empathicepiphany


Russell Brand at the Commons Committee on drugs….or is it Dad’s Army?!

http://www.guardian.co.uk/politics/2012/apr/24/russell-brand-drug-addiction-mps

Read this article written 24/4/12 in the Guardian, it’s a hoot!! And note the irony of the sub-heading: “Actor tells MPs committee on drugs….”

The article reports on Russell Brand’s appearance at a Commons Committee, giving his advice on drugs policy. Reading it induced in me a nostalgic yearning to hear his anarchically humorous Radio show he used to host on Radio 2, before the ‘Sachsgate’ scandal put an end to that. His joke about being arrested ‘roughly’ 12 times is hilarious. But he also highlights a serious point: the police might be inclined to view drug use as a criminal offence, but it is much more useful and authentic to conceptualise drug addiction as a habit used to cope with emotional and psychological challenges or a spiritual malady. Therefore, as Russell Brand says, these people need love and compassion, not being treated ‘roughly’. Rough treatment is tantamount to mishandling vulnerable people. So this potentially highlights a shortfall within the police force in terms of education concerning the need for a compassionate approach rather than a judgemental approach in policing people’s use of drugs.



Crazy little thing called love

The problem is getting Narcissistic Personality Disorder (NPD) sufferers to admit that they have a problem, because only then can they change for the better. Coercing a change would be morally repugnant. Its no wonder that the consensus opinion is that there is very little chance of change or recovery, because if you label someone with such a stigmatising and dehumanising term, they will use that to excuse their bad behaviour and other people won’t go near them with a barge pole because they’ve stopped viewing them as human beings. Under these conditions no improvements are likely to be made. Humanism espouses that people reach their potential under conditions of acceptance rather than judgement. Same goes for these people. The improvement rate is so low because they are dehumanised, whereas in reality they need compassion and understanding in order to make longstanding improvements. The diagnostic labels need to be revised. Labelling these people pejoratively will make them a lot more likely to stay in denial and much less likely to want to improve. Recognising that they are profoundly vulnerable and complex people rather than afflicting them with the terrible stigma of a vilifying two-dimensionality might just help them to admit they have a problem-acceptance of this fact is the first step to changing and healing.

So the reports of intractability of their condition and lack of responsiveness to treatment are a misnomer, and a consequence of the defective philosophy underlying the treatment. They can change, but it needs to be within a culture of compassion and acceptance and recognition of their vulnerability, rather than judgement. A climate of empathy is required for this to become fulfilled.

In the book, ‘Schema Therapy: a Practitioner’s guide’ by Young, Klosko and Weishaar (2003, pp379-380), the authors are critical of the DSM-IV diagnostic criteria for NPD because they “focus almost exclusively on the outward, compensatory behaviours of patients and do not focus on the other modes that we believe are central to the problems of these patients. Furthermore, by focusing solely on the Self-Aggrandizer mode, DSM-IV leads many clinicians to hold an unsympathetic view of patients with NPD rather than one of empathy and concern for the deeper level of pain that most of these individuals share. Finally, we believe that the diagnostic criteria for narcissistic personality disorder….do not lead to effective treatments. The criteria describe only the patient’s coping styles and do not guide clinicians to understand the relevant underlying themes or schemas, which we are convinced must change for these patients to achieve lasting improvement.”

The authors refer to the underlying modes and schemas which are central to the pain of these people. The first mode is The Lonely Child. This mode is usually comprised of two core schemas: Emotional Deprivation and Defectiveness. They find it very difficult to give and receive genuine love, and because of this they are likely to perpetuate their Emotional Deprivation and Defectiveness Schemas throughout their lives. They ensure through their own behaviour that they remain unable to love or be loved-unless they undergo therapy or engage in some other healing relationship.

There is usually a tension between the Emotional Deprivation and Defectiveness schemas. The Emotional Deprivation schema causes them to crave love and long for intimacy, because they feel deprived of love and their long term emotional needs have not been met. But at their inner core, these people feel inadequate and defective. For this reason they can become very uncomfortable with intimacy and feel diffident about letting other people get too close to them. They feel ambivalent about intimacy: they simultaneously long for it and feel uncomfortable and ward it off when they begin to receive it. They believe the exposure of any flaw is humiliating and will ultimately lead to rejection. This self-defeating behaviour probably originates in childhood experiences of rejection, and can account for powerful feelings of shame. It can lead to depression or anxiety.

