Disappointment

I have been let down by someone I trusted again. In fact, in the last three months I’ve been let down by four separate people that I have trusted, in three different separate sets of circumstances, and two of them have been clinical psychologists. That feels like an unpleasant cluster of disappointment. In each case they made me lots of promises and didn’t deliver. I was relying on them and now have to pick up the pieces. I was assuming that my ethical values would be ones that we commonly held, but in fact each person turned out to be entirely self-serving, despite the high cost to others. In each case the other party has taken what they wanted and left me to deal with the fallout.

Being exploited by others always makes me very sad, and it erodes my faith in people. But this time it has coincided with me being physically unwell. It may even be the cause of my health problems. If so, that is something new, and something I need to address robustly and never let happen again. But as ever in real life the picture is complicated and hard to unpick.

I’ve normally been a pretty resilient person, and hardly ever take time off sick. However, the minor road traffic accident in which I was rear-ended by a lorry 18 months ago transpired to have cracked three of my teeth*. One cracked wisdom tooth was removed soon after the accident and the second patched up with a filling. However the third was a visible tooth that had already had a root canal, so it needed to be removed in a way that would allow an implant to be fitted to fill the gap. I paid for expensive specialist dental work to preserve the bone and fill the gap with collagen to encourage regrowth. Unfortunately, removal of the tooth root was harder than expected and involved half an hour of brute force, breaking off a piece of my jaw bone in the process. That led to dry socket pain. I then required bone grafts along with a pin to support the implant, and six stitches to pull my gum back together. I’m not normally anxious about dental work, but it was stressful enough to make me shake before subsequent appointments and involved several weeks of painkillers and a course of prophylactic antibiotics whilst I recovered. So I suspect I was already somewhat physically depleted.

Then the interpersonal disappointments started to compound things. After a particularly unpleasant bit of news in early December I had to go home from work due to what felt like a migraine starting. I’ve subsequently been off work for six weeks with a “severe otitis media, probably herpetic” written on my sick note. The GP was concerned it was a variant of shingles due to the blistering inside my ear, so I was prescribed antivirals as well as antibiotics, but thankfully it didn’t develop into the full shingles presentation and has just felt like a prolonged ear infection. Subjectively I’ve mainly felt like I’ve been underwater, with periods of more marked earache, dizziness, fatigue and a kind of general malaise. Driving in particular has been difficult (as acceleration and even small hills tend to trigger pain), as has going outside (perhaps due to the changes in temperature) but it has also stopped me from playing with the kids in the way I normally would (as spinning, chasing or sudden movements can bring on earache/dizziness), thrown my sleep out and confined me to the sofa for much of each day.

It seems it has also reduced my ability to weather stress, and made it express in a more physical way than I’ve ever experienced before. I’ve had stomach cramps and waves of nausea that appear when I read emails from certain people. I can’t tell how much of the overall problem is a somatic expression of stress, and how much is my resilience being depleted by physical illness and making it hard to cope with the emotional stuff. But it has been an interesting learning experience. I’ve had to stick on an out of office message and binge watch TV serials. It is a big behaviour change for me to disconnect with my work, but I have to accept my own limitations. If it is shingles, then it can do lasting damage to the facial nerves or lead to hearing loss. No contract, colleague or past employee is worth that.

So I’ve made a pledge to myself never to let this happen again. Work is going to be a smaller part of my life, and I am going to make more time for art and music and going out into nature. Within my work I’m going to follow my heart more. I will only work with people I trust, who share common goals, and a sense of fun. I’m going to focus on doing what I enjoy, and what makes me feel I am having the most impact for those who need it most. I’m not going to bend over backwards for people who wouldn’t do so for me. And I’m going to challenge my inflated sense of responsibility for others.

Maybe it comes from being the oldest child of hippy parents, but I’ve always been a person that enjoys helping others, and giving a leg up, or a treat to people around me. Whether it was spending my pocket money on sweets for my friends at school, raising money for charity, or helping someone else out, I’d always put in a little more effort than other people seemed to. When I look backwards I can recognise that sometimes this has led to other people taking advantage, and me ending up feeling exploited.

I first noticed it in an adult reflective way a long time ago. I remember helping someone with a paper they were writing for a journal submission. Their draft was really very poor, and I made a lot of changes, but they didn’t add my name or even acknowledge my input. A year or two after that I coached someone who wanted to get onto the clinical training course I was on, and let her present a small analysis we had done together on my research project data, only to find out that she had presented the whole study as her own and not credited me at all. I also got her a summer job, from which she was fired for her poor attendance and timekeeping, for which she later attempted to use me as a reference, claiming that the service had subsequently closed and omitting to mention the reason for her departure**.

