Twitter Rape Threats: A Glimpse Of A Crumbling World

Since the Bank of England announced the presence of Jane Austen on the new £10 note, Caroline Criado-Perez, who spearheaded the campaign to put more women on UK money, has been subjected to a well-documented and much-discussed barrage of abuse via Twitter and her personal email. It’s been described as trolling, but the difference between trolls and Caroline’s aggressors is palpable. Trolling is the act of being deliberately provocative to elicit an angry response; a threat of rape is a criminal act. There exists a gulf of meaning between trolling and threatening violence against someone whose opinions you disagree with. It’s the difference between playing devil’s advocate and leading a targeted campaign of aggression and hate.

In addition to this, Caroline, her supporters, and other prominent feminists including two female MPs have been subject to bomb threats and racist abuse on the site. Twitter’s response to the tweets has grown sterner and faster over the week, but still the threats keep coming. The senders are quick to reiterate their numbers and resilience against banning, but Caroline and the others continue to pass each new tweet onto the police.

At the time of writing, two men have been arrested; the first aged 25, the second just 21. Their youth is striking – born well after the advent of the feminist movement, these young men won’t even remember a time before the UK’s female Prime Minister, much less a time when women weren’t welcome in workplaces or universities. For a generation who take women’s rights almost for granted, for those who have never had to afford it much thought, it’s a startling deviation from the party line.

For these men, the threat of violence is a means of control. Like the cases of ‘corrective’ rape seen in South Africa, the threats are a way to assert dominance over a woman who challenges their fragile, crumbling masculinity. Regardless of whether they would actually act on their threats or not, their weak self-concept and chauvinistic protection of outmoded gender relations reveals a complicated and defensive psychology.

They system they know how to operate in has failed, and the world has changed around them. Like a small child denied their own way, the aggressors respond by lashing out – in short, they throw a tantrum. Unlike a small child, though, they have sufficient knowledge of social convention to channel their rage into the most effective form and target it at the most vulnerable area. While they deny that they would actually commit rape, the threat of sexual violence is still powerfully intimidating; fortunately, the women in question refuse to be intimidated.

In response to the story, print and broadcast journalist Emma Barnett gave the aggressors the right to reply on her radio show. Her callers provided a telling insight into their mindset: they insist “she was asking for it... if you put your head above the parapet, like she has, then you deserve this type of abuse. It’s what you get when you are a woman shouting about something,” that “feminists like Caroline are undermining what it is to be a man” and subsequently require “sorting out”. They justify their actions by claiming “men are predators... and this is what we do... these men wouldn’t actually come and rape her. They don’t mean it. Rape is a metaphor.”  

Rape isn’t a metaphor. Rape is a tool of domination, of control, of power. Rape is a taboo that these individuals have exploited to intimidate a woman who, in their eyes, has developed ideas beyond her station and must be brought back into line. As journalists, as activists, as feminists, we must resist the fear forced upon us. These threats are an attempt to control a woman who, in their eyes, has too much to say and too big a platform from which to say it. They insist feminism will change nothing, has changed nothing, but their fear is visible behind their anger and spite; in time the mask of anonymity will slip and Caroline’s opponents will stand exposed for all to see.

Behind the explicit threats and creeping menace lies another wave of attempts to discredit; the commentators, both journalists and private citizens, who insist that retweeting threats is ‘attention-seeking’ and that ignoring the problem will make it go away. Chiming in with these are the men who write long articles and aggressive tweets claiming that feminism is no threat - if this were the case, there would be no need to confront it or publicly mock it. Ignore it and it’ll go away, right?

Those with a vested interest in maintaining the patriarchal status quo have been ignoring feminism since its first faltering steps. It’s 100 years since Emily Wilding Davison fell under the King’s horse, 95 years since women were given the vote, 48 years since the UK gained its first female MP, 38 years since the Sex Discrimination Act, 19 years since rape within marriage became a crime, two years since changes to the law of succession allowed a Princess to take the British throne. Campaigners have achieved all this with tenacity, patient effort, and a refusal to remain silent. We did not submit to ignorance then, and we must not submit to it now.

What Nigella Can Teach Us About Violence Against Women

To outward appearances, Nigella Lawson has things all figured out: she runs her own media business, has a successful publishing career, and makes frequent public appearances looking impossibly glamorous. She’s everything that an ambitious woman is meant to aspire to be. And, it emerged on Sunday, she also appears to be a victim of domestic violence.

At first, the images published by the People were shocking, as you’d expect of any depiction of violence against women. But then we started to think about what happened, started to ask questions, and a more insidious suspicion took root: the casual and callous way in which Charles Saatchi laid hands on his wife in public led some commentators to suggest that this wasn’t his first attack on her.

