Planning for failure?

3sleepycatsTwo of my cats are geniuses. They have worked out how to open the cat flap inwards when it is set to only allow them to come in and not to go out. The other cat is either even more of a genius and has been able to hide his skills from me better, or isn’t motivated to go out into the cold at night, or isn’t as smart as his brothers*. I am yet to work it out. But either way a cat should not be able to “hack” an expensive cat flap fancy enough to recognise their microchips, so I phoned the maker, Sure Petcare. They said that it is very unusual for a cat to work this out – so unusual in fact that they hand make an adaptation kit for the few customers that find this an issue, and would send one out, which they duly did. This took over an hour to fit. However it took less than 48 hours before the cats were going in and out when it was set to “in only” again, suggesting the modification was a failure. This didn’t surprise me, as there was a gap above the catch where they could still press it down, and the catch itself would then stay pressed in whilst they scratched the flap open. I rang the maker again, who said it was impossible for a cat to open their flap with the modification fitted. When I sent video of the cats doing it they blamed a faulty catch, and said it would not be possible without it, even though I had witnessed the cats using the same technique even when the catch would spring back up (and it was probably their persistent efforts that stopped the catch working). Sure are sending a replacement modified section and catch, but if that doesn’t work they will refund us, and we can buy a design with two point locking instead.

What was interesting was the figures they let slip in the telephone call. According to the member of staff I spoke to, it seems that five percent of cats can open their catflap when it is on the setting that is supposed to allow inward travel only. That is, if you have a smart cat who wants to go out, then it doesn’t work. When looking at their customer experience, one in twenty of their cat flaps doesn’t fulfil the functions they claim for it and has to be returned or replaced. Yet somehow they have decided that it isn’t worth modifying the design, despite this failure rate. So they are reliant on cats not working it out, and/or customers not complaining, and/or the cost of making and sending out the modifications for this smaller number of cat flaps being cheaper than the change to the manufacturing costs involved in solving the problem.

They aren’t alone in that. The Hotpoint/Indesit fridge that caused the Grenfell tower fire was a model known to have problems with blowing fuses, temperature control and noise at night. Other products by the same manufacturer, such as a particular model of tumble dryer, had been known to cause fires. But neither had been subject to a recall until after the tragedy at Grenfell. Likewise many models of cars have been found to have various safety problems, and the manufacturer seems to weigh up the adverse impact of the negative publicity and the cost of the preventative work, replacements or repairs and to compare this to the cost implications of not acting – it has only been since the larger financial impact of customers taking up legal compensation cases after deaths and serious injuries, and increased government fines for not acting on safety issues that the balance has tipped towards preventative action.

My car was recalled by the manufacturer a couple of months ago because of a fault with the ABS, which can overheat and fail in an emergency situation, so I took it in last week to be checked and modified. The modification was completed without event, but the VW dealership also provided a “free service check” of the rest of the vehicle. This identified two “red” repairs they felt were urgent or affected safety, and one “amber” issue with the brakes, and they suggested I should have all three repaired before leaving, at a cost of nearly £700. What they might not have known is that the car had passed its MOT with no recommendations for work less than three weeks previously, so I took it back to my trusted local garage for their opinion on this “urgent” work. The mechanic explained that the items identified were not necessary, let alone urgent. For example, the suspension bushes were functionally fine, and are a part of the suspension that serves only to make a smoother ride, rather than being a part that can compromise safety. If they are very worn there can be play in the steering (which I had not experienced), uneven tyre wear (again, not present) or noise when going over bumps (likewise not an issue), but it was unlikely to be necessary or cost-effective to replace the bushings on a nine year old, 100,000-miles-on-the-odometer car destined for the diesel scrappage scheme within the next year or two. Likewise the 5mm+ of brake pads remaining is likely to last at least 3000 miles, and is fine to leave a few months until the car is serviced.

I’m not a car person really, so I might have got the technical details wrong, and I can’t remember what the other “red” warning was about, though my mechanic found it equally risible. I mention it only because it seemed to me that VW (or that particular dealership) had decided to offset the cost of the recall to check the ABS, by identifying other potential sources of work they could undertake and presenting minor issues in a way that appeared more serious or urgent than they really were. In that way, garages are pretty shameless about creating work for themselves, and from the start they build in customer expectations of maintenance and additional expenses. We accept the idea that safe operation of vehicles requires periodic checks and repairs, and we need to take them in for regular servicing because certain parts have a limited lifespan, and don’t see that as indicative of the original product being defective.

You would think this is even more true in healthcare, given that so many conditions can be prevented or treated simply if identified very early, saving pain and trauma for the individual whilst also saving cash to the public purse. It isn’t impossible to deliver, as this type of model is used in dentistry – we attend for periodic preventive checks and expect to need maintenance from time to time. Likewise we expect to need regular eye tests and to update our glasses. And we get letters reminding us to come for flu jabs or smear tests from the GP. But it isn’t applied to our general health and wellbeing. In fact my health had deteriorated quite significantly before I was assertive about requesting the tests that showed I was anemic, severely vitamin D deficient, had blood pressure high enough to be risky and an abnormal ECG. And the only context where there are screening and preventative measures for mental health that I can think of are during pregnancy and the occupational health checks when applying for a new job. However, there is a massive incidence of mental health problems and it has huge impact on people’s lives, the lives of those around them, and their ability to engage in education and employment, with knock on effects on physical health, social engagement, work, relationships and parenting.

