My opinions about representing Clinical Psychology and the future of the British Psychological Society

I’ve probably been a member of the BPS for 20 years now, and with it the Division of Clinical Psychology and the Faculty for Children, Young People and their Families, and within that the network for Clinical Psychologists working with Looked After and Adopted Children (CPLAAC). I’ve been to the annual Faculty conference every year since I qualified, except for the one early in my maternity leave. I read some of the publications and I follow some of the social media. Over the last decade, I’ve done a long stint on the Faculty committee, and I’ve spent 5 years as chair of the CPLAAC network. I’ve responded to policy documents, represented them on committees, written papers and edited a periodical. So you’d think with all the energy and time I have put in that I am a great fan of the organisation.

Unfortunately, whilst I am hugely admiring of many of the individuals involved with the DCP and Faculty, and some of the recent Presidents of the Society, I’m pretty ambivalent about it as a whole. I think their website and social media suck. I spent ages looking at how to help them with that through the faculty, only to find out the scope for change was minimal and was within their user-unfriendly structure. Most of it was hard to navigate, and key documents were hard to find, the documents and information on the site were often out of date and much of the content was hidden behind walls for members and separated into silos by the Society structure that were impenetrable by topic. I was censored and then locked out of the BPS twitter account whilst live tweeting talks from a conference on behalf of the faculty because I quoted a speaker who was critical of the BPS’s communication with the media and public.

My experience of running clinpsy.org.uk is that we make everything accessible, searchable and google indexed (apart from the qualified peer consultation forum that is a closed group, and the archive of livechats and other member content that can only be seen when logged in). We are also able to respond to things immediately, and often talk about current affairs. So it is quite a contrast. The view of the BPS on the forum is fairly negative, despite myself and several other qualified members trying to put the advantages of having a professional body.

One theme comes up across both spaces – that lots of people like to moan, but very few are prepared to take the actions that help to change things for the better. So, when a document is put out to consultation, or members are canvassed for views by BPS Divisions or Faculties it may be that no clinical psychologists respond at all, or perhaps just one or two nominated by the committee, someone with a vested interest, or the same old voices who feel a greater sense of responsibility for the group. I’m sure the same would be true on the forum, as lots of people like to read the content, some like to ask questions but few actually write up content for the wiki, or help with the maintenance tasks like checking and updating links. However, the people pay quite a lot for their BPS memberships, whilst the forum is entirely free and run by volunteers, so it is perhaps fair to have different expectations of service. The difficulty being that the BPS expect the few members who do contribute to do so for free, in their own time, over and over again. I worked out that one eighth of my working time as a self-employed person was being spent on unpaid committee and policy work, and I don’t think that this was unusual. Certainly the chairs of networks and faculties give up a large amount of their own time, and although higher up the tree some days are paid, these are not paid sufficiently to reflect the amount of time that is spent on the job.

So when the DCP sent me a link to a survey recently, I had to reflect my views and tell them that I don’t think that the BPS works for clinical psychologists in the UK, and this is predominantly because of the nature of the larger organisation.

I have witnessed time and time again that clinical psychologists, including those on faculty committees and in the DCP committees, are inhibited rather than facilitated in responding to topical issues, speaking to the media, expressing opinions or taking action by the slow, conservative and censorial wider organisation of the BPS. Even sending representatives to sit on government fora, guidance or policy making organisations involves an overly bureaucratic process of formal invitations and nominations that often means the window has closed to have our voice heard. Likewise the process for agreeing documents for publication is onerous and slow and means months of delay. The Royal Colleges and bodies for other health professions make responses to news items in a timely way, but we don’t. We are constantly told not to be political by expressing any opinion, when, as I understand them, the charity rules are not to be party political rather than not to express opinions that affect political policy at all. I would argue that our role as powerful professionals, effective clinicians, supporters for our clients and compassionate human beings requires that we are political in the wider sense, because we should be advocating for the psychological wellbeing of the population and putting the case for provision of adequate mental health services. I would consider that this includes an obligation to argue against policies that cause hardship and emotional distress, and to put forward a psychological understanding of events and individuals in the news.

Whilst there are great people involved in the committees and a lot of good will and energy, the BPS itself makes contributors impotent. It inhibits rather than amplifies the messages we should be sending outwards and it fails also to represent us as a professional group. It is not effective at representing our interests in government policy, national or regional workforce issues, professional negotiations, disputes about funding or other professional matters.

The structure of the BPS also drowns out the fact that the majority of practitioner members are clinical psychologists by giving equal weight to tiny factions and much too much weight to academics and students – the focus on the latter two groups means that the BPS failed to address issues of regulation properly and has left us with a legacy of problems with the remit and standards of the HCPC (including who is included and excluded in the scope of regulation and the criteria for equivalence of international psychologists, which I will no doubt blog about another time). In these areas it has not only failed to promote the profession, but also to protect the public.

Unlike other professional bodies, the BPS does not offer much by way of professional advice and representation for its members (eg about workforce and pay issues, disputes with employers). It doesn’t act like a union to defend individual members or the interests of the profession, or provide us with insurance or collective bargaining. It doesn’t show our value to the public or those in power through media statements, responses to news and current events and policies, representation on government and policy bodies. It is ineffective in building the status and public awareness of the profession. I believe our professional body should constantly articulate the need for proper mental health services and highlight the useful role the profession can play in meeting those needs. Likewise it should constantly express opinions about government policy and other issues that may be harmful to the psychological health of the population, and highlight what we think would help and the role we as a profession can play in systemic changes and in planning strategies at the population level that prevent or reduce distress.

So I think radical change is needed. If that isn’t possible as a program of reform from within, and Jamie Hacker Hughes’ Presidency suggests it wasn’t, then we need to split the DCP away from the BPS and/or build something new that is fit for purpose.

