In all our sanctuaries we sit at risk
  • Mental Health Witness – how to consult with people who have turned to you for help

    Here is a version of a message just written to a mental health manager who recently sent me a draft-“user involvement strategy” being put together for the service where she works. I am soon to retire from a part-time post as free-lance consultant to a group of mental health service users. My task has been to facilitate the process by which their experience of local services is fed through to and influences the people who manage those services.

    “As you know, you have caught me on my way to the exit, so to speak, and my response will no doubt be affected, not just by my proximity to the vast outside, but also by a sense of having left much undone and un-achieved. There are important battles still to be fought, in my view, which I have failed to win ;  major points that need to be seen and understood, of which I have failed to convince people.

    I will not go on at length here, because I have gone on at length elsewhere ; and I will continue to go on, as I depart, and after I have departed. For, somehow, this topic goes to the heart of what the mental health services are about and of the realities they are dealing with. Thus, I talk quite a lot about user consultation on the site of a charity I run called Hyphen-21. I shall be going back to the relevant sections there over the next few months, but have no reason to change much. I need only add and update. The link is http://www.hyphen-21.org/publicsite/consultation-with-the-users-of-care-services

    I am also quite often writing about mental health on this blog these days.  The present piece will the second post directly about consultation.

    Now to your strategy. I will make three main comments on it.

    You are to be congratulated on having one at all. I think the process of engaging on it is in itself a constructive one. I think as a statement of intent and of principle your draft document is commendable, although I would make one suggestion.

    This suggestion is that you should look over it again with the following line of thought in mind, in order to see whether that thought would change either tone or phraseology in any way. I will start the line of thought with a true story. I came off my bike some while ago, straight over the handle bars and onto my head, mercifully helmeted. As I lay on the tarmac, flat on my back, I was not thinking of choice, which hospital I might prefer, which cuisine, which décor ; I was not thinking of “user empowerment” and how much involvement I would be given in my care, how many questionnaires I would have the chance to fill in. I was helpless and needy. I just wanted the nearest hospital and I wanted a safe pair of hands for the support of my head, hands skilled, confident and careful.

    Your document is full of your concern to listen. But is it also full enough of your belief in your own skills and ability to hold me when I am in a state which needs your holding ? I think there is a danger in some of the language that gets used in this area, that it can actually mislead and even intimidate. If I break my head, I don’t want to feel that in doing so I have just taken on responsibility for running the NHS. Or that the people who will be holding my broken head will be so nervous of failing to listen to my directions, that their hands will tremble…

    In proposing that line of thought, I am honestly not criticising your paper. I am just suggesting it as an extra filtration stage, in case it is useful. I think clear boundaries and very clear statements are important.

    The next comment is more an observation. It is that your strategy has a slightly different backdrop or context than many other mental health services, I believe. The difference is that you are working from a small network of community mental health centres. Many of these centres’ clients have attended there for several years. The centres work to sustain these people in the community, who would not otherwise cope without frequent relapse into hospital.  So centre members know each other well, and meet staff members and each other very often. This makes for greater confidence of inter-action, greater freedom in the expressing of views, a stronger sense of belonging, of being in community. In a sense, “consultation“ is endemic in the way you work and have always worked. So power to your elbow, in this brave new world of ever deeper cuts, ever glossier and more delusional slogans, and ever more precarious professional standing.

    The last comment is that your strategy must eventually address the issue of methodology. Ultimately it is how it is done, how the principles are implemented, that requires the greatest thought, and – in my view – most warrants a binding code of professional good practice. For I think there is much bad and damaging practice methodology in consultation, for all sorts of reasons. Paradoxically, the whole target and brownie points culture whose aim is to maintain and measure good standards, is probably the main culprit. Rushed managers look to the tick in the box rather than to the person in front of them, to the quantity of people in the room, rather than to the quality of communication in the space between people in that room. 

    We need to address the fact that user consultation can actually do damage to the people concerned unless conducted with skill and care. It cannot just be a set of good intentions, or for that matter mere blind obedience to a set of directives from above. It must involve suitable methodologies, using creative practitioner skills, methodologies which support and exemplify the respectful listening and responsiveness and sensitivity for which consultation was conceived in the first place. In other words, the means of consultation are core to the end of consultation. Without excellence of means, the end will be meaningless (just as having a “user” in every professional committee is, in my opinion, largely meaningless, and even perhaps irresponsible).”

     

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  • Mental Health Witness – malpractice in mental health consultation

    Health and Social Services in the UK often run open meetings for people who use mental health services. Such meetings are seen as opportunities to give people information on new policy developments, as well as letting them “have their say.”

    By definition, an open meeting means anyone might come, in whatever state they are in. An invitation to an open meeting is an open invitation.

    But, somehow, the whole consultation ethos seems riddled with forgettings on the part of the organisers of events of this kind.