For him to so brazenly attack Nigella in full view of both passers-by and fellow Scott’s patrons, without trying to conceal or disguise his actions, implied much about the dynamic of their relationship.  Witnesses told the newspaper that Nigella had attempted to placate her husband by speaking reassuringly and kissing him on the cheek; many readers will be able to identify this as the classic response of a woman threatened by her spouse.

But Nigella doesn’t fit the traditional profile of a victim of domestic abuse: she has economic independence, makes regular trips overseas on business, and presumably does not lack the resources to move away from her abuser. So, we wonder, why does she stay? A 1998 study[1] reported by Psychology Today may provide some answers: “Emotional abuse plays a vital role in battering, undermining a woman's confidence.”

While it seems that Nigella and women like her have sufficient self-esteem and personal agency to succeed in business and personal endeavours, their intimate relationships are far less clear-cut. What the events of this weekend demonstrate beyond anything else is that even independent, capable women can be bullied and manipulated into accepting physical and verbal attacks that, for whatever reason, they won’t or can’t walk away from.

The emotional manipulation used by abusers is well-documented and wholly discomforting; their victims are isolated from friends and family, deprived of the resources that would help them escape, and worn down to such a low ebb that they accept violence they would never have tolerated previously. In the case of successful or high-profile women, their visibility might discourage them from seeking help; the gap between their private and public personas might seem so great that to report being abused feels like admitting a weakness.

At the time of writing, the UK press is reporting that the police are investigating Charles Saatchi following the publication of these images. Saatchi may later face charges; in spite of his wealth, it seems unwise for him to pursue a libel case when the evidence is so damning. It’s inappropriate to conjecture on the future of Charles and Nigella’s marriage – perhaps she will remain with him in spite of public condemnation of his actions.

If nothing else, we can hope that the story – so shocking when presented against a backdrop of middle-class media comfort – inspires other women to seek advice and assistance if they find themselves in similar situations. This week, like every week, two women in the UK will die at the hands of their violent partners. This week, like every week, all women deserve better.

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[1] http://www.psychologytoday.com/articles/199803/anatomy-violent-relationship

Of Bread And Circuses

Juvenal referred to it as ‘bread and circuses’, George Orwell characterised its worst excesses as prolefeed, and Victorians despaired of the corrupting influence of the penny dreadfuls. It’s plain to see, then, that our love affair with escapism through entertainment is almost as old as society itself.

Marxists, echoing Juvenal’s and Orwell’s sentiments, fear that focusing on the narratives of fiction – be it classic literature, blockbuster films, or soap operas – would distract the proletariat from their struggle towards revolution. In many ways they’re correct; even now, the politically aware cringe as the country invests more attention in TV talent shows than in the comings and goings of our politicians. But perhaps we overlook a significant point – perhaps these distractions are important precisely because they allow us to escape from our reality.

Times are hard, and they’re hard for almost everyone. Perhaps what we really need is to escape into someone else’s life for a while; to try out a different set of burdens like a different suit of clothes, to look out on the world from behind another pair of eyes, to walk a mile in someone else’s shoes.

The shoes may take us across Dartmoor pursuing a gigantic hound, or to Stonehenge with our doomed love, or to the shores of Innsmouth fleeing unthinkable horrors. They may stand on the green grass of the Shire, the cobbles of Edinburgh, the grey earth of Winterfell or the dusty concrete of London Below. But they bear us away from our own lives, our own problems, and permit us to lose ourselves in impossible and fantastic worlds.

We submit to almighty terrors, to wrenching losses, to every twist and machination of vindictive fate, because we know we can close the book and walk away. We can explore our own strength and character without having to experience what Shakespeare called “the thousand natural shocks that flesh is heir to”. Here we test our emotional fortitude, pitching ourselves against blow after blow to examine how well we weather the storm.

We solve mysteries, protect the innocent, play the hero or the villain. Often we don’t decide which we are until the end. We meet soldiers, lovers, wizards, murderers, queens, poets, tyrants, heroes, angels, vampires, monks, prostitutes, revolutionaries, scholars, searchers and seekers, mothers and fathers, brothers and sisters, children. And in time, inexorably, we begin to care.

We dedicate precious time and space in our minds to these characters. We despair that the word ‘character’ makes them sound so flat, so trivial; to us, they are people. We give them sequels, films, TV shows. We make them real in our heads and then we try to make them real in the world. We share them with our friends, discuss incarnations and iterations – are Sherlock Holmes, Hercule Poirot, and John Rebus really so different? Whose face does each of those names conjure up?