If you also have an opinion about the BPS and/or DCP, whether or not you are a member, please answer their survey here. Feel free to cut and paste any part of this blog into your response if you wish to do so. Likewise feel free to share a link to this page, and if you are an aspiring or practising clinical psychologist you are welcome to join in the discussion about the BPS on the clinpsy forum.

A promise to my daughters

As well as being on the progressive left politically, I’ve increasingly identified as an active feminist over the last decade. I’m sure that this has been apparent from my blog, which has at times posted about this topic explicitly. So this has been a depressing few months for me. After the inauguration of a racist, misogynist sex pest as the POTUS, and in the context of the thoroughly depressing situation in the UK with the toxic politics of austerity and Brexit, I have been thinking about the kind of world I want for my daughters. I have also been thinking about what I can do to to instil in them the values that I think are important and will help them have the kind of future I would want for them.

The massive turnout across the USA and around the world for the Women’s March has been a heartening message in a hard time. It is empowering to think that women all around the world and for several generations, as well as their allies, are working towards the same goals of equality and to further progressive causes (such as caring for the environment, LGBTQ and BME rights, and the value of science/evidence over propaganda and opinion). That sense of community and caring for each other and the future is also a refreshing change from all the aggressive posturing, selfishness and commercialism that seem to saturate the narrative at the moment.

The placards and quotes from the Women’s March have been particularly inspiring. I particularly like those shown on the MightyGirl blog. They illustrate how women all over the world are bringing up the next generation of girls to approach the world on their own terms and have whatever aspirations they want, without the boundaries of sexism and prejudice holding them back. There is one placard that says “I am only 4 years old, but I know everyone is equal” and that is the simple truth – until children are skewed by the prejudices they see around them, they understand the fundamental truth that whatever differences there are between people in how they look or how they live their lives, we are all equal in importance and all deserve to be treated with kindness and respect.

My children have often surprised me with their insight into international conflicts and world events. I remember driving them home from the supermarket when they were four years old, and them asking why the rich people of the world couldn’t give jobs to all poor people so that they could afford the things they need like food, clothes and places to live. I couldn’t really answer that, because I don’t think there is any justification for levels of inequality that mean that the richest eight men in the world have more money than the poorest half of the world population. Yet we have stopped seeing how odd and obscene that is, because we are implicitly given the message that we live in a meritocracy, and wealth is earned through hard work (when the reality is that many people inherit wealth, and few would argue that even the self-made plutocrats work harder than anyone else in the wealth spectrum). A year later, after explaining why poppy badges were being sold I remember having a conversation about whether there were still wars in the world. I said that there were, and most of them were to do with people having different religions. We talked about how wars don’t only affect soldiers, and how a recent bombing campaign had destroyed schools and hospitals. My daughters suggested that “we need to send people in that country postcards to remind them that schools are really important”, as “that is where children will learn that people are equal even if they are different, and you need to be kind to everyone”. I’ve never felt prouder.

I’d like to think I’m good role model of a woman facing the world on my own terms, setting up my own business and being “the boss” at work, as my kids see it, and being an equal partner in my relationship, which does not conform to traditional gender roles. We’ve worked hard to expose our daughters to a range of interests, and given them a variety of experiences. I’d hope that they can make choices about what they enjoy or how they want to present themselves unencumbered by narrow gender expectations or unhealthy/unrealistic body norms. Our bedtime stories have characters of both genders who solve their own problems, rather than princesses passively waiting to be rescued by a prince to live happily ever after. I’d like to think we’ve also modelled the way that we interact with each other, and with a wide variety of people with respect. We have taught them to appreciate diversity and to admire those who defy convention or achieve something despite adversity.

But I’m not sure I’ve done enough to show that we can take action to address issues we see happening in the world around us. I should have taken them to the march on the weekend. I think it would have been a great experience for them, but frustratingly I’m still too unwell to travel. So I need to think of other ways to involve them in activism. And I need to do more myself than donate to charities, sign petitions and write messages on the internet. At a time in which the news is dominated by a super-callous-fragile-racist-sexist-nazi-potus I want my daughters to know that I’ve done everything I can to give them the maximum range of choices for their future lives, and the best chance of being judged by their actions rather than their appearance. So I will finish with the words from a placard that resonated with me: I am no longer accepting the things I cannot change, I am changing the things I cannot accept.

Identity and Change

This was the blog I wrote a few days before the US election. After the election I felt like the other stuff was more pressing, so that skipped the queue. I’d be interested in feedback about the topics and intervals of this blog, and whether the pot-luck and intermittent nature of it is disconcerting for readers. So do feel free to tweet or comment to let me know. Anyway…

My kids were given brass instruments at school recently, that they will get to use for the next 4 years. Every child in the school gets the use of a brass instrument for free, along with the group lessons to learn how to play it. One chose a trumpet, the other a baritone. It seemed like a nice idea, but I wondered why there was a scheme to learn brass instruments in particular, rather than woodwind, strings or percussion. The penny finally dropped when I searched for clips of brass bands on youtube and ended up with colliery bands and a poignant scene from Brassed Off! We now live in an area in which the coal mining industry was a major employer until the 1980s. There were nearly 200 mines in the county at the turn of the last century, and there are none now. So presumably the brass music scheme is linked with the idea of preserving local cultural heritage.

It made me think about other disappearing parts of British culture, from learning Gaelic and Welsh to Morris dancing, and how each culture around the world has different bits of heritage and culture to keep alive. There are stories told through the generations, losses to commemorate, celebrations to mark particular dates and events, rituals and arts to keep alive. Language and history seem to be bound into our identity. But why do we want to keep some parts of the past alive, and does it have any value? I’d hope that at least we can learn from our collective experiences, avoid repeating problems and continue the things that give us joy and bring us together. Which brings me back to music.

