Esther McVey and the Samaritans: Psychologists for Social Change and Recovery in the Bin respond

Psychologists for Social Change and Recovery in the Bin response to news of Esther McVey, Secretary of State for Work and Pensions’, position on the Samaritans’ Advisory board.

As a group of psychologists (Psychologists for Social Change) and service users (Recovery in the Bin) we are deeply concerned at news that Esther McVey has a role on Samaritans’ advisory board and believe that holding this along with her position as secretary of state constitutes a conflict of interest.

We think a position advising the Samaritans is incompatible with the beliefs she has been shown to hold based on her record in government. Esther McVey is a conservative government minister with a long record of voting and working to reduce support for those requiring welfare benefits. She has consistently voted against any increases in welfare benefits, including for people who are unable to work through illness and disability and, over a three year period, supported a reduction in total welfare spending 29 times. In addition she has consistently voted to reduce housing benefit for those social tenants deemed to have excess bedrooms (‘the bedroom tax’).

People experiencing financial difficulties are at an increased risk of developing mental health problems (Kiely et al., 2015), being associated with self-harm (Barnes et al., 2016) and depression (Mirowosky & Ross, 2001). Increases in suicide rates have also been associated with times of economic crises (Branas et al., 2015). As such the Samaritans have become something of a lifeline for people suffering the consequences of the reduction and removal of crucial welfare support. It is frequently recommended by stretched Mental Health Services for whom crisis services may be minimal or non-existent, meaning the Samaritans can sometimes be the last resort for people who may feel suicidal.

Representatives of Recovery in the Bin, a group of mental health service users, have described this as an issue of trust and respect, experiencing her decisions and their consequences as abusive and detrimental to their mental and physical health. They drew attention to the fact that the United Nations have found the UK government and particularly the DWP guilty of ‘grave & systemic’ human rights abuses which have caused a ‘human catastrophe’ for disabled people. Therefore they state it is wrong to have a human rights abuser on a charity board, especially when that charity is supposed to help people who are harmed by her decisions.

Representatives from Recovery in the Bin noted that benefit cuts are a leading cause of crisis for mental health service users. Service users and more who are now discharged through service cuts feel betrayed by the Dept of Work and Pensions who have been shown to disproportionately discriminate against mental health claimants as court cases demonstrate. They are also the sole group targeted for employment as a “health outcome” which amounts to sanctions, workfare and removal of benefits.The insertion of Job Centre Plus into libraries and GP surgeries leave service users feeling that there are virtually no safe spaces left from the very government department they are affected by. Some will not not feel able to use the Samaritans until this additional imposition is rectified by the removal of Esther McVey.

#PTMframework: Power Threat Meaning Framework – an evaluation By Avon

First things first, I’m not a “Critical Psychiatrist” but I am a critical psychiatrist in the sense that as a psychiatrist I don’t just blindly accept assertions, I try and evaluate the evidence behind statements. For this Power Threat Meaning Framework (PTMF) I am focussing on the evidence for this suggested alternative for diagnosis (the authors seem to be inconsistent saying it is just a suggested conceptual alternative take it or leave it on social media but in the PTMF itself it suggests using diagnosis is unethical). I will look at the evidence for reliability and utility (usefulness) for clinical, research, administrative and social functions for this classification of mental health problems.

When I read the PTMF I only scanned the bits about diagnosis and biology, from the fragments I saw it seemed a highly selective and inaccurate interpretation of the evidence so to save my blood pressure I will move on from them.

Reliability of mental health classification is usually measured as how often clinicians/ researchers agree on the same way of classifying the same person’s problems. The PTMF repeatedly attacks the reliability of diagnosis whilst seeming ignorant that diagnosis is more reliable than psychological formulation-based classifications (but psychodynamic formulation has similar reliability to diagnosis). Disappointingly there is little information in PTMF about its’ reliability and no news about any research on its’ reliability to be published later. The authors have had 5 years which was ample time to have done some research on reliability e.g. providing vignettes (case descriptions) online and getting participants to formulate the cases using the PTMF and then comparing the similarity of responses. Without reliability data the usefulness of PTMF for lots of functions is badly impaired – how can we know that the problems classified in a particular way in the research would be the same way we would classify them in clinical practice.

The next issue is applicability to the problems people seek help with from services. The authors accept that some problems may not be suitable for the PTMF such as direct effects of brain diseases, short term effects of drugs or core features of autistic spectrum conditions. They may be used for other problems that may arise secondary to these problems, for example low mood caused by the effects of brain diseases on people. Unfortunately, the PTMF does not seem always applicable to all the other problems people present with. For example, it notes the links between trauma and psychosis (but minimises the importance of other factors that operate in conjunction with childhood trauma to produce psychosis) but does not mention that childhood trauma does not cause psychosis in 65% of people who present with psychotic symptoms or that not all clinical features of psychosis are associated with childhood trauma.

PTMF does seem useful for some problems that people have especially if power imbalances or trauma cause the problem. Unfortunately, because of the overselling of PTMF there is no information given as to what proportion of problems presenting to services are best dealt with using the PTMF. Apart from those problems listed as being excluded the authors gave me the impression that they felt the PTMF was the best solution for all problems. (People often have more than one problem and the same person may have some problems helped best with using PTMF and other problems dealt with better using other methods e.g. CBT or diagnosis/ medication). They are also so deeply wedded to their ideology that they recommend stopping specialised mental health teams like EIT. EIT is associated with better outcomes for patients like improved experience of care, improved access to therapy, improved social outcomes and reduced suicide. Better models of care are to be sacrificed on the altar of the authors’ ideology.

There is a lot of references and discussion of social factors and mental health. These clearly showed an association between social factors and mental health but they did not show a sufficiently strong relationship to prove the implied hypothesis that viewing problems through the PTMF is a sufficient and complete explanation of all the problems people present with i.e. other psychobiological factors are involved. Some are reasonably proven – such as the social nature of reason for high rates of people in UK Black communities meeting schizophrenia criteria or for childhood trauma and people meeting personality disorder criteria. There’s also an unfortunate suggestion that ADHD should be viewed primarily through the PTMF which is at odds with research evidence and what patients themselves report about their own understanding and experiences.

The feasibility of using the PTMF in short appointments (of 15-30 minutes) or in emergency work including overnight when time / cognitive resources are under pressure and many issues such as risk or excluding medical causes of problems is limited. The constructs used have little predictive information for outcomes or choosing treatments such as medication (though research in the future may change this). For medication the PTMF uses the misleading “disease centred” vs “drug centred” model whereas most psychiatrists in my experience do not think the medication is reversing a disease process but has research evidence of reducing symptoms or other improvement in outcomes. There is a strange order of questions in the PTMF (asking the person’s story last after 4 questions trying to frame the person’s problems in terms of the PTMF when surely asking the person’s story first would make more sense).

The PTMF avoids drawing thresholds as part of its philosophy of trying to avoid putting people in boxes and separating problems as different from everyday experiences and responses. Unfortunately, this is a problem as one of functions of classification is to establish the problem as sufficiently severe to justify something- such as access to a service, or exemption from sanction or eligibility for benefits. Now this is often combined with other dimensional measures such as for example levels of impairment but being classified as for example having a psychiatric diagnosis makes it more likely to other people that you will meet criteria for these advantages. A diagnosis of agoraphobia makes it more likely to not be able to leave the house unaccompanied and subsequent social impairment.

