Sunday, 25 November 2012

Rape And Responsibility [Trigger Warning]

In today’s Mail on Sunday, Mariella Frostrup’s column focuses on a report prepared by Deputy Children’s Commissioner, Sue Berelowitz. The report, entitled Child Sexual Exploitation in Gangs and Groups, was released last week and describes the number of girls forced into sexual activity by gang members. In response to the report, which is no doubt truly disturbing reading, she argues, “we need a Man Army determined to change cultural stereotypes, full of blokes that boys revere – footballers, musicians, actors and even Top Gear presenters (not normally short of opinions) – saying, loud and proud, that rape is for cowards, child abuse is despicable and treating girls like pieces of meat is simply unacceptable.”

Frostrup presumes that men can be immunised against committing rape by seeing anti-assault messages from men they respect and admire, an approach that suggests that men commit rape because they believe it’s somehow acceptable. She is sorely mistaken – men commit rape precisely because they know it is not acceptable. The power imbalance implied by the act, the misuse and subjugation of a victim by that assault, is very often the entire focus of the act.

For rapists of this type, rape is rarely about sex or the lack of it; it’s about power and domination, control and shame. It’s about telling a person that they mean so little that they can be used in whichever way their attacker chooses. Sexual assault, like domestic violence and emotional abuse, is a way to dehumanise someone; their aggressor shows them that they have so little power that they cannot prevent their own mistreatment. They become, as the article suggests, a piece of meat, lacking agency and control – the shock of rape emanates as much from the complete denigration of the victim’s personality and humanity as it does from any violent physical act.
There is, of course, another type of rapist – one who misreads signals, assumes consent where none has been given, or fails to notice that his partner has lost interest in continuing. These men are not psychopaths, nor do they necessarily set out to cause harm, but the effect on their partner can be no less powerful. Some of these men notice their partners’ waning interest and stop in good time, some never notice and so continue, and some notice and make a conscious choice to keep going.

Some months ago, a discussion on Reddit emerged that allegedly contained contributions from men who had committed rape. Most were from young men who took a previously consensual act too far; few seemed to exhibit the psychopathic aggression we’re led to expect – perhaps these men were present but declined to post, understanding the negative reaction they’d receive. All those who posted were aware of what they’d done, and many knew they were committing rape when they were still in the moment of committing it. The following quotes are taken directly from the discussion, and seem to make little effort to excuse the acts of each correspondent.

I ignored her and did it. She realized what was happening and tried to clamp her legs shut, but it was too late and I was much stronger than her.”

“My hormones were going insane, I didn't have any empathy in my heart at that moment just my own concerns. She wasn't a person anymore just a path, a tool, a means to an end. Then once again, I can't remember. I don't remember what happened, I never asked her. I almost don't want to know. But I know I got off. I hate to say it but after it was done I went to bed, she stayed up crying. It wasn't until two days later that I realized I had done something awful.”

 “Most girls don't really understand how horny guys are, how much stronger guys are, how guys will rationalize what they do. I see feminists and women on the Internet saying that no means no and women should be able to get as drunk as they want and not be sexually assaulted, and I couldn't agree more. But the reality of the situation is that women have to be careful because guys are one way when they're hanging out and another way when they're horny or worse drunk and horny.”

“My rapist (ex's best friend) told me he knew it was wrong, but would have probably done it again given the chance. He also was surprised that forced sex didn't make me want to be his girlfriend.”

A further objection can be raised to Frostrup’s assertion that perpetrators of rape and sexual assault “steal their [victims’] innocence and their futures”. In recent decades, the feminist movement has made efforts to transform the perception of the raped woman from ‘victim’ to 'survivor’ – a semantic shift, but one that can make a powerful difference to the way a woman experiences the time following her assault. Tell her that her life is ruined and she may well believe you, but tell her she can recover and you give her the power to overcome the experience; it’s not difficult to imagine which is the better impression to give someone in that position.

The kind of person inclined to commit rape for power will not be swayed by the words of a TV presenter or a football player, particularly words that have been put in their mouths by well-meaning authority. When one person decides to violently assault another, logic and government-sponsored messages play no part in the thought process. The kind of person who commits rape through misreading signals is unlikely to consider such advice in the heat of the moment; how can they, if they don’t realise they’re doing anything wrong?

Rapists commit rape for various reasons, none of which excuse the trauma they inflict upon their victim. Some do so to intimidate or punish, to inflict fear and denigrate their victim. Some do so because they misread signals or inaction from their partners, some do so because they simply don’t respect their partner’s wishes enough to stop. None of these situations can be remedied by a public service announcement or advertising campaign.
Rape is a cultural problem, but one that occurs in all cultures and throughout history. It’s not the job of public figures to tackle it with good intentions and a public service announcement; instead it’s the job of parents, teachers, sex educators, and then the media. From films like Grease onwards, certain media products have positioned men as pursuer and women as the person who must exercise control and resistance; through these stories, we normalise sexually threatening behaviour. Young women come to expect and tolerate it, and young men feel they are excused to act as their hormones allegedly dictate.

To lower rape statistics, we much challenge the culture that excuses male sexual aggression and tells women that they must take sole responsibility for their own safety. We must abandon the macho culture that places to much emphasis on sexual experience, and instil a sense of respect and consideration for one’s sexual partners. It’s a difficult task, given the extent to which modern life is permeated with messages about sexual behaviour, but it can be done. We must start at the beginning and maintain a consistent message, and in doing so we can ensure that another generation of young women aren’t exposed to the same fear and exploitation as the ones that go before them.