Music has been an integral part of human existence for an extraordinarily long time. Wikipedia tells me that “Music is found in every known culture, past and present, varying widely between times and places. Since all people of the world, including the most isolated tribal groups, have a form of music, it may be concluded that music is likely to have been present in the ancestral population prior to the dispersal of humans around the world. Consequently, music may have been in existence for at least 55,000 years and has evolved to become a fundamental constituent of human life”. Maybe that is why it is such an enjoyable thing to participate in. I know I value the half hour of singing I do with the children each night before bed as a time to wind down, but it also reconnects me to past experiences and brings out particular emotions dependent on the songs I choose.

I think there are loads of skills to be gained from being part of playing music with others. These include patience, persistence, co-operation, and other aspects of social skills and executive functioning. It reminded me how powerful various musical projects have been in changing the identity of people in socioeconomically deprived situations. The El Sistema project in Venezuela, although criticised for its strict regime and some examples of exploitation, has been praised for opening opportunities for young people from disadvantaged backgrounds and getting over 2 million children involved in orchestras. The Landfill Harmonic helped children living in a slum community on a rubbish dump to learn to play classical music and to have aspirations that were previously unthinkable to them.

The Big Noise project in Scotland has drawn on El Sistema but applied it to deprived Scottish communities. Independent evaluations cite positive impacts on different facets of the children’s lives, beyond just the gains in musical skills. Their education shows improvements in concentration, listening, co-ordination, language development, school attendance and school outcomes. Their life skills show improvements in the domains of problem solving, decision-making, creativity, determination, self-discipline and leadership. Their emotional wellbeing shows increased happiness, security, pride, self-esteem, emotional intelligence, an emotional outlet, resilience. Their social skills have improved along with increased mixing, cultural awareness, strong and diverse friendships and support networks. The project also has wider benefits to health, as there has been encouragement for healthy diet and lifestyle choices. The children have also had additional adults to confide in, a calm, safe environment and report reduced stress.

What I like about all these projects is that they help people to learn new skills and change their own identity to reflect that. Instead of being members of a deprived and devalued community pervaded with hopelessness, they have a new identity as musicians who can enjoy the process of creating, sharing and performing and gain aspirations outside of their previous horizons. Even the sense of belonging when singing along to a well-known track being performed live at a festival is up-lifting. How much more so to be performing music in front of an audience, and to travel to new places to perform.

But music isn’t the only thing that inspires change. We are all changing all the time. Life changes move us from being a child to an adult, through education and into professional or employment roles, bring changes in living arrangements and new relationships. In turn, aspects of our identity are sometimes defined by our role within those relationships and settings. We take on certain expectations and responsibilities when we become a being a partner, parent, aunt/uncle, grandparent. Our educational or work experiences can similarly add a facet to our identity (I am very much a psychologist as part of my core identity, even outside of work). So can being part of many different positive community projects or group activities, or even the act of learning new skills or trying new things at an individual level. I learnt to scuba dive a few years ago, and gained a new identity as a diver and a new world to explore. Likewise, the random act of supporting a friend who wanted to set up as a personal trainer introduced me to weight lifting, and for a couple of years that became part of my identity too (frustratingly since an RTA injured my shoulder I have not been able to lift for over a year, though I do hope to get back to it soon). I also like to grow fruit and vegetables, and to make preserves and bake, adding gardening and cooking to my repertoire and identity. And of course I am now a writer and blogger! Likewise I watch other members of my family gain new skills. This year we moved to a dilapidated farmhouse, and my husband has gained a new identity from learning to cut wood, keep chickens, and mow the fields with a tractor. As well as learning their brass instruments, my kids are learning to swim, ride bikes, write stories and poems, make art, and take part in outdoor activities. Their identities have expanded to include facets of artist, poet, writer, scientist, explorer and many more.

Changes to our identity can also be out of our control, and negative as well as positive. Many of us survive traumas, or difficult relationships, or experience rejection or failure. From redundancy to car accidents, cancer to infertility, losses of people we care about, changes of home, job and relationships, we are each shaped by our experiences even as adults. I have blogged before about the impact of adverse childhood experiences, but how we recover from these also forms part of our identity. Do we remain wary and cynical, or learn to trust again. Do we try to shut out the past, or work through it. Do we aim to get closure. These questions have never been more live than in the aftermath of institutional abuse, and in the wake of the historic sexual abuse cases that were triggered by Savile and other cases coming to public attention.

Over the last few years I have been talking to a man in my extended social network who was groomed and then raped as a child by a member of the Catholic church, whilst at a Catholic school. He has had to make a series of decisions about whether to disclose his experiences to anyone at all, whether to share them with members of his family, with his therapist, with his partner, and with friends. Then he has had to decide whether to come forward as a witness and victim in a public enquiry, and whether to seek compensation from the government and/or church. Each decision has an impact on his sense of identity, which has been slowly evolving from a victim hiding the shame of his experiences into a survivor who is able to look back and place the blame firmly where it belongs and manage the consequences on his life successfully. That isn’t an easy journey.

