Cast your nominations for the #MindAwards 2014

Today the categories were announced for the Mind Media Awards, and you can nominate your favourite mental health voices to win.

Although most nominations cost £165 per nomination, there is no charge to nominate for the journalist, student journalist or blogger categories.

The blogger category seems to be replacing what was previously known as the Mark Hanson Award for Digital Media. In many ways I think that’s a shame, because there’s a lot of good stuff being done on other forms of social media (e.g. vlogs, Twitter) to talk about mental health. Then again, the winners from the last three years have all been blogs. In 2011, it was won by Confessions of a Serial Insomniac for her account of recovery from child sexual abuse and borderline personality disorder. In 2012 Mental Health Cop received the award for his detailed analyses of the intersection between policing and mental health. Purple Persuasion won in 2013 for her blog about recovery from bipolar disorder. Continue reading

Prejudice or Privilege? Some Difficulties with Privilege-Checking

A couple of weeks ago there was a fairly spirited exchange between the former MP Louise Mensch and the feminist writer Laurie Penny over the phrase “check your privilege”, which started out as a feminist term on Livejournal, and has turned into something of a Twitter trope. It’s mostly (though not exclusively) used in online feminist debate. Louise Mensch isn’t a fan of it.

And that is what the modern feminist movement has become. Full of intersectionality, debates about middle-class privilege, hand-wringing over a good education (this is again “privilege” and not well-deserved success), and otherwise intelligent women backing out of debates and sitting around frenziedly checking their privilege.

It does nothing. It accomplishes nothing. It changes nothing.

Laurie Penny defended the term.

Telling someone to “check their privilege” isn’t the same as censoring or silencing, but to people who aren’t often introduced to the concept that they might be wrong, it can sometimes feel that way. When someone asks you to check your privilege, it doesn’t mean you should stop talking – it means you should start listening, and sometimes that involves giving the other person in the room a chance to speak. That’s what often upsets people most about the whole idea. It’s about who gets to speak, and who has to listen, and social media is changing those rules.

I’ve been pondering this for a while, and I’m going to give a list of what I think are some of the problems with privilege-checking. Some have suggested that the only people who have an issue with being asked to check their privilege are those who are privileged themselves. Given that I’m white, male, straight, cisgender, middle-class and able-bodied, quite possibly I may be guilty as charged here.

But here’s something I’ve noticed about the often-virulent arguments between feminists on social media (anyone who says, “If feminism ruled the world, there’d be no war” doesn’t have a Twitter account). These are debates where I’m at best an ally and at worst merely an outside observer, but when I’ve criticised some of the discourse, I seem to get an easier ride than when those on the inside say the same thing. Why are those involved expending so much energy to hurl vitriol at other feminists like Louise Mensch, Caitlin Moran and Helen Lewis? Why aren’t they flaming me?

I suspect that might be one to file under, “Be careful what you wish for”.

Anyway, here’s what I think are some of the problems with saying, “check your privilege.”

1. Not all privileges and oppressions are immediately apparent.

When someone says “check your privilege”, it suggests that they know what privileges the other person has. Trouble is, there are plenty of hidden oppressions and privileges. A history of mental health problems and/or childhood abuse, for example. I recently spoke to a woman with an anxiety disorder who got Twitterstormed by various feminists who (wrongly) interpreted a comment by her as transphobic. Getting bombarded with abusive messages telling her to check her privilege for several hours prompted a mental health relapse.

Even apparently straightforward privileges/oppressions might not be especially visible, especially if all you know about someone is from their social media profile. I spoke to a woman who’d been accused of showing her “white privilege”. When she pointed out that she’s actually mixed-race, she got the retort that since she could pass for white, she still has white privilege.

2. It’s patronising and dismissive.

I’ve actually seen some suggestions that Stephen Fry, when talking about his mental health problems, is doing so from a “privileged” perspective. Admittedly that was said before he disclosed his recent suicide attempt, but even so, do we really want to tell people with a mental illness to check their privilege? Sounds a little too close to, “Chin up, you could be starving in Africa.”

depressed

3. Privileges and oppressions don’t necessarily affect prejudices in straightforward, linear ways.

This point leads me onto the question whether we should really be talking about prejudice rather than privilege. There seems to be an assumption in “check your privilege” that more privileged = more prejudiced and more oppressed = less prejudices. Okay, there’s plenty of examples where that’s true, but by no means always. George Orwell was educated at Eton, and went on to become one of the sharpest observers of injustice and the abuse of power in English literary history. Or there’s Joe Strummer, the son of a diplomat.

