Everyday madness

Do you ever get days where you look at a chair, and then say the word “chair” to yourself and wonder how those things can be connected, the object and some random sound we make with our mouths? Or you are driving down the motorway and suddenly think “I’m propelling myself along in a metal box in some arbitrary location on a big blue sphere that is in itself a tiny arbitrary point floating in a massive pattern of spheres that make up the universe” and then wonder why it is we’ve developed such a complicated and unequal society that fills all its time with busy work in the pursuit of status and possessions? I do. I’m pretty sure lots of other people do to. But I’m not sure I’ve ever checked. It isn’t an easy conversation to start as our thoughts are so subjective that there is always the possibility that explaining them to someone else they would just assume we were a bit crazy, whether in the informal lay use of the word, or in a mental health setting as being symptoms of disordered thinking. So what is normal and what isn’t?

Do you ever feel a compulsion not to tread on the cracks in the pavement, or to salute a magpie to ward off bad luck? Do you feel a sort of temptation to set off fire alarms, pull the emergency stop on trains, or open the emergency exit on planes? Do you feel a compulsion to reply to your satnav? Do you ever lie in bed wondering if you locked up for the night? Do you ever go back to check if you locked the door or turned off the cooker or your hair straighteners after you’ve left the house, or phone home to hear the answerphone to be sure the house is still standing? Do you get transitory urges to drive off the road, or into pedestrians or obstacles? Or to jump in front of trains or traffic? Or to throw your keys or phone off a bridge or out a window? Or have a transient desire to do something shocking like swear in church, laugh at a funeral, flash at your boss, stab someone when you are holding a knife, throw your drink in someone’s face? Get images of the harm or death of a loved one? Or unwanted thoughts about sex? If you do, you are far from alone as these are commonly experienced intrusive thoughts that are reported by 90% of the population.

When we had a thread about normalising unusual thoughts, members of the forum gave even more random examples. One person didn’t like the way sunflowers looked at her and once threw her chips at one and ran away laughing. One person heard music coming out of the back of her head, whilst another heard the doorbell repeatedly ring. Another person warns her husband that she might have an urge to kill him during the night. One person can’t shake the idea that cows are just playing dumb and have been gossiping about her before she arrives and will continue when she leaves. One imagines flying insects are like dirty old men rubbing their hands on their thighs. Another sometimes has to put her hands out in front of her to check for glass doors she hasn’t seen when walking down the pavement. Many report urges to do cartwheels, handstands or forward rolls at work or in public. One constantly made bets with the devil in his head in which the wager was years of life-expectancy. One shouts obscenities loudly into the wind whilst cycling along. Quite a few of us anthropomorphise inanimate objects, from imbuing toys with personalities, to feeling sorry for dented tins, weak seedlings, or the families of insects we kill.

Three people feared seeing dead bodies when opening toilet cubicles, and one would imagine worst case scenarios like people dying in fires. One had the sense a person was standing next to them that they could catch glimpses of out of the corner of their eye. One asks ghosts to disappear before turning on the the lights if she returns home after dark. One can’t look in the mirror in case something comes out and eats her, and quite a few can’t look out of windows after dark. Several adults are afraid of monsters under the stairs or bed, or snipers/wasps hiding in low windows. And many people have particular rules about counting or numbers, such as wanting the volume to be on an even number or a multiple of five. Many people have strong desires for neatness or order, including one with a desire to tuck in other people’s clothing labels if they are visible.

Three people report that “If I’m somewhere important where my phone really does need to be on silent I wont just turn it to silent mode. I don’t trust it. I’ll turn it off completely, take the battery out and store the battery and the phone is separate compartments of my handbag. Just in case the battery decides to be sneaky, ‘falls’ into the phone, the phone switches itself on, turns to loud mode and horror of horrors – rings”. A fellow clinical psychologist explained that as a child “I wouldn’t look through a dark window once I was in bed, as I believed that we were experiments/pets and that the world got rolled up when we were asleep for cleaning, and that if any of us pets/subjects found out about it we would be removed from the world/pet enclosure/experiment”. Another was convinced he had telekinesis and could make his lampshade rock from side to side.

