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In praise of the Six Nations

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With the start of the 6 Nations this has got to be one of my favourite weekends of the year.

The first of 5 weekends during which all other social and professional responsibilities take second place to the duty of watching the rugby, the time when, each year, the dreams of a Triple Crown or even a Grand Slam can be safely nurtured. The tournament starts in the depth of winter but by its end we have reached spring.  The sense of anticipation of future pleasure is immense.

While the World Cup has yet again proved that our cousins in the Southern Hemisphere remain top of the rugby pile there is still something special about the 6 Nations. It is so much more than just a sporting contest, epitomising, as it does, the ancient rivalries in this land and with its immediate neighbours. However in allowing us to indulge those rivalries, the 6 Nations championship also expresses what unites us a community of nations.  A good game and a few beers cement friendships across national boundaries.

I first watched the then 5 Nations in 1971, a good year for a budding Welsh rugby fan as the team of Gareth Edwards, Barry John et al won the first of 3 Grand Slams in the 1970s.  In those days the only Welsh games one could watch in England were those against England (and as England didn’t have a game that day) Scotland.  For the other games it was necessary to wait for the highlights, a formulaic presentation I’ve never liked that much.  Rugby, I always feel doesn’t lend itself to highlights, you need to see the whole match to really get a sense of the struggle.  In any case if we had won they were too short and if we had lost they were far too long and painful.

Watching the tournament was, and still is, a great shared interest between my father and his three sons (even my mother has now become a supporter). Unable in those days to get any real tickets we relied on the “magic chairs” in our lounge to take us into the midst of the crowd at Cardiff, Twickenham or Murrayfield.   For 80 minutes, in an early experience of male bonding, we might as well have been there in the flesh for the level of intensity there was in the room.

In later years we have had the chance to see the games live and to make our visits to the various rugby temples in Edinburgh, Paris, Dublin and latterly Rome. These trips have always been very special occasions.  There is something about spotting the first red shirt at the airport or train station, about joining the sea of supporters emptying out of bars on their way to the stadium, the anthems, the Paris bar erupting into Calon Lan, the cultural activities planned for the Sunday despite the scale of the hangover one was nursing, the buying of the present to secure permission for the following year’s trip.

Pilgrimage is probably the word I would use to best describe the experience. While rivalries are great and passion for your team ever present, the tournament also represents a lovely culture of mutual respect between nations and between supporters.  The 6 Nations is a community of interest, something we all share and something which, without any of its participants, even the English, would be seriously lessened.  There is always a welcome for travelling supporters who, unlike the case of football, mingle freely in the stadium and in bars before and after the game.   In the smaller cities such as Edinburgh, Dublin and Cardiff, 6 Nations’ games take over the city for the day and even in the bigger cities their impact is noticeable.

After the golden years of the 1970s Welsh rugby fortunes dipped and we spent nearly 30 years in the wilderness. For a while we continued to be able to beat England but, after a while, we couldn’t even do that.  It didn’t stop each year, however, a sense of awakened optimism on the first weekend of the tournament and a belief that this might be the year where Welsh fortunes would be restored.  Usually the end of the first game had put pay to those ambitions but hope never died and in 2005, probably my favourite of all the 6 Nations I have watched, was eventually vindicated.

So let’s raise a glass to the one of the world’s best sporting events and to the community of nations who make up the 6 Nations. It may not always be the best rugby in the world but it is certainly a very legitimate cause for excitement and optimism on a grey and windy February morning.

 

An age of anxiety

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Anxiety is central to the human condition, essential to our survival as a species, troubling in the extreme when out of hand. It is certainly the most difficult of my own emotional states to contain and I know, from my professional experience, how much misery can be caused by anxiety related conditions.

Anxiety is, at one level, an immensely protective instinct. It is the reflex that helps respond to external threats and anticipate future dangers.  For anxiety is more than fear, more than the immediate reaction to danger. It encapsulates our ability to contemplate future events, to spot distant threats and to take anticipatory action to avoid them.  A little anxiety in the right places goes a long way to help us survive and prosper, both as individuals and as a species.  The origins of many disasters lie in complacency, in too great a sense of security, not in anxiety.

