Talking about feelings does not make you a snowflake | Deborah Orr

Prince Harry spoke over the weekend about the emotional cost of suppressing his grief over his mother’s death when he was 12 years old. Prince William followed up by saying that his work as an air ambulance pilot made him aware of the large number of people, mainly men, who attempt suicide. The two of them, along with the Duchess of Cambridge, have launched an awareness campaign that aims to highlight the dearth of good mental health provision in Britain.

For some, all this means is that – disappointingly – the royals have joined the “snowflake generation” of young people who are simply too sensitive to little things like “feelings”. For others, including myself, their Heads Together initiative is admirable, not least because in itself it calls attention to the ludicrously basic level at which the building of “awareness” needs to begin.

Imagine how weird it would be if this trio were sticking their necks out to raise awareness of physical health, pointing out that you don’t just carry on, yelling that it’s only a flesh wound if you’ve made a gash in your hand. Clean it, at the very least. Put on a plaster. If it won’t stop bleeding, see a doctor. These are things everyone is nowadays expected to know. Yet, not so long ago, humans had no understanding at all of the implications of leaving a physical wound untreated.

We’re not far beyond that point with “mental health”. For a start, this is a huge, catch-all term. In Harry’s case, normal emotional distress was left untreated, and festered into something more serious. And yet … expressing his distress? Having it addressed? That, in some people’s eyes, would have made Harry a snowflake. This dangerous attitude is particularly fostered in men and boys. It’s not masculine to show your emotions – though they tend to show in other ways, in anger, aggression, self-harm or depression. I daresay that in at least some of the cases to which William refers, men bottled up their distress until it became overwhelming.

Very often a “mental health problem” starts out as mere emotional distress, a natural, healthy part of life. It’s when that distress isn’t sensibly addressed that it can grow into something that can be labelled a problem. Simply being aware of one’s emotions is the first step towards regulating them. Telling a whole generation that they’re “snowflakes” for having such awareness is actually an awful thing to do.

Which is not to say that every manifestation of emotional distress should be indulged or validated. That, I think, is what makes people talk of “emotional incontinence”. There’s a tendency among some to start believing that if a view or opinion upsets them then it is wrong. On the contrary, that’s usually a sign that the distressed person has difficulty handling conflict. What’s really going on with the “snowflake generation” is that people are becoming more aware of their feelings and needs, but don’t have the knowledge or experience to understand what those reactions are telling them about themselves.

In January this year, Theresa May announced that schoolchildren will be given greater access to NHS mental health workers. She has also praised Prince Harry for helping to “smash the stigma” around mental health and reassuring people that they are “not alone”. (She’s also called a snap general election, of course, which isn’t going to help anyone’s mental health.)

But this too is evidence of the crudity of our thinking. What is actually needed is far more sophisticated emotional awareness, so that people can recognise and manage their own emotions and, just as importantly, interactions with others who may have unhealthy or abusive emotional agendas themselves.

The good news is that all this is not actually as difficult or complex as it may appear. Emotional awareness could easily be taught in schools. It should be seen as just as necessary as PE. Already people are doing amazing and cost-effective work that can have a huge impact in helping people understand and care for themselves and those around them. Last week, for instance, I took part in a conflict workshop run by youth charity Leap. Around 20 adults who had never met before became fairly emotionally intimate with each other over just a couple of hours.

Emotional awareness should be taught in schools, and seen as just as necessary as PE

Some declared they’d achieved insights that they were going to apply within their marriages. Someone who’d worked for years with the most troubled young people announced she was “blown away”. Yet the room was full of people who didn’t even know that conflict was a problem in their lives.

And that’s the thing. People soldier on, unaware they have a problem. Worse, that problem becomes familiar; it feels safe, even comfortable, because it’s what they know. It’s why people make the same mistakes again and again, abusing others or allowing themselves to be abused without even knowing this behaviour isn’t “normal”.

There’s a tendency to see the “snowflake generation” as narcissistic, demanding constant attention and validation, wrapped up in their own needs and unaware of those of others, refusing to take responsibility for their choices or mistakes, playing the victim. Yet these critics are themselves being typically narcissistic in denying that the youngsters they berate have any right to their own feelings and perceptions, let alone might need or deserve some help in untangling them.

