I am not a therapist

I’ve always been someone that likes to keep busy, and has a lot of ideas about places where psychological thinking can make a positive impact. The aspect of my character that I now identify as entrepreneurial and put to good use in my business has always led me to want to try new things and create innovative solutions to problems. I like a lot of things about being a clinical psychologist, and particularly our ability to turn our hand to multiple types and levels of work. However, unlike many other clinical psychologists, I don’t really see myself as a therapist. In fact, I haven’t seen more than a handful of clients for individual therapy over the last decade, and even before that it was a pretty small proportion of my qualified jobs. I’ve always had more of a focus on the other facets of being a clinical psychologist. I think the picture of a clinical psychologist as a therapist is so strong that a lot of people will now be wondering how I fill my time!

So I will answer that question: I have done loads of highly specialist assessments (of neurodevelopmental concerns, attachment, parenting capacity, mental health, life skills, self-esteem, wellbeing etc) and lots of formulating and report-writing – some in collaboration with psychiatric or medical colleagues or within a wider MDT, but more as an external expert or second opinion. I have advised the family courts as an expert in care proceedings and complex custody disputes, and completed numerous pre-court assessments for local authorities to help inform their care planning. I’ve managed teams and services, and supervised from 2-20 other staff at a time, along with sitting in various organisational/management structures. I have designed and delivered training to parents, carers and professionals, and I have done lots of consultancy to various organisations and professionals (mainly those providing health and social care services, or involved in the family courts), and help placement providers to improve their services. I design and deliver group programs (eg Managing behaviour with attachment in mind), but then rapidly cascade train other staff to continue to deliver them. I wrote a book about attachment/developmental trauma, and lots of papers and policy documents about Looked After children, and acting as an expert witness to the family court. I sat on a BPS committee and I contributed to NICE and SCIE guidelines. I’ve designed, managed and evaluated therapy services (but employed others at lower bands to deliver the therapy). I’ve been an expert advisor to the HCPC in a fitness to practice case and to the team investigating a death in public care. I’ve done loads of practice-led research about each client group I’ve worked with, from looking at the psychological and health economic impacts of offering brief therapy to hospital users with diabetes, to commissioned evaluations of other services. So I have plenty to fill my days despite not having a therapy caseload!

I have reflected on why it is that I don’t feel drawn to therapy, and reached the conclusion that, whilst I see it as a very worthwhile endeavour, I don’t really have the patience for resolving difficulties one person at a time over sessions spanning many months. I’m always more interested in grappling with the bigger questions of why people are in distress, and what we can do to most effectively prevent or ameliorate those difficulties. When I’ve solved the riddle (or at least, reached a plan that improves upon existing solutions) I like to evaluate its efficacy, modify it if necessary and then disseminate the learning and/or train others to replicate the solution. I try to step outwards from the individual issue to the broader themes and ways that we can intervene on a wider scale. To use a visual metaphor, if dealing with mental health problems is like bailing out a ship, then rather than scooping out water one cup at a time, I am trying to work out how to plug the leaks, and to design boats that won’t have the same vulnerabilities to leakage in the future. It also helps me to avoid feeling hopeless about factors outside my control and demand exceeding supply, or burned out by an accumulation of traumatic stories.

Jenny Taylor, a past chair of the Division of Clinical Psychology, once described our profession as the structural engineers of the therapy world. Unlike a therapist trained in a single modality of therapy, we can survey the landscape and assess the need, then design the intervention that best meets that need – even if we are not always best placed to deliver it. We can base that recommendation on our knowledge of the current evidence base, which can change as new information comes to light.  If we consider the challenges people face as a river they need to cross, a therapist trained in a single model of therapy might be a bridge-maker. A psychodynamic therapist might be a mason who can build traditional stone bridges and claims that this design best stands the test of time. A CBT therapist might be a carpenter with a set of designs for wooden arched bridges that he claims are cheaper and quicker to erect. Each sees their own skill as either suitable to solve the challenge or not, but also has some incentive to sustain their own livelihood by continuing their tradition. A clinical psychologist can survey the land either side of the river, the span length required to cross it, and the materials available in the locality. They can then advise on the various options, including the relative costs and the evidence of how they fare in different conditions. They may or may not feel that bridge required is within their own skill-set to erect, but have a reasonable overview of other bridgebuilders in the area to recommend. If new designs of metal suspension bridges are developed, this is not threatening to the structural engineer, who can adjust their recommendations to incorporate the emerging evidence base.

