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A man’s death is not a spectacle for TV
The problem with reality television is its invasion of privacy and modesty without being true to life or even truthful
There is no more awesome reality than death. That is why it was bound to appear sooner or later, despite the taboo surrounding it, on reality television.
It has already appeared once on British television, in a 1998 documentary by Professor Robert Winston, which showed the very minute at which a man expired. Now it is about to be seen again, in a forthcoming ITV documentary made by Paul Watson, in which a man with Alzheimer’s dies in the presence of his wife and a television crew. Programmes like these, which are generally agreed to be high minded and well made, are not usually called reality television. The phrase “reality television” is now almost a term of abuse.
But that is surely what these rather superior films are. Anyone who is interested in privacy and truth must find them alarming, or at least a depressing reminder of a general loss of the sense of intimacy.
There is a case to be made for Paul Watson’s film. He is a long-standing and trusted friend of the dying man and his wife, Malcolm and Barbara Pointon, and had already made a film about them, when Malcolm’s Alzheimer’s was first diagnosed. With that film and in the years since then, Barbara Pointon has campaigned gallantly and effectively for better treatment of Alzheimer’s. She and Paul Watson both feel that this film will continue their work.
So far, so good, and one can only feel admiration and gratitude. It was brave, and it must have been hard, to let strangers see some of the distress that this terrible illness inflicts on all concerned. Perhaps it was less hard to let them record some of the good experiences, but it may have been helpful to many viewers who also face Alzheimer’s.
To see tenderness and courage in the face of illness and approaching death, to see enduring love – the Pointons were married for more than 40 years – must surely be encouraging to other people, whether in fiction or in fact, when it is skilfully represented. By general agreement, this lifts the programme to the moral high ground.
However, at this point the case breaks down. Showing the moments of Malcolm’s death is another matter entirely. Death is one of the most solemn and most intimate moments of life, and there are good reasons for the traditional feeling that strangers have no business there, least of all millions of total strangers who are simply whiling away an idle evening with the goggle box.
That doesn’t mean that nobody should be present at the hour of death or that it should be shrouded in mystery, or that we should be shielded from it. Doctors and nurses and priests may be needed and wanted, and so may wider family and friends, as well those who are most loved.
There are many traditions surrounding death beds, often including many people, and they all exist to mark the solemnity of death and to give comfort to the dying and to those who are about to be bereaved. None of them exists to allow the curiosity of strangers, still less to excite it. Death is not a moment for rubbernecking; there is something of the snuff movie about even the most delicately filmed death rattle.
The film-maker has said that he doesn’t want people to be frightened of death. Apparently Malcolm Pointon’s death was surrounded by peace and tenderness, and was, despite his earlier suffering, perhaps the death that we might all hope for. All the same we cannot possibly know what kind of death is waiting for each of us. The idea that that one can domesticate and demystify death by broadcasting one particular good death – seems to me absurd.
Besides, we should be frightened by death. Death is a fearful thing. The fear of it defines our lives, as we lead them, and its enormity gives us plenty of reasons to examine our lives before the appointed hour arrives. Insofar as we are able to contemplate death, we have constant opportunities to do so. We have the deaths of those around us, and the entire discussion of death in literature, art and music and of course in religion. It’s not necessary to invade the privacy of a total stranger to reflect seriously on death.
It is a racing certainly that when respectable television breaks the taboo about showing real live death, so to speak, it will not be long before less respectable television feels free to break it too. And what’s wrong with reality television - all of it - is not just that some of it is trivial, tasteless and sensational. It manages to invade people’s privacy and modesty and exploit people’s prurience without being real at all - without being either true to life or truthful in the way fiction can.
People do not behave in front of the camera as they do in real life. The presence of the camera drains everything of reality. Directors have to keep staging, restaging and selecting things. Anyone who’s worked in documentaries, as I have, will know there’s usually no other way of getting the good stuff in the can: “Could you just pick up the phone and receive the bad news once again, love” is the stuff of documentary making.
Almost everybody understands this now and is complicit in it. What they are doing when they agree to appear on reality television of any kind, from worthy to unworthy, is to present a reality that they prefer, to manipulate the reality of their experiences and their characters as far as possible, for one motive or another. Sometimes it’s just the simple need for attention. Often the motives are more sophisticated or more commercial.
That’s perfectly obvious from watching Big Brother; everyone is trying to play a starring role in the drama of his or her own life, as they would wish it to appear, often for commercial reasons.
The same applies to the proverbial fly-on-the-wall documentary. Nobody actually forgets about the fly’s television eye; its presence changes the reality it is supposed to be recording neutrally.
Everyone involved is trying to use television to control other people’s perceptions. Reality - which is to say unself-conscious, unmotivated, uncontrolled self-revelation - is the last thing on the participants’ minds, whatever they may persuade themselves.
The solemn reality of death has no place in the manipulative unreality of reality television.
The Sunday Times | Sunday, July 29, 2007 | Comments (0)
An unlovely display of Tory cynicism
Politics is about what you stand for, not about policies, according to a senior Conservative I talked to recently who represents Project Cameron. We have plenty of policies, he explained - that is true and it’s also true that voters and journalists seem usually to ignore Conservative policies unless there’s any chance of a pratfall - but what matters is what people believe you stand for, who you are.
That is, of course, largely an emotional question, but perhaps politics is always about emotion. A recent book by Drew Westen, now being avidly read in Westminster, argues persuasively that voters, even the most analytical of them, think about politics with the touchy-feely part of their brains, rather than the rational.
This can have come as no surprise to snake-oil salesmen of every kind, such as Bill Clinton and Tony Blair, who have always understood it instinctively, or to public opinion gurus such as the American Frank Luntz, who first identified David Cameron’s impressive emotional appeal. It is not something that politicians can afford to ignore. The people’s feelings must be engaged - wooed, earned, won, seduced, manipulated, via the mass media.
The clumsiness and the cynicism with which most politicians have tried to touch up our feelings have been one of the most depressing and demoralising aspects of the Blair era. Countless images of Blair as mood-maker spring to mind, grieving for us, saving the world for us, making Britain a young country for us and ending with his infamous claim to being a straight sort of a guy. However, I suspect that the public is at long last beginning to be tired of this clumsy groping and is becoming much quicker to see it for what it is.
