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Professor Sir Mansel Aylward (Middle) ~ Knighted for ‘Services to Disability Assessment’
Paper By Gill Thorburn 18th September 2012.
“Few people have been involved in as many return to work or rehabilitation initiatives as Professor Mansel Aylward” [1]
I was, quite frankly, staggered to read Professor Aylward’s response to the questions posed to him about his usage of the Bio-Psycho-Social (BPS) Model and his apparent denial that his ideas have been deliberately used in the way that I and others have asserted; which is to establish a process, the Work Capability Assessment (WCA) by which the majority of the sick can be illegitimately found fit for work.
In my article on the subject [2] I believe I argue convincingly quite the opposite to Professor Aylward’s current assertions, providing examples that indicate how this has been achieved.
It is an ideas trail which leads directly back to the esteemed professor and his (and his various colleagues), efforts, (in concert with the insurance firm, Unum), to revolutionise the way in which our health related benefits are administered – with its overwhelming emphasis on ‘proving’, in the words of Chris Grayling, almost everyone capable of ‘some work’.
What the WCA most certainly is not, contrary to claims otherwise, is a fair, impartial and objective method of assessing someone’s capacity for work. And one who must take a large part of the responsibility for that situation having arisen is Professor Aylward himself.
Ruthless promotion of the BPS model
Examining Professor Aylward’s recent defence of his position on BPS, and the links that have been made between his work and the rearrangement of our welfare system, it would seem that he is now claiming to have had no influence upon the changes which have been wrought.
This is an astonishing claim in light of the manner in which he and others of his cohort have ruthlessly promoted and applied some very specific ideas about illness.
These academics, including Professor Aylward, within what I have previously termed the ‘BPS lobby’, have consistently and persistently pushed their ‘new’ notions about illness and disability until they, first successfully penetrated, and then became the sole authoritative discourse within official literature in this area.
They were able to do so through drawing on their privileged positions as leaders of medical and scientific authoritative discourse and doctrine.
We should remind ourselves too that welfare policy is to all intents and purposes a form of law, which in the case of welfare benefits is very strenuously applied.
Results of failure to comply are severe, and punished mercilessly by the modern system.
Those stigmatised as ‘scroungers’ or ‘malingerers’ are afforded zero tolerance and enthusiastically chased to ground and pilloried in our contemporary society.
All the more reason, then, for the ideas which have fed into those administrative instruments by which people’s health is assessed to be above criticism, and fair and just, avoiding adding to any stigmatisation of illness and disability.
On 11th September Professor Aylward claimed to ‘sympathise’ with the ‘grievances’ raised by the disabled community.
He hints that the address he had just given about the BPS model contained criticism of its current application with respect to disabled people; that he now finds it ‘unsatisfactory’, because it “no longer addresses the exclusion of disabled people from society”.
When did it ever, professor?
It is not the BPS model itself that people are outraged by, Sir; but the uses to which it has been put.
And that has been to further ‘exclude’ sick and disabled people from society by further disabling them through adding demonisation to their stigmatisation, and financial penury to their already disadvantaged economic situation.
And all this has been accomplished via the Atos-administered WCA, built as it was on ideas about ‘illness’ culled from your literature, and that of the insurance firm Unum, whose processes have been aptly described as ‘disability denial factories’.
Meaning of the ‘social’
Professor Aylward wishes that people would believe that he had never taken any other view than that “the social element has been neglected” in the application of ideas from BPS.
But what exactly has been the professor’s use of the ‘social’?
That he proposes that this has been neglected in the application of BPS is something I agree with wholeheartedly.
The potentially hazardous effects of that most ‘social’ activity of work have been elided, quite deliberately, by he and his colleagues.
In fact, Professor Aylward has gone to extreme lengths to persuade both medical practitioners and the wider public alike that we all have the wrong idea about work posing possible hazards to health.
The positive benefits of work have been hammered home regularly in the publications and research conclusions at every possible opportunity.
Not only that, but Professor Aylward has decreed that all dialogue about work should be changed, all those ‘erroneous’ ideas that work contributes to poor health must be reclassified as ‘myths’, and work reconstituted in our minds as an essential component of recovery from illness; for everyone, no matter what degree of illness they suffer. [3]
Considering the strong emphasis on ‘work’ in that aspect of his literature, is this the form of the ‘social’ that Professor Aylward is drawing upon?
It appears not.
On the release of his co-authored scientific book ‘The Power of Belief‘ [4] Professor Aylward gave a presentation around its themes to a joint meeting of the British Psychological Society and Association of British Psychologists.
In a graphic which describes the three elements of BPS the ‘social’ is defined by three keywords: Beneath the vague, undetermined ‘culture‘ and ‘social interaction‘ we find: ‘the sick role‘ [5.,Slide 18].
For anyone unaware of this concept, it promotes, among other things, the notion that a sick person has much to gain from ‘playing’ the sick role.
Patients are portrayed as accruing certain advantages from being ill (or merely claiming to be so).
These are so-called secondary gains such as ‘exemption from ‘performing’ in society, and from social responsibilities, as well as receiving attention and help that those who do not claim sickness cannot’.
Those are the ‘rights’ that sick people enjoy.
On the other side is the obligation to do everything a person possibly can to get better and participate fully in society.
The problem around this, of course, is the assumption that illness can always be recovered from, that the sick will always heal.
This is a notion which is not only unhelpful, but is positively harmful when the sick role is attached to the long-term, chronically ill.
This, however, is the very aspect of ‘the social’ which Professor Aylward evidently gives priority to in his theories.
And it is exactly that idea which is incorporated within the WCA, whereby chronically sick people, with progressive and sometimes terminal illnesses are being forced into a perpetual round of reassessment, the black-magic roundabout administered by Atos, just in case they have magically become ‘well’.