We need stories. Like dreams, we use them to explore and make sense of the world. They speak to us about human nature, the subtle dance of interaction and disclosure that takes a lifetime to master. Stories are how we investigate and memorialise our humanity. Stories are what make us human.

Too Many Protest Singers, Not Enough Protest Songs

Today we buried one of the most politically important Prime Ministers this country has ever seen. That, I’m afraid, is the last good thing I can find to say about her. Like many people who were left high and dry by her policies, I had little time for Thatcher, her cabinet, or her legacy. While I agree that it’s distasteful to publicly celebrate her demise, I was secretly pleased to observe that her detractors marked the occasion with a uniquely British and increasingly popular form of protest – inflating the sales of a particular song to register their protest through the UK Top 40 chart.

In a post-Blair society where a million people can march on Westminster and be utterly ignored, it seems the nature of protest has changed. The UK pop charts, formerly the record of an important yet ephemeral cultural progression, have become the battleground for all manner of political and personal rebellion.

For years, music has been an indicator of politics, ideology and cultural identity. Now it’s become a means of registering dissent in a public arena in a manner totally removed from its previous efforts. Gone, perhaps, are the protest songs of Woody Guthrie and Bob Dylan; here instead are Cowell-baiting online campaigns featuring Rage Against The Machine, inspired and perpetrated by web-savvy millennials who have identified the potential that rapidly advancing technology can provide.

A disenfranchised public, seemingly aware that placards and chanting no longer carry as much weight as before, can now convey their anger and disapproval by purchasing a 79p download from iTunes. Surely even the most broadminded futurologists would have failed to envision such a development in technologically-enabled civil disobedience.

It’s not a flawless system by any means – on this most recent occasion, the BBC declined to broadcast the entire song, and their track record for banning controversial songs has been a matter of discussion for decades. Fortunately for those trying to make a point, the nation’s news media have not been reluctant to publicise the campaign; even as they condemn it for its disrespect, they provide the oxygen of publicity.

Of course, the nature of the legal download system – the only way to perform the act of protest is to purchase the track from a recognised provider – means that to register our dissent we must indulge in a singularly undemocratic act; we pay to protest. But contrast this with the alternatives and the recommendations of the new process become clear – rather than travelling to London, marching and chanting, and risking arrest if the protest degenerates into violence, the objector can make their point simply by clicking the button marked “buy”.

Should we be shocked that political dissent has now been rendered marketable, and that profit can be derived? Maybe, but we should be more grateful still that individuals still want to protest.

Why Every Day Should Be World Book Day

“You don't have to burn books to destroy a culture. Just get people to stop reading them.” ― Ray Bradbury

When I was a child, my parents used to hide my books while I slept. It wasn’t out of malice or sport, but necessity; hiding the books was the only way to avoid spending the entire day reading them to me. I didn’t learn to read until I was five years old and attending school, mostly because my mother doubted her ability to teach me, but once I had there was little that could stop me. Independently of the National Curriculum, I read Tolkien at age 10, Dickens at 12, Shakespeare at 14 and Chaucer at 16. Words had power, I knew, and they could take you places.

Today is World Book Day in Britain and Ireland; something of a contradiction, since the rest of the world celebrates it on April 23^rd. We’ve been marking the day since 1995, and I remember the first event. I went as pre-transformation Cinderella in an apron made from an old blue sheet – a poor substitute for my first choice of costume, the peach from Roald Dahl’s James and the Giant Peach. It was precisely my kind of event; from the moment my parents had read me The Very Hungry Caterpillar, books had been my favourite thing in the world. I appeared to be in the minority there, though.

For a bibliophile like me, it was never easy to get along with the other kids at school. I liked reading; I wanted to read the books they disdained. They wanted to watch obnoxious TV shows and talk about ephemeral boybands. It only got worse once I reached senior school. It wasn’t cool to know things. It wasn’t cool to actually understand and enjoy the Shakespeare the others pretended to read. They didn’t want to learn; I did. I wanted to go onto college and university and do nothing except inhale and exhale words for the rest of my life; I’d wanted to do nothing but that since I was eight years old.

The society I grew up in displayed – and still displays – a rabid anti-intellectual streak that imperils the potential of every intelligent, curious child within it. It’s not cool to be intelligent; a large vocabulary is a burden, not a blessing. Grammar is something that happens to other people. We communicate in writing more than ever before. We read more than at any other point in our history. We are never far away from words on a screen, if not in print, and yet so many people still struggle to make themselves understood. Eventually I found a place where I fit in, surrounded by university lecturers and creative types in pubs filled with vibrant conversation. There was no going back.