When thinking about mental health and therapeutic interventions, we could probably learn from the maintenance model of dentists (or the regular intervals of car servicing) that keep an overview of how things are going, give preventive advice and identify the need for more in depth work. It would also take away the stigma of talking about mental health if it was something universally considered at regular intervals. Of course it will never happen, at least not under this government which is trying to strip away essential health and social care services, increase the wealth gap and the vulnerability of socially excluded groups, and blame individuals for the way they respond to experiences outside of their control. But it is nice to think now and again about what things could be like if we strip away the constraints of austerity. And I’d like to have an annual well-being check up where someone with a mental health qualification starts by asking “so how are you feeling at the moment?” and actually cares about the answer.

 

*I’m not judging, I love all three of them equally.

Nature versus nurture revisited

This week I have been reading the Power Threat Meaning Framework published by Lucy Johnstone and colleagues. This document is an attempt to challenge the dominant medical model in adult mental health with a more functional framework for formulation, based on the person’s experiences and circumstances. It is an interesting and challenging read, because it tries to cover the political and philosophical context of challenging the medical model, and input from service recipients about the benefits and challenges of different ways of conceptualising their difficulties. But at the core it rests on a pretty simple and (I’d like to think by now) well-established concept – that the adverse childhood experiences a person has prime them to use survival strategies that make them vulnerable to difficulties later in their life. Those early templates for dysfunctional relationships and the sense of self created by inconsistency and maltreatment also mean that people are more likely than others without those experiences to go on to have other relationships and experiences that are traumatic/harmful as they grow older, which compound the strategies and narratives with which they navigate adult life. The survival strategies which made perfect sense in response to their experiences at the time, have a lasting impact on the brain, body and behaviour. They change the way the person perceives themselves, understands the world and relates to others, and go on to have detrimental effects long after the initial trigger is gone.

As I have mentioned in previous blogs, a person exposed to high levels of trauma or adversity, especially if lacking protective relationships, will become more vigilant to signs of threat, less able to focus on the tasks that help us attain educationally and in the workplace. Where their early relationships have been dysfunctional, they are likely to struggle with forming healthy later relationships, and are more likely to express needs indirectly and in ways that cannot be ignored – including in ways that lead to negative societal responses, such as rejection and/or pejorative judgements by others, involvement with mental health services (and being given diagnostic labels), involvement of criminal justice systems. This leads to an increased risk of socioeconomic adversity, lower social connectedness and a greater chance of a range of adverse outcomes.

In short, thinking about adversity in both the person’s childhood experiences and current context, not only gives us insight into the biggest variable in personality disorder, attachment disorder and other specific conditions. It also explains a lot of the risk factors for wider issues with physical and mental health, challenging behaviour, addiction, violence, crime, homelessness, harmful relationship patterns and helps determine our sense of self and our ability to make healthy social connections. Adverse childhood experiences increase the risk of a very wide range of  physical and mental health problems, for a range of reasons including lower self-care and poor lifestyle choices, a lack of self-monitoring and seeking of appropriate care in the early stages of problems, and what seems to be increased propensity for ill-health mediated by the stress messengers in the body.

I’d go so far as to say that getting child protection and parenting right is the biggest task facing humanity, and the area where I believe we can make most difference for the future – hence dedicating my career to working with the kids who have experienced the most adversity and trying to improve their outcomes. But as I have explained above, it doesn’t just stop there, because the ripples of that early adversity continue to spread out into the lifespan for many people, forming a barrier to the protective factors of education and employment, establishing social networks the means to access pleasurable activities. This can then be compounded by financial hardship, hostile systems (such as benefits sanctions and fitness for work tests) and lack of access to resources (including finding it hard to identify and navigate access to social care and health services, to know and assert their rights, or appeal against decisions made by organisations). So the same people who experienced chronic developmental trauma and have unresolved psychological consequences from that are often struggling with their personal relationships, as well as practical issues like debt, homelessness and crime. In that context, dysfunctional coping strategies like substance abuse or presenting with challenging behaviour or mental health symptoms make more sense as attempts to obtain escape or safety.

There are also vulnerability factors such as being in a disempowered/minority population group, that also bring compounding adversity such as sexism, racism/xenophobia, homophobia, transphobia, ableism, ageism, religious intolerance, etc. These can impact at all life stages. For example, a child with physical or intellectual disabilities is more likely to be the victim of abuse, to experience bullying, and (perhaps increasingly as they grow up) to struggle to access community resources, financial independence or a supportive social network. For people from cultures outside of the majority in the country where they live, there can be language and cultural barriers, prejudice and political/economic challenges, as well as exposure to poverty, war, terrorism and other threats to survival that are outside the experience of the majority of lifetime residents of developed nations. Certain population groups such as asylum seekers find things particularly challenging in terms of finding safety, housing, financial security, after already experiencing multiple traumas in the country they have left and during their journey to find safety. Each individual is unique and their story, current situation and past experiences are a huge influence on the way that they experience and interact with the world.

As Johann Hari rightly points out in his recent article to promote his new book, everybody knows that our experiences, relationships and living conditions impact on our state of mind. If a loved one such as a partner or child dies, you are likely to be sad (and perhaps angry, or relieved if they were suffering, or many other complex feelings). Likewise, if you are given a warning of impending missile attack most people would feel anxious, and become hypervigilant for signs of threat. Therefore, most people would not think of grief after a bereavement or loss, or anxiety when in an acutely threatening situation as pathological. Which makes it somewhat curious that the medical model has been applied to mental health in the way that it has. Why has it become that depression or anxiety or even addiction is seen as a disease, a neurochemical imbalance that needs to be treated with medication?