If anything, I believe, this generation is suffering because generations before it were as narcissistic as any that ever lived. If you think that’s far-fetched, take a look at Donald Trump, elected King of the Baby Boomers.

Talking of kings, there’s not a lot that’s more narcissistic than the concept of monarchy. When the youth of that institution say there’s a problem, then you really, really know there is. And that it’s a big one.

Talking about feelings does not make you a snowflake | Deborah Orr

Let’s applaud Simon Stevens: the NHS boss with a plan | Deborah Orr

One trouble with dropping targets is that such a decision tends to create a target. The head of NHS England, Simon Stevens, has outlined many sensible goals in his proposals for the future of the health service. But attention has focused on one thing. In order to take the strain off A&E departments and improve cancer treatment, Stevens has decided to drop the target whereby 92% of routine surgery is carried out within 18 weeks of a GP referral. The moment that some ghastly failure can be personalised in the form of an iconic victim of this change, Stevens will be held personally responsible. He is the target now.

Why is Stevens taking this risk? Largely because the government has made it clear that the extra funding Stevens needs will not be forthcoming. But it’s also another attempt at a nudge, to GPs and to patients. People can be aggressively passive about their health. They want doctors to fix it for them. GPs are wary of berating patients into losing weight and exercising more, especially now, when patients have read on the internet all about the operation they can get. The promise of elective surgery within 18 weeks, I’m afraid, only encourages both GP and patient to kick the can down the road. The hope is that the removal of the target will encourage GPs and patients to opt first for physiotherapy, which is what all sensible people should be doing anyway.

Some of the problem is with us, and our demands. We trail off to the GP with our colds and beg for antibiotics

Around 150 urgent treatment centres are being planned, to take the strain off A&E, which NHS chiefs say still attracts about 3 million people each year with minor ailments. Stevens is hoping to persuade all GP practices to offer evening and weekend appointments, so that A&E departments don’t become one-stop-shops over the weekend. Astoundingly, Stevens is also demanding that all A&E departments should introduce “comprehensive front-door clinical streaming”. Here in my metropolitan elite bubble, I’d imagined that all A&E departments had been assessing all walk-ins by medical need for decades. It’s easy to forget just how much sheer inertia is inevitable when dealing with a beast as large and complex as the NHS.

Stevens also addresses the system’s two most glaring failures – the lack of integration with social care and the relatively slender access to mental health services. On the first, Stevens aims, through closer coordination between hospitals and councils, to free up potentially 3,000 hospital beds. On the second, the aim is to provide talking therapies to 200,000 more people. These are ambitious goals. Considering the lack of investment, they are valiantly optimistic. Sometimes, people doing tough work need a bit of encouragement and applause. Stevens is one of them.

‘Some of the problem is with us, the users, and our demands. We trail off to the GP with our colds and beg for antibiotics; we call ambulances because our friend is very drunk.’ Photograph: Yui Mok/PA

There is a great deal of cognitive dissonance to Britain’s relationship with the NHS. Yes, we love it. No surprises there. It’s worth loving and not only for sentimental or socialist reasons. All but the most cock-eyed of diehard free-marketeers are obliged to bow to the evidence and admit that the NHS is the most cost-efficient health service in the world. Many politicians have struggled to come up with alternative funding models and had to admit that nothing is really worth the hassle it would cause. Insurance-based schemes around the world have been scrutinised and the conclusion is pretty much always that these simply drive up the cost of healthcare generally, with the US a particularly abject example.

Yet at the same time, our love for the NHS is sometimes skin-deep. When things go wrong or are disappointing, this is seen as proof that the service is falling apart, hardly ever that medical problems can be complex and baffling, or that people are not always the most reliable witnesses to their own problems. There’s still a great deal of suspicion about change.

