Category: Psychopolitics

The first digital antipsychotic pill with tracking. In an authoritarian state, what could possibly go right?

In the United State, regulators have approved the first “digital pill” with a tracking system. According the Financial Times, this is a pill with an inbuilt sensor, which opens up a new front in pharmaceuticals and the “internet of things”. 

The tablet can be tracked inside the stomach, relaying data on whether, and when, patients have taken “vital medication”. So far, the US Food and Drug Administration has given the green light for it to be used in an antipsychotic medication with the aim that the data can be used “to help doctors and patients better manage treatment.”

Patients who agree to take the digital medication, a version of the antipsychotic drug Abilify, can sign consent forms allowing their doctors and up to four other people, including family members, to receive electronic data showing the date and time pills are ingested.

Dr. Peter Kramer, a psychiatrist and the author of Listening to Prozac, raised concerns about “packaging a medication with a tattletale.”

While ethical for “a fully competent patient who wants to lash him or herself to the mast,” he said, “‘digital drug’ sounds like a potentially coercive tool.”

Other companies are developing digital medication technologies, including another ingestible sensor and visual recognition technology capable of confirming whether a patient has placed a pill on the tongue and has swallowed it. 

The newly approved pill, called Abilify MyCite, is a collaboration between Abilify’s manufacturer, Otsuka, and the Silicon Valley based Proteus Digital Health, the company that created the sensor.

The sensor, which contains copper, magnesium and silicon, generates an electrical signal when splashed by stomach fluid, “like a potato battery,” according to Andrew Thompson, Proteus’s president and chief executive.

After several minutes, the signal is detected by a Band-Aid-like patch that must be worn on the left rib cage and replaced after seven days, said Andrew Wright, Otsuka America’s vice president for digital medicine. The patch then sends the date and time of pill ingestion and the patient’s activity level via Bluetooth to a cellphone app.

Abilify is prescribed to people with schizophrenia, bipolar disorder and, in conjunction with an antidepressant, major depressive disorder. The symptoms of schizophrenia and related disorders can include paranoia and delusions, so you do have to wonder how widely digital Abilify will be accepted, given that it is designed to monitor behaviours and transmit signals from within a person’s body to communicate with their doctor.  

Dr. Jeffrey Lieberman, chairman of psychiatry at Columbia University and New York-Presbyterian Hospital, said many psychiatrists would likely want to try digital Abilify, especially for patients who just experienced their first psychotic episode and are at risk of stopping medication after feeling better.

But he noted it has only been approved to track doses, and has not yet been shown to improve compliance with treatment regimes.

He added, “There’s an irony in it being given to people with mental disorders that can include delusions. It’s like a biomedical Big Brother.”

The FT article goes on to say: “Poor compliance with drug regimes, particularly among sufferers of chronic diseases, is a pervasive problem for pharma companies and health systems, leading to lower consumption of the industry’s products and higher costs for payers when patients’ conditions deteriorate as a result of missing treatment.”

 You can see precisely where the emphasis and priorities lie in that statement. Not a word about the poor dehumanised “patients'” wellbeing and importantly, about their choice. It’s assumed that pharma industry’s products don’t have any adverse effects at all, and that taking the medication is always in the patient’s best interest. It’s assumed that medications will improve someone’s mental health. Apparently the key to good mental health is keeping costs low to tax payers while keeping the pharma industry in business, ensuring that they can keep making profits.

Andrew Thompson, Proteus chief executive, said the technology would allow people with serious mental illness “to engage with their care team about their treatment plan in a new way”. Patients will be able to use a mobile phone to track and “manage” their medication. Worryingly, he is already in talks with other major pharma companies about using the technology in treatments for various chronic conditions.

The tablets contain a sensor, so that when they are swallowed, a signal is sent to a patch worn on the patient’s body, which in turn connects to an app on their phones, showing that they have taken their dose. The doctor who has prescribed the medicine will automatically be sent the data and patients can also choose to nominate family and care team members to receive it.

The wearable patch will also be used to track how much patients are moving around — considered a key indicator of overall health — and allows them to self-report their mood and sleep quality via the app. 

There are some problems with the assumptions behind the development of digital pill, and its proposed use. Firstly, it’s a myth that people with mental health conditions are not very good at taking their medication. Studies have shown that “compliance” with a medication regime is no worse in people with mental health conditions like schizophrenia than it is in long-term physical ailments such as asthma or high blood pressure. In fact demographic factors such as whether a person is single or in a relationship are more likely to play a role in medication compliance.

It is also a taken for granted assumption that pharmaceutical solutions are the best guarantee of positive outcomes for people with mental health conditions. Before concentrating on specific medication issues it is important to remember that medication is not the sole focus of a mental health intervention. This is because the causes of mental illness are complex and various, and quite often do not arise solely from “within” individuals, rather, it often arises because of interactions between environmental factors, circumstances, and individual predispositions and vulnerabilities (including both psychological and biological). Some psychiatrists have stated that mental illness – in all its forms – is intrinsically social.

We know, for example, that discrimination plays a part in explaining why certain groups in our society are more likely to experience poor mental health compared to others. Direct experiences of prejudice and harassment impact negatively on mental wellbeing, while indirect factors such as deprivation and social exclusion also contribute to poor mental health. Studies have highlighted the role that prejudice, stigma and discrimination can play in poor mental health.

It is only by fully acknowledging and understanding the external risk factors for poor mental health that we can develop our understanding of protective factors for good mental health at the individual, community and societal level. 

Sometimes causes are confused with effects

Despite controversies in psychiatry regarding the very complex aetiology of mental illness, including the role of sociological practices, political practices and economic conditions, it is widely held that mental illness arises “within” the individual and has a purely neurobiological origin. Yet there is no conclusive evidence to demonstrate that major mental illnesses are “proven biological diseases of the brain” and that emotional distress results from “chemical imbalances.”

One attempt to explain a physical cause of schizophrenia is the dopamine hypothesis. Dopamine is a neurotransmitter. It is one of the chemicals in the brain which causes neurons to fire. The original dopamine hypothesis stated that people with schizophrenia suffered from an excessive amount of dopamine. This causes the neurons that use dopamine to fire too often and transmit too many “messages”. High dopamine activity leads to acute episodes, and positive symptoms which include delusions, hallucinations and “confused thinking.”

Evidence for this hypothesis comes from that fact that amphetamines increase the amounts of dopamine. Large doses of amphetamine given to people with no history of psychological disorders produce behavior which is very similar to paranoid schizophrenia. Small doses given to people already suffering from schizophrenia tend to worsen their symptoms.

However, the problem with this hypothesis is that we don’t know if the raised dopamine levels are the cause of the schizophrenia, or if the raised dopamine level is the result of schizophrenia. It is not clear which comes first. 

One of the biggest criticisms of the dopamine hypothesis came when Farde et al found no difference between levels of dopamine in people with schizophrenia compared with “healthy” individuals in 1990.

Another problem is that schizophrenia is something of an umbrella term that encompasses a wide array of symptoms, and can be reached by multiple routes that may, nevertheless, impact the same biological pathways. However, there is emerging evidence that different routes to experiences currently deemed indicative of schizophrenia may need different treatments.

For example, preliminary evidence suggests that people with a history of childhood trauma who are diagnosed with schizophrenia are less likely to be helped by antipsychotic drugs. However, more research into this is needed. It has also been suggested that some cases of schizophrenia are actually a form of autoimmune encephalitis, which means that the most effective treatment may be immunotherapy and corticosteroids. People with autoimmune illness such as lupus are also at an increased risk of developing autoimmune mediated psychosis.

Some interventions, such as the family-therapy based dialogue approach, show some promise for many people with schizophrenia diagnoses. Both general interventions and specific ones, tailored to someone’s personal route to the experiences associated with schizophrenia, may be needed. It’s therefore crucial that psychiatrists ask people about all the potentially relevant circumstances and routes.

For example, suffering childhood adversityusing cannabis and having childhood viral infections of the central nervous system all increase the odds of someone being diagnosed with a psychotic disorder (such as schizophrenia) by at least two – to threefold. 

Although the exact causes of most mental illnesses are not known, it is becoming clear through extensive research that many conditions are caused by a complex combination of biological, psychological, social, cultural, political, economic and environmental factors. It’s widely recognised that poverty, social isolation, being unemployed or highly stressed in work can all have an effect on an individual’s mental health. 

Adults in the poorest fifth of the population are much more at risk of developing a mental illness as those on average incomes: around 24% compared with 14%. Those who have an existing mental illness are significantly more likely to be living in poverty, also. 

Poverty can therefore be both a causal factor and a consequence of mental ill-health. Mental health is shaped by the wide-ranging characteristics (including inequalities) of the social, economic, political and physical environments in which people live.

Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, requires an engagement with this complexity. Simply medicating a person is neither sufficient nor appropriate. Nor is it ethical. Pharmaceutical companies tend to promote the assumption that mental illness is entirely biomedical. The relationship between economics and health is complex and politically fraught. But it is too important to ignore.

Psychiatric diagnosis tends to reify the complexity of people’s problems. However, in the UK, the political (mis)use of behaviourism has also resulted in the reification of social and economic problems. The government here extend the view that unemployment is evidence of both personal failure and psychological deficit. The use of crude behaviourist psychology in the delivery of social security denies the individuals’ experience of the effects of social and economic inequalities, and has been used to authorise the extension of the state and to justify state-contracted surveillance to individuals’ psychological characteristics.  

In a “business friendly” environoment, with a distinctly authoritarian government, I can’t help but wonder how long will it be before we see the increasingy intrusive Conservative state locking up or drugging patients whose diseases are defined not by organic dysfunction but by politically defined “socially unacceptable behaviours”.

I’m a critic of state entanglement with psychiatry AND psychology. For people with mental health problems in the UK, policies are being formulated to act upon them as if they are objects, rather than autonomous human subjects. Such a dehumanising approach has contributed significantly to a wider process of  social outgrouping, increasing stigmatisation and ultimately, to further socioeconomic and mental health inequalities. Most government policies aimed at ill and disabled people more generally are about cutting costs and removing lifeline support. This has been increasingly justified by a narrative that focuses on problematising sick role behaviours, rather than on the real impacts of illness and the additional needs that being chronically ill invariably generates. 

Earlier this year, George Freeman, Conservative MP for Norfolk and chair of the Prime Minister’s Policy Board, defended the government’s decision to subvert the judicial system, by disregarding the rulings of two independent tribunals concerning Personal Independence Payment (PIP) for disabled people. The government ushered in an “emergency” legislation to reverse the legal decisions in order to cut cost. In an interview on Pienaar’s Politics, on BBC 5 Live, Freeman said: 

“These tweaks [new regulations to cut PIP eligibility] are actually about rolling back some bizarre decisions by tribunals that now mean benefits are being given to people who are taking pills at home, who suffer from anxiety”.

He claimed that the “bizarre” upper tribunal rulings meant that“claimants with psychological problems, who are unable to travel without help, should be treated in a similar way to those who are blind.”

He said: “We want to make sure we get the money to the really disabled people who need it.”

He added that both he and the Prime Minister “totally” understood anxiety, and went on to say: “We’ve set out in the mental health strategy how seriously we take it.” 

He said: “Personal Independence Payments reforms were needed to roll back the bizarre decisions of tribunals.” 

Freeman’s controversial comments about people with anxiety “at home taking pills” implies that those with mental health problems are somehow faking their disability. He trivialises the often wide-ranging disabling consequences of mental ill health, and clearly implies that he regards mental illnesses as somehow not “real” disabilities.

His comments contradict the government’s pledge to ensure that mental health and physical health are given a parity of esteem, just months after the Prime Minister pledged to take action to tackle the stigma around mental health problems. 

Yet people with the following mental health conditions are likely to be affected by the reversal of the Independent Tribunal’s ruling on PIP mobility awards – those in particular who suffer “overwhelming psychological distress” when travelling alone:

Mood disorders – Other / type not known, Psychotic disorders – Other / type not known, Schizophrenia, Schizoaffective disorder, Phobia – Social Panic disorder, Learning disability – Other / type not known, Generalized anxiety disorder, Agoraphobia, Alcohol misuse, Anxiety and depressive disorders – mixed Anxiety disorders – Other / type not known, Autism, Bipolar affective disorder (Hypomania / Mania), Cognitive disorder due to stroke, Cognitive disorders – Other / type not known, Dementia, Depressive disorder, Drug misuse, Stress reaction disorders – Other / type not known, Post-traumatic stress disorder (PTSD), Phobia – Specific Personality disorder, Obsessive compulsive disorder (OCD).

Freeman’s comments signposts the Conservative’s “deserving” and “undeserving” narrative, implying that some disabled people are malingering. However, disabled people do not “cheat” the social security system: the system has been redesigned by the government to cheat disabled people.

When people are attacked, oppressed and controlled psychologically by a so-called democratic government that embeds punishment at the heart of public policies to target the poorest citizens, it’s hardly surprising they become increasingly anxious, depressed and mentally unwell.

An era of technocratic solutions for social problems

Some psychiatrists see a strengthening of psychiatry’s identity as essentially “applied neuroscience”. Although not discounting the importance of the neurological sciences and psychopharmacology, they have argued that psychiatry needs to move beyond the dominance of the current dominant technological paradigm. Such critical practitioners say that psychiatry ought to primarily involve engagement with the non-technical dimensions of their work such as relationships, meanings and values. Psychiatry has operated from within a technological paradigm that, although not ignoring these aspects of work, has kept them as secondary concerns.