Over the time I have known him, he has talked very movingly about how his childhood experiences made him question his gender identity, sexuality, sanity, and whether he would in turn present a risk to others (something I know not to be the case, but which has been his darkest fear, based on the fact that many perpetrators report having been abused themselves in childhood, despite the fact that the majority of survivors do not go on to perpetuate the cycle of harm). He felt that he did not want additional sympathy or allowances making, and said that other people had been through much worse. Nonetheless, his experiences have had a considerable impact on his well-being. He has experienced intrusive flashbacks and images, panic attacks, stress, depression, time off work sick, and at times coped through self-harm. He has struggled to have enough self-belief to assert himself appropriately, and always tries extra hard to please others even at great personal cost – a trait that has been exploited by some members of his network and employers. I know he has had mixed feelings about giving evidence in an enquiry; wanting to come forward to represent and protect others and to ensure that concerns are not dismissed or covered up, but knowing this will be at some personal cost. And he has had very contradictory thoughts about applying for any form of redress, whether an official acknowledgement and apology from the church, or compensation from the fund for victims.

I can empathise with the ambivalence about accepting money. I can understand that survivors don’t want paying off and that money doesn’t make their abuse go away. And yes, possibly things could have been worse, there are people who have crappier experiences or less positive aspects to their lives in mitigation. I get that the people who are in the lucky position of considering claims are already survivors, and probably don’t want to look backwards to the time when they were victim and to have to relive that experience for another second, let alone in statements and testimony and the flashbacks that will bring. I also know there is a discomfort with the idea of financial settlements as a panacea, and that it feels wrong to benefit in any way from the harm that was done to them.

But when we look at the population level we can see that experiencing abuse changes the path of people’s lives. There is impact to the person’s sense of self, their ability to form healthy relationships and to be happy. People who are abused in childhood have their norms and expectations about themselves, other people and the world changed compared to those who aren’t. They have neurochemical pathways that are more primed for fight or flight, and perceive threat that others do not see. As a result they are less able to concentrate and focus, more likely to switch to anxiety or anger, less able to aim high and achieve in school and employment, less able to trust in relationships. Their self-esteem and sense of identity is damaged, and this permeates their ability to enjoy life in the present and to plan for the future. So whilst that doesn’t have a monetary value, there is a quantifiable loss to their earning power and quality of life, and the compensation is just making a nod towards acknowledging that.

Those responsible for compensation are also massive organisations, and in the case of the Catholic church, organisations that have accumulated massive wealth that for the most part they are not using to benefit the needy – it is kept in stocks, shares and property, and some is used to fund the legal defence of the perpetrators and those who knew about the abuse within the church. That is one of many reasons that lead me to say that victims should always apply for any compensation on offer. My general advice is to “take what you can get, use it for whatever feels right, and build upwards from where you are”.

It seems there is a good message in that for us all: Don’t let your past define you. Build your identity on who you are now, your values and aspirations, and the things that you enjoy. Then find a pathway towards self-actualisation and happiness in the future. Take on new facets to your identity. Become the diver, the weightlifter, the mother, the partner, the poet, the film buff, the cook, the gardener, the video gamer, the artist, the builder, the bookworm, the collector or whatever combination of roles and interests makes you happy. And seek out personal and professional allies for the journey to support you until the wounds of the past heal to become scars that don’t stop you from doing the things you enjoy.

Another sad day

It is very sad news for America and the world that Donald Trump has been elected president. I view him as a dangerous fascist with regressive values about every aspect of society from gender to sexuality, race to disability and an agenda that will restrict human rights in the interest of big business and the super-wealthy. He is in it only for himself, and it is shameful that such a superficial and offensive campaign connected with people in large enough numbers to elect him. I feel nearly as sad as after the referendum, although slightly less surprised. We truly are in a post-truth era, where lies and rhetoric mean more than evidence or experience.

As Caroline Lucas put it “Today is a devastating day. On this dark day we extend the hand of friendship to people in the USA who wake up in fear – we know that you are not defined by the hatred espoused by your new president. It’s at times like this when we need to unite, learn, and resist more than ever before”.

Of course this time round many people viewed it as a choice between two candidates that were both far from ideal. I didn’t see Clinton as any worse than most politicians, and viewed her as head and shoulders more palatable than Trump, but I’d much rather have Michelle Obama as the first female POTUS than Hillary. She has much more charisma, passion and colour to her character compared to the bland establishment figure and stand-by-your-man tradition that Hillary represents. Plus I just love the way Barack looks at her, and the nature of their relationship and family. Of course I wish they’d been able to do more to push through healthcare reforms and gun control, and to close Guantanamo and stop the drone programme, but compared to anyone else in politics in my lifetime they are downright inspirational. I hope that over the next few years new leaders can rise up on both sides of the Atlantic so that we can have a better result next time round.

So why did this happen? I see a number of different factors coinciding – the impact of an increasing wealth gap, the impact of two party first-past-the-post politics, white men fearing the changing power structure in the world and a generation of right-wing media propaganda. Hopefully the Brexit vote and Trump being elected are the last death throws of white supremacism.

And what can be we do about it? We need to regroup and to learn from what is happening. I’m inclined to agree with Corbyn when he says “Trump’s election is an unmistakable rejection of a political establishment and an economic system that simply isn’t working for most people. It is one that has delivered escalating inequality and stagnating or falling living standards for the majority, both in the US and Britain”. The world we live in needs reason and critical thinking. It needs education systems which encourage integration and mutual understanding, as well as showing children the value of caring for the environment and evaluating claims based on evidence rather than opinion. We also need to actively teach and reward empathy and kindness, and seek these qualities out in our leaders too.

I’ll give Caroline Lucas the last word, “I will never believe that people are inherently closed minded, or insular, but I do believe that people, the world over, are scared and angry – and are kicking back in ways that nobody predicted… I have a message for those people who will try to stir up hatred, and fear. Where you try and divide us we will stand firmer together than ever before. Where you try and pitch our communities against each other, we will build stronger bonds between ourselves and our neighbours… This is no time to mourn – instead we must organise like never before to keep our communities cohesive and our climate safe. On this dark day we extend the hand of friendship to people in the US who wake up in fear. Solidarity is a popular word, but we have to make it mean something. It’s at times like this when we need to unite, learn, resist and hope more than ever before. Today, in whatever ways we can, let’s light a candle rather than curse the darkness”.

