Back in July ’14 I wrote about compulsory therapy for people with mental illness on benefits. This policy idea was not based on any research – which demonstrates that making people go to counselling is counterproductive – it was a kite-flying exercise to test public opinion: just how much cruelty are we prepared to accept?

Something similar was floated last month this time seeing if the public will accept enforced major surgery. Just like the compulsory therapy business forcing obese people to have surgery perversely ignores all the research:

“ . . . any mandated program should have a strong evidence base for success.       Unfortunately, diet and lifestyle interventions have restricted, often transient, benefits due to biological adaptations, that act to sustain high bodyweight. It is therefore important to ask whether requiring people to participate in weight-loss programmes, despite a high likelihood of failure, is acceptable from the point of view of an individual, provider, or society. Although there is some success with pharmacological treatments for obesity, the only treatment for obesity that has been proven to be successful for substantial long-term weight loss and improved quality of life in a high proportion of people is bariatric surgery."

"It is not fair to ask hardworking taxpayers to fund the benefits of people who refuse to accept the support and treatment that could help them get back to a life of work." This is the standard announcement to persuade people who pay tax (and many who don't earn enough to pay tax) to agree with policies that provably worsen medical problems. 

We all know people who pay tax and don’t work hard. Sometimes it’s us. Whenever I hear “Hard Working Tax Payer” I hear the Shadow echo, “Idiot” because that’s how this term is in fact being used.

At the end of Downfall, a dramatisation of the last days of Hitler’s life, a boy is shown returning home to find his mother lynched by the Greifkommando. This paramilitary group murdered ‘cowards and traitors’ – old men, children, women – to create a climate of terrified compliance. In the film a civilian in a typically Bavarian hat is part of the Greifkommando: he’s not a soldier, he won’t be court martialed or shot if he doesn’t murder people, he’s just along for the pleasure of instilling terror and, if he gets the chance, killing people weaker than himself. He uses his righteous love of country as justification.

Some of us succumb easier than others to this psychopathy. We can’t deal with complexity. Immigrants are bad: it used to be that immigrant simply meant non-white but now we’ve broadened the term to include people from Eastern Europe. People on benefits have always been sneered at but now the disabled are also Scroungers. We can’t cope with the fact that the highest proportion of benefits - 47% - go to pensioners so we ignore that. We’re comfortable with Them and Us where They are something to be despised and therefore so much easier to devastate. 

This is simply human nature. Germans didn't suddenly go bonkers in 1938, any more than Rwandans, American settlers (AKA the British) Cambodians, former Yugoslavians, Turks or any other group of people who lost their sense of humanity. Part of all of us, myself included, loves to hate. Our job is to resist that, to retain our empathy and intellect. Because apart from anything else it might be you who is cut from the herd next.

Once again, our attitudes are being assessed to see just how far down that road Hard Working Tax Payers have gone. Are you happy to force someone to have major surgery?

Are you?

Part of my training as a nurse was to spend time on a mental health ward so in 1983 I was sent to what was genuinely a bin. One of the women there had arrived as a child when the building had been a Work House. There was an elderly man with Alzheimer's, a 16-year-old young woman with alcohol problems, several young people with learning difficulties and about 20 other people with diagnoses that I knew nothing about.

Young doctors practiced electro-convulsive ‘therapy’ on the elderly woman. Every couple of days the elderly man was dragged naked and shouting through the ward and made to stand in a bowl by his bed where water was poured endlessly over him as he became increasingly distraught. The 16 year old young woman was sedated every time she challenged the staff on the basis of what she was actually feeling, which was often. In retrospect she was being punished because the staff felt threatened by her obviously splendid intellect. One of the young women with a learning difficulty was offered voluntary work at London Zoo but the staff laughed at her, saying that the idea was as stupid as she was and they prevented her going. All the women were sexually assaulted by some staff and some patients.

Aged 18 and stuffed with the high moral ideals of my nursing school I imagined that this was an urgent problem. It was only because I was a gobby teenager who didn’t know better that anything got done: none of the managers and just one of the (very senior) teaching staff took me seriously. The school of nursing protected me and two members of staff were sacrificed. Nothing changed. I kept banging on about it until one of my teachers said, “What do you want? Blood?” I was flabbergasted that the alternative to dealing with grotesque abuse was perceived to be killing someone and at that point began to learn to shut up.

News that staff knew about Jimmy Savile’s abuse of patients shouldn’t come as a surprise. We know that people - often very senior, generously paid people - find it easier to punish less senior people than to take whistle-blowers seriously. We know that whistle-blowers are treated with absolute contempt and ill treatment, not just by managers but also sometimes by relatives of abusers.