I really like this metaphor and strongly identify with the role of structural engineer rather than bridgebuilder. I had always thought that this was instilled in me by my first graduate job, where I was an assistant psychologist on a research project about improving quality of life in residential care homes for older people, and I could see how the research and clinical work were closely tied together and built on each other reciprocally. But now I think my love of data and the scientific method runs deeper than that and I can see it infused throughout my whole approach to life since childhood. When it comes to my work I am a scientist practitioner down to my bones, as I always collect data as I go along. Where I don’t feel like I understand the situation well enough, I first look to the literature and then to gathering data and doing my own analysis to try to gain insight. When I develop something new to try, wherever possible I try to evaluate what we are doing, and refine it through an iterative process until we can prove maximum efficacy. I see that process as being part of the USP of a clinical psychologist – that we think like scientists and gather data to inform our interventions.

But I’m not sure that we communicate this mindset well enough, or that it is universal amongst the profession. It certainly isn’t what draws people into the profession in my experience. Too many clinical course application forms I review could be paraphrased as “I want to learn to be a good therapist” with an afterthought of “and do/use research” because they think that is what selectors want to hear – but in my view therapy can be done by lots of cheaper professionals, who might do an equally if not better job of it. I believe that clinical psychologists should be more than well paid therapists. We should know the evidence base and be able to take on the most complex assessments and formulations (even if others then deliver part or all of the treatment) but also to be able to develop, refine and evaluate novel therapeutic interventions, supervise other staff, improve services, consult, train and manage – things that extend beyond the skillset of most therapists. I’m sure it is clear by now that this is where my own interests lie. And I think it shows through in everything I do.

For example, when I was asked to lead the CAMHS service providing neurodevelopmental assessments I started with a literature review and current policy and best practice guidance. I then conducted an audit of the existing pathways, then tried to make things better. We set up a new clinic system with more rapid throughput and more thorough assessments, and then re-audited showing a reduction from an average of 18 months of input to five, with increased clinician confidence in the service and higher client satisfaction. I also wrote a booklet to help provide the information to parents whose child received a diagnosis of an Autistic Spectrum Condition. Although it required dedicated clinician time for the multi-disciplinary clinic and for the psychometric assessments generated, overall the new pathway freed up capacity because less cases were being held open by other clinicians whilst waiting for assessment, or kept open for prolonged periods afterwards to help the family understand the diagnosis and connect up to local sources of support.  I also sat on a multiagency strategy group to look at establishing best practice standards for the county.

I had the same approach when I was asked to support the adoption and permanence service. I initially set up a consultancy clinic, where social workers could bring cases to discuss or book in families to see jointly. I found that I was explaining similar information about attachment, trauma and neuroscience to multiple professionals, parents and carers in the consultations. So I designed a group to share this content. I called it “Managing Behaviour with Attachment in Mind”, and developed some “doodles” I would draw on flipchart paper to explain the concepts more accessibly. I evaluated the impact and showed it to be an effective format for supporting parents in this situation. The groups were popular and over-subscribed, so I trained others to deliver the group to keep up with demand, first in my service and then more widely. Many people in the groups liked to photograph the doodles to remind them of the topic, so I decided to write a book to share them and Attachment: In Common Sense and Doodles was born.