    Many of the recent developments and policies are very complicated and difficult to understand. In recent years, and especially under the Coalition Government, they have also been coming brutally thick and fast, frightening, bewildering and deeply distressing for people dependent on a stable care system for their sustenance, for their ability to take part in community life, for their peace of mind.

    And every manager in charge of this or that strand of rapid-fire innovation is required to “consult with the users” on it. So of course they comply, often using open meetings.

    The first forgetting, very common, is how many other meetings are being organised , often at around the same time, called by other managers, each running a different  project, each instructed to be “passionately keen for users to have their say”, but forgetting that an uncoordinated scatter of momentous consultations can be merely disturbing for people already in a fragile state, without telling them anything that can be usefully taken in.

    But now a couple of questions :

    Is an open meeting, with any number of people round you, the best place and way for taking in a complex piece of information, with possibly worrying implications ?

    Is your average over-worked, middle- or even senior- manager also a born teacher and communicator, experienced and expert at speaking confidently in a public setting, and able to put over in crystal clear terms complex new realities to people in all sorts of difficult mental states, sitting there listening to you while also dealing with the side-effects of all sorts of psychiatric medication ?

    The answer to both those questions is absolutely no. I can personally testify to the fact that it is very common that people come out of these meetings a great deal more confused and anxious than when they went in.

    Let us progress now towards a few more questions :

    On paper, the “open meeting” looks to be a welcoming and inclusive idea, a level playing field where all of us can gather together as equals. Attendance there is surely a “right.” But, to repeat, we are talking here about people with mental health problems and an “open meeting” is an invitation to anyone, in any kind of mental state, to attend. It is not kind or inclusive or “level” to ignore that fact. It means that individuals might come into the room behaving in a way that’s difficult for others to tolerate ; or unclear what the meeting is for, but wanting mainly support and comfort ; or simply finding that a room full of strangers is difficult to cope with. Some people are not iron-clads, able to plough on, whatever the conditions ; some people are not meeting-junkies, scampering avidly from boardroom to boardroom.

    Are there appropriate resources of skill and experience carefully set up to help such people on these occasions ?  Is sufficient support available to ensure that everyone leaves the event in a reasonable state ? Do the organisers check on how people are, as they leave ?

    Again, the answer to all these questions, in the vast majority of cases, is no. Instead, the organisers count how many people came, and if those numbers were large, they congratulate themselves and go home glowing, knowing that their seniors will be pleased. They do not consider how individuals might actually be feeling as they head back to their flats and bed-sits, often so isolated and sparse.

    I believe that the open meeting set up for the purpose of consulting with users of the mental health services is usually a mistake, and worse than that, a mistake which can reasonably be termed as wanton and irresponsible, putting numbers and the ticking of boxes before people’s mental welfare. I believe it is set up in denial of the fact and reality that people with mental health problems experience mental health problems.

    The aim of consultation with users of mental health services is of course to maximise a service’s sensitivity to, empathy with, and appropriateness for, the people who use it. There is a great deal of bitter irony in the fact that the means and methodology so often used for consulting is the precise opposite of the end it seeks –in other words,  insensitive, un-empathic and inappropriate.  

    Consultation with mental health service users has been a requirement for nearly twenty years now. With that in mind, I shall finish this piece with three more questions relevant to the subject, followed by my own answers to those questions, followed by three thoughts. 

    In all these years of practice in consulting, what has been learned about how to do it well ? How much harm has been done, by people who did not mean harm but have boxes to tick and funders to     impress ? How can the malpractice described above still be operating ?

    I would answer : virtually nothing has been learned on how to do it well ; a great deal of harm has been done, much of it serious ; too many employees of the care services seem willing and able to separate themselves off from their own skills and knowledge of what is right, in order to conform to what seems to win approval.

    And here are my thoughts : consultation is about listening. Listening is a skill, a quietness, an act of caring and creativity, a true and open being with. As a function of command-style management, driven and harried, user consultation is a dangerous nonsense.

                                                                                                                                                                                                          


     

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  • Cat vies with Hard Drive for my soul

    A psychiatrist called Iain McGilchrist has written what in my opinion is an extraordinary and important book called “The Master and his Emissary – The Divided Brain and the Making of the Western World.”  I feel instantly at home with, and liberated by, its central thesis. Here is a quote from the blurb on the back of the book : “We need both hemispheres [of the brain] : but, McGilchrist argues, the left hemisphere has become so far dominant that we’re in danger of forgetting everything that makes us human. Taking the reader on an extraordinary journey through Western history and culture, he traces how the left hemisphere has grabbed more than its fair share of power, resulting in a society where a rigid and bureaucratic obsession with structure, narrow self-interest and a mechanistic view of the world hold sway, at an enormous cost to human happiness and the world around us.”

    More information on both man and book can be found by entering his name on Google and going to his website which is easily found.

