Friday, 24 February 2017

Some thoughts on Stoke and Copeland

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And so the much anticipated by-elections of Copeland and Stoke threw up results that were interesting but not altogether surprising.

In Copeland, the result was what I feared it would be. True, there were positives for the Liberal Democrats - we increased our vote and moved into a creditable third place (up from 4th in 2015). I'm not sure it can be called a positive result for us, as a Tory win - the first time a party of government has gained from the official opposition since 1982 - has resulted in Conservative triumphalism and has inevitably been taken by the government as an indicator of approval in its policy direction. After Witney and Richmond Park, the momentum was very definitely with the Lib Dems - but there can be no escaping that the real winners last night were the government. Coming third of course represents some kind of progress, but I argued in December that our main objective should be to avoid a Tory win and that was, unfortunately, something we were unable to prevent.

The Conservative victory is as much a setback for everything we stand for as it is for Jeremy Corbyn's Labour Party. It's a defeat for progressive politics. This is so self-evident that I shouldn't have to explain the point further.

Labour is clearly a party with some real problems, most of them of its own making. Copeland is an unusual seat in that while it has been Labour-held for 81 years, for much of that time it was a two-way Lab-Con marginal. But in usual circumstances a Labour Party in opposition would hold somewhere like this, and hold it comfortably. On the other hand, the Conservatives have proven themselves able to squeeze UKIP and effectively appeal to UKIP supporters. Labour have an identity problem; the Tories are happy to adopt a new Euro-hostile, UKIP-lite identity.

I asked in December whether we should stand a candidate in Copeland at all. In the final analysis, our vote made the difference. In the absence of any constructive dialogue with Labour it is doubtful that any "progressive alliance" would have been possible, but I think serious questions now have to be asked about how collaboration around by-elections can take place. I suspect that More United isn't the answer, but we can ill-afford too many more Copelands.

The media were naturally far more interested in Stoke, not least because of their UKIP obsession. Would Paul Nuttall deliver on his promise to unseat Labour in their heartlands? Well, no - and no-one should realistically have expected him to. Nuttall is clearly a liability and, unlike Farage, struggles to be taken seriously.

In the event Labour held on easily, with UKIP (in spite of all the hype) very nearly falling into third place. Dr Ali, for the Lib Dems, did well to significantly increase our share of the vote and finish in a decent fourth. For me, the Stoke result was the least interesting and unlike Copeland there is not an obvious winner - yes, Labour have a new MP in Gareth Snell but it is clear the party has little direction and that victory was owed, in part at least, to UKIP's counterproductive strategy. There is, however, an obvious loser - and that was Paul Nuttall.

The UKIP leader might only be twelve weeks into his new job, but he staked a lot on this campaign and it failed spectacularly. He went into the campaign in the shadow of Nigel Farage and came out of it with any credibility he once had in shreds. In a constituency in which 70% of voters opted to leave, this really was UKIP's great chance of a historic breakthrough, whatever Nuttall said subsequently about Stoke being way down the list of UKIP target seats. Nuttall successfully managed to transform himself from a relative unknown to a figure of fun and ridicule - quite a triumph in the space of a few weeks. His "honeymoon" period is well and truly over. Indeed, when he insisted that UKIP "aren't going anywhere, and I'm not going anywhere" he was inadvertently making a significant admission. His party aren't going anywhere. Like Labour they are directionless, reduced to unsubtle appeals to working class voters and taking populist potshots at "the establishment".

In all the excitement, for all parties (the Tories aside) there will be some disappointment. For the Lib Dems, there will be some encouragement that the toxicity that saw us reduced to eight MPs in 2015 is evaporating. In both contests our vote share was up on the General Election, which looks good on paper and is certainly evidence that we are moving in the right direction. However, given the huge effort in Stoke, can a distant fourth place be called a good result? There is clearly still progress to be made to get back to 2010 levels. And, while we moved into third place in Copeland at the expense of UKIP (even if it was the second lowest percentage of the vote we have received in that constituency since 1979) a Tory win was the last thing we needed - I suspect I'm not the only party member to see that as a disastrous outcome and a significant setback to the pro-EU, pro-inclusive, tolerant approach being advocated by Tim Farron.

Friday, 3 February 2017

Why we should stop speculating about Trump's mental health

US President Donald Trump (Photo: Quartz)
In recent weeks, there has been - unsurprisingly - a lot of speculation about the mental health of new US President Donald Trump.

I'm no fan of Mr Trump or his policies. I find him genuinely frightening. However, as someone who's spent most of their adult life working in NHS mental health services, I am uneasy to see so many people commenting in public forums on his mental health - usually in reference to whether he has Narcissistic Personality Disorder (NPD).

I'm very uncomfortable with armchair psychology, but especially when it is reduced to some throw-away lines on twitter.

I'm also very worried about the scope for using mental health terminology as a form of abuse.