If the Conservatives want to do something new and inspiring, they should find a way of avoiding it. They would be mad, obviously, to ignore the voters’ emotional brains, but they should try to demonstrate that they wish to avoid, and will avoid, insincere public relations stunts of every kind. It would distinguish them clearly from Labour and its tainted history. In such self-denial they would luckily be helped by the fact that Labour now has a leader who is incapable of making emotional contact with voters at all.
Unfortunately, the Conservatives seem to be giving in to the usual temptations. Last week’s two by-elections were not in themselves disastrous for the Tories. In both cases they actually gained a few votes and Labour’s share of the vote went down by 14 points in Blair’s former constituency and by seven points in Ealing Southall. If this is the Brown bounce, the Conservatives have little to fear. What was disastrous for them was the whiff of opportunism and cynicism that hangs over them.
It was bad enough that their boy in Ealing, the Asian Tony Lit, was found to have given money to Labour only a month ago and had been photographed shaking hands with Blair. Indeed, he joined the Conservative party only a few days before the start of his election campaign. This suggests all too embarrassingly that the Tories were so desperate to have the PR coup of a high-profile ethnic-minority candidate that they just grabbed at the man without knowing much about him or his convictions.
Even worse is the Rwanda stunt. A gaggle of Conservatives, including Cameron, are flying off to Rwanda tomorrow to launch their global poverty action plan, or whatever they call it. Admittedly they seem mostly to be paying their own air fares, but this has all the integrity of Blair’s own constant picking at “the scar that is Africa”, to display his own humanity. The Conservatives should not be doing it.
Hardly anybody is impressed any more by pictures of politicians pressing starving flesh, or posing with amputees, or priming village pumps. Hardly anybody believes it means anything at all, even though good things may in fact be going on. Like obscenely expensive international humanitarian gabfests, the spectacular failures in Africa of pop star philanthropists, as well as of self-serving politicians, have bred deep cynicism. Such PR jaunts do still arouse powerful emotions, but these days they are the wrong ones – distrust and contempt. Perhaps this helps to explain why the Conservatives are now seven points behind Labour in the opinion polls.
Exciting political loyalty and interest need not necessarily be a matter of manipulation and deceit. When all else fails, why not try integrity? Genuine, seal of Good Housekeeping, A-grade integrity still has enormous brand appeal. Admittedly, Labour is also trying to flog it to the electorate in the person of Gordon Brown, but this is doomed to failure.
First of all, the unlucky man is entirely lacking in that innate emotional charisma that Cameron has in almost Blair-like quantities. Secondly, Brown’s record must undermine any claim he might make to integrity. One is spoilt for choice in looking for examples, but perhaps it is enough to mention his reneging on Labour’s election promise to hold a referendum about any European constitution. No one who has behaved as he has, over this alone, can have any serious claim to integrity.
Cameron still has the relative innocence of untried opposition. He could, perhaps, try a style of emotional appeal that is traditional and very British - that of understatement. It is not insincere, or untruthful, but on the other hand it has highly developed powers of persuasion. It tries to convince by its unwillingness to try to convince, so it is not and never has been entirely innocent of the black art of manipulation. But it does have the advantage of being truthful, of being literally true.
It corresponds neatly with Conservative philosophy - not trying to hatch vain empires, not intruding into people’s private lives or promising a new Jerusalem but, instead, modestly trying do useful things where possible and letting people get on with their own lives as much as possible. The Conservative world view is understated - aiming at less government, but not at less concern for the unfortunate. Cameron’s policies do fit this model. He is a proper Conservative. What he needs is to take a proper Conservative approach to public relations.
The Sunday Times | Sunday, July 22, 2007 | Comments (0)
Lucy’s death illuminates a drug nightmare
When a young woman is brutally and meaninglessly killed, it must be tempting for people who loved her to look for something meaningful to blame.
Lucy Braham, a dearly loved fashion designer, was hacked to death in her parents’ home by a family acquaintance, 23-year-old William Jaggs. When the killer was sentenced last week to an indefinite stay in Broadmoor maximum security hospital, Miss Braham’s father blamed Harrow school and Oxford University.
It is easy to sympathise with him. Jaggs had been drinking heavily and taking drugs since he was a teenager at Harrow, starting with cannabis, ecstasy and cocaine, and going on to other drugs including LSD and crack at Oxford. “Drink and drugs appear to be readily available at Harrow,” Mohammed Khamisa QC said in mitigation, and of course the same is true at Oxford and most universities. The court heard that Jaggs suffered from borderline personality disorder and paranoid schizophrenia, partly brought on at Oxford by crack cocaine. He was mentally ill when he killed Lucy.
Her father blames the public school drug culture at Harrow and the “despicable drugs fraternity at Oxford University”. Most people would be inclined to agree that drinks and drugs probably played a large part in this terrible killing. All the same, it is impossible to know quite what causes what. Many doctors and psychiatrists are inclined to think that recreational drugs, not least cannabis, can trigger or perhaps even cause serious mental illness, including psychoses.
But the subject is controversial and it is true that Jaggs might have developed paranoid schizophrenia even if he had never done drugs at all. The reference to personality disorder, and other evidence in court, suggests a character who was always badly disordered. And conversely the overwhelming majority of people who abuse drugs, or who are mentally ill, or both, do not commit atrocious killings.
As Lucy’s father says, we cannot know whether Jaggs’s schizophrenia was induced or triggered by years of drug abuse. However, what is striking - and one can share Mr Braham’s anger - is the inexplicable failure of those in authority at Harrow and Oxford to pay proper attention to a young man who was clearly becoming more and more disturbed, and openly drinking and using illegal, dangerous drugs. Despite many warnings about him, Harrow failed to act, beyond asking him to leave a boarding house after indecently assaulting a younger boy. Oxford merely suspended him.
When I was a student, my university was supposed to be in loco parentis (a position abandoned when 18 became the age of majority). My school most certainly was. What has happened, in these supposedly caring and risk averse times, to these august institutions’ sense of pastoral care?