The second mode is the Self-Aggrandizer mode, which produces the symptoms which the DSM-IV puts undue focus on. The third mode is the Detached Self-soother. This is a set of coping behaviours which are engaged in, in order to distract themselves from the deeper painful emotions arising from emotional deprivation and feelings of defectiveness. It can be anything from watching television to taking drugs, anything that helps them to remain detached from their feelings.

The authors’ criticisms of the DSM-IV’s focus on the compensatory behaviours (the Self-Aggrandizer mode) are very valid. Some clinicians may indeed be inclined to hold an unsympathetic view of NPD sufferers due to the DSM-IVs focus on the compensatory behaviours. The clinicians need to have a deeply empathetic view and concern for the deeper level of pain arising from the individual’s Lonely Child mode, and only a drive to change these underlying schemas can lead to lasting improvement.

One of the diagnostic criteria for NPD from the DSM-IV is: ‘Lacks empathy: is unwilling to recognise or identify with the feelings and needs of others.’ Any clinician who takes an unsympathetic view of NPD sufferers based on this criterion is at risk of hypocrisy, since this would suggest that they are themselves exhibiting the lack of empathy which is attributed to NPD sufferers themselves. Yet as I have already stated, this is the danger of creating diagnostic criteria in the first place-it can inflict a terrible two dimensionality on the sufferers of distress, and contribute to their dehumanisation. The DSM-IV needs to change its focus away from the compensatory behaviours, and concentrate on the underlying pain, distress, vulnerability, emotional deprivation, sense of defectiveness and chronically low self-esteem. These people’s pain and sadness account for their bad behaviour. A fundamental change in focus and attitude could foster their acceptance that they need help, and help them to achieve lasting improvement.

Holding an unsympathetic view of these people is like punishing them for experiencing pain and adversity in their youth. I hasten to add that this is not the same as allowing them to avoid taking personal responsibility for their actions. If these people display a lack of empathy, it’s largely because of the deprivation of empathy they endured as children. They received little empathy themselves, so they have difficulty expressing empathy for significant others. Yet if shown a film of an unloved child, they can become very emotional, so clearly the ability to show empathy is there but their Self-Aggrandizer mode can block their willingness to empathise with others.

Any clinician who coldly accuses an NPD sufferer of having a lack of empathy, displays a lack an understanding of the childhood origin of this limitation, and therefore risks falling into a trap of hypocrisy. They need to cultivate an empathic concern for the deeper pain suffered by these people. This concern can provide the conditions necessary for the therapy that could help these people to begin to give and receive genuine love.



The ‘Roots of Empathy’ program: Creating an empathy epidemic

I believe that the education system is absolutely central to making significant increases in our human capacity for empathy, so that we can fully unleash people’s capacity to care for one another. This will help us to foster deep social changes within society. I strongly believe that people are only likely to develop a healthy capacity for empathy by receiving empathy and witnessing empathy, and this is most crucial in the early formative years of life.

In their wonderful book, ‘Born for love: why empathy is essential and endangered’ by Maia Szalavitz and Bruce D Perry, M.D., PHD., the authors describe how an initiative called the Roots of Empathy program has become part of the syllabus in American schools. This program involves a mother and her newborn baby visiting a class of children, who can then witness the interactions between mother and her son or daughter. The goal is to allow the children to develop empathy with the mother and child by witnessing and interacting with them, thereby developing an understanding of the importance of empathy in human relationships.

The Roots of Empathy program was founded by Mary Gordon. She grew up in Newfoundland, in a very loving, multigenerational household that included her three brothers and one sister, both of her grandmothers, and an uncle who was intellectually disabled. Her father and mother were both deeply committed to social justice. They would take in ‘strays’, such as unmarried women who’d gotten pregnant, or give men who had left prison a free meal in the evening. Mary Gordon herself began work in the field of early childhood as a kindergarten teacher. She was appalled by what she saw as a kindergarten teacher. Szalavitz and Perry describe her reaction: “I couldn’t believe it. Some of those little kids were so troubled already at that age, you wouldn’t imagine that they could be so sad. People used to call them ‘bad’. I thought what a name to put on a little kid. Every time they’d say ‘bad’, I’d say sad. I decided that first week that this [ i.e. calling them ‘bad’] is not the most useful thing to be doing.” She believes it is imperative to reach families earlier.