    Other dualities are suggested by this revelatory finding, but all of those are concept, image, or picture. The tension between the hemispheres of the human brain is, by contrast, a plain discovery from which conclusions are inescapable. Myself I am wary of over-simplifying McGilchrist’s findings and conclusions, but have been moved to write a poem based on this primal duality and struggle which he has been studying for so long. I have dedicated the poem (or poems) to him and to my great pleasure he has accepted the compliment. Here below is the poem, following a short preamble

     

    Cat vies with Hard Drive for my Soul

     

    This poem is suggested by the bookThe Master and his Emissary: The Divided Brain and the Making of the Western World.” by the psychiatrist Iain McGilchrist, to whom the poem is dedicated. He writes about the two sides of the human brain and the tension between them, that tension and relationship reflected in the worlds we have made around us as a race. For the purposes of this poem, I have called the brain’s right hand side “Cat” and the left hand side “Hard-Drive.”

     

    A Confession of Bias

     

    I wish myself cat

    cats-eyes

    cats-ears

     

    I wish myself cat-alive

    cat alert

    sonar centre

     

    electric

    lithe advance.

    Hard-drive blunts me

     

    splits

    and thickens me

    Hard-drive weighs on me

     

    like a hump,

    an imperialist                        

    goiter.

      

    Cat asleep

     

    Ears at attention

    sharp as bayonets

     

    still scanning

    reading.

     

    And eyes though closed

    still reckon

     

    keeping the captain             

    abreast of all our weathers

     

    as he paces

    alone

     

    on the bridge.

    Any time now

     

    those eyes will blaze

    open

     

    and cat will rise

    and crouch

     

    and bare teeth 

    and pounce.

                                                

    Hard Drive in the bath

     

    Hard-drive specialises

    in mean look

    and fierce straight line.

     

    Curves dismay him

    They hint at softness

    and lying back in the bath.

     

    You dont bathe for joy,

    proclaims Hard Drive, but for profit,

    an increase of power and standing.

     

    So yes, bathe often

    but with vigour

    and never lie back.

      

    Hard-drive comes alive

     

    Harddrive waits for nobody

    and never gives way.

     

    To pause is life-threatening

    and to make allowance for other life

     

    risks invasion                        

    by gargoyle

     

    possession

    by Dracula.

     

    I shall force my will

    on the landscape.

     

    I shall stamp myself on the earth

    like a brand.

     

    Hey mother, do you see

    this corpse at my feet

     

    this victim at my hands ?

    Until the moment

     

    of victory

    I had not arrived

     

    O mother, mother,

    I was not born.

     

    Cat in the Sun

     

    Cat glories in the sun.

    He sees it a mile off

    and knows he belongs there.

     

    He rolls in the hot dust

    and delights in that sliding, grain by grain,

    inwards to the skin

    to play among the follicles.

     

    Hard Drive cant bear to look.

    Instead he fixes on the horizon

    in case typhoon is threatening there

    or the barbarian horse

    have broken through at last.

     

    Hard Drive busies himself

    on his preventive measures,

    glancing with contempt

    to where Cat lounges,

    absorbing the suns heat,

    cat ears pointy,

    muscles flexed.

      

    Hard Drive begs to go hunting

     

    Gimme routine

    rages Hard Drive,

    youre unsettling me,

    gimme something that stays

    the same, gimme repeats,

    gimme quarry to

    run down, gimme

    victims, gimme

    leave to blame.

     

    Cats astonishment

      

    Cat spends all his life astonished.

    His astonishment exhausts him

    so he sleeps and then, on waking,

    is astonished all over again.

     

    Interview

     

    So what do they make

    of each other, these two,

    Cat and Hard Drive 

    forced to travel on opposing sides

    inseparable  ?

     

    He leans over me

    grieves Cat, he positions

    himself way beyond his station.

    He eclipses my sun.

    He has tricked me into a cage.

     

    He frightens me, rages Hard Drive.

    Every pace we take on the path

    wears on me. It is like walking

    chained to a fire-storm.

    I never sleep.

     

    Conclusion

     

    It is cat who carries the weight

    of true being,

     

    who loves and suffers

    in his worn flesh

     

    the seasons, the wild heath.

     

    Hard Drive lives in panic, a life-long

    franticness to avoid

     

    being overwhelmed. The fears

    of Hard-drive

     

    will overwhelm us all.

     

    Rogan Wolf June 2013

     

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  • Fable 10 – The Pernicious Appeal of the “Strong Model”

    The Pernicious Appeal of the Strong Model explores the power and attraction of different forms of idolatry, or fundamentalism, for people in disarray or under unusual stress. But this is not a piece about “true faith” as opposed to “false faith”. Idolatry/fundamentalism is not restricted to the religious ; it extends to anyone who accepts a dogma or joins a mind-set, not primarily because it is true, but because it is comforting and offers something simple and sure, while purporting to be the truth. I think idolatry, or the “strong model,” is especially appealing to people asked to serve at a social fault-line or tense frontier, or to address realities which are complex or arouse strong feelings.

    This is the tenth in a series of essays called “Fables and Reflections” which consists of sixteen pieces in all. Each Fable takes just a few minutes to read. I am uploading them one at a time, every month or so.  The idea behind this approach is that people running all day just to keep up, are more likely to read them in short doses and at intervals.