Books are amazing. They take us to places we could never go by ourselves, places that only exist in the landscape of the mind. I’ve been to the Shire, Wonderland, Narnia, the Discworld, other planets and other times. I’ve spoken with witches in the Highlands of Scotland, watched young lovers swoon in Verona, charged across bloodied battlefields in France and accompanied pilgrims to Canterbury. I’ve shivered in the trenches of World War One and battled dragons under mountains at the edge of a different world. I’ve run through moonlit woods with werewolves and hunted in the night with countless vampires.

I’ve solved murder after murder and tracked the course of endless lives and loves. I’ve burnt books with Ray Bradbury, spiralled between blissful highs and desperate lows with Sylvia Plath, been on a boating holiday with Jerome K Jerome, and fled from unspeakable horrors with H P Lovecraft. I was in 1930s Paris with Anaïs Nin, 1900s Dublin with James Joyce, and 1970s Las Vegas with Hunter S Thompson. I’ve lived more lives than anyone has any right to, and there’s no way I’m stopping now. The feel of a book, of paper under fingers, is a trigger no less powerful than the kiss of a lover, and I am not ashamed to feed the addiction.

Basildon Hospital Have My Gallbladder, My Trust, And My Thanks

A week ago, I had my gallbladder – and the numerous large gallstones within it – removed. For geographical convenience, the procedure was performed at Basildon University Hospital, part of the beleaguered Basildon and Thurrock NHS Trust. It wasn’t my first encounter with the hospital – I was born there, I’ve had migraines and disc prolapses treated there – and I doubt it will be my last. It was, however, possibly the best.

Speaking as the owner of long-standing and problematic phobias of both hospitals and needles, the experience was never going to inspire feelings of hope and contentment. No-one likes going to hospital, of course, but my fear was liable to make me tense, anxious, and, regrettably, unco-operative toward the medical staff treating me. To give this some perspective, previous visits have demonstrated that it requires no fewer than four qualified, experienced clinicians to insert a cannula into the back of my hand. I was never going to be Basildon’s biggest cheerleader, and stood a decent chance of becoming their fiercest critic.

In the weeks immediately preceding my visit to the hospital, Basildon and Thurrock NHS Trust were named in the enquiry resulting from the Mid Staffs investigation – one of five NHS Trusts to be singled out for special attention. Concerns were initially raised over the hospital’s “persistent high death rates”, but as the story progressed, former patients came forward with tales of unchanged dressings, unheeded toilet requests, missed medications and Legionella outbreaks.

None of this inspired me with much confidence as the date of my operation drew closer. Gallbladder removal – or Laparoscopic Cholecystectomy, as it’s known to professionals – is a relatively commonplace procedure, but is not without risk. An unexpected bleed or overly large gallbladder can compel the surgeon to move from keyhole surgery to an open procedure, increasing healing time and necessitating a longer hospital stay. Given the reports circulating at the time, this wasn’t a possibility I was relishing. As it turns out, and to my considerable relief, the procedure went well.

It now remains only for me to credit the staff of Basildon Hospital and the extended NHS Trust for ensuring that I’ve had such a smooth ride over the last nine months. My GP, for taking my bellyaching seriously, for pushing on for ever more diagnostic tests and anti-emetic drugs, and for calming me down when I thought I’d inherited the liver tumour that killed my grandfather. My surgeon, for answering my nervous questions when he was obviously up against it and keen to get on. His Senior House Officer, for talking to me like an intelligent, autonomous, informed adult with a degree of insight into their own condition. His registrar, for ensuring that the SHO had gone through absolutely everything I needed to know, and then drawing me a diagram so I was absolutely clear.

Beyond the surgical team, there’s also the Day Unit nurses who clerked me in and helped me push my dodgy leg into the restrictive TED stocking. There’s the nurses in the blood clinic who looked after me when I began to faint in their chair, and didn’t even mind that needles make me panicky and subsequently ridiculous. There’s the Endoscopy team who were doubtless frustrated beyond the bounds of patience when they eventually abandoned all attempts to perform the biopsy I needed, particularly the nurse who succeeded with the cannula where six previous efforts had failed. There’s the doctor in the ultrasound clinic who finally confirmed a diagnosis of gallstones, showed me them on the screen, and looked only a little surprised when I laughed and told her I’d won a bet.