The suggestions for using PTMF for administration, statistics, legal purposes or accessing benefits are ill-thought out and often do not use PTMF itself to fulfil the roles. Third-party payment health systems such as the NHS (or insurance-based models) require administrative data from healthcare providers to provide a justification for funding them. PTMF suggests using broad activity and severity data (not part of PTMF) but administrative data also requires information on nature of presenting problem that PTMF doesn’t provide. Diagnostic codes may not always provide a lot of differential information (but if somebody’s only diagnosis was mixed anxiety and depression it seems unlikely third-parties would pay for 2 years of expensive inpatient secure rehabilitation for instance). Diagnostic codes are already used by the rest of the NHS for the rest of health and diagnostic codes would still be needed in mental health for conditions PTMF admits it’s not suitable for e.g. Alzheimer’s disease or drug intoxication. We could try and have two different systems in mental health but this seems an unnecessary transaction cost and added complication for most mental health services. Similarly, for statistics why have separate systems for collection of data -and PTMF is unable to provide such data anyway relying on alternatives.

As for legal purposes, courts are likely to prefer diagnostic constructs with in-built thresholds with evidence of association with outcomes they are interested in as well as some dimensional assessments. Schizophrenia is more likely to be associated with fitness to plead problems than mild depression. Psychopathy / antisocial personality disorder is more likely to be associated with re-offending and being hard to predict offending than panic disorder. Of course, other assessments help but the legal system is geared towards making categorical judgements which fit well with diagnostic constructs.

The most challenging section for PMF is access to welfare benefits. People with mental health conditions often suffer long-lasting or temporary but recurrent impairments that make it hard for them to work. Benefits/ welfare agencies are under pressure not to pay out benefits. For claimants to overcome this resistance they need to prove their functional impairment. Now of course as PTMF says there needs to be statements of degrees of impairment even with a diagnosis. But a diagnosis has research evidence of association with degrees of impairment – see the example of agoraphobia mentioned earlier – thus helping to validate professional’s statements of degrees of impairment. Diagnosis also fits in with how the benefits agency assesses impairments in the rest of health. A diagnosis from a professional plus statement of degrees of impairment help the benefits applicant prove to the sceptical benefits officer of entitlement to claim. The PTMF provides no adequate replacement and risks people being denied benefits they are entitled to and suffering severe financial hardship.

There are some frankly awful suggestions in PTMF about disagreeing with diagnosis on benefits applications forms or saying people have recovered when applying for benefits. The suggestions on changing the benefits system ignores applicants need to deal with the system as it is now. As for Universal Benefit Income, this is unlikely to be provided at a level that is necessary for people with health conditions who often need more money than the average person. For example, people may need to pay for taxis rather than walk or take the bus because they are too anxious to do so or need to pay for cleaning as they lack the energy or motivation to do so because of their health condition.

In short, whilst PTMF offers a useful technique for helping some problems that present to mental health services it is not useful as a classification for administration, statistics, research (but can be researched as a technique), legal purposes or access to benefits. It is not a practical system for short appointments or emergency work. It is not a replacement for diagnosis for many of its’ functions.

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#PTMframework Power Threat Meaning Threat Power Power Power, review by Scheherazade

Power Threat Meaning Threat Power Power Power!

By Scheherazade

2018 has started with a bang. Well, at least within the small islands of UK’s mental health activism. On Twitter, Facebook and other social media forums, discussions are going on about another ‘paradigm shifting’ publication from the Division of Clinical Psychology of the British Psychological Society in the UK: The Power Threat Meaning Framework. Scheherazade was among the crowd that gathered at Friends House, Euston, on 12th January to listen to the speakers at the launch. We were given a 141-page ‘overview’ document. A 400+ page full document was published on Monday 15th January. Scheherazade has not yet read this document, but promise to do so in the next 1001 nights.

For now, here’s the story of the launch.

Something old, something new?

At the launch, the Power Threat Meaning Framework (PTMF) was presented as a ‘new’ way of thinking about why people experience distress and as an ‘alternative’ to psychiatric diagnosis. We were told that it is for ‘all of us’, not just for those who are caught up in the mental health or criminal justice systems. It is even for those ‘non-western’ countries and their ‘culturally-specific’ understandings of distress which are now under threat by the export of western diagnostic models (No need to get really bogged down by the history and legacy of colonial psychiatry and psychology because that was so long ago, right?!).

There is much in the framework that was presented that Scheherazade agrees with. Much of it is a collation of what has already been researched, evidenced and campaigned for over the last several decades by user/survivor groups, critical psychiatrists (yes, them too) and critical psychologists, feminists, community development campaigners, philosophers, literary critics and cultural theoreticians. The operation of power in what is considered ‘normal’ and ‘pathological’ in societies; in how these are defined and managed; in how the psy-disciplines, mental health and related social care services function; in political, social and economic responses to those considered mad or mentally ill; in notions of care and caring communities—all these have been central to discussions about how we understand and work with madness and distress.

The role of power in how people respond to ‘problems of living’ such as capitalism, patriarchy, racism, white supremacy, cis-gendered (hetero)sexism, ableism etc. and their impact on people including exclusion, discrimination, being confined within state institutions, being forced or coerced into treatment, being subjected to social engineering and Eugenics, being left to rot and die in rich countries boasting of welfare systems—all these and more have been part of many campaigns worldwide and many efforts to change the way we treat vulnerable people in our communities.

But terming problems of living and how people respond to them as ‘threats’ and ‘threat responses’ was new to Scheherazade. To Scheherazade’s non-psy-disciplined mind, it sounded like a somewhat contrived psychologisation of the way power impacts on people’s lives and how they react to it. So, Scheherazade wondered: Psychiatrists routinely defined people’s responses to problems of living as symptoms of illness. Were psychologists now proclaiming (not for the first time but louder than usual, perhaps) that they should have more rights to formulate them in their own languages and within their discourses? How is that going to help anyone who is actually caught in these factional politics for the right to define and manage other people’s distress?   

Mirror, mirror on the wall

Ideological power, we were told, was the most important functioning of power because it is the least visible and least acknowledged and is part of every other form of power. Most importantly, it is central to the experience of invalidation. Scheherazade agreed wholeheartedly and waited for some acknowledgement of the ways in which ideological power operated within psychology. Surely when embarking upon such a momentous journey of changing the narrative, there will be some form of self-reflection involved?

Nope. Not once was the operation of ideological power in psychology as a discipline or as a knowledge system addressed or even acknowledged. (The launch of PTMF happened two days after the controversy around the Eugenics conference at UCL). Or its functioning as part of the machinery tasked with managing distress and distressed/disabled people (for example, in workfare coercion in the UK). There was no examination of how the professional and ideological power of psychology might operate in therapeutic settings. A question from the audience about ‘how we might get our own house in order’ was met with a ‘come and join us’ comment. Does this mean that the disempowering aspects of psychology as a discipline, knowledge base and practice could be fixed by a ‘few good (wo)men’ approach rather than any considered thought about structural, institutional and political power? A further question from the audience asked precisely that: What sort of structural and institutional changes would be needed to put this framework into practice? This was answered by one of the co-authors by narrating an inane anecdote about how he faced off a critic on Twitter by saying ‘yes, we want to change the world’.

Meanwhile, as the day progressed, concepts such as ‘learned helplessness’, ‘self-stigma’, ‘apathy’ etc. kept being repeated, niggling like bone fragments in a perfectly spiced shami kebab. These are powerful psychological concepts, as harmful to the person to whom these are attributed as the psychiatric language of symptoms—as individualising, invalidating and disempowering. Decades of scholarship from psychiatric survivors and others about the harmful effects of such formulations exist, especially in the context of self-harm, eating difficulties, ‘personality disorders’, depression, ‘schizophrenia’… Scheherazade was confused why psychology presented itself as the fairest of them all when it was clear that they hadn’t even looked in the mirror! What was the point if, despite exhorting to connect the social, cultural, ideological and individual contexts together, ‘sick’ is to be replaced with ‘sick role’ and symptom talk with behaviour talk?  
It was time to hear about the framework’s practical application.

