media

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of it was hard to navigate, and key documents were hard to find, the documents and information on the site were often out of date and much of the content was hidden behind walls for members and separated into silos by the Society structure that were impenetrable by topic.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.

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

A promise to my daughters

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

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

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

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

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

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

Spectator sports

We are in the age of the internet. Adele’s Hello has been viewed 1.8 billion times, yet there are five other music videos on YouTube with more hits, culminating in Gangnam Style’s 2.7 billion view parody of the western status symbols rich south Koreans aspire to. Viral memes emerge and hit millions of page views in a day or two. Websites full of recycled content and filler with clickbait titles make up news stories to profit from the advertising revenue. False news engineered for the most gullible audiences makes tens of thousands of dollars a month. False news created by vested interests including foreign governments sways election results. Trivial stories that involve popular vloggers make headline news. Swedish video game blogger Pewdiepie reached 50 million followers last week and reportedly earns $12 million per year. His empty threats to delete his channel made headlines around the world. The top ten YouTube channels each make in excess of $5 million per year in revenue. Yet many people above the age of 40 have never heard of any of them. Part of what they have in common is what image-hosting site Imgur calls step 1: “Be good looking” although, as has always been the case even prior to the internet, that rules doesn’t seem to apply if the content is funny.

This new class of creators and media is packaged into bite-size content that doesn’t require any critical thinking, often with a catchy title and thumbnail that oversell the contents. Clicking from item to item across quick videos, memes, images and articles seems to make a time-sink trap that captures internet surfers in their millions. Amongst the new population of content creators are people with various different personalities, histories and views about the world, ranging from the ordinary to the extreme. And just as in the responses to any feminist video online, there are then vloggers whose content is made up of critiques of more famous vloggers and their content.

As Katie Hopkins has worked out, being sufficiently unpleasant and controversial generates clicks. It then creates responses that drives more traffic to the original content, and perpetuates discussion. There is then meta-debate about the creator themselves, attempts to shame them, and debate about what to do about them. Even publicising her embarrassing apology and substantial payment of damages for making false racist allegations of terrorist links against a muslim family gives her more notoriety and more clicks.

So it has been with the media rubbernecking the car crash of Eugenia Cooney’s weightloss, from a slim but attractive young woman into an emaciated role model of anorexia (weighing an estimated 4-5 stone) whilst denying she has a problem. A petition to ask YouTube to block her videos until she has sought help reached 18,000 signatures before being removed as inappropriate, and this has created a media circus with numerous vlogs and articles about her weight and whether this represents anorexia or not. Some have commented on the obesity of her mother and brother, and her childlike demeanour and role.

Because she has chosen to put herself in the public eye, and to make money from her audience, she is considered fair game for discussion. Yet if she does indeed have anorexia (and from the little I know of the case that does not seem an unreasonable assumption) she is very vulnerable and likely to have very distorted thinking. In the UK, there might well be a case to section her under the mental health act for treatment if there was not an alternative explanation for her weight loss, because of the lack of insight and high morbidity characteristic of this condition. So there appears to be a dangerous incentive of clicks (and the cash from advertising that follows) for being controversial, and in this case, seemingly putting her own life at risk.

Let us not underestimate the seriousness of eating disorders. One in five people with an eating disorder will die prematurely as a consequence of the condition, making it the mental health condition with the highest level of mortality. There is an increased risk of suicide, and an average duration of eight years for anorexia or five for bulimia, with less than half of all of those diagnosed making a complete recovery to the point they no longer meet the diagnostic criteria for an eating disorder. This is significantly more dangerous for your health than all but the most severe levels of obesity, and yet being too thin is often viewed as a positive characteristic and aspirational. The internet term “thinspiration” has nearly 4 million hits, with the top sites being pro-anorexia websites, with young women sharing tips and setting dangerously unhealthy weight loss goals.

Teenage online model Essana O’Neill bravely exposed the truth behind her instagram profile, which had half a million followers, before quitting social media to focus on real life. She later posted about her insecurity, depression and body dysmorphia. But she was far from alone. Photoshopping of images in magazines has become ubiquitous. Various surveys have shown that half to two thirds of selfies shared by adults or young people on social media have now been edited.