Psychiatry sits within a predominantly biomedical idiom. This means that problems with feelings, thoughts, behaviours and relationships can be fully grasped with the same sort of scientific tools that we use to investigate physical problems with our kidneys, blood cells, lungs, and so on.

While psychiatry has generally focused a lot of attention on neuroscience, neuroscientists themselves have become more cautious about the value of reductionist and deterministic approaches to understanding the nature of human thought, emotion and behaviour.

The dominance of this paradigm can be seen in the importance attached to classification systems, causal models of understanding mental distress and the framing of psychiatric care as a series of discrete interventions that can be analysed and measured independent of context.

More recently, models of cognitive psychology, based on “information processing”, have been developed that work within the technological idiom. Psychiatry stubbornly operates within a positivist tradition, and subscribes to the following assumptions: mental health problems arise from faulty mechanisms or processes involving abnormal physiological or psychological events occurring within the individual, these processes can be modelled in causal terms.

These processes are regarded as not being context dependent. They reside “within” the individual. Technological interventions are instrumental and can be designed and studied independently of experiences, subjective states, relationships, and values. However, in 2013, psychiatrist Allen Frances said that “psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests”.

Many people within the growing service user movement seek to reframe experiences of mental illness, distress and alienation by framing them as human experiences, rather than biomedical events, simplistic causal relationships and “scientific” challenges. In a study of users’ views of psychiatric services, Rogers et al found that many service users did not really value the “technical” expertise of professionals. Instead, they were much more concerned with the subjective experience and human elements of their encounters such as being listened to, taken seriously, and treated with dignity, kindness and respect.

Cutting the Stone (Bosch).jpg

The Extraction of the Stone of Madness by Hieronymus Boschfrom around 1494.

In his work, History of Madness, Michel Foucault says “Bosch’s famous doctor is far more insane than the patient he is attempting to cure, and his false knowledge does nothing more than reveal the worst excesses of a madness immediately apparent to all but himself.” 

I have to say I have never seen a person by looking at a brain.

It’s not all “in here”, it’s “out there”: the problem with locating mental illness “within” the individual

To paraphrase R.D Laing, “insanity”, mental illness and psychological distress may be seen as a perfectly rational adjustment to an insane world. Laing examined the nature of human experience from a phenomenological perspective, as well as exploring the possibilities for psychotherapy in an existentially distorted world. He challenges the whole idea of “normality” in society. 

It simply isn’t effective or appropriate to treat distress arising because of, say, socioeconomic problems or difficult relationships with psychotropic drugs alone, administered to people experiencing the consequences of political decision-making, the adverse consequences of socioeconomic organisation, exclusion, stigma, abuse or damaging parenting practices. 

Coping with past or current traumatic experiences such as abuse, bereavement or divorce will also strongly influence an individual’s mental and emotional state which can in turn have an influence on their wider mental health. Psychological interventions are therefore a crucial and integral part of effective treatment for mental illnesses.

However, in the UK, the current political-psychological model also locates social problems “within” the individual. The government plan to merge health and employment services. In a move that is both unethical and likely to present significant risk of harm to many patients, health professionals are being tasked to deliver benefit cuts for the Department for Work an Pensions. This involves measures to support the imposition of work cures, including setting employment as a clinical outcome and allowing medically unqualified job coaches to directly update a patient’s medical record.

The Conservatives have proposed more than once the mandatory treatment for people with long term conditions (which was first flagged up in the Conservative Party Manifesto) and this is currently under review, including whether benefit entitlements should be linked to “accepting appropriate treatments or support/taking reasonable steps towards “rehabilitation”.  The work, health and disability green paper and consultation suggests that people with the most severe illnesses in the support group may also be subjected to welfare conditionality and sanctions.

Such a move has extremely serious implications. It would be extremely unethical and makes the issue of consent to medical treatment very problematic if it is linked to the loss of lifeline support or the fear of loss of benefits. However this is clearly the direction that government policy is moving in and represents a serious threat to the human rights of patients and the independence of health professionals.

The digital pill in an age of surveillance has potential implications for civil liberties

For people with severe and enduring mental health problems, it is crucial that their context is also considered, and it’s important that people are provided with support with their living circumstances, and taking into account their wider social conditions, also. 

Furthermore, there is the important issue of drug tolerability to consider. Antipsychotic drugs are also associated with adverse effects that can lead to poor medication adherence, stigma, distress and impaired quality of life. For example, the stiffness, slowness of movement and tremor of antipsychotic-induced parkinsonism (See Dursun et al, 2004) can make it difficult for a patient to write, fasten buttons and tie shoelaces. Some antipsychotic medications can affect facial expressions, which flatten nonverbal communication and may impact on ordinary social interactions, potentially leading to stigma and further isolation.

Side effect or symptom?

The impact of drug side-effects on patients has not been sufficiently studied. Researchers have stressed the importance of the patient’s subjective experience, in which adverse effects have a role, and are considered and included in the assessment of drugs, though this doesn’t always happen. Although adverse effects are an important outcome, with many antipsychotics, they account for less treatment discontinuation than lack of efficacy; this finding has been noted in naturalistic studies and in Randomised Controlled Trials (RCTs). 

Both older and newer antipsychotic drugs can cause:

  • Uncontrollable movements, such as tics, tremors, or muscle spasms, blank facial expression and abnormal gait (risk is higher with first-generation antipsychotics)
  • Weight gain (risk is higher with second-generation antipsychotics)
  • Photosensitivity – increased sensitivity to sunlight
  • Anxiety
  • Drowsiness
  • Dizziness
  • Restlessness
  • Dry mouth
  • Constipation
  • Nausea
  • Vomiting
  • Blurred vision
  • Low blood pressure
  • Seizures
  • Low white blood cell count
  • Sexual dysfunction in both men and women
  • Menstruation problems in women and feminising effects such as abnormal breast growth and lactation in men. These latter problems are caused by the effect that the newer drugs have on a hormone in the blood called prolactin
  • Osteoporosis
  • Some neuroleptic drugs have withdrawal effects which can be very unpleasant

In addition some side effects of the newer antipsychotics may be confused with the symptoms of schizophrenia, such as apathy and withdrawal.

Antipsychotics can also cause bad interactions with other medications.

Bioethic considerations

One of the serious bioethic considerations is whether the digital medicine could be used coercively, on people against their will or as part of probation, healthcare or welfare conditions, for example.

Otsuka has said: “We intend that this system only be used with patient consent.”

However, here in the UK, the government have been kite-flying the idea of social security support being made conditional to imposed “health” regimes for a while. 

The Conservatives have already made proposals to strip obese or those who are ill because of substance misuse of their welfare benefits if they refuse treatment. This  violates medical ethics. The president of the British Psychological Society responded, at the time, Professor Jamie Hacker Hughes, said people should not be coerced into accepting psychological treatment and, if they were, evidence shows that it simply would not work.

He went on to say: “There is a major issue around consent, because as psychologists we offer interventions but everybody has got a right to accept or refuse treatment. So we have got a big concern about coercion.”

Hacker Hughes lent his voice to a chorus of criticism following the announcement of an official review to consider how best to get people suffering from obesity, drug addiction or alcoholism back into work. 

The government consultation paper, launched in 2015, that raised concerns acknowleged that strong ethical issues were at stake, but at the same time also questioned whether people should continue to receive benefits if they refused state provided treatment.

The government regard work as a health outcome, and believe that welfare creates “perverse incentives” that prevent people from finding employment. However, international research and evidence demonstrates that this is untrue, and that generous welfare states tend to be correlated with a stronger work ethic.

Hacker Hughes said claimants with obesity and addiction problems often faced complex mental health issues. But he warned the government against using sanctions to force people to accept interventions.

“It’s a problem firstly because we don’t believe people should be coerced into accepting any treatment, and secondly there is a problem because the evidence shows that if you are trying to change people’s behaviour, coercion doesn’t work,” he said.

There is a well-documented link between being out of work and psychological problems, but Hacker Hughes pointed out that the government’s plan risked “confusing the symptoms with the cause.”

Paul Atkinson, a London-based psychotherapist and member of the Alliance for Counselling and Psychotherapy, called the government’s proposals an outrage. He said: “It’s the same psychology from the government of punishing rather than working with people. Under a regime like welfare and jobcentres at the moment it is going to be felt as abuse, punitive and moralistic.”

Yes, and that’s because it is.

The government introduced “ordeals” into the welfare system to deter people from claiming the social security that most have paid for via national insurance and tax contributions, in order to “deter” what they see as “welfare dependency”. Yet labor market deregulation, anti-union legislation and other political decisions have also driven down wages, leaving many in work in poverty, also. The government’s “solution” to in-work poverty was to introduce further conditionality, in the form of extremely punitive financial sanctions for people who need to claim in-work welfare support, to “ensure they progress in work”. It is assumed that the problem of low pay resides “within the individual” rather than being the consequence of structural and labor market conditions, the profit incentive, “business friendly” political decision-making and board room choices. Ultimately, it’s down to the unequal distribution of power.

A gaslighting state: punitive psychopolicy interventions

No-one seems to be concerned with monitoring the impact of the government’s “behavioural change” agenda. Strict behavioural requirements and punishments in the form of sanctions are an integral part of the Conservative ideological pseudo-moralisation of welfare, and their  “reforms” aimed at making claiming benefits much less attractive than taking a low paid, insecure, exploitative job. 

Welfare has been redefined: it is preoccupied with assumptions about and modification of the behaviour and character of recipients rather than with the alleviation of poverty and ensuring economic and social wellbeing. Furthermore, the political stigmatisation of people needing benefits is designed purposefully to displace public sympathy for the poor, and to generate moral outrage, which is then used to further justify the steady dismantling of the welfare state. (See Stigmatising unemployment: the government has redefined it as a psychological disorder.)

However, the problems of austerity and the economy were not caused by people claiming welfare, or by any other powerless, scapegoated, marginalised group for that matter, such as migrants. The problems have arisen because of social conservatism and neoliberalism. The victims of the government’s policies and decision-making are being portrayed as miscreants – as perpetrators of the social problems caused by the government’s decisions, rather than as the casualities.

Under the government’s plans, therapists from the NHS’s Improving Access to Psychological Therapies (IAPT) programme are to support jobcentre staff to assess and treat claimants, who may be referred to online cognitive behavioural therapy (CBT) courses.

Again, we really must question the ethics of linking receipt of welfare with “state therapy,” which, upon closer scrutiny, is not therapy at all. Linked to such a narrow outcome – getting a job – this is nothing more than a blunt behaviour modification programme. The fact that the Conservatives plan to make receipt of benefits contingent on participation in “treatment” worryingly takes away the fundamental right of consent.

Not only is the government trespassing on an intimate, existential level; it is tampering with our perceptions and experiences, damaging and isolating the poorest, burdening them with the blame for the consequences of their own policies whilst editing out state responsibilities towards citizens. (See the The power of positive thinking is really political gaslighting, and IAPT is value-laden, non-prefigurative, non-dialogic, antidemocratic and reflects a political agenda.)

It’s very important that we don’t overlook the importance of context regarding psychological distress. The idea that mental “illness” arises strictly “within” the individual, therefore, requiring medicine as treatment, as opposed to, say, different socioeconomic policies, is a controversial one. People’s mental health is, after all, at least influenced by the social, political, cultural and economic spaces that they occupy. 

The current government has a 7 year history of decontextualing structural inequality and poverty, using narratives that “relocate” the causes and effects of an unequal distribution of power and wealth. Such narratives are about coercing the responsibility, internalisation and containment of social problems within some targeted individuals in some marginalised social groups. This process always involves projection, stigmatising, outgrouping and scapegoating. 

Earlier this year, the UK Council for Psychotherapy (UKCP) said that government policies – in particular, the Conservatives’ draconian “reforms” of social security payments and austerity regime – were to blame for a steep rise in the rates of severe anxiety and depression among unemployed people, as benefit cuts and sanctions, together with an extremely punitive and coercive welfare conditionality regime, “are having a toxic impact on mental health”.

It’s hardly ethical, appropriate or effective to impose a medical treatment on people who are suffering because of policies that bring about financial and psychological insecurity, hardships and harms.  

We have witnessed an ongoing attempt by the Conservatives to “rewrite the welfare contract” for disabled people, which has become a key site of controversy within UK welfare reform, and fierce debates about the circumstances in which the use of  conditionality may, or may not, be ethically justified. And denial from the government that their welfare policy is causing some of our most vulnerable citizens harm, hardship and distress. 

Wilkinson and Pickett’s key finding in their work, The Spirit Level: Why More Equal Societies Almost Always Do Better is that it is the inequality itself, and not the overall wealth of a society that is the key factor in creating various pathologies. The authors  show that for each of eleven different health and social problems: physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence, teenage pregnancies, and child wellbeing, outcomes are significantly worse in more unequal rich countries. The evidence also shows that poorer places with more equality have better overall social outcomes than wealthy ones marked by gross inequality. (See also The still face paradigm, the just world fallacy, inequality and the decline of empathy, for further discussion about how neoliberaism itself creates profound psychological trauma, and builds social “empathy walls”).

Theresa May has pledged new initiatives to end “stigma” around mental health and encourage schools and employers to provide mental health support. Despite government assurances mental health services would receive equal treatment to physical health, 40% of NHS trusts saw cuts to mental health services across 2015-2016.

But in the absence of genuine funding commitments, the Prime Minister has faced charges of hypocrisy from mental campaigners, for not doing anywhere near enough to address the root causes of problems faced by disabled and mentally ill people. 

