Bill Cash, MP (23 Sep 08) on regulation

This letter written by Bill Cash is worth holding onto, so here it is for reference:

Letter to the Times (23 Sep 08) on the different ways to regulate.

"Sir, There is one matter that is being overlooked, namely, the importance of self-regulation within the framework of the law. Ultimately, it is up to the directors and those who run the financial companies to behave in a manner that maintains proper standards based on sound principles and, dare one say it, moral rectitude.

It is not by any means a matter exclusively for the Financial Services Authority. We need to see that the City itself throws out the bad apples and blackballs those that transgress, stopping credit lines as required.

Parliament will not solve the problem and may exacerbate it by generating costly bureaucracy that will not fill the moral void here or abroad. Without a sense of fiduciary duty and self-regulating principles along the lines of the Quakers in the 19th century, no amount of legislation in itself will compensate for the greed and incompetence we have witnessed.

The same principles must apply in all professions whether it is finance, law, medicine, accountancy, or whatever — ultimately those who know best how to run the profession must exercise moral responsibility in weeding out bad practices and bad people.

Bill Cash, MP"

London SW1

Quick fix for the soul

This article by Darian Leader and published in The Guardian newspaper on Tuesday September 9th 2008 makes plain part of the problem that lies behind the current governmental policy of supporting CBT as the the treatment of choice for the State. Follow the link in the title to find the page in the newspaper.

Petition: HPC must think again. State reg of psy practice does not protect the public.

Nick Totton, Andrew Samuels, Allison Priestman, Denis Postle, Arthur Musgrave, Guy Gladstone, Kevin Jones have created a petition which now has 1226 signatures. Below is the text from the petition page, click the title of this blog entry to go to the petiton.

[Since launching the petition, we have been in touch with UKCP, BACP and BPC, as well as with the Health Professions Council, pointing out that large numbers of practitioners have signed up including many members of the big organisations, and suggesting that a poll of all therapists and counsellors needs to take place to find out whether state regulation has their support. So far only the HPC has responded, and we are setting up a meeting. If you want your professional organisation to poll its members on state regulation, then let them know! By the way, we are also aware of the double 'and' in the petition, but for obvious reasons we are not allowed to edit the text while the petition is 'live'. - Nick Totton, Andrew Samuels, Allison Priestman, Denis Postle, Arthur Musgrave, Guy Gladstone, Kevin Jones]


To: UK Government and Health Professions Council
We the undersigned psychotherapists and counsellors doubt that the proposed state regulation of psychotherapy and counselling in the UK will be of benefit either to the public or to the profession, and are concerned that it will in fact be harmful; we do not wish to be regulated in this way, and and call upon the Government and the leadership of our professions to halt the proc

Petition against State regulation of psychological therapies

"The Government proposes to regulate psychological therapies through the Health Professions Council. Thousands of psychotherapists and counsellors working successfully in these fields would be barred from using their habitual and long-earned titles if the proposal to make ‘psychotherapist’ a protected title is approved.

Specifically, body-centred approaches, client-centred, humanistic and integrative psychotherapists rely on a model which emphasises self-actualisation and the intersubjective and relational nature of human development and experience.

These are not variants of the Department of Health preferred modalities, and often offer a more fundamental alternative to CBT and related outcome-focussed therapies, whose long-term effectiveness remains unproven.

The DH proposals have failed to make the case for regulation. There is no evidence of widespread client abuse. Current voluntary and professional arrangements already deal with client complaints and maintain professional competence in the field of psychotherapy"

started by Tim Brown – Deadline to sign up by: 25 October 2008 – Signatures: 220

Mark Neocleous

Prof Mark Neocleous teaches politics and government at Brunel University. In this conversation with Natalie Wulfing, he manages to laugh at the preposterous policy of the administrators at Brunel who are 'doing their bit' to defeat terrorism by trimming the foliage of the shrubbery:

MN: "... it doesn’t take much for a State to point to a whole range of insecurities and then to say that we, the State, must act. More interesting, more problematic, is that it doesn’t take much for the State to fabricate insecurities. Once that process takes place, it has a momentum of its own. There’s an interesting document produced by MI5 in 2004 and reissued in 2005 about how universities and large organisations can help in the ‘war on terror’. One piece of advice was to trim the bushes and small trees around entrances. Think about what that does. No terrorist attack has ever happened by a terrorist jumping out from behind a tree near an entrance to a building or planting a bomb there. My university actually did send an email around after this document arrived, and now the bushes at the doorways are all trimmed back! But think: how many times do people go in and out of their work or university building in a day? Now, every time they go through a door they are supposed to feel secure or insecure. So,
something as mundane as going for a sandwich becomes a question of security – or reminds people of their ‘insecurity’."

to read the full conversation, click the heading.
If you want to comment on it - click the comments box below.

