I had to stagger in to work today, feeling like hell and dosed up on Lemsip. If you’re self employed, as I am, you’ll be aware of the pressure to choose between staying in bed and paying some bills, and today I just had to get on with it.

That said, I was also able to come home two hours later and sleep, then continue to do a little bit of work from the comfort of my sofa. That’s a blessing. For the previous two days I’ve done nothing at all even though there’s a never ending ‘must do’ list. There always is. A few days away from it won’t kill anyone.

One of the questions I ask most of my clients is, “What’s the worst that will happen if you don’t go in to work?” Their response is usually to smile, look sheepish and say something along the lines of “Nothing much.” The pressure to keep attending work is astonishing. Just having your body in the office seems to be the single most important aspect of employment, rather than any work you might do. One of my clients* left his employer after a review where he was told his work was, ‘Exceptional, we can’t fault it,’ but he mustn’t listen to the radio on headphones. Why? Because his employers need for control was poisonous.

For this client, after finally realising that he was being bullied every day handing in his notice a couple of days later was the right thing to do. He had the backing of his family and enough savings to see him through 6 weeks of job seeking. For him, it was worth visiting his GP to get signed off, taking a week or so to rest and recover from an absurd work environment, and then get on with finding a new job.

The ideal way of dealing with a job you hate is to find a new one while letting your current employer pay your wage. What makes that difficult for many people is that they won’t admit that their employer is toxic. We tend to bitch and moan about work without doing anything about it, whether that’s looking for new employment or talking to a Union, and wait until something so preposterous happens that things begin to spiral out of control. I’ve had a number of clients who’ve denied anything was wrong until they’ve been assaulted at work. Denial is not just a river in Africa.





*Identifying details have been changed.

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. 

If you google 'Carnival' endless pictures of women catching a cold turn up. You won't see pictures like this one on the news, but for me this is one of the most fascinating parts of Carnival - Jouvert (a contraction of jour ouvert or 'daybreak') sees a small number of people walking Carnival route the wrong way round at dawn, throwing flour and paint at each other and along the route. I find this magical and inspiring, a real demonstration of the subversive and chaotic, a kind of secret ritual that allows and boundaries the following two days. 

Carnival is The World Turned Upside down, a time when some people pretend to be what they're not, things that are illegal at other times are now permitted, and feasting and revelry are indulged. Carnival is not, despite what it may seem, an advert for Top Shop or an opportunity for a politician to make a terrible arse of himself, it's a reminder that racism still exists and that magic remains possible. In the UK it's a farewell to Summer and a blowout before Autumn. Go out and have a ball.

A good part of my working week is spent in other people’s offices where I've noticed that there are little signs telling people how to use a microwave, what the fridge policy (a fridge policy!) is, reminders not to steal and that in the event of a fire they must leave the building to avoid being burned to death. In one office there were 14 full colour, laminated notices telling people to come to work on time, not to pour boiling water on toddlers, to avoid spreading infectious diseases, the sink policy – yes, really - that time in the kitchen was being monitored, and that staff attendance was under review.

This in an organisation that "doesn't have the money" for a box of tissues.

I'm a big fan of Health and Safety legislation, it really is necessary to tell people that hot water is hot, but Health and Safety is not the issue in an organisation that feels it necessary to watch how long individuals are spending in a kitchen.

The private sector doesn’t seem to have the same issues. People there somehow know how to use a fridge without needing a policy. It's not that people who work in the private sector are any brighter than people who serve the public, far from it. It’s more that initiative is more likely to be nurtured rather than treated with suspicion and organisational vision tends to be wider than what’s happening in a microwave.

Work in the public and voluntary sectors is too often reduced to a Kafkaesque model of not-work where flair and imagination are perceived as suspect and personally threatening. In the private sector innovation, ideas and positive critique are more likely to be welcomed.