    But for those who prefer them all at once, here is a link to the sixteen together.

    The series was written in a time of pause after a working life in mental health care. But it is not specifically about mental health. In some ways it tries to offer a few sign-posts for times in which it seems particularly easy to get lost. Above all, perhaps, it explores the issue of what makes community healthy, what secures connection, how are we to live in the world in such a way that neither our neighbour nor our world suffer that we may briefly thrive ?  In a sense you can say that, in exploring the constituents of community here, and at this time of strain and fragmentation, frantic materialism and crude zealotry,  the series asks and discusses what are the binding and redemptive skills of true human connection, the skills of being human, the skills of love.

    All being well, the series will soon be published in book form.

    If you find value in “Fables and Reflections”, please send word of them to people you know who you think might want to read them. You could simply pass on this blog address, or, alternatively,  I am happy to e-mail them individually as attachments to people who would find that easier. I am already doing that for some people.  I would also be happy to send hard copy versions by surface mail.  If that is your preference, just send me your address.

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  • Shahada

    I have recently imagined myself standing before a man of good sense, deep learning and positive engagement with humanity, and professing to that person my basic beliefs. A profession of faith. A sort of Shahada. Once, in a much less comfortable public situation than mine, Martin Luther found himself setting out his position in similar fashion, concluding with the statement, “here I stand.” Here, some hundreds of years later, is where I stand :

    I cannot believe in some divine eye holding me in sight or mind as I go about my business, among all those billions of others going about theirs.

    I cannot believe in some figure sitting, or whatever posture that figure might like to adopt, through eternity, looking over His Creation, grieving for individual sorrows, granting individual prayers, punishing individual sins, and so on and so on.

    I cannot believe in that figure taking souls unsinful or redeemed onto His knee at the end of it all, and finding a house for them in Eternity, in some limitless out-of-world housing estate.

    But I do believe, since I must, in the plain fact and astonishment and wonder and marvel of life and Creation. There is no escape from this self-evident belief so long as I am alive, or life is animate.

    And by Creation I mean, not just the created universe, whose vastness and nature and wonder are in themselves actually beyond rational belief or measurement, but also the moment of Creation, when nothing became something.

    That force behind Creation, beyond my comprehension, I am bound to worship. I am part of this Creation and that is a wonder to me. If I do not live in wonder and worship, then I am not really alive, not really taking in the full fact of life. If I live a moment not wondering and worshipping, then I am having a bad moment, a moment in which I am switched off from and out of touch with reality.

    So there is a force of Creation and by definition, since there is only one Creation, there can be only one such force. It is beyond our comprehension. But we can see that it is Creation. And Creation acts and reveals itself through evolution, and shows its work in the procreation by which species continue and in the effort and tendency to grow and heal across all of nature, wherever there is illness or hurt.   

    So there is a force. It made and is behind the fact of life, the fact of existence across the universe, its planets and moons and immeasurable distances, and the fact of mortal life, and multiplicity of life, on at least this one planet in the universe.

    We can call this force reality, the core, the ultimate, the source of being, Alpha and Omega, the Word, the Light, the Truth, Yahweh, God, Allah. We use whatever name and names seem right or familiar or otherwise acceptable to us. To apprehend the force behind the name, the wonder of it, the bewildering fact of it, we surely cannot be in any state other than bewilderment and wonder and worship and gratitude.

    One step further  :

    I am I, one Self. I say I, meaning my Self. I preside in me, thinking and feeling, inside this Self, this Being, this Being Me. There is no other I in the universe whose experience I exactly share. Even though there are millions and millions of people who all say “I,” not one of them is “I” as I am, or will die as I myself must, in one place and one time, neither of which I can presently forsee.

    I find myself in a particular body, at this particular place and time, and I look out of this skull and see the rest of the universe outside of me, under my eye, and I cannot see the back of my head. I can see the backs of your heads but not of mine. I experience myself, therefore, as the centre of the universe, looking out at it so long as I am able to look out.

    But of course I know, at whatever level and depth of knowledge I am capable of, that you are no less the centre of the universe than I am. As a child I might think otherwise. The only centre I knew then was me. You were altogether unreal and fantasy-ridden, either a part of me, or an object to me. But I grew and – at least sometimes, in my better moments  – I became awake to the fact that you are as real, as subjective, as vital a centre as I am, both of us part of Creation and centres of it. That realisation I am willing to call Love. It is as wonderful as, and is an aspect of, Creation, made of it, and in realisation of it.

    And of course, in and through being awake to you, and the wonder and mystery of your equal centrality, I am bound to behave as properly and carefully towards you as is in me to do.   

    I know the above leaves out all sorts of pressing questions and will seem naïve to theologians of all the various faiths. And people will want to categorise what I’m saying. Oh he’s a deist. Or a humanist. Or an agnostic. But I don’t want to own any of those terms. I am just describing what I see in front of me.