Hunger games (with fishing nets)

Social justice, we were told, was the corner stone of the PTMF, although no social justice groups were involved in its production. A social work expert showed us slides about red herrings and fishing nets—all very symbolic about social care policies and human rights, apparently—and asked us: “Do we want a system where people have to demonstrate how much they are suffering in order to be objects of charity who can then receive their basic rights?” Of course not, Scheherazade agreed fervently with everyone else in the room until she realised that the ‘charity’ referred to was really the basic minimum support and care that any self-respecting welfare state should provide for its vulnerable people—you know, things like affordable housing, disability support, the means to eat and to look after your family, not to be coerced into unsuitable and harmful work, not to die in the process of trying to stay alive, not to be killed by the recovery industry.

So having set up social security as charity, the expert went on to show us how the PTMF can help. We were told that current social policies do not specify diagnostic categories in order to be eligible for social support. They only talk about impairment, disability, health condition etc. that restrict a person from achieving outcomes that impact on wellbeing or impact on their daily living. So, all we have to do is to prove impairment, disability or adverse health condition by using the new constructs—for example, “experiencing temporary and enduring or regularly occurring severe mental distress.” And hey presto, we have a non-biomedical, completely fair system, what Cormac Russell called “communities of hospitality that have a genuine place of welcome for the people who’ve been pushed farthest to the edge…” Yeah, right! Now Scheherazade got the red herring connection!

Even those who (like Scheherazade) vehemently critique biomedical constructs and diagnostic labels are agreed that, as long as social care and welfare policies are punitive, coercive and life-threatening, simply removing diagnostic labels and practices will not be effective in saving lives and ensuring the basic human and civil rights of the people in need of support. In Scheherazade’s humble opinion, it was imperative to involve those who have been campaigning for a very long time about social policies and welfare issues (for example, the MHRN, DPAC, BARAC) as well as experts on welfare rights who actively work with people trying to negotiate these social policies in real time. It would have shown the authors the reality of the nightmarish world of evidencing impairment, disability and/or health condition to the DWP’s satisfaction. It could have helped them avoid the embarrassing and, frankly, harmful flippancy shown at the launch about how the system currently treats those who try to seek support from the state that is legitimately theirs to seek.

Who is afraid of the survivor movement?

That brings us nicely to the much-anticipated reveal of service user involvement in the process that led to the PTMF document. Admittedly, there are two survivors amongst the self-confessed ‘charismatic originators’ of the PTMF, and another one who, like Lindsey Lohan’s ‘poorist’ trip to Delhi, had ‘experienced’ the effects of anti-psychotic medication in a well-publicised stunt and randomly claims such expertise. Who else had been consulted? Apparently, a sum total of eight service users, in the course of five years.

What intrigued Scheherazade was the specific mention that the service users involved “were not mental health activists or campaigners.” And, the speaker—herself a celebrated survivor—hastened to add, although they were “not exposed to critical perspectives in detail,” they were “brilliant and intelligent people.” Scheherazade will leave you to ponder the inherent sanism in that declaration, but let’s examine why, in a process of service user involvement, not being mental health activists or campaigners is considered a positive requirement. Is it because activists and campaigners would be ‘biased’? If so, why is this only a problem for service users and not the professionals involved who, it could be argued, have more to gain from winning the turf war between psychiatry and psychology? Given that there were only eight people involved, would it not have been more useful to ensure that those consulted were well-placed to represent the diverse voices of service user communities that the framework would affect, especially those people affected by the current welfare and benefits system and social exclusion perpetrated by white privilege?  

The unbearable whiteness of paradigm shifting

Scheherazade was aware that this was the second publication from the DCP in the last five years that claimed to shift the paradigm. The previous one, Understanding Psychosis, published in 2014 also made an effort to collate some critiques of bio-medical models. It was, however, criticised for its racist language and for its failure to involve people from racialised groups and engage with their scholarship. A public apology was issued and a revised version was published last year. Lessons were learned, it seemed.

Here was another paradigm shifting happening, the work of which was apparently going on while conversations between the critics of the previous report and its authors were taking place. Some of the authors of that report who facilitated the conversation with its critics are co-authors of this report too. And yet, here we are, another DCP funded project with not one person of colour in the author group.

There were some people of colour in the audience—think how much black pepper Delia Smith recommends for a vat of white sauce, you’ll get an idea. White people display ‘social/cultural capital’ (defined in the PTMF as ‘a mix of values, qualifications, knowledge and connections which ease people’s way through life and can be passed indirectly to the next generation…’) through self-selection and unreflexively excluding persons of colour. This leads to ‘ideological power’ (defined in the PTMF as ‘control of language, meaning and perspective’) which allows for unexamined threatening behaviour. When white people are in self-congratulatory mode and secure in their self-made context of power, they tend to make jokes—jokes that the unsuspecting random person of colour who happens to be in the vicinity experiences as ‘threats’. For example, white people make ‘boss/slave’ jokes and think they are hilarious. Scheherazade knew all of this and yet when the joke came along, it was no less threatening. A big ‘what’s-she-like-haha’ deal was made of how bossy one of the authors was and how another author was her personal slave, to the appreciative laughter and applause from the white audience. And when it was time for Q&A, she invited the previous speakers to the stage by pointing to them (all white, of course) and saying: “This slave, this slave, that slave and that slave, come on to the stage.”

And when the tentative effort to address the issue of whiteness in one of the breakout groups met with resistance, Scheherazade knew that some paradigms are never to be shifted. Threat responses: Anger, giving up (aka ‘learned helplessness’), some more anger, and a pint of vodka.

Saludos!

About Scheherazade: Scheherazade (Sherzad to close friends) was born all over Asia, some parts of Africa and in Disneyland. Her threat responses have been formulated as talkativeness, manipulation, deception and a propensity to invent stories. Her life’s work has been plagiarised in all kinds of languages. She currently resides in Catherine Zeta-Jones, Sulaf Fawakherji, Maria Montez and several other bodies.

Some Models Of Mental Health

Part 1 of 3

So let’s unpack some mental health discourse

Psychiatry – mostly medical model in practice since the seventies or even not until the eighties, it was partly psychoanalytical before the 50’s (despite the history of the bio-medical model going back to Kraeplin and Bleuler and the private hospital mad doctors prior to 1848) and the arrival of chloropromazine but even then it took until decarceration and care in the community for the paradigm. The medical model has a level of discursivity that stems from a neurological condition to distress/ trauma models, but most see medication as the key treatment.

Pscyhoanalysis/ psychotherapy – from Freud to Integrated counselling, the basis that a person can talk out their own symptoms through transference (therapeutric relation) to a safe significant other.

Cognitive behaviourism – The argument that personal insight and narrative (gained through talking therapies) can only take us so so far and adjustments from psychological expertise based on behavioural norms that have been studied through objective observation is sometimes required.

Positive psychology model – at its simplest the focus on the individual as source of recovery (if not always cause of mental distress), from adjusting behaviour, self-conception, negative thoughts, through to lifehacks. Whilst few would deny any individual responsibility in recovery (others argue it is automatic, mental distress being unpleasant) at its extreme form, denying any outside affects from significant others to structural affects, positive psychology can victim blame those it is aimimg to treat.

Neuroscience – the study of the brain, there is a lot of knowledge gained from studying loss of function due to brain damage. It gives sustenance to the medical model but like any science can also criticise core assumptions through falsifying received wisdom with evidence. so the key to a critique of say the dopamine model of schizophrenia may in fact be a systems theory argument of the interaction of all the neurochemicals. There is also room to measure the long term effects of psychotherapy and evidrence test the competing patradigm, but there are limits to this. Neuroscience is however a basic science and is not psychiatry.

Trauma model – That mental poor health stems from previousa trauma and the display that sometimes leads to distress and non-normative bhaviour is caused by the mind and body working through the trauma, not always successfully.