When a friend of a friend (I’ll call her Jo) sent me an email about being suicidal a few years ago, I cancelled a day of work to go and take her to A&E, and spent 24 hours getting her to attend and waiting for various services. Over the next fortnight I helped Jo sort out problems with her rented accommodation and to get a settlement from her job instead of being dismissed. After a second depressive incident a few weeks later, I brought her back to my house for the weekend rather than leave her alone and unsupported, a visit that subsequently extended to a six week stay.

I tried to be a supportive friend. I got Jo a new job within my network and a week later I agreed to be guarantor on the lease for a lovely flat. However the next day after a clash of opinions with a colleague she decided to quit the job. That left her no means to pay the rent, which would therefore have fallen to me, so I withdrew from being guarantor and the flat fell through. Jo was upset that I prevented her leasing the flat she wanted, but concluded that she would continue live in my house, rent-free, until something else came up. I felt that as well as not being the right choice for our family, this would have been enabling her dependence. There were various problematic incidents, but I still agonised before saying she had to leave and helping her move in with a family member instead. I took another day off and drove a 5 hour return trip to take her and her possessions to a new location. Despite all the efforts I put in, Jo remains angry at me for the perceived rejection and feels that I let her down. She periodically tries to shame me in our social group for “abandoning a vulnerable mentally ill woman”. For me it was all cost and given there was no benefit to Jo it was actually a lose-lose situation, but I did not recognise that until long after it was obvious to everyone else around me.

More recently it has been colleagues and collaborators who have let me down. I’d consider that par for the course if I was unreliable myself, but I don’t think that is the case. I always try to treat people as I would want to be treated myself, and to be really clear about the contract between us (whether that is a literal written agreement or an implicit verbal arrangement). I tend to assume that anyone who has the same profession or client group as me will have the same ethics and the same drive to do the right thing as I do. I always assume that people will care about the quality of the service, prioritise what is in the best interests of clients and keep their word, because that is what I would do in their shoes. Sadly, it seems that is not the case, and lots of other people prioritise their self-interest over anything else.

I don’t think I have unrealistic expectations. If someone signs a contract with me then I expect them to honour it. If someone agrees in writing to deliver a particular piece of work, be it training or clinical work, I expect them to turn up and do that work on the date they agreed. If someone agrees to take on clinical responsibility for some of our clients, I expect them to provide a good quality clinical service for those people rather than nothing at all. If someone agrees to purchase our services for a particular period of time, I expect us to have to deliver those services and for them to pay for them. If someone agrees to buy something from me and I deliver it to them, I expect payment. It doesn’t seem a huge leap of faith to me. Yet somehow these very simple expectations are too much for some people.

I’ve spent too many words justifying why, but I am disappointed by that. And, whether by coincidence or causality, I have been physically unwell in the immediate aftermath. But I am not the kind of person that just rolls over. I might be a sucker and go beyond the call of duty to be helpful when I can, but I don’t let people play me for a fool. I have a very strong sense of fair play and once people cross the line, then I feel obligated to do something about that. Just as I am a demanding consumer who will assert my rights for a refund or compensation when things go wrong (and gave Regus merry hell a few months ago for their terrible service with the office I was going to rent), so I will also take action to ensure that professionals honour their obligations. The way I see it is that many people don’t have the resources to address problems (be that intellectual, time, financial or personal) so those of us that do need to help put the checks and balances into the system.

So my plan is three-fold. Firstly I will address each issue head on and reach a resolution. And secondly I will make plans for the future that mean I am not put in the same circumstances again, gather better allies and do more of what I enjoy. I’ve already got a good team around me and lots of irons in the fire for new projects, and I have had helpful legal and practical advice from a number of sources. So it will all pan out in time. However my top priority is to get well again. And that involves the foreign concept of taking time out to rest. For a workaholic that might be the toughest part of all this!

*I don’t believe this to be a common result of an RTA, but I have brittle teeth due to tetracycline damage as an infant

**I didn’t feel able to provide such a reference, and gave them the contact details of the service instead.

Spectator sports

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

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

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

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

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

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

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

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

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

Identity and Change

This was the blog I wrote a few days before the US election. After the election I felt like the other stuff was more pressing, so that skipped the queue. I’d be interested in feedback about the topics and intervals of this blog, and whether the pot-luck and intermittent nature of it is disconcerting for readers. So do feel free to tweet or comment to let me know. Anyway…

My kids were given brass instruments at school recently, that they will get to use for the next 4 years. Every child in the school gets the use of a brass instrument for free, along with the group lessons to learn how to play it. One chose a trumpet, the other a baritone. It seemed like a nice idea, but I wondered why there was a scheme to learn brass instruments in particular, rather than woodwind, strings or percussion. The penny finally dropped when I searched for clips of brass bands on youtube and ended up with colliery bands and a poignant scene from Brassed Off! We now live in an area in which the coal mining industry was a major employer until the 1980s. There were nearly 200 mines in the county at the turn of the last century, and there are none now. So presumably the brass music scheme is linked with the idea of preserving local cultural heritage.