I believe that Mary Gordon’s words carry an utterly profound wisdom, which ought to underpin educational philosophy all over the world. If a child behaves badly, it is most probably because he or she is acting out a lived experience of the impact of distress or adversity. And that has implications for the child’s development of empathy, since if he or she receives or witnesses little empathy, how for the love of God or Science can we expect that child to express empathy throughout his or her life? So, its vital to remember that if children behave ‘badly’, it’s likely to be because they are sad, and I believe that can also apply to adults.

Mary Gordon’s inspiration for Roots of Empathy was based on her observations of the way people respond to babies and what she’d learned at home. In 1981, she founded the first of many school-based parenting centres that have now become an international model for work with teen parents. She used to carry a baby when she was recruiting parents to participate, because babies make you very approachable. Mary Gordon says, “When we use little babies as teachers, it’s not just the babies we’re watching. We’re watching the baby in tandem with the parent. I believe that successful people develop empathy from receiving empathy or witnessing empathy.”

Szalavitz and Perry describe how this Roots of Empathy program works in practice at the West Hill Public School in Toronto, with a class of seventeen sixth graders, who are between 11 and 12 years old. It is an inner-city public school, and the children come from all over the world; the class is made up of Native Cree children, African Canadians, a girl from Iraq, a girl from Afghanistan, a boy from the Congo, and a child each from Poland and Guyana. The authors state that many of the children will move out of the transient housing they currently occupy before the school year ends, and a significant proportion of West Hill students have spent time in homeless shelters.

The authors describe how the seventeen children of the class are focused and even fascinated by a baby named Sophia, who will be six months old the day after this class. Sophia is sitting with her mother, Mary. The children learn about Sophia’s desires and how she feels just by paying close attention to her.

The authors state that the power of the baby is clearly visible among the sixth graders. When Sophia smiles at them, even the coolest boys in the class break out in a big grin. It is natural for these children to feel a stirring of joy in a baby’s smile. The children in the class learn that the attentive care given by Mary to Sophia shapes the brain system involved in forming and maintaining relationships, and the baby’s capacity to ‘self-regulate’, to control herself and her responses to feelings, thoughts, and experiences. They learn that while Sophia is so small and young, Mary is her external stress regulator. The mother and child relationship is the first key relationship that shapes the neural systems of the stress response system to allow self-regulation. The brain regions involved in relationships are the ones that modulate the stress response and allow us to have empathy. These systems are interdependent. They develop together. This is one key to human connection.

The authors state that as a result of this interdependency, problems in the development of the stress response system can interfere with the development of the social and emotional functioning-and vice versa. The brain’s capacity to change with experience influences the way the infant perceives and responds to the world. The earliest, most fundamental experiences that shape the brain are these interactions with a baby’s primary caregiver. They serve as a ‘template’ that moulds future responses to human contact.

From the start of life, other people are absolutely essential to help us cope with stress. Our brain requires social experience to develop properly, and we influence each other’s ability to manage stress in a very real, very measurable way. If we are treated kindly, it has a beneficial effect on our health, whereas the effect of isolation or rejection can be severe.

The essence of empathy is the ability to stand in another’s shoes, to feel what it’s like there and to care about making it better if it hurts. It is similar but different to sympathy. In empathising, we see and feel the world from his or her perspective, by ‘feeling into’ their world. The empathiser’s primary feelings are more related to the other person’s situation than his or her own, whereas in sympathy, while he understands what others are going through, he doesn’t necessarily ‘feel into’ their experience right now. I believe that there are many children and adults in the world who feel that no other individual has authentically expressed and felt empathy for their personal situation. (This can be partly explained by the existential loneliness of the human condition) I also believe that it is very possible that people who suffer distress or abuse can become so dispirited with the notion that no other individual has authentically stood in their shoes and truly felt what its like to be there, and cared about making the pain better, that they, consciously or otherwise, bully others so that they too can experience and feel the pain from his or her perspective. Perhaps this is the only way he can get someone else to ‘feel into’ his world, and understand his pain. In my opinion, this is why bullies need to be confronted empathically and compassionately. A purely punitive response is likely to augment their feelings of sadness, and doesn’t seem at all fair as it is punishing a person for experiencing adversity and distress. Their behaviour of badness has most probably resulted from sadness. Therefore they need love and understanding. Easier said than done of course!

There have been some empirical evaluations of the effects of the Roots of Empathy program. There have been nine independent evaluations, including two randomized controlled trials. These found significant reductions in bullying and aggression and increases in ‘pro-social’ behaviour, including more sharing, helping, and inclusion of children who were formerly bullied or shunned. One study also found increased ability in a reading comprehension. The overall effects were long-lasting too. They were still measurable three years later. Over 2800 schools around the world now use the program, mostly in Canada, but also in New Zealand, the United Kingdom, and Seattle,Washington. More than 56000 children were involved in Canada in the 2008-09 school year alone. Gordon has been asked to bring Roots of Empathy to the New York City public schools, but first needs to ensure that the program is reproduced accurately.



