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of it was hard to navigate, and key documents were hard to find, the documents and information on the site were often out of date and much of the content was hidden behind walls for members and separated into silos by the Society structure that were impenetrable by topic.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

Sherlock jumped the shark

Warning: Contains plot spoilers for series 3 (and for August Rush)

I think Benedict Cumberbatch and Matin Freeman are great actors, and the BBC have made a very stylish production of Sherlock with complex and nuanced characters. Both Sherlock’s use of drugs and the relationship between the two men has been portrayed in an interesting and convincing way. I particularly enjoyed the hint of Asperger’s in the way that Sherlock can use his visual observation skills and visual memory to reason in a way that seems almost impossible to a layperson, whilst struggling with interpersonal relationships. So it was with high expectations that I watched the latest set of episodes, and found them sorely disappointing.

I should say that it isn’t the first time I’ve built up my expectations of a film or show only for the reality to not live up to them. I have long identified a pattern I call “the Total Recall effect” whereby films seem to vary in their quality according to my expectations. The first time I watched Total Recall (the 1990 original, starring Arnold Schwarzenegger) I thought it sounded like a weak premise with a wooden actor, but was pleasantly surprised. The second time I watched it, some years later, I remembered it as a good film and was sorely disappointed. The third time I watched it, after several more years,  I nearly turned it off, remembering it to be dire. However, it wasn’t that bad and I enjoyed it enough to stick with it until the end. I learnt that my expectations influenced my subjective experience; hence naming the Total Recall effect.

I also hate films that mix realism with implausibility. I’m fine with suspending belief entirely for a fantastical tale, or for enjoying the interplay of characters in a different time or place (eg I love Firefly’s futuristic western set in space) but I hate it when stories that are designed to seem within a stretch of reality suddenly take a leap into the impossible. In the film August Rush, for example, I had that experience of a semi-plausible plot jumping the shark. It was a stretch I could just about tolerate for the boy to reject family placements and stay in the care system in the hope of finding his real parents, and to then run away in search of them (despite the fact he’d have been adopted as an infant, would never have known anything but the love and belonging of his adoptive family, and wouldn’t have felt quite the same yearning). His relationship with music was beautifully captured and was the highlight of the film. But the grand finale where everything fell into place, and his parents were both seeking him and each other, and were present in the right place at the right time to hear the concert and recognised it calling to them, then recognised each other and him, made it all fall apart.

That accounts for some aspects of my disappointment with Sherlock but not all. To be honest, whilst I applaud the idea of also including female characters and narrative as a general aspiration for all media, I wasn’t a fan of Watson’s wife being an international espionage expert (it felt a bit like the second series of Heroes, where everyone got superpowers). Likewise I didn’t buy Sherlock having a sister. They felt like a step away from the source material that wasn’t in keeping with the rest. I also found it frustrating that each episode spent three quarters of its time laying out a riddle, and then wrapped it up far too quickly and neatly in the final quarter. I also felt cheated that unlike earlier shows, we didn’t see how Sherlock put together the clues to reach his conclusion. It was presented in an abstract way, a bit like magic. Viewers were left to assume that the song combined with some numbers in the graveyard could be rearranged to lead to a sentence that unlocked the location of the well. But why those graves, and how did it unlock the location – we were short-changed in the explanation.

As ever, huge amounts of trauma were included in the plot, without an appropriate scale of emotional response. The repeated prompts to be soldiers wasn’t sufficient to carry the uneven emotional responses (smashing the coffin because he had upset the pathologist, whilst being unmoved by four murders and recovering from feeling responsible for a suicide in less than a minute). Likewise later scenes showed the repair of 221b Baker Street to its former state, indicating that the explosion that would have supposedly killed Mrs Hudson in the flat below, and threw them out of the windows in bursts of flame had not only caused them no injuries, but hadn’t even penetrated the floor boards of the flat.

However, my main grumble was with the character of Eurus and the plot that surrounded her. The actress playing her was good, and the twist of her being several characters was fun, but the story and back story they gave her was appalling. This woman was supposed to have been born a dangerous psychopath, and to have spent her entire life from the age of around seven in solitary confinement as a result. She was supposed to be lonely, anxious and delusional but to express that by doing nothing for two decades and then engineering plots that skipped continents and killed multiple people without emotional response. Well I call bingo on the theme of propagating negative myths about mental health, with zero points for reality.