DBS checks are a waste of time and a horrific waste of money. What actually protects vulnerable people is a culture, not of suspicion but of openness and transparency where every person from the most senior manager to the youngest student are expected to speak out about what they see. That culture is supported by a policy that has to be followed if someone alleges abuse: it's a statement on the poverty of where we are now, that a policy has to drive people towards transparency. 

I wasn’t the only student nurse on that ward but when I spoke to my peers about what we were seeing I was told that we were only there for 6 weeks, that it wasn’t that bad, that the staff knew what they were doing, that they didn’t want to risk a good review, that they were frightened. Just a kind of non-specific, generalised fear. As if the sky might fall on their head.

Every sphere of employment is full of bullies. Often, those bullies are out of their depth and anxious because they’ve been promoted on the basis of ticking some boxes in a selection process rather than because they are actually suited to their role. How many of us would admit that, turn down the big wage and move somewhere where we might be happier? But that’s their business. What is our business – your business too – is to ensure that we safeguard people who are weaker than we are. It’s not just in healthcare; it’s in offices where you have the power to make someone’s life worse.

Don’t.

The energy that you will have to use to protect yourself from knowing that you have made someone live without heating, without a home, without dignity will exhaust you. The people around you need to tell you that you’re doing the right thing because they’re doing it too. If this kind of behaviour makes you feel uncomfortable, take note. Leave if you can’t change the culture. If it makes you feel powerful, if you’re just following orders, you really do need support to stop. 

Psychiatry has often been used as a tool of state control. People who have been inconvenient or low status or cost too much to care for have been brutalised for centuries, so last weeks 'kite flying' announcement that people who are unemployed and mentally ill may be forced to attend some kind of therapy or have their benefits stopped has precedent.

Throwing an idea out without a formed policy behind it is called 'kite flying' because the people proposing it want to see how such an idea might fly. Will we rejoice that unemployed people are being further required to perform more hoop jumping or will we boggle at what a ludicrous bit of nonsense this is?

Ethically, it's a non-starter. When we begin compelling adults to have medical procedures we enter the world of ethical committees and High Courts: particularly because psychiatry has been used to abuse people compulsion in it is treated with enormous caution. This is not to say that it doesn't occur but when it's used it's almost always in a situation that is considered life threatening. People who are not sectioned but who are so depressed or anxious that they cannot work are not a threat to themselves or others.

We have evidence of what happens when we put a government agency - ATOS - between a patient and their GP. The suicide rate increases and the financial cost of appeals outweighs any savings made. The emotional cost to patients and their families is often catastrophic. There's no reason to believe this new scheme will be any different.

Therapeutically, counsellors know that a person who has been sent to therapy by a spouse, employer or parent is unlikely to do well. Therapy should never be a punishment or way of controlling someone, it has to be freely chosen. Yes, offenders are often compelled to attend therapy and what happens is that a majority learn the language of contrition rather than positively learning much about their motivations and their effect on victims.

So we know that compelled therapy is ineffective. We can also add that if this dreadful idea was ever to be implemented it would be limited to six or so sessions, which is barely enough for someone who is mildly unhappy let alone someone with a mental health diagnosis. The waiting list - already enormous for NHS and most agency therapy - would make it unmanageable and we can guess that, just as with CBT, many of the people trained for this project would not actually be therapists at all, but technicians on a budget and under pressure.

So what might the purpose of this dreadful scheme be? Would people compelled to have therapy be removed from the official numbers of the unemployed? This is what happens to people who are compelled to join other unemployment schemes so that the numbers of unemployed and particularly long term unemployed fall, on paper. If ministers wanted to help people with mental illness back to work they need to give appropriate funding to existing mental health services and reopen the services that closed because of reduced funding.

But we live in a period of time when it's not quite acceptable to throw stones at the mentally ill, yet we are encouraged to pour scorn on them if they are also unemployed. If the public mood likes the idea of punishing people who are so profoundly unwell that they have resigned themselves to living on around £100 a week then this will no doubt happen. At the very best, it will offer therapy to people who have not been able to access it. At worst it will offer dreadful non-therapy from ill-trained, ill-motivated non-therapists.

This idea slunk off in shame in 2009: there's no good reason why, 5 years later, it shouldn't slink off to die.