Pathological communication model – that poor mental health and distress can come from early pathological communication that triggers distress in adult life when repeated and/or becomes a form of trauma that needs working out not always successfully. It can work with the trauma model either as a trauma in itself, or in an inability of significant others to support or even to worsen the experience of working through previous trauma. Can be individual pathological communication or group nexus.

Spiritual crisis model – This is at its simplest level the belief that a mental breakdown is a spiritual breakdown. It has roots that go back to the Quaker’s and the Tuke work cure. but the modern version fits well with the trauma model. It was largely behind the humanist model until the advent of modernism at the dawn of the 20th century and was replaced with a more materialist but still humanist model.

Materialist model -This is not just opposed to the spiritual model, but also some atheist secular dualist models (where mind or consciousness are separate from each other), for this model there mental distress is located in the body (the brain or mind is part of the body – it is also opposed to idealism as a philosophy but that is more complicated). With regards religion it requires at least a deist theology (where God is transcendental and unknowable, earthly matters are material and fallible – but it can be accepting of a materialist conception of mental distress eg Spinoza).

Social model – the interaction of the person struggling with their mental health based on whatever paradigm of above mental health models with their man-made social and economic environment (sometimes called ‘second nature’) that during the period of distress puts them at a disadvantage with regards normative interaction at a human rights level, or similar justification, entitles them to support whether structural, personal or economic.

Ideological model – One version is a variation of the social model, at its most naive, utopian and worst (possibly a straw man), madness is an ideological condition that will disappear with full communism. The more realistic version is that there are iatrogenic effects that stem from the economy that exacerbate existing conditions, impede recovery and trauma such as homlessness can lead to a form of trauma itself. A robust social model combined with a critique of capitalism is required to combat these issues. There is also a version that sees ideological propaganda as adding to pathological language (this might include that used by say medical psychiatry, positive or cognitive psychology that puts too much responsibility (that should be met either by others or structurally) on the individual with mental distress. this language is driven by capitalist ideology at a discursive level. there are also the iatrogenic effects of unequal power disparities at a class level and the attrition effect it has on everyday life.

The other version I include has its worst version as a complete denial of mental illness, that those who suffer are malingerers and need some corrective therapy or a work cure to pull themselves up by the bootstraps. The milder versions accept a level of mental distress but see narrow corrective therapy and sanctions as sufficient policy. This includes views on work as cure and views on benefit dependency as a obstacle to recovery.This sometimes includes the anti-meds and anti-diagnosis lobby where the social model and other structural realities such as a diagnosis for sick notes is denied.

Embodied model – For the most part the embodied model is a materialist conception of mental health. Centred as it is on the body. At its simplest it is a relation of the body to trauma and the need of the body to deal with traumatic events over time. However as it is the embodied model not the ‘body’ model, it assumes that the body afgfects and is affected by the rest of the world as such it has a bodily relation to the world, so most embodied theories accept also the communicative model (especially linguistically) and the social model. Those that have relations to what is called biopolitics have a relation to the ideological model (biopolitics in its simplest form is the body’s relation to governance and its attempts to resist dominating powers centred on that body).

Recovery model – the idea of recovery from mental distress has a long history, from shamans through to Tuke and Pinel (even Bleuler saw schizophrenia as a disease it was possible to recover from – contra Kraeplin), through the early years of psychoanalysis (its early success with trauma victims from WWI), to the humanistic asylum policies of the early 50’s and ’60s (before the medical model took hold), to anti-psychiatry. The term recently, since the 90’s, has had a narrower focus, in its simplest form it is a counter to the disease based model, a model that states that people can recover from severe mental health. However in the last 10 or so years it has come to also refer to a form that capitalises on such possibilities of recovery whilst denying that austerity measures have adverse effects contra the social and ideological model, narrowing the model to more positive cognitive models combined with sanctions. More humanistic recovery models still exist, and few professionals have ‘forgotten’ them, but in the current policy environment they get less funding and the more punitive sanctioning model has taken precedence at structural levels (if not always in the minds of professionals, survivors and service users).

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Welfare, employment and mental health in the 21st century.

It cannot have been a coincidence that this year’s theme for World Mental Health Day was centred around the workplace. It certainly reflects a world in which working is seen as the epitome of recovery, rather like the top of Maslow’s hierarchy of needs triangle. According to this mindset, self-actualisation is achieved by having a full time job and becoming one of those infamous ‘hard working people’ that the Tories regularly talk about when trying to butter up that section of the electorate who pay their taxes to keep MPs in the manner to which they are accustomed.

I don’t know which alternate reality the UK government live in, but in this universe jobs are no guarantee of recovery, in fact they can often impede it, and exacerbate symptoms of mental health problems. Given that many people end up ill precisely because of their jobs, where they often spend most of their day, it seems bizarre that anyone would make a sweeping generalisation about work being helpful to those with emotional or psychological issues, and being a sign of complete wellness. On the other hand, if you follow the doctrine of neoliberalism it makes perfect sense, as the idea of minimalist state assistance is at its core. Things like the welfare state and the NHS are examples of socialism, are therefore evil and must be demolished.

Of course this is disguised as ‘austerity cuts’. The fact is that austerity hasn’t worked, and it is only a smokescreen for a neoliberal agenda. It has been established, even by the IMF, that neoliberalism and austerity cuts stunt growth and increase inequality. This of course is no problem for those who implement these policies as they are too rich and powerful to be adversely affected. But it affects everyone else and in many cases ruins what lives they had. An unstable job market where ‘flexibility’ is the key buzz word, zero hours contracts and the constant fear of being made unemployed and unable to put food on the table is not likely to promote good mental health. And when it comes to people with diagnosed mh problems, the idea that they can deal with their illness and all the added stressors of modern day employment is a sick joke.

We all know that thousands of people have died as a result of the Tories’ welfare cuts, through procedures like the Work Capability Assessment (unless you only read the mainstream media, in which case I can only presume you have stumbled across this page by accident and think that is ‘fake news’). People are starving to death, becoming more unwell after being denied payments for things as ridiculous as not turning up for a job centre appointment when you never received any notice of said appointment taking place, and taking their own lives as existing any longer just prolongs the living hell of being threatened by the DWP and there seems to be no end to it. If the public had had the foresight to vote in the Labour Party, under Jeremy Corbyn, it’s quite possible that many lives could have been saved, as they had pledged to end the WCA and make PIP (Personal Independence Payment) assessments fairer, although what they meant by ‘fairer’ was not made clear. Not that you would know this if you watch the MSM, as they have completely ignored the subject of welfare cuts and the Tory driven breach of human rights as stated by the UN on several occasions. Now with Brexit and the scrapping of the Human Rights Act, along with the ability of the government to bypass Parliament and rubber stamp Bills without a debate or Commons vote through the Henry VIII powers, it seems that things can only get worse for all of us. In fact the Tories have already started ignoring embarrassing defeats in Westminster, as shown by last night’s Universal Credit debate which they lost unanimously. UC will be rolled out as planned even though it will leave many people without money for 6 weeks and force them to use food banks. The fact that the Tories get away with this (apart from the fact that the MSM does not report such defeats) shows that the wider public has no time for benefit claimants, and consider them a burden which is expendable; indeed, less than human.

As someone with mental health issues I am used to being treated as a subspecies and whenever I have had jobs I rarely mention any diagnoses as I know that the mentally ill are deemed even lower than the average benefit claimant. Stigma is a real problem, especially when applying for jobs. The double standards of the general public on this is astounding. On the one hand they want us to stop being lazy scroungers and get a job, as obviously all people with mh problems are not really ill, just playing the system, but on the other hand we might be dangerous, and most likely stupid/inept, as after all we are nutters, and no one wants to work alongside one of those.