I've worked in places where little children bellow and cry too much while stressed workers scream nursery rhymes at them. The staff have obviously gone through training and got appropriate qualifications. The staff ratios are legal and the toilet-cleaning rota is managed very well, everything is fine on paper and that's all that matters. Sickness rates and staff turnover are costing an arm and a leg but the funders are content with the reports sent to them. Funders tell organisations what they expect to hear and then organisations repeat it back to them including, incredibly, sending them ‘case studies’ instead of saying, “No, we will not send you a case study because that would be entirely inappropriate.” Instead, organisations make case studies up.

It's true that many people are put into positions of responsibility that they are not worthy of and they can have a profound effect on the people working under them. It's an irony that those people who don't feel anxious about being competent at their job, who believe they're indispensable to the organisation, are more likely to be so comfortable at work that they feel no need for personal development. Similar problems arise when a leader isn't confident enough to lead but just keeps doing what they're told rather than saying, "Why do we need to be told not to scald children? What's going on here?"

Writing a fridge policy is not a good use of anyone's time. Any organisation that needs a fridge policy has far, far greater problems than manky yoghurt.

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.

Listening to the news has become unusually grueling. I woke to a report about the explosion in child abuse pornography which was part of the behaviour of April Jones’ killer.

Tonight’s news led with the Oxford exploitation case (perhaps more accurately called Child Sexual Slavery) then went on to Tia Sharpe’s murder.

Are child abuse, rape and sexual violence on the increase or being taken more seriously? There are no clear stats to help us here but we know that they have always existed. What we can be very clear about is that this is nothing to do with sex. Child abuse, rape and sexual violence are linearly linked to power and control.

Power and control are most often discussed in relation to domestic violence but it’s clear that abuse of power and control are at play in all cases where adults harm children or men who have machetes and guns harm people who don’t.

The response to all of this distressing news is beginning to emerge in therapy. People are reliving experiences of childhood abuse and suffering distress. John Snow speaks poignantly about his experience of abuse.

Importantly, he explains why people who were abused years ago didn’t come forward at the time. They wouldn’t be believed. They would be punished. They would be shamed - deeply, profoundly shamed. Their abuser will have told them that their parents or carers would die or disown them. If they were taken seriously they’d be subjected to humiliating interviews with police, doctors and social workers, and disgusting cross-examinations in court. We can see this at play in the endless comments on news pages wondering why survivors didn’t make a fuss when it happened and accusing them of being in it for compensation.

It doesn’t help when a barrister proposes that the best way to reduce levels of child abuse is to lower the age of consent.

There are a number of specialist organizations that work with adults who were abused in childhood and I would respectfully suggest that they might be your first stop if you need professional support. Any good counsellor will be able to take the journey with you through your experience but with a specialist agency you’ll be guaranteed a counsellor who is specifically trained for this and who is supervised and supported by people who are also trained and experienced in the subject. 

NAPAC

NSPCC

Rape Crisis

SupportLine

Victim Support

The Mid-Staff Enquiry will create a great deal of media noise but I’m not sure it will make much of a difference on wards where health care workers feel justified in taping a dummy to a sick infants face. That speaks to me of becoming utterly shut down and divorced from reality.

I trained as a nurse back in the 80’s and frankly didn’t like my job very much until I got off the wards. Part of my discomfort was that there was always too much work to be done by too few nurses. Part of my despair was seeing patients treated as ‘The Chest by the window” “The Abdomen in bed 10.” But we were never allowed to speak about patients with contempt and leaving anyone lying in their own waste was genuinely unthinkable, a personal failure that would be punished. This was during the first rabid set of cutbacks, when one qualified nurse and two students routinely looked after 30 patients.

An elderly care ward I worked on as a student was run by a self-satisfied nurse who cared not a jot for the people under her care. The routine for meals was to place as many patients as possible on a commode and put their food in front of them to save time. We quickly got used to doing this, especially since she was a bully and doctors and other professionals who attended the ward made no comment on it. This was a culture of box ticking so that the smug nurse, who could barely drag herself round the ward, could pay for her holidays. And even so, we fed patients who couldn’t feed themselves.