At one point in 2014, there were no mental health beds available for adults in the whole of England, while an NSPCC survey published in October 2015 found that more than a fifth of children referred to child and adolescent mental health services (CAMHS) in England were refused access to support. 

There have recently been a number of high-profile cases reported more than once in the media across the UK when the necessary kind of hospital bed could not be found for mental health patients in England. The NHS Confederation’s Mental Health Network – the representative body for NHS-funded mental health service providers – also heard evidence from its members last year that “there are occasions when there are no routine acute mental health assessment beds available across the country.”

Importantly, Psychologists Against Austerity have said: “Addressing mental health is not just about ensuring more ‘treatment’ is available and stigma is reduced, although they are important. It is fundamentally also about the evidence that ideological economic policies, like the continued austerity programme, have hit the most vulnerable citizens the hardest and have been toxic for mental health.”

The government’s “employment and support programme” for sick and disabled people coincided with at least 590 “additional” suicides, 279,000 cases of mental illness and 725,000 more prescriptions for antidepressants – and one mental health charity found that at least 21 per cent of their patients had experienced suicidal thoughts due to the stress of the draconian Work Capability Assessments. 

It’s crucially important that a positive therapeutic alliance based on trust is developed  between doctors and patients. Specific problems with the therapeutic alliance include doctors failing to acknowledge patients’ concerns, an example of which is the failure to respond to patients who talk about their auditory halluci­nations in schizophrenia (McCabe et al, 2002). Furthermore, doctors appear not to appreciate the degree of distress caused by certain antipsychotic side-effects (Day et al, 1998). There is, therefore a fundamental need for doctors to listen more effectively to patients and elicit their particular concerns about their illness and its treatments. In fact Poor doctor-patient relationships have been cited by recent research as a key factor that influences a patient’s attitude towards treatment.

Critics of psychiatry commonly express a concern that the path of diagnosis and treatment is primarily shaped by profit prerogatives, echoing a common criticism of general medical practice, particularly in the United States, and increasingly, in the UK, where many of the largest psychopharmaceutical producers are based.

It’s an inbuilt “cognitive bias”. 

This critique is not meant to imply that physiological factors in mental illnesss can or should be ignored. However, as I’ve pointed out, the biomedical model avoids the personal, social, cultural, political and economic dimensions of mental illness, in the same way that the political behaviourist (behavioural economics, used in public policy) model does.

One concern is that both the behaviourist and biomedical model protects those formulating provision and care from the pain experienced by those needing support. The temptation to retreat into objectification of those identified as mentally ill may also be a factor in a state cost cutting exercise. 

The UK government has already demonstrated a worrying overreliance on individualistic approaches to socioeconomic problems that prioritise citizen responsibility and “self help”. The behavioural turn has been powerfully influenced by libertarian paternalism – itself a political doctirne, despite its claims to “value-neutrality”.

The Conservatives’ neoliberal policies increasingly embed behaviour modification techniques that aim to quantifiably change the perceptions and behaviours of citizens, aligning them with narrow neoliberal outcomes through rewards or “consequences.” Rewards, such as tax cuts, are aimed at the wealthiest, whereas the most vulnerable citizens who are the poorest are simply presented with imposed cuts to their lifeline support as an “incentive” to not be poor. Taking money from the poorest is apparently “for their own good”, according to the government, as it reduces “dependency”. 

“Dependency” and “need” have somehow become conflated, the government have resisted urges to acknowledge that some citizens have more needs than others for a wide array of reasons, including their mental health status.

Defining human agency and rationality in terms of economic outcomes is extremely problematic. And dehumanising. Despite the alleged value-neutrality of behavioural economic theory and CBT, both have become invariably biased towards the status quo rather than progressive change and social justice.

Behavoural economics theory has permited policy-makers to indulge ideological impulses whilst presenting them as “objective science.” From a libertarian paternalist perspective, the problems of neoliberalism don’t lie in the market, or in growing inequality and poverty: neoliberalism isn’t flawed, nor are governments – we are. Governments and behavioural economists don’t make mistakes – only citizens do. No-one is nudging the nudgers.

It’s assumed that their decision-making is infallible and they have no whopping cognitive biases of their own. One assumption that has become embedded in the poliical narrative is that an adequate level of social security to meet people’s basic survival needs is somehow mutually exclusive from encouraging people to find a suitable job.

In the current political context, it’s easy to see how the medicalisation of political, economic, cultural and social problems may be politically misused, especially by an authoritarian government, and in an ideological era that extolls the virtues of a “small state” and austerity, to exempt the state completely from its fundamental responsibility towards the prosperity, health and wellbeing of citizens.

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Neoliberalism


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More allegations of Tory election fraud, now we need to talk about democracy

The Conservative Party are facing another investigation from the Electoral Commission following evidenced allegations that they operated a secret call centre during the general election campaign, breaching electoral law, an undercover investigation by Channel 4 News has revealed. 

An undercover reporter working for Channel 4 News secured work at Blue Telecoms, a company in Neath, South Wales. In an area plagued by unemployment and low wages, the call centre hired up to a hundred people on zero-hours contracts. For weeks, they contacted thousands of potential voters in marginal seats across the UK. 

The hired callers were told to say they were working for a market research company called “Axe Research”. No such company is registered in England and Wales. Furthermore, callers were instructed to say that the call centre was situated in Cardiff, rather than Neath.

The investigation has uncovered underhand and potentially unlawful practices at the centre, in calls made on behalf of the Conservative Party. These allegations include:

Paid canvassing on behalf of Conservative election candidates – illegal under election law.

● Political cold calling to prohibited numbers

● Misleading calls claiming to be from an “independent market research company” which does not appear to exist

The Conservative Party have admitted it had commissioned Blue Telecoms to carry out “market research and direct marketing calls” during the campaign, and insisted the calls were legal.

A Conservative spokesman said: “Political parties of all colours pay for market research and direct marketing calls. All the scripts supplied by the party for these calls are compliant with data protection and information law.”

Under the Representation of the People Act, it is illegal to employ someone “for payment or promise of payment as a canvasser for the purpose of promoting or procuring a candidate’s election”.

Call centre employees working on behalf of the party used a script that certainly appeared to canvass for support on film, rather than conduct market research. On the day of the election, call centre employees contacted voters to promote individual candidates.

Anya Proops, a QC specialising in information law, told Channel 4 that political parties had to ensure that third parties working on their behalf followed the law.

“It’s an illegal practice, it’s prohibited under the legislation and in so far as it’s something which has tainted the overall result in favour of a political candidate, then it can void that result.” 

Blue Telecoms is run by Sascha Lopez. He told The Guardian: “In relation to the Conservative party project, I am unable to comment on the content of the scripts or calls to TPS [Telephone Preference Service] numbers, as the scripts and lists of who to call and when to call were given to us by Conservative campaign HQ in London and were not influenced by my team.”

However, a whistleblower at the call centre told Channel 4 News that they had been making potentially unlawful phone calls to voters. 

Undecided voters were fed key Conservative campaign messages, including references to the Brexit negotiations and warnings about a hung parliament.

On the day that voters went to the polls, undecided voters were told that: “the election result in your marginal constituency is going to be very close between Theresa May’s Conservatives and Jeremy Corbyn’s Labour Party”. Callers were also recorded quoting media articles that were pro-Conservative. Operating from a script, the staff claimed they were carrying out calls for “market research” and “polling”. 

One caller is recorded saying: “It was reported in the Daily Mirror in September last year that Jeremy Corbyn is not concerned about the numbers of people coming to live in the UK and it was reported on Sky News this year that Theresa May has restated her pledge to reduce net Migration.”

People were then asked: “Just thinking about these reports in the media and the reports that you live in a marginal constituency that may determine who is prime minister. So does knowing that you live in a marginal constituency that will determine who is prime minister for the Brexit negotiations, does that make you a lot more likely to vote for Theresa May’s Conservative candidate or a little more likely to vote for Theresa May’s Conservative candidate, or are you still unsure, or does it not make a difference?”

The broadcaster’s evidence suggests that on the day of the election, staff called voters in 10 marginal seats, including Bridgend, Gower, Clwyd South and Wrexham.

As the election campaign started, the information commissioner, Elizabeth Denham, wrote to all the major political parties reminding them of the law around telephone calls and data protection. She said that calling voters to promote a political party was “direct marketing” and was regulated by law.

A week before the election, the same call centre staff started saying they were calling on behalf of Theresa May’s Conservatives.

The Conservative party said the call centre was conducting “market research” on its behalf, and was not canvassing for votes. The call centre confirmed it was employed by the party, but has so far denied canvassing on its behalf. 

The Channel 4 undercover reporter has captured evidence that certainly seems to refutes that claim. 

The use of ‘big data’ and psychographic targeting

Teams of statisticians and behavioural psychologists who subscribe to the burgeoning practice of “psycho­graphic targeting” have designed their own version of a Myers-Briggs personality test. The original test explores “the basic differences in the ways individuals prefer to use their perception and judgement.”

The test data is supplemented by recent issue surveys, and information from online surveilance, together they are used to categorise political supporters, who then receive psychologically tailored canvassing messages, social media targeting, phone calls and doorstep visits. The micro-targeting of voters has been around for a while, but the Conservative operation has deepened the intensity of the effort and the use of vast resources of psychological data.

This is the campaign approach from a government that claims to advocate a “small state” and “minimal interventions”. However the methods being used which entail the manipulation and management of public perceptions and voting behaviours resemble those of authoritarian regimes, not a healthy liberal democracy. 

Authoritarian propagandists attempt to convey power by defining reality. The reality they portray is usually very simple. The account of reality is offered with the primary goal of switching voters’ value systems to align with the authoritarian value system.

This whole approach is the logical conclusion of the libertarian paternalists‘s “behavioural change” agenda that has been embedded in policies designed by the nudge unit since 2010 in the UK. The political misuse of psychology has been disguised as some kind of technocratic “fix” for a failing neoliberal paradigm, and paraded as neutral “science”. However, it’s role as an authoritarian prop for an ideological imposition on the population has always been apparent to some of us, especially given the more visible evidence of the stage management of our democracy via an extremely manipulative mainstream media over recent years.

The Conservative’s behaviour change agenda is designed to align citizen’s perceptions and behaviours with neoliberal ideology and the interests of the state. However, in democratic societies, governments are traditionally elected to reflect and meet public needs. The use of “behaviour change” policy involves the state acting upon individuals, and instructing them how they must be. This is profoundly undemocratic. In fact it turns democracy completely on its head. 

A dark message for democracy

Political “dark” advertising that is only seen by its intended recipients is a much greater cause for concern than “fake news” in the spread of misinformation, because it is invisible to everyone but the person being targeted. This means that the individually tailored messages are not open to public scrutiny, nor are they fact checked.

A further problem is that no-one is monitoring the impact of the tailored messages and the potential to cause harm to individuals. The dark adverts are designed to exploit people’s psychological vulnerabilities, using personality profiling, which is controversial in itself. Intentionally generating and manipulating fear and anxiety to influence political outcomes isn’t a new thing. Despots have been using fear and slightly less subtle types of citizen “behaviour change” programmes for a long time. 

The right wing media’s blatant propaganda approach to election campaigning on behalf of the Tories had already contributed significantly to a serious erosion of democratic norms in the UK, the undermining of public trust, to such an extent that profoundly anti-democratic alternatives suddenly seem perfectly acceptable here.

The reality is that often, authoritarians construct an incongruent, flimsy and meaningless language of democracy in order to erect a fact proof screen around an undemocratic reality.  They offer a lot of glittering generalities to the public. However, those apparently incoherent, meaningless slogans are especially designed to signal intents to groups from which the government wants to gain approval. Dog whistling and wedge issues are used extensively by the right.  

Dog whistling is closely associated with a broader wedge strategy, whereby the political party introduces a divisive or controversial social issue into a campaign, aligning its own stance with the dissenting faction of its opponent party, with the goal of causing vitriolic debate inside the opposing party, defection of its supporters, and the legitimising of sentiment which had previously been considered inappropriate. Political campaigns use wedge issues to exploit tension within a targeted population, and undermine unity. 

In light of this, it’s hardly a shocking revelation that an authoritarian government is also using highly tailored and underhanded “dark adverts” to target individuals online, on the basis of information gathered about them and then applied to a process of extensive psychological profiling in order to influence voting behaviours, and the election outcome.

UK voters are being targeted with highly specific messages in an attempt to influence their vote.

The shadowy world of online political advertising has until recently gone largely unmonitored, despite the huge power and reach of Facebook and despite social media messaging now thought to have contributed to the election of Donald Trump and the Vote Leave victory.

The new forms of psychological electioneering are invisible to all but the individual people they are designed to reach and influence. 

During the EU referendum, Vote Leave spent a whopping 98 per cent of its £6.8m budget on digital advertising, mostly via Facebook. In the 2015 election, the Conservatives spent £1.2m on digital campaigning, compared with Labour’s £160,000. This meant that the Conservatives reached 17 million people per week, while Labour reached only 16 million in their best month. Facebook claimed that the Conservatives had been able to serve adverts to 80 cent of the site’s users in key marginals. It also boasted that the company “played a part on a highly targeted campaign, helping the Conservatives to speak to the right people over and over again.”

The private companies and individuals who are stage managing our democracy

Dr Simon Moores, visiting lecturer in the applied sciences and computing department at Canterbury Christ Church University and a technology ambassador under the Blair government, said the Information Commisioners Office’s recent decision to shine a light on the use of big data in politics was timely. He said:

“A rapid convergence in the data mining, algorithmic and granular analytics capabilities of companies like Cambridge Analytica and Facebook is creating powerful, unregulated and opaque ‘intelligence platforms’. In turn, these can have enormous influence to affect what we learn, how we feel, and how we vote. The algorithms they may produce are frequently hidden from scrutiny and we see only the results of any insights they might choose to publish.”