Joanna Moncrieff

Joanna Moncrieff is a psychiatrist and a founder member of the critical psychiatry network. In this conversation Roger Litten reminds her of one of her early articles written when higher education was as yet unscathed by the RAE dis-ease.

“Its function was to deal with abnormal and bizarre behaviour which without breaking the law did not comply with the advance of the new social and economic order. Its association with medicine concealed that aspect of social control by endowing it with the objectivity and neutrality of science. The medical model obscured the social process of deviance by locating problems in human biology ...” In three sentences you have condensed a remarkably powerful nucleus.

JM: I wrote that when I was an SHO, a junior doctor. I wrote it for Soundings, which was then a new Open University magazine. It makes me feel sad as I sit here now in UCL! No-one would ever encourage me to write a paper like that today. I’ve got to write papers that get into the Lancet for the Research Assessment Exercise, so it’s difficult to find time and the outlets to write things like that which need to be written, which do actually get to the fundamental core of the issue...

to read more, click the heading of this blog entry

Stephen Frosh

Prof Stephen Frosh used to work in the Science Faculty of Psychology at Birkbeck College in London. He now finds himself in the Arts and Humanities faculty heading up a new discipline called Psycho-social studies. In this conversation Stephen describes some of the process of audit that produces this unintended consequence and argues that what is needed is courageous re-invention, and on no account should academics lose their nerve.

SF: "... I think for instance here at Birkbeck, our audit culture is still laborious and bureaucratic but it’s much better than it used to be partly because the people involved are trying to think how to make it work. We should not be intimidated.

The person I teach most with is just coming out of the probationary period and she had to do the teaching certificate (a lot of people complain about it). She was observed and assessed doing some teaching with me of psychoanalysis to psychology students. What we did was to work in small groups and have an observed conversation: unstructured, unprepared, responsive to students – it was risky. The rather tight-looking observer from the Life Long Learning department gave her a distinction! There was a willingness from the observer, and an unwillingness from us to be completely phased. I’m not denying the power of audit here, but there is something that people can use more. It’s not quite as bad as it has to be, we must take hold of its power. "


To read the full conversation, click the heading.
To make a comment on what you read, click the comment button below:

George Freeman

Prof George Freeman is well known for his work on Continuity of Care in General Practice and for his GP teaching work. In this conversation he talks about some of the unintended and unwelcome consequences that audit culture visits on medical practice, including this rather bizarre example of managerial lunacy.

GF "... Here is a prescription pad...

JL: ... so it is ...

GF: ... if you were to steal that and attempt to forge my signature, you could write prescriptions for this that and the other for patients that might or might not exist, and then you might sell them. Alternatively there’s that [reaches to the paper tray in the
computer printer] it doesn’t even have anything printed on it except for a serial number, and again, apparently it has a market value. Obviously you are supposed to keep these locked – when I’m not here I lock them away. But there are concerns about
the safety, and we have a fifty-one page document now from the PCT about the safety of these things, and it’s really like Securicor! When they are unloading them from the van they’ve got to have a witness, they have to go into a room with grills on the windows, and someone has to witness them being locked up - and it take 51 pages to say that. That’s an example of the bureaucratic effort that’s going into administration these days: it’s disproportionate and it’s happening across the board.


To read the full conversation, click the heading above
To leave a comment, click the button below:

Robert Snell in conversation

Robert Snell is a psychotherapist and art historian. His review of the book "L'Anti Livre Noire" (edited by Jacques Alain Miller, and published by Seuil, 2006) mixes his wonderful wit and erudition, and led me to Brighton to meet him during the town's vibrant Festival earlier this year. Here we wonder whether a certain section of the British might have lost their ability to deploy and enjoy some vitriol.