There’s the theatre nurse and anaesthetist who did everything they could to keep me calm when panic really set in, just before I went under. Most of all, there’s the nurse on Laindon ward who was there when I woke up, helped me to the lavatory when I was still dazed from the anaesthetic, carefully and attentively performed observations on six woozy patients every 30 minutes, brought me endless glasses of water, called my family to reassure them when she really didn’t have to, gave me the only painkillers my body would tolerate, kept me calm while she removed the cannulas from my hand and wrist, and discharged me professionally and patiently whilst running the ward single-handed and still called everyone “darling” like she meant it.

Basildon might be struggling as a hospital. It might be a victim of circumstance, or it might genuinely have a minority of staff members who are incompetent or lazy or both. In this way, it differs from no other workplace. But what it also has is staff who are dedicated to their jobs and their patients, even difficult patients like me. Many of their staff are probably overstretched and likely feel underpaid, and many departments are underfunded and potentially understaffed sometimes, even if only due to occasional staff sickness. Basildon has its problems, but it also has a body of staff who perform difficult and often unpleasant jobs with professionalism, dedication and grace, and without whom all patients would be at a complete loss. When you denigrate Basildon Hospital, you denigrate them too.

Words Matter

Some time ago, I got involved in a Facebook debate over offensive humour, which rapidly disintegrated into an argument over free speech. We managed to avoid invoking Godwin’s Law, but we did successfully provoke the following comment, which typifies the public attitude to free expression: “FREEDOM OF SPEECH means you can say anything to anyone! That does not mean you are right or even moral but you can say it!”

To anyone that’s encountered the UN’s Universal Declaration of Human Rights, the error will be obvious. Free speech is not an absolute right - most countries have laws which state that freedom of expression may be limited in "the interests of national security, territorial integrity or public safety; the prevention of disorder or crime; [or] the protection of health or morals”. Most mouthy schoolboys and drunken racists will insist that they have a right to say what they like about who they like, but a quick examination of statute will reveal that it's simply not so.

Additionally, the Malicious Communications Act and recent Hate Crime legislation, not to mention defamation law for attacks on specific individuals, have clarified the law on what you may or may not say in a public arena such as Facebook or Twitter. Freedom of speech should be invoked in countries where you're imprisoned indefinitely without trial for criticising your government, not bleated about by people who are cocky enough to think that their need to be funny is more important than respecting the feelings of other people around them. Freedom of speech is a conditional right, not an absolute one, and when you think about it, there’s a good reason for that.

The truth is, words matter. Words are how we make contracts, build relationships, connect with others, and describe the human experience. We’re by no means the only species that communicates meaningfully, but we’re the only one capable of such subtlety and nuance. Albanians, for instance, can distinguish between 15 different types of facial hair, and are similarly specific about eyebrows. Perhaps unsurprisingly, Italians can name 500 different types of pasta, and the descriptions of colour in Webster’s dictionary are a symphony of shade and comparison.

There are currently more than a million words in the English language, their ranks swelled by new coinages like “vajazzle” and “selfie”. A tabloid newspaper will use about 8,000 individual words in a single edition. The average person regularly uses 35,000, a university graduate 50,000, and a writer as many as 75,000. Many are beautiful. Some are ugly, inelegant, or too often overlooked. All are powerful, but some are more powerful than others.

Of course, with great power comes great responsibility. Some words can comfort, praise, and reassure, but others can sting, wound and affront. For some people, it’s difficult to respect the broad vista that language opens up for us. They would use it like an indentured servant, all the while claiming that by doing so, they protect its freedom from those who want to see it muzzled and caged.

Instead, we must treat language – all language – like the rare and delicate gift that it is. Where in the past we’ve hurled shards of it at women, disabled people, those of other races, religions and sexualities, to mock the wounds it makes on impact. The time has come to pick up the pieces. This isn’t being ‘PC’ or ‘leftie’ or any other such ridiculous notion; this is about not deliberately insulting the other people we share the planet with. It’s easy to imagine that our house, our marriage, our family is a tiny ship tossed on a stormy sea of outsiders, battered by the wind and waves – in fact, that’s how we should view our planet.

In an unimportant solar system, in a modest galaxy, in one corner of an infinite and uncaring universe, intelligent life has struggled from a swamp and established an empire greater than that of Rome or Britain – the empire of the Earth. We have developed language, enabling us to begin to comprehend the vastness of our reality, or just gossip about inconsequential details. As I’ve said before, we have only each other – seven billion of us against the infinite coldness of space. We are fellow passengers on that storm-tossed sea, and yet we don’t huddle together for warmth and security; we keep confined to our quarters, the doors and stairwells blocked by obstructive, angry words. The worst of it is, we put them there.

