Thoughts on Suicide

What I find hard to believe right now, sitting in the special treat of sunshine that you get on a mild October day, is that ending my life could at times be my only rational and powerful option. It seems like distorted thinking, like a madness, a malady of mind, but it did not seem like that at the time. I do not regret this journey, and I do not forget how I came to this point in time.Now is many years beyond what I could have had.

I am good at this front. I am not expected to be frail, and so my frailty is there in plain sight and unseen. I have no handle to hold on to, and there is no referral or follow up to make or avoid. I am capable. I am a white middle-class heterosexual male, middle aged, parent of heathy children paying my taxes, climbing a work ladder and, apparently a great example of dominant supremacy in society if all of the protests that I have supported over the years are anything to go by. If I told you I was going to kill myself you would find me competent, and there would be no grounds to deprive me of my liberty, despite my catastrophic intent. My inquest like so many others would record that even with the benefit of hindsight, there would have been little that anyone could have done.

But here I am. Proof that someone could do something to change my choices.

How many times will we be assured by the Health Board that Lessons will be learned? How many times is there evidence that they have? Evidence of change certainly, but evidence of impact – almost impossible to show.

What I would like to do is to find the words to describe my self management, and to explore how the lessons that I have learnt may be of help for others who might die at their own rational hands and who currently receive no contact that might help them as I have been helped. What I will shy away from is explaining how the list above of my unworthiness for special concern has shaped my self image, because although it may be pertinent to my particular case and perhaps resonate with others, it would spark another discussion taking me away from the central point of this blog. Suffice it to say, that many of the things that MH professionals might assure themselves as being protective factors, are for me, and for I suspect many others, the complete opposite.

I am not the same as everyone who reports or conceals, suicidal thoughts. I do not claim to be. However, I do believe that I have seen my same thinking in several of the people and many of the case histories that I have encountered, in my personal life, and in my professional life of 38 years mental health work. This is not a research paper, it is a personal blog that welcomes debate in comments if you wish.

The punch-line is the zero sum game.

I compete. It is my nature. Maybe some will say that they recognise that I am competitive, and maybe they are right. If there is a scale of competitiveness, then I am certainly on it rather than at either of the poles. It is my belief that by the common nature of living things there is a level at which all living things compete, and on the Natural Scale my species (and yours) is way towards the top as an apex predator. In this respect, with or without my personality, I am, at a species level, a competitor.

Every living thing competes for resources in a Darwinian way. Humans have taken this still further with complex competition at a social and economic level that blurs the fundamental basics of this competition. It is there though, hardwired into our life-force. The added social layer does not change my essential nature, but what it does do is add multiple and complex additional elements that I behave naturally towards (competitively) even though many of these elements are not of an essential life or death nature. Embarrassment, humiliation, unemployment, loss of friendship or contact with a loved one for example can be excruciatingly emotionally painful, but would not in a natural sense threaten my physical existence.

There are times in our lives when these two worlds (natural and social) collide, the birth or death of a loved one, the realistic impression of being in mortal danger for example, and at these times I am aware of my essential nature being engaged. I remember my first completely unconscious action on the birth of my daughter was to put her to my nose and mouth – I breathed her in. I remember the rage and frustration that I felt with the social/legal dynamic I found myself in when she was withheld from me years later. On both occasions I was not functioning at a social level. Her birth was a matter of natural fact, as was our good fortune in her existence. The same was not true (as it turns out) in the social/legal factors that followed years later, although it felt the same at the time and, on reflection, it engaged the same essential nature of mine.

What I find impossible to deal with, is a zero sum game. Like the point at which every child finds noughts and crosses a pointless exercise, is when they realise that their only chance of victory is a mistake by the opposition. There are times in my life where I have sincerely and reasonably believed that there would be no prospect of even an error in my favour, and on those occasions I review the only rational win to a zero sum game, which is the chose when to leave it.

There is some endorsement in some cultures for this view. I am sure some learned person can correct me on this factually, but from my stance, self euthanasia, or assisted suicide is a rational example of this equation. Some states support this, and permit it with caveat’s and protections, others do not, but the differences we have in law and culture at this visceral level of being do not take precedence for the person whose thoughts and volition are at the centre of the equation. In other words, I believe that despite different cultural resolutions to the equations the human motivation is the same. Other examples might be a situation where a child’s live birth would certainly result in an immediate and possible painful death, so the decision to abort is rational – whatever the moral or religious commentary on that might be.

And yet, here I am. I am here, not because I tried and failed, and not because I was prevented. I am here because I discovered my own user error in my calculations. No one gave me a reason to live. I was able to change my perspective.

This is not a one time deal, but neither is knowing how to achieve this. The more I have practiced, the earlier I can spot the signs, and the easier the adjustments to my perspective get. I have to acknowledge that discussing and discovering this with my partner, who is more objectively skilled than I am to spot the behaviours (my thoughts are my own) and the trust that I have in her judgement, are huge assets. I did not need sympathy or allegiance I needed a critical friend, and I was blessed to have stumbled upon one.

I wanted to put a list together, but the issue with that is that it appears to suggest an order or priority, and I can not agree with myself on what that might be. I am also aware that some, if not all of the elements can be, and perhaps need to be cyclical and simultaneous from time to time. So no check lists here, and that suggests the first thing to write about.

Checklists and risk assessments. – Bollocks

A bit harsh. I can see the value in training helpers to understand risk, and a value the research of the Centre for Suicide Studies. Plan your strategies from statistical research, but consider me personally as the only example of me.

I can see that a checklist can help a clinician to double check that they have covered things. But, in practice, these potential tools are not used as the scientists might wish. There is a fault with the definitions. The statistics can not be predictive at the level of the individual, so should not be used as if they were. There is also a major issue – surprising to the public who have great faith in Health Services, that staff do not understand key pieces of legislation as well as they should, and rely instead on policies that are no doubt well informed by the careful committee of authors, but which are not applied in an informed way at the front line.

Suicide, much in the same way as “Psychopathy”, is not a clinical term, it is a legal term. In the case of Suicide it is an adjudication of a Court following a death. It would be more helpful to me if we could change the language, while the person is alive, and agree on what the issue for them really is. Suicide, is a legal and for many also a moral judgement. What is that we are talking about clinically and socially?

Perhaps suicidal ideation will be several things, variants of self-harm and self esteem the classification of which might help untangle the mess of our statistics and suggest optimum approaches depending on the nature of the situation that the person is in.

Putting each of these excusable faults in series, the individual who presents for a service is really subject to blind luck that the person they meet has any idea about how to best help them. This luck is greatly enhanced of course by the core values and patient centric views of the professional. However this can leave the professional risking sanction if the blurred lines of what “should” happen get re-interpreted by an inquiry following an untoward outcome that benefits from hindsight. The best way that the professional can manage that risk, is to fill in the forms, and follow the process suggested by the policy, which in turn can lead to “The patient had capacity………….. “

Risk, is a probability calculation of the likely coincidence of causal events.

The rock-fall was certain, but the uncertainty of its timing is what mattered.

Since you have no certainty at all about the causal events of my suicide, and the dodgy statistics can only at best suggest my place on a scale of a demographic (and critically post-mortem) then you can not possibly best my own prediction of what my behaviour is likely to be. So, probably best to go with my own assessment, ie, if I tell you that I want to die, then please understand that to dismiss this as attention seeking, or a cry for help is both deeply ironic and a cruel messages to give someone who is vulnerable. It would be better, more often than not, to believe me. Believe that I feel like the best thing for me to do is to leave the game. Believe that I am opting to tell you in the feint hope that you can help me see an alternative. BECAUSE I WOULD LIKE AN ALTERNATIVE.

I have witnessed many sincere clinicians work through a static risk assessment form with a person who is in despair, and I know that they are achieving only two things. Firstly to cover the risk to the Health Board or team to demonstrate that due care was taken, and secondly they are alienating the person by profoundly demonstrating that there is no help for them to be found here.

I have not told you yet – perhaps I have not worked out yet, why my children, their existence and my role is the epicentre of my zero sum game. But if they are mentioned in assessment you put that simple demographic down in the column headed protective factors.

Human life is in fact pretty fragile, its easy to die – natural in fact. The fact that I have not made, or disclosed a plan to you is neither here, nor there – but your preoccupation with this is still further evidence that you simply are unable to help. Yes, I have tickets for the next Home Nations Game, and I can talk about future events ……….. So? Yes, I would rather not die. Yes, I told my GP that I had trouble concentrating, I have poor sleep and that I am agitated so he put me on a pill (that can often have these very same features as a side effect) but it is not your belief in my illness that will end my life. It is my direct action or deliberate inaction that will make it suicide. Your hoops and classicications serve you, not me.

Do you think that you could look up from your form for a moment, listen to me, be with me, and validate my sovereignty over my own existence?

My blood still boils after my retirement, for the shallowness of the systems that see so many of the “frequent flyers” of A&E departments as attention seekers, without any consideration of the human experience of the process itself.

Some times, during an evening of drinking to abandonment, taking an overdose, challenging authority in some way or simply turning up to A&E in despair, I might have chanced into a police officer, hospital porter, nurse, or fellow patient in the waiting room that simply bears witness to my distress and keeps me company, and that moment in itself is worth the trauma I have to go through to get it, and the abuse I experience in the way that it is resolved and dismissed. I don’t want the “help” that you are going to deny me anyway, but I keep coming back for the coincidental kindness that throwing myself under that bus (literally or figuratively) might bring.

Bless the Samaritans. We will never know how many lives they save, but their non-judgmental witnessing of a caller’s words or just silent connection, is a powerful tool in this dynamic. I know that many of the patients that I encouraged to call the Samaritans felt like I was fobbing them off and denying them the “fix” that I am saving for more deserving cases. Perhaps this is the consequence of the medical arrogance shown in Mental Health services that colludes with whilst actively denying a medical model for mental health, put alongside the human frailty of wanting someone to take the pain away, and the implicit “madness” (evidenced by a GP’s prescription) of my intent.

Who says that suicide is a Health Matter?