But I also wanted to know about how we could achieve permanence for more children. I started by looking at the literature about what makes effective adoptive matches. Very little information was available, so I systematically audited the paperwork from 116 adoptive matches and followed them up over 7 years to see what factors influenced the placement outcomes. I was able to look at whether the innovative adoption project to place children with more complex needs had better or worse outcomes, and was able to explore the impact of different motivations for adopting. Whilst to me this was just a natural process of answering the question as an evidence based practitioner, it transpired that these studies of adoption risk and resilience factors were amongst the largest ever done, and I have discovered unique findings that I really should publish*.

You could argue that I was using a sledgehammer to crack a nut by doing all this research and trying to change process when organisations are notoriously slow to change, and that I could have spent my time more productively working with more individual adoptive families. But that’s not how I’d see it. The research I did helped me to understand what the key variables are when considering whether a child can achieve permanence, what kind of family we need to look for to place them successfully, and what kinds of support might ensure that the placement succeeds. I hope that I have fed that knowledge back through my court work, and into various organisational and policy work over the last decade. I have also disseminated it at conferences. However, I would still like to spread it further, because it is my belief that such knowledge can have positive impact at multiple levels – it can help to inform individual placement decisions, service-wide strategies for helping optimal numbers of children to access permanence, and national policy about adoption.

That work led naturally on to developing our services for Looked After Children when I left the NHS and set up my own company, LifePsychol Ltd. We provide training and consulting to foster carers and residential care staff, the social care organisations that support them, and the wider professional networks surrounding them, including education and health staff, police, lawyers, magistrates and judges. As I started to get more immersed in working with children in and on the edge of Care, it led me to recognise that there was a lack of validated and reliable tools to identify the needs in these populations, no outcome measurement tools that could reliably measure change over time in a way that was sensitive to the context and type of life events these young people experience, and a dearth of clinical governance in terms of the efficacy of both placements and interventions for this group of children. That seemed shocking to me, given their highly complex needs, and massively elevated incidence of mental health problems, challenging behaviour, risk to self and others, and prevalence of intellectual or neurodevelopmental difficulties.

As well as the human cost of not being able to identify the best choices for people, it seemed unacceptable that huge amounts of money were being spent on placements and specialist services for this group without any evidence of them changing their wellbeing or life course for the better. Placements seemed to struggle to identify what to work on and how, and there was little objective indication of what defined a successful placement, beyond annual visits from Ofsted (who were predominantly focused on process and procedure). The high level of need and the lack of clinical governance in the sector has allowed various specialist therapists and services to spring up that are virtually unregulated, and many placements have adopted terms like “therapeutic” without these having a consistent definition or meaning. So I wanted to see whether I could make any headway in changing that.

Meanwhile there is pressure from the government to improve outcomes for children in public Care, because they are seen to fare badly compared to the general population of children the same age. The difficulty is that this isn’t comparing like for like – children in care have many more adversities to face, both organic and in terms of their life experiences, that mean they often deviate from the norm. For example, I found that there was a 20 point skew downwards in IQ distribution in children in residential care compared to population norms, meaning that 20-25% of children in this setting had a learning disability, compared to 2% in the general population. Likewise the incidence of Autistic Spectrum Conditions and other neurodevelopmental difficulties amongst children in Care is more than triple that in the wider population. The same is true of young offenders. If we don’t acknowledge that, then the sector is being asked to seek impossible goals and will inevitably be seen as failing, even if placements and services are performing optimally and adding a lot of value to the lives of the children they work with.

To state the obvious, children in care are not just randomly drawn from the population – by definition their needs have not been met, and this can mean both the presence of additional challenges and exposure to harm or deficits in care. I believe that to look at the needs of this population and the degree to which these are met by placements or interventions, we need to either compare them to carefully matched controls or ensure that outcomes are always considered relative to baseline. The latter seems more pragmatic. Scores for young people also need to be considered in the context of what is going on in their lives – as changes in placement, daily routine, contact arrangements, or the arrival or departure of other children from the home can make big impacts on the child’s functioning.

So I’ve been beavering away exploring these issues and developing systems to measure needs and make the data meaningful for those providing care and services. The impact might not be as obvious as delivering psychological therapy directly, but I’d like to think that over time it can improve services for thousands (or even tens of thousands) of children, and make a greater net change in the world.