Sadly it can also be the case that some people subject to various oppressions can internalise the oppressor’s logic, and even applying it to their fellow oppressed. There isn’t a shortage of people on benefits who will tell you that there’s too many benefit scroungers in this country – though they’d frequently be mortified if someone suggested that they might be seen in the same way by others. Likewise, a while back I had a conversation with a Nigerian-born woman, and was surprised to discover that her views on immigration were well to the right of mine. She simply didn’t view herself as that sort of immigrant.

4. Privilege isn’t the only thing that affects prejudice.

Don’t get me wrong, I’m not saying privilege doesn’t affect prejudice. It can affect it a lot. But it’s not the only thing – what about your life experiences, the people you’ve met, your cultural background, the books (and blogs and Twitter feeds) that you’ve read? this is why I think it’s better to have a wider discussion about prejudice (of which privilege can be a part) rather than talking simply about privilege.

5. It talks at people rather than with people.

Laurie Penny insists that “check your privilege” is an invitation to listen rather than telling someone to shut up. That’s fine in principle, but having seen it used in various Twitter flame-wars, it’s clear that all too often it does get used as a shorthand for, “You are male/white/straight/cis/able-bodied therefore argument invalid.”

And even if it is used as an invitation to listen, is the other person also listening? I actually agree with Penny that social media is changing the way people communicate, but for slightly different reasons. Social media changes the old world of books and newspapers from one in which ideas are presented to the public, into one in which those ideas are co-created by people talking and listening with each other rather than at each other.

I’ve actually found blogs and Twitter to be powerful tools in challenging and reshaping my prejudices. I can hear about the lives of prisoners through @PrisonerBen or sex workers such as @itsjustahobby or @pastachips – two groups that tend to be talked about or to rather than with. Just recently I’ve been reading about the experience of having a gender identity that doesn’t fit into a binary male/female divide from @halfabear and @jaspergregory – a group that’s barely written about at all. But these people didn’t change my thinking through, “I’m going to tell you about your life and what you think”, which is what “check your privilege” does. They did so by saying, “I’d like to invite you to hear about my life and my thoughts.”

Ultimately, I don’t think people’s views are changed by simply tweeting “check your privilege” at each other, and in that sense it fails in its purpose. It doesn’t get the recipient to think differently. If anything, it’s the obsolete old media thinking of talking at people rather than with them. I think views are changed through civil constructive discourse where people tell each other about their own lives rather than presuming to tell someone else about theirs.

Intersectionality, Privilege and Twitter Etiquette

As the family therapy essay I’m currently procrastinating on would attest, I’m interested in group dynamics and the way people communicate with each other. I tend to think about these issues both in the real world and in social media, particularly Twitter. There’s lots of good and interesting ways that Twitter can be used for communications, but also some pitfalls. Chief of the latter is the Twitterstorm.

I used to presume, probably rather naively, that if someone is getting bombarded with angry messages from multiple tweeters, then they’ve probably done something pretty unpleasant to deserve it. All too often, that isn’t the case, particularly if somebody is spoiling for a fight.

Here’s the funny thing about Twitter. Where else would a single full stop be the source of enormous trouble? Quick technical primer for non-tweeters: if you start a tweet with somebody’s @ username, like this….

@thus_spake_z your mother was a hamster and your father smelt of elderberries!

….then it goes to them, and also appears in the feed of anyone who is following you both. However, if a tweet begins with text, then it appears in the feed of everyone who follows you. Hence people sometimes stick a full stop before the @ identity, like this:

.@thus_spake_z your mother was a hamster and your father smelt of elderberries!

….and so your caustic retort is re-broadcast to a much wider audience. If you have a large number of followers, then at least some of them will take that as an invitation to a pile-on.

There’s a certain segment of tweeters who seem to get embroiled in Twitterstorms on a fairly regular basis. Melissa Thompson has an excellent and detailed post about the discussions involved. To summarise briefly, those involved tend to identify with intersectional feminism, and also take an interest in questions of privilege.

Intersectionality discusses the way in which different systems of oppression – race, class, gender, sexuality etc – can interact, and calls for greater cooperation between various liberation movements. I think that’s a very worthy aim, and fully agree with it. It’s therefore a shame that the tweeters involved are so often involved in Twitterstorming other members of the left. Most recently it was the New Statesman editor Helen Lewis. Before that it was the Independent columnist Owen Jones, and on Lord knows how many occasions it’s been the author and Times columnist Caitlin Moran. All too frequently, these are over fairly minor issues of semantics. In Owen Jones’ case, it was because he condemned George Galloway’s rape apologism, but didn’t sufficiently emphasise the condemnation.

