Professor Uta Frith’s recent TES interview raises important questions about autism, diagnosis, and scientific rigour. But some of her claims about the spectrum, later diagnosis, and masking risk overlooking current evidence and the lived realities of autistic people. This article offers a critical response, drawing on research as well as personal experience.

Professionals with a prestigious track record or public voice in certain fields can have significant power when it comes to public opinion, and thus people’s lives. In health and social care, education, and other newsworthy fields, individuals can have influence over large groups of professionals, as well as over the media, the public, and policymakers. Especially in an era of divisive politics, ‘culture wars’, and spending cuts, there is a special responsibility to communicate carefully in public interviews and opinion pieces, where claims are tested less by peer review than public interpretation.

In the field of autism research, Professor Uta Frith has had an enormous impact. She was one of the first people in the UK to study Asperger syndrome, and remains Emeritus Professor in Cognitive Development at the Institute of Cognitive Neuroscience at University College London. She has written widely on the neuroscience of autism and dyslexia, won several awards and prizes, been elected Fellow of many prestigious societies. Frith has mentored leading figures in autism research and clinical practice, including Simon Baron-Cohen, Francesca Happé and Tony Attwood. Her foundational work has shaped the field, and her call for rigour in the interview is a continuation of that commitment, but it warrants further discussion in light of recent developments.

Frith was recently interviewed in TES Magazine (formerly known as the Times Educational Supplement; Amass, 2026) in a piece entitled “Uta Frith: why I no longer think autism is a spectrum”. The title itself was bound to raise both eyebrows and alarm, especially in the context of how the spectrum has emerged from empirical research and helped to destigmatise a condition now known to affect far more people than previously believed. Frith argued that “the autism spectrum has widened to the point of collapse”. While she rightly calls for scientific and clinical rigour, some of her positions appear to overlook emerging evidence, disregard the complexities of neurodivergent lived experience, and underestimate how her statements might be interpreted and misused.

I am wary treating any scientist as beyond criticism. Like all of us, researchers bring perspectives and assumptions that can shape how they interpret evidence. Autism is not my field of professional expertise, but as a psychologist with lived and family experience of autism, ADHD, and related conditions, I approached Prof Frith’s interview with mixed feelings. Her research record and impact is undeniable, but I was soon concerned about the potential implications of what I read.

“I am wary treating any scientist as beyond criticism. Like all of us, researchers bring perspectives and assumptions that can shape how they interpret evidence”

In this response, I’ll structure my analysis around some of her major claims, drawing on research along with personal reflections to hopefully offer a balanced yet critical perspective. I aim not to undermine Frith’s legacy but to explore where her views might diverge from certain strands of emerging evidence, and to reflect on how the claims and language in the interview may inadvertently harm those with autism spectrum disorder (ASD) diagnoses, and those considering assessment.

The Autism Spectrum Concept

“The spectrum has collapsed.” Frith believes that the autism spectrum has expanded to the point of meaninglessness, suggesting it no longer unites those diagnosed under a coherent framework. “We’re all neurodiverse in some way,” she noted, making “a medical diagnosis completely meaningless.” This phrasing, while highlighting her very real concerns, has proven appealing to media outlets and social media commentators seeking provocative angles.

Before we go on, for those unfamiliar with autism, it is important to clarify what ‘the spectrum’ means. Most authors and organisations do not conceive of the spectrum as a simple linear scale from ‘mild’ to ‘severe’ autism, where someone is more or less autistic. Instead, the autistic spectrum is typically seen as a multidimensional concept that recognises variability in how autism affects different areas of life. These areas include social communication, forming relationships, sensory processing, repetitive behaviours, restricted interests, executive functioning (such as planning and flexibility), and more. There is no standardised ‘spectrum’ as such, but the ASD diagnostic criteria are, of course, standardised. Some autistic people have unusual gifts or strengths, perhaps due to focused interests. Some autistic people have intellectual disabilities. There are, however, several meanings of the term ‘spectrum’ in relation to autism (see Lai et al, 2013), which DSM-5 does not define.

“This phrasing, while highlighting her very real concerns, has proven appealing to media outlets and social media commentators seeking provocative angles”

Diagnostic frameworks like the DSM-5 include levels of support needed (e.g., Level 1 for requiring “some support”, up to Level 3 for ”very substantial support”), rather than assigning an overall ‘severity label’. This avoids oversimplifying people into problematic categories like ‘high-functioning’ or ‘low-functioning’, which many autistic advocates criticise for ignoring the unique profile of strengths and impairments each person has, and the variability of functioning. For instance, one may be high-functioning in some abilities or aspects of life, but unusually low functioning in others: a so-called spiky profile.

Importantly, ‘high-functioning’ autistic people may function poorly when it comes to mental and physical health, which raises the question of what ‘high-functioning’ really means. It is noteworthy that rates of depression and anxiety (Hollocks, et al 2018), traumatic events and post traumatic stress disorder (Andrzejewski et al, 2024; Quinton, et al, 2024), and suicide (Newell, et al, 2023) are significantly higher among autistic people, especially those without intellectual disability. In an umbrella review, French et al (2026, in press) found, across 134 reviews, a wide range of adverse mental health, physical health, and social and lifestyle outcomes.

The spectrum model emerged from research and from attempts to capture this continuum of experiences, where traits interact dynamically with environments. Dismissing it risks reinforcing outdated binaries, ignoring how the ‘disorder’ part of ASD often arises from person-context mismatches rather than inherent deficits. Evolutionary perspectives suggest that some autistic traits, such as strong attention to detail, intense interests, and sustained focus on patterns or systems, may have had adaptive value in certain ancestral or historical contexts, while modern social and institutional demands can render the same traits disabling, pathologised, or occasionally valorised (Baron-Cohen et al., 2009; Hunt & Procyshyn, 2024).

Going back to Frith’s claim, there are valid questions and concerns about diagnostic boundaries, particularly since the removal of Asperger syndrome from manuals such as DSM-5, which broadened inclusion but risked diluting specificity. (DSM-5 replaced the previous group of four pervasive developmental disorders with a single diagnosis: Autism Spectrum Disorder or ASD.) It seems defensible that over-expansive categories may strain resources, at least for diagnosis (for many who are diagnosed, that is where the resources end), and complicate targeted interventions. However, while her critique raises important questions about boundaries, dismissing the spectrum entirely might overlook its ongoing utility in research and practice. 

“One may be high-functioning in some abilities or aspects of life, but unusually low functioning in others: a so-called spiky profile”

In response to Frith’s assertion, Baron-Cohen was interviewed on the Radio 4 Today programme five days later, on 9 March 2026. He agreed that “the term ‘autism’ is far too wide”, including not only autism but people with and without intellectual disability, and people who are both verbally fluent and those with minimal or no spoken language. He disagreed with Frith on the term spectrum, invented by Lorna Wing in the 1980s (43m 48s into the programme) (see Gillberg, 2015). The spectrum reminds us, he said, that there are individual differences among those who are autistic. 

TES later published a direct counterpoint by Dr Sue Franklin, who argued that progress in recognising autistic girls remains too fragile to risk reversing, and that dismissing masking underestimates the educational and mental-health consequences for girls and women (Franklin, 2026). That follow-up made clear that Frith’s article was not the only credible interpretation presented even within TES itself.

It’s tempting to think that the modern interpretation of autism is a recent development that has diverged sharply from historical accounts. We now know that this is not accurate. In 1925, Russian child psychiatrist and researcher Grunya Efimovna Sukhareva published a paper in which she described the cases of six boys (10-13 years), using what would now be recognised as ASD terminology. Sukhareva described sensory features that only appeared in DSM-5 (2013). The clinical picture was similar to that reported by Hans Asperger in 1944, and later in accounts of ‘high-functioning’ ASD. (The first English-language translation was by Wolff [1996].) Later, in 1927, Sukhareva described five girls (12-14 years), emphasising sex-related differences in autistic features. According to Sukhareva, girls with ASD showed some differences compared with boys, including a weaker and less prominent overall clinical picture, “greater affect dysregulation, less idiosyncratic interests” while the similarities included “autistic disposition, low or absent affective empathy, unimpaired cognitive empathy, systemising thought processes, and motor skill deficits” (Simmonds and Sukhareva, 2020; p. 549).

“It’s tempting to think that the modern interpretation of autism is a recent development that has diverged sharply from historical accounts. We now know that this is not accurate”

Frith’s push for precision and validity is warranted. But evidence from diverse studies continues to support the spectrum’s utility in promoting understanding, reducing stigma, and guiding intervention. Balanced, evidence-based refinements, rather than abandonment, could better serve the field and those it serves. Still, Frith connects the spectrum with a rise in diagnosis.

On the Rise in Diagnoses

A second contentious issue in the interview is the “dramatic increase in ASD diagnosis” that we have seen in recent years. Frith attributes the increase to the spectrum’s widening, driven by subjective self-reports and cultural trends, potentially pathologising normal variations. This resonates with concerns about both social media influence and resource strain. Frith argues for the need for more objective criteria (including observation, but potentially including biomarkers), as vague boundaries could be leading to over-identification.

Taken as a whole, research seems to suggest that there may be ‘many autisms’, just as there may be ‘many ME/CFSs’ (another condition with much in-fighting about what really constitutes ME or ME/CFS), and many ‘Long Covids’. Similar clusters of features can emerge from quite different biological mechanisms. But again, in the context of autism, according to Baron-Cohen and others, subgroups can still likely be seen in the context of a spectrum. Whatever terms are used, it seems that there are differences between subtypes identified by research, but there are also differences between all of these subtypes and those not diagnosed with autism. It seems that this is an empirical and modelling question, but one with significant implications, calling for care and skill both in the science and in its communication. Considering the research, while subgrouping is a promising direction, as Frith and others like Baron-Cohen advocate, a binary approach based on age of diagnosis seems unlikely to capture the heterogeneity revealed in studies such as those by Litman et al (2025).

Again, her claim is one opinion among many held by researchers with significant research records. Professor Baron-Cohen argued on BBC Radio 4 (and posted on X) that “we’ve got to be very careful we don’t conclude that there’s over-diagnosis; there’s no evidence for over-diagnosis”. So we have two leading experts making seemingly contrasting statements. In fact, Frith did not specifically state that there is over-diagnosis. The interview author wrote that the issue of rising diagnoses is something that Frith “has so far been ‘hesitant’ to comment on, due to the sensitivity of debates around overdiagnosis and uncertainty about how an already stretched SEND system should best meet growing need” (Amass, 2026). But ‘overdiagnosis’ has been inferred from her statements, perhaps because of her choice of language. Diagnoses after early-childhood, she said, was “increasing at a rate that is just frightening”. She also commented about the folding in of the previous diagnosis of Asperger syndrome into ASD: “the spectrum was stretched over and over into including people who would never have met the criteria of Asperger syndrome.”  

It is important to acknowledge that there could be some overdiagnosis when it comes to autism, as with any condition. Overdiagnosis has been researched with a variety of conditions internationally (Jenniskens, et al, 2017), and there is strong evidence of overdiagnosis for some (e.g., thyroid cancer; Chen and Haymart, 2025). But ASD is not among the conditions with strong evidence for overdiagnosis. As Baron-Cohen said on Radio 4, the research does not support a claim that autism is broadly overdiagnosed in the United Kingdom; rather, research suggests that underdiagnosis and delayed diagnosis remain substantial, especially in females and adults (see O’Nions, et al, 2023). Frith’s claims may underplay improved awareness, especially among adults, women, and high-masking individuals (something she rejects) who have historically been overlooked. Many pursue or are referred for autism assessment in the context of school or educational concerns, or because of co-occurring mental health difficulties (NICE, 2011; NICE, 2014).

“Research suggests that underdiagnosis and delayed diagnosis remain substantial, especially in females and adults”

It is important to note that the DSM-5 changes were largely empirically driven, and were seen as more valid than DSM-IV. Mandy (2013), citing Frith (2004) herself, concluded that, “On current evidence, there is no convincing argument to be made that autism and Asperger’s disorder are meaningfully distinct entities that require separate labels. People with these disorders show many more similarities than differences, and there is little to suggest that they diverge in terms of etiology, treatment needs or prognosis“. Despite this, there have been debates ever since about the loss of the Asperger category. Mandy wrote that “While the DSM-IV distinction between autism and Asperger’s disorder almost certainly lacked validity, it probably did have some utility.”  Some of those diagnosed, and their parents, accepted the diagnosis and found it useful. It more recently came to light that any association with Asperger was to be rejected for reasons associated with the man himself.

Interestingly, only 13 years ago, concerns were not about over-diagnosis but possible under-diagnosis of less apparent autism: “the bar for an ASD diagnosis has been raised by DSM-5, and that many people who would previously have met criteria will now be excluded from the autistic spectrum” (Mandy, 2013).

“It is important to note that the DSM-5 changes were largely empirically driven, and were seen as more valid than DSM-IV”

Some media outlets quickly framed the interview in terms of overdiagnosis, even though Frith did not explicitly make that claim. The Daily Mail ran an article and poll, “Is autism being over-diagnosed, as top expert claims?” Again, Frith did not make this specific claim in TES. It’s difficult to establish the expertise of Daily Mail readers in neurodevelopment matters, but a large majority responded “Yes” to the hardly neutral question.

Graphs propagated on social media with claims of overdiagnosis. In all of this, few bother to concern themselves with what ‘overdiagnosis’ actually means. According to Brodersen, et al (2018), “Broadly, overdiagnosis means making people patients unnecessarily, by identifying problems that were never going to cause harm or by medicalising ordinary life experiences through expanded definitions of diseases. Overdiagnosis has two major causes: overdetection and overdefinition of disease. While the forms of overdiagnosis differ, the consequences are the same: diagnoses that ultimately cause more harm than benefit.” 

On the first point (“making people patients unnecessarily, by identifying problems that were never going to cause harm“), there is very little evidence of this when it comes to autism. Autism is already associated with many adverse mental health, physical health, and social and lifestyle outcomes that do cause harm (French et al, 2026, in press), and non-diagnosis of ASD can sustain these harms or associated inappropriate treatments.

On the second point (“by medicalising ordinary life experiences through expanded definitions of diseases”), rather than medicalising normal autistic experience, an autism diagnosis can provide an explanatory and legitimising framework for autistic people and for parents, teachers, and others. Studies also suggest that, despite possible negatives such as stigma or diagnostic overshadowing, the perceived benefits of diagnosis are often greater than the harms (Huang et al., 2023; Jacobs et al., 2018). It is important to note that medication is generally not offered for the core features of autism, but some autistic people are offered medication for co-occurring conditions or specific associated symptoms.

So where does this leave the label of ‘autism’? Frith wrote that she “would fight for that label to be limited” those who are “diagnosed in early childhood – usually before age three or age five”. In the UK, this would mean that the vast majority of people diagnosed would no longer be diagnosed with autism. According to one major study, this would include 79% of children diagnosed by age 14 (Hosozawa, et al, 2020). It is more difficult to find comparable data for adult diagnoses, but, considering the whole population, it is safe to say that the vast majority – especially females – would no longer have a diagnosis of autism, under Frith’s suggestion. They might instead, Frith suggests, receive a diagnosis of something like “oversensitivity” or “anxiety” (thus ignoring most of the ASD criteria that underlie their existing diagnoses, and the associated factors that research suggests are linked to ill health). This could inadvertently limit access to understanding and support for many, which might ultimately be an own goal for the field.