And then there are numerous sensory distortions. Some people reported feeling their time was going faster or slower than the rest of the world, or feeling like they were very small or large compared to usual. Quite a few people reported synaesthesia (sensations from other modalities, like seeing the months of the year as having a shape, or letters as having colours). Many people get “earworms” where particular pieces of music play repeatedly in their heads at certain times. Some have a continuous internal radio station of music, which they walk, chew or tap along to.

Personally, I get what I used to call “sicky vision” as a kid. If I have even a mild fever I don’t like the textures of certain things, so wallpaper with vertical bits of string or wood-chip can look ‘itchy’ or things that are crinkled can look ‘spiky’. I don’t really quite have words for it, but they become uncomfortable/stressful to look at. It is an exaggeration of the trypophobia I get at other times (an exaggerated disgust sensation from looking at organic holes – but please don’t google it unless you have no problems with disgust at all, as you may also get an unexpectedly strong reaction). As a result I struggle with the appearance/feel of my own intermittent and fairly mild pompholyx eczema, and when I had to put ointment on my children and husband’s extreme outbreak of chickenpox a few years ago I could see/feel the texture every time I shut my eyes for weeks, and it even prevented me from reading text comfortably as it would distort into bobbles!

So what is it that distinguishes all of these odd thoughts, compulsions or sensory distortions from those which get labelled as psychosis or OCD? I think there are a few distinguishing features. First, the impact of the thoughts and experiences on us: If we are otherwise functioning well in our lives, and are able to notice, accept and dismiss the thought or experience, then they are not intrusive enough to be framed by us or others around us as problematic. Second, the meaning we give to them: If we understand them as transitory, or as a reaction to stress, exhaustion or particular circumstances (or substances) we can apply more self-compassion and are less likely to be scared by the experience or to feel they are outside of our control. Likewise the variation in meaning given to unusual experiences in different cultural group (whether a source of insight, or a sign of possession or black magic, for example). Thirdly, these thoughts/experiences are more likely to be present and construed as symptoms in people who have already got complicated lives and multiple stressors, or are subject to prejudice. With a history of trauma, a lack of coping skills, the stress of socioeconomic deprivation or within certain cultural groups, the response to such experiences may be more overt or distressed, and may compound other problems. Finally, some people are already visible to professionals or in medical settings that make diagnostic labels more likely.

When a CP from the forum described the experiences and behaviours I have listed above to various professionals working in adult mental health services, the assumption was that the person described would surely be a patient with psychosis or OCD. Many were surprised to hear that these were descriptions from healthy adult professionals working in mental health who have never had diagnostic labels applied to them. However, interestingly, when the same question was asked of carers, they were much more empathic and less judgemental and made no such assumptions.

I was reminded of the seminal Rosenhan study in which eight researchers were admitted to inpatient services as pseudo-patients to study the environment. The admissions were triggered by describing auditory hallucinations, but as soon as they were admitted they no longer feigned any symptoms. Nonetheless, all were given psychoactive medication, and seven of the eight were given a diagnosis of schizophrenia that was assumed to be in remission by discharge (the other was diagnosed as ‘manic depressive psychosis’). Again, the patients recognised that the researchers were imposters, but the staff pathologised ordinary behaviours to fit with their pre-existing beliefs about the nature of psychosis (including describing the researcher’s note taking as “pathological writing behaviour”). Rosenhan and the other pseudopatients reported an overwhelming sense of dehumanisation, severe invasion of privacy, and boredom while hospitalised. Interestingly, a hospital then challenged the research team saying they could recognise any fakers easily. Out of 193 new patients in the study period, the staff identified 41 as potential pseudopatients, with 19 identified by two or more members of staff. However, no pseudopatients had been sent at all. Rosenham concluded “it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals”.

It is another salient reminder of how easy it is to make negative judgements about people according to very superficial distinguishing features, and how much it is part of human nature to fear difference. Whether we are judging “schizophrenics” as a group, or Syrians, or Republicans, or Muslims, or benefits claimants, or European immigrants, or the people who voted Leave in the EU election, it is easy to make assumptions about people that we outgroup and to forget that we are all human, and all trying to do the best we can in our own circumstances and based on our own experiences.

