Why and what next?

Let me nail my colours to the mast. On balance, I am in favour of remaining in the EU, and in the USA I’d have voted for Hillary Clinton. I can see some problems with each of these positions, but I can see many many more problems with the option that has actually been chosen. In each case my pros and cons list strongly favoured the progressive choice, because of the potential negative consequences of the other option. But I was in the minority in both cases, and so were half of the electorate (maybe more in the case of Clinton). So rather than just be fed up about that, I want to understand it.

When it comes to Brexit I think it is wrong for the UK to leave the EU for a number of reasons. The unity of many nations ensures that we all maintain basic human rights and the fair rule of law. It prevents the rise of extremists and reduces the risk of international conflict. It was a large single market, and am important strategic alliance. I believe that calling the referendum was a foolish whim from a complacent leader who was too cowardly to face the consequences of his actions. It was supported by xenophobic self-serving politicians and by far-too-influential media moguls with a right wing agenda. I think it has been divisive and stoked xenophobia, as well as causing enormous economic fallout. However, I’m not saying that the EU doesn’t have excessive bureaucracy, or that it hasn’t been excessively harsh on southern European nations like Greece, Portugal and Italy, or that it doesn’t enshrine market capitalism in doctrine.

Likewise I think Donald Trump is a repugnant man whose attitudes to women and minorities are repulsive. He is a sex pest and a tax avoider. His business practices are dishonest, he is a blatant liar and his much touted business acumen is such that he would be three times as rich if he’d just stuck his inheritance into index funds. I find his racist rhetoric abhorrent, and I think he will foster international conflict and unhealthy alliances. So I could never vote for him, and would have voted strategically to avoid him reaching power. However, in choosing Clinton as the lesser of two evils I’m not saying that she doesn’t have vested interests, didn’t support arms sales to the middle east, isn’t associated with numerous scandals or wasn’t stupid to use a private server for her email. In fact I think Obama was right to sum her up in 2008 as someone who would “say anything and change nothing”. If she was running against a more palatable candidate who genuinely supported progressive ideals, I’d be advocating against her. I’m just saying that the idea that Trump could be president was even worse.

In both cases, it was a two horse race, and although I didn’t love either option I felt that one was clearly preferable to the other. That says something about modern politics – that we are voting for the least terrible option, rather than in favour of something we truly believe in. And I want to think a little more about why this is the case. I also want to think a little bit more here about why the results in both these votes went against the polls and against the incumbent business-as-usual candidate, and why the results have been so divisive and triggered such hateful behaviour from segments of the population.

So why did people vote for Brexit and for Trump? It seems that a number of factors contributed. Firstly there were demographic factors – these regressive options particularly appealed to white men and their wives, in areas that have been hit by economic recession. They tapped into a sense that the world is changing and they are being left behind. There was also a real desire for change, not just more of the same select few in the top one percent making all the decisions. The less people feel they have to lose, the more they are willing to gamble that any form of change will be an improvement. Trump carefully marketed himself as an outsider and a voice for change, but that is a carefully designed misrepresentation. It is also contradictory to his simultaneous positioning of himself as a tax-evader and shrewd businessman who is successful and super rich. In reality his businesses face a constant stream of lawsuits for not honouring contracts or dealing with people fairly and it is clear he is out for nobody’s interests but his own. He also has vested interests and hidden agendas all over the place, but this is something we now take as a given for politicians. So how can he connect with the man on the street more than other politicians? The answer seems to be by bucking convention, appealing to the desire for change and speaking in much more simple terms, as well as appealing to fear and self-preservation (some of which sadly overlapped with racism, sexism and homophobia).

Being wealthy and embedded in the establishment is something that also describes the majority of British politicians. Nigel Farage, for example, similarly markets himself as an everyman who always has a pint in his hand, but in reality is a privately educated millionaire ex-banker who claims every EU allowance possible for himself and his German wife, who he employs as his secretary. Cameron led a cabinet of millionaires, and May is herself a millionaire with a network of wealthy donors and has placed even richer men like Philip Hammond and Boris Johnson into her cabinet whilst claiming she will build a fairer Britain that “works for everyone”. They have no idea about the experiences of people who survive on minimum wages or benefits, but they have learnt to talk as if they care, whilst their actions clearly indicate the opposite. And so we have reached a position that everyone in politics is saying much the same things, and nobody appears to be sincere.

