Media representations

On psychology getting its priorities right

Well, it’s been a year since I last blogged, and frankly that’s probably a good thing. I had anticipated a reduction in productivity and so it came to pass. 2017 turned out to be a year in which I changed job several times, moved house and watched two people die, so it’s fair to say it was eventful. Oh and I got a kitten, who is sweet and funny and of whom I am very fond, despite the fact that she constantly gets in the way and that I now get absolutely no peace in my own house. So all in all, keeping my head down – relatively speaking – was probably necessary.

I write this as I journey to Cardiff. My only blog of 2017 was written shortly after a trip to Liverpool, technically because I was speaking at the UK’s main clinical psychology conference, but mainly because I and some friends had organised our own (not exactly rival but not exactly not rival) events: a fringe festival bringing mental health and the arts together, and then a one-day conference looking at psychology going ‘beyond therapy’. Cardiff is the venue for this year’s events, both the main conference, which I’m not going to, and the fringe events, which I am proud to be a small part of.

I think it’s important to be proud of your contribution to your profession. Not in the way that many of us are – considering ourselves experts; getting caught up in the arrogance that can pervade; judging people based upon their academic output – but of the important stuff. Of going to work and doing what needs to be done to help people. Of using the knowledge and skills you have to try to bring psychological ideas to new audiences. Of doing it all in a way that tries make things better. The small things that are really the big things. Often unsung, but vitally important.

I am privileged to do what I do for a living, and I am privileged to know so many people who go above and beyond to try to fly the flag for better health and social care services, and who critique the policies that cause so much damage. Almost all of these people do huge amounts of work – usually for no money and very little in the way of glory – to do these things. Our profession is stronger for them, and lucky to have them.

So I am very dedicated to the profession of clinical psychology. But sometimes I have real concerns about other psychologists. And this past week has brought that to the fore.

A week ago a new document was launched looking at an alternative to psychiatric diagnosis. This blog is not a review of that document, because it’s 400 pages long and I haven’t had a chance to read it properly yet. The principle tenets of this framework are as follows:

And when I’ve finally read it I might write something on it, but there are plenty of people cleverer and better-read than me who will likely do a better job. And 400 pages is no small task. It was actually my planned train reading but I only got to page 18.

I have no major problem with the framework, though I don’t believe diagnosis is going to fall overnight, and I don’t know how health, social care or welfare systems would operate if it did, so I’m not getting too excited just yet. And it does strike me as interesting that a team of white professionals has written a 400-page document talking about power – and, whilst there was a consultancy group, consultancy is not the same as authorship and as a brown Muslim woman I absolutely own my response to that defence – but in the main I’m interested in seeing what impact this framework has on policy, because that’s where it needs to take root.

I do have a problem with the reaction of my fellow professionals to the same document. People who dislike or disagree with the framework have pulled it to pieces and questioned why it was ever written. Now, sure, pull it apart – we need to critique ourselves and our practice – but to denounce it as heresy is unhelpful, particularly if you don’t have the courage to write your own alternative framework. Being catty on Twitter is undignified. It does all of us a disservice. We should be better than that. It’s not that I can’t see why people might be sceptical – when my patients need the be signed off work their employer needs a diagnosis. So does their insurer. If they have OCD or a specific phobia it’s probably helpful to be able to give it a name, because talking about intrusive thoughts and compulsions is all a bit psych-speak for most of us. Labels and names and categories have their uses and we can’t lose sight of that. But there are diagnoses which are very harmful – I speak here of ‘personality disorder’ – and we do need to think very carefully about how we move away from decades of iatrogenic harm based upon a label that tells you that you are defective to the very core. Perhaps, then, trying to look at the whole spectrum of human distress within one framework – even one that’s 400 pages long – isn’t the ideal place to start. But there are ways of saying it, and a substantial number of people haven’t demonstrated much understanding of that.

