science can have a huge impact on our understanding of cognitive disorders, working side by side with psychiatrists and teachers.”
In Smith's opinion, his profession should also be “more bullish” to emphasise how our society got where it is, so we can make better decisions in future and answer the “difficult” questions. “To understand the history of science is empowering to people,” he adds, explaining how our attitudes to mental disorders and medical treatment are closely linked to social and political environment. For example, Freudian psycho-analysis used to talk a lot about our lives as sexual beings, but it was very much a product of its own time and place. It is not that the theory was “wrong,” Smith explains, but developments in psychiatry since then have taught us that Freudianism was not the whole explanation, and tended to revolve around the day-to-day concerns of its middle-class patients, even though members of all classes suffer from the same psychological problems.
Lessons from history also inspire innovation, including the creation of a new educational project at Musselburgh’s Pinkie St Peter’s Primary School, where Smith has played a major role in partnership with teaching staff and healthcare professionals.
The Pinkie Project
One of the most critical factors in every child’s development is what is known as “attachment,” and this is one of the themes of the project at Pinkie which Smith helped to launch in 2015, with £15,000 of funding from the Scottish Universities Insight Initiative. “It all boils down to attachment,” says Smith. “As children grow up, there are very few people they can trust and turn to for advice, and that is why school has a key role to play, especially if there is no-one at home to provide this role for them.” The other theme is all about building a bridge between school and community, overcoming some of the psychological and physical barriers which sprang up in the wake of the tragic events at Dunblane. On a simple level, this means the community learns about what’s going on at the school, while former students are also encouraged to maintain their links with their alma mater.
The project took off after Dr Iain McClure, a consultant child and adolescent psychiatrist at NHS Lothian, heard Smith talking on a radio programme about hyperactivity. McClure was concerned about the number of referrals to mental health services in his own region, and identified Pinkie as a suitable school for a trial because its catchment area is a microcosm of the country as a whole in terms of social deprivation versus relative wealth. And the key question was: “What can we do to improve things?”
After Smith and McClure shared their thoughts on the subject, they made a presentation together at a conference on “Contemporary Childhood in Scotland,” and invited Sarah Ogden, the Principal at Pinkie, and some of her deputies, to join them to discuss what they could do. Lots of good ideas were put on the table, including the suggestion that educational success should be measured in terms of the long-term results, paying more attention to people’s achievements in later life rather than only at school. “We also agreed it was better to try to prevent problems rather than just diagnose them and treat them,” says Smith.
The motto for the project is “enhancing equality, boosting well-being and realising potential in Scottish schools.” Smith comments: “We knew it would be difficult to tackle inequality, but we also wanted education to be linked with social services and housing; and we also agreed that the challenge was to make the children at the school’ more resilient.” Two other members of the Young Academy of Scotland who played a key role in driving the project are Stella Chan (a child psychologist at the University of Edinburgh) and Annie Tindley (an historian from the University of Dundee).
The next step was to hold a symposium at Pinkie school, inviting 18 speakers from Scotland and beyond to present ideas on how to boost resilience, improve achievement and prevent mental illness – suggesting everything from yoga to improvements in diet. Soon after this, they organised a workshop for teachers, and out of this emerged a programme of activities now put in action at the nursery school and at primary level, including the puppets. “Children say things to the puppets that they wouldn’t say to anyone else,” Smith explains.
Other activities include a Nurture Room, which helps to “de-escalate behavioural problems” by taking the children away from their classmates and talking to them one-to-one in a secure, non-threatening environment, rather than “sending them for punishment,” excluding them from classes or giving them a talking-to in public. More subtle changes mean that teaching assistants no longer spend all of their time in the classroom but use private spaces for more individual attention. Altogether, it’s a much more sympathetic and constructive approach,” Smith explains.
Another scheme, inspired by the Room 13 arts-based project started in Fort William, involves children from Primary 5–7 interviewing fellow students and local residents for radio podcasts, as well as using the stories for history lessons and creative writing projects. This means that the children are not only learning useful academic and technical skills, such as how to operate the audio equipment, but are also reaching out to the community. “All these activities improve communication and help bridge the gap” says Smith, “but it also helps the children understand themselves and other people better, and boosts their self-confidence and sense of worth.”
How measure success?
Smith recognises there is no simple formula for personal or academic success. For example, South Korea and Finland are poles apart in terms of educational methods, but both rank very highly on the international league tables for educational standards.
As well as questioning the way we measure academic achievement, Smith is also concerned with how to measure the effectiveness of the techniques used at Pinkie. “The teachers can see it is making a difference,” he says, “but how do we prove it?” For example, after the puppets were introduced into the nursery classes, the teachers noticed more interactions and less misbehaviour, as well as much more positive reactions and improved communication, but this is only anecdotal evidence and it will take many years to measure long-term benefits. Independent assessment would help, but that would also require extra funding.
Smith himself is planning an initiative to follow progress over the next ten years, in terms of mental health as well as educational achievement, by interviewing children involved in the project “about their experiences of wellbeing and emotional difficulties... to assess the interventions made at Pinkie.” He also hopes to roll out similar projects to capture the patient experience of the health service in general, using oral history to understand performance, rather than relying on the verdict of professionals delivering the services who may have a vested interest in results.
In medical emergencies, people immediately call for a doctor, but perhaps our politicians and policy makers will turn more to historians in future, if Smith's research continues to contribute to the complex debate about health and education.
Pinkie: Key Recommendations
1. Promotion of wellbeing, resilience, attachment and other components of positive mental health has to be a core activity at Scottish schools in order to prevent mental ill health and to help children reach their academic and emotional potential.
2. Schools need to integrate in meaningful mutually beneficial ways with the communities in which they exist.
3. Educational services also need to be better integrated with health services, welfare services policing and charities, in order to facilitate better mental health promotion.
4. Mental health is multi-faceted and has to be understood as such in order for effective mental health promotion. It is important to recognise all the various factors that contribute to mental health, but also identify the aspects that schools are best placed to effect.