Despite having difficulties in the areas of social interaction and communication, the introduction of the Internet seems to have encouraged some high-functioning autistic people to communicate with each other via chat rooms and bulletin boards. The Internet can address the social isolation of autism by improving the potential to find others who have similar experiences. Additionally it may be that, for autistic people, the Internet also offers a comfortable space more suited to their communication style, perhaps one in which their interaction seems less odd. If so, there are possible implications for this group of people in terms of education, employment and social inclusion. However there are risks. Autistic people may be particularly vulnerable to individuals misrepresenting themselves or to the possibility of over-reliance on computer-mediated interaction resulting in an exacerbation of obsessive behaviour and withdrawal from face-to-face interaction. An initial survey, to discover the extent of Internet use among people with autism and investigate their motivations for using it, was carried out, obtaining responses from 138 people with high-functioning autism or Asperger syndrome. Results indicated a high level of computer and Internet use amongst respondents and implied that email was a popular means of communication, more so than face-to-face communication even when interacting with friends. This introductory survey raised issues and questions which were explored in more depth with a subset of the respondents who were interviewed by email about their experiences, motivations and perceptions regarding Internet-based communication. In addition to 19 email interviews, data were also collected from 4 non or reluctant users of the Internet who were sent a series of questions by post. A grounded theory analysis of the data revealed a heightened awareness of communication amongst this group of participants, who offered insights into the process of communication in terms of its component parts and how it breaks down for them. Central to the analysis is a theme of the interviewee as observer, feeling detached to some degree from mainstream interaction and like an outsider. From this perspective participants offered their analysis of the complex process of communication, online and offline as they experienced it, highlighting key aspects of the Internet in relation to their own needs, ones which made it a unique form of communication. Their insights into communication are described in four themes: control, clarity, the role of nonverbal communication and the social role of communication. Additionally the interviewees expressed a sense of liberation that could come with online communication for people with Asperger syndrome/high-functioning autism such that they may interact with others on a more equal basis. This could be empowering but with the sense of liberation there was a risk of losing control over one’s interactions. The interviewees’ perceptions of CMC are explored within a uses and gratifications framework which posits that people use particular communication channels to satisfy their individual needs and motives. By using computer-mediated communication some of the social and communication barriers which contribute to the disability of autism may be broken down.

This thesis explores the relatively unknown area of female stalkers. Throughout the thesis the newly defined term ‘Socially Intrusive Behaviours’ (SIBs) is used to unify previous stalking definitions. Chapter One provides an introduction to the topic of females who display SIBs. Chapter Two includes a Thematic Analysis and explores the motives and justifications for SIBs and examines the personality traits, attachment styles and experiences of anger with female patients. Results indicate that SIBs are a maladaptive coping strategy that benefit the perpetrator, provide feelings of safety, are a response to perceived threats of abandonment and require over-control of emotional arousal. Assessment of personality, anger and attachment are also examined and treatment recommendations are discussed. An interesting finding was that SIBs are a maladaptive coping strategy to manipulate the perpetrators’ feelings rather than the feelings or actions of others. Dialectical Behavioural Therapy (DBT) is a recognised treatment which targets a range of maladaptive coping strategies. Chapter Three provides a systematic review of the effectiveness of DBT with female-only populations in Randomised Control Trials. Results found DBT was superior at reducing a range of maladaptive coping behaviours including self-harm, substance misuse and binge/purge eating. It was therefore considered a potentially useful intervention for females whose maladaptive coping strategies are SIBs. Whether DBT could effectively target an adult female patient’s SIBs was tested by a single case study in Chapter Four. The results indicated that DBT reduced her SIBs and improved her anger management skills. Chapter Five is a critique of the State Trait Anger Expression Inventory (Spielberger, 1999) as used in Chapter Two and Four. Chapter Six discusses the clinical and theoretical implications of this thesis, explores its limitations, and provides recommendations for future research.