Exploiting the ignorant: From quack cures to the rise of Trump

I was reading today about a man called Braco (pronounced Bratzoh) who is the centre of a personality cult that believes his “gaze” (looking out into a crowd and not speaking for 5-7 minutes) can heal health problems and have a positive impact on people’s lives and the lives of their loved ones. He does free online gaze sessions, and cheap or free local events all around the world in order to market books, DVDs and items of jewellery containing his golden “sun symbol” (many for $500+ each). I see nothing more than a man who learnt how profitable it was to be a fake healer from a mentor in a similar line of work, and took on his audience and methodologies (but without the stress of having to give any advice, or the risks of making any claims about himself that could be proven false).

Yet, nonetheless he has a plentiful audience of believers. People claim remarkably diverse experiences and attribute all kinds of random positive events in their lives to his gaze. One contributor believes that Braco cured the hearing loss of a newborn whose parent and grandparents went and gazed (and bought the $500+ trinket). Unknown to them, 13% of children identified with newborn hearing loss spontaneously recover, without any superstitious interventions. It reminds me of Tim Minchin’s fantastic song Thank You God [link contains swearing] that describes alternative explanations for a “miracle” in which a lady’s cataracts are “cured by prayer”. These include spontaneous remission, misdiagnosis, a record-keeping glitch, a lie or misunderstanding. He mentions the power of confirmation bias, groupthink, and simplistic ideas of causality based on temporal correlation (as was the case with autism and MMR). On the internet there is also the significant possibility that the review is fabricated.

The same story repeats all over the world. People are paying something for nothing more than woo in numerous seances, palm readings, psychics, mediums, crystal therapies, quack nutritionists, chiropractors, reiki, all energy therapies, coffee enemas, homeopathy, reflexology, magical weight loss products, Bach flower remedies, most vitamin supplements, magnetic items making health claims and anything that promises to “detox”. In fact, any one of us could invent our own snake-oil or novel form of quackery. And then we could invent some titles and qualifications and go on TV as an “expert” to promote them. The trade is worth in excess of £500 million per year in the UK alone. Quackwatch is a good reference point – I check doubtful health claims there, just as I check doubtful internet stories on Snopes.

We are 250 years past the enlightenment in which the ideas of reason and science supposedly gained supremacy over superstition and liberty progress and tolerance gained traction over dogma. Yet here we are in so many ways believing in magic and witch hunts. The public doesn’t understand science, is wedded to superstition, or simply has overwhelming credulity and a lack of critical thinking. This is the same culture that created plausibility for Andrew Wakefield’s weird “measles immunisation” recipe that contained his own blood and goat colostrum and that pushed an appropriately skeptical professor of complimentary and alternative medicine into early retirement because he wouldn’t endorse homeopathy and reflexology on the NHS.

No wonder in the Brexit campaign and in Trump’s electoral campaign there has been such wide deviation from the facts. The public have been told to disregard experts and go with their gut feelings, or with the guy who they could imagine meeting in the pub. That is a very poor way to judge the evidence base, and (as we have discovered with Brexit) a very easy way to be sold a pup. I can’t understand why it is not a crime, or even a disgrace, to lie to the public. Why were there not enquiries and reprimands for people who knowingly lied about the £350 million pounds a week extra that was supposed to go to the NHS if we left Europe? The answer is because we have better protections against a drink being sold with false weight loss claims than we do over vote-changing political claims.

It is interesting to explore why people don’t trust experts, and here it seems that there are a few dimensions that are important. Knowledge is only trusted if it is coupled with a perception of benevolence, and presented in words that people understand and don’t feel patronised by. It is all too easy for people with expertise to use jargon or technical terminology that makes sense in their field, for readers of the journals they publish in or in conversation with their peers, but that makes the content inaccessible to lay people, who then think of the expert as being part of an intellectual elite who are sneering down at them from a position of superiority.

And some people seem to deliberately manipulate any show of expertise to make it seem that particular commentators are not connected with the experience of ‘the man on the street’. Michael Gove (linked above) was probably the pinnacle of this, but Trump also directly appeals to this distrust of experts, and seems to bank on his audience not caring about his content being proved to be factually incorrect later down the line. Tim Minchin captured my feelings and frustrations about this rising anti-intellectualism (and Brexit and even Donald Trump in passing) here [contains swearing, I’d recommend watching from 24 to 35 mins in].

But it is becoming more and more common. I was listening to the radio earlier this week and flicked over from Radio 4 to Radio 2 to hear the host Vanessa Feltz tell a labour party spokesman that the word “narrative” when used in context, with four repetitions of the word “story”, was jargon that was beyond her and her listeners and proudly proclaimed that it was similar to the teaching that went over her head at university (listen at 15:00 for just over a minute). She seemed to want him to pitch his vocabulary lower, whilst showing her own insecurity about wanting to be clever by using the word “elucidate” herself in her instruction to him to do so! It was particularly notable in contrast to Radio 4, where the words that she criticised, such as “managerial”, “technocratic” and “narrative” would not stand out in the discussion or require definition. Maybe it is just a mark of my age and changing listening preferences, but I would always prefer to have conversation pitched at the level that I learn from, than patronisingly dumbed down.

It is also a reminder that, despite a natural tendency to consider ourselves pretty much average at everything, very often we fail to recognise our own levels of skew within the population. My politics are left of average, my income and intellect above average, just as my physical fitness is below average. But this deviation from the norm does not stand out to me as I have sought out a peer group of other professional, intellectual lefties. In my peer group, the remain preference was so strong that the vote to leave the EU was quite a shock!