One of the big issues of the reaction to the American presidential election result, and to Brexit, is in how we think of ourselves and our fellow voters. It is all too easy to make sweeping brushstrokes about ignorant, selfish, racists. But I’m not convinced that there is as much difference between us as these dichotomous choices imply. Whilst there are some vocal and visible extremists who identify as Brexiteers or Trump supporters, the message clearly resonated with a lot of people in the middle ground who don’t identify with the racist or sexist undertones, but also don’t identify with the current power structure. I suspect a lot of people are fed up with the status quo, and feeling disenfranchised by the current political system. And maybe that has motivated a lot of people to vote for candidates who seem to be anti-establishment, straight-talking and authentic. This Jonathan Pie sketch, which is full of swearing and therefore NSFW, is worth watching.

I can’t say that a desire for change and for authenticity over spin is a bad thing. In fact having sincere politicians who mean what they say and are not motivated by self-interest or masking their true agenda is something that has been sorely lacking in the political arena over the last decade. Likewise a willingness to explore more radical change is something that I would want myself and a lot of more progressive people would support. But in the absence of such messages from the left and centre of the political spectrum, it has instead been harnessed by questionable individuals and causes. And voters have been sufficiently enticed by this message that they have been willing to disregard all of the bile it comes packaged with, a task made easier because it is addressed to groups outside of the main voting demographic. In response the progressive candidate is left to defend these minorities, and ends up looking like they care little for the main group. The regressive candidates and policies make more headlines, perhaps because of bias in the media and lies that have not been sufficiently challenged. Other parties and messages appear reactive, and end up fuelling that discussion rather than presenting their own position.

The more progressive candidates and causes need to work out how to tap into that feeling of disconnection with the establishment and the increasing desire for radical change. If they can do so with policies that will genuinely benefit those who are being left behind in the current austerity politics then they can avert the swing to the right. That will take the right mixture of passion and authenticity, a willingness to be plain spoken about who is to blame for problems, and a push for greater accountability for political claims.

So where now? First, I think we need to learn from our mistakes and not be complacent that progressive politics are now the default position. We need a return to politicians that mean what they say, and speak with authenticity and passion. We need people who get fired up about the issues and speak from the heart, rather than with spin and polish that hide vested interests.

Second, we need to explain that the same few people have all the power and are increasingly gathering the wealth away from everyone else, and to show the economic value of being kind to the more vulnerable sectors of the population. We need to demonstrate that the threat comes from above (the rich and powerful people who control the media and the corporate and private interests that have powerful lobbies that manipulate our political system) not below (immigrants, benefit claimants, people in minority groups). We need to name the organisations and individuals who are spreading hate and cheating the man on the street by avoiding paying their fair share of tax, and turn the rhetoric of blame to more appropriate targets.

Third, we need to show that the system is rigged to support the establishment, and needs to be overhauled. That may mean setting fair boundaries and catchments to prevent gerrymandering, preventing conflicts of interest and restricting lobbying, looking at the terms and roles for nominated unelected officials (eg striking out members of the house of Lords that are not actively involved in political debate) and/or changing the first-past-the-post system.

Fourth, we must hold people and organisations to account for their lies and false claims. We must give consequences for propaganda, misinformation and promises that are not fulfilled. We need to hold politicians to account for the claims that they make, and ensure that they cannot benefit from lies and deception.

Fifth, we must do much more work to engage those who are feeling disenfranchised, rather than excluding them because they have turned their resentment to the wrong place and are being selfish/xenophobic etc. We need to explain the issues, using short clear soundbites rather than long intellectual explanations whenever possible, so that these can be accessible to a wide audience and shared over social media. We need to be down to earth and not make assumptions about underlying knowledge or values. We need to understand that many people are feeling excluded and shamed for not sharing progressive values, and reach out to them starting with empathy for their current situation, their hopes and fears.

But finally, and most importantly, we need to continue to educate our children to be better than the generations that came before them. We can teach kids to care about each other, the environment and social issues and to not discriminate by gender, race, sexuality etc. We need to help them to become critical thinkers who can evaluate what people say and don’t just accept a lie as the truth. Then over time, the population will change, and progress will continue beyond what seems possible in the present.

