opinion

Diagnosis vs difference

I read a recent editorial on LinkedIn about the way that the diagnostic criteria for neurodiversity require “impairment” in functioning for a person to reach the diagnostic threshold. It was an interesting topic for a paper, and raised a set of broader interlinked questions in my mind about whether diagnosis is a recognition of difference-from-the-norm in the way some people’s brain or body functions, or whether it is about recognising something that is harmful (like a disease), or whether it causes distress or impairment / difficulties in functioning (like a disability or mental health condition). In particular it is interesting to think about how neurodiversity fits into that framework, compared to mental health conditions or physical health conditions. It opens questions about the purpose of diagnosis and whether that is about recognition of difference and understanding ourselves, or for gatekeeping access to certain types of support. It also raises questions about terminology – whether we acknowledge that many patterns of need or difference fall on a spectrum, and what we call a disorder or condition.

As it stands, in the current diagnostic rules (DSM 5 or ICD 11) each diagnosis has a minimum set of symptoms described. For example, in the DSM for a diagnosis of autism the individual must have “persistent deficits in social communication and social interaction across multiple contexts” and two or more areas in which they show “restricted, repetitive patterns of behavior, interests, or activities”. These difficulties must have emerged early in development, and not be “better explained by intellectual disability or global developmental delay”. However, to be diagnosed, the person doesn’t just need to have the neurotype of autism or ADHD but to struggle significantly with work, life, mental health or relationships because of it. Symptoms must cause “clinically significant impairment in social, occupational, or other important areas of current functioning”.

On first glance it seems a pretty clear description that could be consistently applied, but the more I’ve thought about it the more problems I see. First of all, the impairment criteria mean that people could waver in and out of the diagnostic category according to how well they are doing in their lives at that point, how well their environment and network support their needs, or their developmental stage. For example, a person could be autistic as a child, but then find a lifestyle, job, community or other niche in which they are happy and successful, and therefore fall below the diagnostic threshold – until a change or stressful life event means that they become distressed, when they would be diagnosable once again. Or they could have very subtle challenges that would not meet the criteria in primary school, but increasingly struggle during secondary school and meet the criteria for diagnosis, but then escape the sensory overload and/or social demands of that setting and no longer meet the criteria again.

That doesn’t make much sense given that autism, ADHD and other forms of neurodiversity are currently conceptualised as lifelong, inate differences in how people process information and interact with the world, rather than conditions that come and go. Neurodiversity isn’t a disease that temporarily disrupts a person’s normal functioning and can be treated to return them to normal. Neurodiversity is normal for that person; it is intrinsic to the way they experience and interact with the world for the whole of their lifespan. A neurodiverse brain is set up with a much wider focus of attention, or more attention to detail, or more propensity for sensory overload than a neurotypical one. A person doesn’t stop being autistic or having ADHD or a learning disability even if they learn strategies to fit in better with other people’s expectations or cope better cope at school or in the workplace any more than a person who is colourblind stops being colourblind if someone provides glasses that increase the red-green contrast.

For that reason, neurodiversity doesn’t fit into the medical model of diagnosis in the same way as mental health problems that may come and go, where a diagnosis may be helpful during the period when a person is experiencing depression or anxiety or psychosis, but may cease to be relevant at a later point – as for many people the symptoms will entirely resolve (spontaneously or with treatment) and no longer impact them. In the case of a mental health condition it wouldn’t be relevant to continue to use the diagnostic label after their symptoms resolve, as the individual may return to population-normative ways of experiencing the world. If we retained the diagnosis it would lose all meaning, as about half the population would end up with it, but most of those would have no symptoms that differentiate them from those without the diagnosis.

I also wondered how the idea of impairment fits with masking. In some cases a diagnosis could be withheld from a person who subjectively feels like they are struggling enormously if they were able to mask their difficulties enough for them to not impair their ability to function in their workplace or relationships during the assessment period. Or could it be considered a signficant impairment that it is exhausting to mask difficulties? Or that the effort of masking or coping with sensory overload all day at school or work means the person then struggles to function at home, withdrawing or becoming dysregulated in a way that might on first inspection suggest the difficulty is located within the home.

However, despite all the reservations I have raised, it is possible to think about diagnosis as only being meaningful when it applies to functioning, and a label for a degree of symptoms that is outside of the normative range. Many conditions are not binary variables that are either present or absent. Illness is quite often a matter of degree rather than the presence or absence of a condition. For example, a person’s glucose metabolism can indicate that they are becoming insulin resistant, but it is only above a certain threshold that the diagnostic label of diabetes would be applied, and certain treatments would be considered. Likewise our blood pressure or weight can be in the healthy range, or below or above that, but a diagnosis is only given if it is sufficiently high to cause significant health risks. There are numerous variables where we can be tested to see whether we fall into the typical range, or whether further investigation or treatment would be benficial – from our levels of white and red blood cells, iron, vitamin D, cholesterol, hormones, to the functioning of our liver and kidneys, markers of inflammation, infection or tumours. The threshold at which doctors diagnose conditions is typically the point at which symptoms start interfering with functioning and/or the pattern identified is known to cause harm, risk or distress to the individual.

Sometimes medics have to determine appropriate treatment without a diagnostic test being available, or where there is not a direct relationship between symptoms and the scores from blood tests or scans. For example, calcific tendonitis can affect the shoulder joint causing pain, reduced movement or even functional paralysis. However, sometimes people with scans that show a lot of calcification don’t report any symptoms, and sometimes people with very little visible in the scans have a lot of functional impairment. Physiotherapy and/or steroid injections seem equally effective at treating symptoms regardless of what shows in the scans. So treatment is typically determined by impairment alone. Likewise, a woman might have lower levels of oestrogen during or after menopause, and this might be associated with certain symptoms like brain fog, anxiety, hot sweats or disrupted sleep. But there is a degree of variation in what level of oestrogen the woman’s body is used to, and the effect she will experience from it dropping that means some women glide though menopause naturally without much ill-effect, whilst others (myself included) would find it entirely disabling without HRT – and this doesn’t map directly onto the level of oestrogen detected in blood tests. For this reason, it is the pattern of symptoms rather than the blood test results that should guide treatment.

Likewise, depression is something that ocurs along a spectrum from very mild to totally disabling symptoms. As is anxiety. There are even levels of the unusual beliefs or sensory experiences that occur in psychosis that would be considered normative – such as thinking you’ve seen a person who has recently died, hearing an internal voice giving you advice, or having strange or intrusive thoughts that you are able to quickly dismiss. In the same way, arguably we are all neurodiverse to some degree – we each have different patterns of cognitive strengths and weaknesses, different ways of processing sensory information, and subjective experiences of the world. But some of us are able to function in the world more successfully than others, with some people constantly feeling discomfort, distress or having to put in huge amounts of effort to do things that others find effortless. It therefore seems logical that it is the level of impairment rather than the neurotype that determines whether a diagnostic label is appropriate – even though this brings both a level of subjectivity to the judgement of whether the label is appropriate and an acknowlegement that the degree of impairment reflects not just the qualities of the individual, but also the qualities of the environment and network that they function within.

It might be that like height or hair colour, sexuality or personality traits, our strengths and weaknesses, there are ways in which we all vary that are not “conditions” that need to be diagnosed but simply differences between individuals. If we conceptualise neurodiversity as this kind of difference, then recognising it can still be a helpful way to understand ourselves, and how we differ from others. It can also help us find our tribe – the people that share our struggles or our interests and talents.

However, all this theoretical debate misses the elephant in the room of how widening the diagnostic range helps people with more subtle impairment recognise their neurotype, at the cost of negating the experience of those with more profound impairment who had historically been able to convey their needs with a label that now gives most people a false impression of much subtler difficulties. What terminology do parents or carers of people with the “autism” described by Kanner (or at the more impaired end of the spectrum described by Wing and Gould) use to describe their pattern of needs? These individuals may be non-verbal, with significant developmental delay, very atypical ways of interacting with others, and obvious stims/stereotypies that instantly mark them out as different to members of the public. This group includes people with autism who are profoundly disabled to the point that they will need signficant financial and practical support across their lifespan – attending special schools, not being able to communicate their needs except through their behaviour, unable to reach independent living, or have the capacity to make decisions about their lives. Having an appropriate diagnostic label functions as a gatekeeper to accessing this kind of financial and practical support.

The problem being that whilst this group have used the label “autism” to describe their needs for eight decades, this is not the same population as now use the word “autism” to describe themselves on social media, to friends or in the workplace. As the diagnostic threshold has lowered to recognise more subtle impairments the label of autism has been claimed by many quite “high functioning” people to self-describe their struggles in a neurotypical world, and – because this group is more articulate and able to speak for themselves – they have come to dominate the discourse about autism, overshadowing the smaller numbers of people with more profound disabilities who had previously been described by this label. The larger number of people who are now included in the same diagnostic category but were previously given the diagnosis of Asperger Syndrome or High Functioning Autism, or seen as having difficulties that were below the diagnostic threshold, typically don’t have the moderate to profound learning disabilities, or need for support in their daily living skills as those who were diagnosed with Autism a few decades earlier. This population group might be independent, articulate, intellectually able, employed, and/or involved in interpersonal relationships including friendships and romantic/intimate relationships. Whilst it is evident that they do find some elements of life harder than neurotypical people, and it is a very helpful and affirming label that lets many people understand why they have felt different to the norm and have struggled with elements of their life, the level of support they require is not equivalent – despite the diagnosis on paper now being the same. A parallel process of widening the diagnosis has happened with ADHD and other elements of neurodiversity, to the point that 10-15% of people now identify with at least one element of neurodiversity, when historically only 1-2% of people were given these diagnostic labels.

This mismatch has therefore become the grain of truth that underlies some very toxic discussions about the growing rate of diagnosis, and the expanding numbers of people claiming disability benefits and adjustments or support within education and the workplace. With larger, more articulate and more powerful groups of voices advocating for the needs of the able end of the spectrum (who often object to any implication of there being a spectrum or such a thing as high vs low functioning or find such labels pejorative), it is hard for the voices of those representing more disabled individuals to be heard. I can understand that we need to respect the voices of lived experience about what terminology they are comfortable with. But some people don’t have voices in this conversation. And it wouldn’t be honest or fair to pretend that the needs of everyone with autism are equal.

The changing use of the diagnostic label doesn’t necessarily relate to the type or degree of support people require, and therefore it may no longer be able to function as a gatekeeper of services. That might still have to rely on an understanding of impairment – the areas in which we are struggling or require more support than the rest of the population. We can’t support everyone equally, that just isn’t viable. We also can’t allow resource rationing to lead the decisions about terminology or diagnosis. But it will have to be consideration of impairment that helps systems to differentiate what levels of support are appropriate – even if that involves subjective judgements, of functional states that are impacted by the environment, and will need to be regularly reviewed over time. Because without us evolving the right language to accurately reflect levels of need, the most disadvantaged will struggle to get their needs met at all – with tragic consequences for them, their caregivers, and the public purse. And, as Mahatma Gandhi is believed to have said, “the true measure of any society can be found in how it treats its most vulnerable members.”

Give and Take

I’ve run the clinpsy forum for 18 years, and before that I spent a couple of years as a moderator on a precursor forum. I’ve compiled and/or written about 200 wiki posts that have been viewed millions of times between them. Some individual posts have had over 100,000 page views – the most popular being a giant list of interview questions I compiled, a post about transference and counter transference, and one about keeping a reflective journal and one I wrote on clinical vignettes, followed by my post about formulation, and one about clinical interviews. There are also popular posts such as one about what to do with a low degree mark, a more general post on reflective practice, one on supervision and posts about preparing for assistant psychologist and IAPT interviews. The site peaked at about a million page views per month, but has slowed a little as technology has moved away from forums towards WhatsApp groups, and various people have tried to cultivate this audience via social media (often selling products and/or services).