“Rather than medicalising normal autistic experience, an autism diagnosis can provide an explanatory and legitimising framework for autistic people and for parents, teachers, and others”

One possible influence on current debate is anchoring to much lower historical prevalence estimates, especially those derived from narrow populations and older diagnostic frameworks (Tversky & Kahneman, 1974; Furnham & Boo, 2011). It may look like we have adjusted too far from the anchor. The very low historical figures, focusing on young boys in a period of low access to information and assessment, may bias ideas about the ‘right’ proportion of autistic people today. Some associate the rise of diagnoses with the assessment process itself.

The Assessment Process

On the assessment process, Frith said: “I fear that the way assessments are made now may not be quite right. I get the sense that people are relying too much on detailed interviews that provide a lot of subjective experience, rather than on objective clinical observation. For example, observing the flow of a conversation to spot indicators of poor reciprocal interaction, say, in eye contact or body language. I would guess these are things that are difficult to mask.” 

Interestingly, in discussing “How exactly is autism diagnosed?”, Frith relied on several qualified statements (“I have heard…”, “I fear…”, “I get the sense that…”, “I would guess…”, “I fear…” [again], “To me…”, and “…, in my view, …”.), which may reflect the tentative nature of interviews but contrasts with her emphasis on objectivity. This illustrates the challenges of conveying nuanced views in non-academic formats, where peer-reviewed precision is not feasible. But it may serve to generate speculation and multiply fear.

What is interesting here is that autism diagnosis tends to be an extensive process compared to other conditions. For an adult, it can take several hours over several weeks, involving multiple interviews, as well as observation throughout the interview with the person being assessed, plus a set of observed tasks. For children, the process is even longer. The whole process typically involves involves a team of professionals. The intervention offered – at least to adults – often a reading list and perhaps a discussion group. With autism, there can be a striking mismatch between the length and specialist nature of assessment and the paucity of post-diagnostic support. In contrast, depression is often diagnosed and managed in primary care by general practitioners, sometimes with medication initiated immediately.

“With autism, there can be a striking mismatch between the length and specialist nature of assessment and the paucity of post-diagnostic support”

To sum up, it seems that comprehensive assessments using approved and validated processes with evidence-based criteria have revealed many more previously undetected autistic people, often female and no longer young children, but who struggled through this period without recognition. And yet the process often yields minimal post-diagnostic support. But the message is either “there are too many autistic people!” or “you aren’t really autistic!”. Assessment and diagnostic protocols can always be improved, and they should be. But perhaps the real issue lies in systemic failures. Rather than being frightened by rising numbers of diagnoses, perhaps we could disregard imaginary targets when it comes to autism prevalence. And rather than blaming ‘the spectrum’, perhaps we should be cautious about framing older, narrower presentations of autism as the benchmark for validity. Those with greatest need should of course receive the greatest support. But we should ultimately be led by evidence. This leads us to the next issue: subgrouping autism.

Subgrouping Autism

Autism can look very different from one person to another in terms of features and challenges, and this heterogeneity creates issues for conceptualisation, diagnosis, and intervention. To help resolve these quandaries, Frith proposed at least two subgroups: those diagnosed.early and with intellectual impairments, versus later-diagnosed (perhaps with “anxiety” and “hypersensitivity”). The second group are mainly adolescents and mainly women, she argues. She suggests that many in this later-diagnosed group may have real difficulties that are better understood and treated outside the autism label. Frith argued for restricting ‘autism’ to the early diagnosed (before five years old) and creating new labels for the latter.

Many have baulked at this suggestion, but several researchers and clinicians, such as Attwood and Baron-Cohen, have long argued that something important was lost with the removal of Asperger syndrome (which clearly needed to be renamed and reformulated). There have also been many arguments and much research in support of subgrouping, for enhancing diagnosis, support, and more targeted research, including by: Baron-Cohen in his Radio 4 interview and with coauthors Lai et al (2013), as well as Kamp-Becker (2024), Choi et al (2026), and Litman et al (2025).

“There have also been many arguments and much research in support of subgrouping, for enhancing diagnosis, support, and more targeted research”

Taking this latter work, Litman et al. identified four distinct and mutually exclusive subtypes of autism in their survey and genetic data from over 5,000 autistic individuals: 1) social/behavioural (social communication, repetitive behaviours, attention deficits, disruptive actions, and anxiety or mood issues but normal developmental milestone attainment; ~37%); 2) mixed with developmental delays (strong repetitive behaviours and some social communication problems, but delays in development; ~19%); 3) moderate challenges (mildest overall, with lower levels of difficulties across social, behavioural, attention, and developmental areas, but noticeably more challenges than people without autism; ~34%); and 4) broadly affected (high challenges in nearly everything, and often intellectual disability or other co-occurring conditions; 10%). Each of the four linked to unique genetic variations and brain development. Contrary to Frith’s claim, there was a consistent male predominance (75-80% males) in all groups in this research on 5,000 children and young adults with autism.

Recently, Lin et al (2026) argued that autism research has been held back by treating variability between autistic people as a nuisance to be averaged away, rather than as something meaningful in its own right. The authors argued that idiosyncrasy (“stable, person-specific neural, cognitive, and behavioural patterns”) should be treated as a core feature of autism, not just statistical noise. In other words, person-specific patterns in brain function, cognition, and behaviour should be treated as central to understanding autism.

It might also be said that there is power in measurement, categorisation and language, especially in medicine. The debate concerns who gets to define autistic experience. The slogan ‘nothing about us without us’ remains relevant here, including for those diagnosed later in life. This brings us to Frith’s next claim.

“There is power in measurement, categorisation and language, especially in medicine”

The Concept of Masking or Camouflaging

Autistic masking is something that those diagnosed after early childhood may be acutely aware of, because of the consequences of both not masking and masking. Masking has been defined as “the conscious or unconscious suppression of natural responses and adoption of alternatives across a range of domains including social interaction, sensory experience, cognition, movement, and behavior” (Pearson and Rose, 2021). Autistic masking or camouflaging (both terms as used, with the latter sometimes being seen as broader) has been particularly associated with females in the literature, in a similar way to how ‘autism’ has been associated with males.

In her interview, Frith dismissed the concept of autistic masking as having “no scientific basis” and merely “something we all do”. This stance contrasts with a growing body of research on masking, which suggests it has distinct implications for autistic individuals (see Dolan, 2026; Pearson and Rose, 2023). Frith remarked that, “I expect we could say we are all masking, all the time, trying to adapt to our society’s norms. So, from this point of view, I’m very critical of this idea.” She rejected masking as a factor when it comes to later diagnoses, stating her view that there is no cultural bias against identifying girls and women as autistic, and that they have not been unjustly overlooked. Frith compared the situation with psychopathy: “We know, for example, that psychopathy is overwhelmingly male. Do we ask whether psychopathic girls have been overlooked? I haven’t seen anything like that.” Frith’s assumption seems to be that if you can mask, you are not autistic, perhaps reflecting an old idea that autistic people lack a theory of mind, which has been found to be “empirically questionable and societally harmful” (Gernsbacher and Yergeau, 2019).

Again, Frith’s claim is unevidenced, which is unsurprising for an interview. But because of the complexities and myriad implications of the claim, it might be more responsibly made in a scientific paper than a seemingly authoritative commentary for educators and the public. Frith went further to claim that the exhaustion that people report as being associated with masking “could arise from lots of other causes”. The differential nature of autistic masking, and the consequences of masking, were almost completely dismissed.

Frith also expressed scepticism toward aids such as ear defenders, deeming them unproven or potentially counterproductive. Again, this seems to disregard at least some research showing that earmuffs, noise-cancelling headphones, and similar audio technologies can help some autistic children by reducing auditory distress, improving behaviour linked to auditory hyperreactivity, and in some cases reducing physiological stress (Pfeiffer, et al, 2019; Ikuta, et al, 2016; ‌Zanin, et al, 2024). Ironically, the implication is that autistic people should tolerate overwhelming environments rather than use simple accommodations, which is a form of masking.

On reading this, I could only imagine the reactions of autistic people, the parents of autistic children, and partners of autistic adults. But first, let’s turn briefly to research. Frith’s “we are all masking, all the time” remark seems to overlook studies demonstrating masking’s distinctiveness in form, intensity, and consequences for autistic people (e.g., Alaghband-Rad, et al, 2023; Cook, et al, 2021; Khudiakova, et al, 2024; Klein, et al, 2025). In their systematic review, Alaghband-Rad, et al (2023) found a range of correlates of camouflaging, including gender, a universal finding, but also neuroanatomical. Kim and Bottema-Beutel (2019) found that camouflaging can have positive short-term impacts on social functioning but at the long-term cost of depression and exhaustion. They noted that “inability or decision not to camouflage may result in even greater loss of QoL [quality of life]. Researchers and practitioners should consider this double bind when promoting social functioning as an avenue for enhancing QoL.”

“Frith’s “we are all masking, all the time” remark seems to overlook studies demonstrating masking’s distinctiveness in form, intensity, and consequences for autistic people”

Of course, non-autistic people also adapt socially. But systematic reviews and qualitative analyses reveal autistic masking as conscious and unconscious suppression of autistic behaviours and traits, including stimming, avoiding eye contact, and scripting responses, at significant physiological, cognitive, and emotional cost (Cook, et al, 2021; Klein, et al, 2025). Methods such as the Camouflaging Autistic Traits Questionnaire (CAT-Q) (Khudiakova, et al, 2024, Cancino-Barros, et al, 2025; Cremone, et al, 2023) quantify camouflaging, and studies have linked higher camouflaging to anxiety, depression, burnout, and suicidality. Again, suicidality is highly prevalent in autistic and possibly autistic people without co-occurring intellectual disability (Newell, et al, 2023). Camouflaging autistic traits, meanwhile, is associated with increased risk of lifetime suicidality (Cassidy et al, 2019).

There is still much work to be done on masking or camouflaging (Khudiakova, et al, 2024), but to dismiss it as “unscientific” echoes debates concerning the validation of reported symptoms in conditions like ME/CFS (e.g., fatigue, brain fog, orthostatic intolerance, dizziness, exercise intolerance, post-exertional malaise) (see Ponting, 2024). Communication on these matters has to be approached with precision, even – or especially – in an interview, acknowledging the state of science without outright rejection. In ordinary debates, what can be said without evidence can be dismissed without evidence. But it’s not that simple with such a major figure. The personal weight of Frith’s opinion combined with the lack of expertise of many readers of TES but social media generally, are all relevant. Furthermore, the sequence of arguments from different specialists in contentious fields like autism research is significant; initial arguments are likely to have greater influence on public attitudes (see Haugtvedt and Wegener, 1994). As an interesting side note, there is some evidence that more senior researchers tend to cite older research (Gingras et al, 2008; Xu, et al, 2023), while younger authors are more likely to use new important concepts, and reference more recent and diverse works (Yu, et al, 2023).

“There is still much work to be done on masking or camouflaging, but to dismiss it as “unscientific” echoes debates concerning the validation of reported symptoms in conditions like ME/CFS”

For autistic people, masking may be described as a survival strategy under stigma. It’s a safety strategy with consequences that cannot be compared with those for non-autistic people (though there may be some similarities with masking among those diagnosed with ADHD). Dismissing masking, despite research, may contribute further to gender disparities and the mental health consequences of masking, as well as add to the social stigma via dismissal of masking by family, employers, and the public.

Conclusion

In reflecting on Professor Frith’s interview, it’s clear that her intent was to advocate for scientific rigour in a field grappling with rapid change. This is laudable, and her legacy in advancing autism research is profound. Yet, as I have outlined, several of her assertions risk overlooking, or at least not mentioning, emerging evidence on the spectrum’s utility, the corrective nature of rising diagnoses, and the realities of masking. These views contrast with research highlighting the spectrum’s role in fostering inclusion and validating diverse experiences, as well as studies linking masking to distinct costs like anxiety, depression, and suicidality. Advancing the field calls for blending scientific rigour with autistic-led insights, allowing for refinements such as evidence-based subgroups without unjustified gatekeeping.

I have chosen to speak openly about my autism because a later-life diagnosis provided answers to questions that had haunted me for years. Diagnosis served as an intervention in itself. Before that, I was treated for PTSD through therapy, without resolution. Noise-cancelling earphones helped, but the autism lens connected the dots. Many aspects of the spectrum, including but not limited to sensory sensitivities, were part of a broader profile that runs in my family. The spectrum reframed struggles that prior searches and diagnoses had not explained. Far from pathologising or making me a patient, it normalised my experiences within a particular framework, led to tailored adaptations and interventions that I developed myself, and even to my discharge from clinical services (though I later developed ME/CFS, which may be more common among autistic people; see Grant et al., 2022).

Diagnosis also made sense of my younger years, and this is profoundly important for healing from trauma. From a young age, I learned communication and social norms deliberately and effortfully, almost as a form of performance. That helped me traverse difficult environments at the time, but it may also have come at a long-term cost. Since autism often runs in families, diagnosis has also helped me in other ways in my family context.

By sharing this, I aim to counter narratives dismissing later diagnoses; for me, autism was the last consideration. I actually sought truth, not a label. I remain unattached to the word itself. But understanding the pattern has been life-changing.

“For me, autism was the last consideration. I actually sought truth, not a label”

As someone navigating this from my own perspective, I hope this article fosters more balanced discourse, respecting pioneers and their work while ensuring “nothing about us without us”. With real lives in the balance, influential perspectives can most helpfully promote understanding over division. Embracing diversity of thought and experience can enrich us all, if we listen and adapt.

