Last week on Wednesday a fascinating article appeared in the Guardian. https://www.theguardian.com/lifeandstyle/2019/mar/27/are-sexual-abuse-victims-being-diagnosed-with-a-mental-disorder-they-dont-have?CMP=twt_gu I am not a regular reader of the Guardian but the topic, referenced by someone on Twitter, attracted my attention. It was talking about what is now known as Complex PSTD and setting out the way that this disorder is found among survivors of any severe trauma. A few weeks ago, I made reference to a book by Gordon Turnbull entitled Trauma. This set out his pioneering work in challenging the psychiatric profession to take seriously the study of trauma and the therapies that are able to relieve it. From his experience of being the psychiatrist who headed up the care of those who were first on the scene after Lockerbie, Turnbull has gained an international reputation in describing and treating this disorder. As I mentioned in my short review, the main message from the book is that traumatic stress of every kind is not the cause of mental illness. When the body has to deal with trauma, whether the result of single event or over a period of time, there will be expected and predictable symptoms. These need to be approached quite differently from established mental disorders.
The Guardian article picks up this same narrative, the one which Turnbull wanted to communicate for the whole of his professional life. When stress and trauma create a recognisable psychological reaction for which there are recognised therapeutic responses, a patient is being given a hopeful prognosis. Any diagnosis which carries the implication that the sufferer of trauma is in some way mentally ill is far more alarming. The Guardian article explores the way in which abuse survivors are sometimes labelled with the diagnosis of Borderline Personality Disorder (BPD). The implications of such a diagnosis can be dire. Treatment options are very limited but worse still there is the suggestion that the mental health of the abused may have been fragile before the abuse took place. The BPD diagnosis simultaneously labels them as chronically mentally ill but also untreatable.
It might seem impertinent to write about a dispute that is taking place among professionals where I have no expertise. But it is clear to me that the issue is not just a matter of professional judgement. If an expert gives what is effectively a diagnosis which carries with it a ‘life-sentence’, then he/she should at least allow some kind of second opinion. If the authority of the expert prevents anyone, least of all the patient, challenging this drastic diagnosis, there seems to be a denial of the laws of natural justice. To give prominence to one particular diagnosis over another, one that is equally credible and respectable within the profession is a political decision. The author of the Guardian article, Alexandra Shimo, quotes Gillian Proctor from the University of Leeds who says ‘the borderline diagnosis for sexual abuse survivors is nonsense and misleading because it suggests that the problem is within the personality of the survivor rather than a result of what has happened to them’.
A series of case-studies are given in the article which my readers are invited to consult. They illustrate the point well as to how devastating the BPD diagnosis can be. The abused find that they are carrying the extra burden and stigma of being considered mentally ill. Such a diagnosis robs them of power and agency. They are the object to whom things are done. Their illness deprives them of any decision about what should happen next. Of course, there may be aspects of the personality which have been damaged by the encounter with abuse. Symptoms like depression and dissociation may well be found but these symptoms are not indicative, according to Gordon Turnbull of actual mental illness.
One facet of being labelled with the BPD diagnosis is its implications in the legal sphere. One abuse survivor in Canada found herself undermined and humiliated by a defence lawyer because of this BPD diagnosis. Stigma is a good word that is used to describe what happens to many abuse survivors when they receive the BPD label. They feel themselves somehow marked out by the label and unable to access proper help or understanding from other professionals. These therapists know the textbook definitions of this illness and that sufferers of this condition are a tough proposition and may be impossible to heal.
In 2018 Complex PTSD finally achieved some recognition in the NHS but many therapists and practitioners still find it controversial and hesitate to diagnose it. Meanwhile we end up with a situation where some people are deemed to be mentally ill because they have been damaged through an act of abuse. Of course, professional people must be allowed to diagnose patients as they see fit, but the rest of us must also be able to point out the immense importance of getting things right for a sufferer. Although my personal inclination is to side with Gordon Turnbull is claiming that PTSD is a description of the body responding to stress rather than a mental illness, the opposite point of view has to be heard. The issue becomes more complicated when other things are added to the equation. How do claims for legal injury work out when the professionals disagree? Is it not a temptation for a lawyer seeking to limit legal damages to suggest that the victim was already a sufferer of mental distress before the incident of abuse?