When we have a situation of someone with Down’s syndrome being asked at their WCA how long they have had that ‘condition’, it is not hard to visualise that she too will be continually reassessed to see if her ‘condition’ improves over time.
Atos, too, endorse concept of ‘secondary gains’ when assessing illness
This idea of the ‘sick role’ is mirrored in an Atos publication of 2004. [6]
If any doubt remains about the way in which Atos regards those who are subjected to its formulaic tick box assessment process then this publication will dispel them. A side panel of the document authored by Dr Christopher Bass is entitled familiarly “Symptoms that defy explanation” and includes a helpful list of conditions that fall within this category, including:
Chronic Fatigue Syndrome
Fibromyalgia
Chronic back pain
Repetitive Strain Injury
Non-cardiac chest pain
Dr Bass then proceeds to make much of this concept of ‘secondary gains’ that presumably accrue from claims to these particular types of ‘common’ illnesses, describing them thus:
“Work absence as a reward for years of struggle; turning a socially unacceptable disability into a more acceptable ‘organic’ disability caused by injury or disease beyond their control. They can blame their failures on the illness; elicit care, sympathy and concern from family and friends; avoid work or even sex; and there are financial rewards associated with disability”.
I don’t think I’ve ever seen this defamatory notion expressed quite so blatantly towards the members of the sick and disabled community.
But then again, this is Atos, who have proven themselves to be Teflon against all legitimate complaints that have been made against them.
We think therefore we are…
That ‘version’ of the ‘social’ aside, in practically all Professor Aylward’s work there seems to be nothing but the remorseless application of the psychological, at the expense of any consideration of the social.
“The Power of Belief” [4], was published at the time of the Unum funding of the Centre at Cardiff University under his directorship.
An illustrative chapter title from this collection is “Explaining unexplained symptoms: The role of beliefs in clinical management’ : This volume is a multiple contributor work which centres solely on the idea that how people regard their illness is the most important factor in determining the course of it.
Not their physical limitations; their pain; the barriers their condition puts up between them and everyday social functioning; the distress arising from having an impaired physical (or mental) interface with which to negotiate a society which caters only to the able-bodied.
No, none of these have as much validity or significance in a sick person’s life than what they ‘think’ about the state of their bodies.
This one notion makes it possible to place the blame for someone’s inability to function successfully in the world squarely on their own shoulders, and has made possible, too, the idea that people can ‘recover’ if they only adopt a positive attitude towards that end.
This latter idea too, not only holds a special significance within both the professor’s personal ideology and his literature, but is highly implicit in the justifications for the increasing numbers forced off Employment Support Allowance who are portrayed as needing to have ‘tough love’ applied by their government, lest they ‘fester’ on benefits.
An interesting reference is made within the book’s introduction to the rise in ‘symptom based conditions’ and, as I will cover in a follow up to this piece, this is a concept which has been treated by Professor Aylward in two totally contradictory ways, at different points in time, an action which can only seriously call into question his motives for doing so.
Medicine is the ultimate authority, except when it doesn’t concur…
I have previously written [1] about the inconsistency of the way ideas from the BPS model are used by Professor Aylward and his colleagues – that they are inevitably used in a plastic way, and opportunistically.
When the argument calls for ‘authority’ to substantiate their ideas, such as suggestions that some illnesses lack validity, medical aspects are drawn upon, as is implied in their reference to ‘medically unexplained’ conditions.
In all other cases the ‘medical’ model or ‘bio’ aspect is disparaged or minimised, as, too, are medical personnel. GPs and specialists, are robbed of their authority; and their capacity to determine a person’s capability to function is questioned.
In fact doctors must now be themselves ‘indoctrinated’ to some extent into the ‘new paradigm’ [7].
This taken-for-granted factor, though, is seen as only one influence on them, since many are accused of being of weak character or of ignorance, through ‘fear’ of repercussions from patients should they deny the requested sick note [8], or through their lack of awareness of the positive part that work supposedly plays in recovery for their patients.
They are denied, within BPS ideology, the capacity to exert any form of judgement in any given patient’s situation over whether work would be a help or a hindrance to getting well.
Their reticence to wholeheartedly swallow this new paradigm is constructed as a (misdirected) stubborn commitment to an irrelevant ‘medical’ perspective on sickness and disability.
It is difficult to perceive this as anything other than an attempt to downplay medical authority when it does not suit the ideology or the ends that the Professor Aylward and his BPS lobby are seeking.
SNORB – Indoctrination for the Doctors
What is SNORB?
The acronym stands for ‘Sick Note or Bust’, a slogan whose meaning is difficult to grasp.
Perhaps it makes more sense to GPs, who are its intended targets.
Could it perhaps be meant to represent the attitude of patients who are determined to ‘get signed off’ at all costs?
Regardless, SNORB is an initiative created by Professor Aylward’s Cardiff Centre and is part of a campaign to ‘turn around’ GPs’ thinking and change their behaviour around the issuing of sick notes to their patients.
Its existence came to the fore through examination of yet another presentation given by Professor Aylward, containing the inevitable repeated themes which seek to link work and health as mutually beneficial partners.
This time it was at a ‘Rehabilitation Workshop’ – for insurers, with a panel composed of representatives from the major insurance companies, NFU Mutual, Legal and General and Axa. It’s title is ‘Health and Work: The Moral Obligation’ [9]. As indicated the themes consist of ‘Work is the main (only?) route to wellbeing’, and ‘The most significant obstacle to recovery is found within the psyche, in people’s beliefs about illness’, and so on ad nauseum.
The BPS lobby pave the way for a later discrediting, or minimising, of that which they intend to disparage by framing it in terms of a ‘mystery’ or ‘paradox’ or as a set of ‘myths’.
Thus (in this presentation, slide 8) an alleged ‘Health paradox’ of improvements asserted to have been made in health outcomes versus increased insurance claims is constructed.