The fact that there are now dangerously thin vloggers denying that they have a problem and giving fashion and lifestyle tips to their followers must be considered concerning. It gives a new set of easily accessible role models that parents and clinicians may be unaware of, with very large audiences of young girls. Eugenia Cooney for example has 900,000 subscribers, who are predominantly teenage girls. There are several anecdotal examples of how this has been a trigger for eating disorders in girls trying to emulate them, and given 6.4% of the population has traits of an eating disorder, with most starting in this age range, that is highly concerning.

On the positive side, there have been growing moves to prevent overly thin models being used in catwalk shows and magazines and to indicate when images used in magazines have been photoshopped (something I would strongly support), so some progress appeared to have been made to present healthier role models to young women. There are many positive messages about health and fitness out there too (personally, I particularly like the goal of being stronger rather than thinner). However, there is a huge challenge when it comes to legislation on the internet, because of the many countries that the vlogger, hosting company and viewer can be situated in. Whilst these logistical pitfalls fail to prevent propagation of eating disordered messages (or other forms of toxic content) on the internet, there is little that we can do to prevent more and more young people normalising or idealising unhealthy role models.

Another sad day

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

Terrorism revisited

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

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

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

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

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

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

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

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

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

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

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

From a paper by Silke after 9/11:

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

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

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

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

Is empathy finite? Part Two: Brock Turner

This is the second of two blogs about recent sex offences that have made the news, and is about Brock Turner. The prior blog was about prolific child abuser, Richard Huckle and can be found here. In that case, my ability to have any empathy for the perpetrator was severely tested. In this case, it isn’t my empathy that is under question (because I don’t have the same discomfort in trying to understand the position of all the different parties in this case), but that within our whole culture.

I’m sure you will all have read the story about how Brock Turner sexually assaulted an unconscious woman outside a frat party and her eloquent response to his six month sentence.

What was notable was that the case polarised the world into two camps. Either this was the fault of one individual who did something awful, or he was just the unfortunate example that got punished of a problematic culture of drinking and promiscuity amongst young adults at American universities. Here is how the two alternative stories are framed:

1) Everyone was drunk at the party and coupling off with strangers for casual sex, and that was part of what is expected at frat parties, everyone knows that. The guy was very drunk and paired off with the girl by mutual agreement. They were kissing and she consented to go back to his dorm, but they fell over and were kissing and fumbling on the ground mutually enjoying the sexual activity and he didn’t notice that she lost consciousness at some point before vigilantes interfered. He was a promising scholar and sportsman who has lost a prestigious place at Stanford and will serve six months in jail and be on the sex offenders register for life. He has been an unfortunate example of taking accepted culture one step too far and the poor guy will be paying for that for his whole life in the change in his career trajectory.

Or

2) The victim was really really drunk whilst the perpetrator was just a bit drunk, and he had a pattern of being sexually aggressive to women in similar circumstances. He had made sexual approaches towards the victim’s sister and was knocked back, so he tried it on with her and realised she was too drunk to resist (despite having a long term boyfriend she was committed to) so he led her off and she fell down unconscious by some bins on the way out. Instead of calling for help for her he sexually assaulted her injuring her genitals and would have raped her if not for the intervention of two passing cyclists who noticed her being obviously unconscious. She regained consciousness three hours later with no memory of what had happened, injured and bleeding in a hospital where she then had to be forensically examined for evidence of rape, whilst he expressed no concern for her during several hours of being questioned by police, claimed she gave consent and denied she was unconscious. She then had a year of stress building up to the trial, where she was cross examined and blamed for what happened to her. She has been traumatised for life, and this sentence sets a precedent of rape culture on college campuses being not such a big deal.

I think the evidence best supports the latter version, and the conviction suggests that the court agreed. But I think there is some truth in both stories, because as I have often said before, behaviour almost always reflects the person’s experience and the context as well as the choice that they made. There is a massive problem in modern western culture, particularly amongst young adults, in which sexual coercion is normalised and blamed on alcohol, which is consumed to excess. It is also scarily prevalent. You might call it a rape culture. About 20 million out of 112 million women (18.0%) in the United States have been raped during their lifetime. Only 16% of all rapes were reported to law enforcement. In 2006 alone, 300,000 college women (5.2%) were raped. Among college women, about 12% of rapes were reported to law enforcement. There are similar figures for the UK. And it makes me wonder – why do we not have basic empathy and respect for each other, even when we are intoxicated and disinhibited?