He goes on to say: ”They were using 40-50,000 different variants of an ad every day that were continuously measuring responses and then adapting and evolving based on that response.”

Strategic Communication Laboratories (SCL) is a British behavioural science company. The SCL Group, that once advised Nato on so-called “psy-ops”, is a private British behavioural research and strategic communication company. The company describes itself as “global election management agency”.  SCL’s approach to propaganda is based upon a methodology developed by the associated Behavioural Dynamics Institute (BDI). Nigel Oakes founded the latter and also set up Strategic Communication Laboratories and using the new methodology from BDI, ran election campaigns and national communication campaigns for a broad variety of international governments. BDI say: “The goal of the BDI is to establish Behavioural Dynamics as a discipline for the study of group behaviour change.”

There isn’t much information around about BDI’s connection with military operations, though links with NATO are well-established – see Countering propaganda: NATO spearheads use of behavioural change science, for example. From the article: “Target Audience Analysis, a scientific application developed by the UK based Behavioural Dynamics Institute, that involves a comprehensive study of audience groups and forms the basis for interventions aimed at reinforcing or changing attitudes and behaviour.”

SCL on the other hand, has a clearly defined defence and military division who: “Target Audience Analysis, a scientific application developed by the UK based Behavioural Dynamics Institute, that involves a comprehensive study of audience groups and forms the basis for interventions aimed at reinforcing or changing attitudes and behaviour.”

SCL has different “verticals” in politics, military and commercial operations. All of those operations are based on the same methodology (Target Audience Analysis) and, as far as can be discerned from the outside, SCL and affiliates have very obscure corporate structures with confusing ownership.

In the United States, SCL has gained public recognition mainly though its affiliated corporation Cambridge Analytica (CA). It was created in 2013 as an offshoot of its British parent company (the SCL Group,) to participate in US politics. In 2014, CA was involved in 44 US political races. Their site says: Cambridge Analytica uses data to change audience behavior.” 

And:

PERSUASION

“More effectively engage and persuade voters using specially tailored language and visual ad combinations crafted with insights gleaned from behavioral understandings of your electorate.”

And: “Leveraging CA’s massive team of data scientists and academics, CA is able to provide optimal audience segments based on big data and psychographic modeling. Then, using a sophisticated electronic data delivery system, CA is able to provide TV advertising campaign data that may be used to inform media buyers about shows that have the highest concentrations of target audiences and the least amount of waste; all of which leading to higher media ROI [return on investment] and more voter conversions.”

The company is heavily funded by the family of Robert Mercer, an American hedge-fund billionaire. I’ve mentioned Mercer in a previous article about the right’s undue influence on the media and on voting behaviour. Mercer made his money as a pioneer in the field of Computational Linguistics.

Mercer later became joint CEO of Renaissance Technologies, a hedge fund that makes its money by using algorithms to model and trade on the financial markets. 

One of its funds, Medallion, which manages only its employees’ money, is the most successful in the world – generating $55bn so far. And since 2010, Mercer has donated $45m to different political campaigns – all Republican – and another $50m to non-profits – all right wing, ultra-conservative. This is a billionaire who is trying to reshape the world according to his personal interests, beliefs, wishes and wont. He is an advocate of the neoliberal right, who seek to combine a market economy and economic deregulation with the traditional right-wing beliefs in patriotism, élitism, and law and order, delivered within an authoritarian framework. Mercer is known for his anti-welfare and right libertarian views.

To give you a flavour of Mercer’s interests, you only need to follow the money trail: he funds a climate change denial thinktank, the Heartland Institute, and he likes to disrupt the mainstream media. In this aim, he is helped by his close associate Steve Bannon, self-declared “economic nationalist”, Trump’s campaign manager and now chief strategist. The money he gives to the Media Research Center, with its paranoid, anti-progressive mission of correcting “liberal bias” is just one of his pet media projects. He has also worked as vice president of Cambridge Analytica‘s board, the private data-analytics that is owned largely by the Mercer family

Mercer and his family are major donors to Conservative political causes such as Breitbart News. He is the principal benefactor of the Make America Number 1 political action committee (Super PAC). Around 2012, Mercer reportedly invested $5 million in a British data science company, the SCL Group. Most political campaigns run highly sophisticated micro-targeting efforts to locate voters. SCL promised much more, claiming to be able to manipulate voter behaviour through psychographic modeling. This was precisely the kind of work Mercer values.

SCL claimed to be able to formulate complex psychological profiles of voters. These, say the company, would be used to tailor the most persuasive possible message, acting on that voter’s personality traits, hopes or fears.

Of course Mercer was a major supporter of Donald Trump’s 2016 campaign for president and Brexit in the UK. Mercer donated the services of the data analytics company Cambridge Analytica to Nigel Farage and UKIP. The company was able to “advise” and influence Leave.eu through harvesting data from people’s Facebook profiles in order to target them with individualised persuasive messages to vote for Brexit. However, Leave.eu did not inform the UK electoral commission of the donation, contrary to the law which demands that all donations valued over £7,500 must be reported. 

When SCL Elections formed Cambridge Analytica in 2013, the company hired researchers from Cambridge University, hence the name. CA collects data on voters using sources such as demographics, consumer behaviour, internet activity, and other public and private sources. CA is using psychological data derived from millions of Facebook users, largely without users’ permission or knowledge. The company is also trying to change people’s perceptions and behaviours without their consent.

The company maintains offices in New York City, Washington, D.C., and London.

Cambridge Analytica, claim to predict not just peoples’ voting intentions and preferences, but also their personality types. The company is proprietorial about its precise methods, but says large-scale research into personality types, based on hundreds of thousands of interviews with citizens, enables them to chart voters against five main personality types – openness, conscientiousness, extraversion, agreeableness and neuroticism. With its head office in London, the company is “A global election management agency, skilled in applying behavioural modeling and microtargeting solutions to political campaigns.”

The marketisation of democracy: the highest bidder wins all, while claiming to speak for the “ordinary person”

Stephen K. Bannon, President Trump’s chief strategist and the intellectual force behind his nationalist agenda, said in February that the new administration is locked in an unending battle against the media and other globalist forces to “deconstruct” an “outdated system of governance”. Jennifer Rubin in The Washington Post writes:

“They’re going to continue to fight,” Bannon said of the media, which he repeatedly described as “the opposition party,” and other forces he sees as standing in the president’s way. “If you think they are giving you your country back without a fight, you are sadly mistaken.”

Atop Trump’s agenda, Bannon said, was the “deconstruction of the administrative state” — meaning a system of taxes, regulations and trade pacts that the president and his advisers believe stymie economic growth and infringe upon one’s sovereignty.

For those who doubted Trump-Bannon’s determination to destroy the liberal international order that has kept world war at bay and promoted global prosperity since the end of World War II, this will come as a rude awakening. Bannon’s simultaneous attack on the media suggests that it is not simply about trade or immigration policy.

So data technology, surveilance, psychology and social media and manipulative messaging campaigns are being combined in a powerful new way to sway opinions and win elections without people’s knowledge. In essence, a new, dark, subliminal propaganda war is being waged against citizens by those who wield power, serving the narrow interests of and those who do and funded by a hidden few who want to.

Lynton Crosby has been a close advisor in the Conservative election campaigns of Australia, Canada and the UK, and is well-known for his racist dog whistling and wedge strategies, influential at an international level.

“In a campaign, what you try to do is either change or reinforce some perceptions that people have in order to influence their behaviour,” says Crosby. 

Crosby’s emphasis is on “below the radar” campaigning, and the targeting of marginal constituencies with highly localised campaigning, latching on to local issues and personalities. To find such divisive and potentially diversionary issues, Crosby’s business partner Mark Textor runs focus groups to find which social groups to target with what questions. Crosby is said to focus on delivering simple messages, targeting marginal constituencies and the use of lots of polls and data. 

 Lynton Crosby, second left, at the party’s annual conference in 2015 with, from left, Lord Feldman, Jim Messina (former Obama campaign chief also hired by the Tories) and then party chairman Grant Shapps. Photograph: David Hartley/Rex

“In a campaign, what you try to do is either change or reinforce some perceptions that people have in order to influence their behaviour,” Crosby says.

Their site commentary highlights whose “democratic” interests Crosby and Textor serve:

“We combine decades of experience in research, political campaigns, strategic communications, media, and corporate intelligence to deliver winning strategies at the highest levels of business and government.

Having worked on successful election campaigns across four continents, we understand the need for timely, actionable intelligence, so our clients can focus the right message and resources on their most persuadable ‘swing voters’ to get the results they want.”

Note the reference to “behaviour changing messages”.

textor

Crosby Textor also claim that: “the team are specialists in advising major companies in how to position themselves to ensure they are integral to government decision-making.”

It was Crosby that created the campaign for the Conservatives with the slogan “Are you thinking what we’re thinking?”: a series of posters, billboards, TV commercials and direct mail pieces with messages such as “It’s not racist to impose limits on immigration” and “how would you feel if a bloke on early release attacked your daughter?” focused on hot-button issues like “dirty” hospitals, landgrabs by “gypsies” and restraints on police behaviour.

In April 2016, Mayor of London and Conservative, MP Boris Johnson, was accused of “dog whistle racism” by Shadow Chancellor of the Exchequer and Labour MP John McDonnell, when Johnson suggested US President Barack Obama held a grudge against the United Kingdom due to his “ancestral dislike of the British Empire” as a result of his “part-Kenyan” heritage after Obama expressed his support for the UK to vote to remain in the European Union ahead of the UK’s referendum on EU membership. Crosby also tried to link Sadiq Khan with terrorist organisations –  the Conservative mayoral candidate’s campaign, was run by Crosby Textor

Mark Textor, co-founder of the private company, was mentored by the late Richard Wirthlin, a pollster who was chief strategist to US President Ronald Reagan. Someone else with past connections to the Wirthlin Group is Kellyanne Conway, President Trump’s election campaign manager and now counsellor to the president, serving alongside Steve Bannon, assistant to the President and White House chief strategist.

All singing from the same crib sheet.

Since Trump’s inauguration, Conway has been embroiled in a series of controversies, including using the phrase “alternative facts, making reference to a “Bowling Green massacre” which never occurred, (Conway “cited” it as justification for a travel and immigration ban from seven Muslim-majority countries enacted by Trump), claiming Michael Flynn had the full confidence of the president hours before he was dismissed, and publicly endorsing commercial products associated with the president’s daughter Ivanka Trump. As a result, a number of media outlets have called her credibility into question, with some refusing her requests for one-on-one interviews.

When such manipulative tactics are exposed from time to time, it’s like a curtain shifting temporarily to give you a glimpse into another dimension, populated by billionaires and a handful of mercenary henchmen who drew up the machinations of a war being waged on democracies, in order to terraform political landscapes to suit the dystopic interests of one percent of the global population, at the expense of the needs of the ninety nine percent. You would be forgiven for thinking that the world and the media are being run almost exclusively by a small number of elitist, pan-nationalist aliens. It’s not a conspiracy theory. It’s a reality.

Jim Messina is a political adviser who was the White House Deputy Chief of Staff for Operations under President Barack Obama from 2009 to 2011 and served as the campaign manager for Obama’s highly successful 2012 re-election campaign. Messina was hired as a campaign strategy adviser to the UK Conservative Party in August 2013. Messina operated from the US during the 2015 general election campaign. He has made statements about his personal admiration for David Cameron. Theresa May has also added him to her team of strategists. 

Gone are the days when it was expected that the public decided who to vote for because of the policies on offer from each party. Now the government focuses on the use of private political masters of the dark campaign arts, who use “political-voter surveillance” techniques, along with a combative and emotional approach to messaging, rather than a rational and reasonable one, and a level of cunning that most definitely treads around the very outer edges of ethics. 

One of Messina’s key strategic methods is finding and targeting swing voters through the meticulous gathering and monitoring of voter information using private polls, and the use of social media “targeting”.  He uses social networking techniques and social media, having sought and received advice from top names in the tech world including Steve Jobs.

Messina uses micro-targeting based on online data. His approach is based on the in-depth psychometrically profiling of people, using publicly available data, including their Facebook “likes” and group memberships. This information is used to create effective and directed digital dark advertising to target millions of voters and manipulate their psychological tendencies and play to their traits.  

Messina has developed a private consulting firm –The Messina Group, which “works with organizations in the private, public, and social sectors to achieve their strategic goals.” The company has an office in London, on Old Park Lane. It says on the site says:

“Using state of the art data and analytics, The Messina Group can harness and amplify the reach of your social network. We accurately model your organization’s likely supporter, voter, or consumer, and – by overlaying that with your existing social media base – we can develop a targeted list of potential new supporters. This targeted, person-to-person sharing is the future of advertising in a fundamentally digital and social world. The Messina Group will ensure that your organization is ahead of the competition.” 

One tactic integrated in this method is aimed at generating a bandwaggon effect, which I have discussed at length elsewhere. The bandwagon effect occurs in voting: some people vote for those candidates or parties who are likely to succeed (or are proclaimed as such by the media). The bandwagon propaganda technique has been applied to situations involving majority opinion, such as political outcomes, where people alter their opinions to the majority view. 

Such a shift in opinion can occur because individuals draw inferences from the decisions of others, which shapes an informational cascade. A cascade develops when people “abandon their own information in favour of inferences based on earlier people’s actions, regardless of how irrational that may be. Bandwaggon propaganda draws on our natural tendency towards social conformity.