As pointed out also in my article (1), conclusions made about health by these academics are demonstrably flawed, relying on interpretation of data which favours simplistic over-generalisations that overlook such things as unequal distribution of illness across classes, or hierarchical levels of employment, or indeed geographical location.
Once, however, the seed of doubt has been planted, and a shroud of mystery has been cast, it is a small matter to finish the job of delegitimisation, to render invalid commonly understood notions about illness or disability through proposing a ‘solution’ which by contrast appears clear, pragmatic and founded in comparative rationality.
SNORB is introduced to this insurance fraternity following the heading ‘Why GPs don’t want to know’, under suggestions for the removal of ‘barriers’.
A description of SNORB ‘training’ materials for GPs would not do it justice and a visit to the website [10] is necessary to fully appreciate the manner in which our doctors are being encouraged to conduct their dialogue with patients about work: I do not use the term ‘indoctrination’ lightly in this instance.
‘Objectivity’ sometimes vital, sometimes not – Two contradictory presentations
The BPS lobby take a similar attitude to ‘objectivity’, the cornerstone of any professed scientific method, as they do to ‘medical authority’.
When it suits the professor’s desired aims to emphasise the importance of ‘objectivity’, for example in order to diminish the validity of certain conditions, those categorised in his account as ‘subjective’ or ‘symptom based’ (i.e. depend largely on personal accounts of pain, discomfort and distress), then this is done.
But when the desired effect is to inject some doubt into existing ways of assessing capacity in illness, (i.e. via the ‘medical model’) Professor Aylward depicts ‘objectivity’ as far less reliable or even achievable.
At one end of this scale a presentation which the professor gave in Amsterdam in 2007 for occupational and insurance physicians, ‘The Assessment of Work Capacity in the United Kingdom’, [11] begins with the astonishing claim that:
“The assessment of Work Capacity is frustrated by the meaningless pursuit for objectivity”
The presentation ends with a call to:
“Abandon the forlorn pursuit of objectivity”
and to
“Embrace the bio-psycho-social paradigm shift”.
The cult-like appearance of these last two phrases comes as no real surprise since their objective is to bring about a kind of brainwashing effect into a new ‘way of thinking’.
Revealingly, a note attached to the presentation declares that incapacity benefits are a “big area of reform” by which the employment rates of sick and disabled people may be increased.
Are we really expected to believe that the professor has not had continuing involvement, indeed influence, in these reforms?
Contrarily, Professor Aylward’s presentation at a Sydney conference three years later, entitled ‘Realising the Health Benefits of Work’ [12] to ‘leaders’ from Australian government and industry depicts ‘objectivity’ quite differently.
Here it is presented as a taken-for-granted final arbiter of fact.
In this case it is used, as it so often is by the BPS lobby, to undermine the validity of a range of health conditions, including mental health, musculo-skeletal and cardio-respiratory conditions.
Such illnesses are minimised by alleging that they show “Limited objective evidence of disease”.
WCA – an ‘objective’ tool for assessing ‘Work Capacity’
It is disconcerting, when the professor is so particularly adamant about so many of his assertions to see how flexible a concept ‘objectivity’ becomes in his hands, being capable of being raised or dismissed at will, apparently dependant on which underlying agenda he intends to fulfil.
Considering that the major claim to legitimacy of the WCA is that it is impartial, through being built upon objective scientific principles, if as he asserts ‘objectivity’ in the assessment of Work Capacity is unattainable, then this completely undermines it as an authoritative instrument, and proves it to be a fraud.
A fraud with devastating consequences for tens of thousands of innocent sick and disabled who are being denied support on its basis.
It may seem like splitting hairs to draw attention this way to the use of words. But when words are used to convince governments to undertake policy changes which aim to remove support from an estimated million people there really had better be clear, robust and consistent arguments to support them.
If I were to challenge the government on an issue, and let’s imagine for a moment that it bothered to give me a reasonable reply, it would take a familiar form.
Statistics would be quoted, plausible arguments raised. I would be pointed in the direction of those who had produced the research and whose credentials I should trust to have produced honest, impartial, and yes, objective work.
This cannot be said to be the case with the WCA.
What we have instead is a process whose intellectual origins are worse than dubious, permeated (and therefore tainted) with vested interests of one type or another, and the academic substance of which is wanting and inconsistent at best, seriously biased and compromised at worst, contaminated by an association with private profits.
As a result of it the government is pushing people off benefits faster than Disney threw lemmings off a cliff.
This is Professor Aylward’s legacy, and he is clearly attempting to extricate himself from his indisputable and powerfully influential involvement in facilitating it.
Refuted connections
One of the ways that Professor Aylward is now attempting to distance himself (which in my follow up to this piece I will show is not a first for him) from what is becoming incontrovertible proof that the WCA is a fraud perpetrated upon the vulnerable, is through claims that his input into the development of this process has been minimal, and connected only vaguely to work on assessments he did while in previous service at the DSS.
Why then does he display the acronym ‘DDAM’ among his string of qualifications [13], since ‘DDAM’ is the Diploma in Disability Assessment Medicine, a qualification specifically developed for HCPs administering the WCA – the training and accreditation for which is delivered solely by Atos Origin [14].
The primary academic reference for those studying for this qualification is the Disability Handbook [15], co-edited by Professor Aylward together with his ex-DSS colleague Peter Dewis [16]
Both these doctors left government service to work for insurance firm UNUM, albeit for Professor Aylward it was under the umbrella of academic ‘funding’ provided by that company, though he must have necessarily been involved in negotiations with that company prior to leaving his government post in order to put that in place.