First, it reinforced the association between mental health problems and risk of committing crime, when people with mental health problems are much more likely to be the victims of crime. Second, it gave the impression that mental health problems are things that you can be born with, and unrelated to your life experience. For example, we didn’t see that Eurus had been emotionally and sexually abused to create her distress and anger. We saw a highly intelligent child in a highly intelligent family that felt a little left out when her brother had a friend, and as a result decided to kill the friend, then burn the house down, and wanted to kill her brother. She was portrayed as a petty and jealous child, whilst presumably nobody in this highly intelligent family was able to show her affection or to help her regulate her emotions. And nobody recognised the risk or tried to intervene in a supportive way.

Eurus was supposedly unable to tell the difference between laughing and screaming, and was portrayed as being entirely without empathy, yet she had the subtle social insight to see (from her minimal observations whilst supposedly secured in a prison island) that her brother was unable to communicate any affection for the woman who was in love with him. Then, despite the lack of normal human interaction for most of her life it transpired that she had developed sufficient mind control to reprogram others within minutes of conversation. She had never done so as a practise, or in a way that was unsuccessful or aroused concern, however. But after 20 years she had suddenly taken over the entire prison/asylum island sufficiently to get people all over the place to transport her to and from the island, to set up her murder scenarios, to dangle three men in front of the window and cut the ropes to make them fall off the cliff to their deaths. No single person in the entire staff of the island failed to fall under her thrall, or had any moral doubts about her plans that were sufficient to breach her conditioning enough to raise an alarm (whilst the prison governor was able to disobey her to commit suicide in his attempt to save his wife). And she was able to set explosives, procure sedative darts and transport Holmes and Watson to an entire set created at her old family home. And this frightened, lonely girl who had supposedly only killed a child once in a failed attempt to play was suddenly killing many as experiments to test her brothers.

Sherlock, despite his intellect and his “mind palace” of perfect visual memories, was supposed to have entirely erased the existence of his best friend being murdered by his sister, or even of having a sister at all. When he spent the evening with the daughter of the famous serial killer, he could notice the drips of water and the line on her dress from her exit from the taxi, but not the fact that she was his own sister in disguise, putting on a false accent. Likewise he could predict that Watson would be at a particular location in two weeks time, but not see anything suspect in his flirtation with the woman on the bus. Meanwhile, despite the whole of MI6 and the intellect of Mycroft being involved in her supervision, Eurus could come and go from her prison island enough to make a therapy practise that both Watson and Holmes thought to be bona fide. And in the finale, Sherlock could believe that the voice of an adult woman he had been interacting with, communicated from an attic in the rain or a prison island, was that of a small girl in a crashing aeroplane.

In short, once you apply any critical thought, this series was a woeful disappointment, despite the stellar cast, impressive budget and stylish delivery.

 

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.

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.

Everyday madness

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

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

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

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

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

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

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

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

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

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

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

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

Seeking collaborator to change the world

LifePsychol Ltd is a company with a clear social purpose – to improve outcomes for people who have experienced adversity through the application of clinical psychology, particularly children who are Looked After in public care after trauma or maltreatment. We deliver effective psychological services for Looked After and adopted children by providing assessments, formulations, therapeutic interventions, consultation, training and outcome measurement tools for placement providers. And we are very much in demand. But at the moment we are clinician led, and we really need a COO with complementary business skills as the company scales up, to ensure that we make the maximum impact going forward.

We are at a very exciting time, with the potential of rapid growth and the first evidence of efficacy for our pathway emerging. We have started the process of applying for DfE Innovation Programme funding, and we have great support from key people (Sir Martin Narey, government advisor who just reviewed the future of children’s homes in the UK, described our pathway and tools as “the missing link for the sector”, Jonathan Stanley at the Independent Children’s Homes Association described them as “the new gold standard for our members”, whilst Lord Listowell said the government should fund part of the cost to ensure there is input from a clinical psychologist in every residential care home). Despite having done no marketing, we have more enquiries about joining our system than we can keep pace with. We are already used in over 100 children’s homes, and we have a growing number of local authorities who wish to roll out our pathway across their entire catchment. We are looking at how we train and license other clinicians to deliver the model both in the UK and internationally.