The claim that church abuse victims come up against a variety of obstructing institutional blockages is often heard. The church is sometimes seen to be deploying delaying tactics – ‘forgetfulness’ on the part of those in authority and various legal ploys. The legal system is sometimes felt to be on the side of the abuser as well. Now in addition, the Guardian article points to this further problem of the political divisions within the mental health profession that can also militate against abuse survivors. What we would hope for is that the individual whose abuse is established beyond reasonable doubt would be automatically protected from further harm. The opposite seems to happen. Instead finding instant support and comfort, the survivor is made to jump through a series of difficult hoops, each of which requires considerable stamina. Those who do follow through the difficult path and arrive at an apology or legal compensation may not feel as though they have won. All that they have achieved is what feels like a grudging acceptance of the wrongs that have been to them. Many others who have potential claims must feel deterred by the sheer difficulty of breaking through the many hindrances that are put before them to delay their pursuit of justice. The absence of any sign of generosity on the part of those in positions of church responsibility continues to rankle among the survivors who speak to me.
“a situation where some innocent people are deemed, through no fault of their own, to be mentally ill”. As someone who has been burdened for 40 years with a recognised psychiatric diagnosis (bipolar), I feel rather strongly that you need to be a bit more careful with your language and the thinking it indicates. Those of us with these diagnoses are also innocent people who suffer through no fault of our own, and we also deserve not to have the stigma loaded onto us which you seem concerned to remove only from those who have suffered abuse and trauma. I’m disappointed in this article, because it doesn’t reach your normal standard of informed clarity.
The findings of medical experts in CSA cases is likely to come under close scrutiny at some stage. Perhaps at IICSA hearings in July or later. Survivors are aware that some experts in particular have made highly dubious findings in reports on behalf of churches and other institutions. Arguments such as ‘genetic predisposition’ have been routine in one expert, ie. that a survivor was genetically predetermined to experience certain mental health conditions. This totally negates the recognition of impact realities present in Responding Well, the CoE handbook for how the church should be responding to survivors.
I heard of a case recently where the expert never met the survivor, but was able to argue on the basis of a couple of documents that only 5% of his considerable health conditions could be attributed to abuse. The insurer (Ecclesiastical Insurance) withdrew an offer they had previously tabled. The whole process was enormously re-abusive. The same expert has come under fire from many survivors. It is likely that the reputational damage he and Paula Jefferson (BLM senior partner) have been allowed to do the Church of England will eventually be brought into much sharper focus. Paula Jefferson, who was found to have been brazenly dishonest in one case (mine) to the lead bishop (Bishop of Durham) – should have an understanding of the church’s policy documents, but is allowed to shred them at every opportunity.
I heard another case recently, where Jefferson told a survivor’s lawyer “No-one is getting more than £25,000” in a statement of supreme arrogance and power. There is no doubt that this one lawyer holds huge power over the whole spectrum. She and her partners have operated an adversarial structure to the max against survivors – and have been aided by experts who deliver findings which help maintain derisory settlements. The circus has operated across every institution.
In cases where ‘genetic pre-condition’ has been used – has the expert asked to gather genetic sample? Has the expert asked for access to a survivor’s parental medical notes? One survivor managed to get such a report thrown out.
I have it on good authority that the panel at IICSA are horrified at the behaviour of insurers and their lawyers, and recognise that their litigation strategies need much closer examination. Bear in mind that in the case of Ecclesiastical Insurance it is the Church of England which benefits the most from the ugly games played out against survivors. CoE is the biggest beneficiary from its business to the tune of £millions annually. It pays the CoE to turn a blind eye and pretend that it is nothing to do with them. In reality it is everything to do with them. Diocesan bishops and registrars will be aware of case reports that contain these offensive findings. Some must quietly ask themselves about the ethics of it all. One hopes they stay awake at night.
Not all bishops were genetically predisposed to be bishops!
I have removed the offending word and changed around the rest of the sentence. Hope it now makes better sense.
Thank you, it is appreciated.
Thank you Gilo for your comment. I would want to say more on this genetic predisposition idea if it were possible to find this notion in any of the text-books I look at. I suspect that it is a made-up expression but someone may know different. It would be good if lawyers challenged this idea in a court case as that is one way of exposing if it is false or not.
“It would be good if lawyers challenged this idea in a court case as that is one way of exposing if it is false or not.”
It may be that this particular expert will be challenged at some stage. When he is – I imagine many survivors will want to draw attention to findings he has made in their cases. And I hope lawyers acting for survivors will help them to do so. All of this needs bringing into daylight. The whole system is stacked against survivors in a profoundly ugly way.