A few evenings ago I was with a group of business managers who wanted to talk about how domestic violence affects their work. I spoke with any number of individuals and every single one of them said something along the lines of “It’s such a shame that you have to frame the subject around profits and losses. Shareholders don’t care about human suffering, and the moral aspect of people you know being assaulted has become redundant. In this room it’s only you and I who think about anything beyond money.”

People said they felt isolated, paralysed, disgusted with their employers and themselves. I was able to say, “You’re not as alone as you think. I’ve had this conversation with lots of other people in your situation,” and was pleased to see their surprise, but then a veil of caution came down and the conversation took a turn towards inaction.

Being responsible for other people’s wellbeing is a big deal. Many professionals enjoy the human contact and problem solving that HR and line management can bring, particularly when good polices and attitudes exist to support and contain that helping instinct. But austerity has brought with it cynicism, hopelessness, fear and a disturbing insularity. Increasingly we – particularly people in their late teens and twenties - are looking for someone to blame, whether that’s recent immigrants, asylum seekers or people who are unemployed, basically anyone that we perceive is costing us money.  Even if it’s not our money at all.

A person who is assaulted by a stranger gets a huge amount of support compared to someone who has to take time off work because their partner has attacked them. We blame them for staying. We blame them for putting up with it. We blame them for leaving and depriving the kids of their father. We blame them for making us take up the slack when they can’t work. We blame them for not coming out with us after work. We blame them for being hospitalised. We ask how they contributed to their own death.

Feeling powerless and hopeless at work is debilitating: sometimes you can do something about it and sometimes that’s only going to cause you grief. But if you feel strongly about something ethical at your workplace the likelihood is that you’re not alone, and if you feel it’s dubious to seek connection with peers who might feel the same there is likely to be an organisation that will support you.

Here’s CAADV, the Corporate Alliance Against Domestic Violence, with membership that includes BP, KPMG, the Corporation of London and Diageo amongst many others. They recognise the monetary loss to business of domestic violence. What really motivates them is the human cost.

Happy St George's Day, a day to appreciate the many, many benefits we have as people living in a first-world economy. 

The World Service broadcast a particularly interesting piece last night, on how France Must Change. High unemployment, a State-bound economy in the doldrums, strikes, laughable working hours, and now – get this! – legislation that prevents employees from responding to work emails after 6pm! What an outlandish and economically naive country.

Strange then, that France is ahead of our own Hard Working, endlessly striving, entrepreneurial economy, second only to Germany in Europe and fifth in the world. In a survey out today comes the news that “Britain has the lowest quality of life of 9 major European countries." 

France has the highest quality of life.

The weather has something to do with it as does our naturally cynical nature – we expect to be treated badly and so it comes as no surprise when we’re treated badly – but here’s a chilling analysis:

“We may still be enjoying the fourth highest household income in Europe, but the high cost of living means we are living to work.”

Person Centred counselling has a useful principle called the Locus of Evaluation. It proposes that when we’re allowed to remain in touch with how we genuinely feel we can make good choices; good for ourselves and good for the people around us. This is called The Internal Locus of Evaluation. The External Locus of Evaluation develops when we’re told how we must feel and criticised for feeling differently from the people around us. We have to ignore our genuine feelings to continue to be valued. People who function from an External Locus of Evaluation continue to look to people in authority to decide how they must feel and often feel absolutely dreadful, even if they determinedly continue to believe they are content with the way things are. You can read up on the theory here.

On Sunday the Mail felt it would be profitable to send an undercover reporter to a food bank and, despite noting that the reporter was asked lots of questions about his circumstances, recount that he walked away with £40 worth of groceries, unquestioned. In the past that would simply have added to the sneering disgust of the nation but this time it resulted in £35,000 in donations to the Trussell Trust.

Times and nations are not going to change much. Against all the evidence, as a country we’re going to continue believing that the French are lazy and on the verge of economic collapse whilst we lead the world in toughness and fiscal wisdom. But, as the Daily Mail incident demonstrates, individuals are now more than ever capable of effecting change. I’d propose that the conditions that bring individuals to the point of collapse are those that we are experiencing now. We’re being told one thing – that food banks are stupidly supporting evil people to lie around laughing at the Hard Working Tax Payer – when we know something very different – that food banks are a symptom of an unequal society, that the more unequal the society the more miserable society becomes and that we have the lowest productivity in the whole of the G7. Social media is a tool that individuals use to subvert propaganda, but attending to the messages that we constantly berate ourselves with is another, more difficult matter.

