Planning for failure?

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

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

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

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

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

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

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

 

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

Nature versus nurture revisited

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

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

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

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

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

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

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

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

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

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

“What is your story?” Specifically:

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

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

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

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

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

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

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

The tip of the iceberg

Harvey Weinstein is the tip of the iceberg, and whilst men might be shocked about the numerous allegations and the audio recording of him persistently not taking no for an answer when inviting a woman he had sexually assaulted into his hotel room, most women I know are not. Far from it. We’ve all been there and heard that. We find it familiar. Men are socialised to believe that they need to be persistent and wear women down, rather than backing off when she expresses reluctance. There is also so much social shaming of women’s sexuality that people assume the gender norm is for women to play coy and men to have to overcome their defences.

The Daily Mail coverage* implies that any woman who talked to Weinstein, worked for him, or was pulled in for a photograph is complicit in his abuse. I think they are looking for blame in the wrong place. Whether intentionally or unconsciously, they seem to feel the need to misdirect blame as they are complicit in the objectification of women and the idealisation of powerful men regardless of their exploitative behaviour. What about looking at first and foremost at the man who is assaulting and raping women, then at  the staff who set up and cover up such actions for him, the PR and legal team who defend it, and the board who turn a blind eye to it and then finally at the social norms that allowed him (and so many men with power) to do these appalling things over and over again so for so long?

The Daily Mail coverage, and many other articles (and numerous men in the comments sections), imply it is the responsibility of the female victims to speak up, when they are the very people whose vulnerability and lack of power was exploited, and who then carry shame and traumatic memories that they have to overcome to maintain their ability to work and operate in an environment where Weinstein and men like him have all the power. That’s a really difficult ask. Women who speak up about sexual assault are dirtied by association, accused of being liars, have their sexual history raked over, and are then blamed for not fighting back, not speaking up earlier, giving mixed messages, continuing to interact with the person. There is no winning. And they have to revisit traumatic memories and tell shaming and highly personal stories that expose their vulnerability to their colleagues, friends and the general public. Anyone who speaks up is exceptionally brave. Anyone who chooses to stay silent is still not culpable for the actions of their abuser.

There is also this narrative that concerns should have been reported to the police, and that only a conviction shows an allegation is true and all else could have a multiplicity of motivations from revenge to extortion. The problem is that few examples of harassment or sexual assault have witnesses and clear cut evidence, and this narrative acts as if suspicions and personal experiences without witnesses are enough to build a case. Sadly, in my experience, without biological/medical evidence they are not. The examples that were reported to HR departments and the police led to no prosecutions and were never compiled. Even Bill Cosby with 50 allegations has only had one reach criminal charges and that reached a hung jury. Savile had allegations and rumours, and some reports to police and the BBC, yet nothing happened until after his death. The Fox CEO and lead newscaster were only dismissed after multiple allegations and have faced no criminal charges (and in fact got a $40 million parachute in the former case and continued to be endorsed by Fox despite multiple allegations in the latter). I hope things are changing for the better, and clustering of multiple independent allegations can be used as evidence in cases like this, but that has not been the case to date.

The saddest figures are the way that sexual crimes do not reach convictions by comparison to other forms of crime. I’ve read estimates that 90% of rapes, sexual assault and child sexual abuse go unreported to authorities, and that 90% of those reported do not reach prosecution, and that less than half of those prosecuted lead to a conviction. That means that 99% of perpetrators don’t get convicted – and there is bias in which ones do, as richer, more powerful and more intelligent perpetrators are much harder to convict than those facing the disadvantages of poverty, mental health problems and learning disability, who are more likely to leave evidence or confess and don’t have the deep pockets for an expert legal team to defend them.