During the 2015 general election, the government were accused of trying to “buy the general election” by quietly raising the legal spending limit by £6.2 million to £32.7m in the face of concerns from the Electoral Commission over “undue influence”. The party has reportedly amassed a war chest of more than £70 million. The change to the law on candidates’ election spending, passed without parliamentary debate.

A new project called Who Targets Me, has been attempting to address the lack of transparency of targeted election messaging, by recruiting social media users to share information on what adverts they are seeing.

It says on their site: “Analysing the aggregated data will allow us to draw out insights about exactly which demographics are being targeted and the exact media and language that campaigners are using to influence your vote.”

In an effort to do something about the lack of transparency, Who Targets Me built a browser extension for Facebook users to download that will then report live to that individual when a political advert is being targeted at them. It also tracks that information in its database. You can sign up to be a Who Targets Me volunteer here.

Given the instability of the government, following the general election delivering a hung parliament, it’s likely that political advertising will continue. You will need to use the Chrome browser and install the Who Targets Me extension.

The Information Commissioner’s Office has already launched a wide-ranging investigation over possible breaches of UK data laws. The Conservatives have so far refused to supply examples of adverts the party is sending to individual voters on Facebook, despite the growing concern over unregulated online election activity.

One problem is money. There are no spending limits on digital advertising and, put simply, the more you spend the more people you reach. Until now, that means it is primarily the wealthier, Conservative campaigns that have benefited.

Another is that psychological influences are different from transparent attempts at rational, reasoned and material persuasion, because they operate outside of conscious awareness. Hiding in plain sight, they trigger involuntary emotive responses in the human subconscious that most people are powerless to resist – and that happens even when they know they’re being influenced. Much of the material being used to “persuade” is dishonest, and aimed at simply smearing the opposition and generating irrational and unfounded fears, rather than open discussion, about political and socioeconomic alternatives to neoliberalism and social conservatism. 

Such tactics are nothing less than a political micro-management of the public’s beliefs an behaviours and are ultimately aimed at nudging your voting decisions to maintain a profoundly unbalanced, increasingly pathological and authoritarian status quo. Such tactics deployed in manufacturing consensus are widely used, and combined, they also serve to reduce public expectation of opposition and in doing so establish diktats: it’s a way of mandating acceptance of ideology, policies or laws by presenting them as if they are the only viable alternative.

There is a much needed public debate to be had about the distinction between political “persuasion” and “manipulation”.

And another about undue political influence. In the Summary of electoral offences it says: “A person may also be guilty of undue influence if they impede or prevent any voter from freely exercising their right to vote – even where the attempt is unsuccessful.

Also: “It is an illegal practice to make or publish a false statement of fact about the personal character or conduct of a candidate in order to affect the return of a candidate at an election.”

“Certain offences relate specifically to election campaign publicity material. Election campaign publicity material must contain an imprint, not resemble a poll card and not contain a false statement as to the personal character or conduct of another candidate.”

The Conservatives have certainly taken advantage of our basic tendency to be more motivated by the threat of something presented and subsequently perceived as “bad” than by the presented opportunity for examining positive alternatives.

This is not just a story about the misuse of social psychology and data analytics. It has to be understood in the context of a military contractor using military strategies on a civilian population. The public.

David Miller, a professor of sociology at Bath University and an authority in psyops and propaganda, says it is “an extraordinary scandal that this should be anywhere near a democracy. It should be clear to voters where information is coming from, and if it’s not transparent or open where it’s coming from, it raises the question of whether we are actually living in a democracy or not.”

 

Related:

Social media is being used to stage manage our democracy using nudge-based strategies

EXPOSED: CONSERVATIVES IN HOUSE ‘SURVEY’ TEAM

The great British Brexit robbery: how our democracy was hijacked

Negative campaigning, emotions and political participation

Inverted totalitarianism and neoliberalism

What I don’t understand about Conservatism

‘Tory Election Fraud’ Investigation Sees Conservatives Fined £70,000 By Electoral Commission

Political polls, think tanks and propaganda: the antidemocratic writing on the wall

Strategies and motives for resistance to persuasion: an integrative framework

How To Use 10 Psychological Theories To Persuade People

CONTROVERSIAL GCHQ UNIT ENGAGED IN DOMESTIC LAW ENFORCEMENT, ONLINE PROPAGANDA, PSYCHOLOGY RESEARCH

How Covert Agents Infiltrate the Internet to Manipulate, Deceive, and Destroy Reputations – Glenn Greenwauld

Theresa May pledges to create new internet that would be controlled and regulated by government 

 


 

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Protest at the 10th annual New Savoy conference – Mental Wealth Alliance

 

image-04-02-2017-at-15-15

        Map of venue here 

Find out more about the Mental Wealth Alliance and the background to this New Savoy action here

Source: the free psychotherapy network

“As the links between mental health and DWP benefits policies have developed (see this Government catalogue of Work and Health reports between 2005 and 2014 – https://www.gov.uk/government/collections/health-work-and-wellbeing-evidence-and-research ) so has the link between Psy Professional bodies and the DWP.

New Savoy has welcomed this marriage of workfare and IAPT/psychological well-being support. See their statement on welfare reform here – http://www.newsavoypartnership.org/joint-pledge-on-welfare.htm 

For several years New Savoy invited DWP and DoH ministers to open their conferences (e.g. Lord Freud and Norman Lamb).

The Kitty Jones blog is very informative on the developing use of psychological coercion within the workfare system (e.g. https://kittysjones.wordpress.com/2015/10/28/the-government-plan-to-nudge-sick-and-disabled-people-into-work/) as is the Friedli and Stearn paper – http://mh.bmj.com/content/41/1/40.full

It was in the spring of 2015, when Osborne’s budget proposed co-locating IAPT workers in Jobcentres, that a number of Alliance and PCSR therapists contacted MH activist groups like the Mental Health Resistance Network and DPAC to see if we could work together to oppose the use of psychological therapy to get people off benefits and back to work.

The issue for us, of course, was the abuse of therapeutic ethics and practice through its application to support the goals and culture of DWP workfare – a policy direction based on political ideology, not clinical need.

We see a shared cause between MH claimants on the receiving end of these policies and the unethical and demeaning working conditions of practitioners/workers providing the services. On the latter, see for example – https://www.theguardian.com/healthcare-network/2016/feb/17/were-not-surprised-half-our-psychologist-colleagues-are-depressed

The Mental Wealth Alliance (formerly MW Foundation) was born out of subsequent meetings between MH activists, professionals and welfare campaigners. It is an umbrella for 18 organisations concerned with MH, therapy and welfare:

Mental Health Resistance Network; Disabled People Against Cuts; Recovery in the Bin; Boycott Workfare; The Survivors Trust; Alliance for Counselling and Psychotherapy; College of Psychoanalysts; Psychotherapists and Counsellors for Social Responsibility; Psychologists Against Austerity; Free Psychotherapy Network; Psychotherapists and Counsellors Union; Critical Mental Health Nurses’ Network; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ Network; National Health Action Party; Making Waves

In April 2015 the Alliance for Counselling and Psychotherapy organised a Guardian letter signed by over 400 psy professionals on the consequences for people’s mental health of the Governments austerity cuts, and in particular the plans to expand the use of therapists to ‘encourage’ MH benefits claimants into work – https://freepsychotherapynetwork.com/mwa-response-to-the-psy-professional-bodies-statement-on-benefit-sanctions-and-mental-health-301116/

https://www.theguardian.com/society/2015/apr/17/austerity-and-a-malign-benefits-regime-are-profoundly-damaging-mental-health

At the same time, the MWA began an exchange of letters with the five main psy professional organisations, expressing  our outrage at their support for and participation in DWP workfare programmes. The latest contribution from MWA to this exchange is the response to their statement on sanctions which can be found here – https://freepsychotherapynetwork.com/mwa-response-to-the-psy-professional-bodies-statement-on-benefit-sanctions-and-mental-health-301116/.    

The earlier exchanges can be found here – https://allianceblogs.wordpress.com/2016/04/28/mwf_letters_2/ 

The only organisation that has responded to our request to meet and talk about the issues is BABCP who we met in November last year, shortly before the recent statement on sanctions.

Members of the MWA have campaigned together against the co-location of IAPT, psychological support services in Jobcentres in June 2015 – https://www.theguardian.com/society/2015/jun/26/mental-health-protest-clinic-jobcentre-streatham 

The locating of DWP work counsellors in GP practices in March 2016 – http://islingtonnow.co.uk/2016/03/07/putting-job-advisers-in-doctors-surgeries-will-harm-patients-say-protesters/

New Savoy partnership July 2016 – http://dpac.uk.net/2016/06/protest-against-work-cure-therapy-5th-july-london/ and video here –  https://www.youtube.com/watch?v=VBbXK1Ac7W0 

Here is the double sided leaflet we gave out to attendees of the conference. Very relevant to the March protest – https://freepsychotherapynetwork.files.wordpress.com/2016/07/notinournamenothingaboutus-final.pdf

Associates of MWA helped organise a lobby at the BPS annual conference this January – https://freepsychotherapynetwork.com/united-against-welfare-cuts-against-reform-report-from-the-lobby-of-the-british-psychological-society-conference-18th-january-2017/

We have held two major conferences – in Bermondsey and Liverpool – on welfare reform and psycho-compulsion. Reports here – https://allianceblogs.wordpress.com/2016/04/15/welfare-coercion-conference-report-part-1/  and here – http://socialworkfuture.org/campaigns-events/529-mh-and-welfare-reform-conference-report

We have participated in the Free Psychotherapy Network’s conference and the Psychologists and the Benefits System conference in Manchester – http://www.walkthetalk2015.org/news/psychologists-and-benefits-system.”

My contribution to the latter is here – https://kittysjones.wordpress.com/2016/10/11/welfare-conditional-citizenship-and-the-neuroliberal-state-conference-presentation/

Read more here – Some background to the MWA and the New Savoy demo and lobby Wednesday 15th March 2017

 

Tory MP says PIP should only go to ‘really disabled’ people, not those with anxiety ‘taking pills at home’

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George Freeman, MP for Norfolk and chair of the Prime Minister’s Policy Board, has defended the government’s decision to subvert the judicial system, by disregarding the rulings of two independent tribunals concerning Personal Independence Payment (PIP) for disabled people.

In an interview on Pienaar’s Politics, on BBC 5 Live, Freeman said: 

“These tweaks [new regulations to cut PIP eligibility] are actually about rolling back some bizarre decisions by tribunals that now mean benefits are being given to people who are taking pills at home, who suffer from anxiety”.

He claimed that the “bizarre” upper tribunal rulings meant that “claimants with psychological problems, who are unable to travel without help, should be treated in a similar way to those who are blind.”

He said: “We want to make sure we get the money to the really disabled people who need it.”

He added that both he and the Prime Minister “totally” understood anxiety, and went on to say: “We’ve set out in the mental health strategy how seriously we take it.” 

He said: “Personal Independence Payments reforms were needed to roll back the bizarre decisions of tribunals.” 

Freeman’s controversial comments about people with anxiety “at home taking pills” implies that those with mental health problems are faking their disability. He trivialises the often wide-ranging disabling consequences of mental ill health, and clearly implies that he regards mental illnesses as somehow not “real” disabilities.

His comments contradict the government’s pledge to ensure that mental health and physical health are given a parity of esteem, just months after the Prime Minister pledged to take action to tackle the stigma around mental health problems. 

Yet people with the following mental health conditions are likely to be affected by the reversal of the Independent Tribunal’s ruling on PIP mobility awards – those in particular who suffer “overwhelming psychological distress” when travelling alone:

Mood disorders – Other / type not known, Psychotic disorders – Other / type not known, Schizophrenia, Schizoaffective disorder, Phobia – Social Panic disorder, Learning disability – Other / type not known, Generalized anxiety disorder, Agoraphobia, Alcohol misuse, Anxiety and depressive disorders – mixed Anxiety disorders – Other / type not known, Autism, Bipolar affective disorder (Hypomania / Mania), Cognitive disorder due to stroke, Cognitive disorders – Other / type not known, Dementia, Depressive disorder, Drug misuse, Stress reaction disorders – Other / type not known, Post-traumatic stress disorder (PTSD), Phobia – Specific Personality disorder, Obsessive compulsive disorder (OCD).

Note that some of the listed conditions have known physiological causes, too, such as “Cognitive disorder due to stroke”, whereas Agoraphobia, “Stress reaction disorders”, PTDS, some anxiety and depressive disorders, substance use and PTDS, for example, most often arise because of context, circumstances, events and  experiences, whilst the aetiology of some of the other listed conditions is not yet clearly understood by medical experts.

Regardless of the cause of an illness, it is not possible or appropriate to use constructed and arbitrary taxonomies and hierarchical ranks of disability to decide in advance of an assessment how those conditions negatively impact on disabled people’s capacity to live their lives, to perform tasks, their dignity, social inclusion and independence. Freeman’s generalisation was therefore completely inappropriate.

Freeman’s comments signposted the Conservative’s “deserving” and “undeserving” narrative, implying that some disabled people are faking their illnesses. However, disabled people do not “cheat” the social security system: the system has been redesigned by the government to cheat disabled people.

Criticism

Despite some scathing comments and challenges from the opposition, Freeman maintains: “My point was that these PIP reforms are partly about rolling back some frankly bizarre decisions in tribunals which have seen money that should go to the most disabled spent on people with really much less urgent conditions.”

