Conversation with Jim Orford
2010; Wiley; Volume: 106; Issue: 4 Linguagem: Inglês
10.1111/j.1360-0443.2010.03098.x
ISSN1360-0443
Autores ResumoAddictionVolume 106, Issue 4 p. 698-705 Free Access Conversation with Jim Orford First published: 16 August 2010 https://doi.org/10.1111/j.1360-0443.2010.03098.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In this occasional series we record the views and personal experience of people who have especially contributed to the evolution of ideas in the journal's field of interest. Jim Orford is a psychologist who has made many original contributions to addiction research and to exploring the meaning of addiction as a concept. His book, Excessive Appetites, has been widely influential. EARLY DAYS Addiction (A): Start out by talking about your childhood and your memories of what it was like. Jim Orford (JO): I had a very safe, comfortable, loving, modest, post-Second World War London childhood. I was an only child so I was very influenced by the things my parents were interested in, including their memories of the war. I was born in 1942, so the war was still going on. My father was in the Army, and was away for most of the first 4 years of my life. It was a period of austerity when they got back together again; we were on rationing and there was not much money around. But the memories of the war they shared with me were very positive: what a tremendous spirit there had been—the Dunkirk Spirit was very important. They were Conservative in their politics; Churchill was the great hero. My parents had rented a house in North London and then we moved to outer South London, where they bought their first house. At some stage they got their first car, an eight-horse-powered Ford, a little car that was pretty dangerous over 50 mph. Maybe I was 12 when we got our first telephone. It was that sort of childhood which was basically Conservative, modest, suburban and very safe. A: You keep coming back to this thing about safe, tell me what that means to you. JO: Well, I suppose it is because as a psychologist and a researcher you see so many people with childhoods that are not safe. Mine was very safe. It was a source of some regret to me later on in life, though, that I did not share my parents' politics in the slightest, nor my mother's religious faith. Otherwise I think I am like my mother in many, many ways and I was very influenced by them both. For one thing, I have inherited a love of words and of writing from my mother. Writing was her passion. She had some articles and poems published, and three historical novels. They came later on in her life, because until then she dedicated herself to being a housewife and a mother. My father also had an artistic passion which unfortunately I did not inherit. He was a local government chief officer, in what was then called O&M—Organization and Methods—but it was his water-colour painting that he loved. He taught it to others, sold pictures regularly and exhibited in London and elsewhere. So, in their modest way, they were both very talented. A: And presumably they had an influence on the school that you went to. JO: They sent me to a ‘minor public school’—I think that is how, in the crazy British system of education, it would be classified. I was one of the scholarship boys who went from the local area to this otherwise private school. My parents cared very much about my schooling, and I am indebted to them for that. After that I do not think they had much influence because neither of them had been to university themselves, and they just felt it was beyond what they knew about. A: By this time presumably your academic life had set out in a particular direction. JO: I could have gone on the science or the arts side, but I got best marks in the science subjects and I enjoyed science. I was successful in winning one of the university scholarships that British Petroleum were offering on the understanding that I would go back and work for them afterwards as a chemical engineer. Once at Cambridge things changed. My experience there was not altogether positive. I came away rather anti-Oxbridge. A: OK, say more about that. ENTERING PSYCHOLOGY JO: I see British education generally as being pretty elitist and unequal and Oxbridge is the pinnacle of it. My college, like my school, was all male and the servants treated students like young gentlemen. I was not terribly impressed with all that, but one aspect of the Cambridge system which I was very grateful for was its flexibility. Because of the structure of the natural sciences degree, I was able to change to psychology. Psychology was such a minor and early subject in those days, you could study a little bit of it—I did one-third of my second year and the full third year—and still finish up with a qualifying psychology degree, which seems rather amazing now. A: Why psychology? JO: I had never met anyone who was a psychologist and I do not think I had ever read a psychology book. I simply went into psychology because I needed to find something that looked interesting that enabled me to stay at university but to drop out of the main scientific subjects. But I loved psychology as soon as I was exposed to it. The subject matter fascinated me from the outset and, unlike chemistry, everything was debated and challenged. This was what I had hoped university would be all about. ‘I loved psychology as soon as I was exposed to it . . . everything was debated and challenged.’ A: So you finished Cambridge with a degree in psychology. JO: I also finished with a wife and a baby, which was another major transition. So there were two very good things that happened to me at university: one was I found psychology and the other was I found my life-long partner and we had our first son. We married between my second and third years. Judith had been studying nursing at Guys Hospital in London, and she gave that up and moved to Cambridge. We set up home in a little flat and Tim was born 3 weeks before my final examinations, which was fun. We managed very well. I got a lower second-class degree. Picking up psychology late, I did not have ambitions to gain a first-class degree. A: Were you at that time changing in your belief systems? JO: I was changing in my social and political outlook on life. I was very interested in politics, but it was a struggle to give up the Conservatism I was brought up with. As a teenager at school I was already starting to develop different ideas. For example, I could not really understand why different people who are doing different jobs in society should not earn exactly the same amount—I still can't. I believe inequality is a great curse. Getting married and having a baby clinched it. I realized for the first time in my life what it was like not to have much money, but to have responsibilities for a family. Also, my wife Judith came from a very different background to mine politically; she had a very clear Labour, pacifist background. A: You finished university with a commitment to go and work for British Petroleum? JO: Yes, the expectation was that I would go back to work for BP as an industrial chemist, but I had dropped chemistry so I could not do that. They explained that they did not have enough posts for psychologists, and they agreed to release me. I gained a place at the Institute of Psychiatry, Maudsley Hospital, in London, funded by a health authority in North Manchester. It was to take a course for 1 year, which enabled me to qualify as a clinical psychologist in those days. A: Then you presumably had a commitment at Manchester you had to fulfil if they had sent you off to train in London. JO: Yes I went back to Manchester for 1 year. I became involved, not by my own choosing, because I was still a ‘probationer’ clinical psychologist, in a programme of aversion therapy for sexual disorders and the principal so-called sexual ‘disorder’ that was treated in this clinic was homosexuality. It was in the very last years before the Wolfenden Report in Britain and the law changing in the 1960s that legalized homosexual behaviour in private between consenting adults. It was a time when behaviour therapy was fairly new and psychologists thought of themselves as doing something quite radical, because instead of doing what the psychiatric textbooks did and define homosexuality as some kind of disorder or disease, we were saying this is a form of behaviour that you can change, everybody can change. There was great excitement around about behaviour change. What we did not do at all is think about what is going on in society about homosexuality at the moment. In fact, it makes a very good case for why psychology should be more critically aware of what it is doing. I can see that now, particularly wearing my community psychology hat, but my supervisors and I did not see it like that in those days. One positive thing that I did carry forward from that year, and which has been of influence in my career ever since then, is something about how people change. We concluded that people could change their sexual orientation to an extent, but only if they already had some element of the desired sexual orientation to start with. However, I came to the conclusion that it was not the behavioural methods that were changing people, but that actually what people were going through was a symbolically very important series of events. Here were these people who felt they were breaking the law or felt that their whole sexuality was wrong, coming to a psychiatric unit, being assessed, and entering a special room that was set up with electrodes and homosexual and heterosexual slides. I finished up quite convinced that what was more likely to have an impact was not the stimulus–stimulus or stimulus–response associations, but rather going through this experience of coming to see experts who claimed they could change something so important, and exposing oneself to this extraordinary laboratory where it was going to happen. That has carried through to my ideas about how people change if they have an alcohol or other addiction problem; why I think that some of the processes of change are much more general than the specific theoretical treatment rationales suggest. I was very influenced at the time by Jerome Frank's book, Persuasion and Healing1, about general change processes. ‘I was very influenced at the time by Jerome Frank's book, Persuasion and Healing, about general change processes.’ TO THE ADDICTION RESEARCH UNIT A: How did you come to go back to London? JO: I wanted to do a PhD but I could not find anyone who was keen on having me. Then I had a message one day to telephone someone called Dr Griffith Edwards, whom I had never heard of before but who subsequently turned out to be one of the major influences on my life. He said he was looking for a psychologist to join his new team. He had been given a grant from the Nuffield Foundation for a programme of research on alcohol problems and was I interested. At that stage I would have gone almost anywhere to do a PhD on almost anything. I knew nothing about alcohol problems. I went to meet Griffith and someone called Sally Guthrie, who played a significant role at that stage in my career, because she and I wrote one of the early papers on wives coping with their husbands' alcohol problems, which was something I studied once I joined Griff's unit, and which became the subject of my PhD and has been an interest of mine ever since. A: Which was the first project you worked on? JO: The project we called the Family Study. This was what turned out to be the famous treatment versus advice study which people even mention to this day, which always amazes me. Griff was always very good about authorship. I was the first author on the Maudsley Monograph that we wrote about it