Further, a third co-editor of that book, Dr Moira Henderson went on to hold the post of Chief Examiner for the DDAM from 2003 until 2012 [17]
Dr Dewis‘ involvement with the WCA is substantial
UNUM have described him as having “been instrumental in the setting up of the diploma of Disability Assessment Medicine of the Faculty of Occupational Medicine of the Royal College of Physicians” confirming that he “continues to work as an examiner for that diploma”.
The 2005 UNUM page which attests to this has been removed, but Zoominfo has links to a cached version of it here: [18]
A further reference on that page refers to the ‘leading role’ that Dr Dewis has played in the “development of disability assessment medicine”.
The ‘Disability Handbook’ is quite obviously the authoritative work on which the WCA was built and from which disability assessment has been sourced, and to which all who deal with disability in a general sense refer, bearing as it does the authoritative stamp of the UK government.
Does Professor Aylward wish us to believe that although his co-editors of such an influential work have gone on to become further embedded within the Atos process, that despite being by far the most senior, influential, member of the group, and despite he himself holding the DDAM qualification, he has had nothing further to do with it?
This, while he has continued to work closely with his Unum-employed colleague, Dr Dewis [18], who now holds a Directorship with that company following an initial tenure as Chief Medical Officer ?[17]
Is it really credible that Aylward would be so uninformed about Atos and the WCA?
This information about Peter Dewis, by the way, is all the confirmation that anyone should need as proof of the direct connections between Unum and Atos, since he quite obviously works for both simultaneously.
That, and the fact that Michael O’Donnell, now Chief Medical Officer since 2011 with Atos, held that exact same role for ten years with Unum.
Though this is quite openly public knowledge, it is evidently not regarded as any conflict of interest by our government, despite Unum’s quite blatant attempt to capitalise on the increased precarity caused by these ‘reforms’ with their ‘Income Protection Insurance’.
Integrity – when one finds that the boot is on the other foot
Conscious perhaps of the emerging exposure of the profoundly influential role he has played in the WCA, and evidently experiencing a feeling of vulnerability concerning his reputation, Professor Aylward makes the plea of professing himself to be “a man of integrity”
Whether indeed he carries out his implied promise to ‘speak out’ if he ‘finds the WCA is not proper’ will demonstrate whether this is the case.
What cannot be overlooked is the fact of the, now hundreds of thousands of sick and disabled people who have already had their integrity spuriously attacked via the humiliating, fraudulent ordeal that is the WCA, the repercussions from which have damaged far, far more than their reputations. And the root of which is without any shadow of a doubt Professor Aylward’s work.
Gill Thorburn 18th September 2012.
Update: Welfare Reform: ‘The Hidden Agenda’ by Mo Stewart Posted on April 18, 2013
References
As some of the material referred to is in the form of pdfs and powerpoints I have made them available through my dropbox account. The rest are weblinks.
[1.] Professor Mansel Aylward – The Interventionist https://dl.dropbox.com/u/32109159/Aylward/01.AylwardTheInterventionist-PostOnline2009.pdf
[2.] http://www.internationalgreensocialist.org/wordpress/?page_id=1716
[3.] https://dl.dropbox.com/u/32109159/Aylward/03.Waddell.WorkIsGood.ppt
[4.] http://www.amazon.co.uk/The-Power-Belief-Psychosocial-disability/dp/0198530110
[5] https://dl.dropbox.com/u/32109159/Aylward/05.Sept20BPSCardiff.pdf
[6] https://dl.dropbox.com/u/32109159/Aylward/06.AtosConference2004.pdf
[7] https://dl.dropbox.com/u/32109159/Aylward/07.DWPForDoctorsWorkIsGood.pdf
[8] https://dl.dropbox.com/u/32109159/Aylward/08.Aylward.GPs.pdf
[9] https://dl.dropbox.com/u/32109159/Aylward/09.RehabilitationWorkshopForInsurers.pdf
[10] http://www.healthyworkinguk.co.uk/uploads/decision_aid/resource/snorb/
[11] https://dl.dropbox.com/u/32109159/Aylward/11.Aylward.AssessmentOfWorkCapacity.ppt
[12] https://dl.dropbox.com/u/32109159/Aylward/12.Aylward.RealisingHealthBenefitsWork.pdf
[13] http://www.debretts.com/people/biographies/browse/a/25041/Mansel+AYLWARD.aspx
[14] http://www.fom.ac.uk/education/non-specialist-qualifications-and-training/diplomas/ddam
[15] http://www.fom.ac.uk/wp-content/uploads/ddamread1.pdf
[16] http://www.wharfside.org.uk/events/disability_handbook.pdf
[17] http://www.fom.ac.uk/general-news/new-chief-examiner-diploma-disability-assessment-medicine-ddam
[18] http://www.zoominfo.com/#!search/profile/person?personId=508408589&targetid=profile
[19] https://dl.dropbox.com/u/32109159/Aylward/18.Aylward.Unum.Cardiff.Issue1.pdf
Gill writes:
I’d just like to say how gratified I am to see my work be of some use to the community and isn’t it marvellous that the internet makes it possible for us to spread and share information in this way?
I’ve said before that without all the myriad of material that others have put online I wouldn’t have been able to put together such a strong argument. It’s very important that we keep doing this!
And in that context I would like to give a credit to the Issuu user ‘maxhead’ from whose account I sourced some of the material referenced in this article. They have more documents of interest here: http://issuu.com/maxhead
Also for anyone interested in witnessing a thorough academic ‘thrashing’ of the ‘psychogenic’ approach to physical illness I would recommend getting hold of Angela Kennedy’s new book “Authors of our own misfortune?” which I ‘m currently reading.
I think it will become an important volume in the intellectual struggle against these appalling ‘reforms’.
