Where have all the flowers gone?

This week Liam Fee’s name was added to the list of toddlers killed by their caregivers, alongside Peter Connolly, Victoria Climbie, Daniel Pelka, Ayeeshia Smith and Keegan Downer. And the newspapers have turned their gaze to their favourite post-mortem task of placing the blame. The conclusion, as ever, will be the ‘born evil’ women who killed him, and social workers who ‘failed to prevent’ the death. But that doesn’t tell the whole story.

Firstly, how can social workers prevent child deaths when their services have been cut back so much that thresholds for intervention have risen ever higher?  Social workers are over stretched and morale is at an all time low. When they intervene too much they are demonised by the press as baby-snatchers. When they don’t intervene enough they are demonised as failures who didn’t protect children. Since legal aid was slashed, court proceedings expect them to be both case worker and to cover the role of expert to the court. The social workers I know are amazing people, dedicated to helping make a difference with families, but tell me that some workplace cultures focus on form-filling and don’t allow as much time out in the field intervening with families as they would want.

Personally, I think prevention takes more than reactive services like the current remit of social work. We need proactive screening services to spot where there is need much earlier, when interventions for families are cheaper and more effective. In my opinion we need universal health visiting back, for every birth registered to be followed by mandatory visits twice a year until the kid starts school and for that to include weighing and measuring the child and seeing them in just their pants. It will also see the home environment and the relationship between parent and child. Old fashioned, maybe, but it would hopefully catch malnutrition and serious injuries earlier, and save lives in cases like these.

Secondly, what kind of lives must those two women have had that they were so un-empathic that they could witness and ignore such suffering, let alone create it? There must have been great trauma to end up like that, and a total absence of nurture. Of course no experiences are an excuse for the sadistic things they did to the children in their care. But they can help us to understand what happened, and in doing so to help prevent a future recurrence of similar issues. If we just blame it on innate characteristics of the individual perpetrators there is little we can learn to prevent the same thing happening again (except perhaps chase the fallacy of a genetic marker for evil, which I’m almost surprised is not already being done, given the overly biological focus of research topics that are clearly more influenced by experience).

I’m not convinced that anybody is ‘born evil’. I think people are born with the capacity to be a wide range of things, and their experiences (particularly their early experiences with their caregivers) determine the direction of travel, the types of skills they develop and the behaviours that are in their repertoire. Given exposure to enough trauma, a total lack of safe attachment figures, few skills and loads of dysfunctional strategies, people can end up doing awful things, particularly with a hair-trigger tendency to fight or flight under stress.

This is an evidence based position, not just my opinion as a clinician. We have known for at least a decade that childhood experience is the leading predictor of the health and social well-being, and that this applies on the individual level as well as for the nation. But as well as the self-evident human cost, there is also a huge economic cost to society. Studies show that the financial impact of child maltreatment on the economy amounts to billions of pounds per year, and the impact on lifetime health and employment is equivalent to a diagnosis of diabetes. However, the costs are hard to measure, and occur throughout the person’s lifetime so they are not as obvious.

Violence in society is neither universal nor inevitable (in fact it is almost absent amongst central Thai or Lapp society). Violence is a behaviour that is caused and can be prevented. When it comes to predicting violence, it is clear that the propensity is hugely influenced by experiences in the home before the age of 3. We also know that various interventions to improve care and the quality of the attachment relationship, or the more drastic intervention of removing the child and placing them in a household with better care are highly effective. However, there are also sociopolitical factors at play. Once the use of violence is established in a society, the levels are influenced by many factors, including:

  • Economic inequality
  • Unemployment
  • Alcohol consumption
  • Violence in the media
  • Poor housing
  • Availability of weapons

And yet, over the last decade economic inequality has increased, social housing has been sold off, and more violence has been shown in the media. More hopelessness has been created by the cuts to benefits for people with disabilities, or living in homes with an extra room. Services for people using drugs and alcohol have been cut by austerity measures whilst the need for them has increased. So the government has increased the risk of violence, whilst (as with immigration, single parents or benefit fraud) blame is being directed onto vulnerable individuals and public services.