It made me think about other disappearing parts of British culture, from learning Gaelic and Welsh to Morris dancing, and how each culture around the world has different bits of heritage and culture to keep alive. There are stories told through the generations, losses to commemorate, celebrations to mark particular dates and events, rituals and arts to keep alive. Language and history seem to be bound into our identity. But why do we want to keep some parts of the past alive, and does it have any value? I’d hope that at least we can learn from our collective experiences, avoid repeating problems and continue the things that give us joy and bring us together. Which brings me back to music.

Music has been an integral part of human existence for an extraordinarily long time. Wikipedia tells me that “Music is found in every known culture, past and present, varying widely between times and places. Since all people of the world, including the most isolated tribal groups, have a form of music, it may be concluded that music is likely to have been present in the ancestral population prior to the dispersal of humans around the world. Consequently, music may have been in existence for at least 55,000 years and has evolved to become a fundamental constituent of human life”. Maybe that is why it is such an enjoyable thing to participate in. I know I value the half hour of singing I do with the children each night before bed as a time to wind down, but it also reconnects me to past experiences and brings out particular emotions dependent on the songs I choose.

I think there are loads of skills to be gained from being part of playing music with others. These include patience, persistence, co-operation, and other aspects of social skills and executive functioning. It reminded me how powerful various musical projects have been in changing the identity of people in socioeconomically deprived situations. The El Sistema project in Venezuela, although criticised for its strict regime and some examples of exploitation, has been praised for opening opportunities for young people from disadvantaged backgrounds and getting over 2 million children involved in orchestras. The Landfill Harmonic helped children living in a slum community on a rubbish dump to learn to play classical music and to have aspirations that were previously unthinkable to them.

The Big Noise project in Scotland has drawn on El Sistema but applied it to deprived Scottish communities. Independent evaluations cite positive impacts on different facets of the children’s lives, beyond just the gains in musical skills. Their education shows improvements in concentration, listening, co-ordination, language development, school attendance and school outcomes. Their life skills show improvements in the domains of problem solving, decision-making, creativity, determination, self-discipline and leadership. Their emotional wellbeing shows increased happiness, security, pride, self-esteem, emotional intelligence, an emotional outlet, resilience. Their social skills have improved along with increased mixing, cultural awareness, strong and diverse friendships and support networks. The project also has wider benefits to health, as there has been encouragement for healthy diet and lifestyle choices. The children have also had additional adults to confide in, a calm, safe environment and report reduced stress.

What I like about all these projects is that they help people to learn new skills and change their own identity to reflect that. Instead of being members of a deprived and devalued community pervaded with hopelessness, they have a new identity as musicians who can enjoy the process of creating, sharing and performing and gain aspirations outside of their previous horizons. Even the sense of belonging when singing along to a well-known track being performed live at a festival is up-lifting. How much more so to be performing music in front of an audience, and to travel to new places to perform.

But music isn’t the only thing that inspires change. We are all changing all the time. Life changes move us from being a child to an adult, through education and into professional or employment roles, bring changes in living arrangements and new relationships. In turn, aspects of our identity are sometimes defined by our role within those relationships and settings. We take on certain expectations and responsibilities when we become a being a partner, parent, aunt/uncle, grandparent. Our educational or work experiences can similarly add a facet to our identity (I am very much a psychologist as part of my core identity, even outside of work). So can being part of many different positive community projects or group activities, or even the act of learning new skills or trying new things at an individual level. I learnt to scuba dive a few years ago, and gained a new identity as a diver and a new world to explore. Likewise, the random act of supporting a friend who wanted to set up as a personal trainer introduced me to weight lifting, and for a couple of years that became part of my identity too (frustratingly since an RTA injured my shoulder I have not been able to lift for over a year, though I do hope to get back to it soon). I also like to grow fruit and vegetables, and to make preserves and bake, adding gardening and cooking to my repertoire and identity. And of course I am now a writer and blogger! Likewise I watch other members of my family gain new skills. This year we moved to a dilapidated farmhouse, and my husband has gained a new identity from learning to cut wood, keep chickens, and mow the fields with a tractor. As well as learning their brass instruments, my kids are learning to swim, ride bikes, write stories and poems, make art, and take part in outdoor activities. Their identities have expanded to include facets of artist, poet, writer, scientist, explorer and many more.