Contemporaries of Jaggs at Harrow have spoken of a drug culture founded on boredom and money. “If you wanted to use drugs you could get them - there was little to stop you. If you wanted to do ecstasy or coke you could just walk into someone’s room . . . I used to get sent down town to pick up pills or coke . . . We’d have [covert] parties at his parents’ house [Jaggs’ father, like Lucy’s, was a teacher at Harrow] where we’d do coke.”
This is true not only of Harrow. Every public school I know about has a drug problem; proved by the old joke of the public schoolboy, asked whether there’s a drug problem at school, who says confidently, “Oh no, not at all. You can get any thing you like here.”
One boarding school I know of has two night patrolmen out, with dogs, one for drugs and one for alcohol - despised and fooled by the children. I would like to think most public schools would do a great deal better than Harrow with mental illness such as Jaggs’s, but I don’t think many do better with drugs.
I just don’t understand why today’s schools - and indeed why my own entire generation of parents - are unable to stop our children taking drugs. We know drugs are illegal and most people accept that most of them carry some risk - perhaps a high one - of damaging our children’s brains, even if they don’t actually send them mad. These days only hardened deniers continue to insist there is absolutely no risk. So why this bemused inability to stop our children damaging themselves? Why this toxic laisser faire? It is an extraordinary failure of will and of moral authority.
Part of the answer must be that for so long my generation and later ones just didn’t know how dangerous drugs can be. The information wasn’t there and there was quite a lot of puritanical disinformation around as well. Many people still don’t entirely admit the risks, or feel they have escaped harm themselves. I myself thought drugs were only harmful to a very unlucky few, with addictive tendencies.
I didn’t realise the serious risk of long-term damage for most people and that of psychosis for some. Many of us thought drugs were fun, more harmless than alcohol and nicotine. I remember a university friend saying not long ago that the only problem with her children smoking weed was that it introduced them to tobacco.
The whole of London is lightly covered in a thin film of the devil’s dandruff, to use one expression for cocaine. It’s said there are traces of it on every banknote and not all users are young, by any means. Quite a few of my friends and acquaintances still smoke cannabis and are, of course, unable to keep this from their teenage and adult children. One carefully brought up teenager I know very well, on smelling his dad’s cannabis in the house, merely said to his sister: “I hope he hasn’t taken any of mine.”
What moral authority, then, have parents of all classes who’ve enjoyed drugs themselves to tell their children not to take any? What authority have teachers in much the same position? The problem is compounded by a general loss of authority, or perhaps by the general abandonment of authority by generations of parents and teachers since the 1960s.
Lucy Braham’s death, and William Jaggs’s crime, is surely due to a forsaking of moral authority and of pastoral care that extends far beyond Harrow and Oxford. If it shocks us into recognising that, perhaps it will not have been entirely meaningless.
The Sunday Times | Sunday, July 15, 2007 | Comments (0)
Princess Margaret: A Life Unravelled
By Tim Heald. Self-conscious discretion is not what one wants in a popular biographer
“Poor brute,” wrote Cecil Beaton of Princess Margaret in 1973, “I do feel sorry for her. She was not very nice in the days when she was so pretty and attractive. She snubbed and ignored friends. But my God has she been paid out! Her eyes seem to have lost their vigour; her complexion is now a dirty negligee pink satin. The sort of thing one sees in a disbanded dyers shop window.” Princess Margaret was 43 at the time, a hard drinker, a heavy smoker and about to be a divorcee.
For all Beaton’s notorious spite, this is, on the evidence of Tim Heald’s biography, a fair enough summary of the princess’s story. The pretty and charming Princess Margaret Rose turned fast into a pocket monster, whose adult life was as much farce as tragedy, and ended in extreme ill health and loneliness. She had always been rather surplus to royal requirements, becoming obviously so after the birth of her nephew Charles and her niece Anne when she was barely out of her teens.
It must have been hard to be unnecessary, especially for a young woman brought up with a great sense of her own importance, plus the mixed blessings of beauty, wealth and extreme social status of a kind that is barely understood these days. All this was compounded by her lack of any particular intelligence or talent and her total lack of education. This explains, perhaps, if it does not excuse, her unpleasant and erratic behaviour; however, many aristocratic women then and since (including her niece Anne) have dealt much more gracefully with their lot, and Princess Margaret began to attract, from an early age, a remarkable kind of dislike, as did the man she married, the photographer Tony Armstrong-Jones.
“Such a symbol of the age we live in,” wrote Kingsley Amis at the time of their wedding, “when a royal princess, famed for her devotion to all that is most vapid and mindless in the world of entertainment, her habit of reminding people of her status when they venture to disagree with her in conversation and her appalling taste in clothes, is united with a dog-faced tight-jeaned fotog of fruitarian tastes such as can be found in dozens in any pseudo-arty drinking cellar in fashionable-unfashionable London. They’re made for each other.”
Although Heald never writes so brilliantly or cruelly of Margaret himself, he quotes many such comments, some of them gruesomely funny. And there is little in his account to contradict them. He paints a portrait of a vain, spoilt woman who is overaware of her position and whose adventures are often absurdly at odds with such hauteur. In 1981, for example, she was sent to Swaziland for the 60th anniversary of King Sobhuza’s accession. As Heald writes: “Princess Margaret was a useful emissary for occasions such as this where a royal presence was desirable but not one that was royal enough to suggest that the British were taking it quite as seriously as they might.”
The king was a huge, jolly 80-year-old who had reportedly sired 600 children and went about escorted by lots of bare-breasted women. When the princess was to present him with the KCMG, “he turned up wearing little more than a loincloth, a tiger-tooth necklace and a feathered headdress”.
Margaret had somehow to get the KCMG sash over his befeathered head and find somewhere for the Grand Cross; not easy, because there was only a thin band of goat’s skin to which it could be attached, and “the princess had to be very careful indeed not to plunge it into the king’s chest”. Resourcefully, she hung it on his necklace. “I’m never, ever going to give a medal to a man in a loincloth again,” she said later.