I’ve never really seen running the forum as potential source of income. In fact, it has been a huge drain on my resources – I spent an hour a day for a decade building the content and community, and I’ve paid the server fees, programming, design and other costs out of my own pocket (subsidised at times by a trickle of advertising income). Even now I have to check and activate the new members, respond to emails and PMs at least 2-3 times per week. On the other hand, I have saved a little bit of money on advertising, I’ve been able to promote my own book without cost (and various courses and jobs offered by people that I know). It has given me reach that I might not have had otherwise (I’ve got about 10,000 followers on Twitter, over 5,000 on LinkedIn and this blog has had over 100,000 reads). And I’ve saved a little time in accessing information or publications. So whilst it has cost me about two years of full-time work, and about £5000 overall (plus the cost of the clinpsy URLs and the time spent on social media, but those aren’t constrained to this purpose or audience), I don’t feel like the time has been wasted.

Maybe that is because I don’t do it for the money. I’ve mainly seen it as a way to undermine the added value of nepotistic networks, where information was kept amongst a privileged few who had access to CPs. I wanted to democratise the profession, by puting that information into the public domain, and allowing equal access to sources of support for people from all different demographics. I quite intentionally undercut those who marketed to this group, by offering forum membership and access to various activities for free, and by asking only for a charitable donation for the various webinars, training days, professional development workshops and reviews of applications that I offered (with the level of donation being recommended, but the option being available to pay less or even nothing for people of low means or groups who have been traditionally excluded from the profession). That has also led me to raise thousands of pounds for charities like UNHCR, Magic Breakfasts, food banks, refugee support, and various other causes from replacing the broken electronic whiteboards at a local primary school to dementia care, to educating girls in Africa.

I also get the intangible reward of the people who thank me for the impact that the forum and/or my input has had on their lives. Their notes that say that my feedback made all the difference to them gaining a job or a place on training. Or that my workshop helped them convey their competencies more confidently at interview, or find the next step in their career. It means I am quite widely known in the profession, which builds trust and reputation. And, perhaps most importantly, there are people who have met me through the forum have later become friends, employees and colleagues.

At a few points, people have expressed interest in buying the forum off me. Sometimes that has been an easy no – like when the offer came from the owner of the profit-making travel agency that masqueraded as a charity giving people psychology experience in Sri Lanka and other developing nations. But there have been more benign offers, and now I am so preoccupied with my business, and the other moderators who helped me run the site have mainly fallen away, I do feel like the time and resources I have available to pour into it is limited, and there might be advantages in bringing new energy to the community. So I am torn between a plan to reinvigorate the community, and the idea of handing it over to a new owner.

I also wonder about the balance of give and take, and whether passing on ownership would relieve me of an undue sense of responsibility. After all, there is only one of me, and over 9000 members* and I’m also spinning quite a lot of other plates – I’m Mum of teenagers doing their GCSEs, we are in the midst of building work, and I run my own business which could use my time five times over. There is also something strange about running a forum that feels like the service I provide is taken for granted, assumed to be financed by a professional body, or is treated like public property. Sometimes people have quite unrealistic expectations – demanding immediate responses to messages, sending grumpy emails if their account is not activated right away, breaking the minimal simple rules, or complaining about moderation. People post adverts or self-promoting content without permission or payment (even though our charges are minimal and support the costs of providing the forum). It is as if they believe it is their right to post on the forum to get free promotion for their blog/website/book/course or whatever.

It sometimes feels like a lot of people put very little in but expect to take out as much as they want – asking questions but never contributing to any other discussions, or signing up to request a form review or to apply for a place on a low-cost event without ever contributing to the forum or being part of the community. I like to raise money for the charities and to give people access to information, but each form review takes me 30-40 minutes, and I currently have a queue of 47 requests – which will take about a week’s working time out of my weekends and evenings over the next month. I’d be much better off financially if I donated £1000 to the charities myself and spent the time on income generating work!

But the alternative is to give those selling services to aspiring psychologists an open market to exploit, or for me to have a paid tier of forum membership or to sell products and services, which doesn’t sit right with me, as it reinforces the privilege filter that has always biased our profession towards middle class, able-bodied, white women. Given I don’t want a website and forum full of intrusive advertising, and I haven’t got money to throw at it, the alternative is running the forum on a shoestring – which is fine when we have lots of volunteers contributing to keep the discussion lively and assist with the admin, but more difficult the more of the work I need to shoulder alone.

There are echoes of the same theme in decisions I need to make about my business. As we scale I need to decide whether we continue to bootstrap our growth, or we borrow or seek investment to grow faster (making more impact for more children, but with the cost of being pulled towards earning enough to repay a loan, or delivering a financial return for investors). I need to weigh up the value of locking in the mission to the company structure, versus optimising the business for investment. My gut instinct is to lock in our values with a pledge to prioritise impact, and to donate a percentage of profit above a certain threshold to a charitable foundation that can offer access to the tools to those that can’t otherwise afford them. But it might be that keeping a traditional company structure and taking on investment allows us to reach more children and make more impact to a wider population than we would by being too rigid and narrowing the pool of investors that would be interested.

So I need to think more about how I value and prioritise my time. I’m not sure I owe anything more to aspiring clinical psychologists than any other member of the profession does. So I wonder why I felt obligated to take up this mantle, and continue to stubbornly carry it? And why am I willing to sacrifice my leisure time, or the time I get to spend with my family or on my business, to do things with minimal personal benefit? Whilst I love that I live my values – and the way they permeate almost everything that I do – they do have costs, and I think I probably need to prioritise myself and my family a bit more. I’m not sure I’ll look back on my deathbed and think “I wish I sank more time into that website”, or “if only I had offered more professional development support to aspiring psychologists”, or “I should have achieved more with my business” rather than “I should have spent more time with the people I loved, given more focus to my health and wellbeing, and seen more of the beauty of the world”.

*I haven’t pruned off the dormant accounts for a while, so once I do this may well return to the approx 8000 figure where it has stabilised for the last decade.

Why I dislike the concept of resilience

The way people talk about increasing the resilience of children who have experienced trauma makes me deeply uncomfortable. Likewise the way we talk about people who have lived through traumatic experiences in their work, bullying or coercively controlling relationships needing to “toughen up” or learn skills to “shake it off”. Worse still, the idea of attributing better outcomes to people with a “positive mental attitude”, “determination” or “grit”. It seems to suggest that there is some inner strength that allows some people to weather trauma better than others in a way that implies that anyone who doesn’t manage to do so is somehow weaker or missing skills we need to equip them with, rather than acknowledging that how our brains and bodies respond to trauma is largely out of our control. None of us know how we will cope under adversity, or how it will affect us later down the line.

It feels like saying the outcome from the scenario in the picture above is defined by how well the character can use his shield, not by the size or temperament of the monster, the landscape, the weather, or even the character’s age, size, speed, intelligence or strength.

Resilience is defined as “the capacity to withstand or to recover quickly from difficulties; toughness” (Oxford English Dictionary) or within psychology as “the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility” (APA) and they tell us that “the resources and skills associated with resilience can be cultivated and practiced”.

I’ve got a number of problems with this.

First and foremost, I don’t think it is a helpful way to conceptualise the issue. The responsibility for the impact of trauma should sit with those who perpetrate harm*, not on victims. If you think about other forms of adversity like cancer, car accidents or crime, we work on prevention and recovery; we don’t expect people to be resilient to these things. We broadly understand that the extent of their injuries, the treatment required, the impact on their life, and the time it will take to recover, are largely out of their control. In the same way, we need to understand that there are many types of trauma, with different qualities like duration, severity, numbers of perpetrators and the degree to which it undermines trust. Each trauma is set in a different context, and impacts on different individuals, with different resources and sources of support. But even if we map the type and severity of trauma there is no direct relationship between the nature of the trauma experienced and the symptoms the individual will experience.

Secondly, the individual factors in outcomes from trauma seem to be outside of the person’s control. They are determined by chance (eg being in the wrong place at the wrong time), or our biology and epigenetic factors (eg the length of our telomeres, the protective caps at the end of DNA strands that shorten with each cell division, are impacted by our genes but also shortened by trauma), or related to the quality of our relationships (eg having any one reliable attuned relationship is protective), and our socioeconomic status (eg ability to eat a healthy diet and avoid stress) rather than to do with an individual’s mindset. Research that purports to measure individual differences often appears to measure elements that are impacted by experience. For example, one pop psychology article explains “instead of falling into despair or hiding from issues by using unhealthy coping strategies, resilient people face life’s difficulties head-on. People with resilience do not experience less distress, grief, or anxiety than other people do. Instead, they use healthy coping skills to handle such difficulties in ways that foster strength and growth, often emerging stronger than they were before”. But it seems to me that the ability to use these coping strategies depends on intelligence, relationships and past experience.

In the same way, survivor stories are often framed in terms of perseverence, bravery and determination rather than factors outside their control. I’m not denigrating the value of people with lived experience telling their stories – they are important for other people to hear to understand the nature of problems in society, and important role models that life after trauma is possible for people earlier in that journey. But we need to be careful not to extrapolate that the admirable qualities they now demonstrate were the reason they now seem to be unscathed by their experience (or part of post-traumatic growth). Actually it might have taken immense work to get to the point that their lives are going well and they are able to talk about their experiences. Just like the way the people we see most in the gym are the fittest people, the people able to talk about their experiences of trauma may be those who have the intelligence, reflective capacity, time and support to process their experiences and talk about them in a way that appeals to the audience.

Thirdly, we all tend to attribute too much of many outcomes to individual factors, and too little to external factors that come down to luck. Rich people frequently attribute their success to hard work, without realising that many people who work harder fail to reap the same rewards. Top athletes attribute their success to talent and hard work, but fail to recognise that month of birth and access to facilities play a significant part in their success (people born earlier in the school year tend to be larger and better coordinated, and therefore get more practise and experience of success that leads to greater confidence and opportunity). And it is the success stories that get told to larger audiences and seep into the culture. Was the key factor in the story of a six year old who saved his mother by alerting a delivery driver to her seizure his bravery or was it the stroke of luck that someone was around at the right moment? We like the story with internal locus of control as it gives us hope and makes us feel less powerless in the face of overwhelming or unpredictable threats.

That isn’t to say that there aren’t things that can be done to aid recovery from trauma. Of course learning to be compassionate to yourself, being able to talk about your experiences and having ongoing supportive relationships that help you recognise that what happened was not your fault are all important in aiding recovery. However, these aids to recovery should be focused on how the individual feels, rather than to what degree their distress is visible from the outside. We have learnt from social skills training in neurodiversity that looking normal to others can be performative, and something done at high personal cost to wellbeing. I think there is a risk that in some cases perceived resilience might be just how well a person can mask the impact of trauma.

*and anyone who knows about abuse and has the power to prevent or report it, but fails to do so (from politicians, heads of the church, and powerful figures in each industry through to relatives, colleagues and bystanders).

Words Matter: Prejudice, progress and professional terminology

How we talk about things influences how we think about things. Whether you believe the people arriving in small boats after perilous journeys are “illegal immigrants” (who have come here to exploit the system and harm us) or “asylum seekers” (desperate people who are seeking better/safer lives for themselves and their families) frames how you treat them. If you believe people who have complex offshore tax arrangements are “legitimate successful business people” or “tax dodgers” frames how you treat them. If you believe that trans people are “men in a dress (who present a threat to women)” or vulnerable people who desire to live in a way that is aligned to their deepest sense of self frames how you treat them. Words matter because they set the Overton window – the range of discourse that is considered acceptable in a society – which frames the prevalent perception and accepted understanding of key issues.