 

*Maybe I’ll write more about this in a future blog. But the short version is that I have been trying to secure some funding to complete the statistical analysis and disseminate this information, and would still like to do so, so if you have any ideas or useful connections to assist with this please let me know. Failing that I hope I’ll find enough time to write a book on making better adoptive matches at some point in the future.

Sticking plasters

I realise that this title won’t mean much to Americans or people outside the UK, so let me share a small anecdote by way of explanation before I get into the topic I want to discuss. I was on an American airlines flight back from New York in 2003, having done a lot of walking around the city over the preceding week. When I removed my shoes and straightened my socks it transpired that a burst blister had adhered to my sock, and it started to bleed surprisingly profusely. I asked a member of cabin crew for a sticking plaster, and got entirely blank looks in response. When I explained the situation, a steward showed a sudden look of recognition and sighed “oh, a Band Aid! I keep one of those in my wallet for my kids” and provided what I needed. So yes, a sticking plaster is a Band Aid – an adherent protective dressing for a small wound.

I found it quite an insight into American marketing, as I had also tried to buy antihistamine cream in a drug store to utterly blank looks, until someone realised I wanted “Benadryl”. I had also seen the TV advertising persuading people they had adult ADHD (with a symptom list that seemed to encourage false positives, and a link to a small quiz online that seemed to classify almost anyone as having ADHD), or that they needed Viagra (with the almost comical warnings that “erections lasting more than two hours can be dangerous and require medical attention”). Disease mongering is a pretty interesting phenomenon, and well worth reading about – Did you know that the vast majority of viagra prescriptions are “off label” and written for groups in which there is no evidence of efficacy (including women, when there is not a single study showing evidence of efficacy in this population)? And that the pharmaceutical companies are trying to medicalise “Female Sexual Dysfunction” to create mass markets to address lack of desire or lack of pleasure, with minimal consideration of the context or wider issues, because of the success of such marketing with men? Or that “restless legs” has been marketed to the public as a common condition requiring medication? It made me quite glad for our generics, and lack of medication marketing targeting the public.

But the reason I wanted to talk about sticking plasters is that they are a response after the event. A means of short-term management, and covering up of an injury, rather than preventing it. Like my blisters adhering to my sock, there were many stages at which that bleeding could have been prevented – by covering the blister earlier, or better still byby taking the subway more and/or wearing more sensible shoes to explore New York. The problem is that if we become overwhelmed by demand for the reactive response, we lose the capacity to look at what underlies the demand. And if we spend too much time reacting to distress in health services, it can mean that we fail to do the preventative work that would reduce the need for such services. With austerity politics ensuring that the health and social care sector are too underfunded to be proactive, I think that is where the NHS is heading, along with most of the public sector.

Every single day I seem to read about travesties of social justice, and the lack of thought about the people that bear the brunt of them. Time and time again the most vulnerable members of society are being abused and neglected at a national and global scale. Whether it is the man who has paid UK taxes for 40 years who is being denied essential cancer treatment because he doesn’t have a British passport (due to a paperwork oversight when he arrived as a child with his parents from the Caribbean 44 years ago), or the deportation of a humanitarian/academic couple who are being told to leave because they went abroad for too many days – to complete a government study. Or how about the person that tweeted about having waited for over a year for support after a sexual assault, with rape crisis waiting lists closed for most of London for more than a year due to the scale at which demand exceeds supply?

Perhaps we should look at the rapid rise in mortality in the UK so far this year, falling life expectancy (especially in lower socioeconomic groups) or the rise in deaths amongst mental health patients – despite the falls in smoking and improved outcomes in many health treatments. A man/woman in an impoverished estate in the north of England can now expect to enjoy 32/35 fewer years of life in good health, compared with a counterpart in a wealthy suburb in London or the Home Counties. Or perhaps we can look at the impact of cuts to NHS funding (albeit masked by fake claims of record wage rises) record waits for A&E, the cancellations of operations, and the burnout of NHS staff.