Perhaps it was the tragicomic farce and the tedium of such royal duties that drove her into the arms first of an unsuitable married man (Peter Townsend), a difficult and unsuitable husband (Armstrong-Jones), an unsuitable landscape-gardener toy boy (Roddy Llewellyn) and a rackety, jet-setting life. But happiness eluded her as much as popularity or respectability. Twice in this account, Heald asks himself Brian Redhead’s excellent question for a biographer – “Do you feel better for having known her?” His answer is “a sad ‘not really’”, and so is this reader’s.
A great deal is left unexamined by this book. Although Heald had access to papers in the royal archives at Windsor, he seems to have discovered little that casts new light on his subject, and his chatty, superficial tone doesn’t suggest deep analysis. Something or someone has inhibited him; there is so much he ignores. “She had a brief but passionate liaison with the society photographer Robin Douglas-Home,” he writes, “who subsequently committed suicide.” And that, astonishingly, is all he has to say about that. Rarely can a biographer have hinted at so much and said so bathetically little. Nor does he manage to bring the Townsend affair to life or add to our understanding of it. In his epilogue, he admits that he has said little about the princess and sex, and nothing about cocaine, although both featured largely in her life: “At this point,” he confesses “a certain weariness overcomes me.”
The reader, at this point, feels overcome by a certain indignation; it may be gentlemanly to refuse to speculate about royal sex, and it may be true that outsiders can never be sure of the truth of what has gone on, but such self-conscious discretion is not what one wants in a popular biographer.
PRINCESS MARGARET: A Life Unravelled by Tim Heald
Weidenfeld £20 pp368
The Sunday Times | | Comments (1)
The woman who wouldn't take no for an answer
Twenty years ago, Marjorie Wallace’s report on the mentally ill shocked Britain to the core. Today, this tireless campaigner for the neglected and forgotten asks: why is our mental-health system still in such a state?
Were you to see an elegant woman of a certain age in a smart London restaurant laughing at Establishment gossip with Lord Snowdon, you might take her for a socialite. If you saw her talking with the Prince of Wales at a party or joking with Sting, you could take her for an A-lister – she is, after all, a countess. Her portrait hangs in the National Gallery, and if you knew the names of her powerful friends, you would realise she is a formidable networker.
Were you to see an elegant woman of a certain age in a smart London restaurant laughing at Establishment gossip with Lord Snowdon, you might take her for a socialite. If you saw her talking with the Prince of Wales at a party or joking with Sting, you could take her for an A-lister – she is, after all, a countess. Her portrait hangs in the National Gallery, and if you knew the names of her powerful friends, you would realise she is a formidable networker.
But Marjorie Wallace is also a passionate social campaigner. According to her eldest son she is a “romantic visionary”. She stands firmly and consciously in the tradition of 19th-century social reformers like Charles Dickens. For almost all her adult life she has been an outstanding campaigning journalist, and her greatest campaign of all has been on behalf of the most unloved and unwanted people – the mentally ill.
These days the subject of “madness” is surrounded by euphemism. The word has become unacceptable; the acceptable expression is now mental wellbeing. Wallace finds all this political correctness exasperating, but agrees it is part of a determination to talk respectfully and compassionately about people who suffer the miseries of mental illness. And that new kindness must be in considerable part due to her own long-drawn-out struggles. When Wallace was a psychology student in the 1960s, “mad people” were considered frightening, alienating and, above all, different. Psychoanalysis and talking cures might work for rich neurotics, but people with psychoses were still consigned to the huge Victorian asylums dotted all over the country.
While doing undergraduate research in the back wards of such a hospital, she met the man she married, Count Skarbek, a romantic Polish aristocrat who had escaped to England during the war and qualified as a psychiatrist. It was in such wards that she gained her first insights into the sufferings of people. Although some of these institutions were humanely run and provided real asylum, others were not, and many had become almost as overcrowded and notorious as the workhouses of Dickens’s Britain.
So it ought to have been a kind of miracle when, in the 1960s, new drugs were invented that could almost empty the hospitals. These anti-psychotic drugs could control the more florid symptoms of schizophrenia and manic depression (bipolar disorder). The side effects were often unpleasant, but the drugs were able to set people free from long-stay hospitals. This liberation ought to have brought about great humanitarian changes. Unfortunately, a toxic mix of incompetence, cynicism and under-resourcing turned it into one of the scandals of the 20th century.
The release of patients into care in the community – admittedly a noble ideal – was horribly mismanaged. Around the time of the 1983 Mental Health Act it was accelerated; inmates were discharged in huge numbers, without the necessary preparation or money. It was driven by a combination of wishful thinking and meanness; the tenderhearted, often influenced by fashionable theories questioning the reality of mental illness, simply thought it ought to work. At the same time, public servants and planners thought it would be cheaper than running the asylums and, besides, the valuable sites could be sold off very profitably to property developers. So the asylums were demolished, and psychiatric beds disappeared in their thousands. And the numbers are still going down: since 1990, 24,000 beds have been lost. But there was all too little community and all too little care.
As Wallace says, it was “a social experiment undertaken without any estimates of the numbers, the costs or casualties involved. And it created a new kind of misery – the displaced and abandoned people of the 1980s, carelessly decanted into seaside bedsits and back-street hostels, onto the streets or into prison, or returned to families who had been given no help”. As she said at the time, care in the community was like a leaky tent in a hurricane.
Observing this terrible neglect prompted Wallace as a young journalist to write her famous campaigning series, The Forgotten Illness, 22 years ago. “Campaigning journalists,” she wrote later, “should act as guardians of our unwritten constitution, continually invading and inspecting those spaces of society which by inertia and laziness we have allowed to go rotten”. That is precisely what she did. She went into spaces most people would rather avoid, spending nights on urine-soaked mattresses in hostels, talking to the very disturbed, walking out after dark to meet mentally ill people among the cardboard boxes of the homeless, going to the funerals of those who had committed suicide – all victims of the care-in-the-community policy, neglect and indifference. The stories she wrote about were harrowing. So too were the pictures that went with them, taken by Snowdon, her friend and fellow campaigner.