I can see that right now it seems overwhelmingly sad and frustrating and many people don’t know what to do with those feelings. This negative focus and tendency to turn towards anger and fear is not surprising. We are sensitive to threat, and fear impedes our ability to use empathy and rational analysis. Our brains are programmed to look at immediate risk and the local picture. We are sensitive to potential threats and we easily catastrophise and generate worst case scenarios. We find it hard to conceptualise the bigger picture as this involves timescales outside our own lifetimes, and populations we have never met and can hardly imagine. But my real hope is in the inexorable march towards progress that is happening over the last century around the world. So whilst we seem to have taken a depressing step backwards it is good to remember that progress is often two steps forward one step back.

There has always been a pattern of economic booms and busts, political cycles including changes that seem awful, and international conflicts that kill hundreds of thousands and displace millions. When we focus on these negatives, it feels pessimistic and makes us worry it is all downhill from here. Like a panic attack, we see worst case scenarios and look for escape, rather than realising we can work through it. But over human history we have rebounded from all of these things before, and the same problems have been around before only bigger. For all his hateful rhetoric, Trump isn’t Hitler. Although he is set to enact policies that are homophobic and xenophobic, he has already backed away from some of his more extreme claims, and even in a worst case scenario he won’t kill millions of people. And like with May as Prime Minister here, things will continue much like normal for most people. I’m not dismissing the horrible impact of the rise in prejudice against various minority groups, or the risk of repealing some rights, but in the bigger picture they are temporary and against the overall direction of travel.

When we look at the wider view, the future seems much more optimistic. Science continues to make new discoveries that enhance our health, reduce energy consumption, deal with environmental issues and better understand our place in the universe. Technology and access to information and media are allowing people all round the world to access information and different perspectives. Life expectancy has increased remarkably (even in the face of increasing obesity bringing a rise in diabetes and heart disease, and austerity politics increasing mental health problems and suicides). Smoking is declining. Cancer treatment is more effective. Deaths from road traffic accidents are steadily falling. Even HIV is now treatable and prophylactic medication is available. Despite the constant headlines that make us feel otherwise, deaths from homicides have fallen over time in Europe and wavered and then fallen in the USA. Deaths from wars have massively decreased over time, and even the horrible events in Syria, Afghanistan and Iraq are of a smaller scale than previous international conflicts. More and more nations have democracy, women’s rights, gay rights, access to justice and protection of human rights. I believe that the future for humanity is one of steady progress with temporary set-backs. And we should never forget that from enough distance we are just a pale blue dot.

Starting over: Selecting offices and staffing

After the stress of my last blog about problems with the offices we were leaving in Milton Keynes*, I was keen to make sure that we set up a base I felt really comfortable with up in Derbyshire, and gather a great team up here. I viewed a lot of potential offices and tried to really get a good gut feeling about where we would belong. The plan is to rent an office or set of offices that has scope to expand if we secure the grant we have applied for, or other external funding that lets us expand more quickly.

The first place I viewed was a serviced office centre. The rooms were pleasant and good value (less than half the price per square foot that I had been paying further south) but the site was quite generic and a looked a bit warehouse-like. More importantly it was on the far side of a market town with quite a lot of traffic, and further from the motorway. I then viewed an office suite in a pretty restored station building on a quiet branch line. Despite this being my favourite option, it turned out only a single room was available there, and the tenants who had the rest of the building were spilling out into all the public areas, which were filled with their storage and materials. Plus the room didn’t have an individual lock – and I’ve learnt to be wary of that!

The next two places advertised were full, despite having road signage, listings on Rightmove and vacancies marked on their websites. The next place was a dilapidated shop with offices above, but transpired to be under offer, and to need a lot more work than would be possible in our timescales. The next a single room retail space, with no sink or loo unless you went into the next door building, that was quite a walk from the nearest parking. A small office building for sale, but cramped in a back street in a town slightly further from my preferred areas. Then a lovely large set of rooms in a very smart building with dedicated parking and reception facilities, that became less attractive as the already high rent then gained a service charge, and charges for the phone/broadband and was then ruled out by access only being permitted when members of staff from the main business were present, and the building being locked up at 3.30pm on a Friday!