The culture of deifying talented sportsmen in American universities and the tendency for athletic teams to spend a lot of time together and sometimes live together also appears to have contributed to the answer. A recent study shows that male intercollegiate athletes accounted for 19% of all sexual violence cases reported but only comprised 3% of the student populations. Amongst these groups, attitudes to women are problematic. The researchers found many more “beliefs and situational definitions that excuse rape or define assaultive situations as something other than rape” in athletes. Amongst sportsmen there were also distinctive narratives. The researchers reported that amongst athletes “hypermasculine discourse includes war-like, misogynistic, and sexually violent analogies” and that this was directly related to the difference in attitudes towards sexual coercion. 29.5% of college men in the study sample had insisted on having sex when their partner did not want to, and 5% have used force and 5% have used threats to get a partner to submit to sexual activity. Attitudes toward women were less progressive and rape myth acceptance was more prevalent amongst athletes. You can see echoes of this in the letter from Turner’s father, which blames a culture of drinking and promiscuity rather than his son’s actions and displays no empathy for the victim. Likewise the same theme is present in Turner’s testimony, and in the (repugnant) letter sent to the judge by a childhood friend of Turner who claimed that the accusations levied against him were down to “political correctness”.

The truth is that whilst we can take actions to help reduce the availability and vulnerability of potential victims by helping to educate teens and young adults about the dangers of binge drinking, the main problem is in the attitudes and actions of those who use coercive sexual behaviour. In the words of an infographic from facebook, the causes of rape are 0% slutty clothes, 0% alcohol, 0% college culture and 100% rapists. And in the words of another infographic:

“She was drunk, what did she expect?” “A hangover, that’s what she expected.” Drinking isn’t a crime, rape is. Stop victim blaming.

Whatever else contributed to Brock Turner being in that position, let me quote the letter from the survivor of this incident, “we should not create a culture that suggests we learn that rape is wrong through trial and error”. We need to teach every child about privacy and consent from when they are very small to when they are adults. Here is how I explain it to young children: If somebody wants to touch a part of you that is covered by your swimming costume or to put anything in your mouth, then they need to ask you and not do it unless you say it is okay. And if you want to touch any part of another person that is covered by their swimming costume or put anything in their mouth then you need to ask them, and only do it if they say it is okay. You should only say yes to someone doing that if it is someone who needs to touch you to help with an illness or injury and Mummy or Daddy are with you and say it is okay. If anyone does something like that when you don’t want them to or it doesn’t feel right, you should always talk to me about it or someone else that you trust”. Here is how I explain it to a teenager “Don’t ever pressure anyone else or let anyone pressure you to do things that don’t feel right or comfortable to you. If you aren’t sure, you can always talk to me about it. That includes anything about sex or relationships”.

Whilst the mythology of false allegations implies otherwise, and real life is always more ambiguous than it appears in theory, consent is actually pretty simple. If somebody is in a fit state of mind to make decisions and actively says yes and reciprocates, then they consent. If that isn’t the case then they don’t. When this video came out I wondered why they needed to spell out that if a person is unconscious they can’t consent. Now we know why. It is only a basic level of empathy that is required. The golden rule of do as you would be done by. But it involved placing yourself in the other person’s perspective and understanding that the person you really want to have sex with might not really want to have sex with you, and if they did they might want to do so after a gradual progression of the relationship and without intoxication that would impair their judgement.

On the other hand, one bit of empathy is transparently clear from this case. The judge, a former Stanford athlete himself, appears to have had too much empathy for the impact of the sentence on the life of Brock Turner, perhaps because of over-identification. Whilst I respect that he was a prosecutor of sexual offences, and may also be comparing this assault (which was interrupted, and thus never progressed to what we in the UK would define as rape) to other cases from his career that involved violence or threats, and whilst it may well be that Turner has now learned his lesson and will be very clear about obtaining consent in the future, I was not persuaded by anything I have read that Turner accepts responsibility for his actions. In fact, it appears he only accepts responsibility for drinking, and not for any sexual offence. He pleaded not guilty, and amazingly, he is going to appeal even this remarkably light sentence. On that basis I believe it is important that the sentence reflects the gravity of sexually assaulting an unconscious woman, and his lack of genuine insight or remorse, as well as setting an important precedent to show that college culture or use of alcohol is not an excuse for sexual assault.