Similarly, despite having written a book to try to make the scientific knowledge around attachment and developmental trauma accessible to care givers and professionals from other fields, and working hard to make psychological knowledge available through this blog and various forum posts, not everyone finds my writing accessible. For every ten positive views of the book there is one person who feels I pitched it too high. I’m sure I’m as guilty as the next person of knowing the meaning I intend to convey, and therefore not always recognising when I have not communicated this effectively. So please do point it out to me!

 

 

Rape culture and blame

I blogged a couple of months ago about the Brock Turner sexual assault case, and intended to write this post then, but I left it as a draft for some time – perhaps out of discomfort for the personal disclosure involved, or a sense of distance from the incident that made me want to post about my own experience. But it has never really gone away, because it is so prevalent, both in the tip of the iceberg of individual rape cases, and the massive underlying mass of the pervasive cultural acceptance of male sexual coercion of women (eg the horrifying statistics about misogynic beliefs and rape myth acceptance amongst male college students, particularly those involved in sports that I shared in a previous blog). It seems that just as racial tension has come to a head in America over police shootings, rape has come to a head with the Brock Turner case – with 1.3 million signatures on the petition calling for the judge to be sanctioned for his decision to go for a sentence well below the ordained minimum. And this week debate about whether the olympic diver proposal was romantic or inappropriate*. It seems that themes of sexuality and gender have become fault lines, showing wider problems in society.

Of course there have been many other cases making headlines since my previous blog on the topic, and rape and sexual assault are rarely out of the news. A woman who was raped in Qatar was found guilty of the crime of having sex outside marriage and given a suspended prison sentence and fined (I suppose we should be grateful that she didn’t get the 140 lashes that her rapist got, given they were nominally convicted of the same crime), whilst a woman in Argentina was convicted of murder for possibly having a miscarriage (though the only proven miscarriage in the case was the miscarriage of justice). Here a photographer lured young men to his home for photoshoots where he drugged and raped them. Another victim of campus rapists from athletics teams. This man used a woman’s desire to protect her children as leverage to stop her resisting his rape. This 7 month pregnant woman was raped at gunpoint. The list goes on and on and on. And there is evidence of systemic problems in how US police handle rape cases. Meanwhile lots of people have been brave about talking about their own experiences of “rape culture”. For example, this one, and this one.

I thought I might share some of my own experiences, to talk about both what it says about the culture, and the blurry line around consent. To give this some context, I’m not an extraordinary woman. Nowadays I’m a middle-aged mum. Non-smoking, rarely drinking, overweight and a bit of a workaholic, with that boring but comfortable lifestyle that many families fall into of school and work and supermarket shopping and homework and swimming and weekend outings to parks and historic places, with the occasional family visit or trip to the cinema. I’ve been happily married for 19 years this month, and I lived with my husband for 3 years before that. But even before that, I wasn’t extraordinary in appearance or behaviour, and I wasn’t reckless.

So when I say there were two occasions in my life when I felt I was at significant risk of rape, I’m pretty sure that other people have had similar experiences.

The first was when I was sixteen and had just started at sixth form. I would go out drinking with a particular group of friends from school most weekends, but I usually just had two or three single shot drinks with a mixer to make them last longer (vodka collins was a favourite, and much like a Smirnoff Mule now). One night I was with a group of friends outside a pub and one of the lads bought a bottle of “Thunderbird” fortified wine from a shop. He was pretending to drink himself and with nothing more than encouragement and peer pressure, he effectively persuaded me to drink more than I wanted to. I was a very innocent 16 and when he walked me away from the group and down the dock road out of sight I hadn’t expected more than a snog and a fumble.

However I suddenly became aware of my own vulnerability once we were away from the group. I was wobbly on my feet and nearly fell over, and in an amazing demonstration of both his strength and sobriety he practically picked me up and walked me firmly down the street. A minute later he put me on some concrete ground up a few steps from the road, hidden from sight by a lorry. It was then it became apparent that he was very determined to have sex and started taking my clothes off. I was putting them back on as best I could, but I didn’t know him well and didn’t want to risk him becoming violent (he was a foot taller than me, and I was too drunk to run away) so from his point of view I didn’t give a clear ‘no’. I was still kissing him to buy time to pull my clothes back up and trying to figure out whether anything else would appease him or whether there was a means to escape. But there was nobody in sight, and he was bigger and stronger than me, and this was in the days before mobile phones, so I felt completely on my own. Thankfully after half an hour or so he gave up and walked off. He left me dishevelled and alone, down the dock road of a town that was closed up for the night, having missed my lift home. But even as I stumbled back to the phone box, called my parents for a lift and made excuses about being drunk, I was feeling relieved that things hadn’t gone much worse. I look back and feel it was a lucky escape as no form of penetration occurred.

It was a frightening but in retrospect enlightening experience. Firstly, I learnt never to be drunk enough to lose my ability to run away or plan an escape with my full faculties. Secondly, I realised that from his perspective he was just trying to persuade me to do with him what another guy had lied and said we’d done at a party. He thought that it was just a matter of persuasion and persistence, which are socially acceptable aspects of the interplay between potential sexual partners – and importantly I never said no. Maybe if I’d have said “look Chris, I don’t want to have sex, stop it” he would have. However, maybe he’d have been angry that I was leading him on. I have no way of knowing. If we’d have been interrupted or I’d escaped and I hadn’t experienced him leaving without sex, I think I would have felt it was a near miss. I don’t know if I’d have ended up reporting an attempted rape, but I certainly felt that repeatedly pulling my clothes back on was a pretty clear indication of lack of consent that he should have respected but didn’t.