References

Alaghband-rad, J., Hajikarim-Hamedani, A., & Motamed, M. (2023). Camouflage and masking behavior in adult autism. Frontiers in Psychiatry, 14(14). https://doi.org/10.3389/fpsyt.2023.1108110

Amass, H. (2026, March 4). Uta Frith: why I no longer think autism is a spectrum. TES. https://www.tes.com/magazine/teaching-learning/general/uta-frith-interview-autism-not-spectrum

Andrzejewski, T., Saily Gomez Batista, Abu-Ramadan, T., Breitenfeldt, K. E., Tassone, A. U., Winch, A., Rozek, D. C., & McDonnell, C. G. (2023). Examining Rates of Traumatic Events and Posttraumatic Stress Disorder Symptoms Among Autistic Adults. Autism in Adulthood, 6(3). https://doi.org/10.1089/aut.2023.0022

Baron-Cohen, S., Ashwin, E., Ashwin, C., Tavassoli, T., & Chakrabarti, B. (2009). Talent in autism: hyper-systemizing, hyper-attention to detail and sensory hypersensitivity. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 364(1522), 1377–1383. https://doi.org/10.1098/rstb.2008.0337

BBC. (2026, September 3). Today Programme [Radio Programme]. BBC. https://www.bbc.com/audio/play/m002sdyg

Brodersen, J., Schwartz, L. M., Heneghan, C., O’Sullivan, J. W., Aronson, J. K., & Woloshin, S. (2018). Overdiagnosis: what it is and what it isn’t. BMJ Evidence-Based Medicine, 23(1), 1–3. https://doi.org/10.1136/ebmed-2017-110886

Cancino-Barros, I., Villacura-Herrera, C., & Castillo, R. D. (2025). A meta-analytic review of quantification methods for camouflaging behaviors in autistic and neurotypical individuals. Scientific Reports, 15(1). https://doi.org/10.1038/s41598-025-06137-z

Cassidy, S. A., Gould, K., Townsend, E., Pelton, M., Robertson, A. E., & Rodgers, J. (2020). Is camouflaging autistic traits associated with suicidal thoughts and behaviours? Expanding the interpersonal psychological theory of suicide in an undergraduate student sample. Journal of Autism and Developmental Disorders, 50(10), 3638–3648. https://doi.org/10.1007/s10803-019-04323-3

Chen, D. W., & Haymart, M. R. (2025). Unravelling the rise in thyroid cancer incidence and addressing overdiagnosis. Nature Reviews Endocrinology, 22. https://doi.org/10.1038/s41574-025-01168-y

Choi, T.-Y., Gunawan, A., Seo, D., Park, J., Ahn, E. H., Suh, S. W., Fuccillo, M. V., & Choi, K. (2026). Applying biologically anchored subtypes to advance precision medicine in autism spectrum disorder. Neurobiology of Disease, 218, 107219. https://doi.org/10.1016/j.nbd.2025.107219

Cook, J., Hull, L., Crane, L., & Mandy, W. (2021). Camouflaging in autism: A systematic review. Clinical Psychology Review, 89(0272-7358), 102080. https://doi.org/10.1016/j.cpr.2021.102080

Cremone, I. M., Carpita, B., Nardi, B., Casagrande, D., Stagnari, R., Amatori, G., & Dell’Osso, L. (2023). Measuring social camouflaging in individuals with high functioning autism: A literature review. Brain Sciences, 13(3), 469. https://doi.org/10.3390/brainsci13030469

Dolan, I. (2026). Masking in Autistic Adults: A Clinician’s Guide to Neurodiversity-Affirming Care. Routledge. https://www.routledge.com/Masking-in-Autistic-Adults-A-Clinicians-Guide-to-Neurodiversity-Affirming-Care/Dolan/p/book/9781032935980

Franklin, S. (2026, March 10). Why Uta Frith is wrong about girls and autism. TES. https://www.tes.com/magazine/analysis/general/why-uta-frith-wrong-about-girls-and-autism

French, B., Newell, V., Nalbant, G., Wright, H., Daley, D., & Cassidy, S. (2026). Adverse outcomes for autistic people: An umbrella review of mental health, physical health, and social and lifestyle domains. Frontiers in Psychiatry. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2026.1702822/abstract

Frith, U. (2004). Emanuel Miller lecture: Confusions and controversies about Asperger syndrome. Journal of Child Psychology and Psychiatry, 45(4), 672–686. https://doi.org/10.1111/j.1469-7610.2004.00262.x

Furnham, A., & Boo, H. C. (2011). A literature review of the anchoring effect. The Journal of Socio-Economics, 40(1), 35–42. https://doi.org/10.1016/j.socec.2010.10.008

Gernsbacher, M. A., & Yergeau, M. (2019). Empirical failures of the claim that autistic people lack a theory of mind. Archives of Scientific Psychology, 7(1), 102–118. https://doi.org/10.1037/arc0000067

Gillberg, C. (2015). Lorna Wing OBE, MD, FRCPsych Formerly psychiatrist and physician, Social Psychiatry Unit, Institute of Psychiatry, King’s College London, co-founder of the UK National Autistic Society. BJPsych Bulletin, 39(1), 52–53. https://doi.org/10.1192/pb.bp.114.048900

Gingras, Y., Larivière, V., Macaluso, B., & Robitaille, J.-P. (2008). The effects of aging on researchers’ publication and citation patterns. PLoS ONE, 3(12), e4048. https://doi.org/10.1371/journal.pone.0004048

Grant, S., Norton, S., Weiland, R. F., Scheeren, A. M., Begeer, S., & Hoekstra, R. A. (2022). Autism and chronic ill health: an observational study of symptoms and diagnoses of central sensitivity syndromes in autistic adults. Molecular Autism, 13(1). https://doi.org/10.1186/s13229-022-00486-6

Haugtvedt, C. P., & Wegener, D. T. (1994). Message order effects in persuasion: An attitude strength perspective. Journal of Consumer Research, 21(1), 205. https://doi.org/10.1086/209393

Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2018). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological Medicine, 49(4), 559–572. https://doi.org/10.1017/s0033291718002283

Hosozawa, M., Sacker, A., Mandy, W., Midouhas, E., Flouri, E., & Cable, N. (2020). Determinants of an autism spectrum disorder diagnosis in childhood and adolescence: Evidence from the UK Millennium Cohort Study. Autism, 24(6), 1557–1565. https://doi.org/10.1177/1362361320913671

Huang, Y., Trollor, J. N., Foley, K.-R., & Arnold, S. R. C. (2023). “I’ve spent my whole life striving to be normal”: Internalized stigma and perceived impact of diagnosis in autistic adults. Autism in Adulthood, 5(4). https://doi.org/10.1089/aut.2022.0066

Hunt, A. D., & Procyshyn, T. L. (2024). Changing perspectives on autism: Overlapping contributions of evolutionary psychiatry and the neurodiversity movement. Autism Research: Official Journal of the International Society for Autism Research, 17(3). https://doi.org/10.1002/aur.3078

Ikuta, N., Iwanaga, R., Tokunaga, A., Nakane, H., Tanaka, K., & Tanaka, G. (2016). Effectiveness of earmuffs and noise-cancelling headphones for coping with hyper-reactivity to auditory stimuli in children with autism spectrum disorder: A preliminary study. Hong Kong Journal of Occupational Therapy, 28(1), 24–32. https://doi.org/10.1016/j.hkjot.2016.09.001

Jacobs, D., Steyaert, J., Dierickx, K., & Hens, K. (2018). Implications of an autism spectrum disorder diagnosis: An interview study of how physicians experience the diagnosis in a young child. Journal of Clinical Medicine, 7(10), 348. https://doi.org/10.3390/jcm7100348

Jenniskens, K., de Groot, J. A. H., Reitsma, J. B., Moons, K. G. M., Hooft, L., & Naaktgeboren, C. A. (2017). Overdiagnosis across medical disciplines: a scoping review. BMJ Open, 7(12), e018448. https://doi.org/10.1136/bmjopen-2017-018448

Kamp-Becker, I. (2024). Autism spectrum disorder in ICD-11—a critical reflection of its possible impact on clinical practice and research. Molecular Psychiatry, 29. https://doi.org/10.1038/s41380-023-02354-y

Khudiakova, V., Russell, E., Sowden-Carvalho, S., & Surtees, A. D. R. (2024). A systematic review and meta-analysis of mental health outcomes associated with camouflaging in autistic people. Research in Autism Spectrum Disorders, 118, 102492. https://doi.org/10.1016/j.rasd.2024.102492

Kim, S. Y., & Bottema-Beutel, K. (2019). A meta regression analysis of quality of life correlates in adults with ASD. Research in Autism Spectrum Disorders, 63, 23–33. https://doi.org/10.1016/j.rasd.2018.11.004

Klein, J., Krahn, R., Howe, S., Lewis, J., McMorris, C., & Macoun, S. (2024). A systematic review of social camouflaging in autistic adults and youth: Implications and theory. Development and Psychopathology, 37(3), 1320–1334. https://doi.org/10.1017/s0954579424001159

Lai, M.-C., Lombardo, M. V., Chakrabarti, B., & Baron-Cohen, S. (2013). Subgrouping the autism “spectrum”: Reflections on DSM-5. PLoS Biology, 11(4), e1001544. https://doi.org/10.1371/journal.pbio.1001544

Lin, H.-Y., Breakspear, M., & Mottron, L. (2026). From heterogeneity to idiosyncrasy in the autistic brain. Nature Mental Health, 4. https://doi.org/10.1038/s44220-026-00601-z

Litman, A., Sauerwald, N., Snyder, G., Foss-Feig, J., Park, C. Y., Hao, Y., Dinstein, I., Theesfeld, C. L., & Troyanskaya, O. G. (2025). Decomposition of phenotypic heterogeneity in autism reveals underlying genetic programs. Nature Genetics, 57, 1–9. https://doi.org/10.1038/s41588-025-02224-z

Mandy, W. (2013). Upcoming changes to autism spectrum disorder: evaluating DSM-5. Neuropsychiatry, 3(2), 127–130. https://doi.org/10.2217/npy.13.15

Newell, V., Phillips, L., Jones, C., Townsend, E., Richards, C., & Cassidy, S. (2023). A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Molecular Autism, 14(1). https://doi.org/10.1186/s13229-023-00544-7

NICE. (2011, September 28). Recommendations | Autism spectrum disorder in under 19s: recognition, referral and diagnosis | Guidance | NICE. Nice.org.uk; NICE. https://www.nice.org.uk/guidance/cg128/chapter/Recommendations

O’Nions, E., Petersen, I., Buckman, J. E. J., Charlton, R. A., Cooper, C., Corbett, A., Happé, F., Manthorpe, J., Richards, M., Saunders, R., Zanker, C., Mandy, W., & Stott, J. (2023). Autism in England: Assessing underdiagnosis in a population-based cohort study of prospectively collected primary care data. The Lancet Regional Health, 29(1), 100626–100626. https://doi.org/10.1016/j.lanepe.2023.100626

Pearson, A., & Rose, K. (2021). A conceptual analysis of autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism in Adulthood, 3(1), 52–60. https://doi.org/10.1089/aut.2020.0043

Pearson, A., & Rose, K. (2023). Autistic masking: Understanding identity management and the role of stigma. In Pavilion Publishing | Working with you to support your professional development. Pavilion.

Pfeiffer, B., Stein Duker, L., Murphy, A., & Shui, C. (2019). Effectiveness of noise-attenuating headphones on physiological responses for children with autism spectrum disorders. Frontiers in Integrative Neuroscience, 13(65). https://doi.org/10.3389/fnint.2019.00065

Ponting, C. (2024, October 29). ME – the origins of a modern medical “scandal” – Edinburgh Impact. The University of Edinburgh. https://impact.ed.ac.uk/opinion/me-origins-of-a-modern-medical-scandal/

Quinton, A. M. G., Ali, D., Danese, A., Happé, F., & Freya Rumball. (2024). The assessment and treatment of post-traumatic stress disorder in autistic people: A systematic review. Review Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s40489-024-00430-9

Simmonds, C., & Sukhareva, G. E. (2019). The first account of the syndrome Asperger described? Part 2: the girls. European Child & Adolescent Psychiatry, 27. https://doi.org/10.1007/s00787-019-01371-z

Tversky, A., & Kahneman, D. (1974). Judgment under uncertainty: Heuristics and biases. Science, 185(4157), 1124–1131. https://www.science.org/doi/10.1126/science.185.4157.1124

Wolff, S. (1996). The first account of the syndrome Asperger described? European Child & Adolescent Psychiatry, 5(3), 119–132. https://doi.org/10.1007/bf00571671

Xu, H., Liu, M., Bu, Y., Sun, S., Zhang, Y., Zhang, C., Acuna, D. E., Gray, S., Meyer, E., & Ding, Y. (2024). The impact of heterogeneous shared leadership in scientific teams. Information Processing & Management, 61, 1. https://doi.org/10.1016/j.ipm.2023.103542

Yu, H., Marschke, G., Ross, M. B., Staudt, J., & Weinberg, B. A. (2022). Publish or perish: Selective attrition as a unifying explanation for patterns in innovation over the career. Journal of Human Resources, 58(4), 1307–1346. https://doi.org/10.3368/jhr.59.2.1219-10630r1

Zanin, J., Tomlin, D., & Rance, G. (2024). Effectiveness of noise cancelling earbuds in reducing hearing and auditory attention deficits in children with autism. Journal of Clinical Medicine, 13(16), 4786–4786. https://doi.org/10.3390/jcm13164786

Note

This is a personal reflection based on lived experience and research; consult appropriately qualified and accredited professionals for advice.

How to cite

Shorrock, S. (2026, March 13). Reflections on the autistic spectrum: A critical response to Uta Frith’s views. Humanistic Systems. https://humanisticsystems.com/2026/03/13/reflections-on-the-autistic-spectrum-a-critical-response-to-uta-friths-views/

• Possibility space and patterns: The ‘possibility space’ is where operational decisions are made based on a variety of responses to different demands and contexts. Patterns – learned constellations of responses in this possibility space – play a critical role in decision-making.
• Learning through practice: Most decision-making involves tacit pattern-based recognition learned by doing. Rigid training structures that don’t allow for real-world problem-solving are problematic. Simulation training does not fill all of these gaps.
• Leadership in learning: Effective leadership means encouraging first officers and other professionals to explore their possibility space in order to learn how to create possibilities. People need the authority, competency and confidence to be able to practice.
• Limits of formal systems: Formal safety systems can be overly restrictive, limiting the flow of operational knowledge. Crew rooms, informal networks, and narrative-driven, experience-sharing approaches to learning are needed.

Among front line operational professionals of all kinds, there are those who have a special interest in how to improve performance. Some of these professionals spend much time studying the various disciplines involved – human factors, psychology, complexity science, systems engineering, and so on. I have spoken to many in aviation, shipping, healthcare, emergency services, and other sectors. Some can be found in the back issues of HindSight magazine. One person I have spoken to many times over the years is James Burnell, a Scottish airline captain, union rep, and student of complexity and system performance. I met James to talk about some of his perspectives on People in Control: Staying in the Loop. In his Edinburgh home, close to his base airport, we discussed theory and practice with implications for professionals and organisations.

Journey to Captaincy

Aviation infused James’ childhood. Growing up in Scotland, his father was an airline pilot with British Airways, in the Highland and Islands division. Initially attracted to aerospace engineering, James started a degree at Glasgow University, but he got the chance to fly during that time, and his passion for flying was ignited.

While looking for work as a pilot, James worked for various airlines writing operations manuals. But he realised that he was drawn more to the practical aspect of flying than office-based work. “I enjoyed the problem solving – the novel solution generation – more than routine and rigid structures.” He started flying as first officer (FO) in the late 1990s on Shorts 360s and SAAB 340 in the Scottish Highlands and Islands, and later in Scotland. He has fond memories: “It is probably the nicest job in flying, because you get to see this incredible scenery. My first sector on the Shorts 360 was a mail run from Glasgow to Stornaway. We took off at about five in the morning, with the sun coming up in the East as we headed out over Loch Lomond and across the hills. And I just thought…’I’ve made it. This is tremendous.’”

The financial rewards were better elsewhere, though, and James moved on to bigger airlines. This was more controlled, but still with “a nice amount of problem solving…you actually get to fly a plane”. He eventually got seniority and ended up in Edinburgh, and earned a command rating on the Embraer 145 in 2005. With just a handful of routes, mostly within the UK, the number and timing of sectors were quite different to what he and other pilots experience today.

The next transition was to a new airline with direct entry command, and to the Airbus. To become comfortable with this aircraft took more than a year, which was longer than previous aircraft types due to the very different operating philosophy. From initially flying just UK-based routes, more routes were added over the years “and it became more and more punishing from there”, he noted, hinting at the challenges of flying now compared to 20 years ago.