I remember one job I had working in a kitchen where the people I worked with knew of my problems (I told them I had depression). One day I picked up a knife and walked across the room to use it to chop up some food. A ‘colleague’ told me that he wondered what I was going to do with it. That kind of ignorance about mh issues is pretty widespread in society. If you have a job and have mh problems the chances are that you deal with any triggers or stressors on your own, as people just don’t understand (or want to understand) mental illness. This is of course added pressure and if you live in a small town (like me) you have the extra worry that someone will know you from somewhere and identify you as a nutjob. People are never the same with you again after they find out that you are officially a headcase. They either ignore you, abuse you or are extra specially nice to you, presumably in case you produce an axe from your trouser pocket and start hacking them to death if they say anything remotely negative about you. But that of course assumes that you got the job and were honest about having a mental illness, which is unlikely, especially if you have something like schizophrenia. Yet people with such a diagnosis are told they have to look for work, when they cannot be honest about their health and expect to be ‘successful’ in being employed, and even if they were, there wouldn’t get support at their job and would be ostracised, making them more paranoid and increasing the chance of a relapse or hospital admission. Why the Tories think it is worth pursuing this vindictive welfare policy when it clearly costs more than it saves is beyond any naïve member of the public, but some of us know they are not called ‘the Nasty Party’ for nothing.

Until mh stigma is eradicated for ALL mental health diagnoses there should be an acknowledgement by the government that it is more difficult to get a job when suffering from a mental illness. It is also obvious that when in a job anyone with mh problems/who is disabled should be well supported and have access to a ‘work counsellor’ who they can offload any worries and stressors to. This doesn’t have to be exclusively available to those with diagnoses/disabilites; anyone who is stressed or unhappy in their job should be eligible for such a service. Of course this would cost money, which apparently is the main reason for welfare cuts, that and the idea that work is the best route to recovery. It is unlikely therefore that every workplace will be obliged to employ an internal counselling service/support system for people with disabilities/mh problems. But was that ever the real reason for cutting disability payments? Some of us can see a parallel in the actions of our government and that of the Nazi government of the 1930s. But contrary to their ideals, work is no guarantee of recovery, or measure of good mental health. It is nothing more than a means of surviving for most people, which is another reason why so many hate those on benefits; jealousy. For the Tories the glorification of work and shrinking of the welfare state is a good excuse to euthanise those who need state support to exist, and with a faithful MSM and a dumbed down society they can get away with anything, literally, anything.

Seroquel Susie

The Invisible Whiteness of Being, Philip Thomas

When it comes to matters of race and culture, whiteness is plainly invisible. What do I mean by that, and how can I make such an assertion? Over the years I worked as a consultant psychiatrist, in multi-cultural inner-city Manchester and Bradford, and multi-cultural rural Gwynedd in Wales (where the English were counted as an ethnic minority), I attended my fair share of cultural ‘sensitivity’ training events. At first I found such sessions useful; I’d always been fascinated by cultural difference for reasons that will become clear. But as time passed I began to feel increasingly uneasy about empirical approaches to cultural difference.

This is because we white people were never the objects of scrutiny in these events. Whiteys didn’t have culture; we were invisible. Our culture is so soft, so gentle, we don’t notice it and take it for granted. Like the anthropologists of an earlier generation we assumed we could understand the essence of other people’s cultures as though our own cultural beliefs and assumptions had no effect on how we interpreted other cultures. All we had to do was to learn the objective ‘facts’ and that qualified us to work with people who were different fromourselves. One problem with this is that it overlooks the problematic historical relationships that exist between us and non-European people, historical relationships grounded in
colonialism, slavery, oppression, and the wholesale imposition of White European cultural values and beliefs on non-Europeans. How did this insight become clear to me?

To trace the origins of my personal enlightenment, I have to say a little bit about my own family of origin, where I was born and brought up, and quite a bit about my parents. It is fortuitous that I’m writing this sitting in the departure lounge of Terminal 2 at Manchester Airport, surrounded by people from all cultures and ethnicities, as I wait for a plane to take me via Hong Kong to Melbourne for the funeral of my much-loved Uncle John, my mother’s ‘baby brother’. There’s a sense in which I’m retracing a family journey, one that my Uncle made nearly 50 years ago when he emigrated from Liverpool to Australia with his wife as part of a new wave of Anglo-Saxon colonialism that began after the Second World War and continued into the 1970s. It is of course a deeply moving moment for me, but it has positioned me in the right emotional frame of mind to write about very personal matters. So,here we go.

The first eighteen years of my life were spent in North-East Wales, literally a stone’s throw from the English border, an area that until the nineteenth century was largely rural. But as the Industrial Revolution exploded in Manchester, Lancashire and the Potteries, the coal and brick clay that lay beneath the hills and marshes that bordered the River Dee became a valuable asset. At the end of the nineteenth century John Summers moved his
steelworks from Stalybridge to reclaimed land on the Dee marshes. Consequently the population of what came to be called Deeside exploded, as the new factory drew in people from Liverpool, Lancashire, the Potteries, and of course, Ireland.

My paternal great grand-father and mother, Frederick and Annie Jowett moved from Leeds to Deeside at the end of the nineteenth century. The surname Jowett is thought to be of Norman origin, and descended from the Jouets who accompanied William the Conqueror in the Norman colonisation of 1066. Frederick and Annie were of course not Norman aristocrats, but honest working class Christian socialists, God-fearing, abstemious and hard-working.
My paternal grandfather, Bencie Thomas came with his family from Aberdare in the Welsh valleys to become a highly skilled blast-furnace man at the new steel works. He had a dangerous job, responsible for deciding the precise moment to tap the furnace and release its molten charge of white hot steel. He married Mary, Frederick and Annie’s eldest daughter, shortly after the end of the First World War, a conflict he didn’t fight in because he was in a reserved occupation. There is a family story, how true it is I cannot say, that on the night of their wedding, Mary told Bencie in no uncertain terms that he “…was never to use that heathen tongue in my house”, referring to the Welsh language. The first Welsh Nationalist M.P., the late Gwynfor Evans, described in his book Land of my Fathers (the first Welsh history of Wales) how the English had suppressed Welsh culture for centuries by stopping the
Welsh using it. Bencie was a Welsh-speaker. His Welsh Methodist hymnal in which he wrote in an immaculate copper-plate hand the first lines of his twenty or so favourite hymns (in English, for Mary) is one of my treasured possessions. Then, in 1924, their only child, Roy, my father, was born.

All this is a way of framing my first experience in practicing racism at primary school when I was nine. A new girl joined our class. She had flame red hair, freckles, piercing blue eyes and white eyelashes, a true Celt. Her family left the farm in rural Wales because her father found better paid work in the steelworks. Her appearance and the fact that she spoke Welsh faultlessly set her apart from the rest of us. Those differences singled her out for the most appalling racist abuse. It was her name more than anything that became the butt of crude jokes and derision. She was called Ebrillwen. Only much later did I discover that it meant white April, a beautiful and poetic way of marking through the Welsh language the birth of a daughter in the snows of April. It gives you a glimpse into the love of nature in Welsh culture, and how this is tied poetically to identity. Now to my mother’s side of the family.

My maternal grandfather, Walter Mercer, was a self-made businessman who moved from rural Wiltshire to Liverpool shortly after the end of the First World War. He started a successful printing business in the City, and then built it up again from scratch after it was flattened in the Blitz in the war. His business was successful, and he lived in a comfortable semi-detached house in what was then a middle-class area of Birkenhead, over the river from Liverpool. He married Minnie Love, a beautiful Irish Protestant girl from a large family in Bundoran, County Donegal. The Loves may have originated in Scotland, so-called Ulster Scots, but there is a family story that the name was an Anglicisation of the French Lamour, and that their ancestors were Huguenots who fled the Catholic persecution of Protestants in France following the revocation of the Edict of Nantes by Louis XIV in 1685. The edict safeguarded tolerance for Protestant worship in Catholic France and the Low Countries. If true, it would explain two important aspects of my life: my love of European and French culture, and the unseemly blend of hatred and mockery of Catholicism that I was exposed to at home from an early age.

