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Thursday 2 May 2024

Has Universal Credit made People Sick?

The Conservatives have announced new policies to manage a recent increase in economic inactivity (Centre for Social Justice 2024).

Since the pandemic, total spending on working age disability and ill-health benefits increased by almost two-thirds from £42.3 billion to £69 billion and we now spend more on these benefits than our core schools’ budget or on policing.” (Rishi Sunak 2024)

Official statistics suggest that there has been an increase of something like 850,000 (43%) of economically inactive claimants since the start of the pandemic in January 2000. Successive reports (Kirk-Wade and Harker 2023; Powell 2024) have highlighted the link to long-term sickness absence, and suggested that older-age and ill-health have interacted to cause this trend, with “long Covid” and “Waiting lists” cited as evidence.

“The number of working-age people who were economically inactive, which means they were out of work not looking for work, reached its highest level since 2012 in December 2023 to February 2024. The number of people who are inactive because of long-term sickness increased to a record high of 7% of the working-age population.” (Powell 2024)

 


Source: Office for National Statistics (ONS), INAC01 SA: Economic inactivity by reason (seasonally adjusted), 16 April 2024

The Government narrative is that after the pandemic arrived in the UK on January 30th 2020, successive lockdowns in March - June 2020, September - November 2020, and January - July 2021 caused damage to the labour market by acceleratinging economic inactivity from which we have never recovered. 

However, official reports from 2022 suggest that while the lockdowns differentially impacted vulnerable people in unpaid and insecure employment at the time, the labour market recovered quickly: 

“Coronavirus: Impact on the labour market

Most affected groups

Some workers were disproportionally economically impacted by the pandemic.

Unemployment rates for minority ethnic groups were higher than average before the pandemic and saw a larger increase between January-March 2020 and January to March 2022. People from minority ethnic group were more likely to experience a loss of income at the beginning of the pandemic. While unemployment rates have risen more for minority ethnic groups over the pandemic, employment rates have also risen due to decreases in economic inactivity rates.

Employment among men has fallen slightly more than among women over the pandemic. An increase in economic inactivity for men means that women made up over 48% of the workforce in January-March 2022, a record high.

The youngest and oldest workers were most likely to lose their jobs or be furloughed at the beginning of the pandemic. Youth employment recovered quickly from spring 2021, and had nearly returned to pre-pandemic levels by January-March 2022. Many older workers opted to retire early.

Low paid workers were more likely to work in sectors most affected by the pandemic, particularly hospitality and non-essential retail, so were most likely to be put on furlough or experience falls in income at the beginning of the pandemic. However, the rise in vacancies in 2021 and 2022 was driven by low paying jobs and by February 2022 unemployment rates in low occupation had almost completely recovered.

The employment gap between disabled people and people without disabilities widened during the pandemic, before returning to close to pre-pandemic levels.” 

(Francis Devine et al 2022)

 

Thus, while the lockdowns may account for things like the small but significant (1%) rise in “discouraged workers” during this time (@86,000) it cannot account for the massive rise in long-term sickness absence, particularly as there is no increase in unexpected deaths that might accompany it.

In addition, the Government narrative does not explain the significant ‘churn’ within the economically inactive figures that begins six months before the pandemic. The Centre for Social Justice data shows that starting in April/May 2019 there was a 4.3% (@370,000) swing in the reasons being given for economic inactivity, from “looking after family/home” to “long-term sick”. Although the swing does not account for new claimants, it could account for the link to ill-health, but this has not been addressed in the official narratives. 

 



April/May 2019 was the start of a period of “managed migration” conducted by the DWP, to switch people from individual “legacy benefits” to the household-based Universal Credit system. Reports from DWP concede that the “managed migration” process differentially affected single people on tax credits, which seems to confirm that vulnerable workers were affected by these changes. However, because the change to Universal Credits has been overseen by the Centre of Social Justice, any damage it has done is likely to be suppressed by the current Government. 

Thus, contrary to the Government narrative, there is an alternative theory to the one that says the NHS is responsible for the recent increase in sickness-related economic inactivity: Rather, the evidence is that the group of people who were on "legacy benefits" have been made ill by transferring them onto Universal Credits starting in 2019. 