RS: "... the Miller book was a relief for me to read because the writers don’t seem to be worrying about offending anyone. They
are speaking clearly and making an open attack on a declared enemy. So, it is also a rant. Maybe in England at the moment it is not possible to do that. In France it seems ok to have a fight. It is very difficult to remain calm when someone states boldly that ‘CBT is the treatment of choice’. It’s such a meaningless phrase, and begs all kinds of questions - it comes at you like a slab of concrete. ... What was so good about the Anti-Livre noir was the humour and the irony, and the pleasure that came through. They are engaged in a battle, but not without humour.

JL: Yes, humour is going to be useful. At the moment many of us seem a bit paralysed, unable to think when faced with this demand for evidence and the need to know everything in advance.

RS: Humour, yes, and poetry probably... Keats’s ‘negative capability’ which Bion was so fond of invoking is still as a good a place to start as any: “negative capability, that is when a man is capable of being in doubt and uncertainty without idle reaching after fact and reason...”



to read the full conversation, click the heading above.
to comment, click the button below:

Richard Gombrich: British Higher Education Policy (2000)

The blog heading (above) is linked to the text of a talk given by Richard Gombrich in Tokyo, 2000: British Higher Education in the last 20 years: the murder of a profession. I came across it last year whilst looking for facts and figures on the changing context of British higher education - the enormous increase in numbers of students now attending universities, the simultaneous reduction in library funding, the shift to contract work for staff, and the rise of the RAE and QAA. Such major changes cannot help but have consequences for a country, and I found this talk enormously useful for gathering together the major factors that have altered the structure of higher education. It was also extremely interesting for the anecdotal evidence it provides about on the fictional nature of the RAE. Michael Power (see below) has written consistently on this and has steadily uncovered the structural impossibility within the logic of the audit function. Richard's talk includes some examples of the way that this pressure forces a fabrication into existence whilst also insisting it is treated with the weight of a fact.

Marilyn Strathern: audit cultures

This entry is linked to a conversation between Marilyn Strathern, Pierre-Gilles Gueguen and myself. Marilyn talks about the impact of the audit culture on her work in British universities, and the changes this is making on both the discipline and the topic of anthropology. The administrative function has steadily encroached on the academic role and the impact of this is made clear on the credibility of the subject.

Michael Power: audit explosion

This post is linked to the transcript of a conversation between Michael Power and Roger Litten. This fascinating discussion touches on issues about audit culture and wider questions for society and subjectivity, and poses questions about psychoanalysis and society. The conversation is one of a series that are taking place in preparation for a meeting in London on 20th September, which Michael will also be speaking at. If you would like to leave comments or questions as a consequence of reading it, please make use of this blog to do so.

Ipnosis

The Independent Practitioner Network has a diligant web wizard: Denis Postle. Denis has developed this site over the years to support his ongoing campaign against state regulation of the psy-practice and to maintain a place for independence. Last October he invited me to be a guest editor and now we have developed a series of pages that support some work I have been doing with colleagues to try to shed light on the questions around audit, regulation, and evidence based medicine. In short, we are asking : what on earth is going on?

If you follow the link in the title of this entry you will end up on some sister pages of this blog, hosted by eIpnosis. There you will find the unfolding story and tales from along the way towards a meeting that will be held in September. To begin, there are two very interesting interviews, one with Anthropologist Marilyn Strathern, and the other with Accountant Michael Power. They were the beginning of a series of meetings that some of us have been having in order to get our bearings in the strange times we are in.

Why psy-practitioners need to think about the government

In 2001 the Health Professionals Order was passed through the Privy Council. This gave powers to some new institutional forms. One of these is the Health Professionals Council. The HPO2001 vested powers in the HPC and set the wheels in motion to employ people, pay them salaries, allocate budgets, rent offices, and start a process to enlist a huge number of people onto a centralised register. The people employed in the HPC are new to the field, and don't know much about the professions they will regulate. They don't need to. In fact, according to the logic of the HPO2001, its best if they do not. For to know something about the practice, according to the logic of HPO2001, is ipso facto to be prejudiced.