The chief executive of Scope, Mark Atkinson. said: “It is unhelpful to make crude distinctions between those with physical impairments and mental health issues because the kind of impairment someone has is not a good indicator of the costs they will face.

Many disabled people will be now be anxiously waiting to hear as to whether or not these tighter rules will affect their current PIP award.

The government must offer clarity and reassurance that these new measures will not negatively affect the financial support that disabled people receive now or in the future, and that they stand by their commitment to making no further changes to disability benefits in this Parliament.”

Debbie Abrahams MP, Shadow Work and Pensions Secretary has also responded to the comments by Freeman. She said:

“Mr Freeman must immediately apologise for the comments he made regarding sick and disabled people.

Freeman dismissed the needs of people with mental health conditions saying support should go to “really disabled people” rather than those who are “taking pills at home, who suffer from anxiety.

Not only does this fly in the face of the commitment to ‘parity of esteem’ for people with mental health conditions, but it directly contradicts Theresa May’s comments on mental health and two recent tribunal judgements.”

The Shadow Chancellor, John McDonnell, has called on Philip Hammond not to go ahead with the £3.7bn worth of cuts to PIP which will hit 160,000 disabled people.

The announcement about the two controversial regulations to be imposed without any parliamentary scrutiny and debate, and without any democratic dialogue with disabled people, was sneaked out last week by the government. It will mean 160,000 disabled people are likely to see a loss in their income as a direct effect of the changes made by the government to how PIP is awarded.

 McDonnell said

“Theresa May has used the cover of the by-elections to sneak out this announcement hurting so many vulnerable disabled people.

His is a return to the worst politics of spin that so tarnished our politics for so long. It is an act of immense bad faith. She is degrading politics and demeaning the role of Prime Minister.

Next week the Tories will make out that the economy and the public finances are doing better, however, they are planning to go ahead with a £3.7 billion cut to the disabled.

This time last year when the economy and public finances were not doing as well, and the then Chancellor George Osborne tried to cut PIP, Labour stopped him. And in his u-turn he claimed that he could “absorb” the cost of reversing this cut.

Hammond can’t hide from these PIP cuts in his Budget. He needs to explain why he can’t absorb them like his predecessor while he is still going ahead with tax giveaways to the very wealthiest in our country.”

But cutting PIP may cost more than it will save. 

PIP is an in-work benefit as well as being accessible to disabled people out of work. Cutting PIP will invariably mean that some disabled people can no longer remain sufficiently independent to work. Many have lost their higher mobility rate component when they were reassessed for PIP after claiming Disability Living Allowance (DLA), and as a consequence, have lost their motability vehicles – which includes wheelchairs as well as specially adapted cars –  leaving many completely housebound and unable to work. 

The Conservative claim that “the government is committed to supporting the most vulnerable” doesn’t stand up to scrutiny, given the Conservative’s policy record, including cruelly scrapping the Independent Living Fund, which has had a hugely negative impact on those trying their best to lead independent and dignified lives, and the Access To Work funding has been severely cut, this is also a fund that helps people and employers to cover the extra living costs arising due to disabilities that might present barriers to work.

The mental-physical illness distinction is a false dichotomy

It’s not appropriate to dichotomise mental and physical illness, as they are not clearly distinct. Most people would probably recognise that trauma, anxiety and stress can exacerbate illnesses that have a clear physiological basis. However, illnesses that have clearly defined “physical” symptoms can often also cause mental illness. Depression resulting from dealing with chronic pain and adapting to progressive illness and increasing disability is one example of the overlap between the physical and mental dimensions of illness.

I have lupus, which is an autoimmune illness that potentially progressively damages the joints, tendons, muscles, nerves, skin, eyes, blood cells, capacity to fight infections, heart, lungs, kidneys, stomach and liver. And the brain.

Most people with lupus complain of severe headaches, cognitive dysfunction, short-term memory loss and often, coordination difficulties. However, some suffer from depression and anxiety as a direct consequence of inflammatory changes in the brain, and some people also experience mood disorders.  Other forms of neuropsychiatric lupus include psychosis, seizures, stroke and vascular dementia, chorea and cerebrovascular disease. There is often no clear boundary between the mental and physical symptoms of illness.

Health and wellbeing have socioeconomic determinants

Another important consideration is the context in which people live, this also has a significant impact on health and wellbeing. There is an extremely unequal distribution of power and wealth in the UK. There are also corresponding unequal distributions of opportunity, health and psychological wellbeing, inclusion, human rights and citizen freedoms more generally, such as freedom of choice and participation in democracy.

Precarity and anxiety directed by the state through targeted and discriminatory policies at the poorest citizens mediates and maintains a repressive state–citizen power relationship.

There is also an emerging and clear “cognitive” hierarchy: those in positions of power are formulating policies that are premised on a fundamental assumption that poverty happens because of something that poor people don’t do, or that they do “wrong”, and this happens because of cognitive errors and  “wrong” behaviours and attitudes. The assumption, of course, is that the policy decision-makers are more cognitively and behaviourally competent than those they are “nudging” to change their thinking and behaviour.

However, we know that an economic system founded on mythical “market forces, an even more mythical meritocracy – amongst other just-world fallacies – and competitive individualism, which sets citizen groups fighting for increasingly scarce resources, creates just a few “winners”(around 1%) and many more who are dispossessed (99%). 

Policies controversially aimed at “correcting behaviours” are increasingly punitive (benefit sanctions, increased welfare conditionality generally and restrictions on child tax credits are examples of the government’s behaviourist approach) that draw on psychosocial dynamics – imported from techniques of persuasion at the low end of the advertising industry – build and reproduce socioeconomic hierarchies, not only materially, but through dominant discursive practices, and also through inflicting precarity and perpetual anxiety on those people who have the least share of national wealth. 

It’s remarkable that a government that claims “work is beneficial to health” also fail to recognise the impact of neoliberal socioeconomic organisation, prejudiced political narratives and draconian policies, the relationship between growing inequality and increasing poverty, and how this toxic context has a detrimental effect on people’s physical health and psychological wellbeing.

The Conservatives are so busy diverting public attention, and pointing out what they think those people who need mitigation from the worst ravages of neoliberalism are “doing wrong”, they fail to recognise and acknowledge what it is that the government is doing wrong.

When people are attacked, oppressed and controlled psychologically by a so-called democratic government that embeds punishment at the heart of public policies to target the poorest citizens, it’s hardly surprising they become increasingly ill.

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I wrote a longer article about this for Scisco Media, which can be read here: Social security has been redesigned to cheat disabled people

 


 

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Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died.

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Abbie and her late father, James Harrison.

Julia Savage is a manager at Birkenhead Benefit Centre in Liverpool. She wrote a letter addressed to a GP regarding a seriously ill patient. It said:

“We have decided your patient is capable of work from and including January 10, 2016.

“This means you do not have to give your patient more medical certificates for employment and support allowance purposes unless they appeal against this decision.

“You may need to again if their condition worsens significantly, or they have a new medical condition.” 

The patient, James Harrison, had been declared “fit for work” and the letter stated that he should not get further medical certificates. 

However, 10 months after the Department for Work and Pensions (DWP) contacted his doctor without telling him, James died, aged 55, the Daily Record has reported.

He was clearly not fit for work.

His grieving daughter, Abbie, said: “It’s a disgrace that managers at the Jobcentre, who know nothing about medicine, should interfere in any way in the relationship between a doctor and a patient.

“They have no place at all telling a doctor what they should or shouldn’t give a patient. It has nothing to do with them.

“When the Jobcentre starts to get involved in telling doctors about the health of their patients, that’s a really slippery slope.”

Abbie said James had worked since leaving school at a community centre near his home. But his already poor health went downhill after the centre was shut down because of austerity cuts.

James had a serious lung condition and a hernia before the centre closed, and also developed depression and anxiety afterwards.

Abbie said: “He’d worked all his life. He wasn’t the kind of guy who knew anything about benefits.

“But as his health deteriorated, there wasn’t any chance he could do a job. He applied for employment and support allowance.”

James received Employment and Support Allowance (ESA), but only at the low rate of £70 a week, the same amount as jobseekers’ allowance. He was then sent to attend one of the DWP’s controversial Work Capability Assessments – and declared fit for work.

Despite that decision, Abbie said James remained in constant need of medical help and had to visit his doctor regularly.

However, the GP concerned repeatedly refused to give him a sick note, and James began to suspect the Jobcentre were to blame for this.

Abbie said: “He really needed a note. He was too ill to go to the constant appointments at the Jobcentre and he didn’t want to be sanctioned.

“He became convinced the DWP had been talking to his doctor behind his back.”

Although Abbie felt her father was confused, and didn’t think his explanation was right at the time, she later asked to see her father’s medical records. She found the letter in his file from Julia Savage, the manager at Birkenhead Benefit Centre, in James’s home city of Liverpool.

The letter was addressed to James’s GP.

Context: Government claims that work is a “health outcome”

James Harrison was very worried that his ill health interfered with his obligation to comply with the inflexible and constant conditions attached to his eligibility for welfare support, and that this would lead to sanctions – the withdrawal of his lifeline support, which was calculated to meet basic survival needs only.

The GP should have provided evidence that this was the case. The doctor was advised not to provide further fit notes by the DWP, however, unless James appealed. Yet the circumstances warranted that the GP provide a fit note. 

fit-note-guidance

Last year, the Department for Work and Pensions issued an ideologically directed new guidance to GPs regarding when they should issue a Fit Note. This was updated in December 2016.

In the document, doctors are warned of the dangers of “worklessness” and told they must consider “the vital role that work can play in your patient’s health”.  According to the department, “the evidence is clear that patients benefit from being in some kind of regular work”.

The biopsychosocial model, with a current political emphasis on the psychological element, has become a disingenuous euphemism for psychosomatic illness, which has been exploited by successive governments (and rogue insurance companies) to limit or deny access to social security, medical and social care.

Nobody would deny that illness has biological, psychological and social dimensions, however, the model has been adapted to fit a neoliberal “small state” ideology – one that rests almost entirely on Conservative individualist notions of citizen responsibility, as opposed to a rights-based approach and provision of publicly funded state support.

This approach to disability and ill health has been used by the government to purposefully question the extent to which people claiming social security bear personal responsibility for their own health status, rehabilitation and prompt return to work. It also leads to the alleged concern that a welfare system which was originally designed to provide a livable income to those with disabling health problems, may provide “perverse incentives” for perverse behaviours, entrenching “worklessness” and a “culture of dependency”. It’s worth pointing out at this point that there has never been any empirical evidence to support the Conservative notion of welfare “dependency”. 

Instead of being viewed as a way of diversifying risk and supporting those who have suffered misfortune and ill health, social and private insurance systems are to be understood as perverse incentives that pay people, absurdly, to remain ill and keep them from being economically productive.

The idea that people remain ill deliberately to avoid returning to work  – what Iain Duncan Smith and David Cameron have termed “the sickness benefit culture” – is not only absurd, it’s very offensive. This is a government that not only disregards the professional judgements of doctors, it also disregards the judgements of sick and disabled people. However, we have learned over the last decade that political “management” of people’s medical conditions does not make people healthier or suddenly able to work. Government policies, designed to “change behaviours” of sick and disabled people have resulted in harm, distress and sometimes, in premature deaths

The government have made it clear that there are plans to merge health and employment services. In a move that is both unethical and likely to present significant risk of harm to many patients, health professionals are being tasked to deliver benefit cuts for the DWP. This involves measures to support the imposition of work cures, including setting employment as a clinical outcome and allowing medically unqualified job coaches to directly update a patient’s medical record.

The Conservatives (and the Reform think tank) have also proposed mandatory treatment for people with long term conditions (which was first flagged up in the Conservative Party Manifesto) and this is currently under review, including whether benefit entitlements should be linked to “accepting appropriate treatments or support/taking reasonable steps towards “rehabilitation”.  The work, health and disability green paper and consultation suggests that people with the most severe illnesses in the support group may be subjected to welfare conditionality and sanctions.

Many campaigners have raised concerns about the DWP interfering with people’s medical care and accessing their medical files. I wrote an article last year about how the government plans to merge health and employment services and are now attempting to redefine work as a clinical outcome. I raised concerns about the fact that unemployment has been stigmatised and politically redefined as a psychological disorder, and that the government claims, somewhat incoherently, that the “cure” for unemployment due to illness and disability, and sickness absence from work, is work.

In a critical analysis of the recent work, health and disability green paper, I said: 

“And apparently qualified doctors, the public and our entire health and welfare systems have ingrained “wrong” ideas about sickness and disability, especially doctors, who the government feels should not be responsible for issuing the Conservatives recent Orwellian “fit notes” any more, since they haven’t “worked” as intended and made every single citizen economically productive from their sick beds.

It seems likely, then, that a new “independent” assessment and some multinational private company will most likely very soon have a lucrative role to ensure the government get the “right” results.”

The medical specialists are to be replaced by another profiteering corporate giant who will enforce a political agenda in return for big bucks from the public purse. Health care specialists are seeing their roles being incrementally and systematically  de-professionalised. That means more atrocious and highly irrational attempts from an increasingly authoritarian government at imposing an ideological “cure” – entailing the withdrawal of any support and imposing punitive “behavioural incentives” – on people with medical conditions and disabilities. Doctors, who are clever enough to recognise, diagnose and treat illness, are suddenly deemed by this government to be insufficiently clever to judge if patients are fit for work.