The response to these articles was heart-rending; it inspired Wallace, with the support of The Sunday Times, The Times and News International, to found Sane, now a leading mental-health charity. More perhaps than any other individual, she has raised public awareness of people with mental illness and our failures in caring for them. She created Saneline, the only specialist mental-health helpline giving practical support 365 days a year. Hers is the voice of explanation you will almost always hear when a new policy threatens the interests of sick people and their families, and in the rare cases when a mentally ill person kills someone. Academics, politicians and ministers seek her opinion – last month she was invited to discuss the future of mental-health services and the new mental-health bill with the secretary of state for health.
She is an honorary doctor of science, an honorary fellow of the Royal College of Psychiatrists, and she received a British Neuroscience Association award in 2002. She has also done much to promote scientific research into mental illness. This has meant endless fundraising, lunches and galas and sophisticated begging; with her networking, Wallace managed personally to raise £6m from the King of Saudi Arabia, the Xylas shipping family and the Sultan of Brunei for a research centre in Oxford. It was officially opened four years ago by Sane’s patron, the Prince of Wales.
These are formidable achievements and they represent years of fighting, years in the political trenches. Today, she sometimes shows the strain. The personal cost has been high: her marriage to Count Skarbek ended, and for years she was a single mother of four young children. She took them with her to mental hospitals and prison car parks, and answered constant telephone calls to the background of their piano practice.
It has been lonely spending time with sick, desperate people. And she is susceptible to other people’s distress, partly because of her own tendencies to anxiety and depression. As her eldest son, Sacha Skarbek, says, “Mum is by nature melancholic. She lives in autumn rather than summer. I think that’s why she understands mental-health issues so well. There’s a kind of tragedy about her that helps her empathise with other people.” But empathy can be a heavy burden. And she has at times felt isolated, she says, trying to keep to the vision she had in the face of opposition, when her views were out of fashion. She has had to deal with angry marches against her and even with death threats.
So what has changed since those campaigning articles of years ago? “There are some battles that Sane and the many others of us who have fought for better recognition, care and treatment have won,” says Wallace. “But there are still far too many casualties. The mental-health system is still failing those with long-term mental illness and their families.” And this is despite Labour’s pledge to make mental health one of its top three priorities when it came to power in 1997.
The truth is that the help available today for mentally ill people in this country is shockingly inadequate. Whether in the community or in a psychiatric bed, it is patchy, underfunded and, for many, nonexistent. Expert surveys agree on this. An independent audit published in 2005 by the King’s Fund reported that “there has been no shift in performance, despite the extra resources”.
A 2006 report on NHS mental-health services by the research group Reform documented its own and other experts’ findings of an alarming situation. Most mentally ill people face unacceptably long waiting times for treatment, during which their illnesses take deeper root. Most of the one in six people suffering from common but disabling illnesses such as depression and anxiety may never see a mental-health specialist. The government’s Healthcare Commission itself reported in 2005 that only half of those with depression were receiving treatment of any kind; only 8% of people with depression had seen a psychiatrist. Few of the beds lost in the care-in-the-community policy have been replaced with the promised 24-hour supervised units in the community. Only two-thirds of community-based crisis-resolution teams operate 24 hours a day, and fewer than half of those who receive mental-health services reported that they had access to crisis care. Which means that half don’t. Yet mental illness and personal disasters are no respecters of office hours. This explains in part the anguish behind the callers to Saneline, who talk constantly of feeling lonely and isolated. They are both the sufferers and their families.
As for psychiatric wards: too many are close to a national disgrace. With so few beds, only the most acutely disturbed qualify for a hospital place and are admitted (or confined) to a ward. Some inner-city units are “overcrowded, shabby, dirty and rife with aggression and fear”, says Sane. “It is unforgivable,” says Wallace, “that we have replaced the asylums with units where both patients and staff feel unsafe.” The ominously titled In Place of Fear?, the Mental Health Act Commission report of 2006, corroborates this disturbing picture. The Department of Health’s response has been a building-improvement programme – a completely inadequate reaction, according to Reform, to a crisis that involves significant difficulties with staff and standards.
This is not only a scandal, it is a mystery. True to its promises, Labour spends more on mental-health care than any other country in the EU – about 12% of total health spending compared with a European average of 5.5%. Funding has trebled in the past five years to £4.9 billion a year. There are hundreds of new crisis-resolution teams, assertive outreach teams and early-intervention teams, endless consultative papers, shiny new initiatives and good intentions; but the results are painfully inconsistent. Despite the government’s emphasis on care in the community, most of the extra spending is going to psychiatric-hospital beds. But, absurdly, it is paying for fewer beds than before because they’re more expensive. So nobody wins. Meanwhile, the Treasury’s large increases in funds for mental health have not been ring-fenced for that alone, and have been siphoned off by NHS trusts into acute services, in their efforts to make good their budget deficits.
There was a time when Wallace was best known for her passionate campaign to stop the wholesale closing of mental-hospital beds and to prevent sick people being slung out into misery and neglect. As a result, many wrongly assumed she must be opposed to care in the community. This made her unpopular for years with the mental-health Establishment. In fact she is very much in favour of care in the community for most people, when there are the staff and money to make it work; she also believes that some mentally ill people need periods of time out in a place of refuge and safety – the meaning of the word “asylum”. She believes in both, and in choice, and her concern is that there still seems to be a ruthless agenda to close inpatient beds, without the necessary support in the community.
The crisis in inpatient care is being worsened by street drugs; increasing numbers are being admitted to overstretched wards with psychotic breakdowns due to cocaine and cannabis. The government has been warned by Sane, among other groups, about growing evidence of the biochemical links between cannabis (skunk in particular) and illnesses such as schizophrenia. But instead of preparing for the problem, the Home Office took the decision five years ago, partly to save police time, to downgrade cannabis from a class-B to a class-C drug, with some tranquillisers and painkillers. “That gave out all the wrong messages,” says Wallace. “Three-quarters of young people surveyed recently believe cannabis is legal and harmless. There is a significant minority, perhaps 10-20%, for whom taking cannabis – especially as a teenager, when the brain is developing – can trigger breakdown and, in some cases, lifelong mental damage.”