The aim of the study was to explore the use of the internet in adults with an eating disorder. Previous evidence has suggested that people with an eating disorder are likely to access websites that are associated with their eating disorder (Wilson, Peebles, Hardy & Litt, 2006). The researcher hypothesised that the scores on measures of stage of change, self-efficacy for recovery, eating disorder symptoms, and perceived social support would be different depending upon the type of website accessed. A cross-sectional survey was administered online. 45 participants were recruited from specialist eating disorder services, support groups and via the eating disorder charity B-eat. Survey responses were anonymous and the survey content included measures related to the hypothesis as well as questions regarding internet use associated with eating disorders. The results of this study show that the majority of the participants accessed websites associated with eating disorders. Most participants visited pro-recovery websites, some visited pro-eating disorder websites, and a small minority accessed both types of websites. The majority of the participants in this study visited these websites for social support. However, those who accessed pro-eating disorder websites also visited with the intention of triggering eating disorder behaviour. Nonetheless, no differences were found between those who accessed pro-eating disorder websites or pro-recovery websites on any measures. However, those who accessed both types of website (pro-recovery and pro-eating disorder) had significantly higher levels of weight concern. As participants who accessed both types of website were less likely to be accessing treatment, and had more incidences of hospitalisation than those who accessed pro-recovery websites or pro-eating disorder websites exclusively, the difference in weight concern scores may be more related to whether treatment is being sought than website use. Whilst adults with an eating disorder may access websites associated with eating disorders, this does not appear to increase levels of perceived social support. Additionally, accessing pro-eating disorder websites did not appear related to eating disorder severity. Therefore this study suggests that pro-eating disorder websites may not influence behaviour as feared by professionals.

Background: Child and adolescent mental health teams have traditionally been constructed using multidisciplinary teams of different professions. Current workforce policy in mental health, however, stresses team function and the skills and competences required to fulfil that function which leads to a questioning of professional identity within those teams. Aims: This study aims therefore to define how professional identity is constructed in the policy discourse and amongst a sample of current practitioners in mental health teams. Methodology: This study uses a linguistic method, Critical Discourse Analysis, to question whether functional approaches based on role theory are appropriate when identity work discourse has overtaken role theory as a way of thinking about professional working. It uses elements of role theory and identity work thinking, informed by postmodernist theorists such as Pierre Bourdieu, to look at the need for the underlying conceptual frameworks that professional training and socialisation bring. Findings: By analysing the current policy discourse, and a sample of practitioner discourse on the subject, the study shows that there is a need for the professional identity of individuals to be better addressed and understood. It examines the importance of the underlying conceptual frameworks that inform the skills and competences and what these frameworks bring to team functioning. The study also questions the way in which policy uses linguistic capital as a change agent to bring about workforce modernisation in child and adolescent mental health teams. Conclusions: The study highlights the need for professional groups to maintain their professional identity by being better able to articulate the contribution they make to team functioning by virtue of their conceptual frameworks. These are shown to inform the way in which individuals use their skills and competences to care for service users and their carers.