But anxiety can get out of hand and become a major source of distress. Anxiety disorders including panic attacks, generalised anxiety disorders and post-traumatic stress disorders are calculated to have a lifetime prevalence of as much as 15% with 10% affected at any given time.  This makes anxiety the most common source of mental distress, including amongst children and young people.  The conditions appear more common in developed countries and amongst women.  Anxiety based symptoms are also often central to the experience of many people with psychotic illnesses.

Like depression, anxiety conditions, suffer from a stereotype of being moral failings rather than genuine illnesses. The reality is that, while for many of us anxiety is a passing state, for others, especially where their anxiety condition is linked to some major trauma in their life, the symptoms of anxiety have a significant and unmanageable impact on their ability to function and their quality of life.  Anxiety can also fuel destructive habits of self-medication through alcohol and drug misuse.

Also like depression a significant majority (between 50 and 60%) of people with anxiety disorders receive no treatment despite exhibiting symptoms above clinical thresholds for care. For those who do receive treatment, choice is often limited, with a major focus on medication.  The introduction of the Improving Access to Psychological Therapies programme in this country has improved access to Cognitive Behavioural Therapy, a very valid intervention for many affected by anxiety disorders, but representing but the tip of the iceberg in addressing the unmet need for greater access to talking therapies.  As  I have argued many times before in this blog it would be a national outrage if the NHS were to only offer chemotherapy for cancer patients and yet such a position is still accepted for one of the most common and devastating set of mental illnesses.

As well as affecting individuals anxiety disorders manifest themselves at a societal level. There is no doubt that we live in an age of anxiety.  Constant change, economic uncertainty, the disappearance of old norms and certainties fuel our collective sense of doubt and anxiety about the future.  Our media, now penetrating virtually every moment of our waking lives, operates in the currency of anxiety.  As we can see happening across the world, it is to the advantage of certain political leaders, as it was in other eras, to encourage our sense of anxiety and, in particular, to channel that deep seated anxiety about “others” which goes back to our days as isolated hunter gatherer groups.

So as well focusing on a serious attempt to broaden access to treatment for those who are affected by anxiety disorders we need to think about how we manage our collective anxiety. The decline of religion in the west has removed some of the traditional responses to this and has left a void in terms of philosophical and practical approaches to dealing with the anxiety of our age. Agnostic in my own beliefs I am not seeking to defend traditional religion but rather to highlight the place it took in helping managing our anxieties as individuals and a society.

These are not new problems.  Ancient philosophers such as Epicurus (totally falsely connected with notions of gluttony and good living) were equally concerned with how we might control our sense of anxiety and reach a sense of calm or “ataraxia”.  The consolation of philosophy is much needed in the modern world and some of the thinking of the ancients, who did not believe, like us, that every human problem could be solved by technology is very much worth revisiting.  Similarly techniques such as mindfulness which help us to detach ourselves from and control better the impact of our anxieties are valuable things to encourage and disseminate both in schools and for adults.

Whatever response we take, we should recognise anxiety as great a public health challenge as is obesity and that indeed many of the physical health challenges we face are deeply connected with issues of psychological distress and insecurity.  I had been encouraged, a couple of years ago, by the emergence of interest public mental health.  It is crucial that, despite denuded budgets, public health practitioners and policy makers continue to recognise the importance of psychological resilience.  There is indeed no health without mental health and nothing will better illustrate that than how we respond to the growing threat of anxiety in our society.

 

William Wilberforce – the first modern campaigner

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One of the most interesting and inspiring books I read in 2015 was William Hague’s biography of the anti-slavery campaigner William Wilberforce. While familiar, in general, with Wilberforce as a historical figure I did not know a great deal of the details of his life and work.  It was fascinating to learn about both the highs and lows of the battle to abolish slavery and the particular role which Wilberforce played in it.  It also made me reflect on the wider issues of challenging injustice, affecting social change and confronting vested interests.

Wilberforce was born in 1759 in Hull and, with the exception of a short but important period, when on the death of his father, he lived with his Methodist aunt and uncle in Wimbledon, was brought up and educated in East Yorkshire. His family had made their fortune in the Baltic Trade and Wilberforce had the benefit of a substantial independent income throughout his life.