I think the most telling detail of all in this story, is the terms of Harvey’s contract with the weinstein corporation, which cannot fire him for sexual misconduct provided he pays any compensation to victims himself to keep any costs away from the company. I mean imagine having lawyers write that in, and the board accept those terms of business. To me that suggests he knew he was a serial abuser, and so did everyone else in the company. I like this little snippet from the onion: How Could Harvey Weinstein Get Away With This?’ Asks Man Currently Ignoring Sexual Misconduct Of 17 Separate Coworkers, Friends, Acquaintances. I think it speaks to how common harassment and sexual impropriety is, how it has been normalised as something men do if powerful enough to have the opportunity, and how we are socialised to turn a blind eye to it.

I blogged a year or more ago about rape culture and my own experiences of feeling at risk of being raped. What I maybe didn’t say explicitly is that from personal experience, even without the acute trauma of a violent incident or serious assault, it is incredibly hard to speak up, and incredibly hard to get anyone to take you seriously when you do. You feel responsible for being a victim, confused, ambivalent and shamed about what happened – and, importantly, you often don’t recognise it as assault, abuse or harassment unless it is a violent or traumatic event because it has been so normalised.

Writing this I remembered another example that has stuck with me from the same era of my life. I was sixteen and in an A-level physics lesson, watching a demonstration at the front, when, masked from view by the people sitting in front of us, a boy from my class put his hand on my breast. I was shocked, but I felt like he’d have just claimed it was accidental and I was making a fuss about nothing if I said anything. I was already the only girl in the class, and I wanted to belong and be “one of the lads”. It felt like it would have been prudish to complain about something so trivial, and overreacting to interrupt the lesson to make him stop. Saying even a whispered “stop it” would have caused everyone in the class turn around and stare at me, and would have made a big scene about something small. So I said nothing. And he took my silence as compliance and did it again the next week. He waited until I was seated and stood behind me. He put his hand into my top that time. It turns out it gets harder to speak up once you haven’t the first time. So he kept doing it in every demonstration he could for the rest of the course. He was in a band with friends of mine, and I never said anything to them about it either. I didn’t tell a teacher or even consider reporting him to the police.

At the end of sixth form he and his friends were presenting silly awards at the leavers prom. They awarded me “a pair of jugs for the biggest and best female contribution to science” on stage in front of all my peers. I understood the innuendo, smiled and took the award with good humour, posing for a photo when prompted to do so, with the two measuring jugs held at chest height. Having breasts and doing science was a legitimate target for sexual humour, and not a single teacher or pupil checked in with me afterwards or spoke up to suggest otherwise. I didn’t even think of it being normalised sexism or publicly acceptable harassment. That wasn’t in my vocabulary at the time.

I didn’t speak up about the guy who plied me with alcohol and repeatedly undressed me down at the docks either. I didn’t think he had committed a crime. I think in my teenage mind his behaviour was not that different to my other experiences of persistent sexual approaches, except that I had made myself more vulnerable by being intoxicated and in a private location with him. I was acutely aware that I had kissed him in front of other people, that I hadn’t said no explicitly, and that it would be my word against his. That belief was then socially reinforced – I told several mutual friends what had happened, and the group response was to make us shake hands and pretend to get along. Years later he unexpectedly stuck my hand on his erection at a party, and I didn’t bother saying anything to anyone then either. Somehow that didn’t fit the box for sexual assault in my head either.

I’m quite a confident person, who has strong opinions and would normally speak up about issues. But as a teenager, and in context, I wasn’t able to. I felt I had to continue to allow young men who had been sexually inappropriate to me to be part of my social circle. If I had been an aspiring actress who was auditioning for a role that might kickstart my career, and when I was sexually assaulted it had been by a powerful industry kingmaker of a man with the capacity and reputation to shame me to the media or sabotage my career I can only begin to imagine how powerful the forces at play would have felt. I grew up in a progressive culture, and have the benefits of many aspects of privilege, intelligence and social support. Yet looking back I am shocked at how vulnerable I was, and how normative that is. Men are given the implicit social message that sexual dominion is the reward for status, and that women will show token resistance that they should overcome. Women, on the other hand, are implicitly trained to expect sexual advances, to see them as flattering and to look for a socially acceptable way out. We are taught not to offend men, to be polite when rejecting advances, and to feel responsible male sexual behaviour towards us, and guilty when we did not anticipate risks. The power balance is stacked in favour of the perpetrator and against the vulnerable and those lower down the hierarchy.