The political de-professionalisation of medicine, medical science and specialisms (consider, for example, the implications of permitting job coaches to update patient medical files), the merging of health and employment services and the recent absurd declaration that work is a clinical “health” outcome, are all carefully calculated strategies that serve as an ideological prop and add to the justification rhetoric regarding the intentional political process of dismantling publicly funded state provision, and the subsequent stealthy privatisation of Social Security and the National Health Service. 

“De-medicalising” illness is also a part of that process:

“Behavioural approaches try to extinguish observed illness behaviour by withdrawal of negative reinforcements such as medication, sympathetic attention, rest, and release from duties, and to encourage healthy behaviour by positive reinforcement: ‘operant-conditioning’ using strong feedback on progress.” Gordon Waddell and Kim Burton in Concepts of rehabilitation for the management of common health problems. The Corporate Medical Group, Department for Work and Pensions, UK. 

Waddell and Burton are cited frequently by the DWP as providing “evidence” that their policies are “evidence based.” Yet the DWP have selectively funded their research, which unfortunately frames and constrains the theoretical starting point, research processes and the outcomes with a heavy ideological bias. 

This framing simply shifts the focus from the medical conditions that cause illness and disability to the “incentives”, behaviours and perceptions of patients and ultimately, to neoliberal notions of personal responsibility and self-sufficient citizenship in a context of a night watchman, non-welfare state. 

Medication, rest, release from duties, sympathetic understanding – the remedies to illness – are being appallingly redefined as “perverse incentives” for ill health, yet the symptoms necessarily precede the prescription of medication, the Orwellian renamed (and political rather than medical) “fit note” and exemption from work duties. Notions of “rehabilitation” and medicine are being redefined as behaviour modification: here it is proposed that operant conditioning in the form of negative reinforcement – which the authors seem to have confused with punishment – will “cure” ill health. 

People cannot simply be “incentivised” into not being ill. 

The political use of the biopsychosocial model to cut costs at the expense of people who are ill will undoubtedly have further extremely serious implications. Such an approach, which draws on behaviourism and punishment (such as the threat and implementation of sanctions) is extremely unethical and makes the issue of consent to medical treatment very problematic if it is linked to the loss of lifeline support or the fear of loss of benefits.

This is clearly the direction that government policy is moving in and this represents a serious threat to the health, welfare, wellbeing and human rights of patients and the political independence of health professionals.

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The benefit cap, phrenology and the new Conservative character divination

“This is a round up.”

The song is about a world where citizens are deeply suspicious of one another, where fear of the Other is politically instigated and nurtured, social conformity, discrimination, exclusion and prejudice reign supreme. It’s about a society blindly climbing Allport’s ladder.

 

“Of the forehead, when the forehead is perfectly perpendicular, from the hair to the eyebrows, it denotes an utter deficiency of understanding.” Johann Kaspar Lavater, phrenologist (1741–1801).

 

Back in the nineteenth century, phrenology was the preferred “science” of personality and character divination. The growth in popularity of “scientific” lectures as entertainment also helped spread phrenology to the masses. It was very popular among the middle and working classes, not least because of its simplified principles and wide range of social applications that were supportive of the liberal laissez faire individualism inherent in the dominant Victorian world view. It justified the status quo. Even Queen Victoria and Prince Albert invited the charlatan George Combe to feel the bumps and “read” the heads of their children.

During the early 20th century, there was a revival of interest in phrenology, partly because of studies of evolution, criminology and anthropology (pursued by Cesare Lombroso). Some people with political causes used phrenology as a justification narrative for European superiority over other “lesser” races. By comparing skulls of different ethnic groups it supposedly allowed for ranking of races from least to most evolved.

It’s now largely regarded as an obsolete and curious amalgamation of primitive neuroanatomy with moral philosophy. However, during the 1930s Belgian colonial authorities in Rwanda used phrenology to explain the so-called superiority of Tutsis over Hutus. More recently in 2007, the US State of Michigan included phrenology (and palm reading) in a list of personal services subject to sales tax. 

Any system of belief that rests on the classification of physical characteristics is almost always used to justify prejudices, social stratifying and the ranking of human worth. It highlights “what” we are at the expense of the more important “who” we are. It dehumanises us.

Though the saying “you need your bumps feeling” has lived on, may the pseudoscience of phrenology rest in pieces. 

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Phrenology is dead: long live the new moralising pseudoscience

The Conservatives have simplified the art of personality and character divination. They have set up a new economic department of the mind called the Behavioural Insights Unit. This fits with the age old Conservative motif of a “broken Britain”and their obsessive fear of social “decay and disorder.” Apparently, we are always on the point of moral collapse, as a society. And apparently, it isn’t the government’s decision-making that is problematic: poor people are entirely responsible for the poor state of our country. Those who have the very least are to blame. That’s why they need such targeted austerity policies, to ensure they have even less. We can’t have the poor being rewarded with not being poor, that’s just bad for big business.

Under every Conservative government, we suddenly see the proliferation of bad sorts; cognitively biased and morally incompetent people making “the wrong choices” everywhere and and generally being inept and deficient characters. The way to diagnose these problems of character, according to the government, is to establish whether or not someone is “hard working”. This is usually determined by the casting of chicken bones, and a quick look at someone’s bank balance. If it lies offshore, you are generally considered “a good sort.”

If you need to claim social security, be it in-work or out-of-work support, then you are most definitely a “wrong sort”; a faulty person and therefore in need of some state “treatment.” Apparently, poor people are the new “criminal types.” The only cure, according to the government, is to make poor people even poorer, by a variety of methods, including a thorough, coercive nudging: a “remedial” income sanctioning and increased “conditionality” to eligibility for support; benefit cuts; increasing welfare caps and a systematic dismantling of the welfare state more generally.

Oh, and regular shaming, outgrouping, stigmatising and scapegoating in the meanstream media and political rhetoric, designed to create folk devils and moral panic.

The new benefit cap: a policy designed by the neoliberal rune casters

The regressive benefit cap will save a paltry amount of money in the short term. In the long term it will cost our health and social services many millions. It’s misleading of the government to claim that it will save the “tax payers” money, since most people needing to claim social security have worked and paid taxes too. VAT is also a tax, and last time I checked, people needing support because they lost their job or became sick or injured are not exempt from paying taxes. In fact the poorest families pay the highest proportion of their income in tax

We forget that people in poverty pay taxes because we forget how many different ways we are taxed:

  • VAT
  • Duties
  • Income tax
  • National Insurance
  • Council tax
  • Licences
  • Social care charges, and many others taxes
  • Bedroom tax

Of course there’s a stark contrast in the way the state coerces the poorest citizens into behaving “responsibly”, carrying the full burden of austerity, whilst there is an abject failure to rein in executive pay, or to tax the Conservative party paymasters, and recover the billions lost in revenue to the Treasury through tax havens.

Nearly a quarter of a million children from poor families will be hit by the extended household benefit cap due to be introduced this autumn, according to the government’s latest analysis of the impact of the policy. It will see an average of £60 a week taken out of the incomes of affected households that are already poor, pushing them even deeper into poverty. About 61% of those affected will be female lone parents.

The cap will damage the life chances of hundreds of thousands of children, and force already poor families to drastically cut back on the amount they spend on essential items to meet basic needs, such as food, fuel and clothing. Originally benefit rates were calculated to meet basic survival needs – covering the costs of food, fuel and shelter only. 

The new cap unjustifiably restricts the total amount an individual household can receive in benefits to £23,000 a year in London (£442 a week) and £20,000 in the rest of the UK (£385 a week). It replaces the existing cap level of £26,000. All of this support is dependent on whether or not you comply with the very complex conditionality criteria. The support can be withdrawn suddenly, in the form of a sanction, for any number of reasons, and quite often, because your benefit advisor simply has targets to reach in order to let you know that nothing  at all may be taken for granted: eating, feeding your children, sleeping indoors and keeping warm in particular.  

The government claims the cap “incentivises” people to search for work, and says that 23,000 affected households have taken a job since the introduction of the first cap in 2013. However, the government uses “off flow” as a measurement of employment, which is unreliable, as studies have indicated many claimants simply vanish from record.

Worryingly, an audit in January this year found that the whereabouts of 1.5 million people leaving the welfare records each year is “a mystery.” The authors also raise concern that the wellbeing of at least a third of those who have been sanctioned “is anybody’s guess.” It’s not the first time these concerns have been raised.

It emerged in 2014, during an inquiry which was instigated by the parliamentary Work and Pensions Select Committee, that research conducted by Professor David Stuckler shows more than 500,000 Job Seekers Allowance (JSA) claimants have disappeared from unemployment statistics, without finding work, since the sanctions regime was toughened in October, 2012.

This means that in August 2014, the claimant count – which is used to gauge unemployment – is likely to be very much higher than the 970,000 figure that the government is claiming, if those who have been sanctioned are included.

A Department for Work and Pensions spokesman said: “The benefit cap restored fairness to the system by ending the days of limitless benefit claims and provides a clear incentive to move into work.”

However, people in work are also poor. Those on low pay who need to claim additional support are also being sanctioned for “non-compliance”. In a deregulated labour market, poorly paid workers are now individually and entirely responsible for how much they earn, how many hours they work, and generally “progressing in work”. If they don’t “progress”, then what used to be an issue for trade unions and collective bargaining is now an issue addressed by punitive social security law and welfare “advisors”.

You can see where the incremental increases in the benefit cap are leading the public. The justifications and line of reasoning presented by the Conservatives are leading us down a cul-de-sac of rationale, where the welfare state is completely dismantled, and the reason given will be that this ensures “everyone works”, regardless of labour market conditions and the availability of reasonable quality and secure jobs that pay enough to support people, meeting their basic needs and lift them out of poverty.

If these measures are intended to force people into work, this government’s self-defeating, never-ending austerity policy is hardly the ideal economic climate for job creation and growth, and where are the affordable social homes for the growing ranks of low paid workers in precarious financial situations because of increasing job insecurity and zero hour contracts? The gig economy is a political fig leaf.

An official evaluation of the cap by the Institute for Fiscal Studies in 2014 found the “large majority” of capped claimants did not respond by moving into work, and a DWP-backed study in Oxford published in June found that cutting benefit entitlements made it less likely that unemployed people would get a job. Not that we didn’t already know this. If people cannot meet their basic needs, then they simply struggle to survive and cannot be “incentivised” to meet higher level psychosocial needs. The government need to read about Maslow’s hierarchy of needs, and the Minnesota starvation experiment.(See Welfare sanctions can’t possibly “incentivise” people to work .)

Joanna Kennedy, chief executive of the charity Z2K, said: “Our experience helping those affected by the original cap shows that many of those families will have to reduce even further the amount they spend on feeding and clothing their children, and heating their home to avoid falling into rent arrears and facing eviction and homelessness.”

As Patrick Butler points out in the Guardian, the government have already been ordered to exempt carers from the cap after a judge ruled last year that it unlawfully discriminated against disabled people by capping benefits for relatives who cared for them full time. Ministers had argued that carers who looked after family members for upwards of 35 hours a week should be treated as unemployed.

A previous court ruling found that the benefit cap breached the UK’s obligations on international children’s rights because the draconian cuts to household income it produced left families unable to meet their basic needs. This is the fifth wealthiest nation in the world, and supposedly a first world liberal democracy.

The deputy president of the supreme court, Lady Hale, said in her judgment: “Claimants affected by the cap will, by definition, not receive the sums of money which the state deems necessary for them adequately to house, feed, clothe and warm themselves and their children.

As Stephen Preece from Welfare Weekly pointed out yesterday, the word vulnerable suggests that people are weak, when in fact they are only made vulnerable through the actions or inaction of those around them, including (and especially) the government. 

Ideological justification narratives and pseudoscience

I waded through the government document Welfare Reform and Work Act: Impact Assessment for the benefit cap. Basically the government use inane nudge language and their central aim is to “incentivise behavioural change” throughout the assessment. But they then claim that they can’t predict or accurately measure that. It is very difficult to measure psychobabble accurately though, it has to be said.

There are a lot of techniques of neutralisation and euphemisms peppered throughout the document. For example, taking money away from the poorest citizens is variously described as: “achieving fairness for taxpayers” (as previously stated, people claiming benefits have usually worked: they have and continue to pay taxes); “ensures there is a reasonable safety net of support for the most vulnerable” (by cutting it away further).and “strengthening work incentives”. 

For those alleged free riders claiming support because they fell on hard times, “doing the right thing” and “moving into work” is deemed to be the ultimate aim of the cap, regardless of whether or not the work is secure, appropriate, with adequate levels of pay to lift people out of poverty. Work, in other words, will set us free.

I also took the time and trouble to read the studies that the government cited as “evidence” to support their pseudoscientific claims. The government misquoted and misapplied the research they used, too. They made claims that were NOT substantiated by the scant research referenced. And there are many more studies that completely refute the outrageous and ideologically premised government claims made in this document. 

For example, Freud makes the claims that: “Children in households where neither parent is in work are much more likely to have challenging behaviour at age 5 than children in households where both parents are in paid employment. Growing up in a workless household is associated with poorer academic attainment and a higher risk of being not in education, employment and training (NEET) in late adolescence.”

The study cited was Barnes, M. et al. (2012) Intergenerational Transmission of Worklessness: Evidence from the Millennium Cohort Study and Longitudinal Study of Young People in England. Department for Education research report 234. It says:

“Though it must be stated that much of the association between parental worklessness and these outcomes was attributable to these other risk factors facing workless families. Parental worklessness had no independent effect on a number of other outcomes, such as children’s wellbeing (not being happy at school, being bullied and bullying other children), feelings of lack of control, becoming a teen parent, and risky behaviour. This evidence provides limited support for a policy agenda targeted only at getting parents back into work. ”

It is poverty, not “worklessness” that creates poor social outcomes. That is why around half of the people queuing at food banks are those in work. The biggest proportion of welfare support paid out is in-work benefits.