That is why the “culture wars” in politics and social media is so dangerous. People are being swept up into bubbles where if you believe one misleading thing (eg that the difficulties young white men now face are not being recognised because all the focus is on uplifting women and people from the global south, or that immigrants get preference for housing or benefits or are taking away job opportunities from your community) you are suddenly exposed to more and more hideous things – from the incel mindset to vaccine misinformation, transphobia, racism, islamaphobia, antisemitism, sexism, and regressive views about reproductive rights or the value of people who don’t have children – until your understanding of the world can completely detatch from the reality. Once swept into a bubble like that people end up dividing the world into allies (who think like themselves) and enemies (who think differently). To align with the allies who defended you when you faced one area of legitimate criticism is to align with all their beliefs. So otherwise sensible and progressive people can end up defending the indefensible and entrenching into deeper and deeper prejudice and antagonism. Once it becomes about alliances and identity, it seems our ability to apply any critical thinking to evaluate claims is undermined.

Yet progress has made huge strides over the decades before this recent setback. The public are broadly supportive of gay marriage, of women’s rights, of a health service funded from taxes, of a social care safety net, of the need to take better care of the environment and avoid climate change. These have been positive changes over time. There is also less tolerance of prejudice. You can see it when you watch old TV shows, and hear their casual jokes that have a sexist, racist, homophobic or transphobic edge to them, and realise that such content wouldn’t be commissioned now (and rightly so) – although portrayal of people with disabilities by actors without them persists. Problems are most obvious when we look back 50 years or more, where the issue was overt in shows like the Black and White Mistrel Show and sitcoms contained overtly racist content. Disney have had to add content warnings to some of their old films and cartoons. However, shows that were not seen as problematic in my youth have also been reviewed. Episodes of Little Britain, League of Gentlemen and the Mighty Boosh have been withdrawn for blackface. But even relatively recent content can age badly. If you rewatch episodes of Scrubs or Psych (both still highly rated and available to stream) there is content that feels really uncomfortable now. The former has had three episodes pulled for blackface. Psych remains up in full, but has repeated caricatures of people of different nationalities, and lots of casual sexism, racism and transphobia, despite being made from 2006-2014. Times have changed for the better in this regard. The acceptable discourse changing is a sign that progress is being made to reduce inequalities. Frustratingly, as I wrote in my last blog post, the last government and various figures on the right have managed to reverse some of that progress, with inflamatory discourse about immigrants, islam and trans people. Thankfully there are signs that is being addressed by the new government and that the majority of people don’t share such toxic views.

Language also matters when it comes to the terminology people use about their skills and professional status. It might sound boring and pedantic, but it is super-important to use the right words to describe yourself – especially when it comes to the terms that identify your professional status or qualifications. When I go to my GP it matters whether I get seen by a qualified doctor with five or more years of training with signficant breadth and/or depth, or another form of clinician who may only have a year or two of training and a much lower level or narrower area of expertise. If I have stress and worries, it makes a difference if I see a “wellbeing worker” who only has administrative experience or a qualified mental health professional. At the hospital it matters if it is a or “physician’s assistant” or a doctor that examines you – it can be life or death.

So when I read a CV in which someone claims to be a “Chartered member of the BPS” when they only have GBC – the graduate basis that is the first step towards gaining a qualification that could lead to later Chartered Status* – that is a problem. Yet this mistake was made by more than one applicant for one of our recent vacancies. If I read that someone is a “clinical psychologist” but they are not on the HCPC register as a practitioner psychologist, that is misleading and unlawful – yet I’ve seen three examples this month alone (in applications, and on LinkedIn profiles). I suspect that people in the psychological career paths are being impacted by the lack of clarity in the legislation and professional bodies, just as the public are, because there is no clear single source of this information. It is particularly confusing for people entering the UK from countries with different training paths, terminology and regulatory frameworks. Someone who is legitimately a “clinical psychologist” in another country can’t continue to use that title when living or working here unless they gain HCPC registration. Yet it is interesting that it isn’t as obvious as someone not being allowed to practise as a medial doctor or dentist or social worker without the right regulatory status – perhaps because the regulatory framework for psychology is so weak that if they drop the word “clinical” they are free to claim to be a psychologist with impugnity**.

It also bugs me when people self-adopt the term “consultant” because this is not protected by law and they think it will make them sound more impressive, when that title should reflect external validation of the level of responsibility of your role and expertise. I had to earn that title through a process involving a panel interview for a job with national assessors appointed by our professional body. I gained my consultant grading after many years of service gaining specialist skills with a particular client group, only when I gained a post with responsibility for a multidisciplinary team in a multi-agency context, working with highly complex presentations. Whilst the professional bodies haven’t yet resolved the issue of defining use of the consultant grade outside the NHS or large employing organisations, there are some professional recommendations and correspondence. Consultant is a term designed to mirror our medical colleagues in the NHS and is used to designate an individual who has been assessed as having attained a high level of specialist skill, doing a job with a high level of responsibility for leading a service and managing others, as well as having a deep expertise in a particular model of psychology and/or population. It isn’t obtained by time served or by specialist knowledge alone, it is a reflection of holding a post that scores above a particular threshold on the KSF – normally leading a substantial area of service delivery and being accountable for the outcomes and the team that deliver that service. For that reason, it makes me bristle to see self-employed sole practitioners who have claimed the title “consultant” either because they offer consultations or because they think they have earned it through time served or depth of knowledge of a model of therapy. That isn’t how it works. Not only was I judged to be the strongest candidate for the post and to have the required competencies to work at that level, my NHS role was judged to require consultant banding because of its level of responsibility. I have retained the title “consultant clinical psychologist” after leaving the NHS because I have continued to work in complex multi-agency contexts, leading teams and being accountable for their performance. But if individuals within my profession don’t understand and respect this differentiation, how can we expect the public (or the courts, or private service managers, or colleagues in social care or education) to understand what the terms mean, which of them are regulated and how to recognise when people are using them inappropriately and what to do about it?

I still hope that the government will grasp this nettle and regulate the title “psychologist”, require professional indemnity insurance for anyone offering therapy or mental health services to the public, and give the public much clearer information about how to find a suitably qualified practitioner who can meet their needs. I hope that this will then bring clarity for the terminology that people can use, and for public understanding of that terminology. But we are a long way from this happening. For now, I can only try to share clear information on the clinpsy forum, which continues to get millions of page views and to be one of the most accessible sources of information about the career path for clinical psychology in the UK.

*The BPS have lowered all the standards for what it takes to be a member, and how you can become chartered, so this is less and less meaningful, and they have encouraged members (even student and graduate members) to use letters after their name that I believe the public and non-psychologists would find misleading, so they are at least partly to blame.

**The issue of regulation of titles in psychology is something I feel passionately about and consider an important issue of public protection. The UK is the only country in the developed world not to regulate the term “psychologist” so this is a necessary first step. But I believe that absolutely everybody offering any form of wellbeing service to the public requires professional indemnity insurance and to be within the scope of a regulator. Otherwise people will continue to be preyed upon by unscrupulous, abusive and incompetent practitioners when they are at their most vulnerable.

The worst and the best of us

I wanted to write something about recent events. They’ve had a powerful emotional effect on me, and lots of people that I know. People who are muslim, asian or black have been particularly affected, but I think many people will have been a bit more wary of unrest or concerned about what was going on and what it means about us as a nation. I also wanted to express solidarity to those who have felt fearful over recent times, and to think a bit about what we can do going forward.

There will be those who say that commentary on recent events isn’t professional or think it doesn’t relate to psychology, and more generally claim that politics shouldn’t enter professional settings. But, as you’ll have gathered from my past posts on here, I don’t shy away from politics. I think all human behaviour is worth trying to understand, and everything is ultimately influenced by wider political issues and decisions. Mental health does not happen in a vacuum. It is related to physical health, and to our ability to meet our basic needs for safety, shelter, food and relationships. There are also numerous socio-political issues underpinning the wellbeing of individuals and the trauma that many experience, from poverty to employment stress, polarisation (“culture wars”) to waiting lists.

As anyone who has read any of my blog will know, I’m politically progressive. I’d like to think I’ve always been very active in naming the racism/islamophobia on show in person and on social media, supporting my team to think about and deal with the repercussions (and I’ve been a long-time supporter of Hope Not Hate, Stop Funding Hate and various social justice organisations). I’m also have some skin in the game. I’ve previously talked about being a second-generation immigrant myself*, but never experiencing the same prejudices as friends who are black or asian or muslim because I am white, middle class and non-religious (although I was recently rightly reminded of the way white eastern european immigrants were treated around Brexit). I also believe in the golden rule to treat others as we’d hope to be treated. If there was a massive disaster in the UK, we’d hope that another nation would let us take our family to safety there, and give us the opportunity to work and contribute and become part of the community. We can’t resent the people who move here wanting the same thing.

So where do I stand on the recent riots? As I see it, they were the inevitable consequences, not of “reasonable concerns about immigration” or the tragic events in Southport, but of ignorance and hate stoked by the far right boiling over into acts of terrorism, vandalism and aggression. What happened over the weekend was the fruition of a long process of politicians, media and hatemongers shifting the window of acceptable discourse to include racism and islamophobia, with a thin veneer of patriotism to give it cover. It is a story that began before Brexit or the Trump presidency, and is tied into the growth of social media (see my prior blog here). The riots were the symptoms of a sickness that has been intentionally cultivated and allowed to fester for too long. I have watched it grow with revulsion and a sense of powerlessness. I can only hope that the people who instigated the violence face consequences as easily as the saps who enacted it, who have already started appearing in court and await prison sentences.

On the flip-side, as always, where bad things happen, we see good people stepping up. In this case we saw people coming out in force to clear up their neighbourhoods, repair damage and guard mosques. And today we saw thousands of people turn out to face down fascism in every city there was expected to be a far right protest, donating to fundraisers to cover repair costs for vandalised libraries, shops and cars, and expressing abhorence for the rioting. I also got some joy from watching how far right figureheads were throwing each other under the bus to try to seem less personally culpable, further protests failed to materialise and the media that had stoked hate for so many years was suddenly changing its tune. It was a relief to see that the majority of the population believe in a diverse and inclusive society, not in mob rule, and that those promoting or participating in violence will face consequences.

So where do we go from here? I think the government will need to act to prevent the spread of hate and instigation of violence, by considering how they regulate it on social media and in the press. The move towards rapid and visible justice was something we need to see applied to all violent crime, as the current court system isn’t able to keep up with demand**. We need to see changes to the immigration system too – moving people who are entitled to stay rapidly into work and allowing them to integrate in communities, rather than cooping them up in hotels at the tax-payer’s expense. And we need to address poverty, health and quality of life, so people don’t feel they have missed out on progress. It is much easier to whip up hatred against foreigners when people are struggling in their own lives. If we can offer a functional health service, a benefits safety net of minimum income that means people can afford to pay their rent and bills and feed their families. If we can offer hope for the future, educate people to recognise fake news, and show the value of diversity to our society, it will be harder to whip up hatred again.