Saturday, 24 November 2012

How We Failed Savita Halappanavar

On October 21st, Savita Halappanavar walked into Galway University Hospital complaining of severe back pain. A week later she was dead, fallen victim to septicaemia and e. coli. But Savita could have lived had she been offered one simple and common medical procedure – termination of a failing pregnancy.

When Savita was examined upon admission to the hospital, she was found to be miscarrying, but doctors could still detect a foetal heartbeat. For this reason, she was denied the termination – Ireland’s strict abortion laws forbid the procedure unless the mother’s life is in imminent danger. Instead, she was left to endure the pain and sorrow of a miscarriage, refused the option of inducing labour to hasten the process.

The distress of the experience, prolonged by those who doubtless wished they could help her, is unimaginable to someone that hasn’t experienced it. Savita’s husband, Parveen, said that she dealt with the situation well, even discussing trying for another baby. Savita seemed determined not to let the experience ruin her life; instead, it ended it.

The doctors and nurses who cared for Savita surely saw how she suffered; even though they must have been wracked with compassion and remorse, an unclear law said they could not help her. Whatever their personal politics and morals, regardless of their religious position or Hippocratic oath to protect life, they were compelled to manage and oversee the death of a young woman that they could otherwise have saved.

Savita's foetus was not viable, there was no hope of survival; instead of working to save one life, her doctors were forced to witness the end of two. They will have worked to combat the septicaemia that is believed to have killed her; they will have tried to keep her liver and kidneys healthy and functioning for as long as they could. But the awful truth is that one procedure could have obviated the need for all of that, and she was denied it - not by her doctors, but by the law.

Had Savita refused a termination, we could respect the decision that she had made, assured that she had her reasons for doing so. Had her doctors performed the procedure, there would be no news story; Savita and Parveen could have returned home and slowly come to terms with their loss. Instead, Parveen has lost not just his wife and his child, but his hopes and dreams for the future; everything he thought his life would become has been taken from him because of cruel and unsympathetic legislation.

Ireland's legal position on abortion is well-known; a historic cause for concern. For generations, girls and women have been forced to scrape together all the money they could and travel to England in secrecy - once by ferry into Liverpool, now by Ryanair and Easyjet flights into Heathrow and Luton. We cannot know their stories, but we may be assured that every one was different: some were young girls in the first flush of love who hadn't expected to conceive, some were victims of rape who now faced an additional burden of Catholic guilt to add to their trauma, some were women whose physical and mental ill-health meant that the strain of carrying a baby was an unthinkable challenge.

Thousands of men and women have marched in London, Dublin, and New York in Savita’s name. Across India, political and journalistic voices have been raised, questioning the Irish system. Savita’s parents and her husband have challenged the Irish authorities to explain why an Indian Hindu should be killed by a law intended for Irish Catholics – they have yet to receive an answer.

No-one who claims to respect the sanctity of human life could pardon this unpardonable offence. Anyone who believes that Savita's death was justified and that Irish law is correct has no right to call themselves pro-life; they are pro-foetus, no more and no less. We have permitted a religious position to influence the state, and by doing so ensured that a Christian moral has killed a Hindu woman. If we do not insist on the reassessment and abolition of this murderous legislation, we lose our claim to humanity and empathy.

It would be easy for us as atheists to exploit Savita's death to serve our own moral argument; we must resist the urge to do so. As feminists, we could hold her experience up as damning evidence of the sheer ignorance and foolhardiness of the pro-life movement; we must not. We must instead act in Savita's memory to ensure that this miserable, barbaric chain of events never befalls another woman.

Thursday, 8 November 2012

Perfume, Professionalism And The Perfect Gentleman

This week, I’ve mostly been deciding whether my body is a weapon or a vessel, and whether I’m more devoted to integrity or the drive for success. Like most people, the flesh-and-bone part of me seems to be there to extract energy from food and move me around; it’s not until something goes wrong with it, or until I’m surprised by someone’s reaction to it, that I really even notice it’s there.
As usual, this self-discovery trip has been prompted by a couple of incidents; goatish comments from a trusted advisor, the realisation that I perform better in job interviews when one of the interviewers is a man, and being approached and sniffed at uncomfortably close range in a supermarket by a stranger who was apparently so intrigued by my new perfume that he was willing to risk (and return) an aggressive reaction from both me and my fiancé.
We confronted him angrily and, despite the presence of his young son, he became abusive and threatened us. Plainly he felt it was reasonable to place his own face six inches from the face and neck of a temporarily unaccompanied woman, inhale deeply, and tell her she smelt good, and that she should “cheer up” when she looked perturbed; we disagreed. He eventually went away; I doubt my concerns will be so obliging.
I’m currently in the process of taking on freelance writing work, with the help of a self-employment advisor on a Government-mandated employment program. When discussing the necessity of approaching publications and pitching articles - an intimidating but necessary part of the process - various people have suggested using my gender, “attributes” and “engaging personality” to “intrigue” editors; essentially, flirting my way into a job.
I remain incredulous. I’m not Samantha Brick; I’m simply not confident enough in my own looks and personality to try that. When I look into a mirror I see my father, and he’s overweight and bald with a face like that of a veteran scrum-half. Besides which, even if I looked like Angelina Jolie, shouldn’t a good feminist be outraged by the very suggestion?
This is, at its heart, an entirely sexist issue: male colleagues are not forced to make the same decision. I’ve worked for male managers who flirted remorselessly with contacts of both genders, and for female managers who dispensed with sparkle and charm and got by on talent and professionalism alone, but it’s easy to understand that women surely spend more time agonising over their professional appearance. We must also consider if this approach confers an unfair advantage to attractive colleagues – an anecdote tells of a man who hired pretty girls to work in his office, “because they cost the same as plain ones.”
We know shouldn’t happen, but we know beyond a doubt that it does. It’s just another dubious journalistic practice, and it carries over into other trades too. The approach is likely to be of limited use against female editors; not only is it unlikely to work against them, it will also prove utterly transparent to a woman who has at some point faced the same decision. That said, it’ll prove transparent to anyone, male or female, who is shrewd and perceptive enough to have made it to the top of their industry. A good journalist can read people, break down pretences, and identify dodgy motives in a heartbeat – there’s no way a self-consciously flirty woman in a too-low sweater is going to get past them. Editors will notice it, and colleagues will surely resent it.
This isn’t a problem of my own creation; left to my own devices, I’d make the same effort when I meet with people as I do on any other day, the self-defined minimum appropriate degree of care and attention. The conundrum is thrown up by other people’s reactions to me, not my own opinion of myself. This is another point, one of many, at which I have to decide what kind of person I am. Can I really adopt this approach? Does it devalue my education and skills? What does it say about my feminist principles? Could I – or anyone else – respect a career based on titillating middle-aged men in positions of power? Can I be confident of the integrity I thought I had, or am I as motivated by money and success as the people I thought I stood against?