People I would consider to be quite eminent – by which I mean long in the tooth – have been hostile to the point of vitriol. The authors have been attacked in a most unpleasant way. Clinical psychologists (thankfully very few of them, though) have used Twitter as a platform to call those who disagree with them – including people who use mental health services – stupid or unenlightened. The word ‘stupid’ has actually been used. It’s gone so far that I and some similarly perturbed colleagues had a look at the social media guidance provided by our professional and regulatory bodies. Someone else has grumbled about it being our new professional ‘policy’. It’s nothing of the sort. It’s a model; a construct; not an ultimate truth. You’d think people trained as social scientists would understand that notion. Instead, we’ve had people saying things like ‘Not in my name!’, as though the the document was tantamount to the dodgy dossier which led to the Iraq invasion. It’s ridiculous, and its unprofessional, and it makes me ashamed.

Psychologists – particularly of the clinical variety, it seems – have really got to up their game. We lord about declaring ourselves to be reflective and able to consider a range of perspectives and then we act like this. It’s a disgrace. But it’s also the wrong battle to be fighting.

Today some data was published showing that in poorer parts of the UK life expectancy is decreasing for the first time since 1945. This appears closely linked to cuts to health and social care, as well as welfare changes. The decrease has only been observed since 2011. It’s not hard to make the link. But has there been a social media furore from my colleagues over this? Was it mentioned once in any presentation today? Was it ‘eck. But this is what we need to be talking about. These are the battles we need to fight. Not squawking about changes that might or might not affect policy over the next decade; shouting and stamping about the people who are dying now.

I simply don’t understand why more of my colleagues aren’t beating the same drum. Sure, my perspective is heavily coloured by my demographics and the experiences that have come with them, but surely even the most privileged person must understand that the basics of food and shelter and dignity keep people level. Not entirely level, but they make a good start.

Really what I’m saying is that I have been profoundly disappointed by some of my colleagues recently. And if I’ve been disappointed goodness knows what the public has made of it. And we have got to change. Not just for the sake of clinical psychology but for the rest of society. If we don’t wake up to that we’re going to perish. And that really would be a shame.

On ‘secret diaries’

Secret diaries. The preserve of people who can’t tell you the truth, despite desperately wanting to. Sometimes they’re interesting because, if we’re honest, most of us are nosy and voyeuristic. Some are boring. I will never care what a financial analyst does all day (#sorrynotsorry). But the point of a secret diary is that it’s meant to reveal a mystery in some way. I am trying to think of one which was about someone in a mysterious profession but I can only think of ‘Girl with a one-track mind’ which is going to give you totally the wrong idea about me. Evidently I don’t read enough secret diaries.

BUT. The Guardian has a mental health series on at the moment, and it has featured a few secret-diary-expose-type-things. Yesterday (or maybe on Tuesday – I don’t know and it doesn’t really matter) there was this: ‘The secret clinical psychologist’s diary‘. I commented on Twitter (obvs) that I thought more could have been made of it. Now, I don’t know who wrote it, but I know someone wrote it. As I generally try not to be a douche (no, really, I try quite hard to be a non-douche) I am going to say why I thought more could have been made of it without being cruel.

I think psychologists do a lot. Really. I have been qualified a year and I do a LOT of work. That goes for every health worker I know. But to the outside world what we do is a mystery. Diaries like this are the way – anonymously – to explain it; to make people see that we do more than ‘talk to people’ and drink tea and hug it out. I don’t think the piece says enough about the consultation we do; the teaching; the supervision; the meetings; the paperwork; the demands of the clinical work. Only one clinical case is referred to. This might be because of confidentiality but I obviously don’t know. The final paragraph refers to inpatient work but no mention of this is made in the earlier part. Now obviously I don’t think this psychologist only saw one person in their working week, but the articles doesn’t make much mention of the sheer variety of the work. I am sure, also, that the time constraints are enormous and the pressures immense. In my view, it’s no bad thing to say that in the public domain. In fact, in the current climate, I think it’s essential. We are under siege but no one is listening. People in power think they can slash our resources without any impact on our wellbeing or the care we can provide our patients with. Well we can’t. Public sector staff are beyond stressed at the moment. The stats are freely-available. We need to publicise what we do so that the public at large gets a better understanding of it and of unsustainable it is.