later and he was first author on the main paper 2. I have always explained to people when they ask how the project arose that it was Griff's idea. It was already part of his programme grant proposal. The idea was that the study would compare treatment as usual as given by him and his team at the Maudsley Hospital, versus simply one session of advice to abstain following a full assessment. The sample was confined to married men, because the second main facet of the study was studying the influence of marriage on treatment outcome. I think our family study was probably the start of a whole questioning of what treatment was about. A: You are seen as the person who initiated that interest in family coping. Tell me about that. JO: How the wives were coping with their husbands' drinking was one of the factors we agreed early on that we should look at. One of the people who influenced us at that point was a leading social psychologist from the London School of Economics, Bram Oppenheim, who was a consultant to the unit and who became my PhD supervisor, jointly with Griffith. Among early experiences I remember that Griff said he thought it would be a very good idea if I was introduced to Al-Anon [a support organization for the friends and families of alcoholics], so we met one evening with a number of Al-Anon wives. I took detailed notes and some of the things they said that evening more than 40 years ago found their way into the first version of the coping questionnaire and have undoubtedly found their way into later versions of that questionnaire, which I am still working on to this day. I sometimes think, oh no, am I still working on this after all this time? It does make you think, do you get very far really in a whole career? A: What are the most pleasing achievements of your career? JO: What immediately comes to my mind is my book Excessive Appetites3. The reason I pick that out is because I think at the time it was genuinely doing something that was needed and was pulling things together in a new way. The feedback I have had about it has been very rewarding. I have had people say things such as ‘it got me into the field’ or ‘I realized what an exciting subject it was’. A: It got people into the field. It is a big contribution to make in a field that is so difficult to get people into. JO: I think it is part of something bigger, part of the whole teaching, lecturing, influencing side of my career. Besides research, which is my greatest love, that has probably been the most satisfying general aspect. The other is writing. I did try a bit of creative writing early on, but it was not something that I found I could do. Then it was interesting the way my first book came about. It was another of these out-of-the-blue things. I am a great believer in out-of-the-blue things, actually. I have not been someone who has planned and sometimes I think I could have achieved a great deal more if I had been. Anyway, a message came quite unexpectedly from Professor Eysenck, head of psychology at the Institute of Psychiatry where the Addiction Research Unit (ARU), as it was known by then, was located. He was managing a series of books for Penguin Education on different aspects of psychology. One book was to be on the subject of the social psychology of mental disorder 4, and he asked me if I would do it. At that time I had become very interested in the social side, and I was giving lectures to psychiatrists in training at the Institute on social psychology. Anyway, I wrote this little Penguin book and I enjoyed that and found I could do it. I was getting some papers published and I think probably from then onwards I have never looked back about writing and it has become more and more of a part of what I do. I now think of myself, more than anything else, as a writer. ‘I now think of myself, more than anything else, as a writer.’ A: Say some more about your time in London. JO: The experience of being in the ARU with Griffith Edwards was a tremendous one. I think of Griff as a towering figure in the field. He started off so many good things. The whole treatment versus advice thing was a brilliant idea, fantastically bold for its time. One of the other things I remember early on was that he had become involved in a big way in the movement, that was very strong at the time, of small therapeutic houses, or hostels as they were called in those days, for men with drinking problems. There were two in the South London area around the Institute of Psychiatry. One was Giles House. Griff had been very influential in setting that up and he knew all the men who were living there. He had helped to write a very inspiring constitution about what it was like for men to live together in a house and seeing a new path for their lives. It was also in the spirit of the times; it was the 1960s, influenced by the Therapeutic Community ideas of Maxwell Jones and others. It was very much the idea that they were looking after themselves in the house, rather than other people looking after them, that was what was so exciting about it. He said: ‘You have got to come and meet these people’. So there I was one evening, as a young clinical psychologist who had been conducting aversion therapy in a laboratory in Manchester, sitting round with these men telling me what they were doing, living together and trying to overcome their drinking problems. That was a new experience for me. Having been brought up in a very behavioural psychology tradition, this was mind-expanding, bringing a more social orientation to my psychology. I also remember, early on, asking Griff what books I should read. He suggested two. One was Jellinek's The Disease Concept of Alcoholism5, which I thought was very interesting because I knew nothing about the subject and I was learning rapidly. The second book he recommended was Pittman & Snyder's Society, Culture and Drinking Patterns6, which