Sunday, 4 November 2012

Romney, Republicans, And Rape

Ladies and gentleman, welcome to the uterus. A number of important and complex things happen here, and each of us owes our existence to this useful and multi-talented organ.

You've seen one before, of course, and understand what it spends its time doing. Of course, depending on our biology and education, some of us have a better idea than others of its purpose and function. Women, for instance, will understand it, perhaps, as something they don't have cause to consider unless something unusual happens there. Some men may think that it transforms the normally placid and genial women in their lives into raging hellbeasts with no grasp of logic or reason - indeed, some women may agree with them. But if you're a male Republican politician in the United States, you may believe that it's equipped with a top-of-the-range security system to repel invaders, or that it's an item that women aren't responsible enough to control independently and so must be marshalled and regulated by legislation.

If you are a Republican who subscribes to this school of thought, there's an excellent chance you've already shared your profound insight with the rest of us. Below, with the assistance of many of righteously angry bloggers and commentators, I present a list of some of the most  ignorant and insensitive statements ever to issue forth from Republican mouths.

  • Todd Akin: “If it’s a legitimate rape, the female body has ways of shutting that whole thing down” - 2012 Senate Campaign 
  • Clayton Williams: “If it’s inevitable, just relax and enjoy it” - 1990
  • Chuck Winder: “I would hope that when a woman goes in to a physician with a rape issue, that physician will indeed ask her about perhaps her marriage, was this pregnancy caused by normal relations in a marriage or was it truly caused by a rape. I assume that’s part of the counseling that goes on.” - March 2012 
  • Ken Buck: “A jury could very well conclude that this is a case of buyer’s remorse … It appears to me … you invited him over… the appearance is of consent.” - October 2010 
  • Rick Santorum: “I think the right approach is to accept this horribly created — in the sense of rape — but nevertheless a gift in a very broken way, the gift of human life, and accept what God has given to you… rape victims should make the best of a bad situation.” - January 2012
  • Richard Mourdock: "I struggled with it myself for a long time, but I came to realize that life is that gift from God. And, I think, even when life begins in that horrible situation of rape, that it is something that God intended to happened." - 2012
  • North Carolina state Rep. Henry Aldridge: “The facts show that people who are raped — who are truly raped — the juices don’t flow, the body functions don’t work and they don’t get pregnant. Medical authorities agree that this is a rarity, if ever … to get pregnant, it takes a little cooperation. And there ain’t much cooperation in a rape.” - 1995
  • Delaware state Rep. Stephen Freind: “The odds that a woman who is raped will get pregnant are one in millions and millions and millions […] The traumatic experience of rape causes a woman to secrete a certain secretion that tends to kill sperm.” - 1988
  • Dr. Richard Dobbins, 20-year GOP contributor: “Most women either are not fertile during assault or do not become pregnant because the trauma prompts a hormonal response that prevents ovulation.” - 2006
  • Judge James Leon Holmes, Bush appointee - “Concern for rape victims is a red herring because conceptions from rape occur with approximately the same frequency as snowfall in Miami.”

I don't even know where to begin addressing these, and I'm frankly disgusted that I should have to. If a British politician said something so crass, so ignorant, so entirely devoid of fact, he would be seeking new employment within days. In May this year, Justice Secretary Ken Clark was broadly castigated for making a reference to "serious rape" (which he later clarified as "forcible rape... with a bit of violence") - in response, his party were urged to sack him, and he will surely struggle to escape the contempt his comments provoked. Beyond a considerable online outcry, few of the men (and it is usually men, isn't it?) quoted above experienced any censure.

America, you can do something about this. You can prevent repeated challenges to Roe vs Wade. You can halt the decay of women's hard-earned rights. You can protect other countries from following you into disaster; your decision, and the political moves that result from it, will affect people the world over. You have a chance to stop this aggressive ignorance from spreading, and you can achieve it simply making an 'X' in a box. America, it's time to make the right decision.

Saturday, 3 November 2012

Assisted Suicide: A Debate

This article first appeared on in April 2012. We reprint it here, entirely unabridged, to mark 10 years since the Dignitas clinic in Switzerland first opened its doors. With thanks to Dancing Giraffe and Peter McAllister, my collaborator and anti-AS opposite number on this piece.