It is not hard to imagine the disastrous effects on mental-health units; 80% of new admissions to some of London’s acute psychiatric wards are estimated to be people who take street drugs. “The government’s been brilliant,” says Wallace, with some acerbity. “You make your acute wards unbearable, overcrowded and unsafe, you fill them with people who are having aggressive psychotic breakdowns because they are high on drugs, so there’s practically no responsible psychiatrist who’d dare admit a middle-aged woman having a breakdown, or a depressed and suicidal girl. They have to take the risk of leaving them in the community. It’s terrible.”
Another driver for this lack of inpatient care is the government’s target to prevent extended inpatient stay. For a crisis-resolution team dealing with someone in the community with an acute mental-health problem, a successful intervention, for which they would get brownie points, is one that does not involve a hospital admission. The incentive is to leave a patient to care in the community, with all its shortcomings, because each day of expensive inpatient care is a measure of failure for the team. This is just one of many such perverse incentives in the NHS.
A recently leaked report suggests the Department of Health is actually planning to fine hospitals for every day a patient remains there who could and should have been discharged. However, the crisis in psychiatric wards is only part of the problem. What most people with mental illnesses need and want is care in the community. They want to be treated at home, and to carry on with normal life as far as possible, and this should be possible. But community treatment is notoriously erratic.
Take drugs, for instance. These days there are several relatively new anti-psychotic drugs available, and they are actively recommended as best value for 60% of sufferers. These drugs are much easier to tolerate, which means patients are likely to keep taking them. One of the greatest risks to care in the community is when patients stop taking their medication and fall back into a cycle of acute breakdowns. Yet there has been huge and unnecessary variation in different health authorities: according to a Reform study carried out in 2005, of 28 Strategic Health Authorities in England, 18 were seriously under-prescribing these drugs, and so denying them to people who would do better on them. There is no good reason for this: these drugs are not new and are good value for public money as part of a whole treatment plan.
When Labour came to power with a 10-year strategic framework to improve standards in mental-health care, expectations were high all round. But mental-health service providers were told by Whitehall to concentrate their resources on meeting new targets and creating new specialist teams aimed at assertive outreach and early intervention. New crisis-resolution or home-treatment teams were set up to prevent hospital admissions by making regular visits to check whether people were taking their drugs and living safely in reasonable conditions. But some psychiatrists say these teams were created often at the expense of the existing community mental-health teams, which in some areas were left depleted and demoralised.
Even the new teams (more than 700 are now in existence) are so overstretched, many can only keep a patient on their books for a short time. “It’s harder to get onto the books of one of the new mental-health-care teams,” says Wallace, “than to get into Oxbridge.” Like all services that rely on several people getting together at any one time, they can be difficult to co-ordinate; they also change staff frequently, so that patients meet a bewildering choice of new faces. And in recent cost-cutting, many of the new teams are being disbanded almost as soon as they are formed.
The new teams could have worked if they had not been a drain on the time of some existing community psychiatric nurses. A lifeline, literally, for some patients, this visit from a familiar face is now likely to last no more than half an hour, and in many cases is no longer weekly but once every two or three weeks. Some clients have been known to wait nine months for a replacement if their community psychiatric nurse moves on. “People are being decoupled from the one professional person they can trust and to whom their ‘narrative’ is known,” says Wallace.
All this has not been helped by the closure of day centres that used to provide structure, community and occupation. Or by the fact that day hospitals offering transitional support between hospital and community are under threat. Nor can patients or families turn to the family doctor, who no longer provides care out of hours or at weekends – when people with mental illness are most likely to reach crisis point. This means they have nowhere to go but A&E departments, where specialist mental-health support can be scarce. As one mother caring for a young man with drug-induced schizophrenia says, “Who is the solution to the crisis when my son is holding a knife to my throat? I am.”
Sane responds to an average of 1,000 callers a week on its crisis line, providing follow-up support to many more through its unique telephone outreach service. “We are picking up the pieces from a fractured system that can no longer provide the basic support people could expect to receive,” says Wallace.
So why are things going so wrong? According to Wallace and other experts, the confusions in mental-health policy reflect the fact that society has never really come to terms with mental illness. “The field is riddled with paradoxes and polarisations. The ‘medical model’ of mental illness is at odds with the ‘social model’; and they lead to very different agendas. As long as the mental-health experts cannot themselves decide how mental illness should be understood – whether or not it is a medical condition or a label imposed by society – how can we expect the government to make policies that are coherent and representative?” The current mental-health bill, so long and so controversial in preparation, reflects these confusions and disagreements in the mental-health community, between psychiatrists, civil libertarians and social workers.
In most other medical conditions, such as cancer and diabetes, Wallace says, everyone is working to the same agenda. The patient knows he is ill and wants the most effective and up-to-date treatment. So do families and professionals. Everyone has one goal: that a sick patient recovers. With mental illness, that is not always the case. Self-styled “survivors” of the psychiatric system say that it is not an illness but social discrimination. And then there is the catch-22: the more ill a person is, the less insight they may have to acknowledge it. They may see treatment as unnecessary or, at worst, punitive, and they might understandably refuse anti-psychotic drugs. And their families might get little help from professionals, who have to protect their patients’ confidentiality and best interests.
In reality, people cannot choose to see a psychiatrist, to be admitted to a unit or placed in housing of their choice unless they have enough money or insurance to pay for private care. So disasters happen, great and small, noisy and silent.
Talking of these issues, Wallace begins to look drained. She has other anxieties – about her very ill companion and her frenetic round of TV studios and meetings. “A lot of suicides could be prevented – maybe as many as several hundred a year. It’s just people not being available, not doing or saying the right thing at the right time. Most people really don’t want to kill themselves, and at least some of these can be helped. And with the rare homicides, we believe that one in three is avoidable; we did an analysis of 69 inquiries, and the government now accepts that some are preventable.”
There are, she argues, simple things that can be done. It is known that the most critical period for people at risk of committing suicide is the 48 hours after they’ve been discharged from hospital. Yet official guidelines recommend contact in up to seven days, which is sometimes too late. Sane can offer this contact to some through its telephone outreach workers on Saneline. But there seems to be no way for imaginative services like these to reach the majority of people because central funding mechanisms are overburdened.
What is really needed, she says, is more humanity and personal attention, less bureaucracy and politically correct judgment and jargon. That means a person who will listen, who will be there the next time, and the next, for patients and their families, in crisis times and beyond. The resource that matters the most is people.