Wilberforce entered Parliament in 1780 and was a MP for a total of 45 years. While conservative in many respects and a close friend of William Pitt the Younger, Wilberforce sat as an Independent in Parliament.  Best known for his championing of the abolition of the slave trade Wilberforce was a very active Parliamentarian, taking an interest in and speaking on a wide range of other issues.

Wilberforce is also known for his strong evangelical faith and his membership of the Clapham sect.   Introduced, briefly, to Methodism when he was young he underwent a conversion experience in his mid-20s.  Religion, henceforth, played a major role in his life and was central to his deep and persistent beliefs on the issue of slavery which he saw fundamentally inhuman and unchristian.

Finally Wilberforce had many of the attributes of the natural campaigner. As well as a deep sense of passion on the issues he was concerned with, he was an eloquent speaker in Parliament and on other public occasions. He was a greater builder of partnerships who put the hours in building up a broad constituency of support for the causes he believed in.

Despite his efforts and those of many other committed and passionate campaigners, it took over 20 years to pass legislation banning the slave trade and a further 25 to achieve the final ending of slavery in the British Empire 1834. For something as morally repulsive as slavery it is salutary to understand why change took so long to achieve.  Some of the factors are specific to that age but many are just as relevant to understanding why it is so difficult today to challenge injustice and vested interests.

Winning the moral case against slavery was perhaps the easier part of the equation. Wilberforce and his allies were effective in exposing the brutal realties of the slave trade, including the dreadful and overcrowded conditions in which slaves were transported and the resulting loss of life.  This was in the age before social media and its ability to create an instant sense of outrage or concern.  Indeed even mass circulation newspapers were a thing of the future.  The campaign needed the willingness to travel and speak at numerous public meetings in order to get the message across.  Physical tokens had their place.  A famous pottery medallion produced by Josiah Wedgewood with an image of a slave and the motto “Am I not a man and brother” was an important campaigning tool.  All in all after the 1790s it was impossible for the pro-slavery lobby to make an effective moral argument in defence of the trade.  They could do much, however, to resist the passage of legislation abolishing it.

Two factors combined to make the passage of legislation difficult. In the late 18th century political parties in the way we understand today were non-existent.  Although Wilberforce and other ant-slavery campaigners had the support of Prime Ministers and Opposition leaders that was no guarantee of legislative success.  Gradually a majority for abolition built up in the Commons but the Lords was altogether a more difficult ask.  At the same time events in Europe, the French revolution and the subsequent Napoleonic wars made radical change on an issue of this kind harder. A key argument was that if Britain withdrew from the slave trade other countries would fill the gap.  As often today, for instance in respect of action on climate change, the absence of multi-lateral support stands in the way of unilateral actions which are the morally right thing to do.

Even before the age of mass democracy, public option had a big role to play. The abolitionists managed to secure 579 petitions in favour of abolition with a total of 500,000 signatures, an enormous number for those days.  On the other side only 4 petitions supported the continuation of the trade.  In time, changes in Parliamentary representation also had an effect on the issue.  The arrival of Irish MPs, after the 1801 Act of Union, increased the Commons majority for abolition in 1807 and changes in the composition of the Commons after the 1832 Great Reform Act made more possible the passage of the legislation in 1833 leading to the eventual ending of slavery.

Widespread boycotts of sugar by ordinary people also helped. The soaring demand for sugar, and the enormous wealth which stemmed from it, was the biggest single factor perpetuating the slave trade.  As often vested interests can successfully see off moral challenge until that challenge is felt economically.  The actions of individuals as economic agents have an essential role today in forcing change.

In the end the conditions prevailed for action to abolish the slave trade and in its turn slavery itself. No one individual can ever been seen as the sole agent of historical change on this scale.  Wilberforce, though, does have a powerful claim for the importance of his contribution, as an eloquent advocate for the cause and as tactician.  Above all though, he deserves credit for his moral perseverance.  Many men would have desisted when events did not go their way.  Wilberforce refused to flinch from a position he believed to be fundamental to his morality and beliefs.  The same cannot be said of all politicians.  His is an example worth turning to in an age when injustice and vested interests are still rampant.