Since this article was published, campaigner Tony Nicklinson has passed away. We have chosen to leave the article intact as a respectful tribute to the discussion that Mr. Nicklinson's efforts produced.

In March 2012, Tony Nicklinson approached the High Court seeking leave to pursue a clarification of the law surrounding assisted suicide. Mr Nicklinson had a massive stroke in 2005 while on holiday in Greece and was left paralysed save for slight movements of his head and eyes – a condition known as locked-in syndrome. His mind is unaffected and he is entirely conscious, but unable to move or communicate.

Since the stroke, Mr Nicklinson has been able to communicate only by using a voice synthesiser that interprets his blinking. When approached for comment following his appeal to the legal system, he has stated that he wishes the doctors in Athens had not saved his life. He described his current existence as, “dull, miserable, demeaning, undignified and intolerable”. The UK legal system is by now well-accustomed to such challenges.

In 2009, Debbie Purdy went through the courts in an effort to discover whether her husband would face prosecution if he accompanied her to a clinic such as Dignitas. The House of Lords agreed that it was a breach of her human rights not to know, particularly since this information was likely to play a large part in choosing when and how to end her life. The BBC reports the case of Tony Bland: “crushed in the Hillsborough disaster [...] allowed to die through the withdrawal of feeding tubes. He was in a persistent vegetative state after suffering severe brain damage and the judges said that it was in his best interests to be allowed to die.”
Yet despite these legal successes, and no shortage of discussion in debate amongst medical professionals and within the national press, little actual legal change has been effected. The consultation process for any change in the law is likely to be lengthy and complex, as befits such a weighty issue. Any change in the law, even a relatively minor one, will doubtless alter our society; our attitudes to disability will affect and be affected by the eventual outcome. To investigate the issue further, Peter McAllister and Christie Louise Tucker present a debate of the issues at hand.

Argument Against Assisted Suicide

Firstly I would like to make it clear, I am not an apologist for antediluvian values, nor is this a polemic discourse on the dangers to spirituality of assisted suicide. My intentions are as much a deep-seated personalisation as they are borne of any religious conviction. I do concede, however that religion has played its part in my disagreements to assisted suicide and indeed suicide, but not exclusively.
One of the most ardent opponents to assisted suicide is the Christian Faith. Suicide of any form is morally wrong because, having given life; God is the only one who has the right to take it away. The Fifth Commandment, 'Thou shalt not kill' (Exodus 20, verse 13), makes the point quite unequivocally. I have always found this particular Commandment non-negotiable.

There are arguments raising the point about serious concerns in legislating assisted suicide due to unsavoury family members and shifty doctors who would rather persuade a person to end their life, against the person’s will. Are there selfish reasons involved from particular family members? Do they stand to gain financially? Surely their motives are not borne out of a selfless empathy?
In free will there is another potential problem, that of capacity. Is the person contemplating assisted suicide competent to make such a decision? Are the drugs that people take for pain relief compromising their ability to make clear decisions? From experience, yes this is a factor. Psychiatric conditions may make someone desire suicide. Conditions such as Depression and Schizophrenia disorder can go undiagnosed; people who suffer such disorders could in fact choose to be unnecessarily supported to take their own lives?

Many people fear that assisted suicide will create a climate in which some people are pressured into it. The old, the poor, or minorities and other vulnerable groups might be persuaded to shorten their lives, rather than to "burden" their families. Will the definition stop short of a human’s ability to be productive?
People with severe and enduring disabilities may in turn have to justify staying alive. Is this a situation we really want to embrace? Writers such as The Times columnist, Melanie Reid use emotional tactics to further the cause for assisted suicide. But in my view this masks a very self-pitying nature, expounding their self-interested agenda and turning it into an exercise in scaremongering a civilised society.

Argument For Assisted Suicide

The distinction between suicide and physician-assisted dying is at times subtle, but always important. For a coroner to return a clear verdict of suicide, the Government’s legal definition states that it must be apparent that the deceased, “took their own life whilst the balance of their mind was disturbed.” But for a change of the laws surrounding assisted suicide to work, establishing sound mind prior to acting would be paramount.
This is already the case at the Dignitas clinic in Switzerland, where each client must consult an expert psychiatrist and submit medical records to an affiliated doctor before a prescription can be written, and there can be no doubting the value and importance of this requirement. Currently the only medical procedure in the UK to require the consent of two doctors is an elective termination; of course assisted suicide should be the same, and for the same reasons.

The loudest protests against changes to the law are usually from religious groups arguing the sanctity of life, or those concerned about potential misuse of the eventual act. But when retired American Episcopalian bishop, John Shelby Spong states that “the right to a good death is a basic human freedom”, it’s plain that the debate is a long way from conclusion.
Much is made of“valuing life”, the implication being that those who support assisted suicide lack this conviction. Nothing could be further from the truth. Valuing a worthwhile and fulfilling life is central to our argument; not wanting to continue a life shattered by absolute incapacity is merely a continuation of this.

It’s vital to make clear that it is severe incapacity that is under discussion here – the end stages of degenerative disease, or massive injuries caused by accident or injury. The argument is made best by the individuals attending court to challenge the law, and those close to them: the initiator of this current challenge, Tony Nicklinson, describes his life as “dull, miserable, demeaning, undignified and intolerable.” The parents of Daniel James, who ended his life at a Dignitas clinic in 2008, characterised their son as "an intelligent young man of sound mind" who was "not prepared to live what he felt was a second-class existence".
A southern African saying once related to the author of this article comes to mind; upon the death of a relative, the grieving family are reminded to give thanks to God for “a long life, well lived.” Even non-religious readers will acknowledge the truth and value in this. This is truly when assisted suicide should be considered; at the end of a long and full life, when all other options have been exhausted and the loss of faculty is too great for the individual to accommodate.