It can be profoundly sad and even disturbing to understand that many of the beliefs we hold dear are nothing but empty words, to realise that the way we've lived to this point has been largely meaningless and for someone else's benefit. It takes time to understand how it happens at all, but if you find yourself wondering about this kind of thing then you're ready to explore it. There's a lot to cherish in the English (and British) way of being, we'd be foolish to reject all of it, and there's a lot that needs to be examined too.





*Written by Cecil Rhodes, who left England at the age of 9.

Therapy has been criticised for encouraging solipsism. We focus on the needs of the individual in front of us often to a greater degree than anyone ever before, including parents. Counsellors know that if we create a place of boundaried safety, understanding and respect the client is likely to flourish.

Paradoxically, when a person is given total positive individual attention for 50 minutes a week as well as becoming more understanding of themselves they become better able to understand wider relationships. In some sense, a person in therapy needs to become child-like; to have their feelings valued so that they can value those feelings themselves; next to examine their situation with curiosity and respect; then to formulate some kind of plan for the future; and then go out and live it.

In many ways, therapy is a kind of parenting, allowing the client to move from distress, confusion and retreat from the world to understanding and renewed relationship with the world. Relationship is the be all and end all of therapy and ultimately of life.

Once or twice a week I spend a couple of hours listening to a local talk radio station to get a flavour of what people are thinking. Today’s debate was about the proposed tax break for parents, £2000 for every child under 12 where both parents work. Any number of childless people phoned in to ask why they should fund parents, their reasoning being, “If you can’t afford kids you shouldn’t have them.” Never mind that the rebate includes households with a joint income of up to £300,000. When asked who they expected to care for them when they were elderly, to maintain every part of society from midwives and schools to hospices and graveyards, they didn’t see the connection. They were only interested in their own income and didn’t want to support anyone other than themselves.

Last century, Communism was condemned for offering childcare. A mothers place was in the home taking care of her husband and children and often elderly relatives who had previously helped with housework, cooking and caring for children. Now, children live far from elderly parents who are maintained by strangers, childcare has taken the place of parenting and both parents are expected to work. It takes a lot of thought and strength to organise a family so that children spend more than 24 waking hours a week with their parents, a decision that almost always incurs a drop in status and a greater amount of personal satisfaction and contentment within the family.

Therapy gives a person the space and time to move from the infant position of memememe (where we all go when we’re distressed, confused and threatened) to the more adult viewpoint of how others affect us, how we affect others and the most healthy ways of engaging with that reality. We can pretend that other people don’t matter only as long as we accept that other people shouldn’t give a damn about us.

The majority of my clients come to me with very similar stories: “I have too much work, my boss is either very nice but doesn’t support me or is unpleasant and doesn’t support me. I’m working way over my contracted hours and achieving very little of actual value, but as long as all the boxes are ticked that’s all that matters. I like my work but the kind of stuff I’m expected to do now has really worn me down. I don’t see my family. Secretly, my children have become a burden, they get in the way of my work.”

In some cases coaching helps the client to break down what looks like an enormous pile of never ending demands into smaller, more manageable tasks and attention to relationships, and whilst this can be very valuable it is not the whole answer.

Whether we like it or not the UK is now in the grip of a fantasy approach to life where a lack of hard work is the only thing keeping you from success and the unemployed are all workshy scroungers. I read an article in Forbes yesterday that partly drove me to write this blog entry: “Mentally Strong People: The 13 Things They Avoid.” What really chilled me were the comments, 65 pages of “Thank you so much, this really made my day, this is so amazing and I can see where I need to do more work on myself.”

So many clients are being told that they have ‘the wrong attitude’. Almost always what this means is “You’re not doing what you’re told to do fast enough and you ask too many questions.”

Our concept of success makes us all feel like failures. It may be that a person has to be single-minded to increase their income but the actual facts show us, again and again, that being male, remaining in full time employment and the income of the family you're born into are better determinants of not living in poverty than either hard work or ‘attitude’.

While some of the points in the first article are valid and good advice, for a moment let's turn the rhetoric on its head. Emotionally Damaged People: 5 ways to understand them.

1. Emotionally Damaged People don’t seek insight. They have learned that their feelings – and the feelings of others – are unimportant and they're disinterested in concepts of fairness or integrity. They have been trained to ignore their feelings and to treat harsh life lessons as something to be grateful for, as a matter of personal survival in an incredibly brutal environment. When a situation turns out badly they cannot bear to examine why, or who may have been affected.

2. Emotionally Damaged People don’t care about people who are less powerful than them. They couldn’t care less about criticism or advice from people they perceive to be beneath them. If the criticism comes from people they believe to be more important than them they are trained to be grateful, even if that criticism is persecutory. They can only function in a hierarchy. And they strive to be as high up as possible in that hierarchy, whatever the cost to their family or to themselves.