I guess this is why the right always wins.

Regarding the politics of privilege, I’d broadly agree that it’s good to think about how your relative advantages and disadvantages affect your thinking – but only up to a point. Privilege and oppression can affect people in various ways, and not always in a predictable way. For example, one might argue that George Orwell’s keen awareness of social inequality was at least partly because of rather than despite his Eton-educated privilege.

It also shouldn’t be used as an ad hominem retort.

“Thank you for aggressively tweeting at me to ‘check your privilege’. I appreciated that suggestion, which prompted me to engage in a bout of self-analysis and has enriched my awareness and insight.”

-No one. Ever.

It’s also important to remember that everyone has their own individual privileges and oppressions, not all of which may be immediately apparent. An online friend of mine was recently Twitterstormed over her perceived (though probably not actual) transphobia. Unfortunately one of her hidden oppressions was an anxiety disorder, and the Twitterstorm triggered a relapse.

I’m not going to get into the original reasons behind these various Twitterstorms – actually I think most of those reasons are monumentally banal. But what I am going to do is suggest a few etiquette points that might encourage people to debate in a more constructive way. If I were to get back to the family therapy essay that I really, really need to stop procrastinating on then this would be what’s referred to as “moving from content to process”. Which is a fancy way of saying that often it’s not what’s said that’s important, but the way it’s said.

1. Exercise caution before retweeting or deploying the Thermonuclear Full Stop. Just because you disagree with someone doesn’t mean you need to throw it open into a free-for-all. A discussion is not a gang fight.

2. Don’t presume to tell other people what their privileges are or aren’t. Particularly if you don’t know them offline.

3. Don’t use privilege as an ad hominem. “You are male/white/straight/cisgender/able-bodied, therefore argument invalid” is never an appropriate retort.

4. Remember that the ability to haul in large numbers of other people into the fray is itself a platform and a privilege.

5. If somebody blocks you, or makes their account private, or temporarily suspends their account, then respect the fact that they have the right to do so. Nobody is obliged to have a conversation with you.

6. Finally – and this is probably the most important point – be willing to accommodate difference and disagreement. This is particularly the case when discussing with people who are part of the same broad left. Outside of certain extremes, they’re mostly decent people who mostly share the same views and aims as you. That small part which they might think differently on is not as important as the larger common goals. You don’t have to agree with them on everything and they don’t have to agree with you. If you can do this, then that would be…..oh, what’s the word? Ah yes. Intersectional.

Should health professionals be anonymous or non-anonymous online?

This is a topic I’ve been thinking about for quite some time. Today, the General Medical Council announced that doctors should identify themselves on social media. To the best of my knowledge my own regulator, the Nursing and Midwifery Council, has not yet issued a similar rule. However, I wonder if this is an indicator of what other professions are also likely to do.

Professionals blog and tweet under pseudonyms for all kinds of reasons, and by no means all of these reasons are ominous. Ermintrude2 and Dr Grumble not only use their platforms appropriately and ethically; they also write extremely well and passionately. Some people just feel more comfortable under a pseudonym, and feel more able to speak frankly.

I’ve been Zarathustra on various blogs, and more recently on Twitter, over the years. I’ve grown quite fond of and attached to my online alter ego. Look at Zarathustra’s awesome moustache! I can’t actually grow a moustache in real life. Despite being a grown man any attempts turn into something resembling teenage bumfluff. I ask you, who wouldn’t want a tache like Zarathustra’s?

Over the years I’ve noticed attitudes to social media and healthcare steadily evolving. At first it was something of a free-for-all. I remember the anarchic days of NHS Blog Doctor, Dr Rant and Militant Medical Nurse. A lot of those early blogs were expletive-fuelled swearathons, with people yelling all kinds of earthy insults at NHS managers, at politicians and frequently each other. The language was of a variety that would have a fishwife telling people to tone it down a bit.

A lot of those blogs simply aren’t there any more. In some cases, I suspect it’s because people got into trouble. Some people found out the hard way that internet anonymity can be seriously overrated, especially in the long run. As behaviour on social media started to find its way into disciplinary hearings and fitness-for-practice investigations, the professional guidance became more detailed and suddenly everyone became incredibly anxious about social media. It became a demonic creature, waving a P45 in one hand and a letter from the NMC in the other.