Or look at the increase in homelessness over the last few years (it went up 16% in 2016 alone, with almost 50 000 families living in bed and breakfast accommodation and many more “hidden homeless” living on floors and sofas of friends and acquaintances) with the knowledge that being homeless can worse than halve your remaining life expectancy (homeless women die on average at 43 and homeless men at 47, compared with 77 for the rest of us). As the author of the BMJ article puts it “Homelessness is not an episodic event, but something systemic. It is a neon sign that something is fundamentally wrong with policy across health and housing”. This lack of provision doesn’t even save money as the cost to the NHS of society’s failure to deal with homelessness and other examples of inequality has been estimated at £4.8bn (€5.4bn; $6.7bn) annually.

These same austerity policies have a wider impact on mental health. Psychologists for Social Change have identified five ways austerity policies impact on mental health: 1. Humiliation and shame 2. Fear and distrust 3. Instability and insecurity 4. Isolation and loneliness 5. Being trapped and powerless. They remind us that “These experiences have been shown to increase mental health problems. Prolonged humiliation following a severe loss trebles the chance of being diagnosed with clinical depression. Job insecurity is as damaging for mental health as unemployment. Feeling trapped over the long term nearly trebles the chances of being diagnosed with anxiety and depression. Low levels of trust increase the chance of being diagnosed with depression by nearly 50 per cent”.

So we can’t see mental health in isolation. Whether it is the individual context (for example in the power threat meaning framework I discussed in a prior blog) or in the wider sociopolitical context, we are not brains in a jar, but socially connected beings with experiences that impact on our wellbeing. When we talk about the shortfall in mental health services, too often we are saying that in the context of demand for services exceeding supply, and feeling strongly pulled as psychologists to provide more of the same. That makes sense in at the coal face, where it is hard to have the energy, time or resilience to look at the wider picture beyond the demands hammering on our own door. However, it means that we are discussing the lack of sufficient reactive responses to a problem that could have been dealt with more effectively further up the timeline with proper proactive and early intervention work, and in a lot of cases could have even been prevented with better social policy and provision for vulnerable population groups.

Of course, doing preventative or early intervention work also takes resources, and we can’t take them away from the people currently in need/distress now. But instead of us constantly asking for a little bit more of the same to deaf ears who reply with excuses about finite pots and efficiency savings (and sarcasm about magic money trees), maybe we need to think more creatively about intervening at different levels and in different ways to the set up of existing services. I’d rather be providing sign-posts to avoid hazards than doling out sticking plasters when people trip over them – and best of all I’d rather be fixing the hazards, and helping vulnerable people identify routes that are less risky.

I’ll give Psychologists for Social Change the last word: “Mental health isn’t just an individual issue. To create resilience and promote wellbeing, we need to look at the entirety of the social and economic conditions in which people live”.

Planning for failure?

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

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

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

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

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

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

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

 

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

Nature versus nurture revisited

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

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

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

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

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

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

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

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

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

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

“What is your story?” Specifically:

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

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

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

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

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

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

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

The tip of the iceberg

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Trauma and the return of hope

I wanted to write something about the recent traumatic events including the Manchester arena bomb, the London Bridge incident, the Grenfell Tower fire. These are very painful and raw events that have been quite distressing to learn about, and I am aware that we still don’t have the full picture. I also wanted to touch on the reaction to these tragedies including the One Love concert, and to give my reaction to the election results. I hope it doesn’t seem disrespectful to connect the two, but to me they represent both the fear and sadness of recent events, and the compassion and hope that have followed them. I should warn you now that the second half of this blog is less psychological and more political than usual. That probably isn’t surprising when I am writing about the election, but I know that type of content is not for everyone so I’ve marked where you might want to skip to the end.

Barring 9/11 I can’t remember a month in my lifetime with more traumatic events. The Manchester bomb killed predominantly young people and parents, and felt very close to home for me. The idea that innocent young people and families going to a concert could be the target for terrorists was unbelievably horrific, and the ages of the victims made the story identify with people of all life stages around the country who could imagine it being their child, grandchild, sibling, friend or parent who was affected. This wasn’t some far away event in another country, where people speak another language or have different culture or appearance that can let us abstract the horror away from ourselves.

