What’s in a Word? Patients, Clients, Service Users…

Part of my job is to mentor student nurses. This week I had a look at the recently-revised competency portfolio that the students have to bring on placement. This is a hefty document about the size of the Yellow Pages, which lists all the skills students have to learn with me, and which I need to sign off to say they’ve learned. It’s very detailed and long, with a dizzying array of competencies in it. I’d challenge anyone who thinks a nursing degree is an easy option to read through it and then say so. However, there was one thing that struck me about the competencies.

They didn’t make a single use of the word “patient”.

Don’t get me wrong, it isn’t that the competencies weren’t aware that nurses work with people, but they were constantly referred to as “service users” and “clients”. The word “patient” was conspicuous by its absence. Apparently nurses don’t have patients.

There seems to be a view out there in mental health that “service user” and “client” are good and “patient” is bad. I don’t buy it. I’m not saying there aren’t people who don’t like being called patients, but I’ve also come across people with mental health problems who loathe being called service users or clients. Besides, anyone who’s ever been to the dentist is technically a patient.

The wording on the student competencies is particularly ironic because I work in Wales. Recently the Welsh Assembly Goverment passed the Mental Health Measure, a very progressive piece of legislation that enshrines certain rights for people receiving a mental health service into Welsh law. It gives, for example, the right to have a care and treatment plan that’s formed collaboratively between patients and staff, and a right for people who’ve been in secondary care to self-refer back to services. It’s a very good piece of law aimed at putting the person using the service at its centre. Even so, the term used in Mental Health Measure documentation is “relevant patient” not client or service user.

I suspect there isn’t a “right” or “wrong” answer when it comes to whether one should use patient, client or service user. It all depends not only on what those words mean, but also what people take them to mean. For example, when we talk about “health” some people would take that to mean a fairly narrow, medical model of diagnosis and treatment. However, if you go by the World Health Organisation’s definition of health

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

….then that’s a much broader concept.

It’s also worth pointing out that the meanings of words can be changed, often due to a conscious effort by those to whom they apply. A good example of this comes from the recent #mentalpatient furore that erupted on Twitter and into the mainstream news. The Asda website was discovered to have a “mental patient” fancy dress costume (which Asda has since removed and apologised for) on its online store.

 

The response of various Twitter users was to post pictures of themselves in their own “mental patient costumes.”

As well as patient, client and service user, the term “expert by lived experience” has also been bandied about in mental health debates. I recently asked Twitter users what they thought of this particular wording, and got a high number of responses which I’ve Storified here. The answers varied wildly. Some loved it, some hated it, and quite a few people gave nuanced answers somewhere in between.

I’m not sure that I have an opinion as to which is the “right” wording to use (and as I’ve said, I’m convinced there even is a right answer). I’d hope that whatever wording is used, people are treated with dignity, respect and in a collaborative way that upholds their rights and wishes.

 

 

 

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The Rules of Calling Out

Seen people “calling out” other people on Twitter over their use of language? Want to get into it yourself? Here’s a cut-out-and-keep set of guidelines to help you get started.

1. The greatest enemies of the left are those who agree with you on 95% of issues, but use minor semantic differences

2. Calling out must be done in the most public way possible. E-mail is an instrument of patriarchy

3. Nobody on the left should ever have a “large platform”. Better to cede public discourse to the right.

4. Everyone who disagrees with you is privileged. You know this because you’ve never met them.

5. Nobody who is privileged could also be right about something. The two are mutually exclusive.

6. Under no circumstances is it acceptable to agree with Caitlin Moran about anything.

7. In order to be intersectional and show your alliances with others you must have screaming rows with them every 5 minutes.

8. The ability to muster a large crowd to bellow someone into submission is in no way a platform or privilege.

9. Caitlin Moran posting a subsequently-retracted un-PC tweet three years ago is definitely worth devoting more time and energy to condemning  than recent rape and bomb threats.

 

[This post is based on a sequence of tweets I posted facetiously last night. In a classic case of Poe’s Law, some people thought I was being serious, so for clarity I will state here that this post is satirical. On a serious note, I think disagreement and debate are good, but allies should do so respectfully and civilly rather than by Twitterstorming each other.]

More Trouble with Dr Jessen

A few weeks ago I blogged about getting twitterstormed by Dr Christian Jessen, presenter of the TV shows Embarrassing Bodies and Supersize vs Superskinny, after I asked him to be a bit more polite when talking to an eating disorder survivor. One problem with Twitter is the way a one-on-one argument can quickly be turned into a public affair simply by retweeting or by sticking text in front of somebody’s @ ID, thereby inviting any passerby to pile-in.

If the tweeter involved has a large following, then this can turn into a deluge of abusive messages. This happened yesterday when a famous comedian made an ill-advised joke about self-harm. Somebody with a history of self-harm sent him an angry tweet in response to this. He then responded in turn by retweeting her, with the result that she then received a stream of hostile tweets from his fans that lasted for 11 hours. To be fair to the comedian, she did swear at him, and he did later un-retweet her and ask his fans to stop, but by then the damage was done.