In September 2008, when the Parliament returns from recess, there will be a conversation about an ammendment to the HOP2001 which intends to give more power to the HPC. If this happens, then lots of things will follow, not all of them unpredictable. 

The law sets off from the wrong place. It assumes that professionals are not competent, are self interested and that the public needs to be protected from them. But it also assumes that there is a group of people who are innocent, never incompetent or self interested, and these are the ones who have been given the power. Ironically these are bureaucrats in the employ of the politicians. 

My main concern here is that the kinds of logic behind the current processes will have a destructive effect and expose everyone to the full force of market forces just at the time when globalisation is at its most potent. Commodification races ahead almost unchecked.

Professionals are part of the social fabric that can protect the people from the brutality of market and other forces. It is probably not a good idea to wreck that.

Burning Platforms

In June 2004, I was invited to discuss two texts at the first of a series of annual meetings in the relatively new Said Business School, Oxford. The new Professor of Marketing had been a distinguished Sociologist in the field of Scientific Knowledge, and he had engineered this meeting to bring together the interesting and incisive work from the various fields of sociology of science to see if ideas could translate or transmit to the new business sector (where many sociologists end up working). 

One of the papers was written by prize winning PhD student Stephen Cole who had been honoured by the Society for the Social Studies of Science for his work on finger-print evidence in US courts of law. The other paper was credited to about 8 or so different people, but was in fact written by Marc Berg, a much published author on the way to becoming an independent health consultant in the Netherlands. The practice of including a range of multi-disciplinary stake holders as authors of the paper is a practice that has grown in popularity, alongside the rise in audit culture in some parts of academe. 

Both of the authors were successful in their field but neither had remembered the classic foundations of their chosen disciplines. My essay (on the blog side) put back some of the social staging that makes medicine and law understandable as a human activity. I anchored the action back to its base from a social science point of view and then went on to judge the value of the pieces. Both, I thought, were alarming. Both were highly ambitious. They each wanted to intervene and cause change at the heart of their chosen host field. Cole's pretension was to collapse the value of finger-prints as valid evidence in court. Berg wanted to collapse the practice of medicine in order to make managerial change. The Burning Platforms of my title were his preferred method of practice.

The challenge I faced was that of any scholar: to be true to the principles and knowledge of my discipline, so that the outcome would be an accurate analysis of the papers. If I succeeded then the benefits would accrue all round; witness to my personal worth as a scholar, witness to the knowledge base that I draw from, and an adequate exposure of the strengths, weaknesses and substance of the papers without having to set anyone on fire or collapse a whole tradition.

The meeting itself was set up as a kind of auditing, or auditioning perhaps. Where scholars at different stages in their careers, at different levels in their fields, come together to give a good listening to each other, to rectify wayward practice, argue important points, and learn from developments in adjacent fields. 

Looking back on this with hindsight I see the current regime of audit as extremely out of step with this kind of academic, scholarly, disciplined and learned tradition. One mechanism of auditing a discipline is this very meeting itself. It is one of many ways that academics organise themselves and regulate their practice. It doesn't have to be perfect, and it might not always succeed, but at least it has the virtue of being true to its knowledge, disciplined in its practice, and efficient in the exchange of ideas.

 

Unintended R D Laing

Adam Curtis' trilogy of documentaries came out in March last year. Someone has put short excerpts onto You Tube that relate to the bits about Ronnie Laing's critical American tour (the links are on the blog side).  Curtis argues that Laing's harangue had unintended consequences. In criticising the profession of psychiatry, he paved the way, Curtis says, for a more speedy medicalisation of the mind. 

The argument against the psychiatrists became such a powerful call that it rallied a potent army. Why? Did lots of people suddenly agree that leaving the important business of psychiatry in the hands of a bunch of people following a false science was not a good idea? Laing had said it was a false science propping up a failing society. One of the audience, a young medic named David Rosenhan took up the challenge and invented a radical research project which seems, at least in retrospect, to have catapulted the cause of the anti-psychiatrists into the stratosphere. 

Laing's gambit was a classic manouevre to open up a space for his own radical and interesting ideas. But his style of attack on his fellow professionals seems at least in part to have produced the conditions for a non-human intervention to take its place. How? The logic is over simple. If the men in white coats weren't to be trusted, we should turn to their non-human replacements. Why? Because it is men per se that is the problem? How does this actually happen in practice?