Changes to our identity can also be out of our control, and negative as well as positive. Many of us survive traumas, or difficult relationships, or experience rejection or failure. From redundancy to car accidents, cancer to infertility, losses of people we care about, changes of home, job and relationships, we are each shaped by our experiences even as adults. I have blogged before about the impact of adverse childhood experiences, but how we recover from these also forms part of our identity. Do we remain wary and cynical, or learn to trust again. Do we try to shut out the past, or work through it. Do we aim to get closure. These questions have never been more live than in the aftermath of institutional abuse, and in the wake of the historic sexual abuse cases that were triggered by Savile and other cases coming to public attention.

Over the last few years I have been talking to a man in my extended social network who was groomed and then raped as a child by a member of the Catholic church, whilst at a Catholic school. He has had to make a series of decisions about whether to disclose his experiences to anyone at all, whether to share them with members of his family, with his therapist, with his partner, and with friends. Then he has had to decide whether to come forward as a witness and victim in a public enquiry, and whether to seek compensation from the government and/or church. Each decision has an impact on his sense of identity, which has been slowly evolving from a victim hiding the shame of his experiences into a survivor who is able to look back and place the blame firmly where it belongs and manage the consequences on his life successfully. That isn’t an easy journey.

Over the time I have known him, he has talked very movingly about how his childhood experiences made him question his gender identity, sexuality, sanity, and whether he would in turn present a risk to others (something I know not to be the case, but which has been his darkest fear, based on the fact that many perpetrators report having been abused themselves in childhood, despite the fact that the majority of survivors do not go on to perpetuate the cycle of harm). He felt that he did not want additional sympathy or allowances making, and said that other people had been through much worse. Nonetheless, his experiences have had a considerable impact on his well-being. He has experienced intrusive flashbacks and images, panic attacks, stress, depression, time off work sick, and at times coped through self-harm. He has struggled to have enough self-belief to assert himself appropriately, and always tries extra hard to please others even at great personal cost – a trait that has been exploited by some members of his network and employers. I know he has had mixed feelings about giving evidence in an enquiry; wanting to come forward to represent and protect others and to ensure that concerns are not dismissed or covered up, but knowing this will be at some personal cost. And he has had very contradictory thoughts about applying for any form of redress, whether an official acknowledgement and apology from the church, or compensation from the fund for victims.

I can empathise with the ambivalence about accepting money. I can understand that survivors don’t want paying off and that money doesn’t make their abuse go away. And yes, possibly things could have been worse, there are people who have crappier experiences or less positive aspects to their lives in mitigation. I get that the people who are in the lucky position of considering claims are already survivors, and probably don’t want to look backwards to the time when they were victim and to have to relive that experience for another second, let alone in statements and testimony and the flashbacks that will bring. I also know there is a discomfort with the idea of financial settlements as a panacea, and that it feels wrong to benefit in any way from the harm that was done to them.

But when we look at the population level we can see that experiencing abuse changes the path of people’s lives. There is impact to the person’s sense of self, their ability to form healthy relationships and to be happy. People who are abused in childhood have their norms and expectations about themselves, other people and the world changed compared to those who aren’t. They have neurochemical pathways that are more primed for fight or flight, and perceive threat that others do not see. As a result they are less able to concentrate and focus, more likely to switch to anxiety or anger, less able to aim high and achieve in school and employment, less able to trust in relationships. Their self-esteem and sense of identity is damaged, and this permeates their ability to enjoy life in the present and to plan for the future. So whilst that doesn’t have a monetary value, there is a quantifiable loss to their earning power and quality of life, and the compensation is just making a nod towards acknowledging that.

Those responsible for compensation are also massive organisations, and in the case of the Catholic church, organisations that have accumulated massive wealth that for the most part they are not using to benefit the needy – it is kept in stocks, shares and property, and some is used to fund the legal defence of the perpetrators and those who knew about the abuse within the church. That is one of many reasons that lead me to say that victims should always apply for any compensation on offer. My general advice is to “take what you can get, use it for whatever feels right, and build upwards from where you are”.

It seems there is a good message in that for us all: Don’t let your past define you. Build your identity on who you are now, your values and aspirations, and the things that you enjoy. Then find a pathway towards self-actualisation and happiness in the future. Take on new facets to your identity. Become the diver, the weightlifter, the mother, the partner, the poet, the film buff, the cook, the gardener, the video gamer, the artist, the builder, the bookworm, the collector or whatever combination of roles and interests makes you happy. And seek out personal and professional allies for the journey to support you until the wounds of the past heal to become scars that don’t stop you from doing the things you enjoy.

Why and what next?