Liam Fee, Peter Connolly, Victoria Climbie, Daniel Pelka, Ayeeshia Smith and Keegan Downer are the tip of the iceberg. There are many child deaths from maltreatment that never make the news. Best estimates based on serious case reviews suggest 40-80 deaths of preschool children are caused by their caregivers per year. And of course, many more children are injured physically or emotionally every day. For every child experiencing abuse who is known to services, eight more are going unseen. But this is not down to individuals who are born evil, and it is not down to negligent social workers. It is a socioeconomic and political problem. And whilst the media propagates the narrative of individual blame and politicians turn a blind eye, children will continue to die.

Where have all these children gone, long time passing?
Where have all these children gone, long time ago?
Where have all these children gone?
Gone to graveyards every one.
Oh, when will we ever learn?
Oh, when will we ever learn?

Bedtime routine: The gift that keeps on giving

Of all the things I’ve done as a psychologist who is also a parent, the one I am probably most proud of is my bedtime routine. As I watch other people struggle to get their kids to sleep, or hear about the struggles of kids that keep getting out of bed or will only sleep with a parent present, I feel very grateful of the fact that mine always go down like magic.

The secret recipe started in infancy. After a difficult start with premature twins born before they had a suckle reflex, and six months of having to spend an hour feeding each of them every four hours (meaning we got a maximum of 2 hours sleep at a time), we turned a corner. At six months, we were told by our health visitor that they no longer needed milk in the night and could manage without a feed from the time we went to bed to 7am. So after a late feed at 11pm or midnight we got back our night. There were a few nights with some crying before the new routine was established. The first night pulled on all my emotional hooks, so I went to check and found they were fine and soon settled with me there, so the next night I was able to resist going for the ten minutes it took for the crying to peter out. Two nights later and it was quiet from midnight to seven am and we got back our unbroken sleep and our sanity. Soon after we saw that they were not taking much, if any, milk at the last feed and we were able to withdraw any room service from 7pm to 7am. By then, my night time routine was already in place.

Once baths are done, pyjamas are on and teeth are brushed, the kids get into bed and we make the room darker by closing the blackout curtains. I used to wish them goodnight using the same little rhyme every night, and then move straight to singing. Now they are older, when there is time, we normally have a little chat about the day and read a story – this is one of my favourite Mummy times, as we talk about all kinds of interesting things. Our conversations range from why some children are mean, to where petrol comes from, to why there is war in Gaza, to whether religious beliefs are true or just stories that some people believe and some people don’t, to how families have different configurations, why their second cousin had a brain tumour, or how flowers come back after the winter, or why some people are homeless. I’ve got a strong belief that if they are old enough to ask a question they are old enough to have an honest answer, no matter how difficult that answer is to articulate in simple terms for me as an adult. They have this insatiable thirst for knowledge, and often bring up what they have learnt at other times.

Whenever we have these discussions, my kids amaze me with their compassion and desire for fairness in the world. I still remember being told by a serious-faced four year old that we needed to “send a load of postcards to people in Israel and Palestine to tell them to look after and re-build schools, so that everybody can learn about how to be kind to others, no matter whether they believe in the Hanukkah God or the Eid God”. They were even younger when they explained how they want us to buy things that create employment in less developed countries, because most people have food and houses in England, but the people in other countries would want jobs that let them feed their families. And I remember how nonplussed they were to hear about gay marriage and how they couldn’t understand the examples of prejudice that kept coming up on the news because “its not right to be mean to people because of the colour of their skin or who they love”.