There is an illustration of three men sitting at a table that I often retweet. One man has a pile of cookies on his plate, one has a single cookie and one has none. Sometimes the man with many cookies is drawn to look like a banker or a press baron or a billionaire, and the man without as an immigrant. The man with plenty of cookies tells the man with one “careful mate, that foreigner wants your cookie”. It is an apt metaphor for how the those with the greatest wealth and power have always targeted resentment towards those with least, so that they can maintain the unfairness of their privilege. It is no coincidence that the peddlers of hate are often selfish and narcissistic millionaires and billionaires, wanting the majority of the population to focus their anger on disadvantaged groups like single mothers, immigrants or people who claim benefits, rather than looking at who is really hoarding a disproportionate share of the world’s wealth and resources***.

*My great grandparents fled religious persecution in the USSR, my parents moved continent again to avoid complicity with a regime that was racist and to take up educational opportunities, and arrived in the UK in 1969. My mum returned 40 years of service in the NHS, my dad over a decade in education/care/justice. And they had me and my brother who haven’t been too bad for the UK either – I’m an award-winning CP and social innovator working in health and care, and he’s a world-leading AI researcher. Accepting a fair proportion of people fleeing persecution is the morally right thing to do. But it also makes economic sense. Without immigration, the UK would miss out on amazing people, and essential health and care staff.

**I also think that the draconian laws about peaceful protest, especially when applied to issues like climate change, need to be reconsidered. I don’t have an issue with prosecuting those who cause disruption or damage, but I think preventing them being able to explain their reasons for doing so in court is a concerning precedent, and some of the sentences have been disproportionate when compared to other crimes.

***The scale of wealth held by the richest few is mindblowing. This illustration starts with a single pixel to represent a dollar. Remember that a billion people in the world live on less than a dollar a day. A tiny square represents the household median income in the USA of £69,000 dollars (this seems higher than UK salaries, but they have to pay for health insurance and various other costs, and get minimal paid leave, and employers don’t have to contribute to employee pension schemes). A small square is a million dollars (a level of wealth that would place you in the top 3% of the world). Elon Musk’s wealth is a block so big it seems endless.

Hindsight and reflection

When I watched The Usual Suspects, the twist at the end made me immediately re-watch the whole film. The extra bit of knowledge meant the same information from the earlier plot had entirely different meaning. The same thing happens when you realise someone has lied to you, or manipulated you for some secondary gain – you suddenly need to reappraise all the prior interactions you have had in light of this new insight. It is inevitable as we go through life that we learn additional information that helps us understand things in more sophisticated ways. Just as we learn that our parents are flawed human beings, rather than always right and almost omnipotent, a lot of relationships transpire to be less perfect when the first thrill of connection wears off. It can be quite a challenging process to understand why you were fooled, what you should have noticed, and how you could have avoided the bad feelings that come with realising all was not as it seemed.

In one chapter of my book I talk about the poem “Holes, An Autobiography in five short chapters” by Portia Nelson. It is a nice summary of the patterns we can all fall into, and how it is only reflection and insight that lets us climb out, and eventually learn to avoid falling into similar holes in the future. I found it really helpful realising that there were certain “holes” that I recurrently fall into. In particular, I was susceptible to one when others seem to need my help and support, but keep on taking without recognition of the value of that help or any cost it has for me, until I feel exploited. An early example was a student who volunteered when I was an AP, who I supported to apply for similar posts and to get onto clinical training, before becoming aware she had presented some of my work as her own, and named me as a reference for a job she had been fired from (when I wasn’t her supervisor and didn’t work there, in the expectation I’d say only positive things).

Related to this, perhaps, is my sense of myself never living up to the high expectations I set myself. It means I often assume I’ve done something wrong, until I find out that the other person is getting me muddled up with someone else, or has put the wrong time for the meeting in their diary. I feel acutely guilty if I take too long to write up the notes from a consultation, even if I’ve had time off sick or other crises to deal with. And I always first reflect on my part if there has been a misunderstanding (eg if the builder is asking for much more money than the written quote, and implies that we agreed additional costs for changes to the design – even though I know I would have kept track of that). It also made for very difficult dynamics with an AP who appeared really hard working and humble until I wrote them a reference for training, then started being increasingly critical and undermining, blaming me for their lack of progress in any of the tasks they were employed to do until I felt quite upset. It was only when I shared my feelings with trusted advisors and peers that I was able to recognise that the problem wasn’t with me. I then started to recognise I’d been gaslighted, and that if someone else makes me feel bad, I have no obligation to kept bending around them until they are satisfied.

Sometimes it isn’t new information about what happened or the other person’s motivation, but a new perspective or frame of reference that shows past experiences in a new light. I’ve reflected in past blogs about how what seemed like normal teenage boy behaviours, that were a socially acceptable way for them to show their interest in me (and portrayed in my peer group as something I should be flattered by) were actually quite inappropriate – unwanted, overly persistent and at times clearly non-consensual. Likewise, I learnt the term “stealthing” meant the guy at university who knew my consent was contingent on condom use, and made a show of using one but transpired not have to used it after the fact, was not just a selfish scumbag (as I thought at the time), but had committed a form of rape. The new insight gave a different perspective on past experiences that helped to bolster my trust in my own feelings and ethical judgements. And helped make me even more determined that I wouldn’t be complicit with these patterns again even if it means I sometimes have to risk looking emotional or being seen as a “difficult woman” when I assert my position.

From these relatively small examples in my own life, I also gained a new respect for the task of reprocessing past experiences for those who have lived through abuse and trauma. If a tiny piece of new information, or a new way of looking at things can throw my certainty about my past experiences into doubt and demand a high emotional load to process, how much more demanding it must be for those whose lives were impacted by much more serious or sustained experiences such as childhood sexual abuse, grooming, or coercive control in a relationship. It will take time and effort to reprocess their own story when they are no longer in the sway of the person who is normalising the abuse. But often we are also fighting against social norms (eg many women are socialised into accepting “grey rape” as being not the real thing, if they didn’t say a clear “no”, or were intoxicated, or went back to his place/invited him home/consented to kissing or prior sexual activity). The meaning of experience is very much in the eye of the beholder, and shaped by cultural narratives. And there are forms of cultural oppression that change our whole sense of self, such as messages from family or religious/cultural groups that lead to people not feeling able to show their authentic sexuality or gender identity (the latter issue somehow being co-opted by both TERFS and right-wing figures who see trans people as an easy target for their “culture wars”). Finding a safe place and social network in which to be your authentic self is so critical for our happiness. Even feeling okay about your body and appearance is a challenge for many people, and finding body positive role models and reaching acceptance of ourselves that isn’t conditional on weight-loss or conforming to popular beauty standards can be life-changing.

A similar shift of needing to reappraise the story by which I understand my experiences happened to me recently in terms of my own body and health. After some quite unpleasant side effects to coming off HRT, including excessive bleeding to the extent I ended up in A&E, I had an ultrasound that suggested I have adenomyosis – a thickening of the endometrium, where lining tissue is mixed in with the muscle wall. Reading up about adenomyosis I discovered that this could explain the nature and extent of the period pains I have experienced since adolescence. It might also explain my negative reaction to the Mirena/Jaydess coil (despite this being a recommended treatment for excess bleeding due to adenomyosis) and the problems I’ve had with menopause. It may also explain why I’ve been prone to gain weight, as excess oestrogen can increase fatty tissue and fatty tissue can increase oestrogen production. But the most striking new info for me was the fact it is associated with premature delivery – as I’ve carried a lot of guilt about not having managed to sustain the pregnancy with my twin daughters to full term, and I’ve never had an explanation for why this happened. So I’ve started to reevaluate what I thought were the truths of my own life and how my body operates. I’ll learn more as I follow up with the consultant gynaecologist next week, but it seems bizarre to have lived with something that has potentially had significant impact on me throughout my adult life without being aware of what it was. But women’s health has always been an area in which medicine has lagged, and for the most part when it comes to menstrual or menopausal issues we suffer quietly. I’ve blogged before about how we need to assert our needs, and yet here I am realising I haven’t done so, as I didn’t realise my experience wasn’t the norm until the symptoms became too intrusive to work around.

Health symptoms also remind us of our own mortality, and the privilege of being healthy and able bodied. Having to reappraise our plans in light of health challenges or functional limitations can be another trigger for reflective hindsight. As can the illness or death of a loved one – or a public figure like the queen. Health is not a meritocracy, and lifespan does not reflect the value of a person. We are not guaranteed to live the average lifespan. We may get more time, we may get less. If we knew today that our time was limited, would we look back and wish we had done things differently? If so, maybe it is worth reflecting on our priorities now, because time is always limited – even if I live another 50 years. I feel incredibly lucky to have spent over a quarter of a century feeling loved by someone I love, to have had the benefit of a supportive family, and to have wonderful children who I get to spend time with every day. So the big building blocks of my life are firmly in the right place. However, I’m sure that there are small changes that could help me to spend less time on work and trying to make the future opportunities we have better, and to focus on the joy available within each day. Reading back over this blog, which I started eight years ago, I can see progress in some areas (I’m much clearer about my values, and what I want to do professionally, and have a tighter focus in how I want to make impact in the world). But I also see themes where I identified the need to make positive change that are still pertinent in my life today. So I need to think why I haven’t been able to prioritise self-care more, or to get rid of the physical or metaphorical clutter in my life, and how I can make space to be creative, spend more time in nature and connect with like-minded others. Maybe I should get some more coaching or personal therapy to reflect on this.

Gaining insight about ourselves is a particular kind of opportunity to grow and learn. Whilst it can be challenging, that reprocessing of experience over time and with greater information is a core part of personal growth (and a key foundation of the scientific method – that as we understand the facts better, we look again at our working hypotheses and adjust them to fit the new information). Understanding ourselves better can help us reach greater happiness and self-actualisation, and also helps us to understand our place in relationships with others, and in the wider world. It is a key part of the journey towards both happiness and wisdom, and lets us hang onto our values, despite the storms of political decay, inequality and climate change raging around us, which could so easily lead to feelings of despair and helplessness. Maybe the key to happiness in challenging times like this is to reflect on the things that you can change, and find a way to not dwell too much on what you can’t.

I sometimes find it heartening to think about how each honey bee makes less than 1/12th teaspoon of honey in their lifetime, yet pooled together it is enough to ensure the future of the colony. It helps me to remember that to make the world better, you don’t need to solve the big stuff, just focus on doing your 1/12th teaspoon to help others. A bee won’t directly benefit from the honey she makes; instead, it will allow future generations to thrive after she is gone. This too is how we can change the world — by each doing the small things we can, and inspiring others to do likewise.

Playing the part: Some comments on political cosplay

Both Liz Truss and the disgraced PM have been pictured in the media cosplaying over recent weeks and months. Johnson dressing up as a fighter pilot, a soldier, a fishmonger, and in numerous hard hats and reflective jackets, and Liz Truss mimicking famous photographs and outfits of Margaret Thatcher have received the most coverage. But they aren’t the only ones. Priti Patel had her police jacket for her publicity shoots about immigration enforcement, and Sunak has been photographed in army camouflage, reflective jacket and hardhat, or white coat and mask during various visits, Sajid Javid likewise.

They are dressing up to play-act different roles, and carefully curating their image more generally (even when they are not overtly dressed up) to engineer public perceptions to create a desired public persona. Just as millionaire Nigel Farage likes to be pictured with a pint, play-acting an everyman whilst ranting about the elites (of which he is actually more representative), these outfits in which they don the trappings of those performing highly skilled, socially valued or manual jobs attempt to show that these posh self-serving elites identify with the working class and those who serve the country in the public sector that they are stripping bare. They want to look like they support the police, health, science, education, construction, armed forces by dressing up like them – but their actions say otherwise.