Perhaps the advances of modern science studying genes and neurochemicals made us think of ourselves as complex biological machines that could be understood at a physical level. Perhaps there is wishful thinking about biological models leading to potential cures. Perhaps the fact that brain injuries, tumours, dementias and neurodevelopmental conditions can make an impact on our feelings and behaviours made it seem that all feelings and behaviours could be attributed to brain changes. Perhaps the idea of massive numbers of people suffering is too distressing to think about and it is a common defence to depersonalise that, and to other the person suffering. Perhaps the narrative of mental illness has sustained the power and income of the medical profession as experts and gatekeepers to such treatments. Perhaps it was clever marketing propaganda by the pharmaceutical companies to sell more of their products. Perhaps it was so persuasive because it fits with the neoconservative narrative to think of individual failure rather than individuals showing the symptoms of societal problems (and therefore our collective responsibility to solve these problems and look after each other, rather than just thinking of ourselves). Or, more likely, it was a combination of these and many other factors.

Of course, we don’t want to throw the baby out with the bath water. There are certainly people for whom psychiatric medication has made a massive positive difference. People who feel more able to concentrate and gain attainments when on stimulant medication, or who feel less hopeless, anxious or angry when on antidepressants, or people whose distress, confusion or aggression is reduced by neuroleptics. But we can’t work backwards from positive impact to considering that proof of a neurochemical deficit or imbalance. After all, the evidence for analgesics is very strong, but I doubt anybody thinks a headache is a symptom of lack of aspirin! We need good unbiased data to understand what is going on, not the cherry-picked examples that currently make it into the public domain. Alltrials is a good step in the right direction in this regard, but there is still bias in what research gets funded and what gets published, with bias towards the sexier topics of new technology, genetics, scans and hard science, and less towards the sociopolitical aspects affecting individual and population wellbeing.

I’m not saying that nature isn’t important. It seems likely that various medical/biological factors do mediate the impact of experience. For example, some conditions like autism, intellectual disability, and dementia do appear to have predominantly biological causes, whilst having impact on thoughts and feelings. Brain injuries and diseases can affect personality, mood and behaviour, and various hormonal and physical conditions can affect brain function and impact on mental health. There seem to be genetic differences (eg to telomeres) that make some individuals more resilient to adverse experiences than others. And some twin studies show genetic factors influence the incidence of conditions like schizophrenia and bipolar disorder, although again the epigenetic factors seem important, it is not clear whether the biological differences are a cause or a symptom of the condition, and the role of biology is not large enough on its own to explain who gets these conditions without also considering experience. Like most of these debates, the answer isn’t going to be one extreme or the other. I am glad that the pendulum has swung back towards considering nurture and experience more, and not exclusively the high tech science of genes, psychopharmacology and brain scans. It seems likely that who we are and how we feel and function in the world is affected by both our biology, our experiences, our circumstances and our relationships both now and in the past.

So, whilst Christine Courtois and Bessel van der Kolk’s efforts in the adult and child spheres respectively to get the impact of complex and multiple traumas and damaged attachment relationships recognised as a better way to understand attachment disorder and personality disorder than a neurobiological disease model (and their challenges to the DSM) have not yet been successful, I am heartened if this way of understanding the impact of experience is gaining more credibility in the field. I think the power-threat-meaning framework might be helpful for some clients, and the questions that they advise asking are certainly good way of starting a clinical assessment.

“What is your story?” Specifically:

1) What has happened to you? (How is Power operating in your life?)

2) How did it affect you? (What kind of Threats does this pose?)

3) What sense did you make of it? (What is the Meaning of these situations and experiences to you?)

4) What did you have to do to survive? (What kinds of Threat Response are you using?) and are you still doing this?

5) What are your strengths? (What access to Power resources do you have?)

It certainly resonates for me, and I wrote about a lot of this stuff in my book, Attachment in Common Sense and Doodles in relation to children who don’t live with their family of origin. I wanted to make information about attachment and the impact of trauma more accessible to carers, legal professionals and social care staff and other profesionals in the child’s network. It isn’t novel content, as it was based on themes that had been researched, written and spoken about by others before me, but I have tried to present it in an accessible and engaging way.

I am heartened that in the last few weeks the idea of experiences and nurture being important in mental health seems to be reaching the public consciousness. It seems to be being promoted more vocally by a lot more clinical psychologists, and to have reached me in various different ways. I’m glad if it is gaining traction and a wider audience, but it might be that’s wishful thinking on my part, and merely a product of my unrepresentative sampling. In light of how horrible a lot of the news is since the Brexit vote, Tory election win and Trump victory, I’m trying to be more selective about what I read and the social media I engage with, so it could be I’m in more of a bubble of like minded thinkers these days, and that is the explanation for hearing more about models that fit my own thinking!

Sowing seeds

I was late to plant my vegetable seeds this year. Due to Defra restrictions to prevent avian flu, our chickens were living in our polytunnel until the end of March. It then needed digging over and the raised beds building for this year, as well as some plans for irrigation. We don’t have any staging in there yet, and I don’t have a greenhouse here in which to start my seedlings. And so because it seemed complicated and I didn’t have much energy due to ongoing health irritations, we reached the second weekend in April without any seeds planted. I could have conceded, as I did last year, and bought seedlings to plant out, but that seemed like a lazy option and I knew taking a shortcut makes me feel less proud of the results. Plus I have accumulated a stockpile of seeds that needs to be used, and the kids love planting, so that is what we spent the first weekend of the Easter holidays doing. Thankfully most of them have sprouted quickly and just reached the size where I have started planting them out (though some have not grown at all).