The Possibility Space and Patterns

This variety of operational experience leads us to the topic of variety more generally in operations. There are interesting differences between bases in terms of size and culture that affect operations and approaches to safety. Some bases are very procedurally focused, while others are more adaptive. James has observed that in smaller regional bases, first officers have a lot of responses to various situations. “They can hand fly. They can use the manual thrust. They have lots of different ways of controlling the aircraft.” At the larger bases, things are much more rigid. “They stick to the standard operating procedures because they don’t get that freedom to try things.” Exploring the reasons for this, James said that the captains and the first officers would rarely meet each other more than once a year in the large bases. “They don’t get that comfort with each other to try to explore the possibility space.”

The concept of the ‘possibility space’ and the related concept of ‘patterns’ shaped the next part of our conversation. James’ thoughts about people in control and staying in the loop are surprisingly theoretical for a captain interested in practical problem solving. This is because James has been keeping up with theory in safety and complexity theory over the years, and applying that within the British Airline Pilots’ Association (BALPA), in his role as a safety representative.

The possibility space is just that – the possibilities that exist in a given situation. This depends on all sorts of things, and the many contexts and constraints – regulatory, procedural, technological, organisational, temporal, environmental – and the expertise and networks available. Patterns, meanwhile, exist both in our environments as ‘stable- enough states of the world’ that our mind and bodies are aware of (not necessarily consciously), and within our minds and bodies as corresponding triggered patterns, which have previously developed during similar experiences. These patterned responses are rarely consciously available to us in the form of logical thought, although our minds make us think so after the fact. Patterns, James argues, are the basis for most operational decision-making. Existing patterns can be combined with logical thought to explore different possibilities, generating novel ways of responding to very contextually-specific problems.

In the decision-making literature, this relates both to ‘recognition-primed decision-making’, popularised by Gary Klein in his research and book Sources of Power – How People Make Decisions and the predictive processing models of human cognition developed by Karl Friston, Andy Clark and Anil Seth. “Most decisions involve tacit pattern-based recognition from actually doing the job or other outside experiences,” said James. “A lot of it is autonomic,” not conscious or thought-through. “In very complex situations, especially crisis situations, you need a very quick response. And that’s what these patterns do. They give you a heuristic or a rule of thumb on how to act.” Patterns mean that we don’t have to waste energy on working out solutions from first principles which would very quickly generate information overload.

An obvious heuristic for staying in control that all pilots know is ‘aviate, navigate, communicate’. “When you’ve stabilised the situation enough, you can start making more sense of what’s going on.” There can be even simpler if-then rules, James noted: “if something bad happens in the cockpit, then turn the seatbelt sign on because it gets the cabin ready.”

Learning Patterns

An important way of learning patterns is by doing – by trying things in practice. Again, what is critical here, James said, is creating potentials and possibilities: “You need as many responses as things that happen.” Due to the increasingly complex nature of our system, things that go wrong are very likely to be unknowable or unimaginable in advance. This means that we cannot and should not specify everything people need to know in advance. Learning needs to be delivered by the exploration of the possibility space.

So, some of the focus needs to be on creating possibilities in advance of need. James gave the following example: “If you have a technical issue that precludes the use of the auto-thrust, which is a function of the aircraft that automatically controls speed, then having the ability to manually take on that function becomes vital. It may be that function interacts with another function you have learned and combining these further extends the possible responses that a pilot has to meet the demandsof any given situation.” This means generating potentials to meet needs that are unknown, unpredictable, even unimaginable. “You’re preparing for a need that you can’t possibly specify,” he said. “So, you have to continually generate potentials even though you may never use them.”

This highlights problems with very rigid training structures which encourage thinking of “the next right thing to do in a fixed sequence”, as if flying an aircraft was like operating a production line. “A lot of the new pilots come in thinking ‘this is so controlled that I can just follow the process every time’. That doesn’t work because context changes.” And all of this means that practice in the real world, with all its messiness and unpredictability, is essential. By avoiding practice in the real world, the risk shifts to being unprepared for surprises.

As mentioned earlier, learning by doing also means doing the basics. Regulators and airlines have recognised the need to practise visual approaches, auto-thrust off, and manual flying skills generally, but many airlines only allow this in the simulator. A question for many is whether simulation practice of, say, flying with a single engine with no auto-thrust, will translate to real life. Can you still do it manually in operations?

Leadership for Learning

In learning patterns, people need the authority, competency and confidence to be able to practise in ways that work for them. Those in leadership positions have a particular role here. “As an airline captain, I would say, ‘this is my intent, can you make that happen?’ And I would let that first officer make it happen as they saw fit.” Executing what James calls “generative learning process” of building potential responses to demands and conditions. The idea is that operational people make contextually appropriate decisions, but in the direction that’s coherent with more senior decisions. The same is true in a team and organisation more generally: “maintain coherence of direction and distribute sensemaking and decision-making down through the individual layers”.

James gave the example of an instrument landing system (ILS), where the aircraft would need to capture the glideslope at the right speed and the right height, or this would create problems. Heavy airliners have lots of energy, so getting the aircraft to slow down and go down can be a challenge, he noted. “I would make sure that the FO is in the loop, and I would watch to make sure that the aeroplane is always within my control should it start to deviate. But I wouldn’t necessarily take over if things started to go awry. I could throw in ideas, but they’re never going to become captains if I do everything for them.”

The emphasis, again, is on the need to explore the possibility space. James recalled situations where it’s been windy, and the aircraft has been upset on the approach. “The FO has tried to hand it to me to land: ‘I can’t do this, you take it.’ I say that if you don’t feel that you can land, you can go around. Of course, I can take it, and I can go around and I can land it, but they’re not going to learn anything by throwing their hands up and asking me to do it.” This approach provides an important learning opportunity combined with a confidence gain. “When they come out the other side from where they thought they couldn’t do it, wow, they’re a different person. ‘I can do this. I can learn, I can change.” James gave another example where police have come onboard to talk to passengers. “I wouldn’t necessarily get involved in that because the cabin manager is an experienced professional. They understand the situation and they’re dealing with the passengers already. I am, of course, there for support or direction, or the company line.” His point is that to be in control, people need to learn through experience of how to deal with the context that they’re in.

This approach to leadership and learning is not necessarily common, particularly outside of the aircraft. James observed that among ground staff there can be a lack of decision-making authority. This can result in almost farcical referral to superiors for decisions that should be taken by competent and experienced professionals in the situation. Processes and procedures can be a useful scaffold, he noted, but we all need space to adapt to cope with the complex, changing environment.

Learning From Others’ Experiences

Of course, not everything has to be learned first-hand. Aviation safety is built on generations of experience. This is communicated through patterns. In the social case, social scientists might call them ‘assemblages’. “Pilots have generations of knowledge in these patterns because so much processing of decision-making has been done before. Learning is a social process, and we can pass on these patterns for learning those.”

So, at the beginning of training, “you’re preloaded with enough patterns to get you started.” This continues throughout training. “When I’m sitting in a simulator and I have an experienced training captain talking to me and things haven’t gone quite as well as they could, the training captain may well come and say, ‘look, try this thing that we’ve seen from other people as it works well’.” Those training captains are in a unique position of having observed and listened to hundreds of other captains and are then able to transmit vital cultural knowledge.

Most pilots aren’t in that position, though. So, there is a need for airlines and other organisations to allow information flows. For pilots, crew rooms were always a key part of this learning. “Now a lot of the airlines have got rid of the crew rooms”, James said. “You just report straight to the aircraft. I notice a difference in how these patterns are passed on and the impact on the way people operate.” Many of his colleagues have said that the loss of crew rooms has affected their operational communication with other operational staff. For safety management professionals too, time sat in crew room can be the most valuable experience possible, I have experienced this in simulators, and just hanging out with controllers. This is where informal accounts of experiences can be heard. “There’s no high energy barrier, such as forms to fill in. You can say, ‘look, I did this, and this happened.’” That, for James, is ‘being in the loop’, and radically different to the decontextualised data of reporting systems.

There are a few other opportunities for informal, face to face, verbal exchanges between certain operational staff, and with safety staff. While cabin crew spend much time together, like consultants in a hospital, captains don’t necessarily meet each other often: “You never fly with another captain.” So how do you get those informational flows going? Interestingly, James has observed that captains can also learn from first officers who have picked up patterns from other captains. But he believes that captains especially have an unmet need to sit down in an informal setting to talk about experience and mistakes. This kind of conversation does not happen in the same way with first officers, James said, and if it does, “it’s heavily filtered”. From a company perspective, a lesson here is that people need opportunities to listen and pass on information to others about their experiences.

The Limits of Formal Safety Learning Systems

There are, of course, formalised means to share experience. And in aviation, it is tempting to think that all information should pass through these highly managed conduits. James noted that “I think one of the problems we face in the airline industry is that we are very focused on explicit information.” So, what’s the problem? Why can’t company and other industry reporting and learning systems meet this need, for example? One constraint is that legacy reporting systems – with their forms and taxonomies – necessarily restrict the type of information gathered. What can be inputted is predetermined based on capabilities and limitations of the technical systems involved, their designers, and feedback from experience. That restriction of information flow also restricts the ability of the organisation to respond. Codification and quantitative analysis of free text or interview data – while useful at scale to find trends – deconstruct narratives and removes meaning. Furthermore, there is always a lag in feedback to staff, which can be weeks, months or even years.

There are industry-wide voluntary reporting systems that allow for more free narrative and faster feedback. These include, for instance, the Confidential Human Factors Incident Reporting Programme (CHIRP) in the UK. A constraint here is what is chosen to be fed back, by whom, and how (see Waites and Burnell, 2023). It may be that frequently-reported issues are fed back while others are not. This is relevant, but “what you probably want to do is just get as many potentials as possible for people to consider”, James argued.

Practices that work well are sometimes turned into procedures. But this isn’t always possible or even desirable. This brings us to the difficulty of formalising or manualising patterns. “As soon as you write it down, you’ve almost corrupted it because you’ve fixed it independent of context. You’ve lost that ability for it to adapt and evolve.” James compares this with storytelling of fairytales through the generations in the oral tradition; the lessons for us are lost. “As soon as we wrote these stories down, we started to lose the context of why we were telling them.”

What Can Usefully Be Done?

So, what can usefully be done? Allowing human interactions to exist closer to the way that we evolved is a great start. Social networks have always transferred information in efficient ways to optimise community responsiveness.

An obvious starting point is not to remove crew rooms, or reintroduce them. Crew rooms are not wasted spaces, they can be valuable learning spaces for casual verbal exchanges. For people to discuss operational information, there has to be a low friction way to do so. Crew rooms are also an important space for low-key social support, akin to coffee rooms and water coolers. An organisational desire to systemise everything and reduce perceived ‘waste’ works against these important ideals.

Another idea is a buddy system. James proposed that new joiners to any base or first officers approaching command would get allocated a buddy or mentor whom they could speak to. The buddy would change from time to time. Via this approach, new joiners would get added to informal networks in the background and reduce the degrees of separation between operational groups. These informal networks provide the information flows needed to work around formal constraints. James noted that companies that did well during COVID managed to adapt and keep operating largely due to the quality of their informal networks. For doctors, informal networks emerged as WhatsApp groups, which also exist for pilots. These can provide a means to share dynamic information on developing situations and novel solutions.

Despite the limitations to documenting experience, there are ways to collect short narratives. James suggests documenting people’s accounts of how they work, and why they’re responding in particular ways. “Collect a hundred stories for inexperienced pilots to read on, say, go-arounds that didn’t go as expected. Then build patterns or understandings through these small narrative structures. ‘I did this, and this is what happened.’” Airlines, James said, do this for big incidents and can be very good at it, but not for ‘ordinary work’. He suggested a book of just a few lines on each topic, as many small stories on a topic are preferable to one long one. He also suggested to bias it towards failure rather than success. “Because you’re going to remember failure. People learn a lot more from failure.” Interestingly, many old fairy stories and folk tales concern failure. In learning from our own experience, our current patterns are only adjusted if we perceive them as wrong, the patterns didn’t ‘do the trick’ – they didn’t ‘satisfice’. In evolutionary terms it’s better to not fail than to optimise, so our brains seek ways to not fail.

Narratives can be examined via different methods for themes and patterns that show how groups of people see and use them in the world. Captured narratives can be assessed as optimal or not, allowing us to move them in a preferable direction or to be passed to other groups if they apply. “This is much more powerful than any compliance structures,” James argued, “and much more ethical.”

So where do regulators come into this? “My big thing is that there have to be generative structures at each different level”, said James. “So rather than improving the regulation to create the perfect organisation, we should improve the regulation to help generate organisations that evolve towards greater evolvability.” In other words, regulations should encourage continuous learning, staying contextually responsive and being prepared to be surprised (see Woods, 2023). This is very different to compliance or ‘best practice’, because not everything can be specified and there is no best practice in complex, volatile situations – only practice that is contextually appropriate. “So actually, the regulator has a huge part to play, but it’s not the part I think they’re necessarily playing at the moment.”

Moving Forward

This conversation with James has been one of many, but one that could be useful to reflect on. The discussion raised many questions worthy of reflection by professions and organisations. For instance:  

• How can we foster a greater variety of responses to potential problems, even if those problems are currently unimaginable?
• How can we leverage informal networks to facilitate knowledge sharing and learning?
• How can we ensure that decision-making is contextually appropriate and adaptable to changing circumstances?
• What are the limitations of formal safety management systems and how can they be supplemented by more informal approaches?
• How does the increasing reliance on technology affect the development and maintenance of operational skills?
• What specific roles can leaders play in fostering a culture of learning and experimentation?
• How can regulators promote a more adaptive and learning- oriented approach to safety regulation?
• How does culture influence the way people approach problem- solving and learning?

James is integrating these ideas into his work with pilots via BALPA, using distributed sensemaking and decision-making, and gaining members’ stories to understand what pilots are thinking. James’ emphasis on adaptability, learning by doing, and narrative- driven learning challenges rigid, procedural adherence and overly formalised safety management systems. In aviation and beyond, he highlights the need to create environments where operational professionals can continuously learn, adapt, and evolve to meet the ever-changing demands of their roles. Despite the “punishing” nature of piloting for some today, he remains optimistic about the possibility space. “It is fascinating when you get into the ‘how and why’ of managing systems for safety. There’s a long way we can go, but there’s lots of stuff out there. I think very positively about where it could go.”

References

Klein, G. (2017). Sources of power: How people make decisions. MIT Press. https://doi.org/10.7551/mitpress/11307.001.0001

Waites, J., & Burnell, J. (2023, Summer). Epistemic injustice: The dog has now been removed from the tail. HindSight, 35, 18-20. EUROCONTROL. [pdf]

CAPTAIN JAMES BURNELL is a pilot and safety rep based in Edinburgh with the UK airline easyJet. He supports the British Airline Pilots’ Association in creating and promoting safety theory. James has a strong interest in generalist learning, cutting across many scientific fields with the aim of improving the safe management of humanistic systems.

This article is a reproduction of the an article published in HindSight magazine issue 36 in December 2024 (all issues available at SKYbrary)

What Is Mental Practice?