Is it surprising that “Bullying is endemic in the NHS”?

Nurses now no longer curtsy and avert their eyes when a surgeon graces the ward but health care remains a rigid hierarchy, and as in any hierarchy the most vulnerable are at the bottom of the heap: in the NHS that’s patients. It used to be that a sense of vocation and a national culture of pride in and respect for nurses gave nurses satisfaction and self-respect which didn't make up for the lack of a decent wage but went some way towards making it more bearable. I remember hating the ‘Angels’ label, I wanted higher wages and reasonable working practices, but in the endless grasping for 'professionalism' we got the worst of all worlds: unrepresentative wages, a loss of status and clearly a loss of purpose.

What kind of dehumanizing process does someone have to go through to leave people to starve to actual death, to lie unwashed for a month, to withhold pain relief? Were they born a casual torturer? Do casual torturers make their way to hospitals to get their kicks? Or is it that culture can be so strong as to actively create and reward people who behave like this and scapegoat those who whistleblow? The answer from today’s Francis Report, and from the experience of anyone who’s ever studied any group is a resounding Yes.

Mid Staffs is by no means alone in allowing grotesque failures of care and I suspect yet more revelations about abuse in hospitals will quickly come to light. Where people are vulnerable other people become abusive. That's been the case throughout history and we just need to say that out loud and deal with it. One of the ways of dealing with it is looking at the causes and cultures of good practice wherever it occurs - in a ward, an office, a children's home, a business, a charity. Why do some wards retain their staff, have great results and no complaints? Why do elderly people in some homes live longer and experience less illness? Even more valuable would be to take notice of the huge numbers of such studies which already exist and actually implement their recommendations.

We all are part of the culture around us which at present is frankly pretty crap. We all value and devalue certain kinds of people so that we can feel better about ourselves. When we become too comfortable with that we risk becoming shut down, divorced from reality, capable of doing shameful things.

I was listening to a radio talk show this morning that discussed the man who yesterday stabbed his two small children to death and then killed himself. The question was ‘Why do some men do this and why is there an increase in this kind of behaviour?” People called in to say that the man was obviously suffering from a mental illness, or that it was obvious that men love their children so much that they ‘black out and do something they regret,’ or that, because men are now much more involved in the care of their children, when access to those children is under threat they 'panic and act out of character.'

The next hour was spent talking about April Jones, the little girl who’s been abducted, and how to protect children.

I was struck by the lack of complexity, almost the lack of irony involved in both these discussions: When a child is abducted we all scream for the perpetrator to be lynched. When a father stabs his two children to death – imagine that for a moment, imagine the fathers actions –we call that “A tragedy.”

We know that ‘stranger danger’ is a myth, that most abuse occurs within the home and is perpetrated by people the child knows, very often the child’s own parents, another family member or friends of the family. Ben aged 7 and Freya aged 6 were killed by their father, and yet when this happens it’s is never called child abuse. The media seldom call by its technical name, which is Family Annihilation, a phenomenon that’s rapidly on the increase.

If you Google ‘Father kills children then himself” you will find page upon page of reports of family annihilation which are always linked to domestic violence.

At this point, many people will rush to say that women kill their kids too. This is true but the father kills 95% of children murdered by a parent. The reasons for killing are very different too: most mothers who kill do so because they’re afraid of what the father will do to the children or are genuinely psychotic. Fathers kill as the ultimate punishment to any mother when the mother makes a break from her abusive husband. (This is, by the way, one good reason why women don’t leave abusive relationships – if they and the kids are going to be killed, it’s most likely to happen when they leave.)

We treat women who kill children as “abominable, despicable, vile and horrible” as one judge called a woman who killed her children rather than hand them over to their convicted paedophile father. When a father kills we search hard for reasons to excuse him.