It’s a particularly rum business when this sort of thing involves health professionals. The various regulators (e.g. General Medical Council, Nursing and Midwifery Council etc) have made it clear they expect professionals to behave themselves on social media, and I’m sure bombarding people with abuse is something they expect us not to do.

A couple of weeks after I had my own run-in with Dr Jessen, it seems another Twitter user took issue with his online behaviour.

jessena

One thing that tends to come with a large Twitter following is a fair amount of grief from people lining up to have a go at someone, and if would be fair to say that Dr Jessen is no exception to that. However, it’s also fair to say that the person here was being strongly critical, but not abusive or insulting.

So, how did Dr Jessen respond?

jessenb

Yep, he reposted her message with “UTTER ROT” before it, thereby rebroadcasting it to his 236,000 followers. To put that into perspective, the daily circulation of the Guardian is 204,000. In old media terms, this would be the equivalent of sticking someone’s comments in a national newspaper with a comment of, “Look what this person said about me!” and putting their phone number at the end.

The result, predictably, was that she got several hours of abuse from Dr Jessen’s fans.  This seems to be something of a habit for him.

jessenc

What does the GMC social media guidance say?

You must not bully, harass or make gratuitous, unsubstantiated or unsustainable comments about individuals online.

jessend

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.

Twitter Drama Bingo

Those of you who follow me on Twitter (@thus_spake_z if you’re interested) may have noticed me compiling a Twitter Drama Bingo card. I had too much fun doing it not to share it here.

EDIT: Following feedback from others, I’ve now expanded it to a 6×5 grid, which is bingo fans will note is slightly larger than the tradional 5×5 bingo card. I’ve also added a free space.

TwitDramBingo

 

Feminism, The Left and Unnecessary Twitter Feuds

Recently I blogged about an unfortunate tendency within the online feminist movement to engage in Judean Peoples Front-style feuding, particularly on Twitter. Yesterday that exploded in spectacular fashion. On my lunchbreak from work I checked my Twitter feed to discover that the left-wing Independent columnist Owen Jones and the feminist blogger Zoe Stavri were having an argument. From scrolling back, it became clear that they’d been arguing all morning. When I got home from work that evening, they were still arguing. Not only that, but various left-wing and feminist tweeters were piling in, and things were getting more and more heated. Oh good grief, it just went on and on and on and on

What on earth produced such a vitriolic and lengthy row? Sadly, the answer is depressingly trivial and pointless.

A couple of days ago, Stavri tweeted this.

stavvers

The article by Jones is online here. His argument is that George Galloway is an often-unpleasant character, but has a talent for winning over audiences, and that the left should learn from his communication style.

Despite what Stavri suggests, Jones does call out Galloway’s rape apologism and much else besides. In fact he does so in the first paragraph.

He was mocked for a largely disastrous appearance on Celebrity Big Brother. He has made unacceptable comments about rape – “not everybody needs to be asked prior to each insertion” – that repulsed virtually everybody. He has made apparently sympathetic remarks about brutal dictators (although, unlike some of his detractors, he hasn’t sold them arms, funded them or even been paid by them).

Jones concludes:

Gorgeous George is one of the most charismatic politicians of our time, but also one of the most divisive, and still manages to win over the audience. You don’t have to like him; but, if you want to change the world, you do have to learn from him.

I’ll state my own views on George Galloway. I don’t like him. For all his populist hero-of-the-left image, I’ve always got the impression that his main overriding ideology is himself.  There’s plenty to dislike – his aggressive and at times litigious approach towards his critics. His former support for the old Soviet Union. His periodical sucking-up to dictators and demagogues.

And of course, there’s his utterly revolting comments about rape, which were thoroughly condemned and rightly so. I hope this goes without saying, but I also condemn them.

Personally, I’m not sure that I agree with Jones that Galloway is charismatic. Some people seem impressed by him, but personally I’ve always found that his communication style reminds me of Swiss Toni from the Fast Show.

Jones responded to Stavri.

Jones

And so it continued. Take a look at the Twitter thread. It just doesn’t stop! In fact, the whole row continued for over two days. Jones tetchily insisted that he had condemned Galloway’s comments, while Stavri and various other feminists more and more stridently claimed that he hadn’t condemned it enough.

The whole thing escalated into something more akin to a Twitter-wide slanging match than a debate between putative allies. At one point I rather cheekily decided to respond by tweeting my joke “Generic Condemnation of This Thing That Person Said on Twitter” blog post. Within minutes I received a tweet asking whether I, as a mental health nurse, would be flippant when talking to a rape survivor.

The NMC social networking guidelines require me to uphold the reputation of my profession when blogging, so I can’t repeat the language that went through my head when I read that. Suffice it to say that as someone who works regularly with young people who have been abused, I took it as an appalling and uncalled-for slur on my character.