It can be ridiculously difficult to get a good idea into circulation (think Galileo, Copernicus, and Zero), so why is it easy to get a crackpot idea into circulation? What are the mechanisms that thrust RD Laing onto centre stage as a major player in this drama? 

Curtis's argument is an interesting one if approached in a sensible way. Because it is true that we are now in an era where criticism of professionals has become a serious argument for wheeling in non-human rationality as a replacement. But what are the conditions that have brought this strange situation into being? Why should people latch onto the argument against one idea and completely forget the other. After all, no-one was arguing for a marketing drive for medication. Certainly not R D Laing.

Taking Liberties

Last year Chris Atkins released a film and a book called Taking Liberties (Revolver, 2007). In it he documents the wave of changes in the law that Tony Blair's government have made. Not only were more laws passed than at any other time in history ever, but the particularity of the laws have obliterated the Magna Carta.

The supposition has tuned away from a presumption off innocence until proven guilty. 

When a Prime Minister's strategy of reform ends up tearing up the Magna Carta, it is a very different thing from having him harangue a crowd from a podium, and designate a particular group as The Ones who must be removed. But the lack of evil intent simply removes the consistency in the system. What we have instead is an unpredictable law of unintended consequeces - a great degree of risk and uncertainty.

In Chris Atkins film he re-presents the moment when Walter Wolfgang was slung out of Jack Straw's talk at the Brighon Labour Conference (2005). Wolgang, a very slightly built man in his 80s, had been unable to stop himself shouting Nonsense when Straw was talking of the war. Watching this footage is chilling. Not only is it horrible to watch big beefy bouncers manhandling a little old man, but it is also very upsetting to see most other people stunned into inaction. One brave bloke who attempted Wolfgang's rescue was himself seized, dragged off into a room where the camera couldn't follow and was physically abused. Atkins' film then cuts to a smiling shot of a bemused Blair who says: "I wasn't there".

Desire, life, death, and drive

Socrates, Cicero, and Montaigne have all said that to philosophize is to learn how to die.

This line is from a review in the Times Literary Supplement (21 May, 2008) by Daniel Pick of a new book by Mark Edmundson
THE DEATH OF SIGMUND FREUD
Fascism, psychoanalysis and the rise of fundamentalism
282pp. Bloomsbury. £18.99.
978 0 74758607 4

My thanks to Penny Geogiou for bringing this to my attention moments after I received an email from from a sociologist who had told me the rather pitiful tale of one of his colleagues. They are suffering an excess of audit in their department and being asked to spend lots of time on form filling that has no value for the work that they do, in fact it is detrimental. The colleague was very vocal in her refusal to indulge in such nonsense. Her outburst was sufficient to call a senior administrator in to defend his labyrinthine predilections. Perhaps it is the shift in power relations that led the academic to immediately capitulate. She found herself praising the virtues of the red tape equally loudly, much to the surprise of her colleagues. The administrator withdrew, satisfied.

I wondered what happened to this woman. It is not unusual to find someone beating themselves up after such an unpleasant encounter. When a bully succeeds in pressing home his power, the bullied has three options to deal with the residue that results. Self punishment. Passing the indignity onto someone else. Sublimation, or turning it into something more creative. 

Figuring out how to live with the excesses of our drives is one of life's more important questions. Antiquity and classical literature is full of it, and Freud and Lacan champion it. But in modern British life, it appears to have fallen out of fashion. 

English Professors against QAA

Thomas Docherty, professor of English at Warwick University published a new book this year: The English Question or Academic Freedoms (Sussex Academic Press, 2008). The Guardian's Chris Arnot wrote a column that pit Docherty against some QAA advocates. 

Here's a quote from Docherty: "The QAA, for those of us who have suffered under its tawdry posturing, is a cancer that gnaws at the core of knowledge, value and freedom in education; its carcinogenic growth is now perhaps the greatest pervasive danger to the function of a university as a surviving institution," he writes. "It has presided over the valorisation and celebration of mediocrity, paradoxically at the very moment when it is allegedly assuring the public of the quality of education and universities ..."

and here's part of the riposte: "Hefce has defended its creation. "We strongly refute Professor Docherty's comments," says its director of learning and teaching, Dr Liz Beaty, "and have complete confidence in the way the QAA is carrying out its role." [my emphasis - JL] She points out that, in response to concerns about the administrative burden, the agency adopted a "light-touch" approach after 2001."