More meaningful activity, if not employment, would make a great difference, as would more structure in a sick person’s day (daycare centres, projects). More flexible benefits would help too. Finally, there should be more of a public determination that people on the edge are not allowed to fall over it.
During one of our conversations, Wallace took a call from Lorna Lake, the wife of Paul, who had taken his life after an agonising struggle with depression. Paul went missing for three months, and Lorna was ringing to say his body had just been found. They had begged for him to be visited by the crisis team or admitted to hospital, but he’d merely received a message on an answering machine. When he walked out that day, he said: “If I could go back to hospital [meaning Brookwood, demolished a few years ago], I would not have to do what I’m going to do.” Marjorie Wallace is patently upset.
It is this kind of story that drives her to work ceaselessly, day and night. She doesn’t rest, she doesn’t exercise, she finds it hard to relax. Even when she had cancer in 1994, when her hair fell out owing to the aggressive chemotherapy, she could not stop working, writing and staying in touch with people
Recently, after a business lunch in Notting Hill, she went shopping, for a dress for a fundraising gala at which she is a key speaker; she seemed astonished to have some free time. “I feel as if I were on day release,” she jokes. Then her mind races onwards, to Rory Bremner and Joanna Lumley, who are hosting the gala. Then she’s off to the House of Commons and later to a TV studio: mixing with the rich and famous and exploiting her own reputation is a duty in her world, but she finds it fun too.
She recalls singing one of her favourite sentimental Victorian ballads at a party in Budapest, to raise £50,000 in a dare; it is a welcome contrast to the hospital waiting rooms and the anguished cries for help that often make up her days.
All this has been a strain on her family and her own health. When her campaigning started she had three young sons and a baby daughter. One of her sons had considerable medical problems. Now her companion of more than 20 years has Parkinson’s disease, and Wallace, in remission from cancer, is too busy to bother much about checkups. But she defends her determination to be available round the clock: “The day I and Sane are not on the front line in the living rooms of distressed families, or on the acute wards, is the day that I should leave.”
She is mildly optimistic about a recent government document entitled Commissioning a Brighter Future, a programme to make psychological therapies accessible through trained cohorts of cognitive-behavioural therapists. Callers to Saneline have been crying out for these therapies for years. Wallace hopes it will not go the way of so many other aspirational policies.
Some might call this a triumph of hope over experience, but Wallace is a romantic visionary still. For all the obvious weariness of the long-distance campaigner, she cannot give up fighting for those who endure mental pain.
The Sunday Times | Sunday, July 08, 2007 | Comments (0)
The challenge for peaceful Muslims
Truth is said to be the first casualty of war; trust is one of the many casualties of terror. If your surgeon or your child’s school assistant or your charity’s youth worker might be a terrorist – as we have seen – whom can you trust: the woman in the scarf at the checkout till? Your bearded GP? The tragedy is that trust is essential to a free and civil society; when trust dies, petty animosities and resentments will swell and civility and civil liberties will shrink.
There was a sad example of this last Thursday on the London Underground in the rush hour. A packed commuter train careered off the rails to the accompaniment of smoke, sparks and bangs. The passengers were thrown from their seats, nearly 40 were injured and it is hardly surprising, perhaps, that a few of them, spotting a dark-skinned man sprinting through their carriage, tried to grab him. They assumed in their panic that he was a terrorist.
The poor man was not hurt; he was lucky, because terror creates mindless violence and in other times, in other places, he would have been lynched. Yet he was innocent. There was no bomb, just an accident. He was just another frightened passenger who happened to look the part of a terrorist in these people’s frenzied imagination. And who can blame them. He might have been one. This will certainly happen again with worse consequences.
The problem is not just that a man or woman might be taken for a Muslim and a terrorist. That is bad enough and divisive. The great majority of law-abiding Muslims feel understandably resentful and fearful about that. What’s probably worse, I suspect, is the growing resentment among nonMuslims about the terrible damage that Islamist terror does to us all and the failure of Muslim families and congregations – I will not speak of so-called community leaders – to do much about it.
Every time a prominent Muslim stands up to say that Islam is a religion of peace and that most Muslims are not terrorists, I feel irritated. Islam clearly means many things to many people, even more so perhaps than Christianity or Judaism, and it is almost meaningless to say that Islam has nothing to do with Islamist terrorism, just as it’s meaningless to say Christianity had nothing to do with the crusades or the inquisition.
There are Muslims who believe that their faith does not require women to cover their faces and there are Muslims who are convinced that it does. There are plenty of British Muslims who support the institutions of this country but there are plenty who think we should live under sharia. What concern us all are those Muslims who believe that Islam justifies terrorism and destroying our society.
As for the usual comment that most Muslims are not terrorists, that is true. But the fact is that most terrorists are Muslims. They come from Muslim environments, they attend madrasahs, mosques and Muslim clubs and societies and spend long periods in Muslim countries. And nonMuslims have been waking up to the thought that these Muslim groups could and should do more about the terrorists in their midst.
Take mosques for example. A couple of British mosques have been notorious for years as breeders of terrorism. So for years anyone interested in this question has expressed concerns about imams – who they are and what they teach. There was a move to limit the immigration of foreign imams, which the Blair government bottled out of. And now it emerges, from a BBC report last week, that only 8% of the imams preaching in British mosques were born in the UK and only 6% of them speak English as a first language – fewer, tellingly, than the percentage born here. According to the author of the study, these individuals are deeply conservative and are overwhelmingly qualified in the traditional Islamic curriculum, which he said had changed little since medieval times.
It would be hard to imagine a better way of preventing British Muslims integrating into the wider, modern society or of driving them into the embrace of more worldlywise extremists. Such imams can have little or no understanding of the difficulties and opportunities facing British Muslims, least of all the young; hardly surprisingly many of the young turn to more interesting, more articulate, more modern and more informed groups outside the mosques – some of whom are the worst extremists, like those of Hizb ut-Tahrir. This process was brilliantly described by Ed Husain in his book The Islamist. So why did the congregations hire them? According to Muslims I’ve spoken to, they are much cheaper than the home-grown variety.