That anxiety is still around, but I’ve also noticed a more mature set of thinking around social media starting to emerge. The Royal College of GPs’ Social Media Highway Code, and Victoria Betton and Victoria Tomlinson’s Social Media in Mental Health Practice give good examples of this new maturity. What these publications say is, remember your responsibilities to behave ethically, but also maintain a sense of playfulness to explore this evolving medium, and work out how it can be used as a force for good.

And there’s no doubt that social media can be a force for good. Last night I joined in the #mhnursechat on Twitter, which was on the subject of borderline personality disorder. This is a difficult topic, often laden with mutual suspicion on both sides. Patients with this condition are often regarded as “difficult” or “attention-seeking”. Professionals are accused of dismissing the suffering of people with BPD, and using it as a label to stigmatise and exclude rather than provide support.

The chat was joined not only by mental health nurses but also by a number of people with BPD. For an hour everybody talked openly, equally and respectfully. We talked about what the diagnosis means to people, what helps and what doesn’t help. The feedback from participants at the end spoke for itself.

“brilliant to be able to collaborate with mutual respect for each other, a wonderful experience”

“It was such a nice change to be included instead of being ignored and spoken over so to speak”

“brilliant to see and I am glad that patients welcomed in #mhnursechat not just professionals”

“What a brilliant & informative chat. Thank you all so much for joining in”

It reminded me of some comments by One in Four editor Mark Brown.

Social media, by its nature, puts together people who would never have met.  It creates strong public voices which didn’t get there through traditional routes.  It creates stories that appear from odd angles and at unexpected times.  It makes public issues of things that might once have remained behind closed doors.  It doesn’t let things stay where policy makers have traditionally put them.

It also creates a situation for mental health where it is less ‘them and us’ and more ‘just us’.    There is something hugely satisfying in seeing someone who offline would be seen as a ‘patient’ discussing online with someone who would be seen as an ‘expert’ and both learning from that experience.

Returning to the question of whether to blog and tweet anonymously or non-anonymously, there is the matter of accountability in all this. Ironically my recent Twitter run-in with Dr Christian Jessen has galvanised my thinking on this matter. I’ve been criticised for “calling out” Dr Jessen on his online statements. Personally I don’t think I’ve done anything wrong in that regard. I think he behaved disgracefully in an extremely public manner, and that I’m entitled to criticise that behaviour. But should I be hiding behind an anonymous ID to do so? If I’m confident in what I’m saying, shouldn’t I be willing to put my name to it, and if necessary defend it?

As well as being accountable, there’s also the matter of taking credit for what you’ve done well. There are pitfalls in social media, and if I’m honest with myself I think it’s fair to say I’ve made some mistakes along the way. But there’s also things I’m proud of, such as exposing the shocking lack of regulation in the psychotherapy industry. I’m also proud of helping create and maintain the regular This Week in Mentalists round-ups, in which bloggers take it in turns to tell us about their favourite online mental health writing. I’m proud of the #TwentalHealthAwards that I started this year.

So, I guess what I’m trying to say is this.

Hello. My name’s Philip Doré . Pleased to meet you.

Professionals, Patients and Social Media

Earlier this week I met up for a pint with Victoria Betton, author of the Digital Mental Health blog. This turned into quite an in-depth conversation about social media, and the way it’s used by people who work in or use mental health services. After we met I decided to jot down some of the thoughts and ideas we were bouncing about, and put them up in a blog post.

Where are the subversive professional blogs?

Victoria commented that apart from the Not So Big Society and The World of Mentalists, she hadn’t come across many subversive blogs run by professionals (or in the case of The World of Mentalists half-run by a professional, since I co-edit it with Pandora). I must confess that I was pleasantly surprised that either of those blogs would be considered subversive. Once I’d recovered from the unexpected compliment, I did find myself agreeing that a certain chill has set over the health blogging world – from the professional side anyway; the patient side is flourishing. I’m not saying there aren’t good-quality, subversive bloggers out there – look at Stuart Sorensen and the 20 Commandments for Mental Health Workers. Even so, when you look back to the spleen-venting polemics of NHS Blog Doctor, Dr Rant and Militant Medical Nurse, it’s hard not to feel that professionals are increasingly cautious about what they stick on a blog or a tweet. I’ve felt this myself, and I’ve noticed that there’s things I might have said online three or four years ago that nowadays I just wouldn’t say.