Suicide is not an illness, and whilst it is often associated with depression, it is not helpful to see it as a symptom. The language and crucially the expectations of health in the area is not helpful. The science, care, kindness and concern of the Health professionals is of course helpful, but the same could be said of police officers, strangers, housing support workers, Samaritans, Men’s Sheds and many others.

If suicide is a mental health matter, then Primary Care, and the public falsely hope that Mental Heal Services will provide management and a cure. Suicide is a Community, Family and Individual Wellbeing matter, as evidenced by the number of completed suicides each year where no health intervention was considered, and the multiple case examples where despite presenting in need to out of hours services of one sort or another, no health intervention was considered viable, and the person goes on to complete suicide.

Show me a win, and use whatever lens it takes to do so.

Accept that I am sincere and that I am reluctant but convinced. For many men like me, the tipping point was contact with my children. Not the simple absence or denial of it, but the futility of it. I was caught in a dynamic that presented me with no way to be the parent that I felt I ought to be or that I wanted to be, and I was powerless to do anything about it. I tried, of course (and anyone who knows me will remember my rage and my activism) but every effort simply reinforced the self-fulfilling barriers to my ambition. Every letter (and there were hundreds from CSA, Solicitors, Courts, campaigns etc etc), every car journey over the 260 miles of physical separation followed by the 260 miles back , every news story, every spare moment, and every penny was spent, apparently making things worse.

At a point where I realised the pointlessness of my real situation I was sure that all I could do was to leave the field entirely. It was the only expression that could not be denied me. Two comments broke through to challenge my perspective. The first was my new partner’s assertion that although she always wanted to be a mother, she recognised that the gift of parenthood was for ever, and that despite the concept of parenthood being largely directed towards children, she will be a parent for life, and that barring her death, she will be a mother for as long as her children live, and hopefully decades into their adulthood. Children, grow up quickly into adults, and if we are lucky they stay that way. She will always be their mother, just as I will forever be my children’s father.

If the game is “unwinable” play on another pitch.

If the game is unsinkable play on another pitch.

What father do I want them to find? I had new choices to make that were within my own influence. If I died, I will have deprived them of a father to come and find, and crucially, I will have left the narrative of my absence to others with other motivations and needs, that I knew were different to mine. So who did I want my adult children to find? Someone who was intact, committed to them, honest and reliable, constant and true. The few years that they had under the supervision of another (and sometimes untruthful) world view, was not the point, so it mattered not so much.

– Whohooooo – there you go, a protective factor some might cry. – But the protection is the perspective shift, not the simple existence of my children. This is also subtly different to someone beating me with the guilt that I have often heard offered to people in similar situations – think of your children, your parents, your friends (whatever) and the sadness/grief/anger/etc they will feel. That sort of comment simply made me feel worse. The change was one of perspective, based on my facts not some global statistical or sagely patronage, I was simply empowered to think about things differently.

I know that I am struggling to express this distinction, and it reminds me of a time in clinical practice where I had a similar struggle. A colleague knocked on my office door to check on me, and a “patient” as we were both kneeling on the floor of my office with our noses to the carpet and she was concerned (colleagues are like that in a medium secure forensic psychiatric hospital). The fella I was with sat up and challenged my colleague to tell us what colour the carpet was, and it was green. Obviously unequivocally Green. Ah yes, he said, but from right down here you can see the weave is made up of a whole range of colours. This fellow and I found a new language of zooming in or out from apparently stuck situations to try and discover the true nature of the weave, and he found that he could apply this principle to many everyday and life course issues, bring new and otherwise over-looked options for him.

Dear helpers, bring a selection of lenses, but they are not for you to look through, or to speculated in the Multi-disciplinary team with. Help me to look through them, and believe that I know what to look at.

I met an old friend, and we fell to talking about the time that we spent learning Karate together. Our teacher was an elderly gent of extraordinary character and ability. The only time either of us ever landed a strike on him (all the way up to Brown Belt) was so that he could demonstrate the counter attack. He was a little fella, slightly arthritic, but made of steel, with the apparent ability to move unseen. His greatest, and most enduring lesson however came to me in the pub. He was a dower northerner, who worked in the bus depot doing MOTs in the Hull bus depot, and as we drank, he told us a tale of a completely hopeless work based situation, the detail of which I forget. Having outlined the information, he sat back in his seat, and we both said But what are you going to do? ….. and he lent forward and said. I am going to have another sip (of his pint). Deliberately (I think) or otherwise he gave me a powerful lesson, of zooming in sometimes, one moment, one breath, one sip at a time, and the powerful factors that appear to threaten in the distance might well take on another form when they get closer to you.

Jack Thurlow was his name, and he also told another tale about a Third Dan Black Belt master of several martial arts disciplines that he had learnt under himself. One day this teacher had addressed an audience keen to learn from him and he had asked for questions. Someone asked the rather obvious question of what he would do if he was confronted in the street by two men armed with knives. Hoping, I guess for some preferred combat style, or even a demonstration. But the answer was simple. “I would be in another street” was his reply.

Help me to be in another street, or at least help me to understand that I could be, by my own volition.

I do not have THE answer. I have some answers that help me, and a sincere wish that services struggling with people’s suicidal ideation would attempt to be in another street, when they come to consider how best to address the issues that we face when thinking about Suicide.

Armageddon – The Basics

As a species, we’re fucked.

For a few more years there is a scientific theoretical possibility that we might be able to slow down the pace of our destruction, but I honestly can’t see that happening. The common but never-the-less accurate phrase of the forensic psychologist is “the best indicator of future behaviour is past behaviour” and that alone puts us soundly in the shit.

You do not need to be a scientist to work it out. In fact, for millennia the non-sentient species that we have shared the earth’s crust with have “known” how to behave, even those with only a single cell, but we, in our arrogance and hubris have got it completely wrong, and in doing so we have screwed it up for most of the other species, animal and plant, too. Nature’s (or God’s if you like) free-will experiment is due to end early in a massive fail.

Like so many other viewers I marvel at the complexity that David Attenborough narrates with such wonder. The Tree that contrives to have it’s seed planted up stream, by feeding fish. The zombie wasp, and so on and so on as we can marvel at just about any other species we study, and know that they have been living sustainably benefiting the whole for hundreds of thousands of years longer than it has taken us to destroy our natural environment to the point where now, we threaten both ourselves and all of them.

This beautiful freaky coincidence of energy, and chemicals that found us the winners of a lottery of incalculable, perhaps infinite odds gaining the prize of an incrustation of life on just one of the planetary blobs of the Universe – and we are part of its natural cycle – the part that this time around wipes out most of what we ourselves find wonderful, and we will have done it by choice.

A tree that can stand for a thousand years, grow huge and provide so much to the plants and animals around it simply by drawing up nutrients and harnessing the sun, will return much more than it takes and will eventually be completely recycled is a moment’s work for a logger whose grandchildren will die of thirst because of his efforts.

I saw a TV add yesterday for a home delivery company, that will now also be able to bring to your door the “vegan, Vegetarian and Organic” offerings form the fast food giants. So, you trendy fat lazy bastards who support the companies who are globally responsible for the destruction of so much of our environment can follow the social media trend and feel good about calling some poor dude on minimum wage zero hour contract and a bicycle to go and get a processed version of a vegetable based mass produced flavour bomb for you while you chillax after a hard day fucking up some other part of the environment to satisfy the Market. – The last nail on our coffin was right there being hammered home to me in HD. – WE are FUCKED. Dead humans walking.

All that is left for an old fella is to reflect on why, when, and what my Grandchildren might have to deal with.

I accept that for all of the wonderful species that have survived for millions of years (think cockroach, crocodile, grass, giant redwood, fern) millions of evolutionary experiments will have deceased and failed as their adaptive dependents have twisted their fate to adopt sustainable life. But it will be the distinction of Human extinction to also take out so many otherwise functional species as a product of our failure.

How does something so smart, do something so stupid?

For me, there is an irony, that we might have slipped into this unconsciously, through a perversion of our natural drives, making our subtle nonsense so difficult to see. I believe that we have orientated ourselves towards our Social Reality as it it was Natural and that this fairly successful strategy at first, has evolved and developed into the service of a substitute natural order – THE MARKET. I plan to abbreviate it to TM, partly so that it is easier to personify, or more accurately, to assist our alienation from it so that we can see it in another light.

TM is bigger than Man, it is a reason to be, it separates success and failure, where the strong survive and the weak perish. TM has appropriated much of the concepts and language of the nature. Markets grow, they thrive or they fail, they adapt, the branch out, they exploit new areas. TM colonises. TM is a social thing, it is a Political thing, it sustains our livelihood, it fuels our economy it finances our welfare. TM is bigger than the sum of its parts. TM is not cruel, it has no such concept – it just does what it does, red in tooth and claw. TM is our construct, our explanation, our responsibility, our socially constructed Nature.

There is plenty of debate about how Capitalism and Global Markets are to blame for everything, and I guess I sympathise with that, but my point is a little different, and I am struggling to find the best way of explaining it in a language and culture that has been mostly created within this Hegemony. (Which I suppose is in itself a proof of a Marxist Concept)

Try this….

Our essential nature and drives are the same as any other living thing, the thrive and reproduce. All other things do this unconsciously through a series of consequences and coincidences. The seed lands in the soil and not the path, and doesn’t get eaten and gets the right sun, nutrients and opportunity to flower and make seed – sorted. Humans are driven the same way – its natural. However our foremothers and fathers made choices, learnt from rehearsal, told stories to teach so that we did not always have to learn from direct experience but could through imagination learn vicariously, and there is a short step from there to persuasion, and we have already overlooked the inherent lie (by any other name) involved with imagination. So, through the generations we gradually move further and further from the simplicity of the seed, the cockroach, lion or wildebeest and towards a social reality through which we have encoded the same natural drives as the rest of all living things. Over a thousand generations (ie, not very long in Natural terms) we have reconstructed our duty to Nature into a social delusion TM.