Finally, I learnt that within that group of mutual friends he had done nothing wrong. They saw me leave willingly with his arm around me, and therefore everything that followed was presumed consensual. When I tried to steer clear of him they wanted me to make up with him as he was part of the group, despite the fact that I found his behaviour pretty sinister. However, for a teenage boy, plying a girl with drink, getting her to go somewhere private, trying to take her clothes off and ignoring the signals that she did not want to participate seemed a legitimate strategy, both to him and our mutual friends. He wasn’t a stranger, or someone menacing. He was an ordinary guy who was above average in appearance and intelligence. He now manages IT services for a bank.

The second time, was after the tragic abduction and murder of toddler Jamie Bulger. A friend of a friend at university came to my door and said he was from Bootle and really distressed about it and wanted to talk. Although it was clear he had been drinking, in light of his distress I let him in, and we went up to my room as other people were in the sitting room of my student house. We later heard them leave, and after that the conversation changed to how, despite having a girlfriend, he wanted to have sex with me. He tried to kiss me, but it was unpleasant and unwanted so I moved away. He started to undress, and try to grab at me. I realised I was cornered in the attic room of a house by a drunk man of substantial build with nobody else within shouting distance. However, this time I was sober and a bit more streetwise, so the balance of power was different. I told him that I wasn’t interested and wouldn’t be taking any of my clothes off. I suggested he get dressed and go back home, and I kept myself out of reach until he acquiesced. He knocked at the door the next day to nominally apologise in order to ask me not to tell his girlfriend.

Again, when I told my friends (and this time they were my friends, as opposed to mutual friends) they didn’t really see it as a big deal. I’d guess they didn’t see as having any bigger emotional connotations than “Drunk guy embarrassed himself. Assertive girl put him in his place”. But it’s never quite as simple as that. Because even if it is only for one moment, the awareness that somebody else in your social network could force you to have sex against your will is a pretty stark realisation, even for an extraverted assertive girl. And however you think about it, it has an impact.

Whether by coincidence or subconscious drive, I put on weight after those two events, adding 40% to my bodyweight over a four year period that has stayed with me ever since. I thought it might be due to the contraceptive pill, or a less active lifestyle at university. But it seems more likely looking back that I just didn’t want unwanted sexual attention, and a fat suit is quite good at narrowing your appeal and not conforming to the socially accepted norms for attractiveness.

But it does feel like the psychological equivalent of wearing anti-rape pants. That sucks because anti-rape pants are a terrible idea that I object to in the strongest terms**, because they place the responsibility for not being raped onto the individual women. Rather than stopping a few men being rapists and a heck of a lot of men feeling so entitled that they act like overcoming the woman’s resistance is a normal and acceptable part of the process of dating, it makes women take the responsibility for not being raped. Why should it be that we need special pants to indicate we are not accessible for non-consensual sex, rather than the default position? And why should I feel that being a more attractive version of myself would make me more vulnerable to unwanted sexual advances?

I should perhaps state the obvious here. I’m not a man hater, and I’m not tarring all men with the same brush. I don’t think of men as Schrodinger’s Rapist or at least, I don’t want to, because the vast majority of men I know are lovely human beings who care about other people. But yet, our survival instinct is a powerful thing. One fall down the stairs 20 years ago, and I am still careful about stairs and escalators. Two situations in which I felt vulnerable to sexual assault (and a fair few clinical cases in which I have heard stories of rape, sexual abuse and/or domestic violence) have made me see risk in men that I don’t know well, and to view being perceived as sexually attractive to those outside my trusted circle as a potential vulnerability. It is a troubling conclusion, and one I don’t know how to resolve.

*We’ve got men today saying it is ridiculous that people have questioned the romantic gesture of the Chinese diver proposal, even when the recipient of that proposal looks uncomfortable about it. They’ve been led to believe every woman wants to get married and is just desperate for her long-term bf to propose, rather than that deciding to get married and how to tell everyone about is should be a mutual agreement, or recognising that there could be duress involved. For me, the seed of doubt is in the body language and facial expressions when I watched the video. Of course, it might be a cultural difference, or the amount of adrenaline and anxiety about being in the spotlight with cameras all around her, but her face doesn’t suggest delight. It suggests hesitation and uncertainty. Quite the opposite of the rugby player and stadium manager involved in the proposal the previous day. From the silver medal diver’s reaction you could imagine the subtitles of the whisper in her ear, or the sentence after holding up the ring being “I don’t want it to be over, please say yes, don’t shame me in front of all these people” just as easily as you could imagine it being “I love you so much I want everyone in the world to know it, please forgive me for doing this in public”. And her response involved no grins, no kisses, no seeking physical closeness, just discomfort, tears, a delayed nod and then acceptance of his actions. Whilst we may never know the answers about the specific example, the themes have echoes in how gender roles are perceived across the world. So I believe the discussion is worthwhile and should not be shut down.
**I should also add that there is no evidence that these pants are effective. Instead it seems likely that a man motivated to remove the underwear of a non-consenting woman would play out in other forms of sexual assault or violence if he was thwarted by her pants. They also add to victim blaming of anyone who doesn’t use the product; “but if you didn’t want to get raped why didn’t you wear safer pants?” Similarly, a rapist might threaten the woman to get her to remove the pants, and this might then be twisted by defence lawyers to imply consent. I think this product shows a profound mis-reading of the problem. Most rape is by someone known and trusted by victim, not the kind of opportunistic attack by a stranger that will be thwarted by her wearing lock up knickers. Some thought about who will buy them, and how they will change behaviour suggests problems too. It seems to me that their main customer base will be women who are anxious about being raped who probably won’t put themselves in a position where stranger rape is possible, whilst women who buy these pants to mitigate a risky lifestyle might have false faith in their ability to prevent negative outcomes (eg if they wear them so that they can drink to unconsciousness they probably aren’t addressing why they are making themselves so vulnerable, or the risk to physical, emotional and financial well-being that this might lead to). It made me wonder about when you would wear the pants? Every day to reinforce helplessness and anxiety or just when you feel likely to be raped? If the pants are a means to say no to a partner when sex is not wanted that says something very disturbing about relationships that needs to be addressed in more than just her choice of underwear. Finally, would another person such as a partner or controlling relative ever make the woman wear the pants like a chastity belt?