Sadly, society is full of powerful men who exploit women, and other people who normalise this, turn a blind eye to it, play along with or facilitate the behaviour, or continue to suck up to them for personal gain regardless of what they do to others. It is a serious social problem, and the fact that a serial sexual assaulter and overt misogynist was elected president of the USA says it all really. I am just glad that people are starting to speak out more against institutional abuse, and that perpetrated by people in power. At least this time the consequences are substantial: he has been fired, kicked out of BAFTA, his CBE is likely to be withdrawn, his wife has left him, and he has been roundly condemned by industry colleagues and public figures. The Academy of Motion Picture Arts and Sciences have kicked him out stating:

We do so not simply to separate ourselves from someone who does not merit the respect of his colleagues but also to send a message that the era of willful ignorance and shameful complicity in sexually predatory behavior and workplace harassment in our industry is over. What’s at issue here is a deeply troubling problem that has no place in our society. The board continues to work to establish ethical standards of conduct that all Academy members will be expected to exemplify.

That statement is so much better than talk of Weinstein as a “sad, sick man” entering rehab as if the cause of his bad choices was some kind of irresistible medical condition. There are other appropriate outcomes too: Police in the UK and USA are investigating rape and sexual assault allegations, and this story has allowed other victims to speak up about other actors, directors, managers and powerful men in many industries. The #metoo hashtag has shown how endemic the problems are. There are encouraging signs that victims are being believed, perpetrators are facing justice or social stigma, and cultural norms are being challenged. I hope that this momentum continues enough to make meaningful change.

And whilst I’m on my soapbox, I must mention the Twitter statement after they suspended Rose McGowan in the wake of her calling out Ben Affleck for denying knowledge of Weinstein’s pattern of sexually exploiting/assaulting women. They said

“Twitter is proud to empower and support the voices on our platform, especially those that speak truth to power. We stand with the brave women and men who use Twitter to share their stories, and will work hard every day to improve our processes to protect those voices”.

What utter drivel. Twitter have consistently failed to act on reports of harassment and have been the tool of choice employed to hound and threaten so many women. They empower hate mobs more often than providing a platform for those speaking truth to power.

Regulating and providing consequences for the content on social media according to the laws that apply to other forms of communication is a step that is desperately overdue. Publishers who profit from users on their platforms should be accountable for their response to inappropriate content that is reported. To motivate this I believe that users who are the victims of campaigns of antagonism, threats or unwanted sexual content should be enabled to seek financial redress where the platforms do not respond sufficiently to prevent such harassment.

*this is an indirect link to an image of the DM coverage, so as not to provide traffic for their horrendous clickbait content

What is wellbeing?

A typical GP appointment is 7-10 minutes long. Therefore it was no surprise to me that when I started talking to my GP about my blood pressure a couple of months ago and diverted to talk about my lack of energy, I was referred to the “wellbeing worker” linked with the practise. There was a five week wait for an appointment. I sat in the waiting room at the designated time wondering if this was a new name for a practise counsellor, or an offshoot of IAPT linked to physical health, or whether it was a specific scheme designed to get people eating better and doing more exercise. When she invited me in the wellbeing worker introduced herself and said her remit was to work with people about “diet, exercise, smoking, drug use or to improve your wellbeing”. She asked me to rate my wellbeing on a likert scale for six variables.

So I diligently explained that since being rear-ended by a lorry 2 years ago, I have not been able to make a full range of movement with my left shoulder. This meant I had been unable to continue weight lifting. I also had to have 3 teeth removed and then had a very severe ear infection, causing some other health complications I detailed in an earlier blog. I told her that I have had intermittent earache, headaches, and a feeling of being underwater, which are exacerbated by changes in pressure or getting my ears wet so I had stopped swimming. I have also had ripples in my peripheral vision and a general lack of energy and motivation. I explained that the combination has meant that I had stopped my three times a week gym-and-swim habit and reduced to a fairly sedentary lifestyle with occasional longer walks.