Let me nail my colours to the mast. On balance, I am in favour of remaining in the EU, and in the USA I’d have voted for Hillary Clinton. I can see some problems with each of these positions, but I can see many many more problems with the option that has actually been chosen. In each case my pros and cons list strongly favoured the progressive choice, because of the potential negative consequences of the other option. But I was in the minority in both cases, and so were half of the electorate (maybe more in the case of Clinton). So rather than just be fed up about that, I want to understand it.

When it comes to Brexit I think it is wrong for the UK to leave the EU for a number of reasons. The unity of many nations ensures that we all maintain basic human rights and the fair rule of law. It prevents the rise of extremists and reduces the risk of international conflict. It was a large single market, and am important strategic alliance. I believe that calling the referendum was a foolish whim from a complacent leader who was too cowardly to face the consequences of his actions. It was supported by xenophobic self-serving politicians and by far-too-influential media moguls with a right wing agenda. I think it has been divisive and stoked xenophobia, as well as causing enormous economic fallout. However, I’m not saying that the EU doesn’t have excessive bureaucracy, or that it hasn’t been excessively harsh on southern European nations like Greece, Portugal and Italy, or that it doesn’t enshrine market capitalism in doctrine.

Likewise I think Donald Trump is a repugnant man whose attitudes to women and minorities are repulsive. He is a sex pest and a tax avoider. His business practices are dishonest, he is a blatant liar and his much touted business acumen is such that he would be three times as rich if he’d just stuck his inheritance into index funds. I find his racist rhetoric abhorrent, and I think he will foster international conflict and unhealthy alliances. So I could never vote for him, and would have voted strategically to avoid him reaching power. However, in choosing Clinton as the lesser of two evils I’m not saying that she doesn’t have vested interests, didn’t support arms sales to the middle east, isn’t associated with numerous scandals or wasn’t stupid to use a private server for her email. In fact I think Obama was right to sum her up in 2008 as someone who would “say anything and change nothing”. If she was running against a more palatable candidate who genuinely supported progressive ideals, I’d be advocating against her. I’m just saying that the idea that Trump could be president was even worse.

In both cases, it was a two horse race, and although I didn’t love either option I felt that one was clearly preferable to the other. That says something about modern politics – that we are voting for the least terrible option, rather than in favour of something we truly believe in. And I want to think a little more about why this is the case. I also want to think a little bit more here about why the results in both these votes went against the polls and against the incumbent business-as-usual candidate, and why the results have been so divisive and triggered such hateful behaviour from segments of the population.

So why did people vote for Brexit and for Trump? It seems that a number of factors contributed. Firstly there were demographic factors – these regressive options particularly appealed to white men and their wives, in areas that have been hit by economic recession. They tapped into a sense that the world is changing and they are being left behind. There was also a real desire for change, not just more of the same select few in the top one percent making all the decisions. The less people feel they have to lose, the more they are willing to gamble that any form of change will be an improvement. Trump carefully marketed himself as an outsider and a voice for change, but that is a carefully designed misrepresentation. It is also contradictory to his simultaneous positioning of himself as a tax-evader and shrewd businessman who is successful and super rich. In reality his businesses face a constant stream of lawsuits for not honouring contracts or dealing with people fairly and it is clear he is out for nobody’s interests but his own. He also has vested interests and hidden agendas all over the place, but this is something we now take as a given for politicians. So how can he connect with the man on the street more than other politicians? The answer seems to be by bucking convention, appealing to the desire for change and speaking in much more simple terms, as well as appealing to fear and self-preservation (some of which sadly overlapped with racism, sexism and homophobia).

Being wealthy and embedded in the establishment is something that also describes the majority of British politicians. Nigel Farage, for example, similarly markets himself as an everyman who always has a pint in his hand, but in reality is a privately educated millionaire ex-banker who claims every EU allowance possible for himself and his German wife, who he employs as his secretary. Cameron led a cabinet of millionaires, and May is herself a millionaire with a network of wealthy donors and has placed even richer men like Philip Hammond and Boris Johnson into her cabinet whilst claiming she will build a fairer Britain that “works for everyone”. They have no idea about the experiences of people who survive on minimum wages or benefits, but they have learnt to talk as if they care, whilst their actions clearly indicate the opposite. And so we have reached a position that everyone in politics is saying much the same things, and nobody appears to be sincere.

One of the big issues of the reaction to the American presidential election result, and to Brexit, is in how we think of ourselves and our fellow voters. It is all too easy to make sweeping brushstrokes about ignorant, selfish, racists. But I’m not convinced that there is as much difference between us as these dichotomous choices imply. Whilst there are some vocal and visible extremists who identify as Brexiteers or Trump supporters, the message clearly resonated with a lot of people in the middle ground who don’t identify with the racist or sexist undertones, but also don’t identify with the current power structure. I suspect a lot of people are fed up with the status quo, and feeling disenfranchised by the current political system. And maybe that has motivated a lot of people to vote for candidates who seem to be anti-establishment, straight-talking and authentic. This Jonathan Pie sketch, which is full of swearing and therefore NSFW, is worth watching.