We must thrive and survive through employment, trade, persuasion, governance and those who are best suited to that do best, reproduce, and reinforce the success model in a perverse mirror of Natural Law. In the short term (say 2000 years) this was indistinguishable from Natural success. Whoohoo look at us, the most populous and dominant of all Mammals but at what cost? We did not consider the relative stupidity of burning the earth that we stand on, or polluting the air that we breath or the water that we drink, or the multiple complex and sustaining importance of the habitat that other creatures creat and sustain. How could this be so? Because TM is not part of Nature, it is no more deliberate than Nature, it follows its own rules, just as Nature does, but unlike Nature, it pulls only socially constructed levers, to which we are born to consent. We are raised to this delusion, and because it resonates with our natural drives we struggle to see it in the same way that I am struggling to express it.

The Seed on the path, dies. The seed in drought, dies. The seed that is eaten, fulfils a role for the eater, but dies. The seed that thrives and flowers carries forward the species. The worker who is sacked, does not die, but the population of a failed economy might well do, no matter how brilliant any one of those humans might have been in another context. However, the context is socially determined, not Naturally.

The thing is that Nature is real, and all powerful because it is all things – so power is a bit of a human concept. It is what it is because it is everything. A single cell virus, the flutter of a volcano, a particularly strong solar flare, or some other natural sneeze shows no awareness or care for TM, because it is a purely human delusion, a genetic quirk of a short lived and damaging species, nothing more. The world will not come to an end when we hit 2 or even 3 degrees of Global Heating, Nature will not be destroyed, but we will.

On behalf of my species, I regret that we have not used our gift of sentience to understand our Nature and the Natural World that we are a part of. I regret that we did not spend our brief time on earth between Nature’s hiccups learning how to survive them. I am historically embarrassed that instead of doing this, we have used the interlude to do almost everything we could do over hundreds of years to bring about our own Natural disaster by influencing the otherwise temporarily stable Natural forces that have been so benign to us and the other life on earth that had the misfortune to share some time with us.

I will not be here to see it. But I sincerely hope that at least some of our species survive and that next time around we live in harmony with Nature and learn from those species that have already developed ways of living sustainably.

Hopefully next time, we will not get ourselves into a position where it is considered reasonable to use the internet and fake news to make critical decisions about who leads us, or where will will send someone on a bicycle to pick up our trendy over priced and over-processed food.

Markets without Capitalism? – another perspective.

The song I will be singing is a simple one, but one which we have been trained not to hear. I want to listen again to the real natural tune of our essential nature and harmonise once again with the world. To me it is like we are the cocky Tenors who have become so carried away with our version of a descant that we have completely lost the important elements of the tune itself.

If you think I’m sexy just reach out and touch me come on baby tell me so…..

I’ve been listening to some of the stuff that Yanis Varoufakis has said in lectures found on youtube https://youtu.be/9aK4OztueuE (Markets without Capitalism) and it left me cross and unsettled. The fellow is charismatic and plausible, I am sure he is perfectly correct in his study of Economics and stuff – he is a renowned professor, and a Greek Politician (yes I was surprised that anyone in Greece has economic expertise too), other traits are reminiscent of a check list of traits that I am very familiar with found in various world leaders, lawyers, psychiatrists and psychopaths of all proclivity. We will follow them; it makes us feel good to do so, and we will overlook their grandiose sense of self worth and their unrealistic goals for the privilege of their company.

What got me so riled was not the beautiful way he played the crowd of self selected impressionable followers, or the lack of challenge so kindly engineered by the hosts, but the arrogant certainty that he could be so careless of the logic of his position, safe in the knowledge that none would disrespect him enough to actually think about what he was saying. He dreams of a market system without capitalism – a sweet dream. But the thing about sweet dreams is that it is best to leave them in your unconscious mind. To bring them into reality brings also the awake name for such things which is delusion.

If you think I’m sexy just reach out and touch me………

It is the same magical oversight that human society is prone to. Prisons, for example, work as an excellent deterrent for non-criminals, but for the 65% recidivist occupational criminal who commit the bulk of crime they are a sometime inconvenience. If we want to design a criminal justice system, we should include the nature , context and values of the criminal, and not simply rely on the concepts of the intelligentsia to consider what ought to be right. Similarly, designing a Utopian future based on a passive acceptance of a new order, with no rule breakers, no profiteers no account of an environmental emergency, flies in the face of thousands of years of history that betray these traits as part of the human condition.

So here is another model.

What if we try and understand what has been going on for the last 6000 or so years from the context of the human as just one of many species animal and plant that have certain traits in common. We want to thrive, reproduce and survive. Humans, like so many other plants and animals compete for resources, and compete for mates, and in this way Darwin and others describe the facts of Nature. In the animal kingdom it tends to be males competing for the attention of females- which of course makes perfect sense. If you have a thousand females and three males you have a sustainable species, a thousand males and three females and all you have is a bloodbath before extinction.

Males of various species have refined their mating rituals to some extraordinary degree. Birds of Paradise are great examples of this, but essentially it is so common that you can find your own examples in any of a thousand wildlife documentaries. Over generations the males are gradually selected for their ever increasingly complex mating displays with some quite spectacular and occasionally bizarre results. All that can happen with creatures and plants that we consider to be without free will. Chimpanzees and some other primates develop complex social organisation as that assists with the mating pecking order and also helps the family group thrive and survive. So how much of a stretch is it for us to see ourselves in this same light?

If you think I’m sexy, just reach out and touch me, come on baby tell me so……..

Humans are no different, except perhaps that we have evolved much more complex lies. These lies were at first very useful and gave us the competitive edge we needed to survive against far more ferocious prey. We were able to imagine and then communicate and use these skills to learn from others failure, rehearse and train. We told lies as stories with a moral, and by engaging our imagination we could learn from hypothetical as well as actual experience. A friend of a friend tried such and such, and the outcome was death/success/etc. The more real and engaging the teller the more influential they became and roles devoted to this variable talent evolved. But as well as the constructive didactic lie of the story teller, there were other uses for influence that also enhanced or inhibited standing, survival and success, and so, in a woefully inadequate paragraph culture is seeded. Education, and Politics are functions of survival, competition and bind our common needs to thrive and survive with competition and our base nature. But, (and some have said it’s thanks to a fish diet) we were good at it. We were so good at meeting our base needs that we had time to indulge our playfulness, and time to concentrate on our social constructs as well, for better and for worse. Our mating rites remain the same, but the context of the dance that we developed included new features

If you think I’m sexy just reach out and touch me………..

What if we consider the whole of our society including economics, markets Politics and “power” through this obvious but somehow humiliating lens?

Why?

Because as we have so often been shown by Nature – no matter how smart and different we think we are, we are still after all living beings stuck on the crust of a spinning rock that has some possibly unique atmospheric and chemical properties drifting in space. The wind blows hard enough, and we fall down. The earth’s tectonic plates shift a fraction of an inch and the resulting tsunami washes away our Nuclear power stations, a volcano burps and we cant fly our aeroplanes for weeks, a bat coughs in a wet market, and a million humans die.

So we told some stories and illustrated them on the cave walls, we learned to survive the hunt, to fish, to propagate our food and to create a surplus – good times! We had more time for stories, and we learned to trade, we told lies and gained influence and so on for millennia……

If you think I’m sexy just reach out and buy me come on baby tell me so….

The lies we tell become social constructs with their own social reality and their own social consequences – which, to be fair sexy Yanis (above) acknowledges. This has gone way beyond competing to mate and survive, the social constructs have completely overwhelmed our understanding of our real nature, until of course Nature burps a virus, flood, storm, draught, volcano etc, or; just as likely the real consequences of our delusional social reality cause global warming super-charging all of the natural elements of our frailty. Now we are in the somewhat bizarre arena where our lies are about lies and we can no longer agree on what our constructed truth is.

If you still think I’m sexy just reach out through the Facebook algorithm and I’ll tell you so….

So, No Professor, just no. There will be no Capitalism without markets where everyone plays by the rules and we all eat motherhood and apple pie. The cruelty and excess, the unfairness and inequality, the competition and the non-compliance are in our DNA, they are our nature, and any solution that we must adopt as a matter of imperative for the survival of our species has to accommodate our essential nature in a way that does not compromise the integrity and sustainability of life on earth.

For anyone who wants to see a dramatisation of Yanis’ model I recommend this worthy documentary

The globalisation of markets, has moved us far away from the sort of personal relationship of the entrepreneur and the proletariat to a point where raising a people’s army and seizing control of the State, just simply will not work, not least because the State does not itself control the market, so all you would gain control of is the responsibility for orientating the people to the market. However, unlike the state the people themselves actually still retain some collective power (through demand) over the market. The mission has now to be to raise a peoples consciousness and seize control of the Market through the organised demand for goods and services that will lend themselves towards a sustainable future for our species. We have the technology, and the ingenuity all that we lack is the awareness and the organisation. (no small things I admit).

Some thoughts about Social Prescribing and the Primary Care Liaison Service

Firstly, what is a social prescription? 

Social seems fair enough, but how does it link with prescribing? I suspect that the use of the word conveys a medical instruction. “Take this, it’s good for you”.  But in this respect it is an oxymoron, since the core value of social prescribing is to contrast with a medical model and distract from the helplessness of a patient role towards a more meaningful engagement with social and community experience that will address whatever imbalance has contributed to or arisen from the well-being need of the citizen. A prescription is an instruction, to the pharmacist, and to the patient and is rooted in the “Doctor knows best” doctrine. However, the success of social prescribing rests on personal and community responsibility for addressing matters where, in fact, the doctor does not always know best.  

On the other hand, I concede that the reinforcement and credibility of the term can be a strong motivator for a person who is ambivalent or uncertain, or someone who simply needs the reassurance that there is some science behind the suggestion that they go to a gym instead of taking antidepressants. What’s in a name? – well, if there is merit in the power of the word prescription, then clearly language matters, and in that case my position is that continuing with this oxymoron is feeding the problem, and we should try and influence the language as it can either support or undermine the drivers for success. 

So, what’s the problem? 