Then after our serious discussions and perhaps a bit of reading (Harry Potter and Rebel Girls seem to be favourites at the moment) it is time to wind down to sleep. Then quiet time begins. That signals that it is no longer the time to have a conversation and anything except the most urgent questions need to wait for the next day. I sing a few songs that they have chosen and a few old favourites, and within 15 minutes they are asleep. If we’ve had a busy day and we are out late, I can skip right to quiet time and go from active to asleep in the same time-frame. Friends and family members are often amazed, but I say its the best example of behavioural conditioning ever. I can even make the kids yawn by singing the same song in the middle of the day!

Of course it isn’t always perfect. If one of them is poorly, or I have been away too much in the week for work, they might stir and say “don’t go Mummy, sing an extra song” or they might wake in the night and come down for a cuddle or some medicine. But we always meet that need as quietly as possible and then return them to bed. Because when they sleep well, and we get quiet time as adults to wind down and catch up as a couple, the whole household is happier. We can flex the routine enough to stay up late for a special occasion or to give a little extra time on weekends or holidays, but we also flex the other way and start winding down earlier if they are tired and irritable. The kids even say “Mummy can we have an early night tonight as I’m feeling a bit tired and I want to have enough energy for swimming tomorrow?”

I know there is a lot of debate about ‘controlled crying’ but the few nights in which we ignored some crying at six months have reaped rewards ever since, and we have a happier family as a result. Of course, it won’t work for everyone. There are plenty of children who are more difficult to get to sleep than ours, but my advice would be to have a very clear routine, to start as young as possible, to be very calm as a parent throughout, and to persist through the difficult bit as quietly and calmly and consistently as possible. Because sleeping well helps all members of the family to regulate their emotional state better and have more positive experiences throughout the day as well as at night. I know I’m happier and more able to focus when I’ve had enough sleep, and the same is true for all members of the family.

To the parent in the changing rooms this morning

It made me sad to hear you repeatedly criticise your child for minor things, and then conclude “you’ll go straight to bed when we get home”. When I came out the shower to see the child concerned was 12-18 months of age, and having to sit patiently on the counter whilst you did your hair and makeup, I wondered whether I should have said something. But being British, I bit my lip.

Here is what I’d have liked to have said:

Firstly: A child of that age won’t be able to sit still without making a noise for 20 minutes. It isn’t a realistic expectation, so you as a parent should bring along things to do or a snack for times like that. If the issue is that being up on the counter means they need supervision, use the playpen provided, or leave the child in the creche until you have got dressed. If you took the child swimming then make the whole outing fun, and recognise that after an energy-consuming activity a child might be more frazzled than usual, so prepare for this.

Second: A child of any age needs lots of praise and encouragement to learn how to behave, and to feel that they are a worthwhile person. You teach children best by showing them what you want them to do, not telling them what not to do, and praising any approximation of it whilst giving encouraging feedback until they get it right. Can you imagine teaching an adult to drive by saying what not to do? “Don’t hit the pedestrians… no, don’t mount the kerb… don’t hit that other car… don’t go so fast… don’t use that gear”. Would it work? Then why do you think a child can learn much more complex and subtle social and life skills based on what you don’t want them to do? Like a learner driver, they need to be told what to think about and prepare for, then given guidance how to do it, and feedback about how to improve their attempt next time, whilst making them feel okay about the fact that they are still learning and things are pretty hard until they become intuitive.

At this age, you also need to ensure your expectations are realistic – instructions for a child with a limited vocabulary are like trying to follow directions given a foreign language, whilst you are still learning how to use your body and interact with the world. Set simple clear rules and then be consistent in how you react to them. Hurting others or yourself, or breaking things on purpose are not okay, but the way you manage these has to be age appropriate. With a toddler, being told what they have done wrong and/or removed from the situation is the simplest response.