Our own quirks of thought and behaviour are another good reminded that we are not so different. Mental health diagnoses are convenient labels for clusters of behaviours and reported differences in how people think and feel. But they reflect much bigger stories than just our biology. And people are still people.The baby pulled from the rubble in Aleppo could grow up indistinguishable from my child, if they had the same life experiences. The person with the label of psychosis, the scars from self-harm and substance misuse and the long stay in the mental health unit, would have had a different life path if they had been born into different circumstances. Likewise you and I would likely show equal levels of distress if we experienced similar trauma. As Jo Cox put it so well, we have far more in common than that which divides us.

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!



Not seeing the wood for the trees: A blog on progress and setbacks

After 3 days of feeling overwhelmed with depression about the referendum result and rise of racism, to the point of being immobilised and pessimistic about the future, I went out for a walk in the sunshine this afternoon.
I looked at the trees that have grown for much longer than I’ve been alive, and will still be growing long after I am gone. I noticed the way that rivers travel through the landscape making imperceptible changes that can cut through stone over time. And I thought about how evolution means that current species of plants, birds, animals and insects can make better use of their environment than their predecessors.
It made me think how much progress there has been in the last century in terms of human society across the world. We’ve made massive steps forward in science. We’ve cured diseases and developed more effective treatments and means of prevention. World poverty has reduced, infant mortality has fallen, and life expectancy has increased. We’ve seen the world from space, and started to map the universe and the genome. We’ve become a more secular society. War and violence are reducing enormously over time. Our tolerance of prejudice has reduced massively. Human rights have been championed in more and more countries. Gay marriage is now enshrined in law in most western democratic nations. We are more aware of finite energy resources and more mindful of the environment. Through increasing internet connectivity, many more people have access to information than ever before.
I realised that by the time our kids are adults the world will be very different to how it is now. They have grown up in a different age, with more awareness of the environment, greater opportunities for travel, and much wider access to information than any generation before them. They are world citizens, born into an age of technology and opportunity. I hope they will build a kinder and more tolerant society because of that.
It is easy to focus on the depressing headlines in the news, and the latest murders or racist incidents – but they make the news because they aren’t everyday events that we turn a blind eye to. We might have just taken a massive step backwards in the UK, but progress marches onwards, and despite all the skirmishes and set-backs, good triumphs in the end.
I believe the UK is mostly full of decent people who care about each other. Sure, much of the British media is full of poisonous propaganda, that blames the vulnerable rather than letting us look upwards at the wealthy and powerful who are siphoning off our rights and resources for their personal gain. And yes, the ideological choice of austerity has increased the wealth gap and made many people feel they had little to lose. And yes, a lot of people feel disenfranchised and were so used to being ignored that they voted for change without knowing what the change would mean. But I think the proportion of people who are genuinely racist and hateful is smaller than it appears. And the rest of us want to find a peaceful, progressive way forward.
So we need to stop being overwhelmed, stop the collective messages reinforcing our learned helplessness, and put our heads together and push for the most positive outcome possible. We need to all engage in the political process. Let us stop mourning the loss of the country we had and work together for a better one.

Terrorism revisited

I feel very very sad about the referendum results, but not entirely surprised given the previous election results.

I think the campaign has been fought on dishonest ground that didn’t represent what we were voting for, and the referendum and the Brexit campaign were the culmination of a particular message being pushed by vested interests in the media and politics for many years. It is part of a bigger problem of politics becoming ever more a game of the super-rich, corporate lobbying and propaganda, and less about representing what the majority of the electorate actually want. I think it is a sign of big trouble with the democratic process when two thirds of the cabinet are millionaires, and that demographic represents only 1% of the population, whilst they are supposed to speak for the breadth of the UK.

I’m not convinced that concerns about immigration are the unspoken elephant in the room, so much as one of a number of targets that keep on and on getting vilified and scapegoated for all of society’s ills. To paraphrase the metaphor: An immigrant, a voter and a millionaire politician are sitting at the table with 10 cookies. The politician takes 9 to give to his chums and then tells the voter “watch out, the immigrant is going to steal your cookie”.