The impact of the explosion was felt in ripples that spread far wider than just those who tragically died or were injured in the blast, to those who lost friends, relatives and loved ones, and wider again to those at the concert who witnessed the horrific scenes and felt scared by the situation, the emergency services and NHS staff who responded to it, and those who were peripherally involved in the aftermath of helping people find ways home or places to stay, or in looking for people who were missing. As well as the terrible loss of life, and lasting physical injuries, psychologically these events will have changed the course of people’s lives in various ways and to various degrees.

The same was true of those involved in the events on London Bridge and Borough Market. These were ordinary Londoners and tourists going about their daily life. On another day, or with another roll of the dice this could be any one of us or people that we know. Again, the ripples spread far and wide.

And now we have another unspeakably awful tragedy, where the Grenfell Tower fire has killed and injured large numbers of people representing the full spectrum of age and cultural diversity. What they had in common was living in a tower block built by the council in the 1970s. Preliminary commentary suggests that the decorative and insulating cladding used in a refurbishment of the block was highly flammable and caused the fire to spread rapidly and the compartmentalisation system to fail. If that is true, and it was cost-cutting and a delay in updating the fire regulations that was to blame, then that is unforgivable and needs to lead to legal consequences for those responsible, as well as learning that prevents similar tragedies occurring in the future. I can understand the level of anger that is being expressed by the local residents whose concerns were ignored, and by those who feel that the balance of power in the current political situation means that the lives of people with below average income are given little value compared to the profits of the rich.

Here too the psychological consequences will ripple out widely beyond the horrendous loss of life and physical injuries to those who were bereaved, traumatised by what they witnessed, those who tried to raise the alarm but couldn’t reach everybody, the emergency services who responded so admirably against insurmountable adversity and those more peripherally involved. There will be complex feelings for those who survived when others perished, and I can’t begin to imagine how it must feel for the person whose flat the fire started in. If it is true that a faulty washing machine started the blaze, they must be wondering whether there were any choices they could have made differently that would have prevented or reduced the terrible outcomes that followed. Likewise those on lower floors or adjacent buildings who escaped early on and had to watch others jumping from windows, throwing out children, or being trapped too high to do either. I can’t begin to imagine how that will impact upon them over time, as it was overwhelming to even watch on the limited TV coverage.

Yet, everywhere there is tragedy, we see good people come out to try to help. From the emergency services and NHS staff, to those running charities and organisations to help those affected to those doing practical things on the ground because they happened to be there and felt compelled to do something. The One Love Manchester concert had the highest viewing figures of the year and the fundraising for Manchester victims and charities has topped £11 million. Likewise the fundraising for victims and organisations that can provide support in relation to the London incidents and the Grenfell fire have been astronomical (last figures I read suggested there had been donations of over £1.5 million in 24 hours to causes related to the fire). Overall, following these tragedies we have seen an outpouring of love and kindness on an unprecedented scale.

So perhaps in that context it is not quite as surprising as the political commentators think that the election results suggest the tide is turning against austerity. Public sector workers with frozen pay are those who have been responding to these crises, killing and arresting the terrorists and identifying their networks, fighting the fires and patching up the injured. That means that the public have remembered what heroes they are, and look in a different light at the cuts to the public sector that are preventing them from doing an effective job and mean we are not rewarding them adequately for the essential work that they do. We have also been roused into action to prevent further victims. We can no longer ignore the fact that the NHS and fire service are warning of their inability to provide sufficient cover to meet the need with budgets cut to the bone. Hospitals are struggling to sustain staffing, let alone recruit, without nursing bursaries and international staff. Children are being harmed and dying because of insufficient social care services, and people with disabilities and health problems are suffering and dying because of cuts to their benefits and support packages.