It’s now available at Amazon:
http://www.amazon.co.uk/Authors-Our-Own-Misfortune-Explanations/dp/0857181017
See also:
Welfare reform and the US insurance giant Unum
New Labour, The Market State, and The End of Welfare by Jon Rutherford
La Familia: The corporate cartel behind the welfare reform agenda
Black Triangle and DPAC Confront Professor Mansel Aylward at IFDM2012 Imperial College London
Former DWP medical boss Sir Mansel Aylward makes WCA pledge to protesters ~ Disability News Service
Professor Mansel Aylward ~ My! What ‘A Very Tangled Web’
Unum Influence in the UK Continues to Wreak Havoc
Private Eye Raises Questions Regarding Unum
A fascinating article and obviously from someone who is an expert in the field. My comment is not on the content but rather on the presentation. The mixture of bold, italic and underlined text, along with web links, makes it well night unreadable. Sorry to be a nitpicker, but my eyesight is reasonably good an I struggled. Might be better to use plain text only?
Phill
We began the post with this: This paper has been formatted for ease of accessibility. Please find the original version of this article here
A great article Gill! I agree with every aspect of what you have forensically examined. I feel Professor Aylward has rather fallen into his own BPS Mechanism, and is slowly being drawn apart. A man who tries to distance himself from his own rhetoric is one who suffers from a guilty conscience! One who attempts to divorce himself from his professional missives is a man whose conscience threatens to devour him whole. For all the Bio-Psycho-Social Model is ‘supposed’ to have some profound meaning, it fails to ‘prove’ a damn thing. There is as much relevance in Kellog’s Enemas as there is in all of the esteemed Professors Works, and probably more greater value too. Surely the mind-numbingly tedious notion of “healthy mind equals a healthy body” encapsulates the whole of the encyclopaedic nonsense that tries to pass itself off as “Science.” The ever present danger of ever allowing any Scientist the freedom to pass their concepts directly from the unproven, untested and irrelevant ‘laboratory’ of professional opinion into the ears and minds of Parliamentary or Government Ministers has always threatened those who, by dint of painstaking research, investigation, repeated (and more importantly ‘repeatable’ ) experimentation and the collection of multiple examples of proofs carry out their Science within expected levels of conscious professional and mathematical discipline. Anything that provides neither Empirical Data nor any form of reliable Statistical Data should be dismissed as ‘worthless.’ I think Professor Aylward has wasted much of his professional reputation in the pursuit of a Weapon of Science: one might suggest a new WMD that Government could put to any political purpose it desires. That is perhaps his greatest folly? Yet Aylward must yet face the ignominy and rebuke of disabled and sick alike because of the numerous suicides he has unwittingly (or perhaps through sheer professional conceit and ignorance) tainted his and every other hand which has attested to the subject matter used to wage a propaganda and social injustice “War” against the “most vulnerable.” In my opinion Aylward has less chance of thinking himself into a state of ‘innocence’ over those needless deaths, [triggered by the application of his allegedly “scientific” evidence through the Work Capability Assessment] than the young, terminally ill man I met some months ago who has since, slipped into the final stages of pancreatic cancer, being able to “think himself well.” BPS is a joke, a very bad joke with a very unfunny punch-line. It’s Medical methodologies have no basis in fact. It’s Psychological analysis is spurious at best and it’s Sociological analysis is actually more like the musings of an undergraduate thesis! There is not a single idea that is original: for every concept has been discussed by every Victorian quack!
Gill Thorburn’s analysis strips bare the corpse of the Bio Psycho Social Model, paring back the skin of Professor Aylward’s studies to reveal the hollow bones of mid-Victorian early debates about Diagnosis and the Nature of Illness. She brilliantly illustrates and highlights inconsistencies in Aylward’s ‘theories’ and a history of dismissive ambivalence towards any notion of proof, evidence or the creation of a body of research and /or Empirical Data which directly supports his assertions.
When ‘bad science’ is used to prop up the intolerances, bigotries and prejudices of Government and Governmental Authorities the outcome is always one where the policy of Government appears elevated and authoritative, even though the ‘science’ behind the Politics is actually being used to justify far-reaching, objectionable and even cruel political policies.
What is ably shown in the article is a full understanding of many of the aspects of the BPS Model which most people (disabled and able bodied) may well be unaware. There is much to be learned, and through people like Gill we are ALL better informed.
that’s right I have *so* much to “gain” from being incapacitated – I get to “gain” poverty, I got to gain the loss of my business and income, I got to gain the loss of my home, I gained the loss of an ability to drive myself most of the time, I gained the joys of constant pain, I gained the delightful surprise of random severe agonising muscle spasms, I gained the embarrassment of having to ask for help to do the most basic things, I gained the inability to care for myself, I gained the pleasure of being housebound (and no I don’t have a tv, or games consoles, or a broadband internet line – just an old second hand computer and a small data limit on tethering via an outdated mobile I got for free because no one else wanted it). I gained the loss of my social life, oh yes and I gained LOTS of lovely medical appointments.
Yup, so much to gain from a spinal injury, why on earth didn’t I do it sooner?
I’d just like to say how gratified I am to see my work be of some use to the community 🙂
And isn’t it marvellous that the internet makes it possible for us to spread and share information in this way? I’ve said before that without all the myriad of material that others have put online I wouldn’t have been able to put together such a strong argument. It’s very important that we keep doing this!
And in that context I would like to give a credit to the Issuu user ‘maxhead’ from whose account I sourced some of the material referenced in this article. They have more documents of interest here: http://issuu.com/maxhead
Also for anyone interested in witnessing a thorough academic ‘thrashing’ of the ‘psychogenic’ approach to physical illness I would recommend getting hold of Angela Kennedy’s new book “Authors of our own misfortune?” which I ‘m currently reading.
I think it will become an important volume in the intellectual struggle against these appalling ‘reforms’. It’s now available at Amazon:
http://www.amazon.co.uk/Authors-Our-Own-Misfortune-Explanations/dp/0857181017
Very good piece. Thanks for this.