Background: Smokefree legislation is just one of a number of tobacco control policies introduced in the UK in the last decade in an attempt to curb the harm caused by smoking. Whilst such legislation is known to have reduced non-smokers’ exposure to environmental tobacco smoke, less is known about whether the introduction of a smoking ban encourages existing smokers to attempt to quit and to seek support to do so from appropriate sources such as their general practitioner. High quality data are needed to evaluate the effectiveness of legislation in prompting smokers to change their smoking behaviour, and data collected routinely in primary care may provide such an opportunity. However, there is little contemporary evidence about the quality of the smoking data recorded in primary care, nor how best to analyse these data, which must be addressed before the resource can be used to evaluate the effectiveness of tobacco control policies. Methods: Initially, a systematic review was undertaken to assess the impact of national comprehensive smokefree legislation on population smoking prevalence, cigarette consumption and quitting behaviour. Then, the quality of smoking status and cessation intervention recording in The Health Improvement Network (THIN) database, a large database of UK primary care records, was investigated using indirect standardisation to compare rates of recording with external data sources. Having identified Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis as an appropriate method to assess the impact of smokefree legislation on measures of smoking-related clinical activity recorded in THIN data, several sensitivity analyses were untaken to assess the impact of decisions that must be taken during the data analysis process. In the light of this knowledge, ARIMA models were used to investigate changes in the rate of recording of patients’ smoking status, delivery of cessation advice, referral of smokers to specialist cessation services and prescribing of smoking cessation medications in the months leading up to, and after, the introduction of smokefree legislation. Results: The findings of the systematic review provide some evidence that in populations where well-enforced, comprehensive smokefree policies have been implemented quitting activity increased in the run up to, and/or following, the introduction of the legislation. Assessment of the quality of the smoking information recorded in THIN showed that the data have improved in recent years, such that the recorded prevalence of smoking is now similar to that reported in national surveys. Some uncertainty does, however, remain about the quality of recording of the delivery of cessation advice or referral of smokers to cessation services. ARIMA modelling highlighted a 6.2% increase in Nicotine Replacement Therapy (NRT) prescribing in the six months before smokefree legislation was introduced in England, and a 13.2% increase in bupropion prescribing in the three months pre-ban. A 5.5% decline in NRT prescribing and a 13.7% decline in bupropion prescribing were seen in the nine months post-legislation, declines which were offset to an extent, but not completely, by prescribing of varenicline which was first available on prescription in December 2006. Similar, though non-statistically significant, patterns were seen in Scotland, Wales and Northern Ireland, where the smaller number of practices in THIN in these countries reduced the power to detect small changes in prescribing. In England, the patterns of change in prescribing did not differ with patient sex, age group, medical history or social class. Conclusions: The improved quality of the smoking data recorded in the THIN dataset suggests that primary care data may be a valuable resource with which to evaluate the effectiveness of tobacco control policies such as smokefree legislation. The significant increases in prescribing of NRT and bupropion in the run-up to the introduction of smokefree legislation in the UK suggest that smokers looking to quit may seek support to do so from primary care, though the decline in rates of prescribing post-legislation suggests that this positive change may not be sustained. This may represent a missed opportunity to maximise the impact of smoking bans by ensuring that smokers are aware of, and indeed access, cessation support available through primary care both before and after legislation is enacted, and should be noted by policy makers planning the introduction of smokefree legislation elsewhere. Ensuring that smokers are aware of, and indeed access, the effective support that is available through primary care to help them quit may be one way to maximise the positive impacts of smokefree legislation and reduce the health and economic burdens of continued tobacco use.

A discussion of concepts of lateralization and handedness is followed by an examination of the three-way relationships between lateralization of brain function, level of function, and schizophrenia. It is proposed that conventional examinations of such relationships, using lateralization indices, can be unenlightening or even misleading, and that alternative approaches are preferable. Support for this thesis is sought in analyses of data from two UK national birth cohorts. The author's process of gathering data on psychiatric outcomes is presented in detail. Previously-published findings in this data, employing laterality indices, are presented and their shortcomings discussed. Several alternative approaches to examining the relationships between measures of functional lateralization and level of function are developed, including a novel application of the method of principal curves, and a three-dimensional presentation of function as height over a 'laterality surface'. This latter approach is applied to a number of measures of function in the cohort datasets, including measures of cognitive ability, social success and psychiatric illness, including schizophrenia. The benefits of this method of presentation over previously-published presentations are discussed in the context of several contemporary hypotheses that touch upon the relationships between functional lateralization, cognitive function and schizophrenia.