Then a small set of offices that were a bit too far away and had a contract with an excessive notice period. Next was a bright but slightly run down set of rooms over a letting agent, at a good value inclusive price, but with slightly dingy rear access. Then we viewed another office building that was for sale, but was too big, over priced and came with only a single parking space. Then another serviced office building in a massive complex that contained function rooms and all sorts of entertainment facilities, but had limited parking and was rather dirty and dated looking. Again there were all sorts of extra charges for phone/internet, insurance and a per person charge per month for furniture. However, some of the rooms were nice, and they did come with two parking spaces right outside. Whilst viewing we also met a potential business advisor and heard about the exciting collaborations within the complex, but somehow it just didn’t feel right.

It is always very interesting when your head and your guts give you different messages. Logically the last place had the most to offer, yet it was the rooms above the letting agent that gave me the best feeling, and the owner talked the least and was the most straightforward. A bit of negotiation later, and he had agreed to redecorate the rooms, provide some furniture and jet-wash the rear access, as well as hanging a door so that we could still access the toilets and kitchen, but other staff and customers could not come up to our offices uninvited. Having learnt my lesson, this time the repairs will be specified on the contract as being completed before rent is due!

I also interviewed for a new assistant psychologist for our Liverpool contract. The project is going to be in collaboration with my peer supervisor, so that feels like an extra benefit to me, as I get to spend more time with him. We even had fun interviewing, in the lovely Quaker building in the town centre, and ate delicious food at Mowglis. When it came to the applicants we interviewed, we were really pleased to be spoilt for choice. We felt that three of the candidates would have been great for the job, and were able to select someone we are really comfortable to add to the team.

I have also put up an advert for a new administrator. Having had both brilliant and awful experience of non-clinical staff in the past, I wanted to make sure we recruit the former. This person will be the hub in the centre of the business, around which the rest of us rotate, and they need a mixture of administrative, financial and interpersonal skill, with the ability to keep me and the business organised! So I put a lot of effort into the job description and person specification. It is the first time I have used online recruitment advertising, so fingers crossed we find the right person. The applications seem to be numerous and impressive, so we are off to a good start.

Also during the summer I met an inspirational potential collaborator, so I am hopeful that I can negotiate a productive way we can work together, whether he joins us as a part time COO, or whether we make a service level agreement between our two organisations. I only hope that I can find a few more clinical psychologists to join the team, as we continue to have more requests for our input than we can fulfil.

Finally, keep your fingers crossed for me, as I will hopefully hear back soon about the DfE grant that I applied for to expand our pilot of outcome measurement and our psychologically informed care pathway!

*Thankfully I have now resolved the issues with Regus, so I have edited the previous blog to reflect this. I don’t normally edit things I have posted, because I prefer to write honestly and leave what I say on the record. However, it was a condition of the resolution that I did so. I thought long and hard about it and concluded that this blog and my social media is not the right place for making an angry noise, and that I could tell the story equally accurately in a slightly less detailed and more dispassionate way.

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?

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.

Falling through the cracks – the current state of NHS mental health services

Recently I spent sixteen hours trying to get an acute mental health assessment for a someone. The details of the case are not what matter here, but I want to talk about what I learnt from the process, and to do that I’ll need to give some context. It is necessarily vague and some information has also been changed to protect confidentiality.

However, as a pen picture it is fair to say that there was a combination of a severe deterioration in mental health with risk to others (the person had bizarre beliefs that led them to want to injure/kill people within particular demographics). The person did not want any mental health input, but I felt that the risk issues were so acute that it was necessary to override the lack of consent and request that an urgent mental health act assessment be undertaken. The other members of the household were keen for this to happen, as were various professionals who were already involved from the health, social care and criminal justice sectors. The person was open to a locality mental health service, but after the initial assessment identified various needs nobody had been allocated to undertake the work, so although it was an open case there had been no service for several months.