In Conclusion

The purpose of the assisted suicide debate is not to imply that the lives of disabled people, or anyone else, are in any way miserable or intolerable. Instead, the aim is to enable individuals to make their own decision about when, where and how to die, and to do so with dignity and comfort.
At present, someone seeking physician-assisted suicide must travel to the Dignitas clinic in Switzerland: previously an anonymous, nondescript concrete tower block just outside Zurich, now a pleasant house in a residential district of the city. Many opt to make the journey alone; to have a relative accompany them could expose their companion to prosecution for attempting to “aid, abet, counsel or procure” suicide, a charge that carries a 14-year sentence.

Both sides of the argument talk about dignity, quality of life, control, and ethics, but in the end, the decision is nothing more than a personal choice. What is needed now is discussion – in Parliament, between ministers and the sick and dying, between doctors, between couples and within families. The onus should not be on individuals to ask permission to be allowed to die peacefully.
Assisted suicide is an act of mercy, no less than the actions of a doctor or nurse on any other day in their career. The real enemy is silence and hypocrisy; wishing a dignified death for oneself and others isn’t selfish or unfeeling, it’s human. And our humanity is what necessitates the freedom to make our choice.

Doctor, Doctor, Are All These Pills Really Necessary?

It’s always the same; you wait a week for a story and two come along at once. Just as I was settling down to write about Ben Goldacre’s Bad Pharma, the BBC broke a story reporting that doctors will now face annual appraisals and five-yearly license revalidations. Whereas a doctor could previously work for 40 years without further testing or formal training, as Goldacre’s book observes, these new proposals will ensure that from December, their clinical knowledge and competency will be exposed to regular scrutiny.

In the coverage that resulted from the GMC/DoH announcement, we learnt that perhaps 0.7 per cent of doctors have shortfalls that would be regarded as threats to patient safety. The Telegraph talks about “more than 1,000 bad doctors” – with 129 foundation trusts and 151 primary care trusts in England, this works out to three or four per trust. This might not sound like many, but it’s enough to have the GMC and the Health Secretary worried, and is more worrying still if you’re actually receiving medical treatment.

And here we reach the heart of the matter – public perception. We might like to watch medical dramas, but our understanding of present clinical concerns is far sketchier. Fortunately for the patient, they need never consider medical ethics or whether the benefits of surgery outweigh the risks; they are only compelled to attend appointments, submit to examination, take the prescription they’re offered, languish on a waiting list and sign a consent form. We complain about cuts, budgets and those waiting lists, but we forget that we’re benefitting from a system that remains free at the point of cost – many despair at the state of the NHS, but many others know that they’d be at a loss on their own without it.

For the average patient, seeing phrases like“clitoral enlargement” or “suicidal thoughts or behaviour” on an information sheet, or noting that their newly-prescribed anti-emetic was originally an antipsychotic and can cause dangerous side-effects, is very alarming. Are these conditions permanent, or reversible upon withdrawal? Can I really not even have one drink on these antibiotics? How likely is it they’ll make my contraceptive pill fail? How serious is this headache? Do I need an aspirin, or an ambulance? Who do we even take our questions to? The pharmacist can discuss side-effects and interactions, but may lack the knowledge of the existing condition or potential prognosis to make the right call.

When you consider the complex nature of drug therapy for even a relatively simple symptom, it’s easy to see why a clinician must train for so long: antihistamines used as sleeping pills, antipsychotics for nausea, blood pressure drugs for erectile dysfunction, anticonvulsants for anxiety and migraine, and anti-depressants for seemingly everyone. While each specialism has their own arsenal of relevant drugs, and each consultant will have his own personal favourites, an ongoing and intractable condition can often lead to secondary or off-license uses for unexpected or seemingly unrelated drugs. In this case, a side-effect can become a positive boon.

A number of years ago, a charity I worked for began to see a large number of people with various conditions all being prescribed the same drug; previously used to treat epilepsy, it was now being prescribed for anxiety, depression, personality disorders, neuropathic pain in diabetes, nerve damage through trauma, insomnia, migraines, cluster headaches and sundry other problems. Some patients saw considerable improvements; still others experienced disruptive headaches, terrible nightmares, and serious confusion. Some had it far worse; they found themselves troubled by unwelcome ideas that disrupted their thinking, by suicidal thoughts and urges. It seemed as if the local doctors were throwing the drug at everyone just to see where it worked; we considered ourselves lucky that none of our clients had actually given in to the suggestions and harmed themselves, as had been seen previously with certain antidepressant medications.

As Ben Goldacre observes in his book, doctors cease their lengthy tuition and “spend forty years practising medicine, with very little formal education after their initial training. Medicine changes completely in four decades, and as they try to keep up, doctors are bombarded with information: from adverts that misrepresent the benefits and risks of new medicines; from sales reps who spy on patients’ confidential prescribing records; from colleagues who are quietly paid by drugs companies; from ‘teaching’that is sponsored by industry; from independent ‘academic’ journals that are quietly written by drug company employees; and worse.”