Air traffic controllers, pilots, and astronauts all rehearse complex procedures in their minds as part of learning and preparation. This is called ‘mental practice’ and has a long history in other sectors, from sport to surgery. Mental practice is the deliberate rehearsal of a task in imagination without large physical movements. It is something that we do spontaneously in everyday life, especially when learning a new skill, but is done in a more structured and deliberate way by some professionals.

How Does Mental Practice Work?

Much research suggests that practising a task in imagination can improve motor and cognitive skills. Imagery plays both a motivational and a cognitive role in influencing behaviour. At a motivational level, imagery helps to manage arousal and affect, and helps with motivation for specific goals and activities. At a cognitive level, imagery helps to represent general strategies and practise specific skills.

There is now much evidence from cognitive psychology, neuroscience, and performance research for the ‘functional equivalence’ of mental and physical practice, particularly in skill learning. This means that engaging in mental imagery during mental rehearsal can elicit similar cognitive and physiological responses to those involved in actually performing the task. The brain treats imagery and physical practice in similar ways.

This equivalence stems from the brain’s tendency to process imagined actions in a manner analogous to real actions. Research in neuroscience, using techniques like functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG), has consistently shown that mental imagery and physical practice activate overlapping brain regions. For example, studies show significant activation in the occipital lobe, which processes visual information, both when individuals imagine visual scenes and when they see the scenes. This suggests that the brain processes the imagined action in a way that closely resembles the processing of the actual action.

How Does Mental Practice Compare With Physical Practice?

A common research finding is that mental practice is more effective than no practice but less effective than physical practice. However, the most effective approach is usually a combination of mental and physical practice.

What Kinds of Tasks Benefit From Mental Practice?

Mental practice is particularly effective for relatively complex tasks that rely heavily on mental activities such as problem-solving, decision-making, planning, sequencing, spatial reasoning and visualisation, anticipation, and coordination. These mental activities are fundamental to the tasks of air traffic controllers and pilots. As well as the type of task or skill, mental practice is affected by the type of instructions, and the individual’s skill level, imagery ability, and motivation.

Why Should Air Traffic Controllers and Pilots Do Mental Practice?

Mental practice can enhance skill learning in tasks with a strong cognitive component, which are typical of controlling and flying. Air traffic controllers highlight the importance of their ‘mental picture’ of the airspace and traffic. Research suggests that some controllers use mental imagery to create and maintain this picture.

Controllers could integrate mental practice into training to rehearse scenarios and skills, such as conflict scenarios, communication and coordination, and procedures for using equipment. Mental practice could also help controllers improve their ability to recover from equipment failure.

Mental practice can be incorporated into pilot training to rehearse procedures, improve decision-making in emergency situations, and enhance spatial awareness during flight. This is often termed ‘chair flying’ and has been the subject of research. Mental practice could be particularly beneficial in the early stages of learning.

Mental practice has been found to be effective for training in other professions such as surgery, but has been researched most extensively in the context of sport.

Who Would Benefit Most From Mental Practice?

Individuals with pre-existing strengths in generating, maintaining, and manipulating mental images seem to get most benefit from mental practice. Research has found that this includes controllers and pilots. Within the controller and pilot population, and in other professions such as surgery and sport, individuals with stronger imagery abilities would likely benefit most. Imagery abilities include vividness, controllability, and accuracy of reference.

Vividness refers to the clarity of the images evoked in the mind. Individuals with high vividness experience images that are more lifelike and detailed. They are also more likely to report using imagery in their daily lives. Controllability refers to the ease with which an individual can manipulate mental images. This encompasses the ability to generate, maintain, inspect, and transform images at will. Individuals with high controllability can readily manipulate their mental image of a scene, situation or scenario to explore different possibilities. Accuracy of reference refers to the fidelity of the image’s content in relation to the real world, encompassing dimensions and magnitude of visual images and movements. Those with high accuracy of reference would have a mental picture that accurately reflects relative distances, directions and trajectories, for instance.

“Mental practice can be effectively incorporated into training programmes for professions that rely heavily on cognitive skills and spatial reasoning.”

How Can Mental Practice Be Incorporated Into Training?

Mental practice can be effectively incorporated into training programmes for professions that rely heavily on cognitive skills and spatial reasoning, via the following activities:

• Identify cognitive components: Begin by identifying the specific cognitive components of the skills being trained. For example, in air traffic control, this could include spatial reasoning, decision- making under pressure, communication protocols, and methods of use for equipment.
• Develop realistic scenarios: Create realistic training scenarios that require trainees to engage these cognitive skills. The scenarios should simulate the challenges and complexities that trainees would encounter in real-world situations.
• Guide imagery techniques: Provide clear instructions on how to employ mental imagery during practice. This could include techniques for image generation, maintenance, inspection, and transformation. Encourage trainees to practise with both eyes open and closed to determine what works best for them.
• Incorporate into existing programmes: Integrate mental practice as a complementary component within existing training programmes. This could involve dedicating specific sessions to mental practice or incorporating short periods of mental rehearsal before, during, or after physical practice sessions.
• Target early stages of learning: Emphasise the use of mental practice during the early stages of learning when trainees are still developing their understanding of the task and forming cognitive schemas.
• Tailor to individual needs: Provide opportunities for trainees to assess and enhance their imagery skills through targeted exercises. Consider individual preferences.
• Address potential interference: Educate trainees on the potential for interference effects between imagery and perception. This could involve discussing situations where relying too heavily on imagery might hinder their ability to perceive and respond to actual information.
• Combine with physical practice: Emphasise that mental practice is most effective when combined with physical practice.

Use mental practice to supplement and reinforce the learning gained through hands-on experience.

“Mental practice can be effectively incorporated into training programmes for professions that rely heavily on cognitive skills and spatial reasoning.”

Further Reading

Shorrock, S. T., & Isaac, A. (2010). Mental imagery in air traffic control. International Journal of Aviation Psychology, 20 (4), 309-324. https://bit.ly/3Y1GcQU

DR STEVEN SHORROCK is Editor-in-Chief of HindSight. He works in the EUROCONTROL Network Management Safety Unit as Senior Team Leader Human Factors. He is a Chartered Psychologist and Chartered Ergonomist & Human Factors Specialist with over 27 years of experience in safety-critical industries.

I joined the world of aviation in the late 1990s as a Human Factors analyst in UK air traffic management. I had just completed my master’s degree in work design and ergonomics, following my bachelor’s degree in applied psychology. For the first half of my career, my focus was mostly on micro interactions: breaking down tasks, procedures, and interactions at a granular level – seconds and minutes, button presses and radio transmissions. This work involved incident analysis, critical incident interviewing, human-machine interface evaluation, and simulation observation, all aimed at identifying episodes of what we might call ‘loss of control’. Breakdowns and breakages in countless human-human and human-machine loops preceded interactions that sometimes led to losses of separation, level busts and runway incursions.

Looking back, I was primarily using applied cognitive psychology and cognitive ergonomics to understand control through loops of internal mental processes – perception, memory, attention, and decision-making – along with interactions, and feedback and from the environment. This is often depicted in diagrams with boxes and arrows illustrating the processing of information.

In the second half of my career, my work shifted toward the macro level, zooming out to interactions within and between organisations, over months, years, and even decades. I listen carefully to people in various roles about their unique experiences. Here, the loops involve communication, cultures, and changes over time. These loops are inseparable and interdependent, creating formidable complexity in terms of people, technology, processes, structures, and organisations.

No single frame of understanding suffices; I draw upon many disciplines, especially humanistic and social psychology, systems thinking, complexity science, and the humanities, in my attempts to understand the world. From this perspective, people seek to maintain control collectively through loops of communication and influence that evolve document them.

Looking at the big picture, what is incredible is not that we sometimes lose control, but that we manage to maintain control at all. (Note that there are various meanings of ‘control’, from hard – making something happen – to soft – managing or influencing a process or situation – and it is worth thinking about what it means for you.) This brings me to a question that I often pose to groups, including senior managers: If you had to explain to a neighbour why your organisation is so safe, and generally works well, what would you say? The responses vary, but in the best-connected environments, different groups – controllers, engineers, managers, safety specialists – recognise and acknowledge each other’s contributions, forming large, interconnected loops. It’s a vital question to ponder, because if you don’t, how do you know what to nurture and extend…or defend in the face of cost cuts?

“Looking at the big picture, what is incredible is not that we sometimes lose control, but that we manage to maintain control at all.”

I recently posed this question to an audience of CEOs and safety directors at a EUROCONTROL conference in Spain. It was heartening to hear some senior leaders acknowledge in detail how people are their organisations’ greatest assets. They emphasised that people need to be in control and in the loop. I was surprised at the level of resonance with the theme of this issue of HindSight.

The CEOs’ comments took my mind back to a groundbreaking report by Charles Billings, Human-Centered Aviation Automation: Principles and Guidelines, published in 1996 by NASA. Billings was a former flight surgeon and specialist in aviation medicine, who became an influential and distinguished NASA expert in aviation human factors. The principles in his report remain solid to this day, and the first three are so general that they apply regardless of the presence of automation.

1. The human operator must be in command.
2. To command effectively, the human operator must be involved.
3. To remain involved, the human operator must be appropriately informed.

The remaining principles focus on the relationship between human operators and automated systems:

4. The human operator must be informed about automated systems behaviour.
5. Automated systems must be predictable.
6. Automated systems must also monitor the human operators.
7. Each agent in an intelligent human-machine system must have knowledge of the intent of the other agents.
8. Functions should be automated only if there is a good reason for doing so.
9. Automation should be designed to be simple to train, to learn, and to operate.

While these principles remain valid, they primarily address the operator-machine dynamic, or ‘joint cognitive system’. This was the focus of my interest in cognitive psychology and cognitive ergonomics. But the humanistic psychologist and systems thinker in me seeks principles that recognise people as more than operators, with control (or influence) distributed throughout organisations, industries, and societies. To this end, I propose the following nine principles to help ‘see’ the people in control:

1. People are whole and complex beings. We are greater than the sum of our mental, emotional, physical or behavioural ‘parts’, and cannot be fully understood by focusing on tasks, functions, roles, or occupations.
2. People have unique virtues, values, gifts, and passions. For these to be expressed fully, we need a supportive and nurturing environment that values individuality, diversity, and inclusion.
3. People have goals, and seek meaning, purpose, and creativity. We often seek these things through relationships, work, and personal pursuits.
4. People naturally strive to learn, grow, and develop. We tend to flourish in a supportive and enabling environment.
5. People are inherently social beings. We seek meaningful connections with others to find belonging, identity, support, and shared purpose, and are profoundly influenced by social norms, expectations, and pressures.
6. People’s subjective experience is unique. Our experience shapes how we interpret and respond to the world around us and affects our wellbeing.
7. People live in unique and dynamic contexts. These ever-changing contexts – personal, social, organisational, societal, political, environmental, technological, economic, and legal – strongly influence us.
8. People are part of complex adaptive systems. Our interactions are influenced by a dynamic network of interactions, which are interconnected and interdependent, with outcomes that are often unpredictable.
9. People have some choice, control, and responsibility. But agency is distributed among many and shaped by the opportunities and constraints of the contexts in which we exist, along with our capabilities and motivation.

These principles remind us that people are and need to be considered in the broader context. Although these more than operators principles have remained valid over millennia, the contexts and the complex adaptive systems in which we live and work (Principles 7 and 8) have changed dramatically, impacting our choices, control, and responsibilities (Principle 9). I encourage you to consider the principles in the light of any activity or change, inside or outside of an organisation.

“Things work because people make things work, bridging the gaps in the loops as they arise in order to stay in control.”

Over the last quarter of a century, one observation has become increasingly clear: everything is connected. In a complex industry like aviation, we can rarely discuss ‘local problems’ in isolation. Even the loss of a single individual – who may possess unique expertise – can significantly impact an organisation. This is equally true for the loss of critical resources. For instance, in our conversation in this issue of HindSight, Captain James Burnell discussed the effects of losing crew rooms at some airports. I revisited this impact through the lens of the nine principles I have just outlined. When I recently shared this story with another pilot from a different country, he was horrified at the prospect. “Crew rooms are sacred!”, he said, “There would be riots!” Crew rooms are shared resources that help crews to stay in the loop and maintain control and have even broader benefits for people.

Going back to my “If you had to explain to a neighbour…” question, my answer is that things work because people make things work, bridging the gaps in the loops as they arise in order to stay in control. We do this using our remarkable expertise, creativity and connectivity, and do this sometimes to our personal cost. What is amazing is that things work as well as they do. It’s time that we fully acknowledged the reason for this – us – and respect people as so much more than operators and overseers of machines and processes.

Dogmatism can be prevalent in the all stages of development of a movement. In the early stages, it can come in the form of wholesale, ‘scorched earth’ criticism of a prior theory or approach. This may concern a different genre or paradigm, or even the work of a rival theoretician or commercial rival (which tend to amount to the same thing). This can be a way to lay the ground for a new approach. As a movement gathers pace and ground, dogma is established and adherents move from attack to defence. From this point, there can be uncritical adherence to unchanging principles, formulas, and methods which tend to be commercially calcified.  

Dogmatism is opposed to scientific inquiry. While science relies on empirical evidence, observation, and experimentation to build and test theories, dogmatism is fundamentally belief-based, relying on faith, authority, conformity and tradition. While science embraces new evidence and adapts theories accordingly, dogmatism resists change, even in face of contradictory evidence. Dogmatism is also opposed to critical thinking, including skepticism and peer review, and open exchange of ideas from different backgrounds and multiple perspectives.

Here are some signs and symptoms of dogmatism in the context of new movements and New Safety Movements (NSMs).

Simplism

Simplism, discussed previously, can be a sign or symptom of dogmatism, and the two intersect. For movements concerned with health, personal development, business and spirituality, there are several manifestations. One is rigid adherence to monolithic explanations and overly simplified principles, which become doctrines. On the intervention side, there is likely to be reliance on single methods and contextually-insensitive but dogmatically-applied one-size-fits-all, silver bullet solutions. These are commonplace in movements concerned with diet and exercise, personal development and spirituality. Lack of self-criticality, lack of scientific rigour and a research-practice chasm is also typical, or even essential; no amount of evidence is likely to permeate dogmatic simplism among the heavily invested. Indeed, the combination of dogmatism and simplism is emotionally and cognitively appealing and hence commercially appealing. Commercial interest will tend to reinforce dogmatism, as challenges to simplistic ideas could threaten revenue streams. The combination of the above will tend to multiply the effects of overstatement and overreach.

Implications for NSMs: The intersection of dogmatism and simplism within New Safety Movements leads to rigid, surface-level approaches, such as ‘zero harm‘, a focus on ‘human error‘, simplistic principles for complex problems, one-size-fits-all training, and poorly designed and implemented checklists. These can gain quick acceptance and popularity, but lack the depth required for meaningful and sustained impact. To the extent that they are entangled in egoism and over-commercialism, improvement is impossible for some approaches. This can result in waves of faddism, each with a backwash of disappointment and disillusionment (for some, at least). The difficulty lies in balancing accessibility with complexity. Complexity theory can help here (though this field is a movement in itself and this series applies, albeit to a lesser degree), as can a pragmatic science and research-oriented practice.