This group seems to have included very vulnerable people: single-parent families, unpaid carers, young adults, ethnic minorities and retired people, in insecure employment; who may have been cohabiting with relatives, extended family, or friendship groups as the most viable low-cost housing option. This group's employment had already been affected by lockdown and the imposed changes to their financial circumstances could have been enough to trigger a long-term sickness episode that has been recorded by GPs as something to do with their mental health.

There were 2.9 million lone-parent families in 2022, accounting for 15% of all families. This is not significantly different to 2012, when there were 3.0 million lone-parent families, equivalent to 17% of all families. While the majority of lone-parent families are lone-mother families (2.5 million, 84%), in 2022, 16% (457,000) were lone-father families. Lone-mother families are more likely to include one or more dependent children (66%) than lone-father families (48%).” (ONS 2024)

Our results indicated that: (1) British adults with intellectual impairments were more likely than their peers to be exposed to non-standard employment conditions and experience job insecurity; (2) in both groups exposure was typically associated with poorer health; (3) British adults with intellectual impairments in non-standard employment conditions were more likely than their peers to transition to economic inactivity; (4) among both groups, transitioning into employment was associated with positive health status and transitioning out of employment was associated with poorer health status.” (Emerson et al 2018)

There does not seem to have been any consideration within Parliament of the impact of the Government’s changes to the benefits system. The situation is of course complex, but local counsellors within more deprived areas will be well aware of the sorts of families who are being affected in this way. Unless this information is aggregated at the macro-economic level of data analysis, it is unlikely to become part of the official narrative, unless or until there is a change of Government.   

Thursday 4 April 2024

Meditation on Identity Conflict

Identity conflict involves discrimination against someone,

Not for anything they do, just for being themselves,

It happens if there is something about the victim that the perpetrator doesn’t like,

The victim is categorically unable to change, and the perpetrator refuses to.

The perpetrator feels forced to oppose the victim to save themselves,

And they project their negation onto the victim(s),

This may in turn cause the victim(s) to be split, who will enter a dissociative state,

Or project their negation(s) onto yet more victim(s),


Who are they? 


Maybe they remind them of something they did that they want to forget?

Maybe they remind them of feelings they would rather hide and deny?

Maybe they remind them that they can’t do things that they wished they could do?

Maybe they remind them of someone who has hurt them in the past?

Maybe they do not fit the narrative that they want all their friends to believe?

Maybe they do not fit the order that they want to impose on their world?


Yes, they are ambiguous; they are not them are they?


They threaten their identity because their identity excludes their existence,

They are an inconvenient truth for them,

A truth that is easier to eradicate completely than try to understand,

They cannot do anything to dissuade them of their premeditated acts,

They have tried them and convicted them already,

They must be guilty of a crime even if there is no evidence that they have committed one,

They have caused them to do this to them: they are Evil, they are possessed by the Devil,

They must be destroyed, eliminated, removed, disposed of, abolished, terminated,


They are not them now.

Thursday 29 February 2024

Identity and the State

An article, titled "Anti-western ideology is infecting public sector: King’s College counterterrorism course, on contract to MoD, dangerously downplays extremism", written by Melanie Phillips and published in the Times on 16/01/2024 has caused me to reflect on the Identities involved in the War in Gaza, and how they affect me in my role as a mental health nurse in the UK.

Phillips quotes another writer referred to as Anna Stanley in the article, but I have to assume that Phillips has filtered the meaning of Stanley's article to meet her own needs. The Times is supposed to be a non-partisan newspaper, but I would say that Phillips is quoting from a Trumpian perspective - i.e. from a sort of proto-fascist populist Nationalist perspective.

"King’s College London is the academic centre of Britain’s military and counterterrorism training. Its counterterrorism course, under contract to the Ministry of Defence, has been designed for civil servants and other professionals involved in this work from a number of government departments.

Now, questions have been asked in parliament after an account of the course written by a former civil servant, Anna Stanley, who participated in it a few months ago and who until this month was an open-source intelligence analyst at the Foreign Office.