It struck me whilst I was planting out the seedlings and topping up the seed trays that sowing seeds is an act of faith that they will sprout and grow to produce plants, flowers, fruit or vegetables given time and nurture. Whilst generally the freshest largest seeds do the best, that isn’t always the case as weather conditions and wildlife can easily disrupt your plans in the garden. Sometimes the most promising looking seeds don’t lead to viable plants, or the most lush looking plants fail to produce fruit, whilst the least promising looking seeds or most straggly plants can sometimes surprise you with an abundant harvest down the line. Some of the outcome depends on skill, some on diligence and some on factors outside of our control. Each time you have to prepare the soil, sow the seed and water it regularly to see what comes out. It is an investment of resources and energy that will hopefully be repaid in the future. That idea was resonant for me for a number of reasons.

Firstly, I am trying to invest effort in improving my physical health. The motivation for that comes from looking forward into the prospective futures available to me, and how my health and fitness will affect me and my family. It has become much clearer that what I eat today, or the exercise I do or don’t do, has an impact on me that I’ll feel in the future. I’m making an effort to be more active, get enough sleep and to eat more vegetables and less processed food (I’m a big fan of spring greens at the moment – they are so cheap to buy, but are deliciously sweet and tasty, as well as being seasonal and grown in the UK). So far I have lost 10lbs but I have bigger goals, and want this to be the beginning of cumulative changes in my life. I want my kids to have an active, happy Mum who does lots of stuff with them, rather than a perpetually tired Mum who is preoccupied with work stress. There is a famous Reddit post that talks about non-zero days and effort being a gift from past you to future you that I would recommend reading if you haven’t stumbled upon it yet.

Investing energy for the future potential also connects to the wider theme of working in mental health – where we and the client invest time and energy in trying to make the future better for them – and also that of trying to make a career in psychology. As application season passes on the forum, we can see the hope and heartache that this involves. Many people become almost obsessional about checking the forum for news of when courses have short-listed, and when the offer letters come out – so much so that it completely changes the traffic pattern to the forum (which normally has an average visit time of over 10 minutes, in which the typical user views many pages, but has two months per year in which repeat checkers raise the number of visits, but bring the average visit time down to 2 minutes, often just viewing a single page over and over again).

The early years of most psychology’ careers are seen as an investment necessary to pass the career bottleneck of being selected for training. Prior to that, many applicants feel they are gambling their time on a potential future that may never happen. There is a sense of trying to tick boxes, but not knowing exactly what the boxes are, or why they are necessary which I think needs to be explored and challenged. For many people, it seems like those early stages feel pointless in and of themselves. They are not seen as a long term career plan, and are therefore easily dismissed as being worthless except to jump hoops to try to gain a clinical training place, but I think they have merit in their own right. Many people gain great satisfaction from doing these “low level” care jobs, and they are invaluable in the daily lives of many people in their times of greatest need. They are also a fantastic way in which you can gain and apply the basic psychological skills of listening, empathy and compassion to client’s lives, and to experience the ways that the system around them can help or hinder their wellbeing. Being a mindful and reflective frontline care worker (or researcher) is the time at which people engage the most in the lives of clients, and ensures that the advice we give later down the line is grounded in reality. It also lets us experience the hard work and competing pressures of the staff we may end up advising from the lofty perch of being a qualified health professional, so it is a shame to see so many people horizon gazing to the detriment of getting the most out of the moment they are in.

The same theme of investing time and energy to create something for the future is true in setting up a small business. All over the country people are ploughing in their own money and time to set up small ventures, despite the time involved being more than full-time hours and the initial return often being much less than minimum wage. I hadn’t realised when I set out that even when the business has been running for a while, you often end up having to repeat this process over and over again. As staff move on, or contracts change, or the balance of work stops being enjoyable, or you hit hurdles along the way you have to regroup and use the available resources to fulfil your commitments, or even to start over in a new direction. That process can be disheartening, but it can also be an opportunity for growth, and is a good reminder for those running a business to take a step back and look again at the short, middle and long-term goals of the business and the methods used to achieve them. It is hard when a business feels so personal to lose a member of staff, or to have to step away from a long-standing contract or area of work, but it can allow you to invest more energy in trying to plan the business you want to create.

The toughest part of running a business rather than being self-employed is wanting to do the right thing for your employees, whilst also achieving the aims of the business and creating an enjoyable role (and some profit) for yourself. It can be particularly hard to make good financial and business decisions as a caring, empathic, progressive person who wants to do the right thing by everybody else involved, so it is extra important to have good business and financial advice if you are not just responsible for yourself, and your own plans for the future. The owner of the business is always the last to get paid, and feels responsible for the well-being of every other member of staff – even though for them it feels more like a job, and less like a personal mission.

In a social business we are also the ones responsible for deciding how we provide our services, and what the focus will be. There is endless demand for my services as a court expert witness, as a trainer and consultant to the residential and foster care sector, but I know if I get too swept up into delivering services personally I don’t leave enough capacity to steer the business. So I have to pick and choose the activities that best align with my long-term goals. I have to plan the future of my company in a way that has the most impact on recipients and creates a financial reward for me and my employees in the future. That “triple bottom line” of caring about people (employees and service recipients) and the planet (systems and wider issues) as well as profit (earning enough to pay employees and yourself) is part of the joy and challenge of running a socially worthwhile business.