Absolutism and extremism

Dogmatic movements tend to present their ideas, practices, services or products as absolute truths, leaving little room for nuance, shades of grey, or conditionality. Absolutism may involve insistence that a particular theory, approach or strategy is the only way to understand a phenomenon or intervene, regardless of experience or context. This will be reinforced by a confirmation bias, accepting information that supports dogmatic claims and preconceptions and dismissing anything that contradicts them. Absolutism and extremism is potentiated by authoritarianism and insularity, covered later.

Implications for NSMs: Safety practitioners should beware of absolutism in writings and communication about NSMs. This can be seen in ‘zero tolerance’ and zero harm polices and frameworks. Absolutism and extremism can also be seen in ‘safety first’ pronouncements, and calls to abandon standard operating procedures (SOPs), to not investigate accidents or incidents, or to focus simplistically on behaviour. It can also be seen in idealistic views of people (often under the misguided cover of ‘local rationality‘) or, alternatively, demonising views of workers, safety practitioners, regulators, or managers. A more balanced approach would be to propose new ideas more tentatively and humbly until greater evidence (which may take many forms) and experience exists. (Here is an attempt at this with regard to Safety-II).

Discrediting alternatives and rejection of dissent 

Healthy movements welcome questions and differing viewpoints as opportunities for growth. Dogmatic movements shut down dissent, and ignore, discredit or dismiss research or evidence that contradicts core beliefs, and associated ideas, technologies, or methodologies. They also portray critics as enemies or misguided, penalising or even ostracising those who offer alternative viewpoints or criticisms. Some movements label conventional approaches that have a basis in scientific research as harmful or part of a conspiracy, where those who disagree are seen as enemies. By demonising opposing viewpoints , dogmatic movements offer no space for exploration. There is, of course, a difference between offering alternative viewpoints and criticisms, and attacking or insulting, and the latter is a legitimate reason to ignore assailants.

Implications for NSMs: New Safety Movements should be open to adapting their ideas (tenets, principles, approaches, etc) as they encounter new information. One should probably be suspicious where early ideas remain unchanged, especially where these ideas are commercialised. This is a sign that the NSM is closed, rather than open, to testing and innovation. At a personal and professional level, one must demonstrate a willingness and practice to adapt beliefs in light of new evidence. 

Leaderism and authoritarianism 

New movements often centre around a charismatic leader (a ‘gooroo‘) and one or more foundational texts. (Some even – unironically – publicly label themselves ‘guru’, ‘world leader’, ‘global authority’, etc.) While some individuals can be sources of inspiration, dogmatic movements discourage critical examination of, and disagreement with, their pronouncements. Such figures will typically not invite scrutiny or alternative perspectives, and this will be clear by communication style or behaviour. They may, for instance, rely heavily on emotional rhetoric and anecdotes rather than rational argumentation and empirical data. Or they may exhibit elaborate and rehearsed social displays of dominance and power, typically using their linguistic skills and follower backup to shut down opposing ideas.

As movements become more cult-like, ‘leaders’ may be seen as demi-gods who are infallible (and therefore unchallengable) and demand loyalty. There is much evidence among high control groups of introjection, where an influential person (such as a movement’s leader) is internalised by followers, and affects their thoughts, behaviours, communication, and even emotional responses. What is acceptable is what the cult leader would think, do, say and feel. This has been especially evident in religious, spiritual and personal development movements.

Implications for NSMs: Those with significant influence in New Safety Movements can be tempted by dogmatism in their attempts to promote their ideas. This can bring serious division (and derision) among safety professionals and confusion among other stakeholders.

Safety professionals and other stakeholders should be wary of leaderism and appeals based on authority, and question the nature of authority. If the person is writing or talking about safety management or regulation, what level and diversity of (recent) experience does the person have in practice of the work itself. Alternatively (and ideally additionally) what experience does the person have of the study of the practice of safety practitioners, managers, or regulators? (Neither of these is an antidote to dogmatism, however, and outdated and limited experience can be of more harm than good, with a heightened risk of mind projection fallacy.)

One should also beware of Machiavellianism and narcissism, and associated methods of persuasion and social influence (such as appeals to emotion or club membership). And, of course, one should always follow the money. NSMs are no different to other movements in the central role of the profit motive among innovators and promoters (though this clearly affects some more than others).

Insularity

Collective dogmatism naturally fosters an insular social environment. Movements demanding conformity have a tendency to become echo chambers where like-mindedness is valued for the sake of certainty and belonging (both of which serve to reduce anxiety, or at least some manifestations of it). Some are more immune to this, while others are very prone. External and opposing ideas from other fields, even empirical findings and theory, tend to be seen as threats in dogmatic movements, and hence disregarded, resisted or opposed, sometimes with hostility. Internal diversity of thought and dissent is corralled to avoid cognitive dissonance. This further insulates movements, and widens both group polarisation and the research-practice gap.

All of this can give rise to cult-like dynamics and an ‘us and them’ group mentality. Ultimately, hermetically-sealed movements tend toward obsolescence, desperate to recruit new adherents – often disguising the nature of the movement – as general knowledge of more diverse insights becomes common. While social media has potentiated some of these effects, the internet more generally has helped to expose movements true aims and methods. Some new religious movements even declared war on the internet, and even changed the nature of it.

Implications for NSMs: There is ample evidence of insularity within NSMs. This was evident even before the advent of social media, especially between different safety research traditions. Some authors and groups would advance their own theories but ignore or oppose the theories of competitors (even resulting in Wikipedia edit wars). This can still be seen today, but hypersocial media and over-commercialism have added new insular dynamics. For several years, we have seen increasing populism among safety practitioners on social media grouped according to their NSMs (much more evident among workplace or occupational health and safety practitioners, than major accident hazard safety practitioners).

When closed off and unresponsive to external perspectives and real-world challenges, NSMs lose credibility among practitioners and stakeholders, especially when ideas are oversimplified and over-commercialised. After an initial spike in interest and uptake, some NSMs have seen decreased adoption and ultimate abandonment of NSM ideas. The only antidote to insularity is to abandon group belonging and leaderist followership in favour of critical thinking and diversity of thought. This involves questioning simplistic principles and formulas, rejecting authoritarianism, and – again – following the money.

Ironically, in the case of populist science, some less commercialised innovators occasionally abandon their old concepts and theories for new ones, leading implementers and promoters conceptually and methodologically anchored to old ideas.

A final piece of advice is to follow and listen to critics (which may appear as Benjamin Taylor‘s curmudgeon ego trap). Such voices are suppressed internally, but so long as one isn’t ‘too far gone’, critics offer perspectives that can help one find porosity in the group boundary, to let new ideas in, and people out. (Note that Taylor also characterised gooroos and naive enthusiasts, plus an intermediary group of oversimplifying popularisers, sometimes with deep commercial interests in the outputs of the gooroos. My alternative take on his ideas can be found here.)

New Safety Movements face a difficult balancing act. On the one hand, they should be rooted in science, and so constantly adapting (unless safety science, like human anatomy, is a dead science). One the other, businesses need a greater degree of stability and certainty. Innovators, promoters and implementers – and other stakeholders – can therefore be tempted by, or fall prey to, dogmatism. But when NSMs succumb to dogmatism, they risk becoming outdated, ultimately losing initial credibility among safety professionals and other stakeholders. The only antidote is humility, openness to critique and diverse perspectives, and continuous adjustment in light of experience and new empirical evidence and theories. along with rejection of leaderism and authoritarianism.

Postscript

This series outlines seven possible threats to New Safety Movements, based on my observation, listening, reading, and reflection over many years, concerning a wide variety of other movements: religious, social, health, and business. Not all threats apply to all New Safety Movements, but most of the threats seem to apply to most of the movements, to varying degrees. The seven threats below will each feature in subsequent posts (this post will be updated with summaries and links to each threat).

1. Over-commercialism
2. Egotism and leaderism
3. Simplism and populism
4. Dogmatism
5. Ethnocentrism and neocolonialism (coming soon)
6. Unprofessionalism (coming soon)
7. Cynicism (coming soon)

My hope is that we can be mindful of each of these threats, and reduce – as far as possible – the destructive potential of each. This way, the positive potential that may exist in some of the various New Safety Movements can be realised without too many unintended consequences or otherwise unwanted effects.

Simplism involves over oversimplifying complex issues by reducing them to basic concepts, explanations, causes and solutions. Simplism ignores nuances, details, interconnectedness, conflicting perspectives, and potential complications in a situation. This may be out of lack of awareness or deliberate choice. Either way, it can lead to misunderstanding, flawed decision-making, and unwanted consequences. Simplism is core to one of the steps that are characteristic of work-as-imagined solutioneering.

Populism is a related but different phenomenon, which can both boost and threaten movements. It involves appeals to the ‘common people’, and often positions itself in opposition to established ideas, expertise, professions, and institutions. Populism appeals to so-called common sense, and tends to rely on simplism (simplistic ideas, methods and solutions). Populism also tends to involve manipulative appeals to emotion via slogans and narratives, often combined with a form of authoritarianism (see egoism and leaderism).

Simplism and populism are characteristic of the ego trap that besets ‘oversimplifying popularisers‘, but is also characteristic of ‘gooroos‘. Some symptoms that are relevant to New Safety Movements (NSMs) are as follows. (See this post for an introduction to the series.)

Overstatement and overreach

Many movements throughout history have had a habit of claiming to explain more than they really do, and promising much more than they can deliver. Some new movements offer a ‘theory of everything’ in their general domain. This is typical of some branches of alternative medicine, such as traditional Chinese medicine and energy healing, which lack strong scientific foundations (scientific credibility seems to correlate negatively with overstatement and overreach). Vague or esoteric language is common in such movements, sometimes with the use of emotion or authority (especially in personal development movements), to override critical thinking, doubt, and challenge.

Implications for NSMs: NSMs should be circumspect and realistic in expectations and communications. Barriers to new thinking and practice are significant; some are structural and almost impossible to change (e.g., regulation). For example, most safety work in high-hazard industries will remain in a ‘Safety-I‘ mindset for the foreseeable future. But there is scope to introduce language, concepts and activities, aligned with Safety-II, in a productive way. Care should be taken to avoid overstatement and overreach in anything that may become solidified in a movement. The five HOP principles are a possible example, at least in the way they are popularly promoted and used. These are: 1. People make mistakes; 2. Blame fixes nothing; 3. Context drives behaviour; 4. Learning is vital; 5. Response matter. There is an elegant and efficient simplicity in these, which is appealing (see also the International Civil Aviation Organization’s five principles of human performance as an alternative). But the HOP principles do not describe, define or delineate ‘human and organisational performance’. Human performance and organisational performance are fields with multiple disciplines and professions including biological sciences, sport science, medicine, psychology, human factors and ergonomics, management science, anthropology, sociology, organisational development, etc. The five principles are really about error, an aspect of performance. Similarly, other NSMs are valuable, but limited and context dependent, and practitioners should remain balanced and realistic. As I wrote in this post, we need the self-awareness to recognise our own mindset, wisdom to see its limits, and mentally agility to choose another when appropriate.

Monolithic explanations

Overstatement and overreach often involve monolithic explanations. Many movements have exploited the human tendency to prefer simple or single all-encompassing explanations or causes. These may be conveniently paired with silver bullet or one-size-fits-all solutions. In other words, a lack of whatever is being offered is the cause of your problems. More generally, solutions tend to be sourced from the same limited worldview as the problems, whether spiritual, nutritional, behavioural, cultural, or mechanical.

Implications for NSMs: New Safety Movements differ in their susceptibility to monolithic explanations, but there can be a tendency to substitute an old one for a new one (a conceptual sleight of hand). Some of the classics include ‘human error’ and ‘lack of safety culture’. Newer variations include lack of resilience, poor organisational culture, poor leadership, lack of a just culture, lack of psychological safety, performance variability, and production pressure. There is value in these concepts and in associated theories, but the use of labels to characterise a complex situation (complexity may be another monolithic explanation) is a tradeoff that results in different interpretations of what is meant. For this reason, efficient labels are sometimes best avoided as descriptors for complex and problematic situations, in favour of more thorough descriptions, but at risk of losing popular acceptance.

Monomethodism, formularism and silver bullet solutions

Several previous movements have failed to innovate and improve, and instead relied on monomethodism and formularism – the inappropriate or rigid use of a method or formula that is not suitable for the range of applications, compared to alternate methods. Monomethodism and formularism often come hand-in-glove with silver bullet solutions: simplistic solutions to complex, intractable problems, developed via work-as-imagined solutioneering. In previous social movements (e.g., pseudopsychometric testing, meditation and yoga movements, large group personal development, and leadership events), simplism has been combined with commercialism and leaderism in a sort of club culture; ‘insiders’ are introduced to simplistic, pupularist and convincing ideas, methods and solutions.

Some implications for NSMs: NSMs will not thrive if they rely on single methods and solutions. Monomethodism creates blind spots that require multi-method approaches, while silver bullet solutions fail to solve problems and create new ones, at the same time stifling innovation. Consultancies may end up selling the same thing, which may prove to be only partially helpful, or even counterproductive. Diagnosis should precede treatment, and diagnosis requires a range of methods. A very wide range of methods for the analysis, evaluation and design of tasks, processes, artefacts, jobs, training, teams, organisations, and working environments is available from HF/E, psychology, ethnography, engineering, and other disciplines, but these require investment in training.

Lack of self-criticality

With previous movements, there has often been an unfortunate tendency to lack self-criticality. Over time, writings, methods and solutions became calcified and canonical. This is a hallmark of pseudoscientific approaches, and is especially linked to commercialisation. Since there is commercial value in readings, methods, training courses, and so on, it makes little commercial sense to be critical toward them, even where good evidence exists. Why critique your own personality test, meditation method, or large group training approach, when they continue to be very profitable?

Some implications for NSMs: Self-criticality is essential for any movement with a basis in science, including safety science. For NSMs, it is curious that the founders of ideas (who I describe here as innovators – quite often researchers with a less commercial orientation), are more likely to write critically of their own (old) writings than are promoters, who may still have a personal (and especially financial) interest in the ideas or methods. This is especially problematic for organisations that have formed their whole identity and offering around a specific method. Evidence of self-criticality and self-doubt may be a sign of integrity in NSMs.

Lack of scientific rigour and a research-practice chasm

A related expression of simplism for previous movements has been a lack of scientific rigour, expressed as a lack of use of the scientific method for empirical work, method development, and theory development. The effort and expertise required for planning, data collection, analysis, synthesis, interpretation, critique, and reporting is high, and requires particular expertise that may not be available. This has led naturally to a preference for more commercially-lucrative opportunities (e.g., selling products and training). Simplism has sometimes been expressed via a lack of underlying (testable and tested) theory based on empirical work, with published findings. Many self-development and leadership books and courses lack of sound theoretical basis, for instance, and are at odds with well-supported theory, or overextend the applicability of fragments of theory. Ultimately, developments may invalidate the central claims and methods of movements, but simplism and populism can help to ensure that they remain appealing and commercially viable.

Lessons for NSMs: One would hope that NSMs would be founded on empirical work to try to develop and refine the underlying theory and evidence base for ideas. Practitioners who promote theories and methods should ideally also be engaged in research, in order not to drift too far from pragmatic science, or too far into popularist science. This may involve empirical work or otherwise collaboration with researchers with a strong background in the field. Those reading or using the work of innovators and promotors might usefully look for research outputs, especially where strong claims are made and where there are significant commercial interests. While a research-practice gap exists in most professions, this should be a field of study in itself in safety (something I wrote about here) as it has been in other fields such as management, psychology and human factors and ergonomics. This may prevent the gap becoming an ever-widening chasm, and ensure that NSMs are grounded in evidence.