You will see why I was frustrated, I hope.

I think it’s great when people want to do this stuff; I just don’t think we should be afraid of saying ‘we work damn hard in a job that can be difficult and stressful and exhausting and in which we see and hear appalling things’. Really, that’s all my frustration is: don’t play down what it is you do. We have a history of playing down what it is we do and I don’t think it benefits anyone.

I toyed with the idea of writing my own diary but there are issues. I can’t write it under my own name because I am easily Googleable and my patients might be traceable. I can’t write it anonymously because I have a very particular writing style and it would be patently obvious that it was my work. And I’m too lazy to make it up and invent patients (also I should be writing other things at this very moment in time so, you know, PRIORITIES.

So there we are. Sadly I can do nothing about the points I raise above but it’s really not for want of motivation. If you want to know the nuts and bolts of what I do, ask me. But, in case you’re interested in the more general stuff, here you go.

I work in an Older People’s Community Mental Health Team. Primarily I see people over the age of 75 but sometimes they’re younger. Many have dementia; some are low in mood or anxious. Some are in poor physical health; some are at risk of falling or vulnerable to abuse or exploitation. Most live at home but some are in residential care. I do some inpatient work, but that’s not the bulk of my clinical work. I have no consulting rooms so see everyone off-site. I cover an entire borough of London so I travel a lot.

I work with patients and their carers. Dementia can wreck entire families and often carers need support. They may be watching a loved one disappear before their very eyes and the strain is often enormous. Typically, I will try to help the person with dementia to manage their memory loss and I might also do some family therapy to think about the impact of dementia on relationships. Often I do assessments of challenging behaviour – not uncommon in dementia – and try to implement strategies to reduce the risk of harm to both the patient and their carers. Sometimes I talk to carers about the grief they are experiencing; about the difficulties of looking after someone who may no longer recognise them when they are still trying to maintain jobs and families and lives of their own.

Sometimes it is heartbreaking.

I use an eclectic therapeutic approach. Different approaches work for different people. I spend a day a week in a family therapy clinic and I am also training in family therapy. In addition to traditional therapy I also do neuropsychological assessments for dementia. These assessments can take up to eight hours to complete, plus time to score and write a report – possibly up to six pages of dense text. Sometimes I have the difficult task of telling someone they have dementia. I try to do this in the kindest way I can but it is never, ever easy.

A couple of times a month I am ‘on call’, which means I deal with all referrals to the team. I might have to deal with GPs or Social Services or do an emergency assessment. I am on the phone to Social Services a LOT. They all know my voice now. Sometimes patients or their families call because they are worried about something. Often, we can sort it out by telephone. Sometimes we spring into action immediately. Flexibility is the name of the game. It has to be.

Each day I have a team meeting to check how everyone’s diary is looking and to see if they are worried about any patients, or to see if they need a second person to accompany them on a visit. When you work in the community you need to make sure your colleagues are safe at all times, so there are multiple processes in place to make sure our whereabouts is logged.

On average, every week I will do two initial assessments with a colleague to see if the person has been referred to the team best able to help them. There is a lot of paperwork attached to these assessments, and more generally. Risk management is a big part of the job. In teams like mine, we see people who are often actively suicidal, or whose use of alcohol might place them or others at risk. Emergency meetings with Social Services are not infrequent. We will do whatever we can to keep people safe – we will arrange for smoke alarms to be fitted; for kitchens and bathrooms to be adapted so that people can stay at home for as long as possible.