The massive majority of fathers who are separated from their children by relationship breakdown do not go on to kill their children or themselves. They’re also sad, angry, upset, miss their children and the family home, are shocked, anxious, depressed and sometimes even panicky about suddenly being alone in the world. But they don’t kill their kids. This is overwhelmingly an issue of angry men who treat people as things they own. They’re allowed to do that because as a society we make excuses for them.

Domestic violence isn’t a woman’s issue; it’s an issue that affects everyone who cares about children’s wellbeing. If all of those people now feeling very sad that two young children have been stabbed to death by their ‘tragic dad’ cared as much about domestic violence, perhaps Ben and Freya might still be alive.

So the Able Bodied Olympics are over and weren’t they great? Medals and lots of them, a general lack of rain and a lot of goodwill have given us two weeks holiday from economic misery. But I think there’s something more to it than that.

G4S, who were going to staff the Olympics, couldn’t fulfill their contract. This is the privately owned company that dumped unpaid staff under a bridge overnight in the rain the day before the Jubilee celebrations. The company soaked up unemployed people to work for no pay for an extended period of time with the intent of putting a majority of them back on the dole after the Olympics. So the Army took over the majority of Olympic security at short notice. On the night this was announced the news showed an aerial view of the stadium with soldiers walking around it and I was struck by a simple movement that one of the soldiers made: as he was approached by a civilian the soldier moved towards him and leaned forward in a gesture of confident, competent service.

The picture at the head of this post by David Hoffman is of a G4S Olympic security guard acting in an 'illegal and oppressive' manner. We’ve all been on the end of petty people in uniform, people who are evidently bored with their job and would like you to know that you will pay for their tedium because they’re wearing a uniform and you’re not. You give them what they consider A Funny Look and you’ll spend a lot more time getting where you need to be or doing what you need to do. They can be a monstrous pain and downright dangerous. 

They’re also paid a pittance by the private companies that employ them and treated with contempt by their bosses. If I was dumped under a bridge in the middle of the night in the rain, without a toilet or breakfast, with no pay and the knowledge that if I told my boss to go boil his head I would be sanctioned by the DWP which would leave me literally penniless for some weeks, then I would be incredibly happy to give someone – anyone – a hard time if they gave me the slightest opportunity. That said, many are 'overly enthusiastic' about their jobs as a matter of personality.

Happily, the army doesn’t go down that route anywhere near as often as private security groups. People volunteer to join the army, a respected career, and that’s a huge difference to start with, but perhaps the biggest difference is that the army indoctrinates soldiers into the concept of service. These men and women are trained to kill and to balance that incredible force they’re taught to approach their job through a filter of being of benefit to people, of serving a population rather than seeing people as the thing that gets in their way. I’m not a person that joins in with the sentimental noise about Our Boys – particularly since so many Boys are women – but the fact that the army went about bag searches and general safety measures with dignity rather than cockiness, pleasantness rather than tedium and confidence rather than a jobsworth attitude seems to have made a lot of people feel very safe and very happy, rather than abused and infuriated.

Then there were the Olympic volunteers, whose attitude seemed to be one of pleasure, competence, effectiveness and cooperation. They didn’t wear a pseudo-military uniform complete with little black hat, but something that clearly identified them so that people could ask for help. They weren’t schooled in impersonal standoffishness, but allowed to be themselves.

I was frankly astonished at how many ordinary people, from all kinds of backgrounds, all ages, all ethnicities, volunteered to show people where the toilets were, and did it with grace and humour.

They are called ‘Gamesmakers because they are helping make the Games happen. We want Games Makers to be inspirational, open, respectful, team-focused, distinctive and have a 'can do' attitude.”

It worked.

There is a part of every one of us that would like to put on a uniform and boss people about, perhaps even to abuse them. Fewer of us would accept the cost of being sent to a desert to be shot at but that is part of the price of legitimising power. Most of us are born with the awareness that altruism makes everyone’s life better, including our own, but we are steadily taught that ‘Being nice gets you nowhere.’ Perhaps that depends on where we want to go.