Month: October 2016

Hiding in plain sight: On Louis Theroux and Jimmy Savile

I watched the Louis Theroux documentary on Jimmy Savile tonight, and I wondered why it wasn’t obvious to Louis how slimy and two-faced Jimmy was. It stood out for me from the original documentary, let alone from the rushes shown in the update, how clear it was that he was inappropriate about personal space and made a number of particular types of comments – normalising sexual content, implying connections to power and influence, and schmoozing/bestowing favour – that I associate with people who sexually abuse children that I have met through work. He also behaved differently when he wasn’t on show, and was with someone he didn’t perceive as having influence, in the unguarded footage shot by the producer late at night. I’ve learnt to take note of that too, from bitter experience.

It reminded me that my initial gut reaction to the original documentary was “ugh, my sense of him being creepy as a kid was right – it appears he has a sexual interest in children, and from the way he talks about enjoying his time with her body it seems likely he had sex with his mother’s corpse”. Yet that response at the time was unspeakable, except to my husband. After all, you can’t just say someone is a criminal, a necrophiliac, an abuser and a risk to children without proof and based purely on second hand information. That would be inappropriate, and potentially defamatory, particularly for a professional.

But Louis was there with Savile and heard his entirely unsatisfactory responses to questions, his jokes and inappropriate behaviour, saw his invasion of people’s personal space, heard him made threats to sue and name drop his connections to both establishment and underworld power. Yet, despite being an intelligent guy with suspicions about Savile, Theroux’s reaction wasn’t one of repulsion and scepticism. He was won over by Savile’s charm, and carried along by the fiction Savile had created that he was some odd relic of the 70s with his own rules not quite being in sync with the present overly PC world, and being inappropriate was harmless and par for the course. He probably felt flattered by the attention, and tantalisingly close to being the confidant that would get the big scoop when Jimmy was ready to tell his story. But he stopped being a critical observer and started to consider him a friend, and was present when he continued to behave in inappropriate ways and failed to remark on it. And that shows how easily it is done.

Because if it is your mate, and they just go one step further than you are comfortable about as if that is perfectly normal, then perhaps that is just the way that they are, and you can start thinking that maybe they are too old and odd to have to conform to social norms. And once you start to think that, your own boundaries shift and you become complicit. Something you would instantly baulk at from a stranger, is somehow normalised. You turn a blind eye without realising you have done so. Louis said that he didn’t feel he had been groomed, but I think he was wrong. Sure, he hadn’t been targeted as a potential victim of Savile’s sexual advances, but he had been drip-fed the self-crafted story of the harmless oddball doing so many wonderful things for charity. And he had been slowly habituated to be complicit in accepting the small infringements into the unacceptable, the misogyny, the recurrent sexualised content of his interactions, the invasions of personal space. And he tolerated the evasion, the flattery, the name-dropping, the sinister undertones as part of the special relationship they had developed. And that, to me, is grooming.

I’m not implying Louis is to blame for that. He has shown his intelligence, empathy and insight in other documentaries, so my expectations are high. But it is easy to be groomed. By definition, recurrent sexual abusers who have not been caught are devious and effective in fooling those around them. Plus Savile had a lifetime of practise and an enormous reputation and network to carry him. Nonetheless, I can see why Louis has been looking back and wondering what he should have noticed. I’ve been there and done that.

The first child sex abuser that fooled me (that I know of) was more than 15 years ago now*. He shook my hand, spoke politely, seemed to have a benevolent interest in the wellbeing of the children in the family and always agreed with what the professionals said. He was well educated, middle class, and married with adult children. He was the one who reported concerns about the grandchild who was referred, and was critical of the parents. The child was developmentally delayed, but also underweight and unkempt, with no sense of personal space. In retrospect, I can see that this idealised grandfather was remarkably unsympathetic to his daughter, whose lifestyle of alcoholism and domestic violence punctuated with inpatient stays after self-harm didn’t match up with the facade of happy families he portrayed. But at the time he seemed very concerned about the wellbeing of the child. The receptionist took me aside to mention that he spoke to his wife “like a dog” in the waiting room, but turned on the charm in the presence of clinicians. I didn’t even make a note in the file. I only remembered the comment 6 months later when the social worker said to a case conference that just prior to proceedings to move the child to the residence of these grandparents, the mother had disclosed childhood sexual abuse from her father, along with sadistic punishments like having her hands held against the hot oven door if she didn’t do as she was told quickly enough. This had then been corroborated by another family member, and her records showed the school had reported the burns to her hands. The child was placed in foster care instead.

I remember how stupid I felt. The clues were right there in front of me. The child was vulnerable to abuse, and the developmental delay and unusual behaviour with no sign of organic cause showed that something was going wrong in their life. But it was too easy to attribute it all to the ‘bad’ parents and not the ‘good’ grandparents, falling into the polarised thinking of the family, despite normally having more nuanced formulations. The mother’s story didn’t match the grandparents, and her lifestyle didn’t fit with their descriptions of her upbringing, but she had been branded an unreliable reporter. So why did someone from such a happy middle class home get into such a mess? The answer was given to me on a plate – she had fallen into a bad crowd as a teenager, and ended up drinking and in a destructive relationship – so I didn’t look at other contributory factors. It wasn’t my job to pry, I was just doing a developmental assessment of the child. Yet I know that severely troubled adults have rarely had idyllic childhoods, and have often experienced multiple adverse childhood events, and that attachment styles are often carried through the generations. Likewise I know that trying to charm professionals can be a warning sign, but nonetheless numerous small compliments on your insight, empathy and skill as a clinician can flatter your ego without being so excessive as to raise a red flag. And the receptionist’s comments were given outside of the clinic room, and whilst I didn’t have the file open to take notes. Plus she wasn’t a clinician and may not have heard the full context of the comment, so the team didn’t give it much credence.

Thankfully, the disclosure came in time to protect the child from being placed with someone with a history of abusing children, but it wasn’t thanks to my skill as a clinician. Sure, I was quite early in my career and still quite naive, but I suspect most clinicians think we have uniquely sensitive radar to pick up on abuse and abusers. Sadly, we don’t. Whilst we might not rely on the stereotypes that the public are fed, of dirty old men in trench coats exposing themselves at the park, or strangers trying to tempt children into their car with sweets or puppies, I do think we have some internal stereotypes. The abusers that are easily caught are often socially gauche, lower in intellectual ability and/or socioeconomic status, and we tend to think of men who are unsuccessful in adult relationships and are prolific and opportunistic in their offending, but abusers are a highly heterogeneous group. Few have overt mental health problems, some may appear to be morally upstanding citizens, some are female, they come from all walks of life, cultures and religions, they may have functional adult relationships, and most are known to the child. about a quarter of perpetrators are under the age of 18. The majority of abusers have a single victim or a small number within their immediate network. A tiny minority with a primary inclination towards children are prolific abusers like Savile, but the damage is so wide ranging and the cases more newsworthy and memorable, which is why people are more aware of them. So there is no clear alarm bell, apart from the inappropriate interest in or behaviour towards children itself, the presence of child pornography, or sexualised behaviour or disclosures from the child.

In hindsight, it is easy to recognise signs you may have missed, and if you know there is a history of sexual offences against children certain behaviours show in a different light. And I have learnt to be both more observant and more wary. Those flirtatious comments to the receptionist, or the attempts to find common ground with or flatter the assessing clinician stand out, just like the cringe-inducing examples of Savile’s behaviour we saw in the edited highlights from the rushes that Theroux had of his time with Savile. We can only hope that we learn from experience and aren’t so easily fooled next time.

*all case details have been suitably anonymised

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.