‘Resident’: Language which discourages a fostering of empathy within our culture

I am indebted to my brother for this observation. During a three-day visit to see our elderly father, my brother needed some sleeping quarters, so he booked a room which was available in some sheltered accommodation run by the local council. There were elderly people living there. He noticed that a sign on the wall made reference to the many ‘residents’ who lived there. My Chambers concise dictionary gives a definition of ‘resident’ as: ‘dwelling in a place for some time’.

My brother gave the opinion that it is a word which has a dehumanising aspect. It is a word which has been used in England for some time, particularly to describe the people who live in sheltered housing which is provided for those who are elderly or have mental health challenges. It is a term which has the effect of psychologically habituating these people to a condition of being devalued.

The word ‘resident’ has strong associations with the popular video game franchise, ‘Resident Evil’. That is not fortuitous for the people in England  who are referred to as residents, as the game features undead, ghoulish zombie-like creatures!

I would advocate a revocation of the term ‘resident’, as it is likely that it discourages a fostering of empathy within our culture, and needlessly introduces divisions between different age groups and people from different walks of life. If people from different walks of life are discouraged from having social contact, this will increase suspicion, distrust and ignorance. Language has an important role in promoting our capacity for empathy, which is needed to maintain the health of society. We need an empathy epidemic, and language has its role to play in helping people to receive social acceptance.



‘Destroy’: Language which discourages a fostering of empathy within our culture

In my place of work, boy have I recently heard some colourful language being used by men in relation to sex with women. In my place of work, silly banter and persiflage are highly valued, and contributes immeasurably to our enjoyment of the day at work. Personally, I don’t know how I would cope without it.

Recently I heard a man at my workplace say to his female friend, “Me and my friend will come round one of these days and absolutely destroy you, you’ll love it….” I have to emphasise here that his female friend laughed mirthfully at this, and did not appear to be offended in the slightest, and I reckon the man knew her well enough to know she would receive it in the light-humoured and flippant way it was intended. It was banter, that’s all. Banter is the lifeblood of my workplace.

I absolutely love language; in fact I’m often fascinated by it. I believe passionately in our right to free speech. The man’s use of the term ‘destroy’, by which he meant a particularly energetic display of sexual vigour, which he deemed that she would find delightful, produced a laugh of approval from the recipient.

The part of me which appreciates the way in which language is employed and subverted was thrilled when I overheard this episode. I laughed out loud myself, so I feel reluctant to criticise the use of the term ‘destroy’ in this context because it makes me feel sanctimonious. While I don’t wish to specifically criticise this man’s use of this term, I do wish to reflect upon the influences and consequences of this use of language at a societal level, especially if it has passed into common usage. After all, for a long time now ‘to make love’ has been one of the most spiritual synonyms for the act of sex, and clearly ‘destroy’ is a humorous subversion of this meaning. ‘Destroy’ evokes a more animalistic, energetic meaning, and has a clear association with the concept of death. It seems to convey an emphasis on the violent consummation of sexual needs, while implying a diminishing of the importance of individuals’ needs to deeply connect on an emotional or spiritual level. So there is a danger that this kind of language use is an indication that in England we are living in a culture which devalues empathic connection, and if this language use becomes widespread this situation will become reinforced.

I know it is very likely that the use of the term ‘destroy’ in this context is only a fad and predominantly used by people of a young age. I don’t deny that it’s funny, it certainly made me chortle. But then again, people tell me that I’d laugh if my arse was on fire! : ) Nevertheless, it is likely that this language use discourages a fostering of empathy-our society needs to increase its capacity for empathy, for the sake of its well-being. We need an empathy epidemic.



‘Man up!’: Language which discourages a fostering of empathy within our culture

I have noticed that there seems to be a fad for the use of the term ‘man up’ in informal discourse nowadays. In a self-reflexive moment of horror, I recoil at my use of the term ‘nowadays’, as if I’m saying the march of time should itself accrue some implicit criticism! But I guess you know what I mean.  Don’t worry, I’m only 34, so I ‘m not one of these elderly people who has his heart set in stone against the ‘youth of today’.