So, I rang the local service to ask for a psychiatric assessment. It wasn’t an area where I have worked before or a service that I had any prior experience with so I rang the number on their website. I explained I felt that there was acute risk coupled with obvious decline in mental health, but a lack of consent to treatment, so I enquired what kind of urgent services could be triggered, suggesting that the person involved would be difficult to approach and it would almost certainly be necessary to undertake a mental health act assessment and an admission against the person’s will might be necessary to safeguard others. And that is where I hit a brick wall.

The local service told me they were not commissioned to have a crisis service, and that unless the person involved had self-harmed they did not meet the urgent criteria. No amount of risk to others, or deterioration in mental health would qualify for their service, unless there was self-harm, or the person presented at A&E themselves, or we waited the timescales of their routine service (which had no capacity to allocate a worker). Pointing out the NICE guidance required a same-day response didn’t shift their position. Highlighting the risk to others or the individual likewise seemed to go unheard. The Approved Mental Health Professionals team said that the person met their criteria, but they could not get involved unless there was a psychiatrist from the locality team who had seen the person and would identify the bed if it was necessary to use a section. The psychiatrists said they were not resourced to go out and see people, and that they were not prepared to put themselves at risk by attending a person who presented a risk to others, even though I had arranged for the police to be present. They said the only way they would see the person was if the police used section 136 to bring them to the hospital as a place of safety, where they could then provide an assessment. They suggested that we call 999 to ask for ambulance and police assistance. The ambulance and police said they were not there to provide transport, and if the person was calm and inside the house, they did not present an imminent threat that required removing them using section 136.

Deadlock.

The next day I phoned the local mental health team again and asked to speak to someone senior to raise my concerns about the case. The duty clinician called me back several hours later. I got asked “what do you expect us to do on a Friday afternoon?” and “why is this our problem?” and then got talked over loudly again and again as I tried to explain the issues with risk and mental health. I asked politely four times for the person to stop talking over me, without effect and then asked her name. She refused to tell me and ultimately hung up on me. Her service wouldn’t tell me who I had spoken to, or give me any information about the complaints procedure beyond telling me to write a letter to their postal address. I asked to speak to a service manager. Unavailable. To a psychiatrist. Unavailable. I asked for someone to call me back. at 4.45 I got a return call with the same content as the previous conversations. No crisis service. Doesn’t meet their urgent criteria. A&E, the police bringing in under a 136 or nothing. I wrote a report giving all of my concerns to the whole network in writing.

In supervision I talked about my anxiety about a serious incident, and my fear that nothing would be done, and everyone would pass the buck. I was supported that my concerns were legitimate, and made the decision to try to take it up the chain of command. I called the department again. Then I called the directors of the trust involved, and the complaints department. I made calls all morning with no response, having already had no response for over a fortnight to concerns I felt were so acute they needed a same day response. So I called the CQC.

The CQC were very helpful, and made me feel that it was the right place to raise my concerns. I feel that the systemic issues will eventually be addressed because of the CQC having sufficient power to influence commissioning decisions, but that doesn’t help in the timescale of the individual. Likewise someone near the top of the trust concerned did get back to me the next day, and want to learn from the process (perhaps motivated by awareness of the CQC being involved). Hopefully we’ll look at the pathway, and address the various issues that my experience flagged up. But again, that’s fixing the stable door after the horse has bolted. At the individual level, the outcome was disappointing. The person is moving to a different area within the next few weeks, and the service have decided that means that they don’t have to do anything, whilst the new area will only act if concerns are raised once the person arrives.

So the story doesn’t have an ending yet. There wasn’t a happily ever after, because the service I felt was required within a matter of hours hasn’t been provided, despite several weeks having passed. However, there hasn’t been a serious incident either. I’m keeping my fingers crossed the former happens before the latter.

But it was a pretty weird experience for me. Normally, if I raise a concern people take that pretty seriously. I’m a fairly senior clinician with the titles Dr and Consultant by my signature. I’ve been an expert witness in 200+ court cases. And I’ve had 20 years of experience against which to judge risk and after 16 years in the NHS I also think I have realistic expectations of services. I’ve never made a complaint about an NHS service before, and I hope I never have to again, but I didn’t feel like I had any other option. I was genuinely horrified to see defensive service specifications being used to deny a person with clear acute mental health needs a service. I felt like my concerns were ignored and dismissed because they were inconvenient and didn’t fit within existing pathways.