    Of course I know that far better thinkers than I am have struggled with these questions all through history. And every faith has people deeply versed in their own theology and collections of thought and revelation which makes them sure and certain that theirs is the only true faith, and all others are either lesser or wicked or both. And that goes for the different literatures and collections of utterances, all convinced that God was speaking only there and at that time, and through this voice-box and not that one.  

    But that is the wrong place to put yourself. I will not defer to such people, not because I do not respect the depth of their learning or devotion, but because I do not respect the attitude you find in all faiths, that my correctness gives me the right to despise or even kill you for your incorrectness. Such attitudes and behaviours all through history and continuing in the present are a direct denial of the basic tenets and values of all those faiths and it means that no one of any faith has the right to say that they and they only can claim to have true Faith. Faith is merely human and merely reflects our human nature. All we have is our own flawed nature and by our natures all our respective and often competing faiths and sects have been flawed, all equally.

    So though guilty of presumption, I nevertheless have no hesitation in refusing to defer to anyone claiming to hold the one and only, the true faith. None of us is adequate to make such a claim. All our horribly flawed histories, though, contain gold that can help a bit to protect us from our inadequacies too. So let’s share the gold in each other’s differences, the different traditions. Let us be generous and humble.

    For my son Joe, with love.

     

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  • Fable 9 – The Ark One Hour Long

    “The ark one hour long” explores the ubiquity in modern life of only partial and manipulative human contact, person to person. Most of our encounters through the day are with people who only see our outward edge, our mask, or just a passing glimpse, and anyway do not want to see us true ; we are just their object. By contrast, an hour each week given over to true attentiveness, one to other, without ulterior motive, has power, substance and preciousness. It can make the rest of the week survivable. It is like the ark.

    “The ark one hour long” is Fable Number Nine  in a series called “Fables and Reflections” which consists of sixteen pieces in all. Each Fable takes just a few minutes to read. I am uploading them one at a time, every month or so.  The idea behind this approach is that people running all day just to keep up, are more likely to read them in short doses and at intervals.

    But for those who prefer them all at once, here is a link to the sixteen together.

    The series is a set of essays written after a working life in mental health social work. It thus records what I learned and saw while deployed for all those years at one of Society’s many fault-lines dividing Have from Have-not, Them from Us, I from Other. Above all, perhaps, the series explores the issue of what makes community, what secures connection, how are we to live in the world in such a way that neither our neighbour nor our world suffer that we may briefly thrive ?  In a sense you can say that, in exploring the constituents of community here, and at this time of strain and fragmentation, frantic materialism and crude zealotry,  the series asks and discusses what are the binding and redemptive skills of true human connection, the skills of being human, the skills of love.

    All being well, the series will soon be published in book form, thanks to my friend the poet Mevlut Ceylan.

    If you find value in “Fables and Reflections”, please send word of them to people you know who you think might want to read them. You could simply pass on this blog address, or, alternatively,  I am happy to e-mail them individually as attachments to people who would find that easier. I am already doing that for some people.  I would also be happy to send hard copy versions by surface mail.  If that is your preference, just send me your address.

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  • Mental Health Witness – Marketing “Recovery”

    In the mental health services, the “Recovery Model” has achieved good sales in recent years. Good pitch, good branding. Upwardly-mobile managers and organisations able to lay claim to being passionate about “recovery” win brownie-points and funding. We function in that sort of climate these days, in the care services.

    But this seems more than just a “brand.” I meet people who speak of it as a whole new route to enlightenment. I have heard the word “inspiring” used a lot in relation to it and I’ve seen short tracts and quotes from its literature on the walls of mental health agencies, exactly as if it were some new religious dogma. The tracts imply that all we need do, we souls lost in the wilderness of self and society, is read those words on the notice-board and we will be found, taken up, set free. Day services become “Recovery Colleges.” Trainers become bearers of the Word.

    But what Word ? Why its appeal and ubiquity ? What’s new here ? It’s hard to see anything clear through the glaze of enthusiasm, except ever rising levels of Public Relations gloss and avoidance, and a new way of excluding people with longer term needs, adding to their sense of failure and threat (“What will happen to me if I don’t ‘recover’ ? Will they tell me to pull my socks up ? Will they take my Benefits from me ? Will they refuse to accept me if I seem too serious a case to ‘recover’ in their time-scales ? Will they reject me?”). And is anyone seriously suggesting that, before this model came along, social workers, occupational therapists, psychologists, and, yes, medical practitioners, were not supporting healing, were not working in support of healing, all possibilities of renewal and growth and coping, day in, day out ?

    I am not particularly concerned here with the model itself, its provenance, history or rationale. As with purely religious sects of one kind and another, I have no reason to doubt that the original intentions were worthy and even good. I am looking instead at its shape and effect on the ground, at this time – when the cuts are biting, and morale sinking ; what it has made of present conditions, and what present conditions are making of it. As far as I can see, it is essentially a position of defiance against stigma and, by inference, against the medical model. This psychiatric diagnosis you have given me need not define me. It need not be a life-sentence. There are things I can do to make a meaningful life for myself, within Society, not excluded from it.