In my next blog I may talk about my own experiences of unwanted sexual contact. But for now I want to finish by remembering that two students noticed what was happening and intervened. Many people would ride right on by, and it may be that their Swedish rather than American/British norms were part of what protected this woman from being raped, but in this instance two people saw what was happening was wrong and they did something about that. And the victim has not only become a survivor, she has found her voice and used it amazingly articulately to become an advocate for all women who have experienced unwanted or coercive sexual interactions. I think that is a salient reminder that no matter how skew the norms can get within certain small pockets of society, the rest of us can still recognise right and wrong, and protect each other. However dark the world is, we are not entirely powerless. We can prevent some people from being harmed, and can help others to recover from these experiences. We might not be able to change the world immediately, but we are making slow steady progress over time, and at an individual level and at a societal level, things can be better if the rest of us play our part. No matter how overwhelming the rape culture might feel, we can all be part of the solution.

Edit: I have since read that Brock Turner may have photographed the breasts of the victim whilst she was unconscious, and another stranger may have seen him do so, then checked she was still breathing and put her into the recovery position prior to the sexual assault. If this is true, then any pretence that Turner was unaware of her being unconscious is thrown out the window. It would also appear that he had a history of drinking and using drugs prior to attending Stanford, so the attribution of the cause to the culture of drinking and promiscuity at the college seems like even more of a red herring than it did before.

Is empathy finite? Part One: Richard Huckle

There have been two challenging stories in the news this week. In the UK Richard Huckle was given 22 life sentences for sexually abusing around 200 Malaysian children, and in the USA Brock Turner was given 6 months in county jail for sexually assaulting an unconscious woman outside a frat party. Each of them has been hard to read and aspects of each case have brought me to tears. The stories have made me feel grief for the victims and anger at the perpetrators, frustration about the cultural norms that gave them opportunity and in their mind justification for their actions, and vexed at the justice systems that somehow seemed inadequate in the face of each situation. And in each case, it has been really hard to hold on to any empathy for the perpetrator, despite my strongly held belief that people are the product of their experiences and influenced by the context, rather than ‘born evil’.

Because I have read and thought so much about these two cases, and discussed them online, I thought I would write a blog post about each. This is the first of those two blogs, and is about Richard Huckle.

Make no mistake, what he has done is unthinkably awful. Genuinely evil, to the point it is hard to even comprehend. He deliberately targeted vulnerable children and babies in deprived communities for his own gratification, and shared his activities with others for financial gain through the dark web. He even wrote a manual advising other paedophiles how to sexually abuse children in less developed countries. He was clearly without conscience or empathy, or able to override any remaining scraps of either in favour of sexual gratification. The psychiatric assessments were reported to say that he justified his actions and showed no remorse. His ledger and writings on the dark web boasted about his activities. So I can understand why he got such a hefty sentence, and why many people feel he should have been tried in Malaysia where he could have got a death sentence. He has harmed hundreds of children and families, and changed the course of their lives for the worse. No sentence can ever compensate for that.

I found myself thinking that if he committed suicide or was killed by other inmates very few people would be sorry to hear the news. In fact many would argue that the cost of 25+ years in prison is money that will be wasted on an individual that is beyond rehabilitation. Comments on the internet below the breaking news stories said things like:

“Hope he rots in hell he doesn’t deserve to breath air”

“It’s time to bring in capital punishment for paedophiles. Why should we pay for his upkeep? Death is the only appropriate punishment for this creep”.

“How tragic for his father and mother, who were obviously conscientious and committed parents. It just goes to show, you can give your children a good upbringing but you simply can’t control how they turn out. This guy is a slave to his perverted sexuality and his condition is incurable. He really should be locked up for the rest of his life because he will always be a danger to children. What a terrible affliction for any human being to be born with”.

And a woman in the public gallery shouted “a thousand deaths is too good for you” as he was led away from court.

Despite all of my psychology and experience with child protection issues and knowledge that most people who harm children have been harmed themselves, I found myself hating him and feeling no empathy whatsoever. It was as if he had stepped outside of the range that my empathy could stretch. I wanted him to suffer because he had made others suffer. If I’m honest, I’m still very conflicted about it.