There are layers to the problem. The perspective from which it is seen emphasises different elements and agendas. My issue with the term prescribing, is not so important at the patient/service user/citizen level, in fact it might be helpful, but at a more National or Policy level, I believe including all the associations that underpin prescribing are fundamentally incorrect and unhelpful to the National mission. This is a question of ownership, patients are unique to Health services and more or less to the NHS. We should not, even obliquely, assume ownership of a problem where we are not the main agent for change. Clinical services definitely have a role, in assisting the citizen in formulating their problem and I hope in supporting and assuring the Social and Community groups who deliver social prescribing. I want to consider the layers, of Government, NHS, UHB, PCIC, UHB Secondary Care, GP and citizen.

The effective closure of business as usual for the NHS in 2020 because of the Pandemic, and the effect on the community of Lockdown has forced us to address a pre-existing imperative to transform our communities into resilient and sustainable places to live work and thrive. Everything has changed, and we can invest in returning things to as near as possible to how they were before, or we can seize the natural step-change opportunity that hitherto has only come about through World War.

We can let the Pandemic, lockdown and the inevitable world-wide recession distract from the clear warning of how fragile our species is against the force of nature, or we can embrace it as an opportunity to address our sustainability needs for future generations. With or without Covid 19 or future variants, our unsustainable use of natural resources is bringing us to the brink of a much less survivable natural crisis that will dwarf the effect of the lockdown and pandemic even though these events have given us a mild dress rehearsal, as well as ironically shown us what some of our actions must now be. I am at risk of going off at a tangent that can be found in other blogs. The point is that along with a challenge there is always an opportunity, and we need to be brave and take the opportunity to change rather than the false but comforting hope of some sort of return to a nostalgic idea if the way things were – because frankly, they weren’t that good before. This is not a new agenda, but it can be a supercharged one as right now the community and all of its institutions are in a state of flux.

The problem is that Primary Care is one of the only open doors left on the high street, and that the impact of many of the issues that challenge citizens can, and do, get described in terms of symptoms. The language of the GP surgery is one of illness. I’ll tell you what’s wrong in a way that I know you will understand, I don’t want to waste your time with complaining about my neighbourhood, or my partner, so I’ll tell you what is wrong with me, and you will fix it.”

So, I go to the Doctor and tell them that I am low in mood, that I cant sleep, I binge on unhealthy foods, but my appetite is generally poor, I am drinking more than I used to and I am irritable and unable to concentrate. Hmm sounds like depression, and so it does, but what I haven’t said is that it is an issue with the neighbour’s antisocial kids that is leading me into this helpless and hopeless state, partly because I have already taken 30 of the 10 minutes that the GP has for me and I don’t want to be that person that the waiting room glowers at when they finally leave room 4 with a piece pf paper in my hand that has the answer on it. Truth is, that it is depressing to be put into a helpless and hopeless position, I’m frightened of repercussions if I try and raise the issue again with the lads in the courtyard, and anyway it is only likely to make things worse, so taking something to calm me down might be the best way forward. Clinically, this won’t help, medication will not address the anti-social behaviour, and becoming a “patient” won’t help me to help myself, or the other neighbours who also must be getting disturbed.  

The problem is that I had no one else to raise this with. 

The problem is that the help I received was not based on the whole situation. 

The problem is that after all my self pity and the sense of wasting the GP’s time, they did not have the time to have the full conversation with me, pointing out that the medication will only offer me a window and a little respite from my symptoms, through which I can find a way of addressing the factors that are really driving my mood and outlook. 

The problem is not a medical one, but it has just become one. I will go back as requested in two weeks time, to see how the medication is suiting me, at which point I will discuss the medication and not my situation, and when it seems that the medication is fine, but I’m still not feeling the benefit, I will accept an increase in dose, advice on it being early days and another appointment in 4 weeks time at which I will again talk about the medication. (and repeat sometimes for years) 

As a GP, I am very familiar with this presentation, I have not been told, but I know anyway that the patient whom I have rarely seen before is most likely to be suffering from some change in social circumstances, but they are presenting with symptoms that I feel that I can offer some help with. Roughly a third of my patients on the list today will be similar to this patient and I will try to spend a little longer with them next time they come in, but what I can do today is give them the confidence of a remedy and start them on something that will help them manage their symptoms. I know that there is no chance of their being a secondary care response to this presentation, and nor should there be. I did have a discussion about risk and I am pretty sure that the patient is not an active risk to themselves, so I will ask them to come back in 2 weeks and see how they are getting along.  

I feel so helpless, because this is not sustainable, in fact the next patient in is someone that I saw two weeks ago, and I have just set myself up with the same scenario with the last patient. The patient after that is someone who has been on the same medication for three years now, and when I try to suggest talking therapies to them they decline, or point out that they waited 12 months for their 6 sessions a year ago and “things” are no different. I wish I had the time to get to the bottom of it, but when I have, I inevitably find out that there is nothing in my sphere that I can do about it anyway. I wish I was sure that the next patient who is really fixed and concrete in his thinking and rarely makes eye contact is on the autistic spectrum and not in the early stages of psychosis, but I have to wait until I have good evidence for a referral to anyone who might be able to tease out the difference, and in the meantime I have to see his condition and his position in the community deteriorate.  If only there was a blood test or a scan that could clarify the matter. It isn’t either my specialism or my role, but despite that he remains my patient and I will do my best for him. 

So, I’m due to chair the CD Forum, which is a meeting of all the heads of the 9 clusters of GPs that offer primary care to my UHB. Legally it is my responsibility to provide this service to our citizens, and I discharge this duty by commissioning services from individual GP practices. I am UHB through and through and I share all the demands and commitments of the NHS staff elsewhere in the UHB, the concept of the patient being at the forefront of all that we do is just as strong for me and my colleagues as anywhere else in the UHB, however the tools that I have are organisational not clinical. In fact the main levers I have to pull are the elements of the GP contract that varies the payments to GPs according to targets that we set locally based on the returns that the Government demand from us. We are big business, many millions of public funds, and we manage indirectly the foundations of the UHB. The real NHS starts with us, although sometimes it feels that the expensive clinicians and services of the more dramatic and conspicuous directorates have the monopoly on the NHS Saviour image. If Primary care fails, it does not matter how fancy or smart the theatres are in the hospitals, and the problem is that Primary Care is beginning to crack. Locally each GP is allocated hundreds more members of the public than the Royal College recommends. GPs over 50 are leaving for retirement in droves, and those that remain are unsatisfied, vacancies are almost impossible to fill, and the reputation of the hard working GP which is so very true, is not a big recruiting principle in the Medical Schools.

The Welsh Government is chewing at the Chief Executive, and the Chief Executive is chewing at me to support the GPs, but these are staff that we neither directly employ, or manage. Some practices are well run businesses, and some sadly, are not, but all I have is the supportive intermediary staff that work alongside them (Health visitors, midwives and others) and the strings of our contract. We have done what we can with supportive meetings sharing best practice, with initiatives such as funding community pharmacist, but the simple truth is that we have no mechanism for adding GPs and our population in the City is expanding at a higher rate than the rest of the Country put together. What we are doing is trying to find innovative ways of supporting Primary Care from UHB resources without breaching the separation between us and the right of the GP practices to run their surgeries as separate entities.   

We can see that roughly one third of GP appointments are for patients suck in a primary care loop, and these patients tend to be for Mental Health and MSK. There is a raising of awareness in the general population about mental health issues, and whilst this has gone some way towards fighting the stigma, it is also giving rise to a service demand that can not be sustained under the current ways of working, and the problem with that is that we do not have a direct line management over the ways of working. I would note that MSK, and Mental Health are also both conditions where there is rarely an independent objective verification of the presence and the degree of the disorder, and at the risk of being accused of being pejorative and mistrusting, I would simply note that as sickness policies and Benefit agency scrutiny have become more stringent, the number of people presenting for fit notes for these more difficult to rule out conditions has risen. I will not go so far as to suggest causality in this correlation, but suffice it to say that with changes in the mechanisms within the community, there is a change in the demands on Primary Care, and as we look into a post Covid future, it is clear that many of the drivers for presentation to primary care are being supercharged by the effects of Covid, lockdown and the resulting economic recession.  

Given that Covid is now endemic we are in fact post Covid now. It has happened, there will not be a time when it has not happened, I want to learn from it and celebrate the learning and engagement that we have achieved. Frankly, I have been trying to suggest that GPs could use the phone more with patients for over 20 years, and in the first two days of lockdown – that message got through, along with video consultations and virtual business meetings that do not take GPs or other staff away from their duties all afternoon while they try and find parking at HQ. There is no going back, Covid must change things. The grand gestures of the Dragon’s heart Hospital and other incredible feats were all very well, but once the biological emergency is tamed (perhaps by a constantly cycling mass vaccination program) then the real social impact of the Lockdown, loss, isolation and economic depression will have much longer and more insidious effects on primary care – and these effects can be modelled, understood and planned for.

From the perspective of Adult Mental Health, we need the GPs to stop making speculative referrals. Covid is not known to be a cause of serious mental illness. We accept and understand that the social factors that have stressed every member of our community might have a disproportionate effect on those who already suffer with a serious mental illness, and that in itself has increased our work load. Secondary Care is not there to heal bereavement, fear or isolation. Currently we “bounce” back around 30% of all referrals to UHB services from Primary Care because they have either not tried everything that they could have tried before referring on, or because what they are referring is significantly below the threshold where secondary care would be required.

We are aware of a huge number of other options that can benefit a citizen’s well-being, including Primary Mental Health Support under Tier 1 of the Mental Health Measure for Wales, and it is frankly a little disheartening that we need to dedicate so much of our clinic time towards managing these referrals. We do not simply bounce a referral, we will always write back to the referrer with our best clinical advice. We are under resourced, but if we could divert the time spent on inappropriate referrals into direct clinical care we would be much better equipped to deal with the patients that we serve. 