But there’s more. Minnie Mercer died three months before I was born, leaving my mother in a profound state of grief during the last stages of her pregnancy. In the early months of my life she nursed and loved me through tears, sadness and despair because her dearly loved mother would never see her first grandchild. But my mother made up for the loss, because as long as I can remember I have felt a closeness to Ireland, its people and especially its humour. This is as important today as it was when I was a child.
It partly explains why I have always found girls of Irish descent irresistible, especially Catholic ones. After all, I married one!
We are now in a position to understand how complex whiteness is. It isn’t a two-dimensional thing, a shallow layer daubed over my personality, a thing that can be dismissed in terms of cricket, warm beer and loyalty to the flag. The more I met and became friends with people from non-European cultures, the more questions this raised for me about my culture, and especially what I suppose what some would call my cultural identity. It’s worth noting in passing that I dislike this expression because it implies that who we are is fixed and unyielding. I believe that who I am changes from moment to moment as part of a complex interaction between the social and political environments I find myself in, who I am with, and how the mood takes me.

I began to see that what it means for me to be ‘white’ is riddled with contradictions, conflict and paradoxes. Let me give some examples. When I open my mouth people assume I’m an educated English middle class male. Well, I was extremely fortunate in having had a superb education in a state school, but my accent changed dramatically in October 1967, when I encountered really privileged middle and upper class white males in my first week at medical school. I consciously lost my Deeside accent so as not to stand out from the crowd. My accent marked me out as different; in the eyes of these unthinking young men it marked me as inferior, a pleb, or so it felt.

In fact I had always been acutely aware of the class system throughout my childhood, because of the disjunction between my father’s and mother’s class origins. I’d always felt neither middle class nor working class. I was a Janus figure looking both ways, liminal and borderline. Consequently, the class system held a morbid fascination for me; this was one reason I joined the Navy as a medical officer after I qualified. I had to find out more about it.

Then there was religion. In my teens I lost all religious belief. My scientific education converted me into a secular rationalist who could not admit to the possibility of a life outside the body, the resurrection and so on. That remains my belief, but my view is more nuanced these days. Medicine places you in a uniquely privileged position with fellow human beings in the most extreme states of abjection, despair and distress. I realised that although it didn’t work for me, religious faith of whatever hue brought great comfort and meaning into people’s lives. This forced me examine the partisan nature my early religious experience, mocking Catholics and the Pope. I still feel ashamed about this, as I do about the way we racially abused Ebrillwen.

Then there was the issue of gender and sexuality, and I have to be very careful here. For obvious reasons I was much closer to my mother, and as I matured I rejected the working class notion of masculinity my father offered. What I witnessed in my family life, the patriarchal nature of white working class culture, filled me with horror and disgust. I could see how, in many different ways, this made women unhappy and deeply dissatisfied with their lives. I also rejected the dominant notions of white working class male sexuality. I have always disliked the bluster and macho nature of male company. At university I much preferred the company of women and my growing number of gay male friends, so much so that I know at one point my father was ‘worried’ I might be gay. I think that’s why he had no qualms about me marrying a beautiful Catholic girl of Irish heritage.

So where does this leave me? It made me increasingly aware of and close to other liminal beings, who like me, existed in the spaces between the conventional pillars of identity, Black, South Asian, LGBT and disabled people, people who became my friends, and who helped me to understand so much more about myself and what it means to be human. It made me realise that the mainstream view of whiteness is so riddled with contradictions, half and selective truths, that it can only be sustained by suppressing and oppressing all other forms of difference lest it be found out.

This, after all, is the great lie of colonialism, a political enterprise piloted by the English against the Welsh (never forget Owain Glyndŵr), perfected on a grand political scale against the Irish, Africans and Asian people, and the indigenous peoples of North America, Australia and New Zealand, before reaching its liberal apotheosis in slavery, the subjugation and exploitation of indigenous peoples in the interests of trade, profit and the economy.

I wince in anger, horror and despair when I hear a British (Brutish?) Foreign Secretary recite the opening lines of Tennyson’s Road to Manadalay – a paean to colonialism – in the Shwedagon Pagoda, the most sacred Buddhist site in Yangon, Myanmar. Has he forgotten his otherness?
It also helps me to know that my family’s history is peppered with diasporas: a Yorkshire family travelling to a new life on the banks of the River Dee, a young woman from County Donegal arriving in Liverpool to make a new life for herself, a shy young Welsh man travelling across Wales leaving his roots, language and culture behind, Uncle John travelling across the globe as an economic migrant, just like the thousands who followed in the wake of the Windrush.

Then I wonder how similar their experiences were, and realise there would have been no similarity. Uncle John was a successful White business man with entrepreneurial skills that were valued in the host country. Most of the first generation African-Caribbean migrants met with outright hostility and racism. “No Blacks Here” on factory gates and boarding room doors. Then I think of my putative Huguenot ancestors, escaping religious persecution in Catholic Europe. Many settled in London’s East End. The Jamme Masjid Mosque on Brick Lane was originally built as La Neuve Eglise in 1743 for Huguenot asylum seekers. Then it became a synagogue for the Jews fleeing the pogroms in Russia and Poland at the end of the nineteenth century. And I see the reception that Syrian and other refugees fleeing terror and destruction receive today in our media and from the politicians on the Right. Our pompous, self-aggrandising whiteness has a very selective memory, Foreign Secretary, and remembers only those stories about its origins that suit its purpose.

© Philip Thomas
October 2017

Damned if you do, damned if you don’t…DWP paranoia

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A discussion initiated in RITB about the psychosocial impact of living in fear of DWP processes which have the power to cause; debt, poverty necessitating the use of foodbanks, deterioration or long term harm to physical and mental health, eviction, homelessness, attempted and completed suicide:

• Just saying that the DWP are causing us ‘stress’ doesn’t even begin to cover it and people can’t understand why people are killing themselves over the ‘DWP experience’”

• If we don’t share it, people don’t realise how the DWP are wrecking our chances of good physical and mental health.

• I just find it so hard to actually enjoy having a physically better day because I feel guilty and paranoid.

• Everything about benefits is so counterproductive to being as well as you can be, as and when you can.

• It feels like punishment reinforcement and grinds you down and down and down.

• It has also made me paranoid about having ‘happy’ photos on social media. I know that 90% of my time is dominated by despair as does my GP, Support Worker and genuine friends. Even a ‘happy’ picture can be taken on a suicidal day. In fact one of my best pictures was taken a few hours after I had written a letter to assisted suicide clinics asking them to take me on mental health grounds. I remember Fightback advising people to only post stuff on social media which reflected exactly what they said on their forms and I see their point entirely.

• This is a really important point. I’m afraid to post any positive or happy pictures or statuses under my own name on facebook. It increases isolation because on the one hand to help maintain friendships people want to see positive things, on the other I’m afraid to focus on the positive in case the DWP looks at my facebook page and assumes it is reflective of the 99 other days.

• The dwp have a facebook team in Scotland, they google claimants they are assessing and social media use was used against a claimant at a tribunal. This is why more people feel safer using a pseudonym which goes against FB’s policy of ‘real names’. Voluntary work has also been used against claimants as showing ‘fitness for work’ demonstrating zero understanding of the fact that stress vulnerability can mean that for some people working voluntarily maintains their stability but the pressures of paid employment destabilises it. Levels of voluntary work have always been high amongst mental health service users and former service users, because of stress vulnerability and because of being unable to fit working conditions not supportive of mental health i.e. insecure, temporary, low paid, poor conditioned work which offers limited tolerance of sick leave. These are the working conditions most likely to be offered to unattractive employees with large gaps in their CV’s which cannot be concealed. People with long histories are not desired by employers with an increasingly disposable workforce they can pick and choose.