was completely new to me and very exciting; and of course, Griff was so well connected internationally. There were constantly people coming through the unit who came from the States and other parts of the world. It was helping to give me a social, cultural and international outlook. A: Other activities and influences at the ARU? JO: Griff was also thinking about ‘community responses’. He started a project around Camberwell in South London working with probation officers, social workers, general medical practitioners and other groups in the community to see what they knew about alcohol problems and how they were dealing with them and how that could be improved. This was in the days when it was still mainly thought that ‘alcoholics’ only turned up at special units such as the Maudsley Hospital, so being at the ARU was enormously stimulating. There was a great crowd of people there, including, to mention only some, Celia Hensman, Seta Waller, David Robinson, Gloria Litman, Shirley Otto, David Hawks, Ray Hodgson and others who were associated very closely with the unit, such as Tim Cook, Judith Harwin, Terry Spratley, Marcus Grant and David Davies. It was the start of a big change in how responding to alcohol problems was thought of, with major effects on future policies. It was a very exciting place to be and Griff was so generous with me. At a very early stage he arranged for me to give a keynote talk at an international conference in Sydney, and a little later, one in Washington. He and I travelled to Australia together, spending an hour with Mother Teresa in Kolkata on the way. Tim Cook was someone I came to know well and whom I would rate as another broadening influence. He was running the other one of the two local therapeutic houses for men with drinking problems, called Rathcoole House. He later went on to be the director of a large organization, the Alcohol Recovery Project. One of the groups of people I would include as people of influence for me is made up of secretaries with whom I have worked. One person with whom I worked for quite a number of years at the ARU was Joyce Oliphant. That is important, because I am someone who has been really lucky over the years having some fantastic secretaries like Joyce. Liz Mears, who is an absolutely wonderful secretary and administrator with whom I worked very closely later on in Exeter, and Pat Evans, who is our superb personal and research group secretary in Birmingham, are the others I would want to mention. A: You dictate everything you write? JO: Yes, I dictate absolutely everything using a small dictating machine. I dictate books, papers, letters, memos, absolutely everything. ‘Using a small dictating machine, I dictate books, papers, letters, memos, absolutely everything.’ A: After 10 years you left the Institute, having gained your PhD by then. JO: Yes. My thesis was based on the marital aspects of the family study. It was asking the question: was there something about the nature of the marriages that was predictive of a better or worse outcome? I identified a higher-order factor, which I called marital cohesiveness, which did predict a better outcome. MOVING ON TO EXETER A: So you moved on after 10 years at the ARU? JO: After finishing my PhD I was looking around for other things and found a job in Exeter. Jim Drewery was there. He was external examiner for my thesis, and had written interesting papers on interpersonal perception in alcoholic marriages which I drew upon for my thesis. That was another big move that could have gone in a very different direction. Exeter was a totally new phase in my life, because I moved from being a full-time researcher, doing some teaching for psychiatrists in training, to be the academic half of a two-person team, directing a new clinical psychology postgraduate course. That threw me into being a university teacher, which was a completely new thing for me. At some point Jim Dewery retired and I took over as sole course director. It was a very busy time. I was there for 17 years; our three sons went through secondary school while I was there and Judith went back into training as an occupational therapist. So we embedded ourselves into life in Exeter, which is a lovely city and in an area surrounded by beautiful countryside and coast. A: The clinical side of your research in Exeter? JO: The clinical side fitted in with the community psychology interest that I had started to develop at the ARU. There was quite a progressive health authority in Exeter at the time, and over a short period of years they set up a programme of closing all the mental hospitals and forming community teams. While I was there, a whole set of community mental health teams and a community alcohol team was developed, and that was the part that I became involved in. We joined forces with the local Council on Alcohol—the non-statutory charity that had pioneered services in the field locally. Stan Ford was the director. I should say here that the voluntary sector has been a theme throughout my career. For a few years in Exeter we had a really exciting experiment in delivering a community-based service. I spent a great deal of time helping other people to think through how that service should run. Our students had placements in community teams, and we renamed our training course Clinical and Community Psychology. During that period I wrote my first book on community psychology, Community Psychology: Theory and Practice7. It came out in 1992 towards the end of my time in Exeter. We also developed a UK network of community psychologists. It has now been meeting every year since the early 1990s. A: Community psychology was new in this country, wasn't it? If I were to ask anyone who were the driving forces in setting up community psychology as a branch of psychology in Britain, would I be told you were one? JO: I would like to think you would! Certainly, developing