I go to meetings. I have a weekly business meeting and referral meeting; I have regular supervision and I also supervise some of the work done by a couple of other people who are new to the team. This means that we have to prepare for all their clinical work, that we have to discuss it afterwards and that I have to go through all their reports with them. I enjoy it, and they are bright and keen to learn. I do some informal consultation with other members of the team if either of us needs some input around our clinical work. I am clinical lead for my team so I go to additional meetings to talk about non-clinical issues. Now and then I write reports to do with service development. If my colleagues are away I might visit their patients to make sure all is well.

I eat lunch at my desk, in a hurry, most days. Every day I take a book to work. Almost every day I end up discussing clinical issues or dealing with admin over lunch. Often I feel like I’m chasing my tail. Sometimes I realise I’m up do date with all my paperwork and I feel smug, but it never lasts very long.

That’s an average week, I think. I might have forgotten something, but you get the gist. And you will see, I hope, why I get frustrated when people undersell themselves, and us.

On television

This is a departure from my usual posts but I thought I should perhaps chronicle one of the more ridiculous experiences I have had recently.

Yesterday I was on annual leave. At around half nine in the morning, I got a phone call from an editor at the Guardian (I write the odd piece for it) asking if I could send over something on the Germanwings air crash – the press has jumped on the fact the pilot had depression and there were some pretty awful headlines out there. I agreed and sent the copy over (it’s here, if you’re interested), then on I went with my day.

Later that evening, I was unable to concentrate on my novel, so I was, obviously, scrolling through Twitter. I received a message from someone at the BBC asking if they could call me. I agreed and they did. They asked if I would like to be on Newsnight. ‘Oh’, I said. ‘Oh I see’. ‘As a bonus’, she said, ‘Benedict Cumberbatch will be there.’ ‘Oh, goodness’, I said. So I said yes and they said a car would be with me imminently.

Now prior to this I had been loafing around. My evening plans had been shifted to another day and I suddenly realised that it was half nine, I was in a tangle of blankets and hoodies and that I was aiming to get to the BBC for 10.15.

Never have I got into a suit and some decent shoes so quickly.

Seriously. I went to an awards dinner earlier last week and I swear it took me an hour to get ready. Last night I acquired some kind of transient superhero status which allowed me to simultaneously do up cufflinks, put contact lenses in and shove my wallet into a bag. I was ready in ten minutes. If I could bottle that superpower and keep it forever I would. Instead I just had to pace about waiting for the taxi. Also I announced it on social media BECAUSE THAT’S WHAT WE DO NOW.


Now I don’t know if any of you ever drive through central London, but trying to get from the badlands of South London to Oxford Circus in 30 minutes on a Friday night is borderline impossible. Brixton, Trafalgar Sq and Regent St were DRAMA (at least Soho was moderately entertaining). It took an hour and a half, which gave me lots more time to panic and ask the producer to see if she could keep Cumberbatch hanging around (look, I love Sherlock and his Frankenstein was some of the best theatre I have ever seen and I am not above fangirling). Also, it meant that I got to try to work out what the devil I was going to say, courtesy of the poor taxi driver who very kindly engaged with the whole process in the most charming way (sadly I couldn’t do any actual research because, obviously, my phone had barely any battery). Despite that, I discovered as we approached Westminster that I had some kind of quick-acting RSI in my right shoulder because I had been clutching the wretched thing for the entire drive.

Hilariously, the drive took so long that at 11.20 I got a call from a chap telling me my taxi was outside. I informed him that I was already in a taxi. Turned out that he was my return driver and that I hadn’t actually got to the BBC yet.