    So the “Recovery Model” is at least in part a kind of self-help philosophy which at the same time requires of services that they provide resources in support of self-help, even at the expense, sometimes, of people less capable, more damaged. I think also that, too easily, it allows people, both users of services and people who manage and practice in services, to deny and shy away from the reality of mental disturbance, which is often difficult and complex and resistant of quick resolution. In other words, the model has become another fundamentalist retreat from complex reality into black and white simplicities and certainty. According to this simplification, all you need to overcome your mental health problem is have the right attitude and attend some classes. Having a mental health problem is no more than having a head-cold. We are all in this together in a shadow-less world of phoney bonhomie.

    In decrying the recovery model, I am not thereby surrendering to an equally simplistic medical one, which can seem to suggest that the individual is bound by the iron laws of diagnosis which, once activated, allow you no escape ; so that, after being diagnosed with something long-standing, you cease to be you, unique and God created, you become instead your “illness“, just a set of predictable responses, determined by an incurable condition. How can one fail to understand the dread of being classified, imprisoned, in this way ?

    To treat anyone as just a diagnosis, just an “It” of two eyes and two feet, is actually a kind of escape mechanism for the perpetrator. Of course we know that the model itself allows the scientist to reach for some diagnostic conclusions drawn from research-based methods of categorisation ; in turn, this opens the way to some medical interventions. But theory is one thing, human inter-action is another. A model based on detachment and general rules can also provide an excuse for the person within the scientist to avoid real and sometimes difficult human engagement, by staying detached, humanly and emotionally absent from the individual being in front of you. As far as the recipient of that behaviour is concerned, its detachment constitutes bad and even abusive practice by any standard and from any professional point of view. No good practitioner, of whatever discipline or helping profession , would follow it.

    But that’s the point. You don’t need a whole new model, a whole new service, to change the approach of a few inadequate workers. At most, you should look to correct the fault, and the despair it can elicit, by improving your recruitment practice, the quality of your staff supervision and support, and your systems for keeping work-loads under control.

    For if, in your reaction against one form of over-simplification, you merely set up another, you have actually done nothing except caused unnecessary disruption while joining forces with the real enemy. You thought you were righting a wrong. Not so. All you have done is give wrong a new colour. You have found a new way of failing people, a new golden calf to worship, just another false god.

    I would argue that something larger applies here, as well, or at least is relevant. How do we measure our worth, our value, our place in the community ? Do you only have worth if you function like the majority of “well“ or “recovered“ individuals, taking your place in the rush hour crush and scramble, flagging up and waving about what socially acceptable emblems you can earn, maintaining your outward face ? If so, then to be labelled disabled or unable or “unrecovered” is indeed a social disgrace and puts you beyond the pale. You may have rights, and allies to help you fight for them, but you have no sense of worth to help you rest at nights, no social capital.

    But if we accept that real human worth is not to be measured by material possession, acquisition, conformity, occupation ; not by the amount of “striving“ you do in contrast to “skiving“ (what a wicked, socially mischievous, loutish distinction that was – a real Bullington Rude-boy try-on), not by the amounts of tax you can dodge, but by qualities of soul, levels of generosity and truth-telling, then having a diagnosis, being “un-recovered,” being seen as out of kilter with the norm, is of no essential matter. Of course, nobody would have wished it on themselves or on loved ones. But in essential terms, there is no matter here. Some of the most wonderful and inspiring encounters of my life have been with people diagnosed as “incurable,”“unemployable,” “un-recovered“. Human worth, and a socially valuable human life, are not threatened or lessened by a diagnosis, and you do not need to have “recovered” to be a privilege to know and a force for good.

    There is one more thing I want to say on the subject of the Recovery model. It concerns the use of language. Has anyone noticed ? Language is being used here not to describe but to persuade, not to share a fact but to convert to a belief, not to illumine but to sell, not to reveal but to dress up. We are dealing with a propaganda operation here, whereby people who are “enlightened” are trying to persuade people into the “correct” frame of mind. In plain actuality, the “Recovery College” is a mental health community centre which runs a programme of lessons, lectures and presentations. Some people with mental health problems, most of them at the less serious end of the spectrum of disability, enjoy attending. That’s fine but limited (and a questionable use of scarce resources). But to call this recreational centre a “Recovery College” is to claim something much more, both for the agency and about mental disturbance in general. It is not a description but a public relations gloss borrowed from the market place. It is spin, spin being so habitual to us now, that we can serve it up almost as a form of instant therapy. However worthy the intentions, this and similar selling slogans do subtle but profound harm to the integrity of relationship and partnership between a helping service and those who turn to it for help.

     

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  • Mental Health Witness – Who’s a Skiver, then ?