I heard of one case recently where the medical expert was not averse to litigation herself. Dr Gillian Mezey made a disastrous decision in her health authority to allow a severely psychotic man to go out unsupervised for an hour. She communicated the decision over a phonecall. He went out, bought a knife, and stabbed a stranger to death. The doctor was suspended on full pay whilst an inquiry took place. Astonishingly, Mezey sued her health authority for £300,000 for damage to her reputation and career, and claimed her suspension was unlawful. The family of the man whose life was taken so tragically and suddenly could not understand why it was she who was suing her employer – and not them taking legal action. She rubbed a massive ammount of salt into the wound. And Mezey’s decision was found to be “seriously flawed”. She sent the family “sincere sympathies”.
This same doctor has taken part in at least one CSA case where a derisory ammount was thrown at the survivor with her expert assistance.
One wonders how much these experts are paid to deliver reports in CSA cases. I have been told it can be up to £10,000 in some cases. I suspect BLM would never recognise genuine expertise and knowledge of abuse impact. It was one of the comments made by the Truth Project when I told them of the games played out by Jefferson. There is no doubt that much needs to come to daylight. And the whole circus exposed.
I am reminded of a line we have in the forthcoming book, ‘Letters to a Broken Church’. A Church of England cleric commenting after an Ecclesiastical Insurance day in which their representative said to a group of clergy, “Please make sure you’re very careful what you say to survivors”.
His comment: “I think I’ve just witnessed a quiet English form of corruption”.
https://www.standard.co.uk/news/doctor-who-let-knife-killer-out-of-hospital-to-sue-for-300000-6878379.html
As someone with a BPD diagnosis I thought the Guardian article offered helpful insight. As Gilo rightly points out mental health diagnosis can often be used in malign ways, which is why any survivor who is at risk of being labelled like this needs to involve someone from their mental health team that they trust, or a MIND/RETHINK advocate, in ANY communication with the church. Perhaps more frightening than compensation claims is that once the church knows your diagnosis they can be instrumental in securing ‘sections’ and injunctions when you become ‘bothersome’ either of which can lead social services to make a decision about placing your children in care.
The criteria that most often gives rise to a diagnosis of BPD in abuse cases is if abuse was prolonged and violent, generally familial, or where the care giver was in a position of great trust and where abuse (usually full penetration) occured by the age of 6. This is because the infantile personality has no way of processing what has happened so they often describe it, even in adulthood, as being murdered or dying. This is when DID (disassociative identity disorder) can happen with a ‘derailment’ of the core personality or psychosis (highly contentious diagnosis) for voice hearing, hallucinations etc. So a BPD diagnosis is often combined with other diagnosis which will most probably include PTSD in an attempt to explain what is happening. As there is now a trialled treatment plan for BPD, which is hugely expensive, psychiatrists are moving away from this diagnosis to far more fluid ones!
The church desperately needs to understand mental health better, though users and professionals, but arrogance and fear ensures they remain in the dark ages.
Hi Trish. Hope you’re well. Thanks for your always useful comments.
You are right Trish, findings in reports have often been malign. Based on spurious medical/psychiatric opinions designed to suit the insurer’s need to limit and restrict payouts.
Fraid the church at high level has little interest in understanding these questions – it has suited them very well to turn a blind eye to methods employed by their lawyer and insurer. Page 45 of Responding Well (published by Archbishop’s Council) lists some of the main features of PTSD and would seem on paper at least to validate this as a central feature of the range of conditions attached to survivors’ experience. But the lawyer Jefferson with the aid of her favoured expert routinely trash this policy in their arguments. To such an extent that the policy is rendered meaningless.
https://www.churchofengland.org/sites/default/files/2017-11/Responding%20well%20to%20those%20who%20have%20been%20sexually%20abused%20%282011%29.pdf
Direct quote from the book:
About 97% of people who have been sexually abused are likely to suffer from PTSD.
In time it will become more apparent that Jefferson, BLM, and others in conjunction with Ecclesiastical Insurance have done untold reputational damage to their client, the Church of England. But it has been a two way street. Those in power in the Church with governance of the circus of response to survivors have enabled Jefferson to practice unchecked. It was not until the acutely embarrassing letter sent to EIG by the Bishop of Durham that any senior figure called her out for her methods. He was polite in the letter, but made it very clear that she had acted in ways that she had not given him to understand that she would. (She lied in other words). But Jefferson and Ecclesiastical have been so used to presiding over this rotten circus and getting away with any amount of callousness – that it is hardly surprising. The Church has turned a blind eye and let them do it, knowing that they will reap the dividend from AllChurches Trust. The whole setup is frankly corrupt and needs daylight.