community psychology in Britain and later more generally in Europe is one of the things that I would put high on my list of things that I am pleased to have done. A: And what about your research? JO: When I went to Exeter one of the things that was on my mind was whether in fact my research from then onwards would go into new pastures altogether. In fact, I put in a couple of grant applications very shortly after I got to Exeter, one of them on controlled drinking and abstinence goals among people with alcohol problems, which I received, but another on something completely different to do with behaviour on the wards at the psychiatric hospital. I received the alcohol grant and not the other one. What I discovered fairly quickly was that because I already had somewhat of a reputation in the alcohol research world, it was going to be comparatively easier to gain grants to carry on in the alcohol and substance field than it was in any other field. Another thing that happened around that time, the mid-1970s, was the start of a group called the New Directions in the Study of Alcohol Group, that met for the first time in Dumfries in Scotland. The hot issue at the time was whether it was possible for people who had serious alcohol problems to control their drinking. That was really the catalyst for that first meeting, and it was a group of people who felt they wanted to break away from the traditions and take, literally, new directions in the study of alcohol. It became a group that has met over the years, annually to this day, in fact. So there were a number of things that pulled me strongly back into the alcohol studies field and kept me there. A: Had you started to work with those other behaviours that you address in Excessive Appetites before you left Exeter? JO: Gambling, yes. In fact, gambling has become a big interest of mine in its own right over the years. A number of things happened towards the end of my time at the ARU. I conducted a small study, which was never written up, in which I interviewed a number of people with alcohol problems who also seemed to have problems with their gambling. They talked about it very much in the same terms as they talked about their drinking problems, which led me to think that gambling could be an addiction like any other. I also became involved with a group of professional people in London who were interested in problem gambling. One of them was a Methodist Minister called Gordon Moody. He was said to have brought Gamblers Anonymous to Britain and he started the first residential halfway house specifically for problem gamblers in South London. He was one of these delightful reverends who was intellectually so interesting, but who also brought compassion from his religious background. Everyone loved him and he was one of those charismatic early leaders of a new field. I started to read more about the subject and was becoming quite convinced about gambling addiction. Of course, as a psychologist this was very exciting, because here was something that was not a substance that seemed to be just as addictive as things that were substances, which is a main theme of Excessive Appetites. A: What about the 18th- and 19th-century literature on gambling? JO: Yes, of course there is one. For example, there are things written about Dostoyevsky, who had a serious gambling problem, and his novel The Gambler, which is so clearly autobiographical, and the early 20th-century psychiatrists writing about manias, dipsomania for example, or narcomania, and some were writing about gambling mania. Reading around I discovered a whole fascinating literature about sexual addiction, largely men writing about nymphomania, women's excessive sexuality. But then I discovered there were people writing much more recently about something they were calling hypersexuality, so I wrote a paper, which was published in the British Journal of Addiction, raising the question: is this an addiction? Then I found that people were starting to write about binge eating. I discovered all sorts of parallels with substance addiction, such as the abstinence violation effect. Then I began to read more about the drug field. For example, at that time Virginia Berridge 8 was starting to publish her work on the history of opium-taking in the 19th century. I realized there was something to put together here, that addiction was much more of a general thing than simply one or two of the very familiar substances, and that there was a whole psychology to be written about that. ‘I realized . . . that addiction was much more of a general thing than simply one or two of the very familiar substances . . .’ MOVING TO BIRMINGHAM A: Now tell me how you came to leave Exeter. JO: I left Exeter after 17 years for a mixture of reasons. I had applied for a chair at Exeter and they had turned me down, so I started to look for other jobs. Birmingham University was looking to appoint a new chair in clinical psychology because they were moving from a 2-year clinical psychology masters to a 3-year doctorate and they wanted a new head of course at professorial level. I was approaching 50 at that stage and I thought if I am going to move it is now or never. Judith had been in her job as an occupational therapist in a community mental health team for some time and was ready to change jobs. As you know, Birmingham had a reputation in Britain as being a rather dirty industrial place ringed by motorways, so I was thinking, I will put up with Birmingham, it will be a new experience. What actually happened when I got there was the exact reverse of what I was expecting. As soon as I got to Birmingham I fell in love with the place. As Britain's second city it is modern, full of life, friendly—a wonderful place to live. However, the job of running the clinical psychology training course turned out t
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