I like a laugh more than the average person, and I know that ‘man up’ as a term is probably used to create a good joke most of the time. It’s probably even used as a light-humoured, ironical rebuke against a man by both men and women which carries an implicit awareness that men are capable of experiencing vulnerability and are fallible human beings.

Nevertheless, at face value the term suggests a disregard of male vulnerability, which militates against a culture of empathy and the empathy epidemic I wish to engender in society. The term conveys a disincentive to show understanding of how a male person may be feeling, and represents an inappropriate response to feelings of vulnerability. Please note that there are two parts to empathy: firstly the ability to recognise and understand how someone else may be feeling, and secondly to give an appropriate emotional response. On the face of it, ‘man up’ is a neologism which discourages the fostering of empathy.

I would like to introduce some neologisms of my own, designed to counteract this one and encourage a fostering of empathy. One phrase is: ‘You’re an Empath!’, which can be used as a sarcastic response to someone who unkindly uses ‘man up’ against you. Or you could try: ‘Oh….thank you very much for your empathy!’ But somehow, I don’t think these will catch on easily! I would like to know people’s thoughts on these 🙂 Or perhaps you might have some suggestions.

Any part of language or culture which has a tendency to represent men as weak or defective for expressing their feelings will contribute to increasing mental illness, as some men will not express their feelings and bottle them up as a result. In some cases, that will regrettably mean that men with emotional problems or wounds will only seek help when their personal situation has reached crisis level. I believe that in our society, we should strive to make increasing our capacity for empathy an educational priority from an early age. Included in this goal will be the promotion of the acceptance and encouragement of life-long open expression of vulnerabilities and feelings.



Acid attacks on women in Pakistan

I have been doing a little bit of research into the horrifying and appalling phenomenon of acid attacks perpetrated against married women by their husbands in Pakistan. I already knew that this was happening. But I was particularly horrified to hear that some of these women are so horrifically disfigured that their chances of finding another, more caring partner are barely scarce. I was even more horrified to hear that some of the victims are forced to continue living with the perpetrator. I was equally horrified to hear that most of the perpetrators have never been brought to justice, and that there is a pervasive false perception within the country that some women throw acid on themselves in an attempt to criminalise their husbands.

I was thankfully heartened to find that surgeons are able to use face transplants to reconstruct victims’ faces, and that the results of this surgery can be effective.

Corruption within the criminal justice system and lack of equality in Pakistan will serve to perpetuate the low conviction rate for the perpetrators of these crimes. This needs to change.



Empathy and soldiers with Post Traumatic Stress Disorder

I’m sorry for the amount of times my posts begin with a reference to how my thoughts and views have been inspired by news items or bulletins in the media, but that just seems to be the way of things at the moment lol. I hoping you all think my apology is inappropriate and needless. ; )

Yesterday I watched a news report on TV about the distress experienced by soldiers who suffer mental breakdowns in response to the impact of war, and consequently become diagnosed with post traumatic stress disorder. The news presenter discussed this subject with a man who claimed to be an expert in mental health disorders experienced by members of the British army. During the discussion, the news presenter mentioned that there was ‘a pride issue for the soldiers’ who suffer from this condition.

She did not go on to clarify what she meant by this comment, but it seems reasonable to conclude that she was implying that some of the soldiers would and do feel ashamed of their condition. If so, I wish she could have expanded on this by saying that there is no need for these people to feel ashamed; mental health challenges are not a sign of weakness and that contrary to this, the experience of adversity is a gifted opportunity to become stronger and more resilient in the long-term, once these challenges have been overcome with the appropriate support.

What else might the news presenter have been implying by her comment that there was a ‘pride issue for the soldiers’? There is a small chance that she was implying that having a mental breakdown is shameful. This is unlikely since today a fundamental shift in attitude is gradually taking place, and people are realizing that everyone is vulnerable to mental health challenges owing to the condition of being humanly fallible, and that people can and do recover.

If indeed she was implying that having a mental breakdown is shameful, I almost feel like saying she ought to be ashamed of herself. However, the criticism ‘she/he ought to be ashamed of herself’ would be inappropriate since, on reflection, her comment was devoid of harmful intent. The comment is typical of that which is capable of flowing from anyone’s tongue as a result of uncritical thinking, yet serves to perpetuate the stigma of shame surrounding mental illness. The news presenter deserves no stern reproach for her comment, since it is an indication of how deeply ingrained the stigma of shame has become in relation to mental health in our society. At times, it is as though society has become brainwashed. I aim to uproot these negative attitudes and perceptions of people who suffer mental distress and replace them with a paradigm of empathy. It’s going to take time, but we can aim to achieve a gradual change. People who experience challenges of mental and emotional distress need human love and positive inclusion, and a paradigm of empathy can foster these needs.