I can’t say that a desire for change and for authenticity over spin is a bad thing. In fact having sincere politicians who mean what they say and are not motivated by self-interest or masking their true agenda is something that has been sorely lacking in the political arena over the last decade. Likewise a willingness to explore more radical change is something that I would want myself and a lot of more progressive people would support. But in the absence of such messages from the left and centre of the political spectrum, it has instead been harnessed by questionable individuals and causes. And voters have been sufficiently enticed by this message that they have been willing to disregard all of the bile it comes packaged with, a task made easier because it is addressed to groups outside of the main voting demographic. In response the progressive candidate is left to defend these minorities, and ends up looking like they care little for the main group. The regressive candidates and policies make more headlines, perhaps because of bias in the media and lies that have not been sufficiently challenged. Other parties and messages appear reactive, and end up fuelling that discussion rather than presenting their own position.

The more progressive candidates and causes need to work out how to tap into that feeling of disconnection with the establishment and the increasing desire for radical change. If they can do so with policies that will genuinely benefit those who are being left behind in the current austerity politics then they can avert the swing to the right. That will take the right mixture of passion and authenticity, a willingness to be plain spoken about who is to blame for problems, and a push for greater accountability for political claims.

So where now? First, I think we need to learn from our mistakes and not be complacent that progressive politics are now the default position. We need a return to politicians that mean what they say, and speak with authenticity and passion. We need people who get fired up about the issues and speak from the heart, rather than with spin and polish that hide vested interests.

Second, we need to explain that the same few people have all the power and are increasingly gathering the wealth away from everyone else, and to show the economic value of being kind to the more vulnerable sectors of the population. We need to demonstrate that the threat comes from above (the rich and powerful people who control the media and the corporate and private interests that have powerful lobbies that manipulate our political system) not below (immigrants, benefit claimants, people in minority groups). We need to name the organisations and individuals who are spreading hate and cheating the man on the street by avoiding paying their fair share of tax, and turn the rhetoric of blame to more appropriate targets.

Third, we need to show that the system is rigged to support the establishment, and needs to be overhauled. That may mean setting fair boundaries and catchments to prevent gerrymandering, preventing conflicts of interest and restricting lobbying, looking at the terms and roles for nominated unelected officials (eg striking out members of the house of Lords that are not actively involved in political debate) and/or changing the first-past-the-post system.

Fourth, we must hold people and organisations to account for their lies and false claims. We must give consequences for propaganda, misinformation and promises that are not fulfilled. We need to hold politicians to account for the claims that they make, and ensure that they cannot benefit from lies and deception.

Fifth, we must do much more work to engage those who are feeling disenfranchised, rather than excluding them because they have turned their resentment to the wrong place and are being selfish/xenophobic etc. We need to explain the issues, using short clear soundbites rather than long intellectual explanations whenever possible, so that these can be accessible to a wide audience and shared over social media. We need to be down to earth and not make assumptions about underlying knowledge or values. We need to understand that many people are feeling excluded and shamed for not sharing progressive values, and reach out to them starting with empathy for their current situation, their hopes and fears.

But finally, and most importantly, we need to continue to educate our children to be better than the generations that came before them. We can teach kids to care about each other, the environment and social issues and to not discriminate by gender, race, sexuality etc. We need to help them to become critical thinkers who can evaluate what people say and don’t just accept a lie as the truth. Then over time, the population will change, and progress will continue beyond what seems possible in the present.

I can see that right now it seems overwhelmingly sad and frustrating and many people don’t know what to do with those feelings. This negative focus and tendency to turn towards anger and fear is not surprising. We are sensitive to threat, and fear impedes our ability to use empathy and rational analysis. Our brains are programmed to look at immediate risk and the local picture. We are sensitive to potential threats and we easily catastrophise and generate worst case scenarios. We find it hard to conceptualise the bigger picture as this involves timescales outside our own lifetimes, and populations we have never met and can hardly imagine. But my real hope is in the inexorable march towards progress that is happening over the last century around the world. So whilst we seem to have taken a depressing step backwards it is good to remember that progress is often two steps forward one step back.