I am sceptical of self-styled community leaders and have my doubts about the Muslim Council of Britain. Why did not such people of influence help the congregations to find spiritual leaders who would advise and guide British Muslims in a constructive way? Why have some failed to speak out against extremists, against book burning or the rabble rousers; why have some, such as Sir Iqbal Sacranie, even called for Salman Rushdie to rot in hell?
It is difficult not to suspect that, rather like the tradition of preventing women learning English or leaving the house, it is due to a contempt for British society or to a wish in some circles to avoid integration. But segregation is the enemy of trust, even without the added onslaught of terrorism.
The question is what, if anything, can be done to repair trust. It is not something that governments can do, although they can try to hold the line as far as possible on civil liberties against our fear of terrorists. The challenge is not so much for the indigenous population as for Muslim citizens; the painful reality is that those who want this society to survive will have to take on the distasteful duty of spying and informing on other Muslims, where necessary.
They should, in their own best interests, stop protesting against writers and artists they disagree with and let them be; they should accept that they cannot avenge Muslim history on British soil. They should stop protesting about Islamophobia and racism, although both exist, and concentrate instead on friendship, understanding and integration. Otherwise trust will fail and with it the civil society that enticed their forebears here.
The Sunday Times | | Comments (0)
The souring of the middle classes
Social mobility is where it’s at these days. It is the holy grail of contemporary politics. Nobody dares question it on any political side; you cannot sit at the round table of power without being a true believer. It means – or is supposed to mean – opportunity, equality and fairness. To be passionately in favour of it is good. To fail to “deliver” it is bad.
What social mobility actually means is joining the middle classes – the hard-working, educated and respectable bourgeois masses of middle Britain. However, something shocking was revealed last week. The middle classes are not by any means as respectable as we thought. In fact they – I will not say “we”, though I do to my shame belong to the middle classes, because I do not wish to associate myself with their turpitude – are criminals.
Shock and awe greeted the publication of a report last week from two academics at Keele University. “The moral majority is a myth”, according to a headline in the Mirror. The Express promised to explain “Why middle England is a secret hotbed of crime”. It seems from this survey that 61% of the population admit to pilfering and peculation, from paying builders and au pairs in cash, stealing office stationery, padding insurance claims, asking well-placed bureaucratic friends to bend the rules, keeping quiet about getting too much change in shops, selling faulty secondhand goods and failing to pay the TV licence – 62% of them do so repeatedly. The middle classes are as bad as any. “The law-abiding majority which politicians like to address is a chimera,” says the report.
As Professor Susanne Karstedt, one of the authors, said: “Contempt for the law is as widespread in the centre of society as it is assumed to be rampant at the margins and among specific marginal groups. Antisocial behaviour by the few is mirrored by anticivil behaviour by the many.” Neither need nor greed, she says, can explain why respectable citizens do such things.
I wonder. First of all I wonder about the findings. Her study interviewed only 1,807 people. Perhaps the middle classes can be discredited as an entirety on the basis of such evidence. On the other hand, perhaps they can’t. But assuming the study is right and the middle classes are doing these dastardly things, I wonder whether there isn’t an obvious explanation, which as Karstedt suggests has little to do with need or greed. I suspect these misdemeanours are an expression of middle-class resentment and revolt. Society, they might feel, hasn’t been so civil to them, so they are becoming less civil to it. This is not immorality, necessarily; it is civil disobedience.
A civil society is based on common consent and shared respect. That means, among other things, that civic virtue must be fairly rewarded. Taxpayers and law abiders should be consulted and respected and enjoy the returns of good behaviour. They should be able to feel their efforts benefit themselves as well as others and they should be able to take pride in both. When they no longer do, their inclination to civic virtue will be undermined. They will become demoralised and disaffected and sooner or later will start breaking rules and laws they no longer consent to; illegal fox-hunting is an example.
That is what has been happening to the British middle classes. They have been mocked and derided for decades. It was not so long ago that middle England was a term of abuse. Now, though politicians may try to show more respect to them, the truth is that the middle classes are getting the fuzzy end of the lollipop.
The rich, the poor, the unemployed and the underclass all do relatively well in contemporary Britain. By contrast the middle classes are pinched and squeezed and bullied wherever they turn. It is as if they were being punished for their thrift, their prudence, their hard work and their aspirations – made to pay and pay again, while those above and below them are not. The result is that they are learning to behave as badly as those above and below.
Taxation is only a part of this, though it is a large part. Taxes here are high now; we recently overtook the Germans in our tax burden. While the rich can find legal ways of avoiding it, and the poor get clumsily reimbursed or offered credits, the middle classes have no escape. Yet they see their rising taxes squandered on schools, hospitals, prisons and police services that are all performing badly and getting worse.
If, in despair at their local schools and hospitals, they move to a better area, they will face punitive stamp duties on their horribly expensive new houses; if they want to hire a nanny or an au pair they will have to pay her taxes out of their own taxed income while other less responsible women get masses of subsidised child care – subsidised by middle-class taxes.
If they want to send their children to university, they will find that they are discriminated against by deliberate policies. If they want to leave something to their children, they will find their houses now attract so much death duty they will have to be sold. Their investments – taxed three times before death, as earned income to be saved, as interest and on capital gains – will be taxed again after death. Their pension schemes have been raided and in some cases shut or ruined.
Underlying all this, and probably irreversible, has been the recent loss of shared social identity and shared social purpose in this country. Ten years of uncontrolled mass immigration and cultural upheaval under Labour have weakened the ties that bind society together. Too much diversity has quickly come to mean too little solidarity, and that means much less inclination to pay taxes willingly for the welfare of alien newcomers, many of them apparently working in the black market or exploiting the NHS. Even Margaret Hodge has woken up to this obvious problem.
And cheating is catching. The result is that despite all the government’s expensive efforts, it seems we have less and less social mobility upwards into the middle classes. What we have instead is moral mobility downwards from the middle classes. The demoralised bourgeoisie is slipping into the moral indifference of the upper classes and down into the petty criminality of the masses. Some holy grail.
The Sunday Times | Sunday, July 01, 2007 | Comments (0)