What is unspoken is the responses we need to challenge these poisonous messages and to remind us that there but for fortune we could be in the shoes of an economic migrant, an asylum seeker, a single mother, a person with disabilities, a parent of a child with special needs, someone who loved that child that died because we didn’t have proper health and social care services, someone without legal representation, unemployed, the victim of racism/sexism/homophobia, the generation that live through war, etc. We should want to protect human rights and public services, legal aid, benefits and victims of crime, and to prevent war because we are them and they are us.

But somehow the talk was all focused on the money, and the immigrants, and the pointless bureaucracy of the EU. Maybe I am naive or cynical, but I think that a group of people have been actively driving that narrative for a long time, I don’t believe it is an organic grass-roots concern that has spontaneously bubbled up. I think there are vested interests pushing us towards greater income disparity, blaming of the vulnerable, and encouraging prejudice, selfishness and nihilism. I don’t think people are stupid, I think people have been drip fed right-wing propaganda for many many years, that blames all ills on “immigrants” and “benefits scroungers” so that we don’t look too hard at austerity politics and see all the vested interests. If there was a credible alternative, they’d as easily target that rage against the bankers, the corporations dodging tax and using zero hours contracts, and those using tax havens to hide their cash – all of which I consider to be much more legitimate targets.

As this article in the BMJ eloquently explained, the less people feel they have to lose, the more willing they are to take a gamble on a potentially risky outcome. And the results of austerity politics mean that large swathes of people are suffering financially, and feel powerless, hopeless, disenfranchised and exploited. At the same time as the referendum we have seen an even more tragic set of events unfolding that I think have the same underlying cause.

With the Miami mass shooting and the murder of Jo Cox (and longer ago, the shootings in Paris), I think that we have seen the ugly underbelly of what happens when people feel desperate and voiceless, and are radicalised by hearing poisonous messages blaming particular people for their unhappiness or lack of success in life. Both were horrendous acts, targeting people who had done absolutely nothing wrong in order to convey some kind of political message. Both were incredibly distressing to hear about, let alone for those who were personally involved.

Jo Cox was my age to within a fortnight and had a similar family configuration, so it has really hit home that her husband and kids will never see her again, just because she spoke out for compassion and inclusiveness. She is someone I had never heard of before she was attacked, but the more I read about her the more I like and admire her. She was taking action for the good of others, and she was a great example of our democracy. I have donated to the fund in her memory, and the fact it topped a million pounds in just a few days, suggests that I am not alone in wanting to take some kind of positive action in the face of such awful news.

And with that in mind, and the clear indications that this was politically motivated terrorism with a far-right agenda, I wanted to say something about all the references to mental illness. Being mentally ill doesn’t mean you kill people and killing people doesn’t mean you’re mentally ill. Doing something awful that we can’t understand is not the same as being mentally ill. One in four people has a mental illness, a characteristic as widespread as blond hair. The vast majority of them will never hurt anyone, and are at no greater risk of doing something awful than anyone else (although they are disproportionately the victims of violence). It is abhorrent to stigmatise all those people because of the actions of one person, even if he may have had mental health issues. He didn’t kill Jo Cox because he had mental health problems. He killed her because he wanted to promote his repugnant fascist beliefs.

I posted on Facebook about the causes of terrorism earlier in the week when the discussion was about the Miami mass murder, and this is exactly the same. This was what I wrote:

Just a reminder, but mental illness is not a cause of terrorism. There is pretty good research that has disproved this popular myth. People do awful things. We can’t understand that and we want to feel like they are different from us, so we assume their mind is broken. In fact the research says that it is a combination of a strong need to belong, coupled with a sense of marginalisation and injustice, dehumanisation of enemies, group processes where beliefs get hyped up into extreme actions and strong religious beliefs. Intelligent men who underachieve are particularly at risk for this radicalisation. That is, ordinary people with no genetic or mental abnormalities get pulled down a particular path by their experiences and social networks.

From a paper by Silke after 9/11:

“It is very rare to find a terrorist who suffers from a clinically defined ‘personality disorder’ or who could in any other way be regarded as mentally ill or psychologically deviant (Silke, 1998). Ultimately, the overwhelming majority of terrorists (and this significantly even includes suicide bombers) are average, normal individuals who in other circumstances would be quite unremarkable. Their involvement in terrorism is not the result of psychoses, inner traits or aberrant personalities. Rather, in most cases it is an understandable response to a series of life events.