One of the features of the ripostes is that they call on a tawdry notion of evidence to refute Docherty's argument - look closely and you find that the way they comport themselves is the question, not the reason or logic of their act.  This is part of an attack on the real value of academic work, and the beginning of a slide into fakery (ie pretending to do something by going through the motions).   Arnot frames a clash of paradigms here.

http://education.guardian.co.uk/higher/news/story/0,,2240583,00.html


The book's title resonates with the important work of Conrad Russell: Academic Freedom (Routledge, 1993). http://www.atm.damtp.cam.ac.uk/people/mem/papers/LHCE/uk-higher-education.html

If EBM is the answer, what was the question

If EBM is the answer, what was the question? Who asked it? When?

Although Archie Cochrane is implicated in this process, he didn't spearhead the current rise of RCT in the NHS, and amongst those that did, few mention the man. It was as if it emerged out of nowhere, attached to no-one.

For some bizarre reason, EBM has not become a new science. Instead it has become entangled in politics and is best understood as a rhetorical phrase.  

The phrase has power to hypnotize people. In the particular arrangement of the NHS, the Government and the University sector, it has become a key phrase which is shaping people's livelihoods, money, and jobs. 

Whatever Evidence Based Medicine might have been, it has become the rallying cry in a strange kind of paradigm war. Intended or otherwise, under the banner of EBM a backward step is being taken.

The war is odd tho. Instead of finding pioneering scientists championing new ideas and new ways of doing things, we find bureaucratic systems, and an apparent army of nameless automatons. 

Evidence Based Medicine

Archie Cochrane died in 1988 but in 1972 he published a little book in which he championed the EBM cause in the name of the Randomised Controlled Trial. He said that the first couple of chapters were an easy write, but the rest of the book was a depressing grind. He had said all he wanted to say in the first few pages, but was obliged by the sponsor to pad out the pages to make it into a book. The book sets off saying how little of what doctors do is based on evidence. 

But what kind of evidence is needed in medicine, and who is to be the judge? 

Archie Cochrane points out in his book that if you take a map of the world and place a black dot everywhere you find an RCT you will notice that all the countries concerned are those of a protestant persuasion. Communists and catholics are bereft of the thing. At least that was true in 1972.

This is a very interesting observation. Archie Cochrane, however, joked that it simply showed the natural superiority of the protestant. 

The automated booking system in the nhs

In February this year I visited my GP. One outcome of the visit was that I wrote a letter to Alan Johnson (linked to this blog, and in the side bar). You will see that the process was about an appointment with a specialist team in a local hospital. As the weeks progressed the need  for the appointment receded, so I tried to cancel it. Here's a very short version my three attempts to do that:

1. The automated telephone answering machine: "we are sorry but we are experiencing an unusually high volume of calls and all our staff are speaking to other callers, if you have access to the internet ..."

2. The automated computer response: "We are sorry, but the web browser you are using is not compatible with the online Choose and Book service. We apologise unconditionally for any inconvenience caused by this problem and can assure that we are working to make sure that future versions of the Choose and Book online service work in as many types of browser as possible. You can still book over the phone by calling 0845 60 88 8 88 (Textphone: 0845 8 50 22 50). Booking lines are open from 7am - 10pm. A translation service is available if you cannot speak English. Please have your appointment request letter to hand when you call."

3. The real person, reading from a script, ie the automated person: "Can you give me your special code word ... thankyou, ... and your password ... thankyou. 
Now can I have your full name ...  thankyou
and your date of birth?

My date of birth? For goodness sake, all I want to do is cancel an appointment in the diary!

I'm sorry madam, I cannot do that unless you give me your date of birth. It is a security measure for the computer.

-----------------


"Since coming to power in 1997 New Labour has spent upwards of £70billion on management consultants and new IT systems." p98, Taking Liberties Atkins, Bee & Button 2007.