Incapacity Benefit and the Government’s assessment of the capability of people with a ‘mental disorder’ to work

I need you all to enlighten me-all zero of you who are currently viewing my blog at the moment lol- as to what you think about what I think about what I heard on the radio today. Radio 4 news informed me that Paul Farmer, the Chief Executive of Mind, resigned from the Government panel which is currently investigating the capability to work of people who are claiming incapacity benefit and are out of work due to suffering a ‘mental disorder’.

It is unclear whether the Chief Executive of Mind was pushed or whether he went of his own accord. As a result of this reassessment drive, some people with a mental health diagnosis have been deemed fit for work and therefore classified as ineligible to claim incapacity benefit any longer. While I recognise the importance of preventing fraudulent claims, I very much hope that this policy is not a cynical ploy to save the government and the taxpayer money by reducing the amount they have to pay in incapacity benefits. For the danger of making rulings that people with ‘mental health’ issues are capable of working is that these people may in fact be disadvantaged in terms of entering the job market owing to cultural and institutional discrimination, and hence effectively these people would just be receiving less income.

However, I do not want to believe this cynical view, because society seems to be becoming far too mistrusting, and mistrust can undermine positive projects. I want to believe that there is some philosophical depth to the government’s assessment of people’s capability to work. I want to believe that it is underpinned by an intent to decrease the marginalisation of people with mental illnesses, to promote their inclusion and acceptance in mainstream society and in the labour market. Work carries positive benefits which can assist the recovery of a person who suffers from mental health challenges.

This leads on to the natural question of why the Chief Executive of Mind has chosen to leave the government panel, as surely the best way for him to represent the interests of people on Incapacity Benefit is to be on the panel. On the radio today he claimed that he had knowledge of unjust and ill-judged reassessments of peoples’ capability to work. He gave the example of a man who has been diagnosed with schizophrenia, whose family has been supporting him and has been legitimately claiming incapacity benefit, who under the reassessments has been ruled fit to work. He said that this man and the family had been devastated by this decision, as he has been in a very vulnerable state since he was released from hospital care.

It sounds like some of these reassessments have been dogged by incompetence, as I really do not wish to believe that the well-being and health of these vulnerable people are being deliberately and ruthlessly sacrificed to the need of reducing cost to the taxpayer. Incompetence can be remedied, but ruthlessness of government policy is harder to remedy.

On balance, I refuse to believe that the government reassessment drive is motivated by anything other than laudable goals: reduction on benefit fraud; inclusion of the mentally ill; and the ethos espoused by many grass roots mental health awareness groups that people who suffer mental distress can and do recover if they are provided with appropriate environmental encouragements, positive attitudes, a pro-active opposition to discrimination and job opportunities.

I applaud the Chief Executive’s highlighting of the possibility that some of these reassessments have been dogged by injustice and/or incompetence, but the extent of this malpractice has yet to be learned. And I seek reassurance that this policy is driven by the government’s recognition of the need for inclusion of the mentally distressed population in the job market once recovery and healing has taken place, just as much as it is by a need to make the benefits system less open to abuse.

[Pause]

It is now the day after I wrote this post-3/4/12-, and I can expand on the topic since I have just read Paul Farmer’s statement in the Guardian, in which he offers his explanation as to why he has resigned from the panel.

He explains that he has resigned from the panel that scrutinises work capability assessments because the Department for Work and Pensions (DWP) won’t act on concerns about the effect on people with mental health problems. What! I hear some of you cry, you mean the effect of getting people who have suffered mental distress back into the labour market and feeling included again in society, rather than marginalised!!?? Such a sarcastic response feels delicious and justified, just so long as there is a real chance that the assessments are competent and thoroughly reliable, rather than penalising people who are actually not well enough to enter the labour market. And no doubt Paul Farmer has reason to believe that the latter is occurring. But surely the policy itself and the rationale behind it are laudable, it’s just that the assessments need to be re-evaluated in terms of their practicability.

Here is his full statement: ‘For the last couple of years, welfare reform has consistently been an important issue for people with mental health problems. And one aspect in particular has dominated: the work capability assessment (WCA). It’s worth remembering that the WCA was initially conceived before the recession, when this country was estimated to be within a year of achieving full employment. Even in those early days, we at Mind urged caution as we had real concerns about how a new system would be applied.