(There is no common and regular platform where GPs meet with Psychiatrists in their secondary care team, and there is no real obstacle to that either. When I managed a CMHT I found it easy and welcomed when I set this up but it was not a practice that spread across all the teams. What I had no idea about when I was sending out carefully worded advice back to the referrer was that it was not on the whole read by the GP who wrote the referral, and it was only if or when the patient came back to see the GP that the advice could have a chance of getting through to the patient. I was also blind to the fact that our clinic letters were not routinely copied to the patient – I did this, but I assumed incorrectly that my staff did too. The patient’s experience of this is that after sometimes years of treatment by the GP they finally say that they feel that they would benefit from a psychiatric appointment – which the patient hears as a Psychiatrist, then in the case where the referral is “bounced” they might never hear anything else until months later when they think to chase it up during a GP appointment sometimes for something completely unrelated. In the case where the patient is assessed but not taken on the patient experience could be just as bad. “The GP said that I was going to see a Psychiatrist – a pretty scary prospect but at least they are at last taking me seriously, however I was assessed by an OT and a Nurse  who basically told me things were not so bad, that I had to change and that there was a group in my local church hall run by the UHB that is free and will teach me how to live life to the full!. The Health Service is in ruins and only my GP is taking me seriously  – so I will stick with them”) 

As the Chief Executive of the UHB I am determined to leave a mark and drive forward the Government’s and our Board’s agenda for modernising the Health Service. No longer do we need to be a hospital based service, we need to bring forward agendas described in the Social Services and Well-being Act, and I need to find a novel way of propping up Primary Care or the whole thing will crash down around my ears and that is not going to be my legacy. If I consistently fail to achieve this I might be taken into special measures and directly managed by Government – effectively ending my career. I can not make my systems work any harder – so I have commissioned a management consultancy who have told me that I need to work smarter and count things differently. I am well aware of the lessons from Staffordshire, and I am ripe pickings for a charismatic sales pitch that helps me see things a little differently. I already know that despite the partnership talk, I have ten times the budget of the Local Authority and only a fraction of the legal duties, so I will have no chance of bleeding my services into theirs. All of my Directors who head up the various Directorates are pressing for change, but it seems that they also want to keep things the same so basically they end up pressing for more resources, and I have no more resources.

Step change is nearly always what I am forced to do because step changes come under Capital Costs with a business case and often a budget to chase directly from new funds released by the Government. I know that incremental change is more sustainable, more easily accepted (if noticed at all) and more resilient, but I don’t have enough funds to run the existing services let alone fund incremental training and transitions. Covid and lockdown has had its benefits, I have been able to show true leadership, the Govt has opened up sensible funding streams and all services have demonstrated that they can change positively when they need to. However it has also undone 10 years of work on waiting lists, my front line staff are exhausted and the pressure on an already fragile Primary Care service is intolerable.  

As it happens the shift in emphasis from hospitals to community, might also open up new avenues. If I cant make my net any bigger, then I need to reduce the size of the catch, and so I am supportive of schemes and services that divert citizens from relying on health for a passive answer to their problems, not least because at this rate we certainly will not be. One good example is that fit people tend to have better outcomes from secondary care services such as surgery, so I have coined the phrase “pre-habilitation” and lent my weight to schemes that have set out to prepare patients for their procedures. Telling bariatric patients that they have to loose weight before we will give them weight-loss surgery has never gone down well, but sponsoring a free bike rental service gained world-wide press approval – same message, better handling.

The Welsh NHS has occasionally put clear water between its approach and the English NHS and during Covid in particular the benefit of its proximity to both Government and UHBs has been apparent. It is looking at the next chapter and it is seeing the writing on the hospital walls. Strangely it is in a similar position to PCIC (Primary Care Directorate) in terms of having the responsibility or Duty but not having the line management of the delivery of its services. NHS response is carrot and stick, audits and reviews but also best practice sharing and genuine support for innovation. One such innovation is the advent of social prescribing, although it feels so insecure and unregulated, so these relationships are hard to negotiate – which is why the permissive messages coming from the Welsh Government are welcome.

The Welsh Government was the first in the world to establish a Children’s Commissioner, followed a couple of years later by a Commissioner for Older Persons and a couple of years after that by a Future Generations Commissioner, and they have backed that up with suitable legislation within the devolved powers that they have been given by Westminster. The Mental Health Measure Wales, is a practitioner’s and a patient’s charter, eminently reasonable and a blatant attempt to try and legislate for best practice – with some limited success, particularly in terms of ensuring that all UHBs have a provision for Tier 1 Mental Health Services standing it is thought between Primary and Secondary Care in a sort of Governmental fantasy of how the state would do social prescribing. But they know that this is not social prescribing.

The Social Services and Wellbeing act achieves a great deal of clarity and lends weight to the duty to integrate and enter into partnerships as well as the responsibilities of citizenship that are threaded throughout the act. One issue with the SSWBA is that many NHS services seem not to know anything about it and get no further than the first three words of the title before putting it down relieved that this is for the Social Services, so in some ways the language is a bit too forward thinking for health and it has missed its mark. Then comes the Future Generations Act a beautiful and powerful tool that basically rules out any significant change in public services, or infrastructure unless it can be shown to have incremental benefit to our future as a community and as a Nation. In my mind this is a world leading top of the tree piece of legislation, with smart teeth that encapsulates some of my pride in my Nation. I say smart teeth because it presents a procedural obstacle to development contingent on compliance rather than some expensive and elaborate regulative process, saying there is only one way forward and that is to consider the future and to enter into local partnerships with our citizens. – Awesome! I hope it lasts long enough to have an effect. The impression I get is that the Welsh Government is in fact more forward thinking and needs led than the UHBs, more permissive and supportive than the requests for help demanded by those who might well want to preserve the status quo.

What this means for Social Prescribing is that any commissioner/advocate/innovator/change agent can find a legislative support for their innovation if it is mindful of the core principles of the Government’s thinking which is very clearly laid out in these pieces of legislation.  

The solution? 

You will not find a simple solution to a complex problem unless of course you re-frame it, and the telling point here is the Chief Executive’s perspective in which they suggest that we find ways of reducing the size of the catch if we can’t increase the size of the net. 

1. We know that around a third of GP appointments are dealing with matters that despite custom and practice, they may not be the ideal first port of call even if they might well be able to play an important supporting role. 

2. The patient in Primary Care is voluntary, and also highly motivated. They came for help – a really good start. Currently many believe that they are getting help, but clinically we know that in many cases the medical approach is mostly containing the symptoms until either the circumstances for the patient, or the patient themselves changes, and in the meantime, they will keep coming back. 

3. Patients tend to present a little differently to mental health professionals than they do to Doctors. That is a bag of worms as a statement and is often a factor of perceived social standing and our willingness to please high-status individuals. Many consultations start with an apology for taking up the GP’s time – but there are many other worms in this can so I am not going to distract in that direction. The fact is that the patient above is much more likely to tell a mental health nurse, OT or Social Worker about the neighbour’s anti-social children than the doctor, either because they volunteer it or because the MH professional will think to ask. 

4. Patients trust the doctor as a default, although this can be a diminishing return if they appear not to be able to assist. 

5. We know that many of the referrals into secondary care are for an opinion rather than for a full blown service, but that currently secondary care are addressing this as a gatekeeping issue rather than a demand for outreach. Mental Health is one of the few presentations for which the GP has no specific training and no routine diagnostic support from objective measures, which means that around 80% of mental health/well-being presentations to primary care are managed by the GP without the benefit of specialist expertise – no wonder they will occasionally refer and be dammed.  

6. I know from my own journey that Secondary care often doesn’t know what it doesn’t know about Primary Care who are a black box which fires off referrals.  

7. There is legislative support for communities taking responsibility for themselves, there is very often money in the form of grants behind this and many charities and community groups have established themselves with very powerful motivation to address issues or share success in a model from their own direct experience. 

8.  There is a comfort in “patienthood” for the citizen and for the doctor, but it comes with a dependance and where that is constructive that is a cost worth paying back through careful discharge, but primary care patients are not discharged – how could they be – which then makes their patienthood potentially a much more pervasive experience. Make me feel better is fine when I have a ruptured spleen, but not such a clear-cut deal when I simply can’t live happily with the life choices I have made or had to accept. 

9. If we could increase the number of GP slots we could improve the efficiency of the whole of secondary care, not just Mental Health, but all aspects of diagnosis and treatment supervised or commissioned from Primary Care into and out of the NHS provision. 

10. Citizenship is a powerful therapeutic alternative to patienthood in mental health, and also I suppose in diabetes, smoking, weight loss, blood pressure etc. Beyond ageing,  genetics, bad luck and accidental injury; the biggest risk to our wellbeing is the way that we live our lives, physically and emotionally. The balance of power between the State and the citizen is often thought of in terms of the democratic processes, but it can also be considered in terms of our responsibility for ourselves v’s our responsibility towards others. Who should first care for me? Who should first care for my family? Who should first care for my community? These are my responsibilities and I must attend to them to benefit from my rights, not perhaps as a conditional arrangement, but as a nation’s mutual and moral stance.  

11. Owning my problem instead of packaging into the patient contract, is clinically more productive, effective and sustainable. There are of course many problems that are beyond my skill or understanding, but I often reflect on my different stands between renting a property and requesting that the Landlord fixes the sink, and owning a property and choosing to have a go first before I call for a plumber! Citizenship is self-ownership in this dynamic and in this respect social prescribing is predicated on that as a principle rather than the attitude of many patients towards both dentists and GPs who often present like a tenant to a landlord with the aspect of a maintenance contract no matter how they may have misused the person in question.

12. What I am edging towards is public mental health and community policy. The wellbeing of our citizens is not a health only priority – so it is not a health only issue.  

The Primary Care Liaison Service is not well named, because it would be better described as an opinion rather than a service. Over the past 18 months our UHB has been providing secondary care trained mental health practitioners to work in GP practices to help carry the weight of the Mental Health presentations, not by delivery of brief interventions in the terminology of the tiered mental health services, but much more in line with the “What matters” conversation described in the SSWBA.

In the terminology of this blog, the ideal is that the patient walks in to a consultation and leaves as an aware citizen with a good idea of who they can call on for support in their recovery journey. Often they find that they are not in fact ill, but their situation is out of kilter and re framing their expectations or experiences, or providing them with the leads that they needed to recruit the support they might need is all that it took. Many times, they find that the disorder or malady that they self reported is not the mental health perspective of their situation and are greatly relieved and supported by a new perspective alone without further intervention. These workers are the conduit or perhaps babel fish between Primary and Secondary Care, helping the GP to identify the most productive referral, and phrase it in such a way as to properly capture the secondary care attention to make for a more productive referral regime (in both directions).