Perhaps the new checks, dubbed “medical MOTs” (by people who have forgotten, or don’t care, what “MOT” stands for) will assist with this – if a lack of ongoing training make it easy for pharmaceutical companies to exploit knowledge gaps, then maybe identifying and sealing these gaps will make it harder for them to exert their considerable influence. Perhaps this recommendation was introduced as a response to concerns like those shared by Goldacre; perhaps the timing is purely coincidental. We’ll never know, but we can hope that the plans will lead to improvements in clinical education and patient care. We must hope so; we all stand to benefit from it.

This is, of course, the opinion of a lay individual who has spent eight years depending on the NHS’ best and brightest – the pain clinic consultant willing to exhaust every possibility, the patient and gentle GP who took the time to explain the surgery and was more annoyed by the six-month waiting list than I was, the safety net that provides free prescriptions, regardless of quantity or regularity, when one’s luck runs out and unemployment bites. I’ve seen the NHS at its worst, and at its very best.

It is doubtlessly flawed – jetlagged by bureaucracy, slowed by overuse, hobbled by budgets and dented by news story after news story bemoaning all of these faults and more – but it remains the best system available to us. In the main, those of us born after 1950 take it entirely for granted, and those who remember the public reaction to its inception are becoming thin on the ground. It’s been accused of being alternately bloated and pinched, and its relationship with pharmaceutical companies is obviously in need of close examination, but it remains one of our greatest assets. It is, in every possible sense, a lifesaver.

The Ghost of Sexism Present

When you're of a mind to set the world to rights, even listening to the radio can be fraught with danger. Having resisted the pull of commercial TV and radio for a quarter of a century, I finally yielded. Contemporary music criticism has been done more elegantly by more knowledgable writers elsewhere, so let us just conclude that swapping a non-commercial station for a commercial one was ultimately trading one set of frustrations for another.

I'd managed to successfully limit my exposure to awful music, but had opened myself up to a whole new world of problems: radio advertising. Eschewing my local station for a national one took off most of the rough edges, particularly when it came to maddening double-glazing jingles, but it was while listening to aforesaid national digital station that I encountered the Ghost of Sexism Present.

Plunged into my own Dickensian fantasy, I quickly assessed my surroundings; the Ghost of Sexism Past faded away with the passing of grubby seaside postcards, the miniskirted typist-cum-secretary and woeful situation comedies; in short, around the time the '70s surrendered to the rampaging '80s. The Ghost of Sexism Future, more's the pity, does not limit its moaning and chain-rattling to the company of women. Instead, as did Dickens' rosy-cheeked host, it spreads its arms wide and cries "come forth, and know me better, man!"

This restless spirit, made bold by years of uncorrected manifestations and liberally sprinkled phantasmagoria, approaches both men and women with equal vigour. It's subtle, though, and has distinct approaches for each gender. Its main failing, as with so many bad teachers and politicians, is that it tries to tell us what, and how, we should think and feel. This afternoon, as if to demonstrate its multiplicity, it taunted me with whispered tales of spent headlight bulbs in the darkening autumn night.

It told me that I wouldn't be able to change the bulb - not because of my feminine dearth of technical skill, but because my nails - obviously long, and immaculately lacquered - would weaken and break the very second I lifted a screwdriver. Apparently this is undesirable. Speaking as someone that frequently uses their thumbnails as a makeshift flathead screwdriver for the purposes of spectacle repair and basic home maintenance, my suspicion was piqued from the start.

Next, as if sensing my mistrust, it endeavoured to convince me that my husband - which I don't actually have - would be unwilling or unable to do the job for me. Because of course, as a helpless princess awaiting rescue with attendant melancholy, only a man could possibly fix my car for me. Whether it was due to fecklessness, laziness or technical ineptness, my husband would never fix my car. Of course he won't; like I said, I don't have either.

But, as with Scrooge's ghosts, this entity's message was one of hope as well as foreboding: a modern-day white knight could fix the thing for me. He would do this on the condition that I return to my house (haven't one of those, either) and remark to my pseudo-husband that I'd found "a real man" to complete the Sisyphean task that so far had defeated both of us. Joy! Jubilation! Some orange-clad spanner with a spanner can suck his teeth at me and charge me a nominal fee for performing a chore that my obligatory feminine beauty rituals had until now prohibited me from achieving! Sing Hallelujah, and pass the bucket...

The job of feminism today is basically as it always was; to achieve parity and equality between the sexes. It must achieve this in every sphere of our lives; from the workplace, to the bedroom, to the TV screen. And at the same time that it combats pay and hiring discrepancies, social expectations, threats to healthcare provision, sexual aggression, domestic violence, genital mutilation and wrongheaded laws, it must also manage the hinterland between the experiences of Team XX and Team XY.

When women first cried out for equality, they were addressing the gulf of power and possibility that existed between men and women at a time when, if you wanted to get your entitled male hands on a woman's property, you could simply have her conveniently shipped off to the nearest insane asylum. While we have made headway enough to allow us to own property, we're still insulted when it comes to obtaining more or maintaining what we already possess.

I don't believe that all men, as a symptom of being "a bit blokey", are truly feckless, impractical, selfish and lazy, any more than I believe that women really are all vain, duplicitous, gossipy and obsessed with 'naughty' food and effective cleaning products. But this is what advertising says to us, and I resent its malicious whisper. The cry for equality, now and in years gone by, was an effort to improve the lot of everyone involved, men and women both.

Had I been born male, I would have resented the implications made about me as surely and as strongly as I do having been born female. When we push to attain an equal footing, we aim for higher ground, not the reeking swamp of mutual negation. The aim should be mutual improvement, not the denigration of both. In literature and film, we use prayer and religious iconography to lay restless spirits; in reality, our toolkit is different, but no less important. Words, balanced, thoughtful and tenacious, are our holy water and crucifix. The power of Christ may not compel advertisers, but the power of popular opinion certainly can.