Background The harmful effects of smoking during pregnancy have been well documented within the literature (Eastham and Gosakan 2010, British Medical Association [BMA] 2004). Consideration of these facts encourages many women in giving up the habit during this period. However, following the birth the decision to remain abstinent from smoking is often a difficult one for women to make with quite a number relapsing in the first few months. The risk factors for smoking during pregnancy predominantly focus on the health of the baby whereas the longer term risks and benefits of not smoking, although identified by women are not reinforced in preparation for post natal abstinence. With knowledge of the high numbers of women relapsing to smoking postpartum the purpose of this study was to explore the experiences of women during transition to motherhood who stopped smoking during pregnancy. A mixed methods study was undertaken using both quantitative and qualitative approaches in the form of questionnaires and interviews. Participants Women were initially recruited to the study through questionnaires made available in the antenatal clinics in two large teaching hospitals in the East Midlands. In total 216 questionnaires were returned from a possible 400, however, nineteen had been incorrectly completed so were excluded. Of the remaining 197 questionnaires 75 had been completed by women who had not smoked at the beginning of pregnancy and as such were excluded from the final analysis. Women willing to participate in the interviews left contact details on the questionnaires. In total 27 women were interviewed on three occasions, once between 28 and 36 weeks of pregnancy and twice in the postpartum at six weeks and between three and six months. The women interviewed comprised women born in the UK and women born outside of the UK with ages ranging from 16-38 years of age. Analysis The questionnaires were analysed using SPSS which produced pertinent demographic details of the range of women within the catchment area for the study. Data collected during the interviews were finally analysed as a continuous narrative from each woman aided by the use of NVIVO software. Results/Findings Data arising from the results of the questionnaires showed that 53.2% of the women were primigravida and 57.6% were in close contact with a friend or relative who smoked. The data also indicated that the majority of women gave up smoking for the health of the baby and had little professional help in stopping. Some of the women considered that partners were supportive when stopping smoking, but overall, the women considered they stopped of their own accord. Findings from the interviews revealed three original concepts that had a further six themes and 15 subthemes. Social influence, barriers and facilitators, and most significantly, pregnancy seen as a new start in life or just an interval were the three key concepts arising from the study. These concepts were further broken down into themes and sub themes that impacted upon a woman’s relationship with smoking. The social influence of friends and family worked both positively and negatively for women with regard to remaining a non-smoker, professional support was generally seen as positive. The health of the baby, breast feeding, self-efficacy and self-belief, nausea, the smell and taste of cigarettes and policy change were also drivers for stopping and staying stopped. Where relapse was more likely, women struggled with issues of guilt, stress and difficulty in breaking long standing habits. However, the overriding factor in remaining a non-smoker was the notion of beginning a new chapter in their lives; a new life they discussed planning to stop and the emergence of a new identity. For some women returning to smoking was a reverse of these ideas, viewing pregnancy as an interval or suspension of their lives and a return to smoking signified a return to their previous, familiar identity and confidence in who they were. Conclusion It is anticipated the findings from this research will contribute to the development of more successful interventions to aid long term smoking cessation in the future by adding to the knowledge of the complexities of smoking cessation during pregnancy and the transition to motherhood. Further research is recommended to look at supporting women in achieving higher levels of self-belief and self-efficacy and to consider pregnancy as a time to start a new phase in their lives. For interventions to be successful greater collaboration between health professionals and women must take place to ensure that such interventions meet the needs of the women.

Background Evidence suggests exposure to film smoking increases youth smoking, and this is also likely to be the case for television. Some evidence suggests alcohol in films and television has similar effects on drinking behaviours. It is therefore important to document the extent to which tobacco and alcohol occur in films and television in the UK. Methods Films (1989-2008) and television broadcasting were content coded for tobacco and alcohol including branding, use, paraphernalia, inferred use, and other reference. These episodes were measured using interval recording whereby intervals of film and television were coded for each coding category listed above if at least one such incident occurred during the interval. Results In films, tobacco occurred in 70% of films; 68% of youth rated films. Tobacco fell substantially 1989-2008 for all categories, except branding. Brands were most common in the 15 age category, and 82% were certified as suitable for viewing by those under 18. Brands were most commonly either Marlboro or Silk Cut. Alcohol appeared in 86% of films, and branding in 35%. Alcohol use and branded appearances were higher in 1989, but the frequency of these and other categories changed little in subsequent years. Most films containing alcohol were classified as suitable for youth viewing. The most frequently shown brands were Budweiser, Miller and Coors. On television tobacco occurred in 34% broadcast programmes, and in more than half of all films, reality TV, and comedy programmes. Use occurred in 12% of programmes, particularly films and reality TV. Brands were rare, but several appeared in Coronation Street. Alcohol was commonly portrayed, appearing in 52% of programmes and 37% of advertisements/trailers, and most commonly in soap operas, films, sport, and comedy genres, while use was common in both soap operas and films. Brands were most common in sports programmes, news, and soap operas, with those most frequently being Heineken, Budweiser and Carlsberg. Conclusion These substances are common in films and television in the UK, and are more common in films than on television. Alcohol is more pervasive in films and television than tobacco. Given the evidence on the effects of on-screen smoking and drinking on youth behaviours, measures need to be implemented to restrict these substances in media frequently accessed by young people.