The causes of terrorism need to be focused on – not just the actors. Once you are forced to throw away the ‘terrorists are different’ model, then attention must be given to other areas. An important realisation here is that becoming involved in terrorism is a process. Nobody is born a terrorist. Neither does anyone wake up one morning and decide abruptly that on that day they are going to start planting bombs in public streets. Becoming a terrorist is in the first instance an issue of socialisation. Any given society will possess some minorities or disaffected groups who rightly or wrongly perceive that the world is treating them harshly. In some cases there are genuine and very substantial causes for grievance. Individuals who belong to or identify with such disaffected groups share in a sense of injustice and persecution. It is from such pools that individual terrorists emerge”.

Western politicians will easily condemn muslim extremists, but in America in particular they find it much harder to look at terrorism fueled by prejudice, in this case racism (but previously by homophobia and religion) – because, like the gun lobby, it has so much popular support. I don’t have any solutions for that, but we do need to name the problem, and the problem is the rise of right wing regressive ideas, fueled by prejudice and religion, blaming every vulnerable minority whilst turning a blind eye to the rich and powerful exploiting the rest of us.

I want my country back from all this hatred and fear-mongering. We need to stop blaming the vulnerable, and start looking at the political system that has created an increasingly divisive and selfish society.

Some thoughts on causing offence: 2 Trigger Warnings

The idea of cultural appropriation being offensive (which I discussed in part one of this blog entry) seems to go hand in hand with other recent social movements towards being more aware of the emotional well-being of others. This includes the use of social media to document the pervasiveness of small everyday actions that are a cumulative indication of how pervasive some prejudices are in society. The everyday sexism project has highlighted examples of how women’s daily experiences differ from men’s because of their gender, and there are similar projects to highlight the pervasiveness of racism. These small and often individually minor experiences, particularly in the context of race, are being termed “microaggressions” to denote the harm they cause when considered across a lifetime. I think these projects are helpful because, like the short films ‘Homoworld‘  and ‘Oppressed Majority‘, they humanise concepts that might otherwise be hard to explain, and show the massive quantity of incidents that might each in isolation seem too petty to raise. Without such examples or dramatisations it can be very hard to put ourselves into the perspective of another and to realise that their everyday experience is different to your own. And awareness is the first step towards behaviour change.

This change is happening at both the individual and organisational level. There is an increasing perception that organisations such as businesses, universities, public services and broadcasters having some responsibility for the impact of their content on customers, employees, students or their audience. This means being more aware of how the meaning of various content can impact differently on different people according to their experiences. This includes the use of ‘trigger warnings’ to orient readers/viewers/listeners about the aspects of the content that will follow that may resonate for them in negative ways. This could include mention of rape/sexual assault, violence, trauma, child abuse, racism, hate crimes or other forms of prejudice. The intent is to ensure that any person in the audience who has had traumatic experiences in their past is not re-traumatised by unintended exposure similar material without the option to prepare or opt out of that experience.

Although widely mocked, I think trigger warnings are quite sensible in principle. They aren’t there to molly coddle the delicate sensibilities of a whole generation of students (or social justice warriors) that don’t like being challenged, they are there to protect the small percentage of the population that have had traumatic experiences from post-traumatic symptoms. When I hear people on social media bragging about how they intend to trigger others, it seems like they lack either insight into what this means, basic human empathy, or both.

A trigger is a very specific word for what happens in the brain of people who have experienced serious trauma – normally experiences they have perceived as life-threatening – where the brain becomes sensitised to threat. When similar sensory stimuli to those associated with the event are detected, the amygdala goes into overdrive, and will put the person into a state of high physiological arousal (readiness for fight or flight) and make it harder for them to use brain functions apart from those associated with survival. Because the brain does not encode memories in narrative form very effectively during survival situations (due to much reduced activity in the prefrontal cortex) these sensory links often activate sensory memory fragments from the trauma, causing flashbacks and high levels of distress. This means that certain triggers can cause them to re-experience their trauma later on in their lives. Just as a war veteran might get flashbacks or nightmares about their war experiences, so people who have been seriously abused, raped or tortured experience unwanted intrusive images and memories of what they have been through when they see, hear or feel something similar to something they experienced during the trauma.