 

 

New Year’s Resolutions for the NHS

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I have always been a fan of New Year’s Resolutions, however unsuccessful I have been at keeping them. Sometimes I surprise myself, as I did when I managed in 2011 to run a Marathon, the high spot of my athletics and fundraising careers, while on other occasions I make little progress, despite the good intentions.  However, like most things in life it’s better  trying than not.

So I will settle down in the next couple of days to pen a few personal resolutions but I also wondered what are the resolutions I would ask the NHS to follow in the coming year.

There is no doubt that it will be a tough year, although, as Simon Stevens and as others have rightly pointed out, a slightly less tough year than it would have been if the NHS had not been given a front loaded injection of extra funding in the first year of the new spending settlement. What might have been impossible is now just challenging.

That challenge involves the NHS simultaneously getting its existing financial (all £2 billion of them) and operational problems under control while making enough tangible progress in developing new models of care to ensure that, when the money becomes less generous again, the system is resilient enough not to fall into the same difficulties in future years. To do so will require skill, courage and some measure of luck.  It will also be helped by trying to adhere to some important principles, principles which have not always been at the top of the pile in the recent history of the service.

So, on that basis, I have five resolutions which the NHS should try to follow in 2016.

The first is to put the workforce at the centre of thinking and not treat it as the afterthought which it so often has been in the history of the NHS. This has to be more than just about the costs of agency staffing which is but the symptom of a deeper malaise.  As well as pressing issues about numbers we need to devote some time at both a national and local level to rethinking the psychological contract with NHS employees, to considering again how we value the contribution of both clinical and non-clinical staff in providing good care and to thinking hard  about the psychological stresses of care giving and what more we can do to engage support the staff on whom we depend totally for good care in the present and new models of care in the future.

The second resolution is to ensure that, at last, mental health takes centre stage in the NHS.  2016 will be an important year with the introduction of the first waiting times targets in mental health, an important statement that mental health problems are of equal importance to those relating to physical health.  However this is but the start.  The real revolution in thinking comes when we recognise the centrality of mental health and psychological factors at the heart of the experiences of being ill and providing care. If we want a sustainable health service we can no longer afford to treat the body without taking any account of the mind.

The third is to respect completely the management adage that form should follow function. It has been fascinating in the 30 years or so I have worked in or near the NHS to see how readily the service, and those in charge of it, reach for an organisational solution to any problem.  It would have been thought that the Lansley reforms would have cured the NHS of that tendency for good and, to some extent, it has created antibodies against structural change. However old habits die hard and much precious senior management and governance time is still spent debating the opportunities or threats of different organisational models and configurations.  Accountable Care Organisations are the latest focus but often without any clear idea of what problem they will solve.  I would not be alone in thinking that there will not be the same configuration of health care organisations in 2020 as there are today.  But let’s make sure that organisational changes stem from genuine changes in models of care and are grounded in genuine local decision making.

The fourth resolution is to be clearer than we have succeeded in being in 2015 about our narrative of transformation. The 5 Year Forward View has retained its usefulness as a signpost for change but it is not a roadmap.  While improving efficiency and reducing variation between providers is important and has its place in releasing savings it must not be allowed to distract from a bigger story about changing the fundamental model of care to put the community and not the hospital at the centre of provision in a way, which takes full account of the psychological and social needs as well as the medical needs of patients.  Those of us working in mental health have been on that journey and known how difficult it can be. The NHS, as a whole, needs to know that is what we are about and the public need to know that it will involve closing or changing the use of some hospitals.

The fifth resolution is to focus more on prevention. While it is worrying to see the impact of cuts on local government spending on public health work just at the time when we need it most there is still a lot we can do within the NHS and working with partners to support this agenda.  We can think of prevention at two levels.  The NHS has a major role in promoting healthy lifestyles amongst the people who use its services and will do so all the more effectively if it brings that approach to how it treats its own workforce.  It also, though, has a key role around early intervention and secondary prevention, in particular for those at risk of a crisis in their physical or mental condition.