Introduction: Existing literature on trauma and coping with traumatic events in paramedics has often concentrated on the concept of posttraumatic stress disorder (PTSD), using quantitative pre-defined self-report measures to investigate symptoms and coping strategies, thereby preventing elaboration of these concepts. The concept of positive adaption or posttraumatic growth (PTG) has also largely been ignored. Furthermore, research has often focussed on emergency workers (EWs) within disaster situations, ignoring the impact of their day-to-day experiences, e.g. cardiac arrests and road traffic accidents. Moreover, paramedics have been investigated alongside emergency medical technicians (EMTs) in some studies, and other EWs (e.g. fire-fighters and police) in other studies, despite different occupational roles. This means that focussed research on the experience of individual paramedics in their day-to-day roles is missing. Objectives: Therefore, this study aimed to carry out a qualitative, phenomenological exploration of the impact of multiple work-related potentially traumatic experiences on paramedics, alongside their ways of coping. Therefore, providing a deeper more individualised and nuanced account of their experiences than has been reported previously. Design: A semi-structured qualitative interview was used to conduct a retrospective study of seven full-time qualified paramedics, working for an ambulance service NHS Trust. Methods: Ethical and Research and Development approval was granted. Interpretative Phenomenological Analysis (IPA) was used to analyse the interview transcripts. Results: Four inter-related super-ordinate themes were generated: ‘The salience of memories,’ ‘the process of reflection and making sense,’ ‘the impact of context on coping’ and ‘emotional management and control.’ The first theme discusses the vivid memories experienced by the participants and the types of circumstances that make these memories more vivid and potentially distressing. The remaining themes focus on coping, including factors that impact on the individual’s ability to cope and their particular ways of coping with their job demands. All the themes consider the psychological impact of the job on the participants. Discussion: The results build upon the existing literature providing a more individualised and nuanced account of the lived experience of paramedics who are exposed to multiple work-related potentially traumatic events. A more detailed and exploratory account of the types of incidents paramedics find stressful or traumatic is provided, indicating the impact of such events on memories. In addition, an account of the ways in which these paramedics cope is provided, particularly the process of reflection and meaning making, which has been referred to in previous studies but not as extensively elaborated upon. The study will be of interest to professionals involved in training paramedics and/or providing occupational health support. Study limitations include the omission of objective assessments of PTSD and PTG and these should be included alongside qualitative data in future research, to gain a fuller understanding of responses following cumulative trauma. Using mixed research methods might help to ascertain the types of coping strategies associated with PTSD and/or PTG, something the current study has been unable to comment on, thereby indicating avenues for preventing PTSD and encouraging PTG within paramedics.

This thesis investigates the ways in which hereditary degeneration was discussed by Scottish psychiatrists in the late nineteenth and early twentieth centuries with particular reference to the anti-alcohol debate. I examine the theoretical writings of both clinical and forensic psychiatry to show how the theory of degeneration functioned as part of a new understanding of legal medicine and that psychiatric knowledge was always implicitly related to a broader conception of criminal capacity and the role of the modern state. While the argument is situated in the wider literature covering psychiatry and degeneration in Europe and America during the late nineteenth and early twentieth centuries, I trace a rather singular story rooted in the institutional peculiarities of Scotland, showing how psychiatrists attempted to use the problem of alcoholic degeneration to mould their science into a branch of public health, propelling them into their preferred role as guardians of the race. This public health campaign facilitated the creation of new categories of psychiatric knowledge consisting of mental abnormalities that did not amount to absolute insanity, but that none the less had a bearing on how people thought about the mind, conduct, and criminal capacity. All the leading figures of Scottish psychiatry had a significant interest in alcohol as a cause of degeneration, and in their descriptions of the condition, the legal applications of the doctrine were never from view. One reason for this was undoubtedly the autonomous nature of the Scottish legal system which, when combined with the relatively small professional population of Scotland, greatly increased the rate of intellectual exchange between psychiatrists and lawyers while intensifying the political implications of associating with certain doctrines. Thus, a large part of my thesis will also be devoted to the legal interpretation of psychiatric claims, and in later part of the thesis I examine in depth the extent to which psychiatric knowledge claims were able to modify the laws of Scotland. Three substantive themes protrude from the documents consulted: Heredity, degeneration and alcohol, and medico-legal interaction. In analysing these themes, I engage with specific aspects of the social and institutional life of Scottish psychiatrists in the late-nineteenth and early-twentieth centuries.