I suspect it is no coincidence that many actors have made it into positions of power (like Ronald Reagan, Arnold Schwarzenegger, Volodymyr Zelenskyy) and that politicians who wish to rise up the ranks seek out visibility on reality TV and panel shows (Johnson appeared seven times on HIGNFY, four as host). These opportunities don’t show how well they can do the job, or how well they understand key issues, but they try to make the individual likeable and human by showing their charisma and sense of humour. That plays well for those who like to be centre of attention and have learnt to entertain, but it is a poor metric for selecting people into positions of influence, where it could be argued that more serious skills (like getting on and doing a job, rather than doing something performatively or simply arriving to take credit when it is done) should take precedence. For example, Johnson ineptly mopping the floor at my local specsaver for the cameras didn’t mean that he took any helpful actions about flooding or understands the wider consequences of climate change. In fact, it merely illustrated that he is used to other people cleaning up around him, rather than doing so himself.

Over recent years, we’ve seen a move towards comments from the public and funny responses from social media becoming part of the content of news coverage and newspaper websites. The outfits, relationships and trivial events in the daily lives of celebrities are presented as headlines, alongside coverage of the war in Ukraine or the emerging international health risks from monkeypox. Superficial fluff that wouldn’t have been seen as worthy of coverage before is now everywhere, along with clickbait headlines driving traffic to advertising. News has to compete for attention more than ever before. Has reality TV and social media led to this shift away from issues of substance and judging people by what they do, towards celebrity and appearance? Or is it a deliberate tactic to make incompetence and corruption more palatable?

In Johnson’s case it not only seems intentional, but was a tactic he openly discussed in a newspaper column. The formula became wearily predictable: When news coverage about the government is negative, they create a “dead cat” story to change the conversation and focus of attention away from it. Most typically, if stories break that that he doesn’t like, he distracts attention by saying or doing something controversial. For example, when it came to light Johnson had promoted various women he has had affairs with for public funding or employment, demonstrating clear misconduct in public office, suddenly he was visiting Ukraine. Like Donald Trump, he also likes to create so much noise and controversy that he is always in the spotlight, but fact checkers and those who apply any other perspective are always one step behind and swept away in the next headline. Hence the litany of racist, sexist and homophobic quotes. You could even argue that some of the roots of the public vote for Brexit (compounded by Russian misinformation and the outright lies of the £350 million for the NHS paraded on the bus, and the racist posters of queues of refugees, and the fake threat of Turkey joining the EU) were in his made up stories about bendy bananas, condoms or vacuum cleaners being subject to EU red tape. These were amongst more than 500 misleading UK headlines about the EU prior to the Brexit vote.

But it isn’t just the stories that are weaving a fiction in which the public are encouraged to believe something other than the truth, it is the whole persona Johnson has created. Boris isn’t even his real name, or the one he uses with friends and family, but Alexander Boris de Pfeffel Johnson sounds like the posh entitled man that he is, not the the one he wants the public to see. It is well documented that he intentionally messes up his hair before TV appearances or being photographed, and he dons a silly costume for every possible publicity stunt, because he wants to be seen as that funny, harmless oaf and not as the dangerous corrupt risk to national security that appears if anyone pays enough scrutiny. In the case of the outgoing PM, it is hard to know what is beneath the construction of the scruffy buffoon he plays. He seems to have no sincerely held beliefs, to the extent he claims to have written both pro and anti-Brexit articles before deciding which one will serve him better to publish. The only constants that appear through reports about him over his professional life are his lying, his corruption and his infidelity.

So, when I see Liz Truss posing like a pound shop Thatcher, it seems to me to be a symptom of something bigger. Her history too shows weathervane opinions that shift according to what will help her access increased power. From her early Liberal Democrat politics, and her anti-monarchy speech, to her change of heart over Brexit, there is nothing that Truss will not 360 on if she thinks it is in her interest to do so. The latest shift to the far right with increasing racism and populist tax cuts that are likely to lead to both increased inflation and massive reductions in public spending is designed to please the Tory membership and secure her as the next PM. It shows she is cut from the same cloth as Johnson, and bodes badly for the country.

In some ways, the fact she is so unlikeable and insincere, coupled with the far right nature of her policies, might be helpful in the long term. The public are starting to see through the false promises of Brexit, and to see the harm that having such a self-serving government is doing to our NHS, the handling of the pandemic, our international relationships and standing in the world, and the cost of living. I hope that they will want future governments who care about standards of public life in the UK and recognise that self-interest by those with the most wealth and power harms all the rest of us, and the current incarnation of the Conservative party will never be electable again. Hopefully we are simply counting down until a general election, though I fear how much harm can be done in the interrim.

I’m also worried (after Trump and Brexit and the Johnson majority) that the public are too easily fooled by the characters that are being performed by those in and seeking power, and the biased coverage of the major newspapers. There is unprecedented lack of trust in politicians – which research suggests is not entirely unfounded. I’ve heard too many people say “but they are all as bad as each other” as if this government represents all politicians in the UK. The desperate headlines claiming Kier Starmer has millions of pounds of development land (rather than a field in which his mother keeps rescued donkeys) or that he also partied during the lockdown (rather than had a beer and takeaway where they had been working during election campaigning whilst restaurants and hotel catering were closed) seem to have made people think that nobody in politics is honest or genuinely cares about the issues affecting the population any more. I’ve even heard people equate Starmer having been honoured with a knighthood for his work as Director of Public Prosecutions to him being part of the crony establishment, like Lebedev and Johnson’s numerous other patrons who have joined the peerage.

I desperately want to believe that the next government will bring in immediate reforms to correct the course we are on. Some obvious changes would be to bring in electoral reform, to move away from the two party system in which most votes do not matter, towards a more representative system. They also need to make an independent committee to judge standards in public life, with the power to suspend and strike off any politician or public figure for gross misconduct. This could include sexual, criminal, professional or financial misconduct, serious or repeated lying, or making practical or financial gain for themselves, connected persons or donors. This should lead to prohibitions on second jobs consulting to businesses or working for them in the three years after leaving office, or on holding shares or interests in businesses that could be advantaged by their position or policy influence. I want to see immediate reforms to the House of Lords, striking out all recent appointments, hereditary peers, religious representatives and any member who has not participated sufficiently in the work of that office, and instigating transition to a second elected house which contains a wide range of subject experts. I also want to see stronger rules against misinformation, and support for the independence of the media (including the BBC and Channel 4). Social media companies should be made financially liable for harm caused through their platforms, as this is the only way they will act to prevent it.

But most of all, I want to see people I can trust in positions of power (as, it seems, do 97% of the population). I want individuals who have empathy and expertise, rather than just those with expensive educations. People who are motivated to do the right thing for others, rather than self-enrichment, and who have enough integrity to stand down if they are seen to have acted with impropriety. I want politicians who spend less time curating their image, and more time attending to the best interests of the population. Where you see the real person, not a persona they have created, and where being willing to work hard is not a costume they are putting on for the day.

Difference as a strength

I read an article recently entitled “There are no black people in Africa“. The idea seems like one of those obvious-once-you-think-about-it things that needs to be said more: People don’t inherently identify by skin colour, we identify by our culture, language, geography, function within a community etc and it is only when colonialism and migration put people in a context where they are seen as “foreign” or “different” that the labels of others (often those with power) group them with everyone else in the world with their skin colour as if this is a simple homogenous group. So in America or Europe there is a notion of “black” (or BME/BAME or BIPOC) being defined by being anything other than the majority “white” skintone, whilst in Africa or the Caribbean (or Asia) people are not defined by that (majority) characteristic, but by things that are more meaningful to them.

I agree with the author of the article that lazy stereotypes then follow from this overly simplistic labelling of others, which allow people to make assumptions about whole races or continents (eg the fictitious belief that all of “sub-Saharan Africa” comprises impoverished tribal communities reliant on western aid, whose lives bear little in common with those in industrialised nations, because all many Europeans know of these nations is the charity appeals during times of war/famine). It also ties into the white saviour thing, where people without relevant knowledge and experience arrogantly believe they can go and solve the “simpler” problems of more “primitive” countries, where their unremarkable skills will bring remarkable insights by comparison to local knowledge.

Even the language exaggerates and simplifies a multitude of difference into two categories; using white and black as polar opposite colour terms for what are actually countless shades and variants of colour from pink to deep brown. Whilst the language then links together people with wildly disparate geography and culture, simply on the basis that similar coloured paint would be used to capture a portrait – which seems a rather weird and arbitrary thing to see as a primary defining characteristic. It reminds me of arranging to meet someone at a conference that I had never met last year, where I described myself as “short, overweight, with long dark hair and a colourful dress” and the person I was meeting said exactly the same description could apply to her. We successfully recognised each other from the description, and we realised we had very similar professional interests also. However, we also realised the one thing neither of us had named was our skin colour – she was black and I was white.

I don’t think the author of the article that triggered this blog has the clearest writing style to convey his point – and he is almost certainly not the first person to name this exact thing. Nor do I think that his insights in the other articles I glanced at are unique or always right (eg other sources don’t support the 7 phrases he says we should stop using because of racist connotations) but I’m glad to have read the article, because it did really clarify some stuff I hadn’t put together myself. The fact I had not, is in the end a mark of privilege; the fact I’m not personally impacted and therefore haven’t had to do the work that so many others have to do day in and day out when thinking about race. I’m lucky to have never experienced racism, despite being a second generation immigrant (nor have I been on the receiving end of antisemitism, despite the fact my Jewish heritage carries its own burden of discrimination). I attribute that to being white and secular in appearance (I’m an atheist by belief).

As an aside: Identifying my own privileged position does make it feel awkward to write about race – there are so many things that I could get wrong, and so many people who are rightly feeling angry or depleted, or who might rather have minority voices amplified than another middle-class white woman add her two pence. All of that is true. But sometimes hearing things from a different perspective also has value, or gives the easily digested intro in familiar language that helps people to access voices with more lived experience. So I hope that if I’ve written anything that rubs anyone the wrong way, you’ll let me know so I can fix it up for others and keep learning.

Recent world events really have higlighted the extent of the problem, and how easy it is to foment division during stressful times – with Trump undermining democracy with his increasingly desperate attempts to cling to power, social media and much of the press amplifying divisive rhetoric and expressing the propaganda of their billionnaire owners, Johnson appealing to the worst elements of nationalism and the pandemic highlighting growing inequality, whilst the national act of self-harm of Brexit is reaching it’s final act. So it is no surprise that racial tensions have bubbled to the surface too, with the again so-obvious-it-shouldn’t-need-to-be-said Black Lives Matter protests gaining traction all over the world. Here in the UK the unequal death toll of covid-19, and the inequality enhancing manouvres of our xenophobic current government have really highlighted how prevalent and dangerous this unspoken level of latent racism in systems and the population really is. It is another stark reminder that what appears like a meritocracy in which everyone has equal opportunity only feels like that to those who are not weighed down by the adversities inherent in the system.