‘It’s in everybody’s interests to get this right. When about 40% of people on incapacity benefit have a mental health problem, it makes sense to design the new system so it can properly assess the needs of people with mental health problems. In July 2010, I joined the Harrington scrutiny panel, which was set up to oversee the work of the WCA independent review team. My role was to give advice and criticism regarding the areas the reviewer was looking at and the changes they were recommending.

‘The Department for Work and Pensions (DWP) has committed to making some changes arising from the independent review, but these will take time, and some fundamental changes required haven’t even started to be addressed. Meanwhile, tens of thousands of people are being reassessed using a test that is still not fit for purpose. Approximately 50% of people are appealing against the decision, and a remarkable half of those appeals are being upheld, meaning that as many as one in four tests are wrong. The cost to the taxpayer of the tribunal system alone is £50m, about half the £100m a year being spent on reassessment.

‘I spent some time last week at Mind’s Infoline. Call after call was coming in from individuals with a mental health problem, or a member of their family, anxious about the reassessment letter, concerned about having to appeal and the potential impact on their lives. We’ve heard about jobcentres being shocked when someone who is clearly unwell turns up having been told that they are fit for work. The callers to our line were not benefit scroungers – they were ordinary people whose health had put them in a very vulnerable state. Ordinary people desperate to recover and be able to work, but who just weren’t yet well enough. And instead of offering support and help to recover and then find and stay in work, the WCA process is making their health worse and so, ironically, the prospect of a job even less likely.

‘The time has come to call a halt in the reassessment process until real changes are made. It’s damaging people’s lives. It’s costing the taxpayer a fortune. And it certainly isn’t fulfilling its purpose of supporting people with mental health problems on their journey back to work. This government has some good aspirations on mental health set out in an excellent mental health strategy – it’s seen the importance of good mental health to the country and it’s acknowledged the high cost of poor mental health. But when it comes to benefits and supporting people out of work to get back into work, the DWP is letting people down.

‘I have taken the decision to leave the Harrington scrutiny group. Our concerns about the reality of the WCA have grown, but we see insufficient recognition of the need to change the approach, and the need to do so quickly, before more and more people are subjected to a process that isn’t working.

‘Mind will continue to campaign on improving the WCA until people with mental health problems get the support and respect they deserve. I hope the DWP will hear these concerns and act upon them.’

So Paul Farmer claims that he has resigned from the panel because the work capability assessment procedure in its current form isn’t working in the interests of people with mental health problems-in fact he says that it is undermining these people’s ability to move from unemployed to employed status, rather than providing the support necessary to make this change. He claims that the assessments are beset by incompetence and ill-judgment, as evidenced by people being told they are fit for work when they are still very unwell, which can increase their anxiety and worsen their mental health.

I very much hope that the WCA is re-evaluated so that it is better able to meet the needs of people with mental health diagnoses and make more accurate assessments. I do not wish to be so cynical as to believe that the government is sacrificing the needs of vulnerable people for the sake of making cutbacks. The government has a duty to care to people with mental health diagnoses.



The imprudence of constructing an ’empathy disorder’ diagnostic category

 

Simon Baron-Cohen in his book ‘Zero degrees of Empathy’ (2010, Pages 107+) discusses the case of Rekha Kumari-Baker, the mother who stabbed her two daughters to death in the local village of Strethamon 13 June 2007. Baron-Cohen describes that “she explained in her court trial how she had become jealous of her ex-husband because, even though they were divorced in 2003, he had a new partner and she did not. She wanted to hurt her ex-husband and thought this would be the way to shatter his happiness.”

Baron-Cohen goes on to describe how a psychiatrist assessed Rekha to determine if she was suffering from a mental illness. He concluded that she did not suffer from any of the categories of diagnosis set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the book which psychiatrists consult in an attempt to classify all ‘mental illnesses’. The psychiatrist felt that she did not fit into any of the available categories. She showed no signs of depression, anxiety, psychosis or long-standing personality disorder. According to how psychiatry conceptualises people, she was deemed not to be mentally ill.

The court accepted the decision of the psychiatrist, and as she was deemed not to be mentally ill, Rekha did not have the option to plead ‘diminished responsibility’ on grounds of insanity. So she was found guilty of murder, and the court sentenced her to thirty-three years in prison.