Freud also states that: “A lower cap recognises that many hard working families earn less than median earnings – a lower cap provides a strong work incentive.”

Actually, raising wages in line with the cost of living would be a far better incentive, instead of punishing unemployed people for the failings of a Conservative government that always oversees an increasingly desperate reserve army of labour, and ever-falling wages. 

Perhaps one of the most outrageous claims made in the document is that the cap is consistent with “UN Convention on the Rights of Persons with Disabilities.” Those sick and disabled people in the ESA work-related activity group are not protected from the cap. The government is currently being investigated by the UN for “gross and systematic” abuses of the human rights of disabled people, because of the previous welfare “reforms” (a euphemism for cuts).

This is an authoritarian government that are coercing people into any low paid and insecure work, regardless of how suitable it is. It’s about dismantling the welfare state, bit by bit. It is about ensuring people are desperate so that people’s right to turn down jobs that are unsuitable, thus reducing any kind of scope for collective bargaining to improve working conditions and pay, is removed. It’s also about bullying people into doing what the government want then to do, removing autonomy and choices. That isn’t “incentivising”, it’s plain and brutal state coercion. All bullies are behaviourists.

It’s impossible not to feel at least a degree of concern and outrage reading such incoherent, flimsy and glib rubbish from an ideologically-driven government waging a full on class war on the poorest, and then claiming that is somehow “fair” to the “taxpayer”. And it’s noteworthy that there is a harking back to the discredited and prejudiced theories of Keith Joseph – “intergenerational worklessness” – which were debunked by the theorists’ OWN research back in the Thatcher era. It is being paraded as irrefutable fact once again.

I’m expecting a government phrenology unit to be established soon.

And an announcement that the Department for Work and Pensions is to be renamed the Malleus Maleficarum.

220px-1895-Dictionary-Phrenolog


 

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Two-way mirrors, hidden observers: welcome to the Department for Work and Pensions laboratory

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I regularly write to raise concerns about the current government’s misuse of psychology in public policies and research. There has been a shift towards the formulation of targeted, prejudiced, class contingent policies which have the central aim of “changing behaviours”  and enforcing “compliance” and conformity. This behaviourist approach has some profound implications for democracy. It constrains autonomy and curtails the basic liberties of targeted citizens, whilst excluding them from any political consideration of their human rights. 

On the government website, a contract finder notice for the “Provision of Research Laboratory Facilities” for the Department for Work and Pensions says:

“The Department for Work and Pensions (DWP) requires research to be undertaken, in a research laboratory environment, with recipients of the Carers Allowance and recipients of the Employment and Support Allowance (ESA).

In a typical lab situation DWP shall have one DWP researcher in a room with the participant and other DWP researchers (if appropriate) and invited observers behind a two way mirror evaluating what is happening. As well as viewing the interview they can also see the activity on the web screen via monitors in their room.

The proceedings are currently recorded on MP4 for subsequent use when research findings are being reported. The participants cannot see the people in the viewing facility though they know they are there. There needs to be flexibility to be able to undertake the research in the North West and Leeds and be able to recruit for participants to attend a Government Lab set up at Aviation House in London WC2B 6NH.” 

Northern Voices T/A The Talking Shop is a Manchester based market research and public opinion polling company that has been awarded the contract in June this year. This company will be paid up to £60,000 for experimenting on sick and disabled claimants, using covert observation from behind a two-way mirror, studying eye movements, facial expressions and body language. 

Eye movement measurements are frequently used, though controversially, in criminal psychology, too, as a somewhat unreliable method of “lie detection.” Questions arise regarding precisely how eye movements, perception and cognition are related, and to date, this question hasn’t been answered by academics. 

It struck me that the experimental set up is very reminiscent of the social psychology experiments conducted in the 60s and early 70s to study social conformity and obedience to authority. However, the welfare “reforms” were specifically designed to coerce people claiming welfare into conformity – “to do the ‘right thing'”-  and compliance with a harsh “conditionality” regime and ever-shrinking eligibility criteria. It’s hardly a secret that the New Right Conservatives and neoliberals have always loathed the welfare state, and along with the other social gains of our post-war settlement, it is being systematically dismantled.

The wider context is significant, both in terms of its impact on individual citizen’s experiences and behaviours, and on the way that theory is formulated to conflate  and align citizen’s needs with neoliberal outcomes, and this is also reflected in how research is being designed and used.

Some context

In the UK, the Behavioural Insight Team has been testing paternalist ideas for conducting public policy by running experiments in which many thousands of participants receive various policy “treatments.” A lot of the actual research work is contracted out to private providers. Whilst medical researchers generally observe strict ethical codes of practice, in place to protect subjects, the new behavioural economists and profit-driven private companies are less transparent in conducting behavioural research “interventions.” There are no ethical and safeguarding guidelines in place to protect participants.

Earlier this year I wrote about a Department for Work and Pensions Trial that was about “testing whether conditionality and the use of financial sanctions are effective for people that need to claim benefits in low paid work.” A secretly released document (which said: This document is for internal use only and should not be shared with external partners or claimants.) was particularly focused on methods of enforcing the “cultural and behavioural change” of people claiming both in-work and out-of-work social security.

Evaluation of the Trial will be the responsibility of the Labour Market Trials Unit (LMTU). Evaluation will “measure the impact of the Trial’s 3 group approaches, but understand more about claimant attitudes to progression over time and how the Trial has influenced behaviour changes.”

Worryingly, claimant participation in the Trial was mandatory. There was no appropriate procedure to obtain and record clearly informed consent from research participants. Furthermore, the Trial is founded on a coercive psychopolitical approach to labour market constraints, and is clearly expressed as a psychological intervention, explicitly aimed at “behavioural change” and this raises some serious concerns about the lack of research ethics and codes of conduct in government research. It’s also very worrying that this “intervention” is to be delivered by non-qualified work coaches.

The British Psychological Society (BPS) have issued a code of ethics in psychology that provides guidelines for the conduct of research. Some of the more important and pertinent ethical considerations are as follows:

  • Informed Consent.

Participants must be given the following information:

  •  A statement that participation is voluntary and that refusal to participate will not result in any consequences or any loss of benefits that the person is otherwise entitled to receive.
  • Purpose of the research.
  •  Procedures involved in the research.
  •  All foreseeable risks and discomforts to the participant (if there are any). These include not only physical injury but also possible psychological.
  •  Subjects’ right to confidentiality and the right to withdraw from the study at any time without any consequences.

Protection of Participants

  • Researchers must ensure that those taking part in research will not be caused distress. They must be protected from physical and mental harm. This means you must not embarrass, frighten, offend or harm participants.
  • Normally, the risk of harm must be no greater than in ordinary life, i.e. participants should not be exposed to risks greater than or additional to those encountered in their normal lifestyles. Withdrawing lifeline support that is calculated to meet the costs of only minimum requirements for basic survival – food, fuel and shelter – as a punishment for non-compliance WILL INVARIABLY cause distress, harm and loss of dignity for the subjects that are coerced into participating in this Trial. Participants should be able to leave a study at any time if they feel uncomfortable.

Behavioural “rights” and the politics of moralising

In the UK, the Behavioural Insight Team is testing paternalist ideas for conducting public policy by running experiments in which many thousands of participants receive various “treatments” at random. Whilst medical researchers generally observe strict ethical codes of practice, in place to protect subjects, the new behavioural economists are much less transparent in conducting behavioural research and designing policy interventions.

Consent to a therapy or research protocol must possess a minimum of three features in order to be valid. These are: it should be voluntarily expressed, it should be the expression of a competent subject, and the subject must be be adequately informed of the details.This raises some serious concerns about experimental social research, especially when it may involve people with mental health disabilities who may be highly vulnerable.

It’s highly unlikely that people subjected to the extended use and broadened application of welfare sanctions gave their informed consent to participate in experiments designed to test the nudge theory of “cognitive bias,” for example. The extended use of sanctions in the Welfare Reform Act 2012 was originally advised by the Behavioural Insights Team (the Nudge Unit) back in 2010. It was based on the manipulation of an alleged cognitive bias that we have – loss aversion – and designed as a method of coercing conformity to increasingly unreasonable state-imposed conditionality rules, and as punishment for the perceived “non-compliance” of unemployed people.

There is nothing to prevent a government deliberately exploiting a research framework as a way to test out highly unethical and ideologically-driven policies. How appropriate is it to apply a biomedical model of prescribed policy “treatments” to people experiencing politically and structurally generated social problems, such as unemployment, inequality and poverty, for example? 

The fact that this government regards work as a “health outcome” should raise alarm bells. (Please see: Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records). The government have already stigmatised unemployment, and redefined it as a psychological disorder.

Furthermore, the research models being used are framed by a profoundly undemocratic conservative positivism, which emphasises directed quantitative data collection and excludes the accounts, experiences, narratives and language of research participants. Much of the research is prejudiced, and starts from an authoritarian premise that people experiencing socioeconomic problems do so because they make the “wrong choices” and that they need to be “incentivised to change their behaviours”.

An element of the “laboratory  research environment” research went ahead in March  last year. It’s stated aim was to “to improve the Carer’s Allowance Digital Service.”  The recruitment brief specifies that:

“These self employed people shouldn’t have accounts prepared by an accountant however it’s mandatory that they bring with them details of their self-employment eg a log book or papers of incoming and outgoings. We also need these people to be looking after someone who has a disability.”

It’s become normalised that many millionaires avoid paying taxes and contributing to the society that they have gained so much from. I don’t see anyone intimidating them, demanding details of their “incoming and outgoings,” yet that would profit society far, far more.

Wouldn’t you think that if this were genuinely about supporting carers using software or accessing services online, it would be designed to be USER LED – a direct face-to-face approach would be the usual way, with an input from those service users, which is qualitative and much more reliable, authentic and useful than the account of a group of strangers hiding behind mirrored glass, observing people and applying controversial psychology techniques.

Measuring eye movements is usually coupled with other more inclusive qualitative methodologies, such as introspective verbal protocols, since used on its own, it is unreliable in that it fails to indicate specific kinds of cognitive processing or content.This, dialogic approach, however, isn’t included in the government’s research brief. (Please see The importance of citizen’s qualitative accounts in democratic inclusion and political participation.)

The central premise of justifications for “behavioural interventions” is that the general public has numerous cognitive biases that lead to “faulty” decision-making. Current research and interventions are largely aimed at the poorest citizens, however, exposing a government bias that wealthy people are somehow cognitively competent. Yet many of this powerful, hoarding minority class want to see worker’s rights, welfare support and our public services dismantled. Not a rational or civilised class, on the whole, then.

As I have previously stated, the behavioural approach removes people from the socioeconomic and political context that they inhabit and isolates them from meaningful and impacting socio-structural events and political decision-making, placing the burden of responsibility and obligation entirely within those who are suffering the consequences of neoliberal policies. In a such an economic system of “market forces” based on competition, there are invariably winners and losers. It’s hardly rational or fair to punish those who are simply adversely affected by an intrinsically flawed and unfair system of socioeconomic organisation.

Can you imagine the government carrying out this kind of research and stigmatising, intimidating methodology on billionaires interacting with their accountants, completing their tax returns or interacting with their offshore banks? No, I thought not. 

It’s noteworthy that current Nudge Unit policy is to keep those being targeted for nudges “naive” as people tend to temporarily alter their behaviour when they know they are being observed and that skews research results. In sociology and social psychology, this is called the Hawthorne effect.

However, that approach is profoundly incompatible with established ethical research frameworks, which, as I’ve outlined, always specify a central requirement of participants’ informed consent.

Similarly, the starting premise of laboratory usability testing is that “what people say they do with products is not always what they actually do.” In other words, we cannot trust the public to tell us what they need.

Userbility testing, an American import, is designed to “target” users’ needs and preferences by observing their behaviour. However, a big part of the motivation for this kind of research is Building credibility for usability activities within an organization.” The government often use research like this to formulate justification narratives for controversial, coercive and punitive policies.

Democracy is meant to involve the election of a government that reflects on social problems objectively, recognises and serves public needs, and that designs policy in response to what citizens actually need; it’s not about governments that coerce people to “change their behaviour” in accordance to a partisan, ideological agenda. We call the kind of government that does that “totalitarian.”

I am not the only person who is very concerned about this development.  

A spokesperson for Fightback 4 Justice said:

“This is the company that has won the tender experimenting with Carers claimants using body language techniques and 2 way mirrors. If anyone gets called into one of these meetings please get in touch as I’d be happy to attend. I am very very concerned about a potential breach of a person’s human rights here particularly where mental health is one of the claimants conditions. Nothing about this “study” seems ethical in my legal opinion. A room with a 2 way mirror and capacity for 12 people studying body language and facial expressions is wrong in so many ways, DWP are giving the wrong impression that claimants are potential criminals with this latest research in my view.” Michelle (legal advocate).

The Talking Shop’s research studios

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Related

The politics of blame and in-work conditionality

Nudging conformity and benefit sanctions

G4S are employing Cognitive Behavioural Therapists to deliver “get to work therapy”

The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work

The importance of citizen’s qualitative accounts in democratic inclusion and political participation

Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records

The Conservative approach to social research – that way madness lies

A critique of Conservative notions of social research

 


CONTRIBUTE TO POLITICS AND INSIGHTS

I don’t make any money from my work. But you can contribute by making a donation and help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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