Don’t get wrong, I’m not suggesting we all go out and start swearblogging. There are, after all, good reasons why professionals are more cautious. When I first started blogging on the now-defunct Mental Nurse, there were no guidelines from regulators about social media. Then one day an article appeared in the NMC News, basically saying it’s okay to blog, so long as you don’t breach confidentiality or bring the nursing profession into disrepute (gratifyingly, they recommended Mental Nurse as a good example of how to blog). Then a paragraph or so of guidance was issued. That paragraph has become increasingly detailed, mainly in the wake of people getting into trouble at work through social media.

As a result, professionals are now nervous about blogging or tweeting. In many cases they’ve interpreted “be careful about how you engage with social media” as “don’t use it at all”, which in fact regulators like the NMC have made clear is not their suggestion.

Which professionals are using social media well?

Something I commented on, which Victoria seemed to agree on, is that of the various professional groups using social media, one that seems to do it particularly well are the police. This especially seems to be the case on Twitter, for reasons I’ve yet to fathom. Possibly it may be partly due to the institutional sense of humour of police officers, which seems to translate well into tweeting.

It also strikes me that Chief Constables seem to trust their officers with social media in a way that perhaps directors of NHS trusts and social services departments might not. Nightjack is an obvious exception to that, though in his case he allegedly had the misfortune to be utterly shafted by the Times, to make it look like he’d breached confidentiality when he hadn’t.

If anyone has any additional thoughts on why the police seem so good at tweeting, I’d be interested to hear them.

The Ascent of Twitter

I’ve noticed a change in my approach to social media. Previously I thought of myself as a blogger who has a Twitter feed to promote the blog. Increasingly I think of myself more as a tweeter who also runs a couple of blogs. Interestingly, when I mentioned this to Victoria she felt she’d undergone the same change. Conversations that might have taken place on the comments thread to a blog post will now be tweeted after reading the post.

This goes to show that social media is still evolving. Different platforms come and go (Goodbye Livejournal! Hello Tumblr!) The way we engage with it is also involving, and becoming more multi-platform in nature.

Anonymous versus Non-Anonymous

I’ve generally felt more comfortable expressing myself anonymously as a nurse. This isn’t just because of worries about something I might say causing trouble with my employer. There’s been times when stuff I’ve blogged about has led to individuals trying to make problems for me in meatspace.

I do also have a non-anonymous Twitter and blog. Victoria seemed surprised when I said that I’m actually more careful about what I say under my anonymous Zarathustra alter ego than my non-anonymous one. I think the difference is that as Zarathustra I self-identity as a nurse, whereas the other identity is just me being me. So, if I want to say, retweet a rude joke, I’d do it non-anonymously, but also non-professionally.

Might professional cautiousness swing the other way?

As I said that at the beginning of this posts, some professionals are starting to avoid social media. I’m wondering if the trend might reverse. Just recently in the wake of the Twitter Joke Trial fiasco, the Crown Prosecution Service has issued statements suggesting they’re rethinking the extent to which they prosecute people for what they say online. In the case of the Twitter joke, they caused a man to lose his job, and squandered large sums of public money for something that was monumentally trivial. Their recent statements suggest they now recognise a need for balance to protect free speech.

If the CPS are starting to backpedal, and realise that they don’t need to run around prosecuting left, right and centre every time someone says something stupid on Twitter, perhaps that might lead to a climate in which people might become more comfortable in communicating online. I don’t dispute the need for social networking guidelines from bodies like the NMC, but I think it’s also important to recognise that professionals can use social media to communicate in a responsible, ethical and at times slightly subversive way. When they do, good things can come out of that.

L’Affaire Littlefeet: Social Media and Inpatient Care

There’s been some debate sparked off by the Chaos and Control blog, which suddenly went private in the same week that it won Best PTSD/Extreme Stress Blog in the TWIM Awards. The author, Littlefeet, has since gone public again to announce the closure of her blog, and the reasons why.

I won’t bore you with the long story but the short story is that I was readmitted to hospital on 28 December and discharged today (3 January). On 29 December, I was notified by staff that my blog had come to their attention. Staff read through the archives and my phone was confiscated for 24 hours. I made a verbal agreement with staff that I would not blog while I was in hospital. Given that I wasn’t blogging about other patients and when specific staff were mentioned, they were anonymised, I felt this approach a bit heavy-handed. However, their argument was that patients who were more unwell than me could blog anything, regardless of the truth.

All of which begs the question: is it okay for patients on mental health wards to write blogs? And is it okay for the wards to stop them?
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