I’m not sure that my involvement did any good at all for the person in the end, despite spending hours and hours on the phone and writing emails and letters. But it made me wonder, what if I wasn’t there? What if there wasn’t someone with a title and qualifications and NICE guidelines to cite to try and agitate for the services to do the right thing? What if a family member or friend of the individual rather than a professional was trying to express their concerns? Why are the barriers so high when it comes to accessing mental health services? Why have services got specifications that exclude people in serious need? Why are the processes to raise concerns so opaque and so slow? Why don’t services join up better? Why are services always reactive and so rarely proactive? Are age, gender, race or other demographic characteristics a barrier to accessing treatment? Why are we still so far from parity between mental and physical health services? Why does mental health still not have the kind of services there are for acute physical health needs? Most of all, why does common sense and compassion get lost in pointless bureaucracy when it comes to referral pathways and criteria?

I used to be so proud to be part of the NHS. Now I wonder about what it has become. Is this just what is left after decades of cuts and reorganisations, or was I always a roll of the dice away from hitting a dead end?

A note on the two 12 year old girls with “higher IQ than Einstein or Stephen Hawking”

In the news today, two 12 year old girls who have done Mensa assessments have been pronounced to have IQs of 162, and to “already be cleverer than Einstein or Stephen Hawking”. As someone qualified to test IQ in a validated way, this is infuriating, as it compounds public misconceptions about IQ.

Let me start with some basic explanation of how an IQ test works. A proper validated IQ test shows IQ scores in terms of the number of standard deviations that person’s score is from the mean in a normal distribution of other people of their age in their country. So 2.28% of people score above and below 2 standard deviations from the mean. A standard score means that the normal distribution is set up with a mean of 100 and a standard deviation (SD) of 15 points – IQ scores are calculated by using the raw score on the test comparing it to the norm group and then transposing that onto the standard distribution. That means that the average IQ score is 100, and just over two thirds of people have an IQ score between 85 and 115. The further a score is from 100 the more unusual it is in the population. At the lower end, 2.28% of people have an IQ below 70 (considered a Learning Disability) and at the upper end of the range 2.28% have an IQ over 130 (considered “gifted” or “very superior”).

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So what about people who are super-bright? How accurately can we measure their ability?

Given that IQ tests are normed on only a few thousand people, the sample and thus the knowledge we have about the distribution of IQ in those ranges is pretty limited. By the time we look at the sample 3 SDs above the mean at 145+ we are studying 0.03% of the population (three people in every ten thousand) and that means that the normative sample will probably contain only two or three of those people at best. Of course most of the tests are normed in the USA, and the UK sample used to ensure it transfers to this country was only hundreds of people, so it probably didn’t contain any.

We then have the variable of error in measurement, which increases as you get to the edges of the distribution. You get a noise in the background during one item or a moment of misunderstanding and it can change the score by one or two points, and in these ranges that could make a huge difference. How valid can it be to stratify people in these extremes according to individual items of knowledge?

So, you would typically give either a confidence interval (the range at which the person is 95% likely to score if re-tested, according to the statistical properties of the test, usually the individual IQ score plus or minus 4-6 points) or a percentile. And the general practise is to say “the top 0.5%” for all scores above 140 and be no more specific than that. So the answer to my question is that we know fairly little about the distribution of IQ scores above 130 and the tests are not very good at reliably differentiating between scores in that range. That means I’d be sceptical about anyone claiming “genius” who cites a specific IQ score, as they clearly aren’t enough of a genius to understand the statistics or science of IQ measurement!

Does someone with a high IQ as a child keep getting higher?

No, cognitive assessments are designed to measure ability relative to your age peers, so that it is likely to remain a similar score as you get older. A child with an IQ of 130 is likely to become an adult with an IQ of 130, give or take the error of measurement, unless there is a significant head injury or some other explanation for the change. If someone under-performs on the test for some reason (for example because their attention is very poor) their score might improve if that reason is addressed (if their attention is improved by medication, change in their environment or practise at similar tasks). You can practise the specific tasks used in IQ tests and learn general knowledge and vocabulary deliberately to improve your score, and the score is not normally considered valid if the same test is used again within 24 months because of practise effects.