Baron-Cohen states that while he believes the sentence she received fits the horrific nature of the crime she committed, the case has highlighted the limitations of the DSM-IV and therefore of psychiatry, given that the prevailing diagnostic system categorized her as normal. He believes her killing of her two children dictates that she cannot be normal. Also, he believes that her crime by definition shows that she lacks empathy, at least at the time of the crime. He says that, “even if she had previously shown a normal level of empathy, it must be the case that at the very moment she was climbing the stairs holding a kitchen knife, with the intent of stabbing her children, and at the very moments she plunged the knife into her children, she lacked empathy. Her empathy must have gone… the obvious conclusion is that the medical and psychiatric classification system is crying out for a category called ‘Empathy disorders’, which is where Rekha would have naturally fitted. Even if she did not show the long-standing empathy impairment that would be required for a diagnosis of a personality disorder, at the very least she must have had a transient or long-standing ‘empathy disorder’. The problem, though, is that the category of ‘empathy disorder’ does not exist in DSM-IV, and as far as I know there are no plans for such a category to be created in the next edition due to be published in 2012.”

Baron-Cohen argues that at the very least, a lack of empathy was transparent in her action, and therefore a diagnosis of an ‘empathy disorder’ would be appropriate in this case.

I foresee some major problems with Baron-Cohen’s proposed category of ‘empathy disorder’. Firstly, a lack of empathy would never be as transparent as Baron-Cohen perceives it to be. He assumes that Rekha’s stated reason for killing her children, namely to hurt her husband and shatter his happiness is true or the only motive for her actions. It is sometimes difficult to judge the state of someone’s mind from their actions or what they say. Her actions may have been consciously or unconsciously propelled by an intense empathetic connection with her children, whom she may have considered to be deeply wounded by their father’s abandonment. She may have also considered that her children had been unfairly impacted by an embittered and jealous mother, whose feelings of jealousy were impairing her ability to provide the nurture she would have naturally felt her children deserved. She may have put herself in the shoes of the children and experienced an intense understanding of how distressed they were- i.e. deeply empathised with them- and in a reckless and misguided moment decided on a course of action to end their suffering by killing them. Empathy does not always result in a morally justifiable course of action- sometimes it can lead to an immoral or  reprehensible course of action, as it tragically did in the case of Rekha Kumari-Baker. Yet in this hypothetical instance of actions being consciously or unconsciously propelled by an intense empathetic connection with the victim, a diagnosis of ‘empathy disorder’ would seemingly be inappropriate.

Another problem with the category of ‘empathy disorder’ is that, even assuming that Rekha’s stated motive is accurate, it is very likely that she herself had been experiencing an extreme degree of distress owing to the nature of her personal circumstances, and it could have required these specific extremes of personal circumstance to impel her to the tragic action of murdering her own children. Humans as a race are often profoundly and inherently flawed and beset at times by powerfully negative emotions, and as such even though her crime was horrific, she deserves some compassion. Under normal circumstances, she might have a normal degree of empathy. To give her a diagnosis of ‘empathy disorder’ could be to unfairly stigmatise her and suggest that she has a long-standing neurological disability, when her actions may instead have been fuelled by an extreme set of unique individual circumstances. I believe there is a danger that, once created, the category of ‘empathy disorder’ would likely be extended to many people, stigmatising them for unpleasant actions which they carried out under a state of extreme stress, which every human might be vulnerable to doing. This smacks too much of punishing people for experiencing distress or extremely stressful circumstances. I am not here excusing people’s wrongdoings, and I firmly believe that people should take personal responsibility for their wrongdoings. But I am saying that there is a danger that the creation of the diagnostic category of ‘empathy disorder’ could constitute an overly punitive approach. I would encourage people to perceive that when someone behaves badly, it doesn’t necessarily mean he/she is a bad person-one has to see the action as potentially separate from the person, which means attributions of a longstanding empathy deficit should be made with great caution. I would be extremely interested in finding out other people’s views on these issues, as I am aware there are many who would disagree with me. Please let me know ; )

I also foresee that people who receive the diagnosis of ‘empathy disorder’ could use it as a way of avoiding taking personal responsibility for their actions and wrongdoings, since they may attribute them to having a neurological disability. There is a danger that people would develop a belief that there is little or nothing they can do about their behaviour, which would be a lamentable consequence since, as I have already stated, I strongly believe that everyone should strive to take personal responsibility for their actions. Again, I would be very interested to find out other people’s views on this, as I know there are many who would disagree with me and instead advocate the construction of the ‘empathy disorder’ category!! Please let me know ; ) Lets get a debate going!!