We have a great clinical team, a graduate project manager/admin, a fantastic professional network and a great product set. What is important to us now is getting the right person to drive the business side forward at this critical time. To do that we really need someone with business skills and experience, combined with a passion for making social change to take on a leadership role on the financial/business side of the company. We are therefore seeking an extraordinary COO who will help us achieve extraordinary things.

Who are we looking for?

You need to genuinely care about making the world a better place, and to share our goal of making a measurable difference to the lives of vulnerable children and young people. As a clinician CEO it is vital for me to have someone I trust to bounce ideas around with, who will ensure that we are on a sound financial footing to enable us to deliver our ambitious plans. You will be familiar with all aspects of the finances for running a business, have a good working knowledge of the UK social care system and be a dynamic manager, but with a willingness to turn your hand to other aspects of the business (from fundraising to recruitment to CRM) until we are large enough to take on a full team. You understand the value of evidence-based practice and you have a good awareness of the financial demands of the social impact sector. You are the kind of person that can nail down complex ideas and grand ambitions into concrete and achievable plans that will make genuine social change.

You will ideally be based in Derbyshire at our new Matlock office and will help to develop a team there, but with some travel to other sites. However, we already have a base in Milton Keynes that I visit fairly regularly, along with existing relationships and use of shared working space in North London (Kings Cross), so if you are the right person then these might be possible alternative locations, provided you are prepared to travel regularly to meet with me in Matlock and are comfortable using video chat in between times.

How to apply

If what we are looking for sounds like you, and you are looking for a new challenge, please get in touch and we can set up a meeting. Or if you know someone that might be the right fit, please pass this information along to them. Email lifepsychol@gmail.com to express an interest. No agencies or recruiters please.

Background information:

LifePsychol currently consists of a small clinical team who provide assessment and therapy services, particularly for children and families, and services commissioned by local authorities to support Looked After Children, adoption or families at the edge of care. Our Clinical Psychologists also provide expert assessments for the family court and to local authorities considering entering proceedings. We provide consultations advice on service development and service evaluations for social enterprise and third sector organisations. Our main specialist area is around attachment, trauma and maltreatment and how this evidence base can inform the care of children who do not live in their family of origin. We therefore provide training for adoptive, foster and residential carers, as well as health, social care and legal professionals, and have a network of associates who provide regular consultation into organisations.

However, our primary goal at present is nothing less than to improve the quality of placements for all Looked After Children in the UK. LAC are a particularly vulnerable group of children and young people because their needs are complex, and often include mental health, developmental difficulties, problems with relationships and behaviour. We hope to achieve this ambitious goal by training carers and implementing a new set of standards for care providers (PRIME) and through regular use of outcome measures (BERRI).

The PRIME standards are about ensuring that strategies carers use are evidence-based, individualised to the background and needs of each child, evolve as the child’s needs change, and are based on a thorough psychological assessment and a multi-faceted formulation of the child’s needs. We believe that having advice from a clinical psychologist to inform the care of all Looked After Children (and other children with complex needs) will both reduce stigma and improve outcomes, whilst helping carers to feel better equipped to meet the children’s needs. We have developed a training program and care pathway as one means to implement these standards for placements.

We have also developed a set of online tools for commissioners and placement providers to use to identify and track the needs of children in their care. The tools are known by the acronym ‘BERRI’ because they explore Behaviour, Emotional well-being, Risk to self and others, Relationships and Indicators of psychiatric or neurodevelopmental conditions that may require further assessment or diagnosis. We want every young person with complex needs to have a service that meets their needs in an effective and evidence-based way. We have therefore developed tools that allow us to gain a more holistic picture of children’s needs, to track how this changes over time and to target particular concerns and monitor the effectiveness of interventions to address them.

Our first data suggests that we can reduce concerns about children significantly within six months of using the pathway and tools we provide, and our services gain exceptional feedback from carers and professionals, but we hold ourselves to tough standards of evidence, and gather data about our effectiveness every step of the way.

Note: The BERRI questionnaire and online tools were developed to improve the outcomes for children Looked After in public care in the UK. However, the system is also applicable to those receiving other forms of intensive or multi-agency input, such as those on the edge of care, attending special schools, placed in inpatient services, secure units or involved with services for young offenders. The system would also be equally applicable in other countries, and could be adapted to other populations (eg adults using mental health inpatient services, people with learning disabilities, or those within the criminal justice system).

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.