Third: Using sending to bed as a consequence for undesirable behaviour is a really bad choice for several reasons. Most obviously, it isn’t an immediate consequence. The child will not link the behaviour with the punishment if there is a gap of more than a few minutes until they are much older (even at 4-7 children will normally need an immediate consequence like a sticker to help them understand the longer term gain or loss is related to the behaviour). But it is also really silly to link going to bed with being punished. It sets up a negative reaction to being put to bed, which will increase arousal at exactly the time you should be helping a child to feel soothed and start winding down to sleep, and set up expectations of resisting going to bed or staying awake and active/noisy which are likely to lead to more negative feelings. If it is normally nap time just after lunch, make that a pleasant time, not a punishment. If it isn’t a nap time, then don’t use it at all.

Being put in isolation feels like being rejected and neglected and is a very serious consequence, even if only for a minute or two (which is why it works so powerfully in time out with older children). A preschool child being shut in their room for longer than a few minutes is abuse, and with an older child I’d still advocate for the shortest possible length of time. Consequences should last no more than the child’s age worth of minutes and be proportionate. Never deprive a child of food just because they have done something irritating – for most things your displeased facial expression and tone of voice are enough. With little ones you may have to physically intervene to make them safe or to take away something being used inappropriately (eg a crayon that is being drawn onto the table) but make sure to repair the relationship after you’ve given that consequence, and to praise the behaviours you want to see instead. Choose your battles wisely. Ignore the little stuff, it doesn’t matter compared to your child having a positive experience of themselves, others and the world. A positive relationship with their primary caregiver is the biggest gift you can give them and makes them resilient for the rest of their lives.

Finally, if you are stressed or unhappy, or lack parenting skills or support, do something about that. Your child sees you as the centre of their universe, and deserves to experience warmth, safety and love rather than recurrent criticism. If other stuff in your life or your mental health or experiences of being parented are a barrier to providing the kind of care you want to provide for your child, get some help. Ask your GP or speak to your health visitor. Lots of good parenting services exist, and it really is a sign of strength not of weakness to seek them out when it might benefit your child.

I hope I observed an unrepresentative sample of the relationship today, and that there was something the child did that merited the negative feedback, like trying to touch the hot hairdryer or the plug sockets. We all have bad hair days and moments when we aren’t the kind of parent we would like to be. But it made me realise how much of the maltreatment I see in the histories of people through work is the chronic, insidious, low-level kind, and how we all turn a blind eye to that every day. Maybe I should have spoken up to ask whether I could help, rather than being caught up in my own discomfort and feeling it would be difficult/inappropriate to criticise.

Sadly, I am sure there will be another time in another situation with another parent, so hopefully I can give that a try.

The battle isn’t won yet: Why feminism still matters and is relevant to everyone

It is easy for me to be complacent about equal opportunities. I’ve never personally been held back by discrimination. I mean, I’ve had people think it is their right to comment about my appearance, and I’ve even had a few individuals who have bordered on stalking because of my internet presence, and my gender has certainly been a factor in that, but I’ve never not been able to do anything because I’m a women. Likewise, although I’m a second generation immigrant and my heritage is from a cultural minority, I’ve grown up as a white British atheist and have never experienced discrimination (even if there have been occasional incorrect assumptions about my religion or politics). I’ve had a broad social network, but I’ve never witnessed my friends or colleagues experience overt discrimination either.

I’ve always seen gender stereotypes as something of a challenge, in fact. I was one of three female students who did A-level physics, compared to about 50 males, and got good marks in maths and hard sciences before I went into psychology. As a student I bought a Haynes Manual and replaced the starter motor of my Vauxhall Astra along with an oil and filter change, because I couldn’t afford the quote from the garage. Likewise I have learnt all about the construction of houses, and was involved in the design and manual labour of various home improvements. I’ve been an early adopter of technology and a fan of video games as an emergent art form. And now I lift big weights at the gym, defying the gender pressure to lose fat through cardio rather than build muscle. I’ve encouraged my daughters to be brave and strong as well as kind, and to want more to the story than for the main character to marry the prince and live happily ever after.