Thinking about the uneven playing field also ties into a phrase I read recently: Talent is evenly distributed, but opportunity is not. As I mentioned in a previous blog, when it comes to investment in business ideas in the UK:

  • only 1% of investment went to all-female teams, whereas 89p of every £1 invested went to all-male teams, and 10p to mixed gender teams
  • black entrepreneurs receive only 1% of funds invested in the UK
  • black female founders received only 0.0006% of the funding invested in the decade from 2009-2019, with only one black female founder in the UK reaching series A investment in that period (compared to 194 white women, and over 4000 going to all male/majority white teams)
  • female and black founders who do gain external investment, secure lower sums of money than their white male counterparts
  • 72% of investment goes to companies based in London
  • 43% of funding goes to founding teams with at least one member who attended Oxford, Cambridge, Harvard or Stanford
  • investors are 91% male, and 93% white, and only 3% of VCs in the UK are black
  • you are 13 times more likely to receive investment with a “warm introduction” from someone in your own network, which reinforces social exclusion
  • 88% of black entrepreneurs self-fund their business without external investment

Yet there are so many challenges that benefit from personal insight that might only come from certain subgroups of the community. I recently read about the founders of CapWay struggling to get investment because the venture capitalists didn’t understand that there are currently people who don’t have a bank account in the USA, for example. Imagine if the founders of Air B&B had never been broke enough to want to stay over on (or rent out) an airbed in a spare room. It gives a glimpse of what might solve a problem those who have had an easier life might never encounter. I’ve met social entrepreneurs who have explained to me the need for a mobile phone in order to identify sources of food or accommodation if you are homeless, or how much female offenders value employment and how this makes them highly dedicated employees. There are also traits that come from surviving adversity that are really helpful in an entrepreneur – being resilient, persistent, being able to juggle multiple demands at once, being grounded in the reality of customers or service users. There are also strong signs that more diverse founders lead to better returns on investment – women founders return more than men, and diverse founding teams more than all white teams. So this is very much an area that is rightly getting more attention.

In my recent business networking with other social entrepreneurs there has been a wide range of people represented in terms of gender, race, country of origin and socioeconomic class. I’ve spoken to people using their links to other countries and cultures in their business, working spanning boundaries, timezones and continents, and bringing ideas to their business from all kinds of prior experiences both personal and professional. I love speaking to people who see things from a different angle, and I am convinced that it so much more helpful to throw ideas around than simply speaking to others who have had similar life experiences to my own. It is one of the reasons I love Impact Hub, as is one of the organisations where all of us in the early stages of developing businesses with a social purpose can find equal support and a culture in which there is value in different perspectives. I’ve used them as my London base for many years, because their co-working space is so convenient for Kings Cross/St Pancras, but they have been brilliant at making an online only membership to adjust to lockdown. And living through a pandemic, I have never been more grateful for my virtual networks to keep me inspired about what I am trying to achieve.

Learn more about the inequalities in business investment here and more about Impact Hub here.

Accountability

On 31st March, a week or so after the coronavirus pandemic lockdown began, I was contacted by the HCPC.

“I am writing to inform you that we have received a concern about your fitness to practise” the letter began. “We will now carry out an initial investigation into the potential fitness to practise issues identified in the concern. This may involve gathering relevant information from a number of sources.
  
In order to assist with our enquiries, I would be grateful if you would provide the following information:
  
– Confirmation that you are the owner and/or moderator of the site ClinPsy.org.uk.
– Confirmation of whether you, or any of the other owners/moderator of the site have received any concerns/complaints about the content of the forum, particularly regarding [celebrity psychologists]
– If yes, please provide a copy of the complaint/s and the site’ s response.
– If not provided above, you are welcome to provide a brief response to concerns raised.
– Confirmation of your current employment arrangement.
– If applicable, please provide the name and email address of your line manager and HR director.

I replied the same evening:

I own www.clinpsy.org.uk I can confirm that I have never had any complaints in any form about any comment on [celebrity psychologists] on the forum – in fact I have never even heard of [the complainant], and can find no reference to him on the forum. I’m afraid you will need to let me know what comment is being complained about to enable me to respond to it.
As to my employment, I am self employed and run my own small business, so there is no line manager or HR involved – but I have to ask why you would think that relevant when a person is complaining about an unspecified comment on social media?

I then contacted my professional indemnity insurance provider and spoke to Mike Wang, chair of the ACP (he was my MSc supervisor and then my clinical course director, and we have stayed loosely in touch since then) who were both reassuring that this wasn’t a legitimate complaint. Later I got legal advice through my membership of the FSB, to check I had fully understood my legal obligations as a forum owner. All of us wondered why the HCPC would launch an investigation at all, given that I had never made a comment myself about any of the individuals named in the complaint, and the forum had been very proactive in ensuring no defamatory content was permitted. The forum does have a thread about “celebrity psychologists”, where legitimate concerns are raised about individuals who appear on television or in the newspapers making comment as “psychologists” who are outside of the scope of HCPC registration. But I could see nothing defamatory in it. In fact the moderating team had carefully checked the content and I had even posted a reply to remind people about our defamation policy and how to raise a concern. So I started to draft a full reply to the HCPC.

Just to be sure, I spent many hours obsessionally trawling through content on the forum and my social media and could find no interaction with the individual concerned, or any defamatory content about any celebrity psychologist on my forum. That isn’t to say members of the forum haven’t criticised such individuals, or that I don’t share similar concerns. Quite the opposite, I’ve been raising concerns about the limited scope of regulation for psychologists and therapy professionals for more than a decade and see this as another example of where the legislation fails to protect the public. However, I have never expressed this as a personal attack on an individual, or said anything unprofessional or defamatory.

At this juncture it might be helpful for me to note what defamation is, what a complainant can do about online defamation, and what the legal rights are both of the individual who believes they have been defamed, and the established defences against claims of defamation, as they will set this complaint in context.

Defamation is the action of damaging the good reputation of a person through the oral or written communication of a false statement about them that unjustly harms their reputation. The important part of that definition is that the statement must be false, and it must cause them harm (which must be demonstrable within 12 months of publication). Being rude about someone or insulting towards them would not normally be defamatory, though it might be unprofessional. As a website owner I am technically the publisher of the content shown on the site, and whilst I cannot be held legally accountable for other users being rude or insulting (though we have worked hard to create a professional culture and to have policies that prevent personal attacks or unprofessional behaviour), I would be accountable if something defamatory was published – if I was aware of it and failed to act to remove it when requested to do so by the individual it affected.

The problem here was that the HCPC did not share any details of the complaint with me, and the complaint communicated was entirely vague and did not refer to particular comments or even allege defamation. It was also made by a third party, rather than the individual that the complainant said had been maligned – making it rather extraordinary that the HCPC would give it even a cursory investigation.

But even with the assumption that someone had said something on the forum that an individual had felt was defamatory – which was far from the case – the law requires that individual (not a third party) to inform the publisher and ask them to remove the content, within 12 months from publication. And in this case most of the comments about celebrity psychologists had stood for 7 years, and no complaint had ever been raised with the forum – despite every post having a button to report it to moderators for review, and a prominent defamation policy that was linked by me in the very thread concerned, in a post giving the forum email address to make such a report.

There are also two main complete defences to defamation allegations; truth and honest opinion. If a statement is true it cannot be defamatory. For example, to say that a celebrity psychologist is not a registered practitioner psychologist or does not have a doctorate is not defamatory if these statements are factually correct. The other defence is that someone is expressing an honest opinion or making “fair comment”. This allows discussion of matters of public or professional interest, and means it is not defamatory to express a view that an honest person could have held on the basis of any facts or anything asserted to be a fact by reasonable sources available to them at the time. That is, if I said “Boris Johnson is a liar” this could not be defamatory because numerous sources have asserted this to be the case. Honest opinion can also be a reaction to something else that has been published, and can even defend someone posting something that is incorrect, if it was an honest belief based on the information available at the time (for example, writing “X isn’t registered with the HCPC” wouldn’t be defamatory if a person had their HCPC registration in a different name, or it didn’t show on the website yet, or the name checked was spelt incorrectly because that was the spelling used in the article under discussion).

As far as I could see, all comments that were on the forum about celebrity psychologists, or made or retweeted by me on social media, involved telling the truth or making fair comment about known or published facts.

On the other hand, my investigations showed me that the complainant was someone financially connected to a celebrity psychologist who frequently threatens properly registered mental health professionals who criticise his connection with referral to the HCPC. I also found that the individual concerned had used anonymous IDs to respond aggressively to critics of his favoured celebrity psychologists, and to place more flattering quotes and reviews about them into the public domain (and to post about her on my forum). I also heard from other colleagues who had been harassed for raising similar concerns. One noted:

“This is one of the perversities about the register and use of the title psychologist; as [celebrity psychologists] are not registered they are able to freely mislead the public about their status and not be held accountable and yet they can put in complaints to the HCPC about those of us that are properly qualified.  The complaint is vindictively motivated [and yet effective as a deterrent/punishment for critics]“

So on 2nd April I sent the HCPC a robust reply:

I have had a better look into this and I am now in a position to reply more fully.

For reference, the forum has run for 13 years and contains 152,000 posts on over 15,000 topics. We have never had a formal complaint about our content, and we have a team of moderators who are all HCPC registered clinical psychologists who help to ensure we maintain a professional tone in all content. Every user has to agree a statement about the rules of the site to sign up (which can be read here: https://www.clinpsy.org.uk/forum/viewtopic.php?f=2&t=16012) and we have written guidance for users that spells out our rules (which can be read here:https://www.clinpsy.org.uk/forum/viewtopic.php?f=2&t=10). The guidance is sent to each user in a welcome message as they sign in for the first time and cautions against personal abuse or defamation. Rules 9 and 11 specifically talk about being respectful of others even when disagreeing, avoiding defamation and ensuring posts do not risk bringing the profession into disrepute. It also explains how any post can be reported to moderators by clicking the small triangle button and stating your concerns. We have a pinned post giving specific guidance about defamation (see here: https://www.clinpsy.org.uk/forum/viewtopic.php?f=2&t=9&p=10) that is linked prominently from that guidance, and note it includes the means to contact us to report any content that is potentially defamatory at the bottom of the page: “If you believe a post has been defamatory about you, or an organisation you represent, please email us at clinpsyforum@gmail.com and we will respond as quickly as possible”. 

We have a proper process for responding to a complaint, and a team of qualified CPs who act as moderators that I consult with. However, our complaints process has only been activated once (when an approach to purchase the website turned into correspondence disputing our negative review of a travel agency offering work experience placements to psychology students, but they did not register a formal complaint and we did not find any content that was not factually supported when we investigated) and I can confirm that we have never had any complaint from any of the individuals mentioned in your email. We respond frequently to reports on individual posts, which mainly notify us of spam but can also highlight inappropriate content such as potential breaches of confidentiality. These are dealt with within 3 working days. We have never had a report in relation to defamation or to any content relevant to this complaint.

We do have one thread where [celebrity psychologists] are mentioned – you can read it here: https://www.clinpsy.org.uk/forum/viewtopic.php?f=12&t=13708. It was started in 2012 where forum members raised concerns about “celebrity psychologists” who do not have HCPC registration but appear to be giving the public the impression they are regulated professionals. The thread stood for 8 years and the majority of content was posted two or more years before I contributed to it at all. I did review the entire thread at that point and found nothing defamatory. Nonetheless my response includes the following: 

“The issue of psychological therapists who practise outside the scope of professional regulation is one that is important to many of our members who work hard to gain practitioner status with the HCPC, because we believe in the principle being important to protect the public (regardless of the individuals involved).

As with any other thread on the forum, if any of the content of this thread is considered defamatory the the individual involved is welcome to email the site (clinpsyforum@gmail.com) and point this out and we will remove it.” 

The thread was then dormant for nearly six years, before being raised to discuss the way some “celebrity psychologists” were using BPS membership to give the impression of professional qualifications, whilst apparently breaching BPS guidance. I had raised these concerns with the BPS and mentioned doing so on the forum and on twitter. However, as with the content in the thread, the concerns were about the misrepresentation of professional titles and skills, and the role the BPS take in giving credibility to psychologists who are not HCPC registered practitioner psychologists, and their lack of will to intervene or regulatory teeth when concerns are raised about these individuals. Whilst one or two of my posts are critical of specific things that [individual celebrity psychologists have] written or said I cannot see any defamatory content. I have made no direct criticism of [the individuals named in the complaint], and there has never been any mention of [the complainant] on that thread or elsewhere on the forum.