My last resolution relates to the involvement of patients and carers in decisions about their care. This something which we have been starting to do better in the NHS and I can certainly see some of the progress we have made in my organisation in recent years on this agenda. However we can go further and we need to start judging things not just by the good conversations we have had but what we have done differently, both individually and collectively, as a result of listening to patients and carers.

The next year will not be easy for anybody in the NHS but it will be better if we start with the right intentions.

The meanings of Christmas

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So once again Christmas comes round. This is my 52nd, my first in London and good time to reflect on what this time of year means for me and others.

Christmas is the closest we have to a universal festival in this country, something which, be it in different ways, is marked by most of us and for a day puts the normal rhythm of life on hold. That for me is the first of its charms, as in an age when the tentacles of work, commerce and news stretch into virtually every corner of our waking lives it is good to have a time when we can disconnect from all of that and have some space for something more timeless.

A number of traditions come together to create our modern of festival of Christmas. One part comes from the Roman festival of Saturnalia, held at this time of year, with its powerful imagery (preserved in some of the traditions of the office party) of masters and slaves swapping places for the day.   Another part is that of the pagan mid-winter festival, a feast of the winter solstice when the day is at its shortest when animals fattened during the autumn are slaughtered and a brief plenty exists before the depth of the winter sets in.

Amidst these traditions, and linked to both of them, sits the Christian story of Christmas, God , taking on humble human form, born in a stable, worshipped by shepherds and wise men. A story which is the harbinger of peace on earth and good will to all men but also, through the gift of myrrh, of the events of Good Friday.

We also have the more modern myth of the Victorian Christmas captured, classically, in Dickens’ tale of A Christmas Carol. Many of the trappings of modern Christmas date from this period as does the sense of the Christmas spirit which, at least to start with, Ebenezer Scrooge is so reluctant to partake in.  While not Dickens’ best writing, it is a story which is becoming increasingly relevant in an age where unscrupulous Capitalism is becoming ever more rampant.

Finally, as with all our festivals, we have blended the folk and religious traditions of Christmas with all the tawdry trappings of modern marketing and commerce, elevating the figure of Santa Claus into the principal character of Christmas and letting ourselves be surrounding with a make believe world of over indulgence and white Christmases like the ones we never had.

Out of these traditions each of us makes their own particular Christmas, which while sharing much in common (less so than in 1970s when childhood Christmas were shaped by a common diet of the Queens Speech, Disney cartoons and Morecambe and Wise), has its own specific characteristics. Christmas was one of the interesting points of negotiation when my wife and I were first married as the rather understated approach of my family Christmas vied with the much more enthusiastic traditions of my wife’s family.  26 years later I think we’ve just about worked out a modus celebrandi.

A festival of plenty and assumed jollity can exaggerate the misery of those excluded from the party by poverty, illness, bereavement, loneliness or other problems. I always remember my stint as a Christmas postman when I would deliver a stack of cards to one house and push nothing more than a gas bill through the letter box of the next.  The twitching curtain at that house said a lot to me about the unevenness of human fortune.  Those who respond to those who need help at Christmas, whether the volunteers at Crisis at Christmas who entertain their homeless guests or the thousands of NHS and other care workers who staff hospitals and other services over the festive period, deserve a special vote of thanks and highlight the best side of Christmas spirit.

Christmas is also a time for families, one of the few times of the year when we still gather in extended families. It can be a mixed blessing at times, sometimes exaggerating or reopening tensions in family relationships in ways which are both difficult at the time but can also cast a long shadow over relationships through the rest of the year.  An unhappy Christmas is doubly so in contrast to the expectations of happiness with which the season is associated.

Family Christmases can also be very special occasions.  The first Christmases you have with young children inevitably stick in the memory.  I have also especially treasured the last couple of Christmases with my now ageing parents.  It has been one of the few times in the year when I have had the time to properly do something for them and those times have had a particular quality, not knowing quite how many  future Christmases lie ahead of us.