In Fathom, the journal of a pro-Israel research group, Stanley wrote that although the lecturers included a previous defence minister and former senior officials at the Foreign Office, Home Office and GCHQ, some of them spouted “typical postmodern identity politics”.

Those on the course were told that labelling an organisation “terrorist” was a problem because it “implies a moral judgment”. Lecturers showed slides that stated: “Condemning terrorism is to endorse the power of the strong over the weak”, and, “terrorism is not the problem, rather the systems they oppose are terrorist”.

The course, wrote Stanley, was a “deeply, existentially depressing" experience. Extremism and terrorism, she said, were being misunderstood to the point of creating a national security risk. She found herself surrounded by civil servants who “hate the concept of the state”. Their unchallenged assumption was that Israel was a terrorist state and Hamas’s atrocities should be “contextualised”.

They accepted without demur an argument mounted by one civil service participant, whose brother had fought for Isis, that Britain’s anti-radicalisation programme, Prevent, was inherently racist because it focused on Islamist extremism — mere mention of which made Muslims “feel uncomfortable”.

While lecturers gave right-wing extremism disproportionate weight, wrote Stanley, the overriding emphasis was that Islamist extremism was exaggerated. This directly contradicts the conclusion reached by Sir William Shawcross in his review last February of Prevent, which he found was dangerously underestimating Islamist extremism while exaggerating right-wing threats."

It struck me how Phillips' article focuses on the sort of post-colonial identity conflicts that I have seen playing out at work. It is fascinating to see how they are playing out at the heart of the British establishment. 

Phillips cleverly positions herself in binary opposition to the process she claims to promote, e.g. outside of the democratic debate and superior to it. She accuses others of doing the same, so she is quite clearly admitting some familiarity with this sort of splitting as a technique, as do I. 

This mutually inclusive exclusivity then sets the scene for a metaphorical battle between an evil invasive virus and the heroic immune system of the unsuspecting host, which is where she positions us, the Times reader, viz. the Nation State.

Thus, my initial impression was that Phillips was using Stanley's voice to:

a) devalue the rights of minorities to express their voice within what is supposed to be a permissive learning environment;

b) adopt a tone of xenophic fear, demonising any opinion that corrupts her own ideal, covert, and therefore imaginary, vision of what the National identity actually is; and

c) conclude that the inability of the State to develop a coherent narrative in the face of several competing perspectives is a weakness, rather than a strength, of our multi-cultural political democracy.

As a mental health nurse and public servant working in the NHS I recognise the sort of identity work that Phillips is doing as being very familiar, but the reference to 'Israel' makes it particularly relevant to the current war in Gaza, and the Rishi Sunak's attack on 'anti-semitism' in the ranks of the Labour Party. This raises some unsettling questions about the sort of racial insecurities that are going to be driving our National security agenda at the coming general election.

So this article tests out my identity along racial fault lines when I am more used to it being tested out on other fault lines: for example, gender. I am aware that I have to adopt a non-binary gender identity as I go to work and resume a more traditional, more gendered, binary identity, as soon as I get home (the male is the one who has to take the bins out in our household apparently!). I do this to adapt to the social context I am in.

But nobody ever accuses me of being in any way less authentic for doing this - or in any way of being more of a threat; I do not get accused of being a 'double-agent', or of being an 'agent provocateur', or even of being a 'change agent' anymore. I am simply doing my job, for my patients, and this job involves some 'identity work'. So if I can cross between the boundaries of one protected characteristic, i.e. gender, so effortlessly, then why not any others, i.e. race and/or ethnicity?

Well, the obvious answer is that it isn't effortless, it actually takes a lot of hard work. Employers may not take account of this labour activity so it comes free of charge to them, but many of us do have to change our identities as we move between different socio-cultural environments as part of our everyday lives. This is particularly obvious as we go in and out of work, and less so perhaps as we go in and out of different domestic households and families, or in and out of different pubs and clubs. So why is identity agility so hard to accept when it comes to our racial identities?