The norms for IQ tests are gathered for each language and country, so although they are meant to be “culture free” you also need to be mindful of cultural or language barriers to performance. And of course, in the end IQ scores measure how good you are at IQ tests, which may not reflect how “intelligent” you are in real life, where social skills, emotional intelligence, interests, ability to use executive functions to concentrate, self-monitor, learn from feedback and many other factors affect the degree to which you can succeed or appear exceptional. In fact it is often the people with the narrowest focus in their skill-set who are able to make the most impact in that area, and they may often not have the breadth of skills to appear that intelligent in other contexts. Of course there are some genuine polymaths, but it isn’t clear that IQ scores reflect functional skills beyond being reasonably predictive of academic attainments.

So what about these scores cited in the media of IQs of 162? Are they cleverer than Stephen Hawking or Einstein?

Many high IQ societies don’t use the cognitive assessment tools that Clinical Psychologists use (like the Wechsler tests, or the Stanford Binet). Mensa for example use the Cattell which is not widely accepted as a valid test of IQ and has relatively low correlation with the standardised tests I mentioned. This test has a completely different scoring system, with a standard deviation of 24 points. This makes the highs look higher and the lows look lower, and it seems it is popular amongst high IQ societies because it is cheap to administer and pleasing to their members as it gives nice high numbers. On this test a standard IQ score of 130 (achieved by that top 2.28% I mentioned earlier) would be a score of 148 – a higher number, but still designed to indicate the same level of ability (a score in the top 2.28%) – and a score of 145 on a standard test (achieved by the top 0.03% of the population) would be a score of 172.

So those published scores of 162 are high, but statistically we’d expect 3 in every ten thousand people to score over 170 on that scoring system – and simple multiplication tells us that across the population of the UK we’d expect there to be 18,000 people with that level of ability – whilst the error of measurement in that range must be enormous. In fact, we can say little about their IQ beyond “it is above 130 on a standardised test” due to the confidence intervals being very wide. To differentiate amongst super high ability people we would not only need a test that is able to be sufficiently granular at that ability range, we would have to norm it on representative samples of higher ability people studied in sufficient numbers to see what happens to the distribution as raw scores go up.

As to scores higher than Stephen Hawking or Einstein, that’s purely speculation. Neither of these two people have done comparable IQ tests, and the norms change year by year. Plus people can be brilliant at some things and less good at others, and there is not a perfect relationship between IQ and ‘intelligence’ let alone IQ predicting who will be a “genius” and increase the boundaries of current knowledge.

I’ll leave the last word to Stephen Hawking, when asked what his IQ was by the New York Times:

“I have no idea. People who boast about their I.Q. are losers”.

General election manifestos and their implications – Will Curvis guest blog

Just a quick one tonight as I really should be writing up my thesis…
I just wanted to share a letter published in the Independent yesterday (you have to scroll to the bottom of the page), which I co-signed alongside a number of other psychology professionals.

This was in response to an aspect of the Conservative party’s election manifesto, published this week. In a nutshell, they are proposing that people who are in receipt of benefits but refuse to consent to ‘treatment’ for physical and mental health problems can have their payments reduced or stopped.

While I didn’t write it, the letter does a fairly nice job of summarising my feelings on the matter. I’m very happy to have my name attached to it. While I have my own political opinions, I would have signed the letter no matter which party had suggested this.

The NHS – and particularly mental health – are becoming bigger political talking points and bargaining chips than ever before. That’s generally a good thing. But it’s imperative that we remain critical and wary of the implications of policy changes for people on the ground.

I feel that – as you no doubt can guess from my initial blog post – it’s vital for everyone to make their feelings on issues like this known, to ensure that the needs of the vulnerable people in our society aren’t forgotten or ignored.

And for goodness sake, register to vote NOW (you have until Monday!) and make your voice heard on 7th May.

p.s.
I also feel compelled to direct interested parties to this blog entry from Alex Langford, a very vocal psychiatrist on Twitter. Additionally, a few psychologists who teach on the Lancaster course are contributing to The Conversation’s analysis of different party manifestos. The discussions on the Tory and the Green Party’s manifestos are well worth a read.