So while (with my non-conformist roots) I am not a great person for all the paraphernalia of modern Christmas I am looking forward to celebrating it again this year. It is a break from the normal pressure of life and a time to spend with my family.  It is a moment to stand outside the present and think of Christmases Past in a way which connects me more vividly than any other time of the year with my former self.  A time to count my good fortune and think of others less lucky.  Nadolig Llawen – Merry Christmas to you all.

Stress in the City

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Cities are one of the most remarkable human creations, a product and driver of our development since we started to establish settled communities in the Near East at the beginning of the Neolithic. But while cities can promote prosperity and happiness, they can also provide a paradigm for what is worst about humanity. The pressure and pace of big cities creates enormous stress for their inhabitants and extremes of wealth and wellbeing are brutally visible.

London, the first metropolis of the modern era, remains one of the greatest world cities, its iconic buildings and traditions known across the world. Its vibrancy, energy and genuine multi-culturalism are infectious and attractive but it is also a city with significant social problems which are in many cases the consequences or cause of mental ill health.  The poet A.E. Houseman was not the only one to be challenged by the harsh and impersonal aspects of London life:

But here in London streets I ken

No such helpmates only men;

And those are not in plight to bear

If they would, another’s care.

Having come back to live in the city for a second time I’ve made been made to reflect on what it takes to manage the stress of living in a big city and of the importance of raising the profile of public mental health as an essential component of what is required to promote the future prosperity and happiness of the city and its inhabitants.

I hope to write a few blogs on this subject but wanted to start today on my own thoughts on how to manage “stress on the city”. Like most public injunctions some of these are observed more in the breach but they all have contributed to keeping my sense of wellbeing in the hectic rush of the capital.

The first is the ability, in the famous words of W.H. Davies, “to stop and stare”. London is a beautiful city but too often we are tied up in the bubble of our business to notice.  William Wordsworth, better known for his love of the Lake District, wrote in 1802 of the view from Westminster Bridge:

“Earth has not anything to show more fair:

Dull would he be of soul who could pass by

A sight so touching in its majesty.”

I am lucky that my daily cycle to work takes me along a stretch of the Thames path between Wandsworth Bridge and Battersea Bridge.  The view of the river, always slightly different each day, is able to grab my attention and distract me from my ruminations about what faces me at work.  It cannot change the events of the day ahead but it can put them in a different context.

The second is connection. While the city itself is too big to relate to there are communities within it which are more accessible.  It’s been a lovely discovery to find that the neighbourhood we have moved into has a strong tradition of social events, providing an opportunity to get to know the community we live amongst in a way which the normal rhythms of London life make it very difficult to do.  Communities of interest are also important. I am also grateful for the friends and community I have been able to connect with in London’s welsh community. While at times London can be forbidding and impersonal there is something about it being a city full of outsiders which can make it more accepting of newcomers than other more settled communities.

My next reflection relates to courtesy, not you might expect necessarily the most common characteristic in London.  Many days whether on my bike or on the tube I can be left thinking just how selfish and rude other Londoners are.  As a result it is easy to fall in with the view that in the city every man (or woman) is best left looking after number one.  Yet when offered, received, acknowledged simple acts of courtesy offer a great sense of wellbeing, so much better than the momentary advantage secured by trying to get ahead of the crowd.

My fourth ingredient is the ability to break routine. London’s very busyness can make the daily round of work and other activities all the more oppressive.  A city which never sleeps is a city which never rests.  The ability to change pace, break routine, do something different or not very much at all has a profound impact on how I feel.  The discipline not to be drawn into work, not to look at my phone for at least a day a week helps make the stress of my job containable and ensures that I have some physical and psychological energy to devote to it when I return.  The ability to escape the city and seek quieter places from time to time is necessary and makes London all the more enjoyable when I am back.

My final protective factor is laughter.  It’s possible to get angry, at times, with London and Londoners but it’s so much better when it’s possible to laugh with, or occasionally at, your fellow citizens.  There’s much evidence for the psychological, and indeed physical, benefits of laughter but it’s also an expression of the ability to detach oneself from the immediacy of situations which create stress and take a different perspective on events.  There’s much to make one smile in the capital and when that is shared with others it is so much the better.