What I’m trying to say, I suppose, is best summed up by a seasonal message that we let our children sing but never actually heed. We’ll pick it up, remove its historical gender bias, and repackage it for use all year round. Dickens said it, Dawkins implied it, and I can only echo it: peace on Earth, and goodwill to all humanity.

Rape And Responsibility

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

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

For rapists of this type, rape is rarely about sex or the lack of it; it’s about power and domination, control and shame. It’s about telling a person that they mean so little that they can be used in whichever way their attacker chooses. Sexual assault, like domestic violence and emotional abuse, is a way to dehumanise someone; their aggressor shows them that they have so little power that they cannot prevent their own mistreatment. They become, as the article suggests, a piece of meat, lacking agency and control – the shock of rape emanates as much from the complete denigration of the victim’s personality and humanity as it does from any violent physical act.

There is, of course, another type of rapist – one who misreads signals, assumes consent where none has been given, or fails to notice that his partner has lost interest in continuing. These men are not psychopaths, nor do they necessarily set out to cause harm, but the effect on their partner can be no less powerful. Some of these men notice their partners’ waning interest and stop in good time, some never notice and so continue, and some notice and make a conscious choice to keep going.

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

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

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

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

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

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

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

Rapists commit rape for various reasons, none of which excuse the trauma they inflict upon their victim. Some do so to intimidate or punish, to inflict fear and denigrate their victim. Some do so because they misread signals or inaction from their partners, some do so because they simply don’t respect their partner’s wishes enough to stop. None of these situations can be remedied by a public service announcement or advertising campaign.

Rape is a cultural problem, but one that occurs in all cultures and throughout history. It’s not the job of public figures to tackle it with good intentions and a public service announcement; instead it’s the job of parents, teachers, sex educators, and then the media. From films like Greaseonwards, certain media products have positioned men as pursuer and women as the person who must exercise control and resistance; through these stories, we normalise sexually threatening behaviour. Young women come to expect and tolerate it, and young men feel they are excused to act as their hormones allegedly dictate.

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

How We Failed Savita Halappanavar

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

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

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

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

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

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

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

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

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

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

Perfume, Professionalism And The Perfect Gentleman

This week, I’ve mostly been deciding whether my body is a weapon or a vessel, and whether I’m more devoted to integrity or the drive for success. Like most people, the flesh-and-bone part of me seems to be there to extract energy from food and move me around; it’s not until something goes wrong with it, or until I’m surprised by someone’s reaction to it, that I really even notice it’s there.

As usual, this self-discovery trip has been prompted by a couple of incidents; goatish comments from a trusted advisor, the realisation that I perform better in job interviews when one of the interviewers is a man, and being approached and sniffed at uncomfortably close range in a supermarket by a stranger who was apparently so intrigued by my new perfume that he was willing to risk (and return) an aggressive reaction from both me and my fiancé.

We confronted him angrily and, despite the presence of his young son, he became abusive and threatened us. Plainly he felt it was reasonable to place his own face six inches from the face and neck of a temporarily unaccompanied woman, inhale deeply, and tell her she smelt good, and that she should “cheer up” when she looked perturbed; we disagreed. He eventually went away; I doubt my concerns will be so obliging.

I’m currently in the process of taking on freelance writing work, with the help of a self-employment advisor on a Government-mandated employment program. When discussing the necessity of approaching publications and pitching articles - an intimidating but necessary part of the process - various people have suggested using my gender, “attributes” and “engaging personality” to “intrigue” editors; essentially, flirting my way into a job.

I remain incredulous. I’m not Samantha Brick; I’m simply not confident enough in my own looks and personality to try that. When I look into a mirror I see my father, and he’s overweight and bald with a face like that of a veteran scrum-half. Besides which, even if I looked like Angelina Jolie, shouldn’t a good feminist be outraged by the very suggestion?

This is, at its heart, an entirely sexist issue: male colleagues are not forced to make the same decision. I’ve worked for male managers who flirted remorselessly with contacts of both genders, and for female managers who dispensed with sparkle and charm and got by on talent and professionalism alone, but it’s easy to understand that women surely spend more time agonising over their professional appearance. We must also consider if this approach confers an unfair advantage to attractive colleagues – an anecdote tells of a man who hired pretty girls to work in his office, “because they cost the same as plain ones.”

We know shouldn’t happen, but we know beyond a doubt that it does. It’s just another dubious journalistic practice, and it carries over into other trades too. The approach is likely to be of limited use against female editors; not only is it unlikely to work against them, it will also prove utterly transparent to a woman who has at some point faced the same decision. That said, it’ll prove transparent to anyone, male or female, who is shrewd and perceptive enough to have made it to the top of their industry. A good journalist can read people, break down pretences, and identify dodgy motives in a heartbeat – there’s no way a self-consciously flirty woman in a too-low sweater is going to get past them. Editors will notice it, and colleagues will surely resent it.