These workers are also the in-house support to the GP, helping to share and double check positive risk taking and to see the wood for the trees with some very confusing presentations, as well as un-sticking some cases that appear to all involved as being stuck by offering a new perspective. It is the responsibility of the MH professional to keep abreast of community projects and developments to signpost citizens to where they will find the resolution of the issue that might have been driving their well-being concern. The team fund community based guided self help in the charity sector, and are networked with many local groups outside of this direct commissioning from barbers who can talk with distressed men, through to flower arranging, faith groups, gardening clubs and football teams.

The PCLS is not the answer, but, they are certainly part of the answer. They offer between 30-40,000 appointments per year as a direct alternative to a GP appointment, releasing therefore the same number of GP slots that can then be reinvested into helping others, but without impacting on the essential terms of the GP contract or challenging the surgery’s sovereignty over their business.  

The success and the face value common sense of the PCLS is a little deceptive, and we have seen other UHB’s attempt to replicate in in line with their local circumstances, however the key to it is often mis-judged, because the key to it is who owns it.

The staff are under the employment of the Adult Mental Health services, and if that was a matter of ownership then before you knew it their role would inevitably morph into servicing the needs of Secondary Care. “Since you are there could you triage our referrals, or offer step down from CMHT or any number of other issues that ultimately would concentrate on the 20% of patients that go into the UHB services and who have a clear “Caseness”, leaving the 80% still in the lap of the GP.

If it were owned by PCIC it would go a long way towards meeting their needs, but the staff would soon go native and be orphaned from their Mental Health roots “Why don’t your staff qualify as prescribers?”

If the PCLS were owned by the GP Clusters, then it would soon morph into an alternative to CMHT with staff doing home visits, carrying cases and undertaking soft medication reviews. “Doctor X started you on an antidepressant two weeks ago and they asked me to contact you to see how the medication is treating you.”  

Instead the PCLS sits sometimes uncomfortably, but in my view essentially between these three huge powers and attempts to fulfil the promise given by the Chief Executive, directly to GPs to support their sustainability- and perhaps in time to fulfil his fantasy of a smaller catch. 

Social Media The Good the Bad and the Ugly

I have written before about the effect that the Global Market has on our environment, and our democracy, and I have cited Social Media as one of the key facilitators of the harm that is being done. Having just watched The Social Dilemma produced by the Centre for Humane Technology I feel that the properly qualified scientists can, and have evidenced my hitherto speculative philosophy.

There are ugly moments of doom in this documentary which, for me at least, provides shocking confirmation of my worst fears for humanity in the decades to come. So there is good and bad news.

The bad news, is that it seems pretty much a certainty that we are becoming more and more divided, as we tumble towards the chaos of our extinction and that our finite time before it is all too late for the majority of our species will not be spent drastically attempting to survive and repair, but doing the complete opposite, tearing each other apart. Our democratic processes will be unable to address this. Our understanding of even the most substantial facts will be unreliable and disputed and we will be without a reliable touchstone as arbiter. They accurately describe how the “users” are in fact the product of of the industry of personal data and behaviour prediction/manipulation, add this together with other human behavioural factors such as our vulnerability to addictive behaviours to produce a compelling well reasoned and evidence based proof of their concept. I am not writing a film review, or a critique of the documentary, but I would strongly recommend that you see it for yourself before reading on.

The documentary suggests some mitigating actions that we can take as individuals, and as communities, and they offer various tool kits on their site, but admit frankly that they have little optimism for there being substantial change (necessary for our survival) without considerable social upheaval ie local and global conflicts. However, I feel that they have overlooked an element of our human psyche and an element of the Global Markets that add up to a slither of hope and suggest to me at least a possible alternative.

The good news is that the Global Markets, and the decisions made, along with the mechanisms that Social Media provide to maximise the Market’s utility and function is not human, non-sentient, artificially intelligent. It literally does not care. – WE DO.

I’m thinking about a game of monopoly. A game that is strangely addictive, that many families will bring out at holiday times as the family board game. It is a game of pure (ish) capitalistic ideals. If we play it to the rules, six players will become five, then four, then three, and eventually two, who may be stuck in a stalemate, or sometimes will become one. We nearly all know the dynamics, two of the less successful players who reluctantly join in but really just want to have fun will cheat. One player will develop a form of mutual support bond with another – but it will not be an equal partnership and one will eventually buy the other out with good grace, but essentially the same effect as the other two players who have taken the whole thing terribly seriously and are at each other’s throats duelling to the death and crying fowl reading and re-interpreting the rules and so on for hours of attrition till the end. The end, is an end in which one person gets only the satisfaction of owning everything – on their own – and the game stops. No one benefits, no one gains anything the economy of the board implodes, and as we stack the notes, and sort out the cards for the next time, no one knows why we thought it was worth doing anyway, but they will do it again next year.

The rules, are the fundamental principles of the game and in following them we are absolved from our unkind and ultimately unsustainable behaviour to our friends and family. This is distressing for many of us – but its only a game others will say. Many families will seek to adapt the rules to even things out – but all that achieves is a pointless un-ending game that agrees to simply stop. There is no point doing it of you don’t follow the rules. The rules – don’t care, they don’t know me, they don’t know any of the players, they don’t think, but they have a constructed internal and inevitable logic, they do not have the interests of the players in mind, in fact the humanity of the players is irrelevant, all that is needed is for the humans to participate. – within the rules – and they do because it is pointless playing if you don’t follow the rules.

So, here is what I’m thinking. The algorithm is a complicated non-sentient self learning set of rules which, unfortunately and to some extent unforeseen by the creators of the rules, we are hard wired to subjugate ourselves to. There is little prospect of success with trying to put the clock back, or the genie back in the bottle. The lack of trust in facts means that there is not prospect of an independent arbitration for what is true and what is fake news. If you want to shut it down, you would need to over throw the Global Markets, but first, because of their role with economic management you would also need to over throw the State – all of them.

Ironically, the cumulative effect – or side effect of the psychological trauma and decimation of our social structures is beginning to threaten social disorder, particularly with the effect of the Lockdowns and other economic and social impacts of Covid 19, and that is before we really start dealing with the escalating disasters arising from the Environmental crisis that we have contributed to. But, that is not an answer that anyone who loves us would find desirable – even though I have to say that I recognise it as a possible future.

I think that we need a story.

I think that we need faith in something new.

I believe that in order to assert our human needs and interests we need to engage in a way that is uniquely human.

I am not a bot. I click on this to assert the truth of it, but I know it to be true because I do uniquely human things, guided by rules – sometimes, driven by desires and needs sometimes but neither of these things prove my “non-botness” – The fact that I die, poop, respire, sleep and lots of other facts are not relevant to my engagement with the Market, except in terms of the demands that they create for the market to supply, so these qualities are on the wrong side of the equation- and therefore not helpful. But, I love.

Since the beginning of our species, the very first thing that we did with language, was to engage our imagination and tell stories. The reason that cave paintings are frankly crap representations of things is that they were stories, not pictures. These stories were training, in the hope that you don’t actually have to go through the trauma of fighting off a predator in order to learn how it could be done. We told stories about how a friend of a friend survived, and we engaged our imaginations. So, as time went by we used stories to explain things, and this developed into systems of belief. Belief in these explanations is not necessarily evidence based, so……. we had faith.

The greatest stories that we still tell codify our social organisation and culture. All of our great religious texts are in parable form, and I do not believe that this is coincidence. The stories of the New Testament, or the Koran (other religions are available) illustrate the principles of the faith, and engage our imaginations towards finding novel applications in the novel situations of our everyday lives. Societies that seek to turn the commandments in to rigid law such as we see in the fundamentalist religious groups don’t work out so well, in fact, as we all know they feed extremism and exclusion, in complete contradiction to the meanings found in the parables.

When I studied martial arts, I learnt to use the power of the opponent and this is what I feel that we should do with this mighty foe.

Remember, the bots and the markets actually don’t care. They will not be hurt by campaigns or protests, and they will be protected by the state that shields them. So we work with it. The motivation is to trade and make profit, so OK, that’s what our social structures rely on too (currency/trade, work, status all basic human drives). Social media is organising and shaping our demand, but for the sake of our continued existence we need to change our demands because the systems and processes that we are using to sully that demand are driving us towards an Environmental disaster, as well as exposing us to novel treatment resistant diseases. But, we can not use fact (because these are disputable) and we ought not to use dogma or violence because neither are they very sustainable or efficient. So, what is there that is essentially human? Stories, and specifically parables.

It is pointless to refute or deny a story – it is purely fiction, with meaning.

So, that’s it? A Story? That’s the big idea?

We don’t need to agree on what is true, we need to do what is uniquely human, and agree on what we believe, and our long history shows us that this is best conveyed through a story.

The stories that underpin our existing religions have not protected us from where we are now. I would say that they are still relevant but that they have been corrupted over time and by our human failings. I’m aware that this is disputable, and that is not my point, perhaps its ok to say that they were written to address other issues, and we need to add a sequel. I am not bothered if this is seen by some as a new religion (another uniquely human thing) but the story needs to illustrate how we can escape from this new apex predator, or we will die discovering its power directly.

A Few thoughts about an Independent Wales

I want to see things from a slightly different perspective. Not a party Political one, not in terms of the present set of parameters, but in terms of the future. I have written in earlier blogs that I know that no one reads about what I see as the impending extinction of our species, the fallacy of Democracy, and the imperative of sustainable ways of organising and living. Global issues of Pandemics, and Global Warming, extinction of pollinator species, and Global Markets superseding National democracies, give me pause for dreaming of a sovereign homeland, self governed and fit for the future.

To do this, we have to have a new vision of the future, one that is based on fact and probability, not on political power and ideology.