Surely, what this article actually validates is that identity is somehow tied to place as much as it is tied to our physical characteristics; identity is as complex, multi-layered, and as malleable as our autobiographies are; identity is transactional and co-produced, manufactured even, marketed, consumed, and exchanged - there exists a political-economy of identity but not a financial market, identities have a currency, a certain value to one person and another to another.

So if people still get upset about having to modify their identities to 'fit in' with their surroundings, what cognitive mechanisms can we suggest they employ to help them do that? If identity is at least partially about observing the emotional etiquette of a place or social context, then the dual process theory of emotional regulation can help us understand it. As the name suggests, there are essentially two parts to this process:

a) the 'threat avoidance' part that seeks to suppress all other possible identities, through a slavish ritualistic addiction to an 'alpha identity' that must prevail above all others, or succumb to a primordial fear that the whole structural edifice will come crashing to the ground; and

b) the 'reward seeking' part that seeks to predict the changes that are needed to successfully adapt the current identity to meet the demands of a changing social and emotional environment, by constantly reading any alternative narratives available to it in any social situation.

Both mechanisms are present in all of us but may be weighted one way or the other, depending on the biological inheritance and environmental habitat involved. The first process is probably higher in people on the autistic, obsessive-compulsive, and schizophrenic spectrum, while the second is probably higher in people with more resources for emotional intelligence. The combination effectively equates to a lower and higher capacity for empathy and socialisation, and a more or less significant trauma history, respectively.

Within a social network the two processes will be in constant opposition and their relative strength may lead to the sort of dynamics observed in the cohort of students referred to in Phillips' article. So I turned to the original article to evidence this: "Scandalous Indoctrination: Inside a Kings College Counter-Terrorism Course for UK Civil Servants" (Stanley, 2024). And true enough, in it Stanley attempts to prioritise the 'threat avoidance' of the Israeli's over any others, whilst ignoring any mutual 'reward seeking' that could be found between the different parties involved.

Apart from some egocentrism, there is nothing inherently wrong with her argument. For example, Stanley claims a moral and cultural superiority for the Israel State and legitimises this position as a valid form of collectivist politics. From a psychiatric perspective, I agree that there is a legitimate need for a culture to defend itself based on its learning from a collective trauma history. This principle is effectively written into the definition of a delusion by the World Health Organisation’s International Classification of Diseases version 11:

Delusion MB26.0:

A belief that is demonstrably untrue or not shared by others, usually based on incorrect inference about external reality.

The belief is firmly held with conviction and is not, or is only briefly, susceptible to modification by experience or evidence that contradicts it.

 The belief is not ordinarily accepted by other members or the person's culture or subculture (i.e., it is not an article of religious faith).

To all intents and purposes, this means that Stanley's fear that Israelis have been/ are being/ will be being: “anally raped at a peace festival by someone shouting ‘Allahu Akbar’” is neither a persecutory nor a religious delusion, at least as long as there are enough Israeli’s who believe that this remains a possibility, which would also rule out personality disoder.

Persecutory delusion MB26.07:

A delusion in which the central theme is that one (or someone to whom one is close) is being attacked, mocked, harassed, cheated, conspired against, or persecuted.

Religious delusion MB26.08:

A delusion involving religious or spiritual themes or subject matter that other members of the person's religious group do not accept as possible.

However, such a fear would probably meet the criteria for being considered a ‘paranoid ideation' within the context of a more or less historic, or more or less vicariously experienced, 'post-traumatic stress disorder', with or without 'specific phobia', although not necessarily needing any further treatment, depending on its duration, complexity and severity:

Paranoid ideation MB26.7:

Ideation, not held with delusional intensity, involving suspiciousness or beliefs of being harassed, persecuted, or unfairly treated by others.