Nobody has raised a complaint about that thread. I have reviewed it today, and whilst there is legitimate concern about misrepresentation of qualifications and the public perception of psychologists, based on things written or said by various unregulated “psychologists” in the media, I cannot see anything defamatory in the content. [Far from being unprofessional, I believe we have gone above and beyond requirements to prevent defamatory or unprofessional content. I posted in that very thread] how to report any concerns about defamation, and have been mindful to allow only appropriate professional concerns about misrepresentation to be raised on the forum, rather than personal attacks or potentially defamatory content.

I do not believe that it can possibly impair my fitness to practice as a clinical psychologist to have hosted or participated in discussion about potential misrepresentation of professional qualifications by “celebrity psychologists”. This has not been defamatory, and I believe it to be legitimate for members of a clinical psychology forum to raise professional regulatory concerns about public figures – especially when these are factually based, shared by many practitioner psychologists and early career stage psychologists, and have been raised appropriately with professional bodies including the BACP and BPS. The posts on the forum that were critical of these individuals were based on the content of their newspaper columns and television appearances, how they are introduced in TV programs, and their stated qualifications and experience on their websites. For example, it is a true fact that Emma Kenny is not a clinical psychologist, despite being introduced in a BBC television series as being one, and this being a breach of the regulations that brought us under the auspices of the HCPC.

I would note that it is entirely lawful for individuals to publish honest opinions on a matter of public interest and based on facts which are true – this is known as “fair comment” or “honest opinion”, and has been tested through the courts by cases such as British Chiropractic Association vs Simon Singh, which led to the Defamation Act, 2013. This introduced a number of protections against allegations of defamation, including truth, honest opinion, public interest, and a defence for website operators hosting user-generated content, provided they comply with a procedure to enable the complainant to resolve disputes directly with the author of the material concerned or otherwise remove it. This ensures that individuals who own or run websites that allow comment are not liable for the content of other user’s comments on it. It requires that the complainant must contact the site owner or administrator to raise a complaint in which they specify the complainant’s name, the statement concerned, where on the website it was posted and explain why it is defamatory, before taking any other action in relation to alleged defamation. These complaints can only be made by the person who has allegedly been defamed or their legal representative.

We have never received any complaint or notification of potential defamation, or any communication from [celebrity psychologists] or their legal representatives, and as previously stated we have never mentioned, heard of or communicated with [the complainant]. Thus a non-specific complaint to the HCPC made by an individual who has never been mentioned on the site seems quite inappropriate as a means to address concerns. I would therefore hope that the complaint can be quickly dismissed.

Yet the case still wasn’t dismissed, despite the fact I had demonstrated that a) I had not made any defamatory comments about the individuals concerned and b) there was no legal basis to hold me accountable for posts made by others on a forum that I own (even had any been defamatory, when none of them had been).

I was then asked on 6th April to provide proof that no complaints had been made to the website. Aside from the fact that it is not my burden to prove a negative, and almost an impossible task, I spent the next 3 hours responding to this request, searching the email correspondence, administrator and moderator report logs for each name or the word complaint, and submitted screen shots of every search. These were acknowledged on the following day.

Yet the case still wasn’t dismissed.

I then heard nothing for 4 months. So I wrote on 12th August to ask whether the complaint had been dismissed. This email was acknowledged, and I was told I would receive a reply within 5 working days, but received no reply. I therefore emailed again on 20th August, which again had no reply. So on 26th August I raised a complaint.


My complaint was that this “fitness to practise concern” was obviously spurious from the start, and should never have reached the point of even a cursory investigation (given the complaint was from a person I had never interacted with, about comments made by people other than me about people other than him). But even if it did, in error, reach a cursory investigation, surely the information I provided within 3 days was enough to say “sorry, it is now clear this isn’t a legitimate complaint” and not keep me under the stress of a formal fitness to practise investigation? How this can still be hanging over my head five months later is very troubling. Surely there must be a process for checking the prima facie validity of complaints, that should have dismissed this? What if I had been employed, and this had led to me being suspended or fired? How you could do this to a person struggling to sustain their business through a pandemic lockdown over such a trivial and spurious complaint is beyond me.

On 4th September the investigation was officially closed. The HCPC informed me:

I am writing to let you let you know that we have now completed our initial investigation into the concerns we received about your fitness to practise.

During our investigation, we obtained information from the Complainant and yourself. We have now assessed the concern, and all the information we received, against our threshold criteria for fitness to practise investigations.

In doing so, we have considered whether this matter may be a breach of the following HCPC Standards of Conduct, Performance and Ethics:
2. Communicate appropriately and effectively
6. Manage risk

The outcome of our assessment is that the threshold criteria for fitness to practise investigations has not been met in this instance. This means that we do not consider that the concern, or the information we have obtained about it, amounts to an allegation that your fitness to practise may be impaired.

The reasons for our decision are explained in more detail below:

Issue 1 – comments of an offensive, bullying or inappropriate nature on social media

Registrants are not prohibited from expressing their opinions on social media, provided the content or language used is not inappropriate or offensive.

HCPC Guidance on Social Media advises Registrants: ‘ When using social media you should apply the same standards as you would when communicating in other ways. Be polite and respectful, and avoid using language that others might reasonably consider to be inappropriate or offensive. Use your professional judgement in deciding whether to post or share something.’

From the links and screenshots provided, the content of the forum appears to be confined to a discussion of professional concerns and information already in the public domain. Regarding the opinions and concerns expressed in the forum, the HCPC would be out of place to prohibit its Registrants from having a free discussion about their concerns or limit their ability to express their opinions. Of the information provided and the search conducted, I am unable to find any statements which amount to ‘trolling’  or bullying.

As our process is evidence based, we cannot proceed with our investigation without evidence to support the concerns. The Complainant was given multiple opportunities to provide evidence that you contributed to and offensive or inappropriate content, but has failed to provide information which supports the concerns.

Issue 2 – hosting comments by others of an offensive, bullying or inappropriate nature on your site

You have provided evidence that you have put multiple protections in place to ensure the tone, language and content of the forum is not defamatory and does not stray into inappropriate content or language. Where members breach these terms, you have a team of moderators who will respond.

In providing individuals the ability to report specific posts and comments, you have acted in accordance with your professional duty to support and encourage others to report concerns(SCPE 7.2). You have evidenced that you have not received complaints on this thread, and therefore have not been in a position to respond to such concerns.

In the absence of any evidence to suggest you have not complied with the relevant obligations, there is no information to suggest that your fitness to practise may be impaired.

We will therefore not be taking any further action in relation to this matter and have closed our file on this case. However, please continue to be aware of our communication guidance when reviewing your forum/website.

We appreciate that this has been a very stressful time for you and would like to thank you for your co-operation and patience during our investigation.

So, to my relief, they got there in the end and the complaint has been dismissed. However, my question is why the complaint got through the starting gates, and why it took 5 months, 2 emails and a formal complaint to resolve.

But more than this, why do the BPS continue to endorse these “celebrity psychologists” and do nothing to protect or support genuine practitioner psychologists against this kind of attack? Despite numerous complaints about “celebrity psychologist” Jo Hemmings in the context of her article about Meghan Markle being manipulative, the BPS sat her down for a chat and took her at her word that she would be more careful in future. And they’ve not replied to any of my emails in the six months since I suspended my membership, saying I would not continue membership until they responded to the concerns I raised about their endorsements not protecting the public.

And more than this, why does the legislation not distinguish genuinely qualified and accountable professional psychologists within the scope of regulation from anyone who calls themselves a psychologist? In Australia it is an offence with enormous financial penalties to misrepresent someone as a psychologist or claim to be a psychologist if not within the scope of statutory regulation. So the public cannot be misled by the media citing quacks or charlatans who claim qualifications, but actually have to check their registration before using them as experts. Here we haven’t even got that protection for who can be called as an expert witness to inform critical decisions in the courts. The scope of current regulation fails to protect the public, yet nobody – not professional bodies or politicians – seems to care.

Coping in a time of coronavirus

Are you finding it hard to adjust to the impact of Coronavirus policies on daily life? If so, you are not alone.

If you aren’t too saturated with top tips for wellbeing type posts, I thought I should share a little bit of basic advice compiled from my knowledge as a clinical psychologist and what I have read on science twitter, in case others are also struggling with the impact of social distancing and experiencing changes to their daily life that are causing high levels of anxiety.

Note: This blog is mainly targeted at those people who are staying at home and trying to comply with social distancing, rather than those of you who are doing the kind of essential work that has to continue to involve direct contact with others. If you are in that group, I’m incredibly grateful to you, but I don’t feel skilled enough to provide specific advice. If you have greater knowledge than me and would like to improve this blog (particularly in terms of the physical elements, which I appreciate will change as the situation and our knowledge base evolves) please let me know and I can fix things.

So, with that said, on with the blog.

It is a worrying time for many people, and there is a real threat that we have very little control over, and a lot of misinformation on social media. However, there are things that we can do, and you are not alone – we are all facing this together. So this is my very simple advice of where to start to ground yourself and remain as psychologically healthy as possible in these challenging times.

First the physical health stuff:

1) Do everything you can to remain safe and protect those around you. First and foremost: Get your vaccination when it is offered. Don’t be put off by scare stories about side effects, as a day or two of aches in your arm or a few hours of flu-like symptoms are a small price to pay to reduce the risks of a deadly disease. Staying safe also means following the latest guidance about lockdowns, masks and social distancing. This applies even after you have had your jab! It is still possible to get covid after you have been immunised, and whilst it is much more likely to be symptomless or very mild, you can still be part of the chain of transmission to others, especially with more contagious variants like the delta strain.

So what do we need to do? The government have put a focus on hand washing with soap for 20 seconds (make sure to wash between fingers, around thumbs and wrists and under fingernails if you have had any contact with someone who may be contagious), and remind us to cough or sneeze into a tissue or your elbow rather than onto your hands. There has also been a focus on cleaning surfaces – however the evidence of fomite transmission (droplets on surfaces) has been minimal, whilst the evidence for aerosols (tiny particles exhaled by an infected person that are airborne for several hours and accumulate in enclosed spaces) has become overwhelming. Thus the key prevention strategies are to wear a mask when entering shops or public indoor spaces, and to follow the rules about physical distancing. This means not greeting people with handshakes, hugs or kisses and standing or sitting further away from them than we would previously have done. Minimise your face-to-face social interactions with people outside your household bubble, and try to ensure you only interact with larger groups of people in a safe way – ideally outdoors or in a well-ventilated space. Unless you work in an essential role this means avoiding crowded events and places, not meeting up in large groups, and trying to remain 6 feet away from others, especially anyone outside of your minimum necessary network. Wear a well-fitted mask in any enclosed space apart from your home – try not to put it on and take it off more than you have to, and avoid touching the mask except by the strings.

2) Be aware that Covid-19 is potentially dangerous, so it is really worth preventing contagion if possible. Even if you are not concerned about the impact of covid on yourself, each of us interacts with people who are older or clinically vulnerable – whether that is elderly parents or grandparents, people with chronic or acute medical conditions (eg cancer, heart disease, diabetes, immune disorders, physical or learning disability, obesity, asthma) whether we are aware of them or not. People we know might also be carers for individuals with these clinical vulnerabilities. In fact 3.7 million people in the UK are regarded as clinically extremely vulnerable, and many of them remain very anxious about the risk of catching covid, even if immunised, despite the fact that the official advice to shield has been lifted.