The sheer number of choices and possibilities can be quite overwhelming at times, and each decision feels like it needs knowledge that I don’t have to make it in an informed way. For example, I need to decide whether to formalise the social enterprise structure within which we deliver our outcome measurement tools. If we do it will open doors to sources of investment that might allow us to scale more rapidly and would be closed to a traditional company. However investment always comes with strings attached and can easily change the direction of the company, or reduce the autonomy with which it operates. It feels similar to decide on a new office base. Do I rent a serviced office, commit to a 3 year rental of a unit on a local farm, or get a business loan and purchase a small building? What if we need to grow or shrink so that this choice doesn’t fit the company structure in 12 months time?

It is hard to predict the future impact of seemingly small choices in the present. I can see why anxiety can sometimes make these choices overwhelming, as it is easy to end up with endless background research and tables of pros and cons that are immobilising. I’m sometimes tempted to make them with a coin toss* or a counting rhyme as we did on the playground at primary school. Like sowing seeds, we just have to research and plan the best we can within reasonable time constraints and then follow the instructions and see what grows!

 

*I was once told to toss a coin and then check if your reaction was relief or to want to make it “best of three” and to then follow your gut rather than the result. It seems as good a method of decision making as any other.

Unwanted approaches: An example of everyday sexism in my social network

I was having a conversation with a man on social media the other day, when he said to me that women “don’t really experience unwanted approaches on the street”, and that if they do they are “mainly lighthearted and easily deterred”. He didn’t believe me when I said that for almost every woman, unwanted approaches are a common experience, not just in social settings like pubs and clubs, or even in the evening, but when going about our normal business in the daytime, like walking to the shop, catching a bus or train, in our workplace or educational establishment. I said I thought most women would be able to recall a recent unwanted approach, and an example in which the man became antagonistic when he was ignored or rebuffed. He was incredulous and felt this was an exceptionally rare event.

So I asked my network on twitter whether any women aged between 18 and 40 would answer a few quick questions on the topic. I phrased the questions as neutrally as possible:

  • Can you think of a time that a male stranger whistled at you, commented on your appearance or made another form of unsolicited approach to you in public?

  • If so, how long ago was this?
  • How did you respond?
  • What was the man’s reaction to your response?
  • How often have you experienced a negative response to rejecting or ignoring unwanted approaches or comments from strangers?

  • If you want to make any more comments, or state your age, or tells us any more about the situation feel free to do so here.

It wasn’t a research study, and I had been explicit about the topic when asking the question amongst my network, but none-the-less I felt that it might bring up some negative memories for people, so I tried to signpost people what to do with that at the end.

  • If this survey has brought up any bad feelings or memories, please seek appropriate support from your friends, family, GP or a listening and advice service such as supportline (who can be contacted by phone on 01708 765200 or by email at info@supportline.org.uk)

Before you read the results, if you want to add your responses to my survey, feel free: https://www.surveymonkey.co.uk/r/VWLKQS5

So, what were the responses?

To date I have received 97 responses from women aged 22 to 37, and the results were depressing if not surprising.

Fewer than 4% of respondents said they couldn’t immediately recall an example of an unwanted approach in public from a male stranger. 79% of the women said that they have experienced “numerous” examples of unwanted approaches, most of them overtly sexual.

Screen Shot 2017-03-14 at 22.27.21More than 42% can recall examples within the last month, and 72% within the last year.screen-shot-2017-03-04-at-01-11-3580% ignored the approach, 19% gave some kind of negative response. screen-shot-2017-03-04-at-01-11-49But here is the key part – whilst 59% of the time the guy then backed off and 10% of the time he was friendly or accepted the person was not interested, more than 31% of the time he was “negative, unpleasant or threatening”. screen-shot-2017-03-04-at-01-11-57Only 13% of women surveyed couldn’t remember a getting a negative response from a man after being ignored or told they were not interested. More than 50% had experienced negative, aggressive or unpleasant responses on several occasions with 9.5% of women saying this happened to them “often”.

Screen Shot 2017-03-14 at 22.31.53

Thirty six women gave examples of unpleasant responses they could remember from the past year. These included:

“When you ignore them, they’ll usually say something about the fact you’re ignoring them e.g. call you stuck up”
“Shouted something along the lines of me being miserable because I didn’t respond”.
Typical responses are along the lines of “fuck off then”, “stuck up bitch”, “you think you’re too nice” or “you’re not that nice anyway”
“When I ignored him he grabbed my arm and pulled me towards him.”
“Called me a whore”
“It was along time ago but I remember being called a stuck up bitch but then nothing else”
“In groups, men will continue to shout and on occasion follow me down the street.”
“Started swearing at me, said I was ugly anyway”
[in relation to men offering money for sex from their car] “when i ignored them they shouted that i was a stuck up rich bitch”.
“I was followed home by a man who started walking beside me. I stated he was making me uncomfortable and that he should leave me alone. He wouldn’t leave stating that he just “wanted a hug”. When i refused he became quite hostile and his body language was aggressive but he eventually left.”
[when I told him to go away] “he got very up close to my face and then finally left”

“Continually returned to talk to me, vaguely threatening, called me a lesbian”.

“Laughed in response to my negative reaction, saying that what he had done (touched my bottom) was what men do in his country (Ireland)”

“He scowled and they walked off without further comment”.