So living again in London has made me think afresh about those strategies and habits which can help protect my sense of wellbeing amidst the pressure and stress of a big city.

Paris – the need for some thinking space

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Paris and the month of November are closely associated in my mind.  Until last week that was for totally good reasons.  In 1989 we spent the first couple of days our honeymoon there and it was was the perfect backdrop for that most happy time of my life.   Last year we returned at the same time of year as we celebrated our 25th wedding anniversary.

I have probably been to Paris more often than any other city other than those I have actually lived in.  I have always loved its elegance and character with the chance, in more recent years, to broaden my acquaintance from beyond the well-known sites to discover some lesser known corners of the city.  However many times I have visited it never disappoints.  It is one of the great cities of the world, not just because it is beautiful but because of its deep culture and the values of it represents of freedom, joie de vivre, intellectual curiosity and tolerance.

From today November and Paris have a different association as I try to get my head round understanding the terrible nature of last week’s  attacks on the city and the death of so many innocent people going about their business on a Friday night.

We live in difficult times in which the regular intrusions of terrorist acts have become a reminder of how fragile, at times, the civilisation we take for granted can be.  As well as the individual tragedy for those who have lost their lives or the life of a loved one there is a sense of affront to the lives and values of many more.  The object of terrorism lies in its name and it succeeds in that aim to no greater extent than when it makes us feel that the places we know and love are no longer safe and spreads mistrust in the midst of our communities and neighbourhoods.

I do not begrudge all the hard talking and promises of retaliation which have come out of the lips of politicians and others over the last week.  I would not want to sit in their shoes and try to offer reassurance in the wake of such horrific events.  Such acts can only be condemned in the strongest language but at the same time something much deeper and more thoughtful is required if we are to find an effective response to the monstrous events which have been unleashed in our midst.  The Archbishop of Canterbury, Justin Welby, was much closer to the mark in describing how the extent to which his faith had been shaken to its roots by what had happened in Paris.  Certainty in the light of such events can only be a superficial state of mind.

So how can we can get to the bottom of what the Paris attacks really mean?  History offers some lessons.  Paris has seen similar events before, whether the St Bartholomew Day’s Massacre of Protestants in 1572, the Revolutionary terror of 1793-4, when human life has been recklessly sacrificed in the name of a religious or political cause.  However ideology is rarely the cause but rather the container of human wickedness.   The Paris massacres were no more about Islam than the Robespierrian Terror was about liberty, equality and fraternity.  However it suits the terrorists for us to see their actions as the clash of cultures and for the bonds of trust between different groups in our communities to be undermined.

What is most worrying for me is to see the deep sense of alienation at the heart of our societies.  To some extent this is nothing new but there is something very frightening in the scale and depth to which young people from a range of communities feel totally cut off from western societies whether they act as terrorists in Europe or lone gunmen in the US.  While the last thing I would wish to do is to pigeonhole such a phenomenon as mental illness there is no doubt there is a deep level of unexplored trauma and mental distress which leads what in many cases are quite ordinary young people to play out such extreme roles.

I can accept that there has to be a response.  Sad though it is these attacks, just like those of the IRA and 9/11 will lead to restrictions in freedom of movement and civil liberties.  As we know, once lost, they can take a long time to recover.  Some kind of war must be fought against IS but before we go too far we must be clear about what are tactics and objectives are and whether we can be sure of achieving them.  Even if we can be sure of winning the war we must think carefully about whether we can win the peace.  Recent events in the Middle East and elsewhere are not promising.

On a different scale we were shocked four years ago when the streets of London erupted into riots and indiscriminate violence.  A sense of alienation amongst the young and tensions between communities were again a strong factor in what happened.  My organisation was involved in responding in one of the communities affected, Tottenham.  Through the Thinking Space initiative we were involved in creating a facilitated opportunity for communities to come together and explore their experiences.  I am not claiming that it was a panacea but it appears to have done some good in opening dialogue in that community and building trust.

So my plea after Paris is for thinking space.  To recognise that however shocked we rightly are by the atrocities that have happened we need not just retaliation but actions which respond to the deeper cause of the horrific events we have seen.  For the present though “nous sommes Paris.”

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