Anyway. New Broadcasting House is swanky and has lots of bright lights (it looks pleasingly like a glo-stick) but obviously it also has those bizarre sofas which are neither entirely comfortable nor entirely uncomfortable. Also, protip: if you’re going to rock up to the BBC, it’s a good idea to know who you’re meeting and what programme you’re doing. I knew neither. Nevertheless, I persuaded them to give me one of these:


Obviously the poor lady at reception could make neither head nor tail of my handwriting. I refrained from asking of Cumberbatch because I was probably already getting odd looks. Bear in mind it was half eleven, I was knackered, I was a bit stressed and I hadn’t planned what I was going to say because I didn’t actually know what I was going to be asked. I have done TV a stuff a few times but I generally have more than ten minutes’ notice. Amazingly, though, I was once going to do a live show in North London and I had to be there for around 7.15. By half six my taxi had not arrived to pick me up. You won’t be surprised to hear that I didn’t make it.

Anyway, since I had missed Newsnight I was to be on shortly after midnight (several of my friends, bless them, who should really have been out having fun, were glued to the BBC News channel, which I find alternately pleasing and amusing). I was whisked into the bowels of NBC (or, rather, we took the lift to the lower ground floor) and I paced about a bit more, drinking water nervously but trying to look cool. Yeah. I actually had to ask the chappie shepherding me around what channel BBC News was on Sky, which obviously screams ‘ALL MY FRIENDS HAVE BEEN INFORMED OF MY IMPENDING APPEARANCE, YEAH?’. Tres cool.

And then, I was marched to the studio and had a minute or two to discuss the piece and then, there we were, on air. And it was ok. I felt like I was slurring slightly, which happens when I am tired, but aside from that, I thought it went pretty well. If you fancy it, it’s here. Yes I recorded it off a recording. I’m keeping it real:

And that was it. The return journey was far quicker, obviously, and in the end I had spent four hours on a five-minute interview. But it was exciting and I can’t pretend I don’t enjoy that kind of thing. Also it seems I’m finally reconciled to the fact I speak the way I do on film (though I don’t quite believe I speak like that ALL the time. I consider this my ‘TV voice’).

Telly – it’s less glam than it sounds, but more glam than most things. And I got to put on a decent suit, which I don’t get to do very often in my line of work. And I get to swan around saying ‘I WAS ON THE BBC, YOU KNOW’, though I’ll try not to do too much of that because my friends are very indulgent but they also might tell me to shut up at some point.

This post has not been remotely psychological, but, then, it’s not like I’ve got a remit (I’m not the BBC after all *snort*) so whatever.

I just wish my poor shoulder would stop aching. Super-quick, panic-induced RSI, brought on by the BBC. I should sue, really.

On the relative irrelevance of sex offender demographics

This piece was originally written for the press and published in September 2014. The delay in posting it here has been my own.

From Jimmy Savile to Rochdale: sometimes, it feels as though the news over the past couple of years has been about little other than the sexual abuse and rape of children. Major institutions have been charged with failing to investigate accusations of impropriety and of covering up the ‘open secret’ of celebrities having sex with minors. More recently, there have been the Rotherham scandals, involving gangs of men grooming and sexually assaulting young girls subject to the care system – a system which, quite obviously, failed to care for them adequately. It’s certainly not the case that everyone in care is preyed upon and exploited but a cursory glance at the facts suggests that care sometimes falls short: children in care have poorer educational outcomes, are more likely to have poorer emotional and behavioural health and to use substances than their peers who are not cared for by the State. Rates of criminality, mental health problems, teenage pregnancy and homelessness in adulthood are also higher. Frequently, children in care will have experienced early adversity, be it parental substance use, domestic violence or a history of abuse or neglect. These are often vulnerable individuals and they are likely to require enhanced support compared to other children their own age.

But all that has been forgotten. The press is busy describing the Rotherham offenders as ‘Muslim’ or ‘Pakistani’ or ‘of Pakistani origin’ or something similarly designed to tarnish all members of one or other community with the same brush. Cue counter-pieces stating, rightly, that not all paedophiles are Muslim, Pakistani or of Pakistani origin. The overwhelming majority of sex offenders in prison are white, though it would be incorrect to assume that the rates of reporting and conviction are the same across ethnic groups. Ethnic minorities, particularly those from Asian backgrounds, are less likely to report abuse because the dual burdens of shame and stigma continue to act as a deterrent. The effect is that ever-increasing numbers of children are raped and that rapists get away with it.