I mentioned that been overweight for my whole adult life, and I had drawn some psychological links to the root of this. I explained that I am fairly comfortable with the idea of being overweight but that stress may have contributed to my more recent problems. I was of the opinion that there is clearly a significant physical component to my health issues, as it has transpired I am anaemic and vitamin D deficient as well as having high blood pressure. But I acknowledged that there is also a lifestyle component, as I had reduced activity and gained weight over the preceding months, and I acknowledged a substantial stress component too.

I noticed that the wellbeing worker had not taken any notes beyond “weight” and “exercise”, so I paused and tried to clarify her role. I asked what professional background she came from, expecting to hear she was a nurse, health worker or psychology graduate. “I’m an admin” she said, and explained that she had taken the job during a reorganisation, having been told that it was predominantly administrative. She said she had initially worried about what she would do if told about problems she didn’t know the answer to, but her manager had been reassuring that it wasn’t her job to solve everything and she could report any concerns to the appropriate person.

It turned out that her job was to identify which pathway to put people onto, from a choice of weight management, exercise, smoking cessation, drugs or alcohol and then fill in the paperwork to make it happen. She booked me in for the weight management group, and gave me a referral to the local council run leisure centre for 12 weeks free membership.

Don’t get me wrong, those things are good low-level interventions. The weight management group is friendly and non-shaming, even though it is pitched at a simplistic level, and I completely endorse exercise on prescription schemes for improving physical and psychological wellbeing. But where was the space to actually talk about what was going on my life? The website for the wellbeing service says:

‘Wellbeing’ means feeling happy, healthy and content in life. Our wellbeing can be affected by our physical and mental health, the people around us, the place that we live, the money that we have and how we spend our time. Our Wellbeing Workers can help you to identify and prioritise changes you might want to make to improve your overall health and wellbeing. They offer lots of support to help inform, motivate and empower you [including through] … Support with confidence issues and to improve self esteem

They offer services to reduce social isolation and assistance to address issues such as debt, housing and education (though this branch appears to prioritise people who have an intellectual disability or socio-economic deprivation) but the only mention of mental health or psychology is in relation to the specialist branch of the weight management pathway for people with BMI over 45 and those considering bariatric surgery. There are also leaflets linked from the weight loss section of the website which talk about “finding happiness” (helpful habits) and “mastering your thoughts” (basic CBT intro) and “relaxation and stress relief” (mindfulness, visualisation/anchoring, breathing exercises). But I was never even told these existed, and even when on the website I had to use the search feature to find them, and as far as I could tell there was no connection to the local IAPT service.

Six weeks later the wellbeing worker rang me up again, to see how I was doing. But again, she didn’t really want to know how I was doing psychologically in any meaningful sense. She wanted to know if I had followed the pathways she had offered. She asked me to give the six ratings again. It felt pretty hollow giving more positive scores, as I didn’t feel like the services provided by the wellbeing service were responsible for the changes – I had lost 10lb in weight before I joined the weight management group (and 2lb since), and feel better because I have more iron, more vitamin D, lower blood pressure, more energy and less pain.

So I was left feeling that it was a service that I was glad existed, but it seemed to tackle symptoms in isolation to their causes, and didn’t seem to connect physical and mental health. I’m guessing that is because public health is still local authority commissioned, whilst mental health is within the NHS. Wouldn’t it be nice if there was a single point of entry to this kind of wellbeing service and IAPT? Surely that would reduce stigma and mean that both symptoms and cause could be addressed, and patients would be able to tackle the interwoven issues of mental and physical health together.

 

Sowing seeds

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

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

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

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

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

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

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

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

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

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

 

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

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.