However, like the awesome film Arlington Road illustrates, there is rarely a lone gunman. As much as it is an attractive narrative that distances us from responsibility, I don’t think that one person in a million is randomly born evil and will inevitably do things like this. I believe there are things we can do to make such events less likely to recur over time, and it is that belief that stops me feeling hopeless and helpless when the news constantly bombards me with all the evil in the world.

When I took a step back from the emotions raised by the awfulness of what this man did and thought about what I have learned from both research and practice, I found that there are in fact lots of pieces of knowledge that can help us to make sense of what happened and what we can do to reduce the chances of it happening again. In other words, I started to think like a psychologist again, and I wanted a formulation that would help me to reach some understanding of how he got to the position of doing such evil things. Such an understanding would let me sidestep my helplessness, anger and desire for retribution, and instead focus on something constructive; doing something positive to prevent similar cases from occurring again in the future.

As I mentioned earlier, I believe that people like Huckle are a product of their experiences as well as their innate character, and their offending happens within a context. Of course I still believe in free will, and that people are culpable for the outcomes of the choices they made, and clearly Huckle made very very bad choices again and again and deserves to face the consequences of that. But we don’t make those choices in isolation. Although he was particularly prolific in his offending, Huckle was far from the only person to perpetrate child sexual abuse in the UK. In fact, there are over 100,000 people in the UK who have committed a sexual offence against a child and around 5000 new convictions are made each year. About a fifth of the population have experienced some form of unwanted sexual contact before they reach adulthood. Police recorded 36,429 sexual offences against children in the UK in 2013-14, and estimates suggest that only one in eight offences are reported. So this is a massive problem. (To put it into context, 1600 children per year are diagnosed with cancer, so sexual abuse is more than 20-180 times as prevalent). I believe that when it comes to any form of antisocial behaviour, violent or sexual crime, particularly on this scale, such actions are also an indication something is wrong in our society. It doesn’t surprise me that numbers on the child protection register are rising during this decade of ideological austerity that is widening the wealth gap in the UK. Just as suicide rates, substance use, homelessness and the incidence of mental health problems are increasing as a result of political decisions, so domestic violence and child maltreatment is rising as people fail to cope with the additional stressors imposed by benefit cuts, sanctions and reductions in public services.

There are several likely risk factors that relate to the abuser. First we know that whilst experiencing sexual abuse is neither necessary nor sufficient to create a perpetrator, the chance of sexually abusing children is increased threefold if he was sexually abused in his own childhood, and that experiencing sadistic emotional or physical abuse can also increase risk. We know little about Huckle’s family, but attachment disorganisation and the absence of any secure attachment figures seems much more prevalent amongst abusers. It is known that many sex offenders have sexual dysfunction. Isolation, low mood, loneliness and lack of social skill seems to also contribute, as do neuropsychological impairments – and Huckle was described as a loner who spent most of his time on the computer, as well as “uncharismatic” and on the periphery of things. Finally, the majority of people who sexually abuse children are religious (studies show 93% of abusers to report a strong religious identity, and around 5% of priests have been named in disclosures of sexual abuse). In between trips to Malaysia to abuse children Huckle was actively involved in the church and described himself as a devout Christian. Was that just an act, designed to gain the language and credibility to access children, or was there another motivation? Was he perhaps conflicted about his actions and trying to compensate or seek forgiveness? Or did he believe he was already going to hell, so he might as well do what he wanted in the meanwhile? Or did he have outwardly strong morals as compensation for lacking an internalised moral code? I suspect we will never know.

The part of this picture that is less often a focus of attention is the contribution of online communities to the normalising and even encouragement of abusive activities. However, we know that using the internet gives people an (often false) sense of anonymity and privacy, that brings out certain traits in their behaviour that might otherwise be inhibited because of the social consequences. On top of that certain communities have developed that collect and exaggerate certain types of behaviour. For example, the notorious bulletin board 4chan has boards within which particular patterns of behaviour from trolling to internet vigilantism (such as the hacker group Anonymous) have become the norm. Likewise certain boards have allowed the gathering of gamergaters, men’s rights activists, furries (people who like to role play anthropomorphised animals), bronies (adult male fans of the children’s cartoon My Little Pony), otaku (Japanese nerds), toonphiles (people who want to have sex with cartoon characters), adult babies, truthers (people who believe in elaborate government conspiracies, such as that 9/11 didn’t happen), those trying to give up masturbating to pornography, and many other quirky groups that would not be able to express themselves within a mainstream community. There are groups that advocate in favour of all kinds of risky behaviour from anorexia to suicide, drink-driving to barebacking (unprotected sex between men, which includes “bug-chasing” – having unprotected sex with men who are HIV positive with the intention of gaining HIV positive status). Online people can present with whatever persona they want to create. Instead of being lonely and powerless they can be charming and popular. In that context, it is not surprising that there are websites that normalise and encourage child pornography, and create demand for more content (including a financial incentive, which Huckle had used to seek crowd-funding for pornographic material he had made related to his abuse of a 3-year-old girl).