“Verbally abused and insulted. Groped.”

[Told me] “You’ve got a black heart” comments that I’m a “snob” or “stuck up”

“He kept trying to talk to me and come into my personal space (within arms length), even after I explicitly told him several times that I didn’t want to talk to him and that I just wanted to go home so please leave me alone, and physically backed away from him several times.”

“Yesterday walking home from work, when I ignored his first calls and whistles, he continued and followed behind a safe distance [I kept walking past my home] until he got bored of no response”.

“Yelled who do you think you are etc, then made negative comments about my physical appearance”

[I ignore them now] “In the past when I’ve said something back [the response has been negative] examples have included laughing at me”.

“He swore at me and said something aggressive”

“Derogatory comments”

“More comments about being rude or stuck up. Its just a joke. Even more comments”

“Male strangers often act offended or aggrieved if you do not react the way they would like you to. You are told that you are uptight/rude etc”

“Usually it’s mocking behaviour. Worse if they have been drinking alcohol”

“swearing, name calling- normally whenever I don’t just choose to ignore the behaviour”

“sometimes they might make themselves as big as possible (as if reminding you they can physically over power you), some might follow for a bit”

“Being touched anyway (occasionally), verbal abuse (occasionally), more generally just a refusal to go away meaning that I have to continue to deal with them.”

“when I said I had a boyfriend, he aggressively said I shouldn’t have wasted his time”

“when asking men to let go of my arm/ stop pulling me towards them in a night club or bar, the most common response is for them to laugh. Very often (about) 1-2 times a month): men instruct me to “smile” or “cheer up” when seeing me in the street. If I meet this instruction with a negative reaction, almost always the man tells me to lighten up or not be so serious (or something to that effect) as he was just being friendly (as though attempting to make me feel guilty about my response)”

“People being rude swearing, trying to touch you or calling you arrogant.”

“Being told I was a bitch, ugly, or worse (if I ignored them); being told to shut up or receiving more sexualised comments (if I confronted them).”

“start laughing at me”

“He carried on as before with the harassment”

“Called me something along the lines of an uptight bitch.”

“They have commented negatively or have laughed when I have ignored them or told them to leave me alone.”

“Insisting, pushing, coming in my personal space. Not often, but particularly when the man was drunk.”

“You’re ugly anyway, are you a lesbian, why are all women so up themselves I could go on…”

“It was along time ago but I remember being called a stuck up bitch but then nothing else”

“They’ve insulted me if I’ve ignored them or asked them to go away, usually the insult is about my appearance”

“I’ve been called a ‘fat slut’ when rejecting an advance, as well as ‘stuck up bitch’.”

“You must be f**king up yourself to turn this down!”

Sometimes misogynistic comments were coupled with racist ones:

A guy once asked for my number, when I said “sorry, I have a boyfriend” he proceeded to call me a nigger…which was particularly interesting considering he had JUST asked for my number but as I declined he quickly decided that actually my black self isn’t worthy… I still think about this often and as you can imagine it infuriated me and still does.

Remember, the majority of these incidents took place in the street or on public transport during the day, rather than during nights out socialising in pubs and clubs.

Other respondents recalled annoying but not as aggressive things like:

“A guy continuing to ask/plead to come into my home after I’d repeatedly, politely said no”
“Grinning and doing it again”
“He kept going with the analysis of my facial expressions until I left, and suggested that I get some more rest as I looked tired.”
“There was some kinda of “aw why not, love” type response”
Recoil/shocked [that I’d respond negatively]
“All right love I’m only joking, whatever.”
“Generally they look pissed off and then walk away”
“He moved on to another woman on the bus”
“It was a group in a car, they laughed and drive off”
Often males getting defensive or annoyed that I do not appreciate their approach.

Some gave specific examples or reflections:

I would estimate that I experience negative responses after ignoring unwanted approaches around 20% of the time. This can range from a particularly intense stare, the person making a clearly audible comment about me (but not directly to me), or being told directly that I’m ‘stuck up’, a ‘bitch’ or them retracting their ‘compliment’ to then tell me I am in fact ‘ugly’.
[I remember a] Group of teenagers (mostly male) blocking my path in park on way home. Several leered, one asked if he could “lick my pussy”. I blamed myself for walking that way at night and never repeated the journey.
I remember I was in a packed pub at age 22 said excuse me and went to make my way past a group of men. One rubbed his erect penis against me (through jeans) as I squeezed past.
I was wolf whistled at by a van driver last week then shouted abuse because I didn’t respond. My mother told me I should be flattered by the wolf whistling.
I remember a bad experience for me once when I was at college. I walked up the stairs at the train station and there was a group of lads from the college who were training to be footballers running down the stairs and one of them slapped my bum really hard on the way down. That was humiliating.
I’m 29, I feel that this kind of experience and way of approaching and interacting with women, viewing them as objects has been the norm and socially acceptable. It was only when I met my bf (now hubby) at 24 that I understood what acceptable behaviour (inc sexual) was and realised I’d been sexually assaulted by my previous 2 partners.
I was sitting on a train station bench, drinking from a straw, and three male passers-by asked me to give them a blow job. At first I ignored them, but they kept hassling me, and one said, “We’ll pay.” They were very persistent and only stopped to get on their train.
I get unwanted attention from men almost every day – it’s animalistic.
I am 24 and have experienced the above for several years. I can recall it happening since my early teens.