This isn’t a problem of my own creation; left to my own devices, I’d make the same effort when I meet with people as I do on any other day, the self-defined minimum appropriate degree of care and attention. The conundrum is thrown up by other people’s reactions to me, not my own opinion of myself. This is another point, one of many, at which I have to decide what kind of person I am. Can I really adopt this approach? Does it devalue my education and skills? What does it say about my feminist principles? Could I – or anyone else – respect a career based on titillating middle-aged men in positions of power? Can I be confident of the integrity I thought I had, or am I as motivated by money and success as the people I thought I stood against?

Romney, Republicans, And Rape

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

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

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

• Todd Akin: “If it’s a legitimate rape, the female body has ways of shutting that whole thing down” - 2012 Senate Campaign 

• Clayton Williams: “If it’s inevitable, just relax and enjoy it” - 1990

• Chuck Winder: “I would hope that when a woman goes in to a physician with a rape issue, that physician will indeed ask her about perhaps her marriage, was this pregnancy caused by normal relations in a marriage or was it truly caused by a rape. I assume that’s part of the counseling that goes on.” - March 2012 

• Ken Buck: “A jury could very well conclude that this is a case of buyer’s remorse … It appears to me … you invited him over… the appearance is of consent.” - October 2010 

• Rick Santorum: “I think the right approach is to accept this horribly created — in the sense of rape — but nevertheless a gift in a very broken way, the gift of human life, and accept what God has given to you… rape victims should make the best of a bad situation.” - January 2012

• Richard Mourdock: "I struggled with it myself for a long time, but I came to realize that life is that gift from God. And, I think, even when life begins in that horrible situation of rape, that it is something that God intended to happened." - 2012

• North Carolina state Rep. Henry Aldridge: “The facts show that people who are raped — who are truly raped — the juices don’t flow, the body functions don’t work and they don’t get pregnant. Medical authorities agree that this is a rarity, if ever … to get pregnant, it takes a little cooperation. And there ain’t much cooperation in a rape.” - 1995

• Delaware state Rep. Stephen Freind: “The odds that a woman who is raped will get pregnant are one in millions and millions and millions […] The traumatic experience of rape causes a woman to secrete a certain secretion that tends to kill sperm.” - 1988

• Dr. Richard Dobbins, 20-year GOP contributor: “Most women either are not fertile during assault or do not become pregnant because the trauma prompts a hormonal response that prevents ovulation.” - 2006

• Judge James Leon Holmes, Bush appointee - “Concern for rape victims is a red herring because conceptions from rape occur with approximately the same frequency as snowfall in Miami.”

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

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

Assisted Suicide: A Debate

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

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

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

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

In 2009, Debbie Purdy went through the courts in an effort to discover whether her husband would face prosecution if he accompanied her to a clinic such as Dignitas. The House of Lords agreed that it was a breach of her human rights not to know, particularly since this information was likely to play a large part in choosing when and how to end her life. The BBC reports the case of Tony Bland: “crushed in the Hillsborough disaster [...] allowed to die through the withdrawal of feeding tubes. He was in a persistent vegetative state after suffering severe brain damage and the judges said that it was in his best interests to be allowed to die.”

Yet despite these legal successes, and no shortage of discussion in debate amongst medical professionals and within the national press, little actual legal change has been effected. The consultation process for any change in the law is likely to be lengthy and complex, as befits such a weighty issue. Any change in the law, even a relatively minor one, will doubtless alter our society; our attitudes to disability will affect and be affected by the eventual outcome. To investigate the issue further, Peter McAllister and Christie Louise Tucker present a debate of the issues at hand.

Argument Against Assisted Suicide

Firstly I would like to make it clear, I am not an apologist for antediluvian values, nor is this a polemic discourse on the dangers to spirituality of assisted suicide. My intentions are as much a deep-seated personalisation as they are borne of any religious conviction. I do concede, however that religion has played its part in my disagreements to assisted suicide and indeed suicide, but not exclusively.

One of the most ardent opponents to assisted suicide is the Christian Faith. Suicide of any form is morally wrong because, having given life; God is the only one who has the right to take it away. The Fifth Commandment, 'Thou shalt not kill' (Exodus 20, verse 13), makes the point quite unequivocally. I have always found this particular Commandment non-negotiable.