Personally, I have no interest in the demographics of paedophiles. You don’t violate a child because of your ethnic background, nor because you notionally subscribe to a particular faith. You violate a child because you disregard the rights of that child to only engage in consensual sex. It’s not about being Asian, or Muslim, or white, or Church of England. It’s simply about being a rapist.

As for the girls? Who knows? What we do know is this. Children who are sexually assaulted are more likely to experience mental health problems, including eating disorders, and to self-harm. They are more likely to misuse drugs and alcohol and to attempt suicide. They are more likely to have difficulties in forming and maintaining relationships and to be in violent, emotionally abusive relationships. The impact is often devastating, and may be life-long. But, what with all our hand-wringing over our religious and cultural identity, we have forgotten that there are children, violated children, at the centre of this.

On ‘Midsomer Murders’ and the scuppering of public health initiatives

I was amused to read a pice in The Independent yesterday relating to this article in the Journal of Forensic and Legal Medicine. A group of researchers in Edinburgh, concerned about the unrealistic depiction of murder in television drama, have compared the frequency and method of murders and the characteristics of the perpetrators in all episodes of MM from 1997-2011 (as I shall henceforth refer to it) with data relating to real murders in Lothian & Borders from 2006-11. Here, then, is my summary:

(A caveat: I love MM and, to be honest, this blog post is a bit self-indulgent.)

A very robust methodology, involving watching around 80 episodes of MM in order to ascertain the characteristics o the act, the murderer and the victim was employed. In MM, there were 217 murders, carried out by 105 people. In Lothian, 55 murderers carried out 53 murders. In Lothian, 89% of murderers were male, significantly higher than the 57% who were male in MM. In MM murderers were much more likely to be white British (hardly surprising, given the demographics of the cast – until 2012, it was almost entirely white, and only in the last eighteen months or so have the murderers hailed from outside this green and pleasant land) and there was much less evidence of mental disorder (11% compared to 47% in the (Lothian sample). Victims of murder in Lothian were also significantly younger than in MM (35 vs 52). 

So. How do the means of murder stack up against each other? In Lothian, 58% of people are killed using a kitchen knife. in MM, that drops to 5%. It seems that the residents of Midsomer much prefer more inventive methods, including poisoning, drowning, fire and the classic ‘blunt instrument’.

So what do the authors conclude? Well, they seem genuinely worried about the impact of crime dramas on the public perception of risk. Most people, it seems, are murdered using kitchen knives, but you wouldn’t get that impression if you were to watch MM. perhaps that means that viewers will not understand the reality of the prospect of murder and that they may not take adequate precautions, such as storing knives securely.

I always like research which references popular culture, but I confess to being a bit puzzled by this. To my mind, public perceptions of violence are more likely to be coloured by televised and print news, which is often very good at scaremongering. Despite being an MM devotee, I can’t say I have ever found myself actively considering whether I would be drowned in a barrel of whisky or unsuspectingly ingest ground glass, or, indeed, find strychnine in a biscuit tin. Part of the reason I like MM is that it requires little thought and is essentially, light relief, although probably not quite as light as Morecambe & Wise (or whatever the 21st century equivalent might be). And MM is hardly unusual in its choice of bizarre murder methods. All the great detectives spend most of their time solving planned murders – Poirot, Holmes, Columbo; even Jonathan Creek. They all involve a degree of ingenuity (as the authors of tis study quite rightly say, who wants to watch a stabbing with a kitchen knife every episode for all eternity?) and showmanship. But they are fiction, and the whole point of fiction is that it is decidedly not real life. So whilst I understand the authors’ concerns, I confess that I do not entirely share them, and that I shall continue to enjoy MM, and Poirot, and Holmes (but, I hasten to add, not Columbo) entirely unhindered.