This isn’t something that has been made up, or reflects certain people being “sensitive flowers” either innately or by choice. It is a scientifically evidenced change to the brain after trauma. Intrusive images or thoughts, including re-experiencing of trauma is one of the diagnostic features of PTSD, and it is well established that certain experiences trigger these flashbacks. MRI scanners show the limbic brain (eg the amygdala) lighting up faster and brighter to threat signals that would not be perceived as threatening by others without the trauma, and the resulting decreased activity in the prefrontal cortex. Neurochemical analysis (eg from swab tests) have shown that this has a significant effect on the person’s neurochemistry and chemical messengers (like adrenalin and cortisol) are released that prepare the body for fight or flight. In short, this is a serious and well-documented physical response to serious trauma that I have blogged about previously. I’ve worked with lots of traumatised and/or abused children and adults and it is a really horrible thing to go though. It seems like a double dose of adversity for those whose abuse/trauma continues to echo through their life months or years later. It is not something to make light of or mock, and only a truly repugnant person would do so.

But being thoughtful about the impact of content on others, and orienting the audience about what is going to be covered, does not have to equal censorship. We should still talk about the tough stuff, study it, make art about it and even sometimes joke about it. It often makes for the most interesting debates, and it is through engagement with these complex and challenging issues that people learn to analyse the motivation of the writer/speaker and to appraise the context as well as the content of what is said.

As uncomfortable as it can be when people use it to say annoying, idiotic and offensive things, I am a believer in free speech. I don’t think being offended is a reason to silence someone. It is a reason to reply so that others are not persuaded by them, to ignore them, or to deny them their audience (because free speech doesn’t entitle you to a platform, and any website, venue or business can decide not to welcome/endorse somebody). But it isn’t a reason to stop them saying their piece, unless it incites violence or racial hatred and is therefore against the law. As hateful and bigoted as Donald Trump is, for example, the answer to the awful things he says is not to ban him from the UK, it is ignore him and deny him the oxygen of publicity, or simply to laugh at him. Mock his ignorance. Share your disgust. Highlight how hateful and harmful his ideas are, and how he has not earned the right to lead by showing any personal qualities that are admirable. Ensure that he faces legal consequences if he oversteps and breaks the law by inciting racial hatred whilst in the UK. But don’t censor him and allow him to take the role of being oppressed, as it would be counter-productive.

Even President Obama has weighed in to say “Anybody who comes to speak to you and you disagree with, you should have an argument with them. But you shouldn’t silence them by saying, ‘You can’t come because I’m too sensitive to hear what you have to say.’ That’s not the way we learn.” I’m inclined to agree. We are all responsible for this conversation, and in the therapy professions, genuine empathy has to include acknowledging the difference between the client’s perspective (or a colleague’s) and your own.


Some thoughts on causing offence: 1 Cultural Appropriation

Cultural appropriation” seems to be something increasingly causing debate, especially in the USA, and reading about all the new terminology and topics of debate, I feel like I’m playing catch up. There are certainly some pretty extreme emotions being raised by some of the incidents (eg a student screaming at an academic whose wife sent an email expressing that the restrictions around halloween costumes recommended by the intercultural affairs committee might be excessive). It seems to have hooked into the fraught racial tensions in the USA, and a broader debate about whether to protect people from offence versus being able to speak freely and discuss any topic.

Cultural appropriation is the term used when people dress up/make up to look as if they are from a different culture or ethnic group. It is particularly controversial when white people impersonate or borrow from minority ethnic cultures. It seems to be an increasingly widely used term. The perception of it being inappropriate to stereotype racial groups by borrowing from their culture has spread much more widely from it being taboo to use ‘black face’ makeup into examples that have until recently been considered to be more acceptable, like a pop star wearing an outfit referencing a particular country or culture. Some people find this highly offensive, and feel it is appropriate to publicly shame anyone involved in doing this. The gist of this viewpoint is that people who have not experienced the oppression of being in the less powerful group should not be able to cherry pick and borrow the superficial bits they like of exotic cultures, especially when these same cultural traits have been disparaged within western cultures by the dominant white narrative.