I am not qualified to give an historical rebellious account of how the Principality of Wales conceals an enslaved nation, hidden and exploited by the British Empire, but you can certainly find well argued and researched historical evidence for this. I will leap to a version of that which I am sure can be debated. In fact, I am sure that petty debates about this will be a major part of a Nationalist agenda in at least part of the argument for independence. My problem with this is that I do not believe that winning or loosing such an argument will inform the future that I wish for my homeland. In fact, I believe that all of the understandable posturing and recriminations that will go back and forth with concepts of fairness, justice, etc, will simply distract from the real point. I would say though that the Imperialist English used Wales as their battery providing the coal, steel and then water to fuel their early Industrialisation giving their Empire the momentum that gave rise to their deluded conceit as a world power in the first place. I feel the shame of our Imperialist Past and I feel that we should step aside from it; be, and behave, differently. We can not simply say…. oh that was them…… it isn’t true,, and its even a bigger lie if we chose not to step aside when we could.

I want to think again about the type of nation that we will need to survive the next 500 years, not simply argue for a local alternative to Westminster, and Her Majesty the Queen.

Being tethered to England, is not so smart. The Empire is gone, the assets are stripped, the Commonwealth is self governed, England has left the European Markets, its utilities are owned by foreign companies and states, and it is deluding itself that it remains a world power by hanging on to its self written history and its nuclear weapons. England is not going to be Europe’s Banker as it has proven itself Internationally Untrustworthy, its water supply is limited, its manufacturing is diminished and will diminish still further. It is a nation of shop keepers that has closed its doors to passing trade. England can not produce the food it needs, and it cannot produce the energy it needs sustainably. England has several areas of extremely dense population, massive disparity between rich and poor, and is plummeting towards a set of circumstances that look pretty scary for the next few generations. England is fast embedding itself in the USA’s cancerous colon, and I don’t want to be there with it.

Wales on the other hand has a small population, excellent farm land, access to abundant fresh water, and can boast the second highest tidal range in the world along with proportionately a top ten ratio of coast. In fact we could still be a battery for trading partners, but this time around a sustainable one.

For our future generations to survive we humans, as a species will need to make a shift towards sustainability as being the key factor around which we organise. So, where would you rather be, New Zealand, or Texas?

This will not be a future world of exploration. We will not be flying all over the place just to see what is there and buy an over-priced souvenir. We will need to live far more within our environmental means, and local borders.

Wales, can, or could, feed its population (which is no bigger than the West Midlands). We currently export 300 million cubic meters of water each year to England, that would need to be renegotiated as a trade deal post independence. We have vast areas of windy hillsides, and the tested blueprints for tidal lagoons, both of which could be exploited to provide all the clean and sustainable energy that we would need, and more. We also have the honour to manage areas of awesome natural beauty and huge tourism potential.

The other thing that I feel that we have as a nation is a culture and set of priorities that lends itself far more towards cooperation and support than competition. We are ok about being champions of Hwyl rather than captains of industry, and it is with that Hwyl, along with our Kiwi friends that we can still compete fairly on a world stage in sport, literature, and music.

Dear Independence future, can I just say, clearly that….

I don’t want to be a poor slave to a mini state of the American union. I want to be move sustainably towards a new, homely order of things, content within our own sustainable and renewable resources.

DEMOCRACY THE NEW OPIUM OF THE MASSES

This is just a follow on from a tweet that I made in response to a friend’s ambition to consider representing us in the Welsh Senedd.

In a secular State that is under the control of global markets; isn’t sham democracy the new opium of the masses? Were you thinking we might vote for our survival? And you can count on my vote 🤔😁

To see humans endlessly debate and resist the psychopathy of our world “Leaders” is exactly the camouflage and distraction that disaster needs to continue to develop towards our ultimate destruction as a species. And to see this continue with all the lessons we could have learnt about our common humanity in the face of a pandemic is truly heart breaking.

You see don’t you? It doesn’t matter if Trump is an egotistical fool, if your country is on fire, your neighbours are killing each other and your children are starving not from a lack of food, but from the lack of a fair distribution of that food.

Get over the fact that the imperialist British Government chucked in the grenade of partition as they left your country, and realise that the way that you are organised means that your rivers are poisoned with plastic and chemicals, your crops are being devoured by locusts.

Squabble about whether you can fly to Greece all you want, but remember that the Covid 19 virus is travelling with you.

See Venice now, because in a short while it will be Atlantis as the icecaps accelerate their melting and the sea levels rise.

In Europe, or out of Europe, whatever you wish, the weather remains the same, as does the global environmental issues that threaten our future generations.

Extinction rebellion, or Extinction Party? Perhaps it is too late and we should simply go out with a Bang!

There is such a tragic irony in seeing thousands of people who fall into the most vulnerable of groups forgoing social distancing to make a political point – to a system that ultimately is not in control of what their lives do indeed matter for.

As long as smart people continue to negotiate and debate with democratic processes that are not the main driver of what threatens us, we are wasting time on a distraction and benefiting no one in the long run.

And that is the point. The fake sense that the few who do fully engage with democracy get when they feel that they are doing something that matters towards tomorrow is pitiful. I despair. This is the new opium in the updated Marxist perspective. It isn’t the Catholic Church, or any other religion that is giving us easy to understand but ultimately fake answers to our life problems, it is the false belief that democracy as it is now, has any hope whatsoever of saving our species from extinction. While we march, petition and campaign to a body that actually has no hope of achieving anything that we desperately need for our tomorrows we are wasting the time on a clock that is ticking away the last moments of our species.

The Government, from whatever country you are from, is not able to address the Global and environmental issues that are poised to overwhelm the way that we have been living. Channelling all of your time, resources and resistance towards the petty (by comparison) issues of their own calling, will have no effect on the icecap, or the Ozone layer, or the diseases that we can no longer contain, or the hundreds of other natural consequences of our neglect for our environment that may well be simple natural occurrences, but will make our survival much more challenging.

Sounds hopeless doesn’t it? But it doesn’t have to be. We need to open our minds to see beyond the smokescreen of the distractions that we are the hosts of. Stop wasting what time we have left debating what colour shirt our leaders wear and understand that they are not leading the species, they are maintaining the distraction. We, the species, are responsible for this. Our demands for the supply of unsustainable products and resources. Our permission for people to profit from the destruction of our atmosphere. The cows that are belching their way through our global warming are producing the milk that we demand for our coffee, and the meat for our burgers – that we need less than we need the atmosphere.

Destroying the Amazon to produce the palm oil that we demand because it is a “healthier” and more profitable option (cheaper therefore for us – so we can consume more rather than earn less) means that we have released viruses into circulation that we have no immunity to. Wet markets that cater for the impotent and deluded eastern wealthy, bring this disease into the population, and the precious holiday and airfreight trade effectively carries it to every corner of our world, whilst burning irreplaceable carbon resources.

Look at the choices our political leaders have taken in the management of the Covid 19 invasion. Prioritising the opening of Costas, Starbucks, Weatherspoons, McDonnalds, and international travel, then berating you for bringing the virus back. If the same folks had seized the opportunity of the quiet airspace to let the world breath again, stop over producing food to be over consumed, concentrated on sustainability and international cooperation to save our species, then I could call them Leaders.

Wake up sleepy deluded humanity, you are being led by Markets not humans. Your demand is all that drives the market. Of course we need organisation, but that organisation needs to be orientated towards our survival not one small group of humans’ position relative to another and relative to the market. It is all a little bit more simple than that. If we carry on like this most of our descendants simply will not exist.

Tomorrow’s world

Dear Harri

I thought I would try and write about some of the abbreviated discussion that we had yesterday, because I am concerned that you might have thought I was a little mad, and I wanted you to be sure that I am completely mad, so all is well.

What if…….

Covid 19 busts things up a bit?

What if, The Dollar crashes, and the USA goes into a state of revolutionary transformation?

What if we understand that Black lives matter because of the lives bit not the black bit, and that brings us to an understanding about us as a species?

What if we own our history so that we can properly learn the lessons from it? What if we recognise that history isn’t a black and white matter either?

What if, the imperative of a dollar and carbon based global economy is not such an imperative anymore?

What if people don’t attempt to unite around a set of political ideals but around the core truth of our need to exist and persist as a species in harmony with our nature and place? It has only been the propaganda that we bought from Capital that led us to see this fact as another set of ideals. The imperative of the amoeba, or the squirrel or a blade of grass is the same imperative that we have, but we must chose to respect it consciously. We need to see that it was “Hobson’s choice” all along. If we do not respect sustainability, we will fail as a species, fact, not ideology at all, just a simple fact of Life.

What if we discover that the smart thing is to do what other resilient species have done for millennia and chose to work with Nature rather than to try unsuccessfully to conquer it?

What if success is measured by sustainability rather than power?

What if we awake from our delusions and see that even in the socially constructed world of economics and capitol the most successful way to survive is to be Global, locally?

What if after 12 weeks without Coffee shops we realise that we didn’t need the overconsumption that is contributing to our extinction? What if we grew crops as an alternative to the 30 unused herds of cattle that were needed for the overconsumption of the milk we no longer need for the coffee shops?……. and folks are fitter …… and we produce less waste…. and all those other things that a small shift in our behaviour can set off in a chain reaction?

What if we realised that the real need of a Nation for security is actually security of food, health, welfare and power production and not protection from one flawed ideology by another flawed ideology? What am I saying realised? The nation already knows! Who amongst us questioned the obvious assumptions about which were essential workers, and which were non-essential? Oh…. and as an aside, how many of the essential workers are also amongst the lowest paid in our flawed ideological current set up?.

Wait, I know I risk going off at a tangent, but I have to say that when we thought as a natural species to save our lives, did we not recognise that food, shelter, health, education and waste disposal were the things that we would risk death to support?…… Miss-understand that if it suits, but I mean no offence to the millions of folks whose livelihood will be threatened as we move towards tomorrow. Their livelihoods were sustaining the economy, not life, and when we need to know that, we seem to. But transforming towards tomorrow will be full time occupation for the species, we will act, and sing, and brew coffee, we might not produce nuclear waste, or plastics or burn carbon for short term gains. We might exchange , but it might not be stocks or futures. We must not need to change our slogans to “non-essentials lives matter” having learnt from our past.