However, there is much that is unknown about the relationship between use of the internet, viewing child pornography and sexual abuse of children. Does the availability of “edgy” content pull users of legal pornography towards more extreme material that they would not otherwise access? Does the market create an increase in abuse to provide the materials that can be sold? Does viewing child pornography online become a stepping stone to contact abuse? Or does it allow potential contact abusers to meet their needs without harming additional children? Is it related to the grooming of children online? One in eight people convicted of viewing child pornography on the internet had a known history of offending against children in person but it is still unclear which is chicken and which is egg when it comes to a sexual interest in children and viewing of child pornography. But it is clear that law enforcement resources are totally outnumbered by the prevalence of child pornography online.

Finally, there are factors which make some children more vulnerable to become victims of child sexual abuse than others. These include the lack of a secure attachment figure, shame, isolation, neglect, disability, the presence of other forms of child abuse, socioeconomic deprivation, stressors placed on the family (eg unemployment, bereavement, divorce), cultures in which secrecy is encouraged or permitted, prior sexual abuse in the family (particularly if this was not reported and discussed), alcohol or substance misuse, domestic violence, and settings in which there is sexual language, pornography or exposure to adult sexual activities. These same factors make it harder for children to disclose what has happened to them, and for such a disclosure to lead to suitable protective action. Only one in eight children who experiences abuse receives any professional input to assess or intervene with it.

So there are things that we can do to mitigate the risk of future harm. We can protect future children by addressing inequality, providing more support for parenting and attachment, providing more prosocial opportunities for engagement for disenfranchised young people, being more proactive about responding to child abuse, having more investment in policing the internet so that access to child pornography reduces or is perceived as more risky. We can help victims of abuse to speak up early, to the right people, and to be believed. We can encourage the investigation and prosecution of sexual offences against children, and ensure that conviction rates and sentences are sufficient to act as a deterrent. We can specifically develop international policing solutions to address sex tourism. And most importantly of all, we can also help victims to recover from the abuse they have experienced, to feel safe and protected and develop healthy norms about relationships.

Huckle has done evil and unforgivable things. I still can’t find much empathy for the person he is now. However, if I think back to him being born, and the experiences that must have taken place to take him to the point at which he could abuse children, I am able to feel sad for that baby and angry at those who harmed him and failed to protect him or to intervene much earlier to divert him from his path and recognise their contribution to his development and the harm that he then perpetrated. And if behaviour is learnt, then no matter how unlikely, there may be a future point at which it can change. So maybe in 25 years from now it is worth reconsidering whether he still presents a risk, or whether he has gained insight and empathy that he is currently lacking. Perhaps new treatments will have emerged by then to make it possible. It seems hard to imagine that being the case. I’m usually an optimist, but for Huckle, I can’t foresee a happy ending – and I’m not sure I want to.

But there is a note of optimism in the bigger picture. Despite all the evils of austerity, and the massive burden that is creating on the wellbeing of the world population, and a few horrific cases that have been well-publicised in the media there is some progress. Sexual abuse is being talked about more, and more resources are being targeted at prevention and intervention. And there is fairly solid evidence that although there has been a dramatic spike of reports of abuse in the UK over the last two years, the overall prevalence of sexual abuse in the western world appears to be decreasing over time. Hopefully, that decrease will continue to accelerate over time, until sexual abuse really is the one in a million exception, rather than an all too present reality for a significant proportion of children.

 

Where have all the flowers gone?

This week Liam Fee’s name was added to the list of toddlers killed by their caregivers, alongside Peter Connolly, Victoria Climbie, Daniel Pelka, Ayeeshia Smith and Keegan Downer. And the newspapers have turned their gaze to their favourite post-mortem task of placing the blame. The conclusion, as ever, will be the ‘born evil’ women who killed him, and social workers who ‘failed to prevent’ the death. But that doesn’t tell the whole story.