So from my position of relative privilege it is hard not to assume that the battle for equal opportunities has already been won. However, as soon as I look a little more broadly at the world this is clearly not the case. So many different examples illustrate how my experience is the exception rather than the rule.

In the UK women on average earn 21% less than men per hour. This is the case in most of the developed world and the disparity is much worse in less developed nations. Although there has been significant progress over the last 50 years to reducing this disparity, economists admit the gender gap in wages is likely to take at least the next 100 years to close. Even in the most conservative figures, when all the variables that affect wages, such as lower experience due to career breaks and lower levels of qualifications for some population groups are taken into account, women still earn 5-10% less when equivalently skilled and doing equivalent work. In the most senior roles there are far fewer women, and those that are present earn substantially lower salaries. The earnings gap is larger as people get older, and in the higher earning percentiles of the population, suggesting that choosing to care for children does sacrifice status and earnings for the remainder of the woman’s career. These are figures I find appalling.

Thankfully there are movements and books containing advice about how to counter this effect. Cheryl Sandburg’s “Lean In” movement encourages women to take a seat at the table where big decisions are being made in big companies. The excellent “Give and Take” by Adam Grant advises people who are natural givers to advocate for their dependents when making decisions and entering salary negotiations, if they are not assertive/demanding enough when arguing for themselves. And many women and men are advocating helpfully for the value that women bring to senior positions.

In psychology and therapy professions we hit another facet of gender politics, with the dominance of women in the workforce reflecting the idea that empathy and caring are perceived by much of the public as feminine qualities. This message that facts are the male domain and feelings are the female domain is seen to be natural and innate, because of the typical division in gender roles between hunter and home maker in the origins of our species. However, since industrialisation and the invention of effective contraception, these roles seem to be transmitted more as a story based on past experience than in terms of reflecting the current reality (in which we can purchase food by selling other skills, and few of us would be very good at hunting or gathering our own food if this involved strenuous physical activity). After all, women being naturally suited to be the home-maker was ‘true’ in a time that it was also ‘true’ that the earth was flat, bathing frequently would have been seen as a wasteful fad, nobody understood the connection between hygiene/sanitation and disease, and very few people stayed alive beyond their 40s.

I believe that providing attachment relationships is probably the single most important job in society. That quality of caring about another person, and holding them in mind is essential for each of us to be happy. It is a powerful gift, whether in terms of parenting, friendship or a therapy relationship. However, I have seen no evidence that efficacy in this role is determined by gender. It may be true that in general women have slightly better ‘folk psychology’ and men have slightly better ‘folk physics’, as Simon Baron-Cohen’s research has shown, but apart from the head start that pregnancy and breast-feeding give to mothers, there is a paucity of evidence that the gender of parent who takes the primary carer role affects outcomes for children. Certainly, women feel more guilt about returning to work or choosing not to be the primary carer, but does that reflect a genuine concern about attachment security or the projections of a society where a women is supposed to ‘have it all’ in the form of balancing work, parenting and their own identity, having gained expectations of being an equal provider whilst not having handed over equal expectations of looking after home and family.

By devaluing caring and empathy for men, we lose a significant proportion of the potential workforce for psychological therapies. Those that remain often have less traditionally masculine qualities than are typical for males (whilst women who gain places in clinical psychology typically have more of the ‘masculine’ qualities of assertiveness, ambition and intelligence than are typical of their gender). We also make it unacceptable for boys and men to express their feelings openly, or to seek help for emotional problems without shame. And of course there is the wider issue of devaluing homosexuality, and through association any gentler or more feminine traits in men (for example with the playground taunt of “gay” for disliked characteristics or outcomes). This leads to lower uptake of psychological therapies or treatments for mental health problems, along with greater rates of completed suicide in young men.