What do you think about the government sponsored research done last year (I think) which found that only 20% of Uk employees are neither obese nor have at least one health condition? This large-scale survey of the UK workforce has, unsuprisingly, not been widely publicised. But if only 20% of employees are neither obese nor unhealthy, then of course the government want to ensure we all think it’s fine to keep on working regardless of chronic illness. It seems to me that despite increased longevity (probably largely due to the NHS) general levels of health in this country have deteriorated in the last 30 odd years and will continue to do so, especially under the present government, because neoliberal economics has greatly worsened inequality. Economic inequality has been shown in The Spirit Level and associated research to be related to poorer health, decreased longevity and a plethora of social problems.
It’s all so depressing. Cameron would be happier rounding us all up and shoving us into the gas chamber. I can’t believe he actually had personal experience of disability.
Yes, just after reading the notice that states “Work Makes You Free”. They are slowly and inexorably changing it to “They Make You Work For Free”. And we all know what happened to those unable to work.
First of all I should like to thank you for your dedication to this cause; the research you have done to write this article amazes me.
When ever I hear this BSP rubbish spouted it makes me so angry. My mind is drawn back to my youth when I used to watch miners walking to the coal pit ( a 3-4 mile walk) to then spend hours working seams only 3-4 feet high, I think of how work ENRICHED their lives as I recall their stooped figures walking by ; years of working bent double had made it impossible for the older men to stand straight. They were the lucky ones. My great grandfather was badly injured in a mine explosion. He was retired with a small pension. It makes my heart bleed to think that, if it was now in the 21st century, ATOS would have found him fit for work. The BSP model seems to deny that years of hard physical labour has an immense effect on the body. I have seem so many history programmes where ancient bodies are examined and their bones tell a story of hard physical labour which has contributed to their death. Yet in the 21st century we are being sold the idea that “Work heals us” “Work is Good for us”. I do agree that keeping ones mind active and doing as much exercise as you can is beneficial, however where the Government/ATOS/DWP are concerned this is not the agenda. If they were acting in an altruistic way to try and benefit the health of the sick and disabled why are they closing Remploy factories? The WCA assessment is designed not to help us but mearly to save the government money. The BSP model is designed to add to the stress that chronically sick and disabled people suffer and also to reduce their income to starvation levels. I read recently that 47% of people found fit for work, have not found work and have been too ill to register with JSeekers. They are currently receiving no benefits at all. In other words they have £0.00 income. Some are supported by family, some have resorted to begging, but the truth is no one knows how many are left stranded, alone and slowly dying of starvation.
I really salute the writer of this article for all the dedicated research she has done. I dearly hope that this work will be very widely shared and spread. The architects of the current welfare “reform” scandal need to be held to account, now, and redress given to all the sick and disabled people who are being made to suffer. Sadly of course, it’s too late for the poor souls who have already died.
There is also a view amongst the medical profession that chronic pain is caused by depression because most people with chronic pain are depressed. I was sent on a pain management course at my local hospital where this view was put forward. I pointed out to the psychiatrist that I didn’t become depressed until I’d been in pain for over three years, to which he replied that I was probably depressed during that time and I just wasn’t aware of it. So I offered the following scenario to him:
You are not depressed at the moment, but imagine that starting at midnight I follow you around all day every day. When you get up in the morning, I kick you in the testicles as hard as I can. When you arrive at work, again I kick you in the testicles as hard as I can. I do the same when you stop for your morning coffee break, when you stop for lunch, when you start your afternoon shift, when you have your afternoon tea break, when you arrive home in the evening, and when you go to bed.
I bet that within a few weeks you would be extremely depressed. And that would be from what is only intermittent pain. I have had chronic pain 24/7 for nine years. After that I think that I am entitled to be depressed. I hope that you can now understand that it is chronic pain which causes depression, not depression that causes chronic pain.
He was silent for a good five minutes, and then said “I see what you mean. What I was taught, is clearly wrong. From now on I’m going to help people cope with their depression and pain as best I can. Not tell them that they would be pain free if they weren’t depressed.”
So I managed to get one psychiatrist in one hospital to change his view, but there are still thousands out there who still believe that “it is all in the mind.”
Dave,
Makes perfect sense to me.
My sister has gone/going through similar and is currently trying pain killer etc to find the best for hers amongst other things.
Reading your post helped me understand her depression better from the pain she is going through – thank you
p.s. would you agree that dealing with the cause of the pain is the key element then? I hope you get the help you need.
I certainly would agree that dealing with the pain must be the priority. Is your sister aware of the PainSupport web-site http://www.painsupport.co.uk/index.asp? This is a free to access site (not even a membership fee) for people with chronic pain, and there is a lively forum http://www.painsupport.co.uk/connect/dfviewtopics.asp where questions can be asked, and answers given by those with practical experience of chronic pain. If your sister uses the search facility she could find information of the various combinations of medication that have worked for other people. Just “talking” on the forum to people who genuinely understand helps reduce depression. The “Laughter is the Best Medicine” thread is my area of expertise, and I try to get at least 1 joke per day put up but often fail…
This man and his discredited work are beyond rationality. This type of pseudo science can only be used for political gain and the advancement of bigotry, ignorance and stupidity among those who know nothing of the lives of those in the Disabled community. Neither do they know of the conditions in which we all bravely contend with on a daily basis. If i were in charge of the body which this man belongs to i would strike him off, as what he says has no basis in reality. Maybe he should just get one of the imagined illnesses, yes Fibromyalgia would be a good one i feel.
I just need to point out that I’ve discovered that during changes made during my own editing I neglected to update one of the references, so that when I refer to my original article on the subject it should link to ref [2], not [1] which is a copy of an interview that Aylward gave. Just wanted to avoid any confusion!
The ‘plain format’ link that BT give at the top has already been corrected.