Each of the spirits that visited Ebeneezer Scrooge vanished again within the course of one Christmas Eve. Can we expect our restless phantom to disappear overnight? No, I fear not; but we can tear away the clanking chains and unmask it like the Scooby-Doo schmuck it really is.

When I Say I Grew Up On An Estate, I Didn't Mean Downton Abbey

Earlier this year, the F Word ran an article concerning feminism and working-class women. The piece included a quote from a teacher in a senior school in Lincoln, “slap bang in the middle of one of the Midlands' largest housing estates,” who is concerned about that lack of feminist influence her students receive.
"When they get older, middle-class girls know the talk, the language to use, and so they have louder voices when it comes to the feminist movement. They're more educated, more confident, and feel they deserve opinions, maybe because their role models were professional women with assertive attitudes. You're not going to be like that if your mum struggled on benefits. Girls from low-income families have had to struggle more so they can be excellent at debating, but not necessarily in the very intellectual way that debating is taught in private schools. It's not deliberate, but our voices and issues can be drowned out, so we don't relate to it all because we're not part of it."

The basic premise of the article is correct; yes, feminism should be open to women of all classes. But to achieve that, we must shed our prejudices about those who belong to other classes. The patronising tone so often adopted when discussing working-class women bears an unpleasant aftertaste of the treatment disabled feminists and feminists of colour still resist – we are a subject to be written presumptuously about, not a group to accept contributions and insight from. It seems they would sooner discuss us than listen to us; rather talk about us than to us.
Rather than being limited by watching a mother “struggle on benefits”, some children are enlightened by it; they develop tenacity and resolve, and a precocious understanding of the workings of the world. While the teacher grants that “girls from low-income families have had to struggle more so they can be excellent at debating“, she still condemns the absence of “The Guardian's women's section lying on the coffee table, or political discussion ringing around their ears”, which she takes as an indication that “they are less likely to access feminist discussion early on.”
But why ought this be the case? Who is more inclined to espouse feminist principles; a single mother, struggling with underemployment, a feckless ex, a tiny income and no childcare, or comfortable middle-class couple with two jobs, two cars, and an after-school childminder? Who, more importantly, is this childminder that the middle-class mother in full-time employment is so beholden to? Even if they don’t know it, the girls in question will be absorbing feminist principles like background radiation – they might not discuss the works of Germaine Greer and Camille Paglia around the dinner table, but they’ve little doubt about their own ability to hold their own in a world that's set against them.
The teacher’s reference to “benefits” in general seems to expose ignorance of the system; are we discussing unemployment benefit, disability benefit, child support, or just working family tax credit? Or, to this woman, are “benefits” just something that only poor people need concern themselves with, like puffa jackets, pound shops and ITV?
In the interests of transparency, I should explain that the reason I’m so provoked by this is because that’s me they’re talking about; a writer for the F Word has just insulted my mum. Are my opinions worth less because I wasn’t dressed in Boden or sent on skiing holidays as a child? Because we had spaghetti on toast, not penne al pesto? Tesco Value rather than Waitrose? Were my lecturers at University correct – should I have taken voice training classes to eradicate the wide Essex sound? If the cut-glass vowels of the Fawcett Society fundraiser at the end of the line are anything to go by, the answer’s a well-enunciated “yes”.
What writers of articles like this seems to overlook is that anyone, anyone at all, can be compelled to claim benefits – an employment advice service in the next town over regularly sees doctors and lawyers claiming Jobseekers’ Allowance; even the most qualified and privileged can fall ill and require sickness benefits. What’s more, the authors seem to be missing a salient and important point: high intelligence leads to increased likelihood of mental illness, as do divorce and unemployment. Bouts of mental ill-health are statistically likely to lead to periods of unemployment, financial difficulties and longer-term incapacity – all factors that drive an individual to seek financial support from the State.
For too long commentators have disseminated the myth that only the working classes – ill-educated, understimulated, petty, ignorant or deprived – need to claim benefits. For too long, also, have they ignored the improved social mobility that post-war society has facilitated. Does the education process make one middle-class? Maybe the increased earning power and career potential of a successful graduate do lead to a perspective shift, entry into a brave new world of mortgages, not housing benefit; dinner parties, not chips on the way home. But few people that grew up in an impoverished household will forget their early years – however much they might want to. For many, those early experiences will be what drives them on through college and university, always pushing onwards to better results, more pay, a less uncertain future. And when they reach that point, if it takes two years or twenty, they’ll be proud, anxious for dignity and recognition. And after all that, someone who doesn’t know them, who has only a tiny window onto their experiences, belittles their struggle, repudiates their opinion, and – most heinous of all – insults their mum.

An Atheist Finds Hope

Losing faith in God - or never having had any to begin with - means creating a worldview free from the usual guarantees: no eternal life, no supernatural punishment for 'sins', no comforting hand on the wheel when we feel we're losing control. It requires the ultimate reality check - the realisation that we alone are responsible for our actions, with no heavenly third party to refer to when things go wrong. For many people with faith, this proves a difficult concept to understand.

When atheists face questions from those who have faith, often the same few enquiries come up. With no holy text to dictate our morals, what stops us from committing heinous crimes? With no fear of hell, what prevents us from mistreating those around us? Many atheists find this notion hilarious - the threat of judgement by God is all that prevents a decent, moral believer from committing murder? The sense of right and wrong that we imbue young children with is insufficient to this end?