So that’s the reality of what women experience, and is probably familiar to most women reading this. Worse still it is normalised by the most powerful man in the world, who has attempted to brush off and justify repeated examples of sexual assault, walking in on women whilst they are changing, sexually harassing employees and those he deals with in business, and criticising the appearance of fellow politicians. He has even attempted to excuse “locker room talk” about women, such as discussing teenage girls and his own daughters in sexual terms and normalising sexual assault on women by saying that he can “grab them by the pussy”. We are in dark times indeed. A Polish MEP felt emboldened enough to say in a debate about the gender pay gap today that women deserve to earn less because they are smaller, weaker and less intelligent than men.

Most of the men I know are feminists and would be appalled to read the results of this survey, let alone by what the neanderthal MEP said. In the general population however, there is probably more diversity. I think some men are aware of the issue, but others are probably not. So feel free to share the evidence of what is happening, in 2017, to ordinary women going about their business in the daytime.

Of course many other groups experience harassment, and in some cases this is much worse than that women experience. For example, I am sure that the recent spike in xenophobia means that many people of colour, or whose religion is apparent from their dress or appearance are on the receiving end of much more aggressive and intrusive unwanted approaches, as the videos from public transport that have been shared on youtube over the last few months demonstrate. I am sure that gay people receive both harassment and unwanted sexual approaches, and I know that trans people are disproportionately targeted for harassment and sexual assault (in fact, I recently read figures that suggest that half to two thirds of transgender individuals have experienced a sexual assault). I am not saying that there are not some examples of men being targeted for unwanted sexual approaches by women. There are multiple factors which intersect, and multiple reasons for individuals being vulnerable to be targeted in this way. However, I simply surveyed the example with which I am most familiar and the example that was the topic of my conversation.

The incidence of sex crimes and is an embarrassment that we need to address, and too often blamed on the victim. We all need to be responsible for our own behaviour, and for gaining consent before we touch anybody else or engage anyone in any sexual activity – that is so basic that I shouldn’t even need to spell it out, and it should be taught to every primary school child as part of PSHE. No harassment is acceptable, and unsolicited sexual approaches to strangers in public outside of the context of a social setting should really be a thing of the past, no matter who they target.

Note: Minor edits to quotations have been made for clarity and anonymity, but never to change the nature or severity of the incident.

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

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

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

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

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

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

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

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

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

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

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

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

Disappointment

I have been let down by someone I trusted again. In fact, in the last three months I’ve been let down by four separate people that I have trusted, in three different separate sets of circumstances, and two of them have been clinical psychologists. That feels like an unpleasant cluster of disappointment. In each case they made me lots of promises and didn’t deliver. I was relying on them and now have to pick up the pieces. I was assuming that my ethical values would be ones that we commonly held, but in fact each person turned out to be entirely self-serving, despite the high cost to others. In each case the other party has taken what they wanted and left me to deal with the fallout.

Being exploited by others always makes me very sad, and it erodes my faith in people. But this time it has coincided with me being physically unwell. It may even be the cause of my health problems. If so, that is something new, and something I need to address robustly and never let happen again. But as ever in real life the picture is complicated and hard to unpick.

I’ve normally been a pretty resilient person, and hardly ever take time off sick. However, the minor road traffic accident in which I was rear-ended by a lorry 18 months ago transpired to have cracked three of my teeth*. One cracked wisdom tooth was removed soon after the accident and the second patched up with a filling. However the third was a visible tooth that had already had a root canal, so it needed to be removed in a way that would allow an implant to be fitted to fill the gap. I paid for expensive specialist dental work to preserve the bone and fill the gap with collagen to encourage regrowth. Unfortunately, removal of the tooth root was harder than expected and involved half an hour of brute force, breaking off a piece of my jaw bone in the process. That led to dry socket pain. I then required bone grafts along with a pin to support the implant, and six stitches to pull my gum back together. I’m not normally anxious about dental work, but it was stressful enough to make me shake before subsequent appointments and involved several weeks of painkillers and a course of prophylactic antibiotics whilst I recovered. So I suspect I was already somewhat physically depleted.

Then the interpersonal disappointments started to compound things. After a particularly unpleasant bit of news in early December I had to go home from work due to what felt like a migraine starting. I’ve subsequently been off work for six weeks with a “severe otitis media, probably herpetic” written on my sick note. The GP was concerned it was a variant of shingles due to the blistering inside my ear, so I was prescribed antivirals as well as antibiotics, but thankfully it didn’t develop into the full shingles presentation and has just felt like a prolonged ear infection. Subjectively I’ve mainly felt like I’ve been underwater, with periods of more marked earache, dizziness, fatigue and a kind of general malaise. Driving in particular has been difficult (as acceleration and even small hills tend to trigger pain), as has going outside (perhaps due to the changes in temperature) but it has also stopped me from playing with the kids in the way I normally would (as spinning, chasing or sudden movements can bring on earache/dizziness), thrown my sleep out and confined me to the sofa for much of each day.

It seems it has also reduced my ability to weather stress, and made it express in a more physical way than I’ve ever experienced before. I’ve had stomach cramps and waves of nausea that appear when I read emails from certain people. I can’t tell how much of the overall problem is a somatic expression of stress, and how much is my resilience being depleted by physical illness and making it hard to cope with the emotional stuff. But it has been an interesting learning experience. I’ve had to stick on an out of office message and binge watch TV serials. It is a big behaviour change for me to disconnect with my work, but I have to accept my own limitations. If it is shingles, then it can do lasting damage to the facial nerves or lead to hearing loss. No contract, colleague or past employee is worth that.