What if we recognise that all our Governments can do is orientate their economies towards the most beneficial relationship with the Global Markets that they only have the smallest margin of influence over?

What if we realise that the one fundamental control that we have over the same Global markets is the personal choices of the world’s citizens? The power is really with the people, every click of the mouse, every coffee purchased, every delivery requested, every bill paid, every hour worked, every drug administered, sniffed or injected, every product preferred or rejected, every loan requested. What if the people rather than the market knew and understood that?

What if we realised that our personal preferences and choices were the beast that we are campaigning to impotent governments to vanquish? The data that we own, our information, our thoughts, behaviours and preferences are traded within the Global economic machinery driving it forward. What if we recognised that the truth of this means that we are the drivers of the global system and also therefore the solution, personally, no Government required.

What if we recognised that at the point of a Global Pandemic, only those who operate globally and act locally thrive, in business and in Nature? The box being carried down my drive is being carried by a company that exists globally.

Tomorrow, we will know that we are a species among many other species that must collaborate to protect our home. We will not burn it down or cloud its skies…. we live here. We will not fill it full of waste for our Grandchildren to play amongst as they starve and fight, we will accept the same responsibility that other blessed species obtained as a hard wired reason to live, which we unfortunately had to discover and monitor for ourselves.

Tomorrow we will photosynthesise, we will harness the wind, we will use our waste to fertilise our future, we will contribute, and repay. We will do this out of self interests at last, no doctrine to follow, just an instinct reconnected with no longer repressed.

We are a smart species, playful and ingenious, but we have been wasteful, wrekless and arrogant, like an adolescent species, and we will grow up.

Tomorrow, we will climb down from our self deceit and acknowledge our place amongst the other species in our home. We shall apply all the same smartness that we applied to profit the few, towards sustaining our place on Earth, and our part in its future.

It’s about cooperation stupid.

Watching the fabulous BBC program on Primates sent me along a track to considering that we too are part of that group of species, Great apes, hominoids. But it strikes me that we have turned out to be the fatal fail in the creator’s one step too far with the whole “free-will” trial.

What I saw was that primates are social, and adaptive. Primates use tools, and smarts to overcome natural challenges. How does a single wounded ape take on a fighting fit leopard?  – With a smart family, cooperatively.

Adapting to our environment and compensating with cooperative smartness would probably have worked out fine, just so long as we were not the primary predator, but then Nature went and spoiled it all, for all of us, and gave hominoids free will, and the smarts to adapt the environment. One of those little experiments like the Dodo, that seemed like a good idea at the time, except that unlike the Dodo, when we extinguish ourselves we will take, or we are taking, a shit load of other species with us.

The problem through this lens appears to be a combination of free will, adaptation of the environment and the expertise in tools that inappropriately left us as an apex predator. We didn’t need to cooperate to survive once we got to a certain tipping point, and within the lifespan of a human we could conquer survival against Nature, red in its tooth and claw, and cooperation transformed by excess and success, into perverting the natural competition for survival into – well political economies. Sometime later, while we burned the irreplaceable earth on which we stood, the companies bled across borders, and global markets took even the semblance of necessity and survival off the menu, along with conscious capitalism producing a form of inanimate alternative to the  Natural imperatives of cooperation, procreation and recreation – at least in human timescales.

At times like these, we should remind ourselves of the geological timescale of the spinning rock we call home, and be aware that we are a flash in that pan. At times like these, when threatened with  natural predator, of a virus, volcano, tsunami, storm, meteor, etc. when our true and natural vulnerability is revealed in the certainty of geological time, then it is sadly charming that the vestige of our natural essence is revived, and pathetically expressed through group cohesion and cooperation, stronger family bonds, and sparkling inventiveness and ingenuity.

The point though, that our primate cousins have stuck to, and done very well with without extinction and for much longer than us, is cooperation – in tune with natural order. It is not so hard to see, it is instinctively obvious. It is however, hard to believe, because the news is told by the established order. I don’t mean fake news in the current context, fake news is just a corollary to the official news. Its all fake in the Natural order. The eternal oceans, or the microbial infestations don’t really give a toss who the lunatic President of the landmass we know as USA is – clearly, it could not matter less, yet still in an overly large wave, or a randomly successful genetic mutation, it can wipe us out.

If we are going to stick around, then we need to grow up, and understand our place and role. We need to use the smarts of our species to adapt to the environment on a geological timescale, because ultimately we are deceived if we think that  we are the apex. Nature is, always has been and always will be.

Viral Liberty

We need to do some thinking about exit reality from the Covid 19 lockdown.

• We are restricting the spread of a virus that we have no vaccine for by reducing the risk of contamination, and we are doing this by simply avoiding contact with others, nothing more sophisticated than that. I have not got it, and I know you have not got it, so I’m OK with you, but I don’t know if they have got it, so I need to avoid them.

 

• The reason that the number of people infected by a single case has dropped to 1 is purely because of reducing the amount of social contact that we have with each other. In other words there is no change in the nature of the virus, we are limiting its impact by changing our behaviour.

 

• Social distancing is a restriction of movement, and yes it limits our freedom, but it is not a restriction of liberty, because Liberty is freedom to act within a legal framework, and we have consented (?) to a law that justifies the restriction of our freedom.

 

• We will only be able to take this strategy out of our homes when either the opportunity for the virus is extinguished, or the opportunity for us to encounter it is; or, of course, if we are prepared to risk infection. 

 

• To reduce the opportunity for the virus, we need to either completely kill it (unlikely) or we need to develop an immunity to it, either through Herd immunity (and the sacrifice of many deaths) or through the development of antibodies by artificial means (a vaccine).

 

• To increase the opportunity for us to avoid the risk, we need to be able to identify who has the virus and where they are which means mass tracking, contact tracing of everyone so new infections can be traced and quarantined.  What will be the real social cost of such a loss of privacy?

 

We are currently compliant, for the most part with the Rule of Law in respect of lockdown, but will our consent remain such an overwhelming consensus? Will all who are told that they must re-engage with work activity outside of the home be ready to expose themselves to potential risk when the Government calls for it? Will we all agree to remain in isolation for months? How resilient is our compliance, is it based on obedience or informed consensus and group interests? Do we have confidence in the information that we have? What are the limits of our decision making? How do we scrutinise the collective, and are we satisfied with the scrutiny? 

Before we go waving flags and lighting up buildings to celebrate the easing of social restrictions in China, we should take a look at what that really means. In the Middle of April 2020, the people of Wuan are able to leave home to shop, and to work. But – only those people that have a green status. The testing used is largely just a temperature reading. This of course has the advantage of an instant result, but has the disadvantage of false positive – as there are any number of reasons why a person might have an increased temperature. Any citizen with an increased temperature (and their household) are required to be in quarantine. All Citizens who are outside will be temperature tested at several points in the day, entering or leaving public places and by law at work several times during a shift. All citizens are required to carry proof of their green status, and this is achieved by the use of a smart phone app.

So, how does that feel in a Western context?

How does that look in a world-wide context?

What in terms of natural human engagement does this form of liberty bring to us?

Before we blindly stumble into consenting to any of the logical potential outcomes from lockdown, we need to consider our priorities as a species, because if we don’t, then the priorities that we will tacitly support will be the priorities of the establishment. Here too is a big problem for the average world citizen, because we are not really that well informed about who the establishment actually is. We are deluded by national and cultural division into colluding with a firmly held beliefs that our various governments and/or our social values and cultural beliefs are the establishment. However, this writer at least believes that with the globalisation of Capital, it is in fact Global Capital that is the true establishment, and that our local government and cultures merely express the idiosyncratic cultural choices that nations make in how they relate to the world economy.

This is important because we believe that democracy is important, and yet, democracy has nothing to really contribute to the global economic super-powers that determine our local priorities. We vote for our elected members of our governments, we are not all share holders or influencers of Microsoft, Google, General Motors, Shell Oil, Amazon, Serco, etc.

So, when we are “free” to leave our homes, what is the priority going to be? Are we now going to prioritise managing the issues that define us as a species, or prioritise the needs of the establishment? Let’s get the economy working! Will be the cry. And of course most of us will desperately need that to happen because our entire community life is centred on the economic exchange of our labour for money to pay for goods and services that we can not independently produce ourselves.

Well, there are a couple of things about that which we ought to reflect on. Firstly, we have discovered in lockdown that our needs for things, and our demand for things are not perfectly correlated. Why did I put that so obliquely? We learnt that we don’t actually need three huge cups of expensive coffee from a shop each day, and that these shops in turn don’t actually need the amount of milk that we produce to service them, so we don’t need so many cows, and we can therefore do without the methane and the land waste that is involved in this one small examples section of the global economy that is in fact (remember before the virus) leading our species to the brink of extinction.

We do not in fact need to fly all over the world just because we can – in fact it was certainly this habit that led to the global spread of the disease. But what we do need is better control over local sustainability – grow more food, produce more goods locally and so on…… and guess what that will help with? 

Maybe, post lockdown we should transform our global community into re-aligning our natural needs with our economic ones. Perhaps reinvesting in producing things locally, and in a sustainable way should take priority over the over consumption that threatens an environmental disaster far greater than Covid -19.

I am aware that there are a lot of question marks and maybe’s in this posting, but that is because our future is so uncertain. I would not like to blunder into it, but the risk of us literally becoming wage slaves only allowed out for the benefit of the economy is staring us in the face, and if we do consent to that, it would be as well for that to be purposeful and informed consent.

We are not worse off if we can not afford a new car lease, or a foreign holiday on credit, in fact in the longer term localising both our industry and our leisure might be of great benefit. We are worse off if our lives are simply measured against the benefits of our labour to capital at the cost of our freedom to socialise, relate and recreate. 

It can not be right, or sustainable for the State to pay our unskilled labour from the leisure industry 80% of their wages to stay at home, whilst we fly in a foreign workforce to pick their/our food. 

The division of labour between those who produce wealth and those who service the workforce and community has never been clearer, and the sacrifices made by those who serve the public needs to be honored and dignified by societal changes that enhance the sustainability of our lives, not simply our economy.