In short, as events have awakened our empathy it has become clear that the government’s policies are without compassion, and are all about protecting big business and the super-wealthy. They are making the rich richer and the poor poorer, and the vulnerable are dying as a result. Tough talk about immigrants and scroungers has been used to justify a lack of public spending coupled with policies that harm the most vulnerable in society – yet the sudden change away from austerity when their electoral majority was lost confirms that these were idealogical rather than economic choices. The negative focus on blaming disadvantaged groups in society has turned the spotlight away from much bigger abuses of the system by international corporations who manage to pay little or no UK tax, and who exploit staff on zero hours contracts, or even force them to work for their benefits through work fare schemes. The wealthiest in society are able to pay accountants and lawyers to help them avoid tax the most, and to hide income in off-shore schemes for tax avoidance purposes.

So at a time when compassion is so needed, and so evident in response to terrible events, there has been a political shift. It hasn’t happened in isolation – we have seen increasing unpredictability in public voting over the last year. I can only make sense of this in terms of a desire for radical change. Young people and those who have felt disempowered and disenfranchised by a political system that seemed to occupy only the middle-right and work only to sustain the vested interests of those who are already wealthy and powerful have been voting for the option that they think will upset the establishment. Sadly, the only options for rebellion available last year were to vote for Brexit and for Trump, or to not vote at all. But this year, as the government has moved the Overton window further right since the Brexit vote, clear blue water has emerged between the parties. And to the surprise of many, the Labour Party has moved left from their centrist policies and candidates of the last decade. Somehow a genuine socialist candidate has been voted into leadership in the form of Jeremy Corbyn, and despite all the efforts of the press and his own party, he has stuck in there stubbornly, growing support from the ground up, and now he seems to have popular support and the potential to be a future Prime Minister.

[If you aren’t a fan of politics, feel free to skip to the last paragraph now, because the second half of this blog is about the election results and what they might mean].

Corbyn might be an unlikely leader following past templates, as he does not use glib press-friendly soundbites. But he is a man who has stuck to his principles throughout his political career, and has been a voice of reason and negotiation when others have been shouting. From day one he has been an authentic voice in a world of spin. Although he was damned for it at the time, he acknowledged the complexity of the issues and did not ally himself fully with either of the polarised sides of the Brexit debate (though he said on balance he would prefer to remain). He has subsequently been able to make a positive campaign in a time in which the fashion is to blame and ridicule. In the words of Michelle Obama that I like so much “when they go low, we go high“. It doesn’t mean not being outraged or angry. It means choosing to focus on how we can solve problems, rather than on denigrating opponents. Corbyn was not only an underdog that would upset the establishment but an opportunity to say enough to austerity. That message has connected with people whilst Theresa May was curiously defensive and robotic, repeating the same soundbites over and over again and refusing to engage in the debate.

Corbyn’s politics roused a new generation of political campaigners (Momentum) who fought a savvy campaign on social media, where it is said a budget of just £2000 reached more voters than over a million pounds spent by the Conservative party. Over 12 million voters saw a facebook post started by a Momentum member in the week before the election. Partly as a result of this, 622,000 people registered to vote for the first time. This image of Facebook reactions to a live stream of the Prime Minister made me smile:

It is obvious to anyone that knows me or anyone who reads what I write that I identify as being on the left of the political spectrum. I was alienated by Labour’s move to the centre, and have become a lifetime member of the Green Party, despite being pragmatic enough to recognise that whilst we have a first past the post voting system the UK will be a two party political system. So I have been quite interested in the rise of the left within the Labour Party, and a fan of Corbyn as an individual politician for some time (I wrote about Corbyn on this blog a year ago).

So, unsurprisingly, I saw the election outcome as a great result. I was afraid that the Tories would get a landslide victory and use it to push through ever more austerity, and channelling of wealth to the super rich. So to see them lose their majority was a brilliant outcome. I’m delighted, and the more I have thought about it the more I think a hung parliament is about the best possible result.