More recently social media has provided a new means of networking which have been widely taken up, especially by young people. Mobile phones, text, Facebook, Twitter, chatrooms, Vine, Snapchat, Instagram, Tumblr, forums, multi-player gaming and video chat have allowed people to find those with similar interests and to communicate in new ways, but have also been media in which new forms of bullying and harassment have emerged, along with pockets of rampant prejudice including misogyny. In these contexts sexism, racism and discrimination has emerged in new forms, and some media are better at moderating this than others. Online video gaming spaces, Facebook and Twitter in particular have proved to be free playgrounds for “trolls” (those who gain enjoyment by harassing others online) due to their lack of willingness to intervene about abusive content.

There have been remarkably sad examples of what happens when such media allows the predatory minority to find vulnerable targets, such as the tragic story of Amanda Todd, the teenage girl who was encouraged to flash over webcam and then blackmailed with these images by an adult man until the point she committed suicide. There was also the disturbing video manifesto of Elliot Rodgers, a college student who killed 6 and injured 13 before committing suicide due to the perceived injustice of him not being as attractive to girls as he felt he deserved to be.

In amongst the array of content on the internet a subculture has developed that is profoundly sexist and has disturbing ideas about how to “play the game” in ways that “put women in their place”. Some of the members identify as Pick-Up Artists (PUAs) or Mens Rights Activists (MRAs), but the idea that women now hold too much power, and that men have seized upon feminist and progressive thinking to impress women, seems to be a common strand. There is great anger from members of these groups against men who speak up for women’s issues or social issues more broadly, who are often disparagingly labelled “White Knights” or “Social Justice Warriors” (terms which are intended as insults, despite sounding pretty awesome). Many women have learned to use gender-neutral names on social media, and not to speak when playing multi-player online video games, rather than to risk the onslaught of comments, which range from “get back in the kitchen” to violent threats of rape and murder of them and their loved ones (especially when defeated by the superior skill of a female player).

The latest iteration of this undercurrent has been the harassment of women who have highlighted the sexist tropes within video games, or otherwise become a figurehead of progressive thinking within that culture. Anita Sarkeesian’s highly accessible video series “Tropes vs Women in Video Games” has been a focal point. When her Kickstarter attracted death threats, harassments and attempts to discredit and silence her the community spoke out by massively over-funding her project and giving it a much bigger audience. However, she has continued to be subject to a variety of death and rape threats for merely casting a light on the fact that a small percentage of the content of many popular video games is a set of tired old tropes in which women are the decoration, damsel to be rescued, or die as motivation for the hero’s vengeance, rather than the protagonist of the story. Likewise a bitter ex-boyfriend’s rant about female developer Zoe Quinn led her to be a target of harassment (with a thin veneer of concern about ethics in games journalism that was not evidenced by similar hounding of the journalists who were wrongly alleged to have given favourable write-ups of her work due to personal relationships with her) and games writer Brianna Wu, for writing an article saying that the old stereotype of a gamer has been superseded by a much wider demographic (perceived as a “death threat” to “true gamers”). In each example, the profound sexism of the antagonists is evident, and the impact on the target has included them needing to move out of their homes due to the severity of threats to their safety, after their identifying information has been discovered and released into the public domain (a harassment tactic know as doxxing).

So whilst I observe from the safe space of being a successful female professional, who to date has had very limited personal experience of sexism, I am reminded that feminism is far from being a battle that has already been won, and equality is far from ubiquitous in the hearts and minds of the whole population. The internet has always been a great leveller, by forcing us to judge people on their words and not on their gender, age, ethnicity, sexuality, disability or any other aspect of their physical self, and I think that is an amazing thing and as close to a meritocracy as we will ever experience. So I am saddened by the resurgence of such hate and vitriol into places where these variables shouldn’t even be relevant, and that there are now seemingly topics about which women cannot write without fear of a personal backlash. It shames me that I have a little bit of fear about the repercussions each time I express an opinion online through this blog, or twitter or my forays towards podcasts/videos. We all need to do our little bit to change this, to speak up for equality and against harassment, and to reclaim those spaces in which prejudice is showing – for the benefit of everyone.