As a fairly privileged white British woman who hasn’t experienced this first hand (despite being a second generation immigrant and having high levels of prejudice and persecution associated with my cultural heritage), it is sometimes hard to see why the reactions are so extreme. However, I understand from what I have read that for people who have been shamed for their culture and forced to conform with white norms, the adoption of non-white symbols or traits as a mark of difference or rebellion by white people is a reminder of that oppression. It is notable that it has a different meaning to those observers than the positive interpretation that is typically intended by the person involved, or that which is construed by other white people (who may not hold the same negative associations). Sometimes people can be absolutely blind to stereotyped imagery that they do not have personal associations with (see this example regarding racial imagery in a video game).

However, there is now a backlash saying that these complaints are part of a whiny politically correct subculture that enjoys being offended, and takes offence on behalf of others as part of a progressive agenda. More regressive voices like to scathingly label this as a desire for social justice, as if this would be a bad thing. See the comments on any article on this topic published online for plenty of examples.

So let me start by saying that I absolutely see the core legitimate grievance within the wider label of cultural appropriation. I can completely see that having white people ‘black up’ or ‘red face‘ is racist and would be offensive to people of colour, and that using cultural or religious artifacts when stripped of their meaning or commercialised (eg feathered head dresses, or the Hindu bindi) is controversial and could be considered to be in pretty poor taste. I also acknowledge that these appearances often go hand in hand with other elements to the role that make it more racist (such as using stereotyped accents or behaviours). I think it is right that overtly racist caricatures like ‘golliwog’ logos and toys, or racist scenes in early cartoons are relegated to the history books. Similarly, the use of logos and names that stereotype native Americans by sports teams in the USA has persisted for far too long. However, I can’t help but feel that the issue of cultural appropriation isn’t as clear cut as some people make out. It seems to me that the rules being made to restrict the risk of offence over culture (eg in American universities) are becoming as much of a problem as the issues they seek to address, and obscuring the very genuine issues of race inequality that lie underneath.

So are Halloween costumes on campus really oppressing people from minority groups? Is it really of concern if someone morphs her own white face to represent endangered African tribes? Or if white models get braided corn-rows? Are musicians like Madonna, Selina Gomez, Iggy Azalea and Beyonce really being “disrespectful” when dressing with elements of Indian costumes, such as wearing a bindi, sari or facial jewellery, or when Katie Perry wears a Geisha-like outfit, or Lady Gaga references a burqa? Is Miley Cyrus twerking disrespectful to working class black women?

If these examples are offensive, how far do we take this? What of actors who play people with different nationalities, religions or accents within a particular skin-tone? What about able bodied or neurotypical actors taking on roles of characters with physical, developmental or learning disabilities? What about actors who have not experienced mental health problems playing characters experiencing them in films/TV? Can musicians/artists only draw on influences within their own country/ethnicity/experience? Can writers only create characters of their own ethnic background? Can art or media not be provocative or controversial any more? Can I not cook curry or sushi or chow mein? The slippery slope could continue ad absurdum.

Surely, several issues are being confounded here. Firstly that there are many areas in which there is very little diversity of representation. For example, we clearly need more ethnic and gender diversity in business leaders and politicians in this country, as most of them remain white men. We also need more varied faces, accents and perspectives in the media, and as role models across the board. We need more diversity in the people who win awards (all white oscar nominations two years running is ridiculous, for example) and we need more diversity in those making decisions. Secondly, we can’t compensate for this lack of diversity by putting yet more of the same group into costume to represent others, and doing so would disrespect the lived experience of those being represented. There is a real need for representation and not just for increased mindfulness from those in power.

I’ve sat on a committee in which we have tried to ‘hold in mind issues of race, age, gender, religion, culture, sexuality, disability and other aspects of diversity’ but I don’t think it was possible when very few of those characteristics varied much within the group, and those which did vary were not much spoken about. The focus tends to be on what the group have in common, and each individual might feel unworthy of their status (particularly if they feel they don’t fit in as well, or are there because of a particular minority status), and that makes it much harder to highlight times when a devalued characteristic of an individual might be relevant. For example, in a mostly male boardroom, women tend to take on more traditionally masculine forms of discourse, and to feel less able to express emotions or feminine characteristics or needs. So, it seems likely that it is even harder to speak up about other aspects of diversity. It felt brave yet somehow risky for Crispin Blunt MP to talk about his use of poppers and how banning this would be criminalising a substance used widely by gay men. However, this is more the exception than the rule. Diverse voices tend to be marginalised and to find it hard to reach a platform, and this is something that needs to change. And that change needs to start right from the top. Having a minister for equality who voted against gay marriage is patently ridiculous, for example, yet we have had two in a row, neither of whom have any more experience of inequality than their privileged example of being female.