• Totally conscious of the evil watching eye if the DWP when I write. FB is one of my main social outlets/point of connection – especially when I’m housebound. Which is a lot. But there’s lots I don’t say that I’d like friends/people more generally to know about. But U don’t write it coz I worry about this

• HUGE factor! Kept me trapped indoors for well over a year around PIP claim. Thought I was being scrutinised, filmed all the time. Thought anyone asking me for directions or for change in the car park was a set up. Made me so much more paranoid and more unwell and restricted me from doing anything remotely beneficial. It still haunts me all the time but trying so hard to not let it now. One letter from them though and I think it will all kick back in. It got to the stage where I thought any car driving past, any plane flying over my house was filming me. I thought the TV and my computer were filming me at home. I didn’t want neighbours to ever see me in case they were keeping notes on me. I remember a little old lady asking me to read something on a packet for her in a supermarket and I did and for weeks after I was terrified. Another time a man asked me for change in a car park and he had his phone in his hand and I was convinced I was being filmed. I have always been prone to paranoia but it got completely out of control when I was being reassessed. It has taken really intensive work with my Support Worker over a year to undo the harm from the assessment, reminding me constantly of the validity of my claims, that I am genuine and have nothing to feel guilty about, the unlikelihood of any of this and that I suffer enough and should not let the DWP dictate my life any more than they already do. So much easier said than done though once you get stuck in that mindset and fear you could lose everything you depend on and be publicly shamed by people who have zero understanding of how debilitating your invisible illness can be. There was even a time when I wanted to write them an explanation letter every single day to explain and justify my actions.

• Scared to open the door due to not always using my stick, and furniture surfing instead indoors, or opening the door to a ‘Daz doorstep challenge’ setup, that I heard was their way of catching out ‘fakes’ years ago. Scared to leave the house with just my stick even going to a car directly outside and using a wheelchair the other end. Scared to walk the distances I can manage for fear of being accused of being able to do more. Like others, I have had paranoia about being recorded and 2 psychotic period’s, one where I thought they were on my street and in my house and had decided I was a psychopath and not deserving of support or benefits. One where the DWP could get inside my head and were inside my head day after day quizzing me about my abilities. Scared to smile or laugh. Constantly paranoid outdoors. Felt paranoid sharing this. Paranoid about telling doctors what I can and can’t do. Paranoid every time my psych used to say to me ‘you’re walking well’. Scared to tell or show anyone what I can do – feels vulnerable for anyone to spend much time with me, because then they’re able to see over time what I can ‘usually’ do.

• DWP are utilising paranoia etc to weaken us, it is a tactic that pertains to democide.

• Until I got the letter saying I had my money back I could not settle, my PIP started in December and only got sorted now. It impacted in every area of my life, the complete invalidation of peoples illnesses is awful, the DWP are cruel

• Watching all of you go through this “brown envelope” thing is like watching friends get tortured. That is the best way I can put it. It’s senseless and cruel. It is clearly nothing but a systemic, governmental, genocidal process that is horrifying on the scale of other intentional genocides. I am sick for all of you.

• Whoever said if you stand up to bullies they’ll go away was talking through their shitehole, every day is an anxiety-ridden nightmare, no-one can help, I am alone. They won’t stop until I’m gone, that’s their raison d’etre now, from social care agency to search and destroy unit in the space of a year or two, it’s a cull. Terrified of the mega judgmental outdoors, and the television and Facebook are an extra level of hell, with their faux documentaries & dismal manufactured opinions,’ oh, I saw someone get out of their mobility scooter & go in a shop the other day, they’re all on the take’. There is no hope.

• The fear very rarely goes away of a double -whammy. F*cked over on DLA -PIP etc -then (for me and I would guess most) impossible schedule on a “Job Search”. Have been trying to look for Plan B’s -but thin on the ground

• Since 2010 I have become much more nervous going out – even in my wheelchair. I feel paranoid about any strange cars or vans, and also feel that the average person on the street has become much more judgemental.

• Just go into hiding. No social visibility. I hate the game to play for the form to be completed, the residual self-doubting of your own disability is awful after you have been made to feel like you’ve had to manipulate a broken system. Amongst all the anxiety and sleeplessness it’s hard to manage this and remain able to value yourself. I’ll never forgive them.

• I was advised by a welfare advisor in 2011 to cease all publicly advertised activism and to only do things which were strictly under the radar. I feel like I’m part of a world war underground resistance whereby I can never speak of previous public voluntary work, can never speak or write in my own name, be photographed or filmed, which makes attending any event in the age of mobile phones and live streaming impossible. This has cut me off at the knees in terms of the contribution I can offer to; peer support, alternative and user defined approaches, teaching. I withdrew from research because of the fear of being visible in any way, professional colleagues understood why and share my anger at being hamstrung. My world has become smaller, some days I am afraid of standing by the window as my voices tell me that the cars across the road have long range camera’s spying on me. That the council have CCTV monitoring every time I leave the building. That the webcam and mic must be switched off or else I am under surveillance. That my phone is being tapped, neighbours are being paid to watch me for signs of fraud, and that undercover operatives are in my supermarket (I’m too paranoid to state which supermarket).

• My voices now echo what I’ve read and listened to in the media over the last 7 yrs and for a few months everything I read I heard in my head in the voice of Ian Duncan Smith which was deeply distressing. Voices call me a ‘useless eater’, and if I go outside will tell me that strangers are ‘proper people’ unlike me because I have no economic or productivity value. I know that my voluntary contribution was highly valued by professionals, but now I’m too afraid to do it so I feel useless and worthless. I used to be proud of what I used to contribute voluntarily, now I feel like scum, and my voices tell me I’m scum. I’m afraid to claim legitimate concessions, do an Adult Education course, speak to people, and are afraid to make any noise in my home because of fearing an anonymous malicious report because they typically occur in our immediate community by people who are uninformed or unhappy with their own circumstances. I so wish I could sing, I would love to sing again but I’m afraid to sing in my home in case neighbours hear me and view it as being self-indulgent and lazy.

• I now treat every GP appointment as a Work Capability Assessment and fear that if DWP intrude into primary care further I will cease all physical healthcare.

• I fear the DWP more than being sectioned and would rather die than face their processes. I know I am living on ‘borrowed time’ but I have no escape because I am unable to get into full-time work and sustain it. The fear of DWP is without doubt now worse than what took me into services in the first place. It has taken my hope, my potential, my future.

• I feel that everyone, including some peers now judge me on the basis of whether I am employed or not, that no amount of voluntary work could ever match up to the gold standard of being employed.

• I took the dwp to tribunal for pip the whole thing took 9 months and it made my paranoia massive i got to point when i thought they were spying on me all the time thankfully they gave me pip in end but it was a big fight took up so much of my anxiety 24/7 glad it’s over for a few years.

• Being treated like a criminal as it went to court. I’ve not been able to go to that part of town since.

• IDS decided to put tribunals in courts there was never any reason for them to be there…

• I am currently in work so relatively ‘safe’ but do worry about the what if’s. I’ve lost three good jobs because of my mental health which was really traumatic each time but applying for benefits was relatively straightforward and the money came through within a couple of weeks. With recent welfare ‘reform’ I feel I’ve lost my safety net.

• That’s part of why they are doing this. They don’t want people to have a safety net. That way we are more compliant workers willing to put up with worse and worse conditions. And those who can afford it will get private insurance. I am in work too and I worry about what will happen should I lose it – whether because of my health or because of losing funding for my post. Insecurity and precarity are the tactics.