There are arguments raising the point about serious concerns in legislating assisted suicide due to unsavoury family members and shifty doctors who would rather persuade a person to end their life, against the person’s will. Are there selfish reasons involved from particular family members? Do they stand to gain financially? Surely their motives are not borne out of a selfless empathy?

In free will there is another potential problem, that of capacity. Is the person contemplating assisted suicide competent to make such a decision? Are the drugs that people take for pain relief compromising their ability to make clear decisions? From experience, yes this is a factor. Psychiatric conditions may make someone desire suicide. Conditions such as Depression and Schizophrenia disorder can go undiagnosed; people who suffer such disorders could in fact choose to be unnecessarily supported to take their own lives?

Many people fear that assisted suicide will create a climate in which some people are pressured into it. The old, the poor, or minorities and other vulnerable groups might be persuaded to shorten their lives, rather than to "burden" their families. Will the definition stop short of a human’s ability to be productive?

People with severe and enduring disabilities may in turn have to justify staying alive. Is this a situation we really want to embrace? Writers such as The Times columnist, Melanie Reid use emotional tactics to further the cause for assisted suicide. But in my view this masks a very self-pitying nature, expounding their self-interested agenda and turning it into an exercise in scaremongering a civilised society.

Argument For Assisted Suicide

The distinction between suicide and physician-assisted dying is at times subtle, but always important. For a coroner to return a clear verdict of suicide, the Government’s legal definition states that it must be apparent that the deceased, “took their own life whilst the balance of their mind was disturbed.” But for a change of the laws surrounding assisted suicide to work, establishing sound mind prior to acting would be paramount.

This is already the case at the Dignitas clinic in Switzerland, where each client must consult an expert psychiatrist and submit medical records to an affiliated doctor before a prescription can be written, and there can be no doubting the value and importance of this requirement. Currently the only medical procedure in the UK to require the consent of two doctors is an elective termination; of course assisted suicide should be the same, and for the same reasons.

The loudest protests against changes to the law are usually from religious groups arguing the sanctity of life, or those concerned about potential misuse of the eventual act. But when retired American Episcopalian bishop, John Shelby Spong states that “the right to a good death is a basic human freedom”, it’s plain that the debate is a long way from conclusion.

Much is made of “valuing life”, the implication being that those who support assisted suicide lack this conviction. Nothing could be further from the truth. Valuing a worthwhile and fulfilling life is central to our argument; not wanting to continue a life shattered by absolute incapacity is merely a continuation of this.

It’s vital to make clear that it is severe incapacity that is under discussion here – the end stages of degenerative disease, or massive injuries caused by accident or injury. The argument is made best by the individuals attending court to challenge the law, and those close to them: the initiator of this current challenge, Tony Nicklinson, describes his life as “dull, miserable, demeaning, undignified and intolerable.” The parents of Daniel James, who ended his life at a Dignitas clinic in 2008, characterised their son as "an intelligent young man of sound mind" who was "not prepared to live what he felt was a second-class existence".

A southern African saying once related to the author of this article comes to mind; upon the death of a relative, the grieving family are reminded to give thanks to God for “a long life, well lived.” Even non-religious readers will acknowledge the truth and value in this. This is truly when assisted suicide should be considered; at the end of a long and full life, when all other options have been exhausted and the loss of faculty is too great for the individual to accommodate.

In Conclusion

The purpose of the assisted suicide debate is not to imply that the lives of disabled people, or anyone else, are in any way miserable or intolerable. Instead, the aim is to enable individuals to make their own decision about when, where and how to die, and to do so with dignity and comfort.

At present, someone seeking physician-assisted suicide must travel to the Dignitas clinic in Switzerland: previously an anonymous, nondescript concrete tower block just outside Zurich, now a pleasant house in a residential district of the city. Many opt to make the journey alone; to have a relative accompany them could expose their companion to prosecution for attempting to “aid, abet, counsel or procure” suicide, a charge that carries a 14-year sentence.

Both sides of the argument talk about dignity, quality of life, control, and ethics, but in the end, the decision is nothing more than a personal choice. What is needed now is discussion – in Parliament, between ministers and the sick and dying, between doctors, between couples and within families. The onus should not be on individuals to ask permission to be allowed to die peacefully.

Assisted suicide is an act of mercy, no less than the actions of a doctor or nurse on any other day in their career. The real enemy is silence and hypocrisy; wishing a dignified death for oneself and others isn’t selfish or unfeeling, it’s human. And our humanity is what necessitates the freedom to make our choice.

 

Doctor, Doctor, Are All These Pills Really Necessary?

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

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

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

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

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

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

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

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

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

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