And to everyone, as ever, I am totally knocked out by what people contribute in comments on these articles. The personal stories and observations always get to me, and particularly the fact that everyone is informed and comes to their conclusions through their actual experiences of life. Very much puts these ‘theories’ invented by Prof Aylward and his ilk to shame.
Great article Gill. Where do you think Aylward stands with “learned helplessness” and disability? I think Martin Seligman’s “psychology” is also having an effect on social security policy, a poisonous effect.
http://www.guardian.co.uk/commentisfree/2011/jul/28/david-cameron-disability-benefits Stuck in a 90’s timewarp …and no it wasn’t New Labour that started all this …it was Free Market zealot Peter ” I’ve a little list ” Lilley during the Major Tory Govt …there were ” coincidental ” adverts for Unum / Unum Provident ? in the press at the time …this didn’t go unnoticed by ” Private Eye ” but a conflict of interests was denied …so that’s all right then as they say in The Eye
It’s just an extension of the silly American idea about positive thinking, I found this interesting.
http://writing.gather.com/viewArticle.action?articleId=281474981510783
Great article, read it and feel i understood a great deal of the detail. After reading your comments here I can only add my 2 cents (which unfortunately is kinda playing devils advocate, but hopefully it has some worth)
As we all know the ruling factor for the government is balancing the books. This is so vastly complex and opinionated that it is carried out in a modular form by ‘experts’ taught by previous ‘experts’ and so on.
These people have recently had newer and newer statistical system access and the system is always changing influenced by power and opinion more than we would ever like it.
My point is, the system is trying to save money on the increasing numbers of ‘claimants’ who play ill to live off of money that coul dbe used in a better way. I understand that the people it affects must go through hell, but our system is evolving and trying to find ways to defend itself against claims that ‘my back hurts, so pay my bills please – forever’ has become a non-disputable state of life for so many fraudsters that, in my opinion, have no honour and self-respect.
This new system is wrong for the genuine claimants and should be more carefully administered, but the false claimants have nothing better to do than say their problem until they believe it themself and try to convince others their lie is truth, because until its disproven, they keep their benefits.
Instead of pulling the system apart, why not devise a system that no longer leaves the window open for the false claimants and considers the complex issues that are already being included and present THAT system as an alternative. If it uses a reliable method to determine the ‘definitely false’, ‘probably false’, ‘probably genuine’ and ‘definitely genuine’ catergories based on FACTS, then it seems you have a perfect new system that can be modified as new medical info is proven.
The issue is the system shows the powers that be a shift of benefit claims, and a shift usually means a loophole or trend due to other factors, and they try to address the issue directly instead of finding the problem.
…For example, we all know wages are rising slower than housing, and letting is slowly taking over the country. People who can’t get a mortgage like their parents had are feeling less inclined to work for rent and cannot get a job that pays enough for the place they want and feel they deserve. These people are usually unskilled workers and run in the circles of people who come from generations of ‘system players’. These people advise them of the ‘loopholes’ and ‘how to play the system’ and so it perpetuates. When the government ses this proportion of people rise and the benefits outgoing increase, do they drop house prices or give away mortgages?..no, they try to stop the age ranges of people who can get a council house, so these people get to stay home with their parents, and then we get another problem. (p.s. I am none of the above, am a homeowner and have only had 2 weeks off work since I was 14, except holiday etc, worked during my studies between 14 and 18, and am now in my mid 30’s, and have no kids yet)
I applaud and respect the genuine deserving claimers and wish we could make their lives better, but we need to create a system that catches the bluffer and supports that with proven evidence so the tax drain is reduced. Then the reduced genuine claimers can be given more as there is more stretch in the budget to reward them for the hard work they usually give before their unfortunate need arises. As other may have already said ‘what if it ‘genuinely’ happened to you?’
…and in respone to ‘scrapheapchallenge’ : The people who fall from the height you mentioned are the first i’d put as ‘probably genuine’ as you had nothing to gain through it’ the ‘probably false’ and worse usually come from people never to have worked, or built up anything to lose, and are the ones who need checking, as they usually had to gain from falsely claiming.
Sorry if I offend anyone but I am trying to be level-headed.
Economic Bob, thank god we live in a democracy still and that nobody has spurted any bile at what you say.
I was treated as a potential “scrounger” by the system, despite loads of medical evidence (facts) that I had serious problems and these problems were degenerative and life-long. A failed WCA and tribunal made my condition much worse and so I have to receive more and expensive treatment. So I was ruled fit to work, then my GP said no absolutely not fit to work, then not able to look for work as I am not insurable because I am a health risk to myself and others but still not able to claim social security. So out of that episode any costs saved by DWP were wiped out (and overtaken) by the expense of specialist treatments and medication to the NHS.
The fraud rate of ESA is less than 1%, this means over 99% of claimants are not fraudsters. The Daily Mail always gets this wrong.
Anyone who is on ESA is reassessed, even those with cancer and have undergone treatment, even those in kidney failure and undergoing dialysis. There was a case of a person with Down’s syndrome being asked “when will you get better?” and a man with an arm missing from before birth being asked jokingly “When will it grow back?”
Once you start thinking about “deserving claimers” you are creating an even more divisive society. Think of Germany in the 1930’s and the treatment of the disabled- forced sterilisation to begin with and then the right to life denied them by the state and a passive populace. This was all based on spurious “medical facts” about eugenics.
Much better for the UK to go back to the Personal Work Assessment where the GP’s opinion based on the medical history and examination of his/her patient actually counted and was respected by the DSS.
Your point about “experts” learning from “experts” is valid. Interestingly the Scottish Parliament have brought in a Dane, Jon Kvist, to help formulate a unified social security plan for a devolved Scotland. While he is an expert, he is far removed from Aylward and his like and so won’t pass on the same Wesselyian biopsychosocial bias that dominates Westminster and Whitehall.