Covid is worth avoiding as even if you are not in a vulnerable group you can pass it on to others, plus – even within the group that are considered to have had only mild symptoms – it makes some people feel like a very bad flu with aches and serious chest pain/breathing problems, and can lead to weeks or even months of tiredness or recurrent symptoms in some people known as “long covid”. However, for many/most people it may not be obvious that you are ill at all, let alone with a serious condition.

If you test positive, or if you have a dry cough or fever, or if you lose your sense of smell or taste, or if you feel suddenly exhausted/weak, you need to get rested and to self-isolate to prevent spread of the virus. You must also minimise risk of transmission until you have been tested if you have had contact with someone else who has subsequently tested positive for covid, to break the chain of transmission. If you have school aged children you will be asked to complete lateral flow tests twice a week, but be aware these are not as reliable as other tests and can lead to both false positives and false negatives.

3) Take extra care over social distancing if you have an existing health condition or are elderly, or if this applies to anyone else in your household or if you are interacting with or providing services to someone vulnerable (as well as older age this could include more serious medical conditions like cancer, but also ones that are not normally seen as a big impairment to daily life like asthma, heart disease or obesity, particularly in combination). Ensure you have enough medication, and keep taking preventers if you are asthmatic. If you are in a high risk category and there is a high level of prevalence in your area, then where possible have deliveries dropped off without interpersonal contact. If you need to interact with others or use shared facilities, wash your hands and surfaces that others touch frequently (eg door handles, railings, keypads, taps, etc) with soap or sanitiser regularly and wash your hands after using them.

4) Remember that viral load may be important in how severely people experience the virus, and ensure that you take precautions when caring for a dependent with possible coronavirus, or if you think you have it, even if the symptoms are mild. A mask is particularly important in this situation, along with good ventilation, careful handwashing and ensuring you avoid physical contact, which can be challenging with a loved one or small child. Anyone ill or who knows they have been exposed to someone who definitely had Covid-19 should stay separate from the rest of the family as much as possible. This needs to be for at least 7 days after testing positive if you have had no symptoms, or for 7 days after you stop having symptoms. Where someone is ill but needs care use PPE such as a well fitted mask and disposable gloves, use as much ventilation as possible, and keep washing your hands.

5) Although the government are telling us to act as if covid is no longer a problem, we don’t know if there will be additional waves of new variants of covid, or whether future variants will break through the protection offered by immunisations. Covid is also still causing preventable deaths and lasting health impacts for large numbers of people, as well as causing large numbers of people (including health and care staff) to self-isolate. Combined with the impact of Brexit and chronic underfunding the NHS is creaking at the seams. We need to ensure that the NHS can catch up with the level of need for other conditions, and is ready to cope with an increase in demand if required.

Politicians and NHS managers need to act to grow the capacity of the NHS by addressing the funding and recruitment issues. However, each of us can play our part by reducing our risk of spreading the virus or adding to NHS demands in other ways. This means we should aim to slow the spread of coronavirus (by getting immunised and using sensible precautions) so that the rate of people requiring hospital treatment doesn’t exceed NHS resources, and lower the baseline demand for NHS services. We can do this by avoiding preventable reasons for requiring hospital care. This means taking care of your physical health and existing health conditions (eg taking preventative medication/inhalers, following dietary advice for diabetes or high blood pressure), being mindful to reduce risk of accidents (eg drive slowly in built up areas, be extra cautious to avoid falls and injuries) and improving your respiratory and cardiovascular health (eg give up smoking, increase exercise, eat healthily, and attempt to lose weight if you are obese).

But importantly you need to care for your psychological health too.

6) Connect with loved ones (physically if you are in the same household and nobody has symptoms, but virtually or with social distancing precautions otherwise) so that you do not feel alone. Hug your kids or your partner if you are together, or speak to them as frequently as possible if you are apart, and listen to how they are feeling. Check in with people who might be isolated and with those who have been bereaved or have had serious ill-health, traumatic experiences, or have lasting symptoms from covid. Keep in touch with your relatives and usual network via phone, social media, email or video chat. Make the effort to speak to your colleagues even if you are all working from home, keep in contact with your friends even if you can’t gather in person. Confide in the people that you trust.

7) Acknowledge that what we are going through is tough, even if you feel lucky not to be having to deal with it face on like those working in health and social care or doing supply chain or deliveries. Trust your own gut about what level of potential exposure to the virus you feel comfortable with, and don’t let anyone make you feel bad if you don’t want to go back to face-to-face work or social events. Change is challenging, the perceived threat is intangible and unknown, so it is hard to reason with the anxiety it provokes, and uncertainty is stressful. The changes imposed on us to manage the outbreak take away some of our comforting routines and our expectations of the immediate future, and it is normal to worry about the impact on ourselves and loved ones. It is absolutely normal to feel shock, denial, anger, fear, grief, or a mixture of feelings and for these feelings to ebb and flow or change unpredictably (think about the Kubler-Ross stages of grief). You might find yourself literally shaking and/or crying at the idea of having to do something you don’t feel ready for, or you might feel nothing at all. Be kind to yourself, and give yourself time to adjust.

8) Manage your own anxiety. First and foremost, breathe (there are some good little graphics and apps about). Then make sure that you take care of yourself by doing all the basic things that we need; eat, sleep, exercise. Try to avoid increased use of alcohol or drugs, including smoking. Give yourself a routine. Confide your feelings in those you trust, or seek out support if you need it. Join in online mindfulness or therapy groups, or – if the anxiety is becoming a problem for you – seek out personal therapy from a suitably qualified professional. If you have a garden or safe outside space, get out there and appreciate the elements. If you don’t, try to sit near a window and let some fresh air in as often as possible, and leave the window open when the weather isn’t too cold. Exercise and relaxation are both important. The former can burn off negative neurochemicals and produce more positive ones, and the latter can help you to soothe yourself (so indulge in a long bath, or listen to a relaxation video). Likewise sex (or masturbation) is good for our neurochemistry, can maintain intimacy in a relationship through a stressful period and/or help you to sleep.

9) Limit news consumption and stick to reliable sources. If you are feeling anxious you might want to learn everything about Covid-19, but whilst this can bring some temporary relief, too much focus on the potential threat can be counterproductive and increase your anxiety. So try to limit how much time you spend on news sites or social media, and ensure that you check the sources of what you do read as there are many seemingly plausible articles and posts that are not true doing the rounds. The BBC, World Health Organisation, official government sources or a trusted newspaper (for me that means the Guardian or the Independent) are probably more trustworthy than celebrities, social media influencers or some politicians. Don’t get your information about the outbreak from social media unless you have personal connections with medical/epidemiology experts and are very skilled at evaluating the quality of the sources and understanding the limitations to individual studies. If covid content makes you anxious but you like connecting over social media, you might wish to use your preferences to tune out posts using terms like “pandemic”, “coronavirus” and “covid”, so that you can focus on more positive content.

10) Keep busy. Give yourself small goals and structure your time into small chunks, rewarding yourself for small achievements. Be mindful about what you are doing, and give it your full attention. Don’t let yourself ruminate, or slouch about in your pajamas all day. If possible, make sure that you sleep when it is dark and are awake for natural daylight. Stick to routines of mealtimes and maintain as many of your normal activities as possible. If you are unable to work or have less work to do, see this as an opportunity to do things you wouldn’t otherwise have time for. Try to find enjoyable activities or those that keep your mind occupied, whether that is arts/crafts, reading, gaming, sorting/tidying, decorating, programming, writing, making or listening to music, watching films/telly or learning something new (there are loads of fab free courses online).

11) Turn your focus towards the practical things you can do. For me that means trying to increase my cardiovascular fitness and lose some weight, because my pre-existing conditions mean I’m at greater risk, and my lack of fitness compounds this – so I’ve been trying to run up and down the stairs first and last thing each day, and each time I feel particularly anxious. This gives me a sense of doing something positive and it can be rewarding to see yourself making progress. You can choose an activity that suits your starting level of fitness, get out and walk or cycle or there are fantastic exercise videos of all sorts on youtube, so why not try some zumba or yoga or calisthenics. Or improve your living environment, or create or improve a garden or vegetable bed. These kinds of things will give you a tangible feeling of achievement and improve your quality of life.

12) Be kind to others. Manage your anxieties before you speak to children, answer any questions they might have and help them to feel safe and loved. Try to be kind and patient if children are off school, and don’t put too much pressure on them to do academic work until they are in a calm enough emotional state to do so. Listen to loved ones and empathise with their experiences, even if they feel differently or are responding in a different way to you. If there is a spate of panic-buying (whether of toilet rolls, fuel or fresh produce) try not to buy more than you need, so that others can get some of key items too. Thank delivery workers, supermarket staff, carers and other essential workers, and don’t pass on frustrations about lack of stock or delayed/cancelled deliveries to them as they are doing their best. Reach out and make connections to those who might be lonely. If you are young and healthy try to be particularly considerate towards those who are not – keeping in touch with older relatives and friends or those with disabilities and/or health conditions whilst keeping them away from contagions. Join neighbourhood networks or the NHS volunteers list. Leave a note with contact details for vulnerable neighbours in case they need help with shopping or collecting prescriptions, or someone they can speak to on the phone or through the window if they feel isolated. Donate to food banks and local charities if you can afford to do so. Shop with smaller companies and local traders where possible.

13) Take time to be grateful for what we have. If you have people who love and care about you, appreciate them. If you have pets that share your life, pamper them. If you can access nature, take time to enjoy that. If you have had the opportunity of education and can continue to learn, value that. Remember that we live lives of relative plenty. Most of us have relatively secure places to live in locations with relatively good health services to fall back on if we need them. Many of us have meaningful work to be involved in, and live in developed nations with some form of social security to fall back on and/or within networks that would support us in a crisis. So although there are greater challenges in our daily lives due to the pandemic (or Brexit and an inept/corrupt government), we still have a lot to feel grateful for. Focusing on the positives helps you put the challenges into perspective.

14) Know that we’ll solve this in time. So many brilliant people are working together to address this new disease. Health care professionals are doing brilliant work all around the world. Scientists are hard at work exploring faster and more effective tests and treatments. New drugs are being developed at a faster pace than ever before, and well-established medicines have been found with positive effects on disease severity/duration. Uptake for immunisations has been good enough to massively reduce mortality. We have tests to show who is contagious. Immunised people (and those who have had covid) are less likely to be a vector for transmission, so rates of infection are likely to fall over time. Air filtration devices are being tailored to removing the aerosols that increase risk of transmission in indoor spaces. Advances are being made all the time.

15) We all know the death rates and current numbers of people infected. The negative stories are spread far and wide, but some good things will come out of this too. Pollution has been reduced by the decreased travel and factory activity, saving lives of vulnerable people, especially in the developing world, as well as helping the environment. Reduced car journeys might mean reductions in accidents. Political recognition of changing public perceptions should lead to greater investment in health and social care, as well as increased funding for medical research and response-readiness for the future. The pandemic has also shown that all nations face the same threats, and all people are the same, so (with the exception of some racist idiots) it has increased international cooperation and the knowledge that we are all interconnected. This has the potential to allow greater collaboration on international issues in future. Mass working from home has shown that it is possible for more people to work remotely, meaning there are likely to be reductions in travel and more adjustments for people who need it available in the future. It has also highlighted the value of essential workers in supply chains and delivery as well as in health and social care, raising their status and priority in public perception. The economic impacts have shown the value of universal health coverage, social safety nets, and minimum income guarantees. It has reduced the mindless consumerism of recent years, and made us conserve resources and reduce food waste. So hopefully we will come out the other side having learnt some important lessons and can genuinely build back better (and not just use this as a vacuous slogan to cover for government inaction).