At this point it would be tempting to declare both sides as bad as each other, and admonishing the whole of the left and feminist Twitterati to Go To Your Respective Rooms And Have A Think About What You’ve Done. But I don’t actually think both sides were as bad as each other. The various feminist tweeters rushed to form a twitchfork mob not because of what Jones did or didn’t say, but because they felt he didn’t sufficiently emphasise something. As a result they created a totally unnecessary feud.

The depressing thing about all this is, most of the time tweeters like @stavvers, @sazza_jay et al have good and worthwhile things to say. I agree with them more often than I disagree, and I consider myself instinctively sympathetic to feminism. I suspect this post may get dismissed as “mansplaining” but I spoke to women who self-identify as feminists who were equally dismayed by the exchange.

Personally I am, to use a tagline that Stavri uses regularly, not angry just disappointed.

Ultimately, who does this sort of pointless feuding benefit? It certainly doesn’t benefit either the left or feminism.

 

In praise of Sally Bercow

The wife of the Commons speaker is not normally someone who I’d go out of my way to admire. When she appeared on Celebrity Big Brother she struck me as somewhat vain and publicity-seeking. She’s also a former member of the Oxford University Conservative Association, a group that I’ve been gleefully sarcastic about in the past.

Even so, the news that she’s refused to settle in the matter of Lord McAlpine vs The Internet suggest the actions of someone with a lot of gumption. Libel cases can run into costs of £100,000 without even reaching court. Simply fighting the case (never mind losing it) can financially ruin all but the considerably wealthy.

Over the past month a lot of rubbish has been talked about the supposed evils of Twitter and other new media. This conveniently forgets that the original allegation was made in old media, and on usually-trustworthy Newsnight. The tweeters simply discovered that Newsnight was referring to accusations that had previously circulated, and correctly identified who they were talking about. Unfortunately, the Newsnight report then turned out to be inaccurate.

I can appreciate that Lord McAlpine must have experienced an extremely distressing week, but it’s also important to remember that he was not only generously financially compensated by the BBC and ITV. He was also quickly vindicated. The entire world now knows that Lord McAlpine is not a paedophile.

But more importantly, McAlpine’s subsequent legal action is one that could set a hugely dangerous precedent. That large numbers of people could be pursued and financially ruined for briefly and non-maliciously discussing the TV news. Those who’ve cheered on his pursuit of 10,000 people simply haven’t thought about the consequences.

News about his mass action against tweeters seems to have gone a bit quiet lately, but a few weeks ago these claims were circulated, suggesting that Twitter was simply refusing to hand over personal information to Lord McAlpine’s lawyers without 10,000 court orders, and that overtures to the police were being met with a bland “not a police matter”. I have to add some words of caution here in that these claims are unsourced, and if we should have learned anything recently, it’s not to believe everything that’s tweeted. Even so, it seems hard to imagine that any demand to Twitter that 10,000 sets of personal details be disclosed en masse would be met with anything other than a referral to the reply given in Arkell v Pressdram.

According to news reports, Lord McAlpine is demanding £50,000 and an apology from Sally Bercow. Given that Mrs Bercow has already publicly apologised, it seems likely that the sticking point on settlement may well be the matter of fifty thousand quid. And since, Mrs Bercow has indicated that she’ll meet him in court, what is her defence likely to be?

A quick disclaimer here. I’m not a lawyer, and I’m therefore not qualified to parse the following suggestions. For that reason the next few paragraphs should be treated as speculation and not as legal advice.

This blogger claims to have already obtained some legal opinions on any possible defence.

“The McAlpine case is weak on three grounds. First, the evidence that his reputation was maligned by contemporary tweeting is flakey, given the pre-existence of internet rumours going back a long way; second, suing individual tweeters for £500 could easily be construed by a Judge as a ridiculous not to say greedy valuation to put on one quite possibly neutral enquiry of others; and third, singling out Twitter alone is preposterous in the context of a multivariate world of online social networking. You have Facebook, Linkedin, blog threads and a dozen other equally effective ways of innocently transmitting speculation – up to and including word of mouth gossip in the office. To set a precedent in favour of civil prosecutions against mass opinion and gossip would be ridiculous. Further, we suspect that any higher Court (especially one within the EU’s legal framework) if faced with an appeal against any judgement favouring such a view would overturn the verdict without exception.”

‘The issue of intent is much murkier with regard to mentioning someone’s name on Twitter – especially if Mr X’s guilt or innocence in relation to the media expose was inconclusive at the time. Twitter users were simply commenting in real-time on what they were seeing, without any premeditated malicious intent,’ remarks another online source.

Meanwhile the political journalist Michael Crick has said that there’s another objection which will be raised by Bercow’s lawyers. Even in the worst libel cases, the maximum damages are usually around £220,000. Lord McAlpine has already received £310,000 from the BBC and ITV. Adding another £50,000 to the pile starts to look, well, a bit greedy.

The false accusations against Lord McAlpine were unfortunate, and they do show some of the potential pitfalls of social media. However, they also show the way in which our draconian libel laws can be used as a weapon by the rich and powerful against everyone else. This is why libel reform needs to happen as a matter of urgency. In the meantime, hats off to Sally Bercow for deciding to stand and fight.