Firstly, how can social workers prevent child deaths when their services have been cut back so much that thresholds for intervention have risen ever higher?  Social workers are over stretched and morale is at an all time low. When they intervene too much they are demonised by the press as baby-snatchers. When they don’t intervene enough they are demonised as failures who didn’t protect children. Since legal aid was slashed, court proceedings expect them to be both case worker and to cover the role of expert to the court. The social workers I know are amazing people, dedicated to helping make a difference with families, but tell me that some workplace cultures focus on form-filling and don’t allow as much time out in the field intervening with families as they would want.

Personally, I think prevention takes more than reactive services like the current remit of social work. We need proactive screening services to spot where there is need much earlier, when interventions for families are cheaper and more effective. In my opinion we need universal health visiting back, for every birth registered to be followed by mandatory visits twice a year until the kid starts school and for that to include weighing and measuring the child and seeing them in just their pants. It will also see the home environment and the relationship between parent and child. Old fashioned, maybe, but it would hopefully catch malnutrition and serious injuries earlier, and save lives in cases like these.

Secondly, what kind of lives must those two women have had that they were so un-empathic that they could witness and ignore such suffering, let alone create it? There must have been great trauma to end up like that, and a total absence of nurture. Of course no experiences are an excuse for the sadistic things they did to the children in their care. But they can help us to understand what happened, and in doing so to help prevent a future recurrence of similar issues. If we just blame it on innate characteristics of the individual perpetrators there is little we can learn to prevent the same thing happening again (except perhaps chase the fallacy of a genetic marker for evil, which I’m almost surprised is not already being done, given the overly biological focus of research topics that are clearly more influenced by experience).

I’m not convinced that anybody is ‘born evil’. I think people are born with the capacity to be a wide range of things, and their experiences (particularly their early experiences with their caregivers) determine the direction of travel, the types of skills they develop and the behaviours that are in their repertoire. Given exposure to enough trauma, a total lack of safe attachment figures, few skills and loads of dysfunctional strategies, people can end up doing awful things, particularly with a hair-trigger tendency to fight or flight under stress.

This is an evidence based position, not just my opinion as a clinician. We have known for at least a decade that childhood experience is the leading predictor of the health and social well-being, and that this applies on the individual level as well as for the nation. But as well as the self-evident human cost, there is also a huge economic cost to society. Studies show that the financial impact of child maltreatment on the economy amounts to billions of pounds per year, and the impact on lifetime health and employment is equivalent to a diagnosis of diabetes. However, the costs are hard to measure, and occur throughout the person’s lifetime so they are not as obvious.

Violence in society is neither universal nor inevitable (in fact it is almost absent amongst central Thai or Lapp society). Violence is a behaviour that is caused and can be prevented. When it comes to predicting violence, it is clear that the propensity is hugely influenced by experiences in the home before the age of 3. We also know that various interventions to improve care and the quality of the attachment relationship, or the more drastic intervention of removing the child and placing them in a household with better care are highly effective. However, there are also sociopolitical factors at play. Once the use of violence is established in a society, the levels are influenced by many factors, including:

  • Economic inequality
  • Unemployment
  • Alcohol consumption
  • Violence in the media
  • Poor housing
  • Availability of weapons

And yet, over the last decade economic inequality has increased, social housing has been sold off, and more violence has been shown in the media. More hopelessness has been created by the cuts to benefits for people with disabilities, or living in homes with an extra room. Services for people using drugs and alcohol have been cut by austerity measures whilst the need for them has increased. So the government has increased the risk of violence, whilst (as with immigration, single parents or benefit fraud) blame is being directed onto vulnerable individuals and public services.

Liam Fee, Peter Connolly, Victoria Climbie, Daniel Pelka, Ayeeshia Smith and Keegan Downer are the tip of the iceberg. There are many child deaths from maltreatment that never make the news. Best estimates based on serious case reviews suggest 40-80 deaths of preschool children are caused by their caregivers per year. And of course, many more children are injured physically or emotionally every day. For every child experiencing abuse who is known to services, eight more are going unseen. But this is not down to individuals who are born evil, and it is not down to negligent social workers. It is a socioeconomic and political problem. And whilst the media propagates the narrative of individual blame and politicians turn a blind eye, children will continue to die.