Spreading too thin

In general I’m a frugal person. I buy foods that are reduced because they have reached their best before date and most of my clothes and shoes in the sales. I collect coupons and shop around for good offers. I try to waste as little as possible, and to recycle as much as I can. So I can understand wanting to get good value for money.

On the other hand, I like doing things properly. For example, when it comes to a sandwich, I like a thick slice of granary bread, fresh from the oven, with generous amounts of toppings. As it happens I’m not a big fan of butter or margarine, perhaps a symptom of being overweight in the 1980s and 90s when fat was literally seen as a cause of fat, whilst the carbs underneath were seen as relatively healthy. But whether it is soft cheese and cucumber, avocado and salad, cheddar and chutney, hummus and roasted veg, or toasted cheese and banana, the topping needs to cover the bread, with sufficient depth to make the sandwich proportionate. If the cheese has nearly run out, I’ll have half a cheese sandwich that tastes good rather than a mean whole.

So when it comes to services, I can see the motivation to get value for money, and to ensure that resources are being used in the most cost-effective way. I’ve developed pathways, clinics and groups to meet needs more effectively, and I’m happy to delegate less complex work to less experienced or less qualified staff. I can’t see the justification for paying psychiatrist salaries to deliver therapy, when a member of staff with half the hourly rate can be an equally good (if not superior) therapist. I can see the importance of capping the cost of agency staff, so that this money can be invested in increasing the substantive workforce. And when it comes to staff who are not pulling their weight (my record being a member of staff who had spent a whole year with a caseload of four clients, whilst colleagues in the same job had five times that along with other responsibilities) I can see the need for performance management.

However, there comes a point that too much pressure for efficiency actually makes services less effective. I saw this happen gradually over the 16 years I worked in the NHS. If we cut out all the conversations between cases, all the informal supervision, all the CPD opportunities, the time to bond as a team and to reflect and process information between appointments, then clinicians are less able to be empathic and individualised with clients. If you also give people tougher and tougher cases to work on, expecting faster throughput than with the more mixed caseload that preceded it, and couple this with cuts in admin despite there being more and more paperwork to do, you increase burnout and time off sick. Add some pay freezes, lose a proportion of posts, put people in smaller premises and tell them to hot-desk or become mobile workers and they no longer feel valued. Make it a set of competing businesslike trusts rather than one amazing non-profit organisation, tender out services like cleaning and home visiting to allow them to be done on minimum wage without the terms and conditions of the NHS, allow private companies to win contracts, and keep people in a perpetual state of change, then morale falls. Nobody has any loyalty or job security and it no longer chimes with the ethics of the people who work there.

The sandwich has been eroded down to bread and butter, and then to crackers and margarine, and then to a value brand version of the same that is 30% smaller. It might look like costs have been driven down, but the price is a reduction in the quality of services, and in the wellbeing of staff. It reduces the willingness to go above and beyond that has been the backbone of the NHS, and increases presenteeism – the tendency to feel that you need to be at work longer, and look like you are working harder, without this making meaningful impact on the work you get done. The UK has lower productivity than most other developed nations, perhaps because we have longer working hours, and work expands to fit the time available.

All over the public sector at the moment I see services trying to spread their resources thinner and thinner, and I’m acutely aware that this means they can’t do the whole job. Social Services departments have barely the capacity to maintain their statutory role, so supporting families in need goes by the wayside. Some good staff find other jobs. A proportion of the remainder go off long-term sick, leaving an ever bigger burden on those that remain. Teachers are forced to teach to tests that assess primary school pupils on aspects of English grammar that graduates struggle with that have little relevance to daily life, and squash the rest of the curriculum into less time. Children’s centres, youth clubs and leisure facilities are disappearing at a time when it is clear that parenting support and exercise are critical in improving well-being and decreasing long-term health and social care costs. We’ve been feeling the cost of ideological austerity bite, even before the financial shock of the Brexit vote, so I am struggling to see how things can improve in the foreseeable future, let alone once any steps are made to implement the extraction of the UK from the EU.

It is hard in this climate not to feel overwhelmed by pessimism. Staff are not pieces of equipment that can be upgraded or replaced at the click of your fingers. I can make a plan for how to cover a remit that needs 12 staff with 7, but I can’t then tell you how to do it with 5. I can only tell you that if you want the job doing properly it needs 12, and if you go below 7 it won’t be fit for purpose. If I sticky plaster over the cracks, you can pretend that paying for 5 is enough, and that it is the clinicians who are failing, whilst we burn out trying to do twice the amount of work each. But no matter how hard I work, I can’t be in four parts of the country at once, or do recruitment, service development, supervision and provide a clinical service in a part-time job.

Maybe the problem is that I am stubborn. I won’t just toe the line whilst covering my eyes and ears and going lalalalalalala when it comes to everything that isn’t being done. Like my exit point from the NHS, there comes a time where I’d rather leave than do things badly. And where the only efficiency available for me to recommend that fits the prevailing rationale is to pay two cheaper staff instead of my time. I’m teetering on the edge of the plank they’ve made me walk, and I’m increasingly tempted to jump. Maybe in retrospect they’ll recognise how much was getting done with such limited resources.