Simplism and populism are rooted in a genuine need to translate safety theory, sometimes with a basis in research, for non-academic audiences who need a different language and more practically-oriented methods. This is difficult to balance, and is probably the most well-meaning of the seven threats (unless combined with egotism and over-commercialism). It remains a difficult balancing act to find the right levels and combinations of communication and engagement for New Safety Movements. Indeed reluctance to simplify is a characteristic of ‘high reliability organisations or HROs (Weick and Sutcliffe, 2001), one particular NSM, which “take deliberate steps to create more complete and nuanced pictures of what they face and who they are as they face it” (p. 10). For NSMs, this may mean addressing some of the symptoms of simplism and populism highlighted above.

Postscript

This series outlines seven possible threats to New Safety Movements, based on my observation, listening, reading, and reflection over many years, concerning a wide variety of other movements: religious, social, health, and business. Not all threats apply to all New Safety Movements, but most of the threats seem to apply to most of the movements, to varying degrees. The seven threats below will each feature in subsequent posts (this post will be updated with summaries and links to each threat).

1. Over-commercialism
2. Egotism and leaderism
3. Simplism and populism
4. Dogmatism
5. Ethnocentrism and neocolonialism (coming soon)
6. Unprofessionalism (coming soon)
7. Cynicism (coming soon)

My hope is that we can be mindful of each of these threats, and reduce – as far as possible – the destructive potential of each. This way, the positive potential that may exist in some of the various New Safety Movements can be realised without too many unintended consequences or otherwise unwanted effects.

Self-proclaimed grandiose titles and dubious ranking systems

Self-proclaimed grandiose titles have been a hallmark of hubris and egotism in many individuals in religious, personal development and business movements. More recent generic examples in social movements have included the ever-popular ‘thought leader’, the cuilturally appropriated ‘guru’, and even the amusing yet worryingly narcissistic ‘world leader’. The use of grandiose self-declared titles can be an overt sign to help distinguish whether a person’s focus is primarily on self promotion and commercial interests, or a shared human ideal such as human wellbeing. Dubious ranking systems such as belts, grades, and ‘master’ status have also been introduced in some movements, from meditation to pseudoscientific approaches to therapy and communication. These ranking systems are often based on relatively little investment of effort but great investment of money, and so provide commercial benefit to training and certification providers. They also provide perceived social status to awardees, who don’t realise that they are victims of a triad of social biases: authority bias, social proof and in-group favouritism. 

Lessons for NSMs: Self-proclaimed and dubiously-awarded grandiose titles and ranks are best avoided and, when encountered, treated with great caution, and in some cases publicly challenged and rejected. ‘World leaders’ in topics tend to be world-renowned professors (think Nobel prize winners, or those among the most highly cited in the field) and others having committed similar levels of achievement in a profession or craft. But even these people are parts of teams and networks with emergent expertise; the whole being greater than the sum of its parts. Interestingly, such people rarely seem to use titles such as ‘world leader’. Similarly, few who actually deserve the title would use the term ‘thought leader’. This tendency appears to be less common (but not unheard-of) in respected professions, perhaps because such professions tend to self-police grandiose titles, and instead maintain systems of certification based on standard criteria (which are sometimes criticised for being too onerous). The practice is also less common in some countries than others.

Celebritism and fanaticism

More generally, movements can suffer from celebritism and fanaticism, from new religious movements to popular science. Celebritism is an almost obsessive, uncritical reverence for high-profile figure. It is an unhealthy extension of normal respect for those with significant achievement in various fields, and inspiration through their work and practice. Celebritism creates the conditions for fanaticism – an unusual or extreme level of devotion to a celebrity figure within a movement. This phenomenon is often fed by simplism and populism and can result in a decline in freedom of thought and speech or writing, along with reverence for the words of celebrity leaders.

Some implications for NSMs: There are and have always been various high-profile figures in the many NSMs, and this in itself is not problematic. Innovators are necessary for new ideas to develop. What is problematic is when such figures, and their adherents or followers, put personality before principles, failing to debate, discuss, and critique, perhaps because of a reluctance to question or challenge ideas, methods, approaches, or solutions of celebrity leaders. NSMs should emphasise collective utility and diversity of thought over the charisma, message or style of any individual.

Excessive use of self for branding

Founders of businesses, authors, and others seeking influence have made prominent use of their names and photographs. This is to be expected, but excessive use of self for branding can be a threat to movements. It can be found in many social movements, including pop-psychology, personality testing, and of course leadership courses. It is now common on social media platforms and a prominent part of influencer culture. There is a reasonable middle ground here, but most outsiders probably recognise when self branding becomes image over substance, and commercialism over care.

Lesson for NSMs: Excessive use of self for branding should be approached with caution by practitioners; it can backfire, reducing credibility by making the person and the movement appear more interested in self-promotion than any underlying underlying discipline or genuine human concerns. Social media can instead be used to amplify the voices of those affected by safety issues.

Dubious awards

Many conference organisers, associations, societies and publications operate award systems. These have a valid place in rewarding genuine achievement, especially recognising team efforts. Anonymous or secret nomination of colleagues, in particular, can be an honourable and collegiate way of acknowledgement within a fair and respectable award system. But abuse of award systems and ceremonies is another symptom of egotism and leaderism in movements. This can occur in several ways: undisclosed self nomination, pressurising colleagues to nominate or second an application, discrimination against minorities, and financial influence. Members of award committees, meanwhile, can be swayed by financial interests, friendly relationships, shared ideologies, or simply name recognition. Often, the voting process for awards remains is secret, making it difficult to scrutinise awards decisions.

Lesson for NSMs: Awards should be treated critically, favouring award systems with clear criteria for award selection, focusing on the impact and quality of safety work, along with a transparent nomination process, perhaps precluding direct or indirect self-nominations. Award committees should have relevant but diverse expertise and no undisclosed conflicts of interest, with rotating committee membership. Transparent voting could also be used. Awards could also focus more on team efforts.

Many New Safety Movements have the potential to positively influence how we approach work, technology and organisational life, for the benefit of society. But as with any movement, NSMs face the challenge of maintaining a focus on purpose and integrity while avoiding the pitfalls of egotism, especially among innovators and popularisers. Leadership in NSMs, as in other movements, is important but should not descend into leaderism or celebritism. And connectorship is just as important, and often more so, with an external focus on connections between groups, disciplines, professions and movements. More generally, NSMs should be self-critical and evaluate their own practices and cultures. By prioritising transparency, egalitarianism and the collective good over self-promotion and personal gain, NSMs can cultivate a healthy environment for reflection and discussion.

Postscript

This series outlines seven possible threats to New Safety Movements, based on my observation, listening, reading, and reflection over many years, concerning a wide variety of other movements: religious, social, health, and business. Not all threats apply to all New Safety Movements, but most of the threats seem to apply to most of the movements, to varying degrees. The seven threats below will each feature in subsequent posts (this post will be updated with summaries and links to each threat).

1. Over-commercialism
2. Egotism and leaderism
3. Simplism and populism
4. Dogmatism
5. Ethnocentrism and neocolonialism (coming soon)
6. Unprofessionalism (coming soon)
7. Cynicism (coming soon)

My hope is that we can be mindful of each of these threats, and reduce – as far as possible – the destructive potential of each. This way, the positive potential that may exist in some of the various New Safety Movements can be realised without too many unintended consequences or otherwise unwanted effects.

Perpetual marketing and advertising

It is normal for movements of all kinds to want to understand the market for their purpose, and seek to communicate with and influence those who may find the movement of benefit. But methods used in other movements – even (or especially) related to seemingly noble aims such as mental health and spiritual growth – have often been less than honest and transparent. Previous movements have employed carefully designed methods to manipulate people, concealing pertinent information that the target person or organisation would want to know. It is often only some time into the influencing process, perhaps at the end of talks, training sessions, reading material, tests, and so on, that the hidden commercial intent becomes more evident. Organisations have even scraped social media, or otherwise obtained lists, to contact conference attendees in order to sell services and products. The problem of excessive marketing and advertising has, of course, been strengthened with the support of algorithms, and this will continue with AI.

Implications for NSMs: This is a creeping problem in NSMs. It has become evident on LinkedIn, where some NSM posts are essentially infomercials, and in highly commercialised conferences, where talks include hidden or excessive ‘service placement’. (As Drew Rae put it at EHS Congress 2024, “A lot of presentations at a conference like this are thinly described marketing exercises.”) While some advertising is normal and necessary, advertising that feels misplaced or (especially) manipulative should be challenged by followers and others targeted, while service providers should take care to ensure ethical commercial practice.

Unusually high fees

Fees for services and products should reflect quality. Previous movements that became highly commercialised (such as personal development) realised that events could be a cash cow as speakers could demand high fees while reusing or recycling speeches, and also sometimes recruiting new adherents and buyers of products and services. Motivational speaking events prioritised entertainment and emotional impact over substantial, theory-based content. While it is normal for fees to reflect expertise, celebritism distorted payments such that there was no rational relationship between fees and quality or benefit.

Implications for NSMs: There are already signs that this has become a problem for NSMs, with several organisations pointing out inordinately high fees and expenses – even tens of thousands of dollars – from some ‘keynote speakers’. NSM practitioners operating in this way risk generating cynicism via a combination of crass commercialism and celebritism. Conference fees are an ethical problem also where evidence emerges of cronyism and undisclosed and unfair discrepancies between speaker fees. Conferences should disclose who has been paid for talks and workshops, or whether other benefits in kind have been provided. Invited speakers and other delegates could ask explicitly about this. Conferences by professional societies usually demonstrate good practice in this area, but should also be sensitive to the need for transparency and fairness. Organisations seeking services, meanwhile, should choose competency over celebrity; choosing a suitably qualified and experienced person for the work.

Frivolous trademarking and opportunistic domain name acquisition

Trademarking and domain name acquisition can be an important means to protect genuine intellectual property. But these practices have also been abused. Some movements have employed opportunistic registration of words and phrases that are already in use. This is done to try to stifle competition, and attempt to prevent terms or concepts from being used without reference to the ‘owner’, who may not have been the originator of the word, term or phrase.

Implications for NSMs: There have been cases of trademark disputes in NSMs, and this is likely to continue along with frivolous trademarking, trademark trolling, and other bad faith practices. There needs to be vigilance about all aspects of trademark misuse and abuse on all sides. The use of preexisting or common terms as trademarks, URLs, business names, etc, should be discouraged and opposed by safety practitioners and organisations, as potential misuse of common intellectual resources, or even a form of conceptual theft against a community.

Low-value training and certification programmes

Training programmes and learning materials are a part of all previous movements, and a necessary one. For some movements, however, such as the personal development genre, such courses have often been self-certified, low-value reading packages, typically with no face-to-face interaction or hosting (a convenient form of passive revenue). Such movements have also developed their own certification programmes, offering a perceived prestige to buyers via certificates, grades, etc. The rapid expansion of the life coaching industry, for instance, led to a proliferation of coaches with varying levels of training and expertise.

Implications for NSMs: Learning programmes should involve good practice in development, from training design to competency testing. Those looking to develop competency or otherwise seeking services might consider their need for face-to-face contact, materials, professional society accreditation, and suitably qualified and experienced facilitators and educators who have expertise beyond the standard materials beyond taught. Free or open source reading materials, such as can be found on Wikipedia SKYbrary, may also be considered by NSM communities as a possibility where reading materials are required.

New Safety Movements are inherently commercial. This in itself is not a problem. The problem is over-commercialisation and commodification which erodes trust and engenders cynicism. A detachment from disciplines often occurs when the emphasis shifts away from rigorous, evidence-based approaches that are rooted in theory, used by people with appropriate expertise. This detachment is more evident in some NSMs than others – especially those amenable to simplism and populism. To avoid some of the traps of previous movements, NSM practitioners must prioritise transparency and ethical practice, while those seeking services must be discerning, asking critical questions about competence, fees, sponsorships, and accreditation (including codes of ethical conduct of professional associations). Those seeking services should also understand that practitioners differ significantly in expertise, and most titles used by NSM practitioners are not legally protected or regulated, and may not be particularly meaningful.

Postscript

This series outlines seven possible threats to New Safety Movements, based on my observation, listening, reading, and reflection over many years, concerning a wide variety of other movements: religious, social, health, and business. Not all threats apply to all New Safety Movements, but most of the threats seem to apply to most of the movements, to varying degrees. The seven threats below will each feature in subsequent posts (this post will be updated with summaries and links to each threat).

1. Over-commercialism
2. Egotism and leaderism
3. Simplism and populism
4. Dogmatism
5. Ethnocentrism and neocolonialism (coming soon)
6. Unprofessionalism (coming soon)
7. Cynicism (coming soon)

My hope is that we can be mindful of each of these threats, and reduce – as far as possible – the destructive potential of each. This way, the positive potential that may exist in some of the various New Safety Movements can be realised without too many unintended consequences or otherwise unwanted effects.

In safety-related industries, I call these New Safety Movements (NSMs): collective and loosely-organised action rooted in belief systems, to achieve particular goals related to safety, or to use particular approaches to achieve goals. New Safety Movements may aim to introduce (or resist) a perspective, set of principles, ideology, theory, method or intervention. New Safety Movements are a catalyst for reflection, dialogue, and change, but often introduce or exacerbate tensions, resistance, and struggles within a community.

Some examples of New Safety Movements, include the following: behavioural safety, crew resource management (various forms and iterations for different sectors), hearts and minds, high reliability organisations, human and organizational performance, just culture, patient safety, psychological safety, resilience engineering, safety-II, safety culture, safety differently, threat and error management, and vision zero/zero accident/zero harm. Most of these are not ‘new’ or even very recent, but once were (even if most or all were rooted in ideas much older, but further developed and popularised). Some NSMs spring splinter movements (as has happened in the history of psychology, and other disciplines).

There are many other other movements related to system performance (such as agile, scrum, devops, and leadership movements) and human wellbeing (such as community development movements, human potential movements, self help movements, recovery movements, and wellness movements). In some cases, there may have been no intention to ‘start a movement’, but that is what ultimately happened. For others, there was a clear intention to start a movement (sometimes with hidden commercial intent).

I have researched many ‘movements’ from more banal self-help or wellness movements, to various high control groups (such as religious and ‘personal development’ cults). In some cases, movements can become counterproductive, for adherents and for society. This tends to be when movements shift too far away from disciplines, professions, or indeed the perspectives of ordinary citizen outsiders, in terms of what seems reasonable and ethical.

So, this series outlines seven possible threats to New Safety Movements, based on my observation, listening, reading, and reflection over many years, concerning a wide variety of other movements: religious, social, health, and business. Not all threats apply to all New Safety Movements, but most of the threats seem to apply to most of the movements, to varying degrees. The seven threats below will each feature in subsequent posts (this post will be updated with summaries and links to each threat).