Where have all these children gone, long time passing?
Where have all these children gone, long time ago?
Where have all these children gone?
Gone to graveyards every one.
Oh, when will we ever learn?
Oh, when will we ever learn?

Why is there always a can of worms?

I’ve run http://www.clinpsy.org.uk for 9 years now, and built it up to 6900 members, 600,000 users and nearly 10 million page views per year. I’ve put enough hours into that site to add up to more than two years of full-time work, and I’m proud of what we’ve achieved. It is an informative, welcoming community that allows people to network and ask questions. It also levels the playing field of information and reduces the impact of personal connections within the early stages of the profession, and I hope that this will in the long-term act to increase diversity in the profession. Over those 9 years, members have written upwards of 135,000 posts on the forum, and our wiki of information and answers to frequently asked questions has been viewed millions of times, with some posts about preparing for interviews, the route to qualifying, formulation, writing a reflective journal, and transference proving particularly popular – the latter having been read over 115,000 times.

In all of that time we have had remarkably little need to intervene in the forum as moderators. We remove the occasional bit of spam, and we have sometimes anonymised posts in retrospect on the request of the author, and from time to time we have to explain to service users that this is not an appropriate place to ask for advice, but we rarely have to warn or ban forum users. I think the total to date is seven banned individuals and one banned organisation. Not bad when we’ve had 10,000+ sign-ups, and 135,000 posts! This is perhaps a reflection of our clear guidance about how we expect users to behave on the forum, and also of the large number of regulars who act as a more informal feedback loop. We also have quite a large number of qualified clinical psychologists who log into the forum regularly and often act to provide information and correct misconceptions. This is a very important function, as the pre-qualification arena can often become an anxiety-provoking echo chamber, where rumours are propagated and exaggerated without being confirmed or refuted. It also allows us to have a (hidden) peer consultation forum, which is a very good place to discuss concerns with peers in a safe environment in which every member is an HCPC registered clinical psychologist.

However,  the few times when intervention is necessary always tell an interesting story. And the strange thing is, that every single time somebody has been a persistent concern on the forum, this has opened a can of worms that makes us worried about wider ethical issues for the same individual. We had someone who was very unboundaried, and at times threatening to their colleagues and other members in the LiveChat space, and transpired to have caused concern with aggressive conduct in real life. We had a member who was somewhat grandiose and wanted to be a moderator, who attempted to delete and vandalise site content. They later had issues in their workplace, with a similar theme of acting beyond their level of competence. One poster lied to persuade successful applicants to share their applications for clinical training and plagiarised them, and when we identified them it transpired they had plagiarised site content into a publication without acknowledgement and had been unprofessional in numerous other ways. Another odd poster used the same username to post topless pictures on another website. And most recently we have had an organisation recurrently attempt to circumvent payment for advertising on the forum by signing up stooge accounts to promote their service, where it would appear that the appearance of an ethical non-profit organisation instead covers a profitable privately owned tour operator.

It has made me wonder whether ethics and professionalism are the kind of thing people have or they don’t, and that show in numerous domains of their life. Or, is the seeming anonymity of an internet forum a place where traits are exaggerated and played out. Either way, the association between inappropriate use of the forum and inappropriate professional behaviour in other domains seems too high to be a coincidence.

Yet the ethical and professional guidance for psychologists has little that applies in our context. We have had to work out our own boundaries amongst the moderating team (we now comprise ten qualified psychologists and a lay member, although many joined the team as APs or trainees). It makes me realise how much unique our position is, on the technological frontier, and how we are learning case by case. For example, we have had to interpret the balance between confidentiality and risk to apply to our unique setting. We settled on a position that is broadly consistent with what I’d do with clients in real life; we would identify and report a member if we felt they were at risk or presented a risk to others, but otherwise aim to respect the pseudo anonymity of using a posting ID, where only a minority of people choose to be identifiable as a specific professional, or in a way that could be recognised in their workplace. Likewise, we have learnt to log everything typed into our LiveChat space, so that we are able to review the usage of particular members, or read the content if a report is made of inappropriate behaviour. I’d like to think that we’ve reached a good place, and have always been transparent in how we behave. It has been an interesting process though, so I’m thinking of presenting some of the ethical dilemmas and our process at the CYPF conference later this year.