• So much of this resonates with me. I even avoid seeing and talking to friends (more than illness dictates) because I get paranoid one of them might mention me to someone else who might shop me to the DWP. I try not to have a searchable presence online, and I find myself checking around on the street before I leave the house to see if anyone’s watching. I don’t volunteer for an organisation I care about and which could really use the help, even though I’d like to try, because I think they’ll use it against me.

• I can relate to every word you’ve said. I avoid friends for the same reason and have lost some of them as a consequence – purely through this DWP fear; have done everything In my power to wipe any traces of myself offline (though have been a bit freer lately because I really want to be transparent – to be who I am illness and all – but since this thread that is now really making me anxious again) and there are certain voluntary organisations who are crying out for help round here who I know I could be useful to, and thus it would potentially benefit me too – yet I do nothing due to fear of DWP scrutiny, of demonstrating any kind of capacity which could suggest to them I could do certain things reliably when I know I absolutely couldn’t. The assessment process was so traumatic and made me more ill than my usual baseline Ill so I would never do anything that would invite being reassessed again and risk losing yet another year to the daily terror it invoked.

• This makes me so sad, human potential crushed

• Potential crushed – this. It was a huge contributory factor in my letter to the assisted suicide clinics. Continuing to live like this is intolerable. It is the complete antithesis to being supported in being able to make the best of what you can and of contributing what you can. I am trying to challenge it personally at this current time but one push from the DWP and I know I’ll be back right over the edge. Every contact from them makes life that much more precarious. For those on here subjected to repeat assessments it is nothing more than sadistic.

• Independent living of people with physical/sensory/intellectual difference meant being supported. Now it doesn’t, & I’d say even less so for mental health.

• Mad people have contributed much voluntarily which Trusts, charities & uni’s have benefited from. This vital contribution is being lost because of the fear it will go against claims. It’s never mentioned that before 2010 voluntary work as an unofficial outcome had been supported by many professionals.

• Charities etc. have lost a committed ‘as and when able to be’ workforce of often very talented, caring people.

• You have to be incapable as a claimant, and the fear & paranoia they induce makes people’s lives harder to live so you can end up becoming what they require. Then services require positivity and recovery the complete opposite of the dwp which skews all healthcare relationships.
It seems so easy to some people, to escape all of that by being employed. The welfare system doesn’t support part-time working without PIP & self-employment will assume a full time min wage before Working Tax Credits. The rise of shift/temp/unsocial/zero hrs hasn’t helped anyone’s wellbeing. Then there’s the never talked about issue of people who are unemployable. People with very long gaps in their CV who won’t even be attractive to employers for insecure work.

• I had pseudonyms for years as both an artist and musician to stay off the dwp radar, tried to think I liked it as it was a strategy per se but felt like a physical manifestation of being controlled so got rid of them. It stops me from pushing forward my art (even though it is the one true constant I have). To explain any of this to galleries curators etc just seems like I’d come across as a fraud or I’d be asking them to be complicit. Just realised the comparisons with everyone’s paranoia/fear, that this so flippin STASI

• They have taken the concept of independent living to mean self-sufficient living – which is total bullshit. Independent living means living your life and getting the support you need to live it, including financial help.

• My ability to trust any health care professional was severely comprised by my experience of mental health services especially inpatient and secure provision, but now the collusion of healthcare professionals with the DWP especially since latest ‘Work and Health’ proposals and changes to ESA as it becomes embedded into Universal Credit means I no longer feel able to consult with a GP about any health concerns physical or madness. Having said this I don’t feel this is paranoia just being sensibly cautious. I am however very worried about Scottish Government proposals for claimants for new disability benefits to be asked for informed consent for DWP to have direct access to our medical records. How can it be informed consent if the choice is let us see your medical records or we will take all your money that you need to survive and you can just go away and curl up and die.

• The Scottish Government has just consulted on their Social Security Bill and are due to take over provision of disability benefits which will replace PIP DLA and AA as well as carers allowance and some of Social Fund benefits such as funeral payments. Although at the start of process there was a lot of rhetoric about treating everyone with respect and dignity and fairness as well as involving current claimants of disability benefits in drawing up proposals for new benefits, but in reality what’s gone into the Bill is making a lot of entries that things will be worse under the new Scottish Social Security Agency then they are under the DWP if that is possible for you to even imagine. Also feel the involvement of people with experience of claiming benefits has been really tokenistic and we have not really been listened to. Their whole approach seems to be driven by the need to protect the public purse rather than the rights of disabled people. Very very disappointed.

• I think that it becomes paranoia for some of us when it infiltrates everything you do 24/7 as it did for me for over a year, it even affected what I did locked indoors 24/7. My claim was genuine and still is but no matter how much my doctor reminded me I have nothing to feel guilty or worry about it totally took me over. I think I am now back to sensibly cautious. I have a brilliant GP who absolutely refuses to let the DWP compromise how he supports his patients but know when he retires and the next generation of doctors are less likely to question colluding with the DWP that it will be like being thrown to the lions. It is awful how all this is affecting our trust in consulting about our health and could result in dangerous consequences for many of us. I am in England and I had to agree to full access to my medical records for my PIP claim which I absolutely hated doing and added to how traumatic it was. There is so much sensitive stuff in my notes and I can’t bear even genuine doctors having access to it. My GP tried to reassure me saying they can’t even be bothered to read the medical evidence we submit and don’t have the time or resources to ask for access to more records. Nonetheless it feels like a gross invasion of privacy and just as you say it is not informed consent at all, it’s the worst kind of ultimatum: you lose everything you need to survive if you refuse consent.

• Does anyone else feel this constant guilt for being on benefits? However much I understand where the guilt comes from (outside ideology) it never goes away.

• Yes constant

• Yes all the time and deep shame, like I no longer qualify as human in others eyes.

• If you can volunteer you’re ‘fit for work’ and can be stripped of all disability benefits, social care support and on a JSA path to destruction.

• That’s the worst position – the JSA and temp poor conditioned work see-saw

• Trusts, charities and mental health projects need to be careful with suggesting voluntary work as a key part of recovery when people have lost ESA because of it, ditto ad hoc paid work unless under Permitted Work AND viewed as supporting ‘recovery’ AND be prepared to write supporting letters to that effect. Failure to do so can mean rapid suspension whilst investigated. Permitted Work and whether this goes for or against a Work Capability Assessment is unclear.

• I understand why some people do peer, recovery college type jobs whilst privately hating the line they have to toe, because where they exist that’s better than precarious manual work, the only problem is if the shit hits the fan personally they’re in no better a position than people fast food and retail where you’re out and back into the worst end of the DWP mincer.

• I used to have security, the system was so much fairer and easier to negotiate and with support. Now, it feels like they have a list and when your time is up they will get you and they will crush you to death whilst hoping you will jump before you’re pushed.

Useful resources:
http://www.fightback4justice.co.uk
http://www.shop.cpag.org.uk/big-book-of-benefits-and-mental…
http://www.benefitsandwork.co.uk
http://wcainfo.net
http://pipinfo.net
https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/pip/
https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/employment-and-support-allowance/

http://www.walkthetalk2015.org/sites/default/files/Introduction%20-%20Maddog.pdf
http://www.walkthetalk2015.org/news/video-uk-benefit-sanctions-black-triangle
http://www.walkthetalk2015.org/news/open-letter-about-benefits-system

*RITB is aware that Universal Basic Income instead of progressive taxation can be viewed as a ‘solution’ to the punitive welfare system of the last 7 yrs, we firmly promote caution, please see our blogs on this issue:

https://recoveryinthebin.org/2017/09/04/ubi-the-good-the-bad-and-the-ugly/
https://recoveryinthebin.org/2017/06/25/the-neoliberal-writing-on-the-wall-ontarios-basic-income-experiment/