First off the Tories have lost the mandate for their hard right, hard Brexit plans. And young people have been engaged in politics. Hopefully we can prevent repugnant policies like the dementia tax and fox hunting and cuts to education because the majority is so slender and these policies haven’t played well with the public. But I like that brexit will be a Tory problem to resolve, because when it gets messy they will have nobody else to blame. There is a stronger position to oppose boundary changes and to press for electoral reform. Maybe we can improve the terrible cuts to benefits and the regime of sanctions whilst their focus is on damage limitation and Brexit. And the next election might be one in which change is possible.

I don’t think it is a panacea. After so many cycles of hope and disappointment in recent politics, I’m cynical about whether this is the beginning of a sea change, and worried there is still a lot of conservative thinking about the economy and UKIP influenced blaming of foreigners around. I’d like to believe that things will get better from here, but I don’t think we should expect too much too soon. Some of the optimistic predictions of having a Corbyn government by the end of the year, and reaching a point at which the populace don’t want to go through with Brexit by the two year deadline seem just too good to be true. However, I am optimistic about the long game, because of what the analysis about voting patterns shows. Corbyn’s support is younger and more educated than that of his opponents. That is supported by this chart from the Financial Times:

Screen Shot 2017-06-10 at 01.27.16

You can see that over 65s were 35 points more conservative than the UK average, whilst under 45 year olds are more prone to voting progressively. That split by age is a relatively new thing and it has been much more marked over the last two elections. Then I think about what the five year interval between elections means to the population. With half a million older people dying every year, and half a million younger ones becoming eligible to vote, surely over time that will tip things in a positive direction. The only question is whether the tendency of people to swing right as they get older will continue as the current population ages and/or whether the Tories can start to market successfully to these new voters.

I’ve been trying to understand the reason for these demographic shifts, to judge whether the current middle aged moderates are the retired conservatives of the future. From what I have read I’m not sure that the fade from red to blue is inevitable. I think a lot of us who will be entering the top half of that graph soon age-wise grew up under Thatcher and have much more reticence for those kind of policies than the current over 65s who grew up during and soon after the war. We are also more educated (and education is associated with more progressive values) as well as growing up in a more socially liberal world, with greater exposure to diversity. As this article puts it “When my parents first voted in the 1960s, homosexuality was illegal, abortion was largely illegal, the death penalty was still in force and openly racist attitudes were widely acceptable. Now, the death penalty is a distant memory, abortion rights are firmly entrenched, gay marriage is legal” and (perhaps with the exception of the Brexit effect and islamophobia) racism isn’t socially acceptable. Environmental issues are really embedded in the values of young people, and the scientific consensus for climate change and the need to preserve our limited resources has become overwhelming over the last decade or two. Every school has recycling bins and anti bullying policies, every home has energy efficient light-bulbs and lots of products market their green credentials. There is an increased focus on making healthy choices for ourselves and our planet. Anyone under 40 is also growing up immersed in social media, and with the perspectives of the whole world available to them immediately, rather than just the opinion of the local community and the newspapers. The media barons have less influence, and the circulation of the tabloids is decreasing (and there is increased coverage of celebrity “news” within them, and less coverage of the more serious topics).

So I’m optimistic. Despite all of the things in the world that are upsetting people and setting them against each other, I think the march of time takes us towards an increasing prevalence of progressive values. I hope by the time my children are voters the world will be a nicer place, and the Overton window will have moved back to the left.

 

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

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

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

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

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

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

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

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

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

So, what were the responses?

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

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

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

Screen Shot 2017-03-14 at 22.31.53

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

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

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

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

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

“Verbally abused and insulted. Groped.”

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

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

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

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

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

“He swore at me and said something aggressive”

“Derogatory comments”

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

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

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

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

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

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

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

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

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

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

“start laughing at me”

“He carried on as before with the harassment”

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

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

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

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

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

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

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

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

Sometimes misogynistic comments were coupled with racist ones:

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

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

Other respondents recalled annoying but not as aggressive things like:

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

Some gave specific examples or reflections:

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

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

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

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

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

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