To go back to cultural appropriation more specifically, I’m not sure it is the action or costume in isolation that is the problem. I suspect that the context has a lot to do with the derived meaning. If actors and public figures were more varied and included people with physical disabilities, learning difficulties and mental health problems, a variety of religions and cultures, diverse ethnicities, all sexualities, genders, ages and body shapes, then everybody would feel represented and emotions would not be so heightened. If musicians, celebrities and scholars gaining funding and media coverage were more diverse, then the cliched references to other cultures would have much less power. Similarly, if the fashion industry routinely used models with a variety of skin tones for all campaigns, and treated their sources of inspiration more respectfully, then the hairstyles of models used to showcase collections with international influences would be much less problematic. If people from different perspectives had similar levels of power, then speaking up to criticise someone from a majority group would not be so difficult do or as easy for critics to attribute to sour grapes. But attitudes and power structures take a long time to change, and can be very resistant to progress, particularly where this threatens the status quo. The difficulty is therefore twofold – how we move towards the bigger goal, and what we do to manage the problems that will continue to appear until we get there.

Broadly I think we should allow people to express themselves, but also encourage thoughtfulness and conversations that challenge people’s preconceived ideas. Dressing up is usually playful, and done for fun rather than to make a statement. Sometimes, being a little ‘edgy’ is part of that fun. I would hope that a certain degree of role play allows us both flights of imagination and greater empathy. It would be a great shame if children couldn’t dress up as anyone outside of their own cultural group in play, for example, or if fancy dress costumes were similarly restricted. However, we should also be open to learning from other’s experience. So if a costume is culturally insensitive or causes offence, people need to speak up to say so.

However, there are two very important provisos to this. Firstly, it isn’t the responsibility of disempowered minorities to challenge the actions of the majority group, it is everybody’s responsibility. And second, highlighting a different perspective should, as far as possible, be done without publicly shaming the person involved, unless they continue to repeat the same actions which are causing offense. We can all have times when we accidentally do or say something thoughtless, and that shouldn’t be an irreparable error. It is what we do when that is drawn to our attention that is the measure of the person. Publicly shaming a person who makes a mistake or poor judgement is the kind of black and white thinking (if you excuse the pun) that polarises opinion and drives a wedge between different population groups.

I would also note that there are times that it is perfectly appropriate to join in with traditions and wear costumes as an outsider, and would be disrespectful not to. For example, for female western tourists to cover up exposed skin and perhaps their hair when visiting various religious sites, such as mosques and temples, or for guests to festivals and weddings to be dressed and decorated in the local style as part of the ritual preparations. Similarly it is sometimes helpful for somebody independent of a particular culture to study and document aspects of it that those within the culture might take for granted. It doesn’t replace the voices from within that culture (which we need to facilitate and amplify), but can be a helpful supplement. Similarly, I can’t see that use of influences from other culture as inspiration for art can’t be done respectfully or that having different perspectives isn’t generally a way to drive progress in any area of study. We wouldn’t have mathematics, a calendar, politics, written language or many sports if we relied solely on our indigenous and anglo saxon heritage.

Overall, I think nowadays we are in a melting pot whether we want to be or not. Our culture isn’t static, it is fluid and constantly evolving. There is increasing globalisation, and our history has gained from many different cultural roots. We travel internationally more than ever and we all have heritage in our DNA that we can track across continents. Our fashions, arts and sciences are enriched with knowledge and influences from all over the world. I’d see that as a positive thing, and an opportunity for ongoing dialogue and learning. To me, the key to drawing on other cultures is the context and respect with which we do so. There are some good examples of cultural appropriation. If we want to be sensible about culture, then giving credit to our sources, being open to feedback, and doing it with respect and admiration seems like a good place to start.