Of course, it's perfectly acceptable to look to make sense of someone's behaviour. Historians often do this retrospectively, using evidence from  a different time to suggest someone may have had a condition we now recognise as a medical problem. From Henry VI to Nicolae Ceausescu, historical figures have had their lives and achievements revisited to take account of likely mental health issues. Relatively recently David Owen wrote a book, considering world leaders including Tony Blair and George W Bush as potentially suffering from a "hubris syndrome". He brought both political and medical expertise to his work, and while I felt it unfairly judgmental in some respects, ultimately he was merely putting forward a medical theory. Should that be allowed? Should historians be permitted to speculate about physical health problems, while mental health is off-limits? I'm not sure I would support a "don't ask, don't talk" approach towards mental health, as if it should somehow be taboo.

But it is difficult - especially when mental health isn't so black and white and a great deal of stigma remains - and how we do it is of enormous importance. I'm reasonably comfortable with people questioning whether someone's behaviour is narcissistic, etc in general terms - I have more of a problem with people arriving at their own (public) diagnoses, however consistent a presentation may appear with the diagnostic criteria. We reduce both humanity and psychiatry when we do that. Those who make diagnoses about public figures can do more damage than they know.

I worked in both acute and forensic mental health services over 16 years, and have some experience of working with people with NPD. What I would say is that NPD is notoriously difficult to diagnose, and is rarer than people imagine.

It's not only on social media. This week a number of prominent psychologists have stated their belief that Mr Trump suffers from a "malignant narcissism". John Gartner described him as being "dangerously mentally ill and temperamentally incapable of being president"; Dr Julie Futrell believes “Narcissism impairs his ability to see reality so you can't use logic to persuade someone like that". While these people are undoubtedly expert clinicians, their public statements give fuel to others who use them as ammunition for their own insults on social media and elsewhere. So while their views may be informed, we should ask: are they helpful?

Added to this, yesterday House minority leader Nancy Pelosi has publicly stated she would support legislation requiring the President to undertake a mental health assessment. It should be obvious to anyone why that would be a terrible idea.

Equally unhappy at the NPD-focused conversations on twitter and in the wider media, psychiatrist Allen Francis has hit back in a series of tweets. Some of these raise very valid points, and are definitely worth repeating. For example, he warns that "instead of misdiagnosing Trump, we must analyze the societal sickness that gave someone so flawed the power to determine fate of the world", and observes that "calling Trump crazy also insults people who suffer from mental illness, most of whom are well meaning & well mannered. Trump is neither." So far, so good.

But he goes further, and insists that Trump has no psychiatric condition: "Constantly saying Trump's crazy wrong & misses point. He doesn't meet DSM Narcisssistic criteria (I wrote them). It's worse-he's bad, not mad".

So for Dr Frances it's open and shut. A closed case. Trump is pretty nasty. He's bad, not mad. All based, presumably, on his public appearances and statements.

The news article in Refinery 29, a US online lifestyle magazine, states that Dr Frances "wrote the diagnostic criteria for narcissism" - it's not quite true; he has never defined narcissism. He was part of the task force that helped to revise the framework for defining NPD (which has undergone several revisions). That's a significant distinction. No doubt it's possible to be narcissistic without having NPD, just as it's possible to be anti-social without experiencing Antisocial Personality Disorder.

I'm concerned about his response. Just as I am troubled about the kind of armchair psychiatry that positively diagnoses from a distance, and uses mental health related terms to insult and abuse, so too am I concerned that an eminent psychiatrist has weighed in, presumably without ever having met Mr Trump, to assert an absence of NPD. As he should know, NPD is notoriously difficult to diagnose. I have no doubts about his expertise and experience, but isn't he too guilty of making diagnoses from afar? Isn't this undermining psychiatry? Should health professionals be making any kinds of diagnosis of public figures on twitter?

I accept a lot of the points Frances is making, especially in relation to society, but did he need to go so far as to make a negative diagnosis? I don't know whether Trump has a mental health problem; he may have, he may not. He may need help, he may not. Bad guys can have mental health issues too. Ultimately, I think Frances is guilty of a similar "well meaning, but misguided" approach he accuses others of following - namely, of trying to destigmatise mental illness by public declaring that the objectionable Mr Trump doesn't have one. But at best it's an unprofessional approach - unless you sit down with someone and undertake a proper and full mental health assessment you have absolutely no right to speculate (publicly or otherwise) on their mental health, let alone make an unequivocal diagnosis.

For me, two wrongs don't make a right.

Ultimately, I think the problem here is how we view mental ill health. It is with dismay I see the words "personality disorder" used to insult and demean - or, even worse, used in a politically partisan way to depict someone as somehow less than human. That it's often liberals doing this, who honestly should know better, is equally worrying.

If we can strip away the stigma and it is seen as a health problem like any other, perhaps the idea of suffering from it will seem less offensive. A positive flip side would be fewer people using mental ill-health to abuse and insult others. We need to work to create a society - and health system - in which mental well-being is given parity with physical well-being, and in which stigma and discrimination towards mental ill-health are eradicated. In the meantime can we concentrate on resisting the President's destructive policy direction, rather than allow ourselves to be distracted by the question of his mental health?