There has always been a pattern of economic booms and busts, political cycles including changes that seem awful, and international conflicts that kill hundreds of thousands and displace millions. When we focus on these negatives, it feels pessimistic and makes us worry it is all downhill from here. Like a panic attack, we see worst case scenarios and look for escape, rather than realising we can work through it. But over human history we have rebounded from all of these things before, and the same problems have been around before only bigger. For all his hateful rhetoric, Trump isn’t Hitler. Although he is set to enact policies that are homophobic and xenophobic, he has already backed away from some of his more extreme claims, and even in a worst case scenario he won’t kill millions of people. And like with May as Prime Minister here, things will continue much like normal for most people. I’m not dismissing the horrible impact of the rise in prejudice against various minority groups, or the risk of repealing some rights, but in the bigger picture they are temporary and against the overall direction of travel.

When we look at the wider view, the future seems much more optimistic. Science continues to make new discoveries that enhance our health, reduce energy consumption, deal with environmental issues and better understand our place in the universe. Technology and access to information and media are allowing people all round the world to access information and different perspectives. Life expectancy has increased remarkably (even in the face of increasing obesity bringing a rise in diabetes and heart disease, and austerity politics increasing mental health problems and suicides). Smoking is declining. Cancer treatment is more effective. Deaths from road traffic accidents are steadily falling. Even HIV is now treatable and prophylactic medication is available. Despite the constant headlines that make us feel otherwise, deaths from homicides have fallen over time in Europe and wavered and then fallen in the USA. Deaths from wars have massively decreased over time, and even the horrible events in Syria, Afghanistan and Iraq are of a smaller scale than previous international conflicts. More and more nations have democracy, women’s rights, gay rights, access to justice and protection of human rights. I believe that the future for humanity is one of steady progress with temporary set-backs. And we should never forget that from enough distance we are just a pale blue dot.

Another sad day

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

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

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

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

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

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

Hiding in plain sight: On Louis Theroux and Jimmy Savile

I watched the Louis Theroux documentary on Jimmy Savile tonight, and I wondered why it wasn’t obvious to Louis how slimy and two-faced Jimmy was. It stood out for me from the original documentary, let alone from the rushes shown in the update, how clear it was that he was inappropriate about personal space and made a number of particular types of comments – normalising sexual content, implying connections to power and influence, and schmoozing/bestowing favour – that I associate with people who sexually abuse children that I have met through work. He also behaved differently when he wasn’t on show, and was with someone he didn’t perceive as having influence, in the unguarded footage shot by the producer late at night. I’ve learnt to take note of that too, from bitter experience.

It reminded me that my initial gut reaction to the original documentary was “ugh, my sense of him being creepy as a kid was right – it appears he has a sexual interest in children, and from the way he talks about enjoying his time with her body it seems likely he had sex with his mother’s corpse”. Yet that response at the time was unspeakable, except to my husband. After all, you can’t just say someone is a criminal, a necrophiliac, an abuser and a risk to children without proof and based purely on second hand information. That would be inappropriate, and potentially defamatory, particularly for a professional.

But Louis was there with Savile and heard his entirely unsatisfactory responses to questions, his jokes and inappropriate behaviour, saw his invasion of people’s personal space, heard him made threats to sue and name drop his connections to both establishment and underworld power. Yet, despite being an intelligent guy with suspicions about Savile, Theroux’s reaction wasn’t one of repulsion and scepticism. He was won over by Savile’s charm, and carried along by the fiction Savile had created that he was some odd relic of the 70s with his own rules not quite being in sync with the present overly PC world, and being inappropriate was harmless and par for the course. He probably felt flattered by the attention, and tantalisingly close to being the confidant that would get the big scoop when Jimmy was ready to tell his story. But he stopped being a critical observer and started to consider him a friend, and was present when he continued to behave in inappropriate ways and failed to remark on it. And that shows how easily it is done.

Because if it is your mate, and they just go one step further than you are comfortable about as if that is perfectly normal, then perhaps that is just the way that they are, and you can start thinking that maybe they are too old and odd to have to conform to social norms. And once you start to think that, your own boundaries shift and you become complicit. Something you would instantly baulk at from a stranger, is somehow normalised. You turn a blind eye without realising you have done so. Louis said that he didn’t feel he had been groomed, but I think he was wrong. Sure, he hadn’t been targeted as a potential victim of Savile’s sexual advances, but he had been drip-fed the self-crafted story of the harmless oddball doing so many wonderful things for charity. And he had been slowly habituated to be complicit in accepting the small infringements into the unacceptable, the misogyny, the recurrent sexualised content of his interactions, the invasions of personal space. And he tolerated the evasion, the flattery, the name-dropping, the sinister undertones as part of the special relationship they had developed. And that, to me, is grooming.