    George Osborne’s division of the nation into Us “Strivers”  and Them “Skivers” (but weren’t  we once “all in this together” ?) has reminded me of some nineteenth century history I learned at school. It provides some context for Osborne’s venomous jingle two centuries later, and a way of measuring its quality and pedigree.

    I still find the nineteenth century fascinating, gripping, a revolutionary time. Of course, the be-numbing changes of our present time are even greater and yet more rapid, yet the overwhelming nature of the changes that took place nearly two centuries ago is clearer to me, more dramatic somehow, than the changes happening now. Time travels faster and faster. The world we have made for ourselves, on top of Nature’s world, is transformed through our activities at faster and faster rate. But we’re in the middle of all that, and it’s harder to see the present from inside and we can only try constantly to catch up, in mind and in psyche, as well as in behaviour.

    We are now outside the nineteenth century, well past it, and therefore, at least to some degree, we are in a better position to see its shape. Also perhaps, partly because change was slower then, we can see the rate of it clearer, and can see how that rate must have seemed absolutely bewildering to the people alive at the time. Its effect upon Society was quite volcanic, as a country once mainly agricultural and rural and steady became a country mainly industrial and urban and frenetic.

    Just one example : the century began with a road system consisting still largely of mud, with only the main roads dressed with tarmac. Short journeys still took days and there were not even telephones. Canals were a new invention, speeding things up no end. And digging them was speedily done. In just a few decades, the whole country was a vast network of canals. A revolution in communication thus took place within a generation, transforming the country, its economy, its social patterns. But then, only a couple of decades after that, the canals were all effectively out of date and now it was railways, spreading smoke and drama across the land, and leaving the canals far behind, already slow and peaceful havens from industrial rush.

    This piece is not a history lesson. It is about the distinction recently made by a man of inherited wealth in a powerful social position, between skiving and striving. I’ll come back to him shortly. But, as I struggle to understand, I need to put him in his place and time, and to do that I need to stay in the past for a little longer.

    And what we see as we follow the story of that century is the story of governments, one after the other, playing catch-up with events, as whole populations shifted into new cities formed around factories, away from the land. Slums sprang up, built on the cheap, and these horrendous new urban conditions, unprecedented in the world at that time, did not just call for urgent action, they forced minds to change their appreciation of reality, of the nature of government, of rule and social responsibility.

    This was the century of Free Trade, when, for decades, that untrammelled Enterprise so beloved of present-day Tories, held sway. But all the time, Government, whatever the party in power, was taking on more and more responsibility, as the century progressed, to enforce essential standards and regulation which otherwise would not have materialised.

    For example, the Public Health Acts, the Factory Acts, and so on.

    We don’t have video recordings, of course, of the conditions of those times. But we do have some wonderful etchings (see those of Doré) and also we have Dickens. Dickens raged in his novels and elsewhere at what he saw all round him in the new and burgeoning city, the sub-human conditions in which the poor were living in the slums. But he wasn’t the only one appalled. Generations of social reformers, among whom Quakers were often prominent, kept pressing for amelioration, for stronger government action, for more central responsibility to be taken.

    For they began to see that the earlier models of social care and responsibility, the doing of Good Works by the daughters of the gentry, with the Poor Laws and the Work House as last resort, were unable to cope with modern urban conditions. The old interventions, founded in and for a rural economy, were too idiosyncratic, haphazard and occasional. Something more systematic, more centralised, more organised and better resourced, was needed.

    And what did those reformers and activists meet when they began to press for change ? They met the convictions of Osborne’s ancestors. There can be no other explanation for this human squalor and degradation, those ancestors told the distressed reformers, than that they have brought it on themselves through wanton living and idleness. It’s their own fault and they deserve it. They have no one to blame here but themselves.

    But there is some excuse for this line, at that time. Or at least, I can find something human in it. People need a frame of reference, by which to understand what happens and what confronts them. And of course, all of us want to insulate ourselves a bit, if the going gets rough and challenging.

    And these were new conditions, and convincingly rough and challenging, even to onlookers. No one had met such conditions before, affecting the lives of so many people. So middle-class onlookers tended to reach for the nearest and easiest way of explaining the cause, for lack of any other perspective from which to make sense of it.

    The low church Christianity professed by much of Society at that time commended thriftiness, sobriety and hard work as indicators of right living, associating it with godliness ; wealth in this life was seen to be an early reward for all that effort, to be followed by grander rewards in the next.

    Therefore, it only stood to reason, according to this frame of reference, that anyone poor was likely to be so for lack of virtue and thrift, rather than for any external reason. In other words, they were skivers.

    Yah Boo, skivers ! Rolling in the dirt ! It is you who made this dirt your bed ! So now lie in it !