So I’ve made a pledge to myself never to let this happen again. Work is going to be a smaller part of my life, and I am going to make more time for art and music and going out into nature. Within my work I’m going to follow my heart more. I will only work with people I trust, who share common goals, and a sense of fun. I’m going to focus on doing what I enjoy, and what makes me feel I am having the most impact for those who need it most. I’m not going to bend over backwards for people who wouldn’t do so for me. And I’m going to challenge my inflated sense of responsibility for others.

Maybe it comes from being the oldest child of hippy parents, but I’ve always been a person that enjoys helping others, and giving a leg up, or a treat to people around me. Whether it was spending my pocket money on sweets for my friends at school, raising money for charity, or helping someone else out, I’d always put in a little more effort than other people seemed to. When I look backwards I can recognise that sometimes this has led to other people taking advantage, and me ending up feeling exploited.

I first noticed it in an adult reflective way a long time ago. I remember helping someone with a paper they were writing for a journal submission. Their draft was really very poor, and I made a lot of changes, but they didn’t add my name or even acknowledge my input. A year or two after that I coached someone who wanted to get onto the clinical training course I was on, and let her present a small analysis we had done together on my research project data, only to find out that she had presented the whole study as her own and not credited me at all. I also got her a summer job, from which she was fired for her poor attendance and timekeeping, for which she later attempted to use me as a reference, claiming that the service had subsequently closed and omitting to mention the reason for her departure**.

When a friend of a friend (I’ll call her Jo) sent me an email about being suicidal a few years ago, I cancelled a day of work to go and take her to A&E, and spent 24 hours getting her to attend and waiting for various services. Over the next fortnight I helped Jo sort out problems with her rented accommodation and to get a settlement from her job instead of being dismissed. After a second depressive incident a few weeks later, I brought her back to my house for the weekend rather than leave her alone and unsupported, a visit that subsequently extended to a six week stay.

I tried to be a supportive friend. I got Jo a new job within my network and a week later I agreed to be guarantor on the lease for a lovely flat. However the next day after a clash of opinions with a colleague she decided to quit the job. That left her no means to pay the rent, which would therefore have fallen to me, so I withdrew from being guarantor and the flat fell through. Jo was upset that I prevented her leasing the flat she wanted, but concluded that she would continue live in my house, rent-free, until something else came up. I felt that as well as not being the right choice for our family, this would have been enabling her dependence. There were various problematic incidents, but I still agonised before saying she had to leave and helping her move in with a family member instead. I took another day off and drove a 5 hour return trip to take her and her possessions to a new location. Despite all the efforts I put in, Jo remains angry at me for the perceived rejection and feels that I let her down. She periodically tries to shame me in our social group for “abandoning a vulnerable mentally ill woman”. For me it was all cost and given there was no benefit to Jo it was actually a lose-lose situation, but I did not recognise that until long after it was obvious to everyone else around me.

More recently it has been colleagues and collaborators who have let me down. I’d consider that par for the course if I was unreliable myself, but I don’t think that is the case. I always try to treat people as I would want to be treated myself, and to be really clear about the contract between us (whether that is a literal written agreement or an implicit verbal arrangement). I tend to assume that anyone who has the same profession or client group as me will have the same ethics and the same drive to do the right thing as I do. I always assume that people will care about the quality of the service, prioritise what is in the best interests of clients and keep their word, because that is what I would do in their shoes. Sadly, it seems that is not the case, and lots of other people prioritise their self-interest over anything else.

I don’t think I have unrealistic expectations. If someone signs a contract with me then I expect them to honour it. If someone agrees in writing to deliver a particular piece of work, be it training or clinical work, I expect them to turn up and do that work on the date they agreed. If someone agrees to take on clinical responsibility for some of our clients, I expect them to provide a good quality clinical service for those people rather than nothing at all. If someone agrees to purchase our services for a particular period of time, I expect us to have to deliver those services and for them to pay for them. If someone agrees to buy something from me and I deliver it to them, I expect payment. It doesn’t seem a huge leap of faith to me. Yet somehow these very simple expectations are too much for some people.

I’ve spent too many words justifying why, but I am disappointed by that. And, whether by coincidence or causality, I have been physically unwell in the immediate aftermath. But I am not the kind of person that just rolls over. I might be a sucker and go beyond the call of duty to be helpful when I can, but I don’t let people play me for a fool. I have a very strong sense of fair play and once people cross the line, then I feel obligated to do something about that. Just as I am a demanding consumer who will assert my rights for a refund or compensation when things go wrong (and gave Regus merry hell a few months ago for their terrible service with the office I was going to rent), so I will also take action to ensure that professionals honour their obligations. The way I see it is that many people don’t have the resources to address problems (be that intellectual, time, financial or personal) so those of us that do need to help put the checks and balances into the system.

So my plan is three-fold. Firstly I will address each issue head on and reach a resolution. And secondly I will make plans for the future that mean I am not put in the same circumstances again, gather better allies and do more of what I enjoy. I’ve already got a good team around me and lots of irons in the fire for new projects, and I have had helpful legal and practical advice from a number of sources. So it will all pan out in time. However my top priority is to get well again. And that involves the foreign concept of taking time out to rest. For a workaholic that might be the toughest part of all this!

*I don’t believe this to be a common result of an RTA, but I have brittle teeth due to tetracycline damage as an infant

**I didn’t feel able to provide such a reference, and gave them the contact details of the service instead.

Identity and Change

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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