I’m not implying Louis is to blame for that. He has shown his intelligence, empathy and insight in other documentaries, so my expectations are high. But it is easy to be groomed. By definition, recurrent sexual abusers who have not been caught are devious and effective in fooling those around them. Plus Savile had a lifetime of practise and an enormous reputation and network to carry him. Nonetheless, I can see why Louis has been looking back and wondering what he should have noticed. I’ve been there and done that.

The first child sex abuser that fooled me (that I know of) was more than 15 years ago now*. He shook my hand, spoke politely, seemed to have a benevolent interest in the wellbeing of the children in the family and always agreed with what the professionals said. He was well educated, middle class, and married with adult children. He was the one who reported concerns about the grandchild who was referred, and was critical of the parents. The child was developmentally delayed, but also underweight and unkempt, with no sense of personal space. In retrospect, I can see that this idealised grandfather was remarkably unsympathetic to his daughter, whose lifestyle of alcoholism and domestic violence punctuated with inpatient stays after self-harm didn’t match up with the facade of happy families he portrayed. But at the time he seemed very concerned about the wellbeing of the child. The receptionist took me aside to mention that he spoke to his wife “like a dog” in the waiting room, but turned on the charm in the presence of clinicians. I didn’t even make a note in the file. I only remembered the comment 6 months later when the social worker said to a case conference that just prior to proceedings to move the child to the residence of these grandparents, the mother had disclosed childhood sexual abuse from her father, along with sadistic punishments like having her hands held against the hot oven door if she didn’t do as she was told quickly enough. This had then been corroborated by another family member, and her records showed the school had reported the burns to her hands. The child was placed in foster care instead.

I remember how stupid I felt. The clues were right there in front of me. The child was vulnerable to abuse, and the developmental delay and unusual behaviour with no sign of organic cause showed that something was going wrong in their life. But it was too easy to attribute it all to the ‘bad’ parents and not the ‘good’ grandparents, falling into the polarised thinking of the family, despite normally having more nuanced formulations. The mother’s story didn’t match the grandparents, and her lifestyle didn’t fit with their descriptions of her upbringing, but she had been branded an unreliable reporter. So why did someone from such a happy middle class home get into such a mess? The answer was given to me on a plate – she had fallen into a bad crowd as a teenager, and ended up drinking and in a destructive relationship – so I didn’t look at other contributory factors. It wasn’t my job to pry, I was just doing a developmental assessment of the child. Yet I know that severely troubled adults have rarely had idyllic childhoods, and have often experienced multiple adverse childhood events, and that attachment styles are often carried through the generations. Likewise I know that trying to charm professionals can be a warning sign, but nonetheless numerous small compliments on your insight, empathy and skill as a clinician can flatter your ego without being so excessive as to raise a red flag. And the receptionist’s comments were given outside of the clinic room, and whilst I didn’t have the file open to take notes. Plus she wasn’t a clinician and may not have heard the full context of the comment, so the team didn’t give it much credence.

Thankfully, the disclosure came in time to protect the child from being placed with someone with a history of abusing children, but it wasn’t thanks to my skill as a clinician. Sure, I was quite early in my career and still quite naive, but I suspect most clinicians think we have uniquely sensitive radar to pick up on abuse and abusers. Sadly, we don’t. Whilst we might not rely on the stereotypes that the public are fed, of dirty old men in trench coats exposing themselves at the park, or strangers trying to tempt children into their car with sweets or puppies, I do think we have some internal stereotypes. The abusers that are easily caught are often socially gauche, lower in intellectual ability and/or socioeconomic status, and we tend to think of men who are unsuccessful in adult relationships and are prolific and opportunistic in their offending, but abusers are a highly heterogeneous group. Few have overt mental health problems, some may appear to be morally upstanding citizens, some are female, they come from all walks of life, cultures and religions, they may have functional adult relationships, and most are known to the child. about a quarter of perpetrators are under the age of 18. The majority of abusers have a single victim or a small number within their immediate network. A tiny minority with a primary inclination towards children are prolific abusers like Savile, but the damage is so wide ranging and the cases more newsworthy and memorable, which is why people are more aware of them. So there is no clear alarm bell, apart from the inappropriate interest in or behaviour towards children itself, the presence of child pornography, or sexualised behaviour or disclosures from the child.

In hindsight, it is easy to recognise signs you may have missed, and if you know there is a history of sexual offences against children certain behaviours show in a different light. And I have learnt to be both more observant and more wary. Those flirtatious comments to the receptionist, or the attempts to find common ground with or flatter the assessing clinician stand out, just like the cringe-inducing examples of Savile’s behaviour we saw in the edited highlights from the rushes that Theroux had of his time with Savile. We can only hope that we learn from experience and aren’t so easily fooled next time.

*all case details have been suitably anonymised

Everyday madness

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

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

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

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

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

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

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

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

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

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

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

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