1. Over-commercialism – Over-commercialism has been evident in many previous movements, with signs including perpetual marketing and advertising, unusually high fees, frivolous trademarking and opportunistic domain name acquisition, and low value training programmes. In more recent years, social media has exacerbated these problems. To safeguard the integrity of New Safety Movements and practitioners, ethical principles and practices must be prioritised over commercialisation and commodification.
2. Egotism and leaderism – Egotism and leaderism have had a a toxic effect on many movements, and are evident in self-proclaimed grandiose titles and dubious ranking systems, celebritism and fanaticism, excessive use of self for branding, and dubious awards. New Safety Movements should beware of the signs and reject egotism and leaderism, focusing instead on  egalitarianism, humility, diverse perspectives, transparency, and the collective good.
3. Simplism and populism
4. Dogmatism 
5. Ethnocentrism and neocolonialism (coming soon)
6. Unprofessionalism (coming soon)
7. Cynicism (coming soon)

My hope is that we can be mindful of each of these threats, and reduce – as far as possible – the destructive potential of each. This way, the positive potential that may exist in some of the various New Safety Movements can be realised without too many unintended consequences or otherwise unwanted effects.

When things go seriously wrong and people are harmed, there are often mixed views on what happened, how, and why, including culpability and responsibility. How we make sense of accidents and their human contributions has many influences: informational, temporal, personal, social, cultural, historical, organisational, regulatory, legal, and so on. But we can never fully understand work-as-done in a complex situation. Since work-as-done and the associated context are unknowable, we construct an understanding via proxies. These proxies and the multiple contexts of sensemaking interact to inform our work-as-imagined, combined with our imagination of context of work-as-done. It is on this that we base our judgement, evaluation or appraisal of work – work-as-judged, which has several characteristics.

For all of us, but especially those in certain professions, it is important to learn about how we make judgements, the nature of these judgements, and the effects of them. We can learn about this from books and articles of course, but a more immersive experience results in a different type of learning.

The Film

To help understand our work-as-judged, a short film was made in 2023. The film concerned a fictional serious medical accident or ‘Never Event’ where the wrong kidney was removed from a patient. The film is a mix of narration, imagery, filming in a hospital theatre simulation facility, and an interview.

The filming was done in the Scottish Centre for Simulation and Clinical Human Factors in Scotland in summer 2023. I coproduced the film with Sebastian Daeunert (safety specialist), Dr Michael Moneypenny (consultant anaesthetist), Mr Craig McIllhenny (consultant urological surgeon) and several others (see Credits below). The idea for the film emerged from a training session that I co-facilitated with Mr Craig McIllhenny, Dr Michael Moneypenny, and Dr Shelly Jeffcott (Human Factors Specialist) in 2017, where we introduced a description of the accident and some statements (see below), written by Mr McIllhenny. Trainee urological surgeons taking part in a systems thinking training day were asked to choose five statements as a basis for discussion about the accident. The session powerfully showed how we can be influenced by opinion, hearsay, and others’ judgements about an event.

So, six years later, the concept behind the film production was to explore judgements and evaluations about the accident and those involved using film instead of a description. The aim was to produce a training simulation video to recreate a medical accident scenario for discussion. The emphasis during recording was on high learning value rather than high production value. (All involved are amateurs when it came to short film production acting on a volunteer basis.) The whole film was recorded on an SLR camera and smartphones during a short slot in the simulator, and voice over audio and some additional filming was done afterwards. (Subsequent production by my coproducer Sebastian made the most of the video and audio material that I provided.)

The film is supplemented by 19 statements by various stakeholders, both involved and not involved on the day. There is no statement from the patient or his family. This is the 20th ‘missing statement’. reflecting a lack patient and family involvement in this (fictional) hospital.

The Accident

The film The Wrong Kidney concerns a fictional accident with features similar to real cases. It shows how several factors can combine to produce a severe medical accident, or ‘never event’. The film features a very serious type of ‘wrong site surgery’ known as wrong site nephrectomy – removal of the wrong kidney. This is defined by NHS Improvement as “an invasive procedure performed on the wrong patient or at the wrong site (eg wrong knee, eye, limb). The incident is detected at any time after the start of the procedure.”  This is an extremely rare event, but it has happened many times, which can be found in news reports. There are usually various factors that combine, but each incident is unique.

The fictional hospital setting is ‘St Just’, a modern, well-equipped district general hospital. The patient is Craig Ferguson, a 48-year-old man with a left renal tumour requiring a laparoscopic nephrectomy. On Friday 7th of April, Mr Ferguson was booked in for surgery. The surgery had been planned for a long time, and the date of surgery was just within the target waiting time. Targets have been a critical issue for the government post-pandemic, and waiting times are critical for patients, especially those with deteriorating conditions. 

Background on Wrong Site Nephrectomy and Never Events

In its 2018 Never Events Policy and Framework document, the National Health Service describes Never Events as “Serious Incidents that are wholly preventable because guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers.” The Never Event concept was introduced into the NHS in 2008. 

The Never Events policy and framework suggests that “Never Events may highlight potential weaknesses in how an organisation manages fundamental safety processes. Never Events are different from other serious incidents as the overriding principle of having the Never Events list is that even a single Never Event acts as a red flag that an organisation’s systems for implementing existing safety advice/alerts may not be robust.” When a Never Event occurs in a health care facility such as a hospital, it must be reported.

In recent years, the NHS has emphasised that the concept of Never Events is not about apportioning blame to organisations when these incidents occur. The original concept, however, included an option for commissioners to impose financial sanctions when Never Events were reported. This option was subsequently removed. 

The foreword to the framework states “We heard that allowing commissioners to impose financial sanctions following Never Events reinforced the perception of a ‘blame culture’. Our removal of financial sanctions should not be interpreted as a weakening of effort to prevent Never Events. It is about emphasising the importance of learning from their occurrence, not blaming.” 

The Investigation Statements

Those involved on the day of the fictional accident, and several others, have given ‘statements’ (see below). The statements are fictional and were initially written by Mr Craig McIllhenny, and subsequent adapted and edited by me and Dr Michael Moneypenny. The informal verbal statements are from various stakeholders, from close working colleagues to the Chief Executive at St Just.

The statements differ in various ways in content and tone. The statements contain conflicting or incomplete information, reflecting work-as-disclosed and other varieties, proxies and archetypes of human work and the associated contexts. There are clear differences in evaluations (work-as-judged). Some statements are broadly positive toward the surgeon Mr Black and his character or work performance, while others are broadly negative, with others being mixed. More generally, the statements give confusing messages, which may reflect personal perceptions, opinions and suppositions, sometimes reflecting relationships between the stakeholders and Mr Black.

The statements are classified red, amber or green according to the overall favourability of perception of Mr Paul Black:

• (G) – Positive
• (A) – Mixed
• (R) – Negative

Involved on the day

• Mr Paul Black – Consultant Urologist Surgeon 
• Dr Colin Northcote – Consultant Anaesthetist (A)
• Abbie Peat – Scrub Nurse and Team Leader for the Operation (A)
• Ms Cynthia Rawlins – Urology ST3 Registrar (A)
• Lorna Taylor – Student Nurse (A)
• David Millar – ‘Runner’/Circulating Nurse (R)
• Mr Ross Perrow – Urology ST3 Trainee (A)

Others

• Ros Green – Urology Service Manager (G)
• Mr Gavin Brown – Consultant Urologist and Clinical Lead for Urology (R)
• Mr Bill Broom – Consultant Urologist (colleague) (G)
• Mr Michael Evans – Consultant Urologist (colleague) (G)
• Diane Killman – Theatre Manager (R)
• Lorraine Smyth – Theatre Co-ordinator, Band 7 Nurse (A)
• Dr Fiona Martin – Anaesthetist (colleague – Mr Black’s ‘usual’ anaesthetist) (G)
• Anne Jenkins – Theatre Nurse (colleague – usually works with Mr Black) (G)
• Morven James – Unit Secretary (G)
• Henry Ribble – Associate Medical Director (G)
• Monica English – Head of Clinical Governance (R)
• June Blunt – Chief Executive (R)

Using the Film and the Statements: Some Practical Tips

The film and statements may be used freely for education purposes subject to the Creative Commons license. The work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).

The film was first used in a conference on Just Culture and the Judiciary in October 2023. The film was screened to a large group of safety and human factors practitioners, pilots, controllers, and members of the judiciary. Tom Lintner (an experienced safety investigator, controller, pilot and manager), masterfully facilitated the session, which lasted around 60 minutes. Tom asked preprepared questions which were answered by participants immediately after the film, and then again after he read batches of selected statements.

I used the film in a Masterclass on the Safety Culture Discussion Cards for the Chartered Institute of Ergonomics and Human Factors in April 2024. The group was mixed, representing many industries and various professions. In this exercise, the cards were used with sticky notes to reflect on the accident in terms of influences (see ‘Talking about just culture and safety culture’ below), again with selected statements read out in batches at different stages of discussion, from negative to positive. These applications have shown that the film and associated resources can be understood and used by many people in different sectors (the film can be used with YouTube subtitles and translation if required).

There are various options for using the materials. After watching the film, people may be asked a variety of questions about the accident, concerning the people, the operation, the context and the outcome, and the needs and responsibilities arising. The statements are optional and don’t have to be used at all; three are already integrated into the film. If you wish to use the statements, they are probably best read out to participants, or read by them, after viewing the film. Of course, it is also probably best if participants have not seen the film or statements before. A good approach is to give (selected or all) statements in batches, e.g.:

• negative, then mixed, then positive
• close working colleagues, then distant colleagues, then managers
• selections – eg “Choose 5 based on job title only”.

In terms of discussion, this may take place as follows, for example:

• immediately after seeing the film
• after hearing or reading batch 1 statements
• after hearing or reading batch 2 statements
• after hearing or reading batch 3 statements.

Many different approaches may be used for discussion and analysis and synthesis. Some examples are below, along with several associated Humanistic Systems albums and EPs and associated posts, along with some sample questions. Of course, other lenses are available and many thousands of articles elsewhere, along with many other questions. The below is just to give a few ideas.

Reflecting on ‘human error’ (see Album 1 & Album 12)

• Critically evaluate the human-error-as-cause explanation in the context of the accident. How well does this fit and what are the alternatives?
• Consider how errors propagated through the system. How could so many things go wrong?
• Critically evaluate the concept of ‘Never Events’. What are some of the intended and unintended consequences?

Exploring human work: varieties, archetypes and proxies (see Album 2, Album 4, Album 9 & Album 12)

• Reflect on the accident in terms of the varieties of human work. Where were the gaps and overlaps?
• Consider the archetypes of human work. Which were evident in the film and the statements?
• Prepare micronarratives for the archetypes you find. How would you summarise the narrative?
• Zoom out from the varieties of human work (work-as-done and three proxies). Which other proxies for work-as-done are evident in the film and the statement?
• Explore how the sequence in which statements are presented affects judgements. Do judgements change over time, or are they anchored to initial information?
• Consider sources of subjectivity in work-as-judged. How might opinion, interpersonal relations, hearsay, and heuristics and biases affect work-as-judged?
• Reflect on the public, private and secret spaces for work-as-disclosed. What disclosures in the film and statements fall into each of these and what is the implication of this?
• Consider the various contexts for work-as-done, and proxies for work-as-done. What is the influence of these contexts?
• Reflect on the steps of work-as-imagined solutioneering. How high these have affected the accident, and what should be avoided?

Talking about just culture and safety culture (see EP5, EP8, Album 7, Album 12)

• Compare retributive and restorative just culture principles. What might be an appropriate responses from these two perspectives?
• Consider barriers to just culture. How might the barriers might be relevant to this accident?
• Consider the characteristics of work-as-judged. How do these play out in judgements of the event following the film and statements?
• Browse through the safety culture discussion cards. Which of the cards apply to the situation and your reactions to it?
• Reflect on interrelationships between issues and topics on the cards. How do the issues on the cards influence one another?
• Look through the different methods indicated on the cards. Which would be useful way to help talk about the accident?

Using the lenses of Safety-I and Safety-II (see Album 6)

• Consider the scenario and accident through the lenses and principles of Safety-I and Safety-II. What are the differences and similarities between the perspectives?
• Consider three zones of performance. How do these relate to the event in terms of what happened and what could have happened in different circumstances?
• Reflect on the situation in terms of everyday or normal work. What conditions and aspects of work were present at some time prior to the accident?

Systems thinking and diagramming methods (see Album 5, Album 8 & Album 12)

• Consider the influence of targets. How did the risk of the patient breaching the target waiting time seem to influence decision making and the situation as a whole?
• Reflect on the EUROCONTROL ten principles in the context of the accident. How do they apply separately and together in terms of influence?
• Consider the event from different perspectives and professions using person and process empathy: judiciary, regulator, management, administrative staff, clinical staff, family, patient, etc. How do the different points of view affect your thinking?
• Construct a system map (see video). What new insights does it bring about system structure?
• Construct an actor map (see video). Who is influences or is affected by the event?
• Construct an influence diagram (see video) or AcciMap. How does the method help conversation and understanding?

Exploring complex work (see Album 10)

• Think about the goal conflicts and trade offs that seem to be at play. How did they emerge, and were they specific to the event or people involved?
• Discuss the checklist and how it was used. What were the issues with the use of the checklist and how might these issues be relevant more generally?
• Consider the surprises that the various stakeholders were faced with. How did they emerge and how were they handled?

Thinking about explanations and interventions for system safety (see EP2)

• Reflect on the accident in terms of the friends and foes of explanation. How might the explanation look different when viewed through these concepts?
• Reflect on the accident in terms of the friends and foes of intervention. How might past interventions have influenced the event?
• Reflect on the accident in terms of the friends and foes of intervention. What might be the influence of future interventions that could be imagined now?

Thinking about the four kinds of Human Factors (see EP3)

• Consider the four kinds of Human Factors. How does each influence understandings of human and system performance?
• Think about intervention possibilities through the lenses of the four kinds of Human Factors? What interventions might make sense from each lens?
• Think about the context that you are familiar with. What kind of Human Factors is likely to be the predominant lens for examining such an event?

I and the co-producers of this work hope that the film and related resources offer helpful way to discuss and reflect on the complexities of understanding accidents and our responses. We hope you find it as useful and enlightening as we intended, and have found in our own screenings.

Credits

Thank you to everyone who contributed to this project. Your efforts have created something really valuable.

• Scriptwriting – Dr Steven Shorrock
• Video production – Sebastian Daeunert
• Filming – Dr Steven Shorrock
• Statements – Mr Craig McIllhenny, Dr Michael Moneypenny, Dr Steven Shorrock
• Narrator and interviewer – Dr Steven Shorrock
• Interviewee – Dr Michael Moneypenny (Consultant Anaesthetist)
• Surgeon (acted) – Jamie Dickson
• Anaesthetist (acted) – Dr Michael Moneypenny
• Scrub nurse (acted) – Catherine Moneypenny
• Theatre nurse (acted) – Andrew Bain

How to cite (APA)

Shorrock, S. (2024, May 24). The wrong kidney. Humanistic Systems. https://humanisticsystems.com/2024/05/24/the-wrong-kidney/

Creative Commons Licence

The Wrong Kidney © 2024 by  Steven Shorrock is licensed under CC BY-NC-ND 4.0 

This license requires that reusers give credit to the creator. It allows reusers to copy and redistribute the material in any medium or format.