    But then, around the end of the century, reports came out saying something different. There was no discipline of sociology then. So these reports had few precedents and charted new ground.  But rather than theology and accusatory moralising, they offered hard evidence, based on careful and methodical observation at first hand. There was a major study by Seebohm Rowntree called “Poverty: A study of town life.”And perhaps the most famous and influential of them, “Life and Labour of the People in London,”written by a man called Charles Booth, came out in 1903. And the findings gathered by these reports influenced and finally convinced the policy-makers. The story the reports told was irrefutable and very different from “moral fault” in the victims. They made it indisputably clear that the fault and the cause lay with the conditions those people had to live in, and their powerlessness to change them.

    It was those findings, providing hard evidence of the human and social consequences of untrammelled and unregulated capitalism, ruinous to individual and social well-being, in the long term ruinous to the whole of Society, which led to the Welfare State. Interestingly, the very first element of a Welfare State structure appeared, not in England, but in Prussia. This was a state-run old age pension scheme introduced by the arch-conservative and pragmatist Bismark.  In the UK, the foundations were built in the early twentieth century, by a Liberal Government under Lloyd George. The task was completed by the Labour Government under Atlee, which came into power just after the Second World War.

    Let’s pause a moment, just there. I am a soldier coming home after that war. I know a great man has been Prime Minister through most of these last appalling six years. He has brought us through. But I did not fight this war, under his leadership, merely to continue the world and times he belongs to and speaks for. I shall come back and vote for something new and necessary for a more inclusive and egalitarian Society, something worth all the sacrifices I have made and seen. And having built that new world, after all this pain and learning, I will not allow it to be taken back from me. I will not allow the people who once claimed precedence over me in the old world to climb back on their horses and shove me back to the side of the road.

    So the Welfare State was put in place, the National Health Service being perhaps its most iconic feature. The essential principles behind the development, were that Want, and all that follows from Want, does not belong in a civilised Society and won’t be accepted there ; that the State will act powerfully as friend and guarantor of justice for the Weak no less than for the Strong ; so that a strong and enabling State, funded by and accountable to the taxpayer, will be empowered to run essential services to the benefit of the Many, so that civilised living standards are no longer just the preserve of the Few.  

    I think we have travelled far enough along this particular story-line, this rudimentary tracking of recent history.

    It has surely shown us that the Welfare State was founded on the recognition, through decades of learning from experience, that unbridled individualism in industrial and post-industrial societies, unregulated “enterprise”, leads not to social health but to social degradation and ultimately disintegration. The story tells us too that over 100 years ago, responsible people accepted, and acted on their acceptance, that in an urban society, poverty and unemployment is not to be explained by moral fault-finding and pointing fingers ; in the vast majority of cases, the cause comes from external and other factors beyond the individual’s control.

    In other words, the whole “skiver” line was disproved ages back and history has moved on.

    We are safe in assuming that Osborne was taught as much history at school as I was. He knew that in reaching for the word “skiver” as an explanation for long-term unemployment, he was talking factual and statistical nonsense. He must have decided to go ahead with the lie, because more people would want to hear it, whether they knew it was a lie or not, than would be repelled by it. At worst he would get away with it ; at best, he and his friends would profit by it in some way, presumably at the ballot box.

    I can just about understand that reasoning, given what is already clear about how the man works. In the same way, I can more or less understand how a dishonest greengrocer might knowingly sell me a rotten cabbage, and feel himself clever as he retires into his shop, leaving me to discover his deceit when I get home. And will I ever go to that greengrocer again ? Well, of course not. But that doesn’t matter, there will be other poor fools he can deceive tomorrow.

    But there is much I cannot understand in Osborne’s wickedly deceitful sally, clearly deliberate, carefully honed to be memorable, carefully timed and swiftly followed up by dramatic skiver-stories gleefully headlined in the still unregulated hooligan press.

    It is not just Osborne the individual I fail to understand in this. I believe that, at some level, everyone knows that the Skiver/Striver distinction is a cheap and wanton lie, the throwing down of a piece of red meat for the pack to gorge on. Osborne and his friends and many of his listeners find it profitable to maintain and subscribe to this transparent lie. But henceforward, we shall all know, friend and foe alike, that Osborne is a calculating and brazen liar who doesn’t care two hoots that we know that he is. Such utterly nihilistic cynicism bewilders me. However ineptly, this man holds an important office of state in a democracy. He is showing it scant respect, even while he fails in it. Democracy is a fragile entity. We all need language to speak through, Osborne included, and to use language presupposes that we agree to preserve it for the passing on of fact and truth, one to the other. Otherwise, why speak ? Why not just grunt, or snarl, instead ? The lie is a threat to democracy and to community and leaves us no human world to live in. Osborne and his friends and his tactics are destroying Osborne’s own world. What will his children say ? We are so proud of our father. He sold such rotten cabbages.   

    I must explain, in my last paragraph here, why this piece is included in a series on mental health issues. It is because 2/5ths of people on long term state benefits have severe and enduring mental health problems. Osborne will know that, too. Many of them will have read or heard that Osborne has called them “skivers,” even though both he and they know that they are not. He used the term, having decided that the profit he could make from his lie would override the possible loss. Manifestly, his lie’s effect upon them did not enter into his calculations.

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