Post-Traumatic Stress Disorder 6B40:

Post traumatic stress disorder (PTSD) may develop following exposure to an extremely threatening or horrific event or series of events. It is characterised by all of the following: 1) re-experiencing the traumatic event or events in the present in the form of vivid intrusive memories, flashbacks, or nightmares. Re-experiencing may occur via one or multiple sensory modalities and is typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations; 2) avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event(s); and 3) persistent perceptions of heightened current threat, for example as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. The symptoms persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Specific Phobia 6B03:

Specific phobia is characterised by a marked and excessive fear or anxiety that consistently occurs upon exposure or anticipation of exposure to one or more specific objects or situations (e.g., proximity to certain animals, flying, heights, closed spaces, sight of blood or injury) that is out of proportion to actual danger. The phobic objects or situations are avoided or else endured with intense fear or anxiety. Symptoms persist for at least several months and are sufficiently severe to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.Specific phobia is characterised by a marked and excessive fear or anxiety that consistently occurs upon exposure or anticipation of exposure to one or more specific objects or situations (e.g., proximity to certain animals, flying, heights, closed spaces, sight of blood or injury) that is out of proportion to actual danger. The phobic objects or situations are avoided or else endured with intense fear or anxiety. Symptoms persist for at least several months and are sufficiently severe to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

The counter-argument would be that the politics of cultural superiority can easily become a racially divisive ideology, and Stanley's argument comes close to this. This can occur when membership of a collective is predicated purely on owning a racial heritage (as per the concept of “Aliyah”), rather than being drawn towards a moral or religious affiliation or signing up to a nationalist identity (as per the politics of the “United Arab List”). But in the end, it is not really clear to me which of these alternative definitions of cultural identity Stanley is actually trying to defend?

Stanley attacks “typical post-modern identity politics” which I would argue is synonymous with most post-structuralist forms of any post-Freudian psychiatry. “Surely we can acknowledge subjectivity while being able to come up with a collective understanding of what terrorism is?” she says. Here I think she is referring to the split between structuralist and post-structuralist interpretations of the cultural lexicon that emerged in the 1960s. But I would argue this split is resolved through viewing the self as both an objective “Me” and subjective “I” as characterised by the Chicago School of Sociology. The “I” may involve some form of innate cognitive capacity to use language, but the “Me” is any and all the social identities that we construct when we use it. 

Ironically, the post-modern identity politics that Stanley rails against probably support her position. The post-structuralist argument a scholar of Foucault might make is that the structure of a cultural lexicon is based on asymmetric power relations, and the cultural lexicon can quickly lose its clarity in a conflict zone; this is exactly what Stanley appears to be complaining about, if I understand the authors concern over the ambiguous and/or ambivalent use of the term “terrorism” correctly; but she misses the point that Prevent’s focus on Islamic extremism is racist because it excludes all the moderate views caught up in the conflict, which again, is part of the catastrophe that we are now witnessing unfold in Gaza; and what I'm afraid to say is so evident in the polarised position that she takes.

In summary, Stanley is justified in feeling the way she does because her identity positions her in a collective history that has a moral perspective on the current conflict. This position is supported by others who have the privilege of being able to be an external observer. However, this remains one position in a whole theatre of other positions, with different perspectives on the conflict, with different histories, different objectives, and different beliefs. We are thus, all equally justified in taking a position, whether or not it is consistent with the majority or minority view, as long as the collective that we belong to can endorse it. What is not possible though, is to resolve the conflict while the two main protagonists prioritise 'threat avoidance' over any 'reward seeking' positions. It is only when the balance of these cognitive mechanisms is able to change, that we will be able to see an end to the War in Gaza.   

Footnotes - click on names to see video links for events of the day: Rishi Sunak George Galloway ; Keir Starmer 


Thursday 25 January 2024

Existentialism

I exist as the Homunculus,
I hold myself together, 
Across the sensing and responding,
Across the time and space,
Bridging a river of emotions,
Where all emotions are communications,
Between a past self and a future other,
Where all others split me from the I,
And memory splits the I from all of me,
We hold each other, 
Across past and future,
Good and bad both dominate,
Our Western Christan order.

We exclude our non-binary Identities,
We banish our demons to Hell,
But between Alpha and Omega,
There are many stories to tell,
There are many stations to Nirvana,
And many avenues to explore,
Veins and arteries come full-circle,
Both inside and outside ourselves,
Information is at the boundary,
Of a knowledge that makes us feel safe,
But keeps us ignorant of the other,
Inside and outside the borders,
Of our Western Nation States.