Perhaps the issue is one of simple and understandable ignorance: if a believer has spent their entire life taking their moral cues from the Bible, maybe they simply don't appreciate humanity's ability to regulate their own behaviour without that hand on their shoulder. If you'd spent your entire life breathing oxygen from a canister with a mask, would you trust your ability to breathe the air? Would you be prepared to slip the mask off and take the risk?

One of the finest (and most surreal) questions of this type, though, is an example that was circulating on the Internet this summer. Discussing a post on another blog entitled "20 Questions Atheists Struggle To Answer" the author applauds her comrade's efforts to "engage with a group who simply don’t understand Christians" - a curious description, given that a great many atheists have become so after moving away from the religion of their youth. But her crusading counterpart has been remiss in his interrogation; he has missed a vital opportunity to ask a question which these godless heathens will be completely disarmed by.

"How do you live without hope?"

"This really is a cruel world that almost seems to be thinking of ways to disappoint, damage, or ultimately destroy us. So I ask, how do you live without a hope in the after-life? I simply cannot understand how someone faces life each day, believing that their existence and that of those they love can be permanently snuffed out in an instant. Believing that they will never meet again with those that have died. Believing that ultimately this short life is all there is."

We concede that this is a painful conclusion for any new atheist to come to: that we will not see our beloved friends and family members again, that innocent people lead good lives and die meaningless deaths without the promise of heaven to console those that loved them, that death really is the end. No-one likes to consider that they can be "snuffed out in an instant", or to realise that they too will be passed over and forgotten by history, their efforts trivialised by the passage of time. But acknowledging the absence of an afterlife is not the same as giving up on the future: it forces a shift of focus to the present and the people we share it with.

It takes a special kind of ignorance not to look around and notice the struggles and misfortune of those around us. Between countries torn apart by war, communities decimated by famine, natural disasters and disease, and the private struggles against ill health, addiction, poverty and hopelessness fought by families and individuals the world over, one could be forgiven for briefly wondering if the fabled Horsemen of the Apocalypse already rode amongst us. But it is our response to this suffering, rather than our beliefs about the cause of it, that defines us as human beings.

Let us consider the online responses to a natural disaster like that which affected Japan in 2011. Facebook, 21st-century almanac of public opinion, lit up with emergency appeals for assistance. But the specific requests varied wildly in their nature. Some asked for money - in the UK, the Disasters Emergency Committee were quick to set up a dedicated number to facilitate the giving of donations to the Red Cross, Medecins Sans Frontières and similar aid organisations. Some asked for donations of food, clothing, blankets and children's toys to be sent out to those in Japan who had lost everything. Some asked people to petition their government to pledge millions in aid, even in countries struggling against recession. And some asked people to pray.

To pray. Not to give money AND pray, not to send warm clothing AND pray, just to pray. As if prayer alone would solve the problems. As if prayer alone would provide shelter for the displaced, food for the hungry, and comfort to those who had watched loved ones swept away by the endless, swirling, dirty water. As if prayer would induce God, whose involvement with the human race has been at best minimal from the alleged moment he placed us on this earth, to return from his current residence on high, look at what one of his creations had done to another, see that it was not good, and somehow fix it for everyone.

Maybe I am mistaken, or being too literal. Maybe God was present. Maybe he was in the hearts of the rescuers, and in the minds of the people that tended to the injured, comforted the bereaved, and sheltered the dispossessed. Maybe he was in the actions of everyone that donated money to the charities on the ground, and of those that helped to rebuild the shattered cities. Maybe he was in the hearts of the men that walked into a compromised and dangerous nuclear facility, securing and controlling the material that threatened to cause a bigger disaster than Chernobyl, in the certain knowledge that doing so would lead to a desperate illness and a horrible death.

Or maybe that was not God. Maybe it was something far more real, and far more useful to us as a fragile species clinging to the face of a lonely planet: human compassion. The simple concern for another human being that comes from a place that psychologists and evolutionary biologists still cannot agree on. When you accept that God doesn't exist, and you consider our planet, circling endlessly under a cold and empty sky, you realise that all we have is each other. If God will not help us, all we can do is help one another. If God will not provide a blissful eternity for those that suffer, we must do what we can to make things better for them in this life. If this is the only life we have, we must use it to make our flawed and difficult world better.

Let us return to the words of the blogger mentioned earlier. She continues, "the Christian believes that behind a broken world there is a sovereign God who will one day fix it all, and in the meantime is working everything round for good to those who love him (Romans 8:28)"

Of course! How silly of us to forget! God's going to fix things for everyone, and we needn't worry about taking any action at all. We don't need to give money to support cancer research or treatments for catastrophic spinal injuries. God will "fix it all", and if we want him to move a bit more quickly, we can just pray! That's why you see so many of those appeals on Facebook: "pray for my friend's sister, she has cancer" or "pray for the people of [disaster-struck country]". Conversely, of course, those who don't "love him" can expect to receive none of his goodwill - an atheist fallen on hard times deserves it, then?

If God exhibited even the slightest inclination to assist the day-to-day struggles of the sick and the dispossessed, these requests for prayer would be far easier to swallow. If you believe in God, pray for sick children if you feel you must; but be ready to donate to a group who do practical things to make their lives better. As it is, we're asked to believe that we're his greatest creation and he still doesn't seem to give a damn about us. Instead of praying, we must continue to support organisations taking practical steps to combat these problems. If God will not remove them, then humanity must strive together to overcome them. And that, Christian bloggers, is where atheists find hope.