3. Emotionally Damaged People ignore the costs that instability have on them and on others. Emotionally Damaged people are not interested in how bereavement, low pay, illness, children, elderly parents or anything else affects anyone. They perceive themselves and especially other people as things.

4. Emotionally Damaged People are not interested in the causes of problems or how to alter anything for the better, other than the manner in which their betters perceive them.

5. Emotionally Damaged people are desperately lonely. They've been told from childhood that they are entirely alone in the world. They know that they will not be supported by anyone and they’re not interested in supporting anyone else. If their culture includes being seen to be supporting others via charity or mentoring they will become involved in these activities in order to be seen to be compliant. They have learned that human nature punishes failure and non-compliance, even if that’s the failure to be born in a prosperous family, and the emotionally damaged person is resigned to this situation. They have learned that it is better to stand on other people than to be trodden on.




Genuinely successful people know that relationships are what matter, not status or income. Having enough money to remain healthy, pay the bills, eat and sleep well, spend time outdoors for pleasure and relaxation and with people who contribute positively to their wellbeing is important – having more is nice but not necessary.

Here’s another piece of research: 1 in 5 British workers have taken time off due to stress.

“According to the study difficult deadlines, management pressure and a lack of support are the main reasons for workplace stress and 6% and 3% of stressed workers resort to unhealthy practices to cope, smoking and drinking alcohol respectively.”

Look at your attitude. See who you're trying to please, and why, and what you genuinely want from life.

I went to lunch with a friend this afternoon and talked about how much more sane she felt having left her work. Marian used to work for a large organisation moving terribly important bits of paper around, something that added very little to the sum of joy or convenience to the world. When she joined the organisation she had to opt out of the Working Time Directive which would limit her working week to an average of 48 hours. Predictably, she began experiencing racing thoughts, became anxious, started having panic attacks, felt paranoid (although her employers really were out to get her.) got insomnia, began drinking too much alcohol in order to regulate her mood and sleep, lost friends, got exhausted and crashed. Her ex-employer provides a GP something Marian believed to be altruistic until she realised that this GP was contracted to let HR know about staff ailments. And so Marian was unable to see an actual GP rather than a sinister informant for some weeks, and then, not surprisingly, was signed off work for 3 weeks. 

To cut a depressingly common story short, her life was made hell and so she left.

There's something punitive and smug about employers who, in the 21st century, believe their staff should work more than 48 hours a week. Is their company so disfunctional, so incompetent, that people have to work this many hours? And yet an increasing number of people are buying into this nonsense. There's been a very sharp increase in the numbers of people I'm seeing who are suffering not so much workplace stress as workplace abuse, being asked to sign away their lives and privacy to organisations that bleat loudly about how awful The State is and then behave like a Statist dictatorship.

The rhetoric around Hard Working Tax Payers has become pathetic. If hard work is the route to success then the recent immigrant with three low status jobs or the pensioner who can't afford to give up work should be living the high life. The LSE agrees.

I'm seeing people on the verge of serious mental illness because their employer treats them like a disposable machine part. This has a lot to do with status - somehow it's become high status to work like a donkey as long as money is thrown at you. Let me say this clearly: having lots of money doesn't make you better than anyone else. Time and again, it's been proven to make people behave very badly. 

I tried to find an image to illustrate this blog and searched images for "Hard Working Tax Payer." Endless snarky pictures about how the poor are milking tax payers came up. There are a growing number of people who are very content to punch down, to hate and fear people who are vulnerable, and they're useful to people and organisations who like to keep employees hard at work. But it's poison to the soul. 

If you want to be happy then behave like a human being. Spend time with your friends and family. Get some sunlight in the fresh air - if you can't spend an hour a day outdoors then your life is way out of balance. When you leave work, leave work. Get some exercise, not a three minute blast in the gym but a pleasant run or walk. Do something that you enjoy and give yourself enough time to enjoy it. And for goodness sake, do something meaningfully useful for someone who can't pay you.

It may be that you lose status if you stop commuting (in conditions that are illegal to transport cattle) to your ace job and take up something less exciting closer to home. You may have to move house if you take a lower-stress job but that's much better than making an emergency sale when you're thrown away because you can't handle the pressure. Yes, you won't be working in the same glossy environment, but you will be able to take a leisurely lunch with a friend, soak up a bit of autumn sunlight and think about how much more human you've become.