Incidentally the current Chair of AllChurches Trust (owner of Ecclesiastical) is Sir Philip Mawer. His role is interesting. He was on the board of Ecclesiastical Insurance for six of the years he was also Secretary General of Synod. Running both the church and its insurer.
1990 – 2002 Secretary General of General Synod
1996 – 2002 Ecclesiastical Insurance (EIG) board of directors
2008 – 2013 Mawer rejoins EIG
2010 – present, AllChurches Trust (ATL) trustee
2013 – Chair of ATL
2015 (and possibly earlier) – President of Nobody’s Friends
Nobody’s is a secretive Lambeth Palace dining club which includes bishops, lawyers, prep school heads. It was cited in IICSA in connection with letters of influence in Peter Ball case.
It’s all very nested, isn’t it! Joining up the dots you realise just how quietly corrupt it has all been. EIG started regularly attending CoE safeguarding central commitee in the early 90’s … right through…
(My comments got lopped off at the end due to word count)
It’s all very nested, isn’t it! Joining up the dots you realise just how quietly corrupt it has all been. EIG started regularly attending CoE safeguarding central commitee in the early 90’s … right through until 2015.
That’s how nested!
This is what my Bishop did. The counsellor I was sent to said I didn’t need counselling. The Bishop didn’t believe that and refused to relicense me until I was well again! Punishing me for what the church did to me! Bullying in this case.
Thanks Gilo that is really interesting if a bit upsetting about Responding Well, which my Authorised Listener was on the working party for and I always quote back at the church. That was certainly not the spirit it was written in and is very disrespectful.
I know you do a brilliant job trying to bring all this to light so a big thank you and which is good because I think a lot of people, like me, just feel overwhelmed by insurers and that has probably contributed to them being able to carry on without being held to account. I can remember how touched I was when my area Bishop was so very concerned about my mental health in 2009, until I found out he was a director of EIG and it all turned into another horrendous round of re-abuse with, for all his concern, him refusing to meet me because I was too unwell !!
I sent this by Yeats to them because it means so much to me but I don’t advise this strategy, carry on as you are, because this was the final nail in my coffin of madness for them!
But I, being poor, have only my dreams;
I have spread my dreams under your feet;
Tread softly because you tread on my dreams.
Keep up the good work.
Thanks Trish for your kind comment. Much appreciated. I love Yeats. He is one of the inspiring voices for my own lyrical writing – and I aspire to his greatness, but know that I cannot match it.
Your bishop on EIG has form I think. They are reluctant to address the obvious corruptive influence the relationship to Ecclesiastical has had in all this. It seems obvious to most of us. If you are a bishop or senior figure responding to survivors of abuse in your patch how is it also possible to hold fiduciary responsibility to the insurer who survivors will be claiming against? Especially when the profits might substantially increase an annual block grant for your diocese? It’s a major conflict of interest. In the early 90’s when the insurer started attending the Church’s safeguarding commitee regularly – there were four senior figures on the board of the insurer. Over a third of the board. Remember that the 90’s were the period of the beginning of the cover-ups in Peter Ball case, but also in many others as well.
As I say, it’s been a very nested culture. And the Church has benefitted hugely from the quiet corruption of it all. And they hoped that no attention would ever be drawn to the structural complicity.
Just got my copy of the report from ?SCIE? Sheila Fish. Haven’t had time to even open it yet.
You need time Athena it’s hundreds of pages long! For anyone who didn’t get a copy delivered personally it’s on the main NST website under reports and reviews. I got a very different letter from Dr. Fish because though I fought hard for the surveys when they arrived they did not follow standard safeguarding protocol for surveys for people who may be vulnerable, and being completely fed up with us, as survivors, always having to settle for second best, I became bothersome!
However none of that detracts from the fact that there are some good points in the report so anyone of the 58 that took part has every reason to feel pleased. Whether that 58 is due to lack of distribution ethics or a repeat of PCR arithmetic sadly we will never know, though because of the sheer length of the document sentences can easily be slipped in that seek to raise questions, so does ‘less people responded than expected’ become ‘oh well these 58 moaned on a bit but all the thousands of others are well pleased.’ Long reports without a summary conclusion always tend to have a measure of tactics involved.
Yeah. You need to set criteria first. I’ll need to use the laptop, and I habitually use the tablet, which won’t have the capacity.