A sensible approach, but the figures given out by Government are actually false. Out of the disabled benefits, a freedom of information request established that only (if I remember correctly) 0.7% of claims are wrong, but out of that over half of the wrong payments are due to Department for Work and Pensions errors rather than fraudulent claims by claimants, and of those down to the claimants fault around half are due to unintentional errors where people have made a genuine error in completeing the 32 page claim form, so the actual number of deliberately fraudulent claims is very small indeed, about 0.17%. The percentage of MPs who made fraudulent claims on their expenses is much, much higher, yet they are claiming the moral high ground.
Pure evil. Demonising extremely sick people for what will ultimately be private gain. Do any of these bastards involved have any sense of shame? Apparently not.
I have not read such a illuminating piece of research for a very long time. It seems to me that at the rate that Professor Aylward’s studies have advanced physical & psychological understanding must have him well on the way to mentally walking on water, It causes me a great deal of concern when the government resort to use the study of a Frankenstein like Megalomaniac who’s obvious only concern is to see his name in light whether for the good of mankind or for its destruction. Thank you for putting this on line to be read & keep researching.
My dealings with the Benefits Agency go back as far as 1998 when I applied for the DLA Care and Mobility components. In my case I had been invalided from the Merchant Navy in 1975 in which I was serving as a 3rd Engineer and Senior Electrical Officer as unfit for further seagoing employment due to Arthritis and Spondylosis. I retrained at the Polytechnic of Wales in Work & Method Study.
At the age of 39 I failed to obtain employment in my new career as
an Industrial Engineer, but was fortunate enough to get a staff post as an Engineering Inspector with a Cardiff firm of Aeronautical & General Engineers doing contract wok for the Ministry of Defence as a disabled person with a green card.Unfortunately in 1985 I was made redundant and became interested in journalism in the field of disability problems.
Unfortunately in 1987 I started to have problems with the re-occurrence of back pain, limping and staggering when walking.
I made repeated claims for the DLA Care and Mobility Benefits which were rejected on what I had said in the claim pack, the
visiting doctors medical examination report and the rejection by the Decision maker. On the first occasion I appealed and lost. I let about 6 months pass and applied again. This was rejected on
the same grounds. In due course I again applied with the help of a solicitor and was rejected in the same way. I decided not to
appeal, but to let more time pass until 1998. On this attempt I
got the same letter of rejection although a report from a surgeon had been sent with my application. However to my surprise their
letter of rejection also referred to a report written by my GP. I saw my GP and asked why he had submitted a report on my health condition without first examining me. He told me that he had not been asked for one and was prepared to write a report if I needed one. I put the matter in the hands of a solicitor who was approved to do work for the Benefits Agency and we challenged
the benefits agency with a report from my GP who said my health condition would get worse and I was aware of it. He also mentioned the safety risks my health condition exposed me to.
The Benefits Agency changed the decision makers findings in my favour and I received a considerable benefit back payment. However from the misery I went through over those years I cannot come to terms with the way I was treated by the Benefits Agency Medical Services contract doctors who must be brainwashed, blind and devoid of common sense. I finally make the point that I as a person who was trained in work and method study know that the fitness to work tests are a load of nonsense
as well as the point scoring system because they do not consider the working physical aspects of the benefit claimants body when
under load. My experiences are before the introduction of ATOS and their computerized system which I see as a way of deskilling the examination system and creating a one fits all system which is illogical and unfit for purpose like the unworkable legislation
newly introduced by this Westminster Con-Dem Coalition Government. Let us face it. Where there is no sense there is no feeling!
I’ve been through the idiotic system. First round (Atos mental health nurse with no neurological training) failed both WCA and appeal despite abundant and solid medical evidence of the effects of systemic neuropathy, diffuse osteoarthritis and CRPS. Second round a better ESA50 and less medical evidence submitted and was put in the Support Group without going through a WCA. Same degenerative medical conditions, being degenerative a bit worse than at the first round. Just waiting for round 3 which will again find me fit for work.
I wish they would go back to the old PCA, more objective and a clearer outcome.
“The assessment of Work Capacity is frustrated by the meaningless pursuit for objectivity”
How on earth can Aylward’s words be applied when registered doctors have a duty of care towards their patients, a duty of care arising out of a meaningful medical history taking and the objective and meaningful examination of signs and symptoms? Unless of course he expects in time the duty of care to be abandoned by “the bio-psycho-social paradigm shift”. This appears to be happening.
His call to “Abandon the forlorn pursuit of objectivity” and to “Embrace the bio-psycho-social paradigm shift”. This appears to have been adopted by Dr Peverley (Sunderland area GP) in a diatribe printed in the GP trade magazine Pulse.
“Embrace the bio-psycho-social paradigm shift” Newspeak comes to mind…
“Paul Foot on the Insurance Company Unum and Cuts to Disability Benefit in Private Eye from 1995”
http://beastrabban.wordpress.com/2013/08/12/paul-foot-on-the-insurance-company-unum-and-cuts-to-disability-benefit-in-private-eye-from-1995/
“Also from 1995: Tories Reject Report on Poverty in Wales as ‘Communist Propaganda’”
http://beastrabban.wordpress.com/2013/08/12/also-from-1995-tories-reject-report-on-poverty-in-wales-as-communist-propaganda/
Your outrage does you credit, but ultimately this represents the extension of BPS theory from us ME/CFS sufferers, amongst others like Gulf War Syndrome and IBS, to the entire disabled community. I can’t help wondering where everyone was ten or twenty years ago when the reputations of our often very severe illnesses were being destroyed. Perhaps if someone had stuck up for us at the time, instead of swallowing nonsense about there being ‘no biomedical evidence’ for these illnesses and patients ‘not being motivated to recover’, then it might not have ended up being the thin end of the wedge.