Feature Story
Making a story of psychology
Published on 04 May 2021

Dr Suzanne Ho-Wai So (Croucher Scholarship 2009) was the first clinical psychologist in Hong Kong to offer early assessment for young people with psychosis.

Dr So chuckles at the suggestion she is a role model for science students. After all, she studied literature and history at secondary school and when in 1996 she moved from Hong Kong to the University of Oxford on a scholarship to study experimental psychology, subjects such as physiology came as a shock.

“I became interested in psychology when I was choosing my major. I did not do it at secondary school. I was interested in literature,” recalled So, an Associate Professor of Psychology at the Chinese University of Hong Kong (CUHK).

However, there was a link. “I really loved stories and reading people’s stories, especially about their families, their ups and downs, and how they relate to each other. And I love observing people as well.

“ [At] Oxford, psychology is experimental psychology, a science, but to be honest I did not know much about it. We had to study physiology, which was completely alien to me. The essays were scientific writing – it was a very steep learning curve,” she said.

Also challenging was reading journal articles and philosophy texts – as required by her course – in English, her second language.

But when she spoke to school students at the Croucher Science Week events, telling them about her unusual start, she urged them to embrace such challenges. “I told them, you can go different paths. You cannot stay in your comfort zone and when you step out of it you learn something new.”

In addition, she hoped her straightforward explanations of her work, including how real and frightening delusions and hallucinations are for sufferers, would help the students develop understanding of and empathy for those with mental illness.

From Oxford, So returned to Hong Kong to undertake a master’s in clinical psychology at CUHK, planning to enter practice. She worked in public hospitals, serving those suffering from severe mental disorders. As a pioneer in her field, she was the only clinical psychologist when Hong Kong’s new service offering early assessment for young people with psychosis was set up in 2001. This was Asia’s first such service.

“They [young people] previously had to wait for a long time to see a psychiatrist, when the condition was really poor and they had to be hospitalised,” she said. “Some psychiatrists began to see the chance of intervening earlier, at the time when their [patients’] mental state was less chaotic, and you can talk to them and understand them.

“In the past people just thought they had gone mad. It was a game changer.”

So adopted a multidisciplinary approach, including working with psychiatrists, which she continues today. Her research interests emerged from this. “I saw these people day to day, and their families, and how they struggled to make sense of what they were experiencing. They had hallucinations, delusions. All these are very real to them and it’s very hard for them to understand.”

“After many years, I realised that we need to know more about the disorder. That’s how I came to be more interested in doing more research,” she explained. “The more episodes [patients] have, the more damage it does to their brains and it is less likely they will respond to treatment. Psychosis is still the root of my research interests, though I have some spin-offs from there.”

In 2008, So enrolled in a PhD programme at King’s College London, with her thesis focusing on changes in delusions over time and the role of reasoning biases. Delusions remain a key research interest in her laboratory experiments and treatment trials, both through collaboration with psychiatrists. For example, she runs collaborative treatment trials for those with bipolar disorder and schizophrenia.

“We are hoping that if we can test the effectiveness of some treatment packages and how they work, we can add to the toolbox of other clinicians,” she said.

How cognitive biases and the emotional state of sufferers contribute to auditory hallucinations have also formed part of her research. “Some people like them and think the voices are their good friends, but the majority hate them because the voices scold them and they react.” She was lead author of a study, published in January 2020 in Psychological Medicine[3], that found a clear link between schizophrenia patients being negatively affected by hearing voices and then hearing more of them.

For psychologists, how sufferers make sense of what is happening to them and how they react is key in early intervention.

“I started out looking at early intervention from first episode patients. You gradually zoom out a bit and think whether the same psychological mechanisms might contribute to the development of psychopathologies before the onset,” So said.

She has, for example, published on whether the way individuals perceive risk contributed to both paranoia and anxiety, across both clinical and non-clinical populations[4]. The researchers found that while the anxious group perceived negative events as risky, the paranoid group even saw neutral events that way.

In a separate study[5], she found that worry and “worry-about-worry” contributed to both paranoia and anxiety among individuals who did not have a psychiatric diagnosis. This line of research helps to enhance our understanding of the building blocks of paranoia, So said.

“We also follow up people with no psychiatric diagnosis and try to identify psychological factors that might explain how they develop down the road. We started with a broad sample and then found some individuals with sub-clinical symptoms – for example, they hear voices or find it hard to trust people,” she explained.

“Most people live with this and these experiences don’t get worse, but for others things go downhill. We want to be able to identify who would go downhill and who would be able to live with it.”

Dr Suzanne Ho-Wai So Is an Associate Professor in the Department of Psychology at the Chinese University of Hong Kong. She has a BA (Hons) in experimental psychology from the University of Oxford, a Master’s degree in clinical psychology from the Chinese University of Hong Kong (Dean’s List) and a Master’s degree in forensic and legal psychology by distance learning from the University of Leicester. She was awarded her PhD from the Institute of Psychiatry, King’s College London, in 2012. She is the recipient of several teaching and research awards, including the 2016 CUHK Young Researcher Award, 2016 University Education Award, and 2016 Faculty of Social Science Exemplary Teaching Award, as well as the 2017 UGC Teaching Award (Early Career Category). She received her Croucher Scholarship in 2009.

Further Reading:

  1. Dr So’s personal page (The Croucher Foundation): https://scholars.croucher.org.hk/scholars/suzanne-ho-wai-so
  2. Dr So’s personal page (The Chinese University of Hong Kong): https://www.psy.cuhk.edu.hk/index.php/?option=com_sppagebuilder&view=page&id=93
  3. The scientific article Dr So published on Psychological Medicine in 2021: https://www.cambridge.org/core/journals/psychological-medicine/article/abs/momenttomoment-dynamics-between-auditory-verbal-hallucinations-and-negative-affect-and-the-role-of-beliefs-about-voices/9B8F8E9B0CC3641BC4457117E21BF325
  4. The scientific article Dr So published on Schizophrenia Research: Cognition in 2020: https://www.sciencedirect.com/science/article/pii/S2215001320300032
  5. The scientific article Dr So published on Schizophrenia Research in 2018: https://www.sciencedirect.com/science/article/abs/pii/S092099641830046X