Stevens has come up with a solid plan, and everyone’s up in arms because operations that might not work are being sidelined in favour of restorative exercises that probably will, if only people commit to carrying them out. Why is this supposedly awful thing being done? Just so that people who have been knocked down by cars or people with cancer can have their actual lives saved. Just so that hospitals don’t have to farm operations out to private providers simply to hit their targets on not always terribly necessary operations.

Some of the problem is us, the users; our own expectations and demands. We have this precious, amazing resource. We stand with it and see the government as its enemy. Yet we trail off to the GP with our colds and beg for antibiotics; we call ambulances when our friend is drunk; we’re astounded when our neighbour reveals himself as proficient in first aid.

Right now, there’s a hullabaloo because elderly people with some money behind them are expected to pay for people to help them with things they can no longer do for themselves. This, apparently, punishes “the thrifty”. How can having the wherewithal to pay for things you need be “a punishment”? Sometimes, the basic problem is that we want the best but we don’t want to pay for it. Full stop.

Let’s applaud Simon Stevens: the NHS boss with a plan | Deborah Orr

It’s painful watching the male crisis onscreen – more painful in real life | Deborah Orr

Had Moonlight not come along, hard on its heels, Manchester By the Sea might have seemed like the most emotionally revealing film about a man to have been released in years. But since Moonlight is probably one of the most emotionally revealing films about a man ever to have been made, it wins.

It isn’t fair to set the two in competition. They’re doing similarly important things in their different ways – exploring negative aspects of masculinity. In Manchester By the Sea a single, unlucky catastrophe turns a warm, fun-loving young man into an angry, aggressive, emotionally shut-down loner. In Moonlight, a whole childhood conspires to drive a man to become a numb synecdoche of all that has blighted his own upbringing.

It’s undoubtedly because I’ve recently been diagnosed with a trauma-induced anxiety disorder myself. But I immediately saw the symptoms of chronic or complex post-traumatic stress disorder in both leading characters.

In Manchester By the Sea, Lee Chandler, played wonderfully by Casey Affleck, displays symptoms of chronic PTSD, in which a single trauma comes to dominate the brain’s neural pathways in an extremely unhealthy way. You can also see these symptoms simply as emotional reactions that any person in Lee’s situation might develop. But the point is this: we are so used to these destructive and damaging responses to life’s vicissitudes that they seem natural rather than horribly dysfunctional.

In Moonlight, Chiron, played by three actors as a child, a teenager and an adult, already has complex PTSD, to my eyes, as a little kid. Complex PTSD is brought on when a person is subjected to a series of traumas, most often by a caregiver they ought to be able to trust unconditionally, but from whom there is little chance of escape. Abused or neglected children are very susceptible to C-PTSD. By the time Chiron is an adult, from my reading of the film, C-PTSD is rampant.

There’s a lot of controversy at the moment about whether armchair diagnosis of mental health problems should be indulged. I think it’s totally valid when the character being examined is fictional. I’d say it’s more than valid. It’s necessary if humans are going to get to a point where we can understand ourselves and the messes that we make.

In Manchester By the Sea, Lee is a man who really, really needs therapy, though this isn’t mentioned as an option in the film. The culture he’s in is far too blue-collar for that. Lee fights his miserable losing battle with his trauma, guilt and shame alone. As with Chiron in Moonlight, his symptoms are classic too. It’s so plain in the film that what a psychiatrist would call symptoms are also self-protecting emotional responses, recognisable to anyone who cared to view them in that way.

Having mentioned the controversy around amateur diagnosis, I’m now going to tread carefully. After the screening of Moonlight I attended, there was a Q&A session with Tarell Alvin McCraney. He wrote the play on which Moonlight is based, In Moonlight Black Boys Look Blue.

McCraney makes no secret of the fact that the early part of the story, of a boy growing up in Miami with a crack-addicted mother, a flawed father-figure who loses his life very young, and the experience of being bullied as a “faggot” by his peers, is based on his own life. McCraney’s life clearly has not followed the trajectory of Chiron’s because, you’ll be glad to know, the film doesn’t end with our hero sitting down to write an amazing play that becomes a film. You’ve seen that movie already, more than once.

Boys are told not to cry, told to fight back, told to toughen up, in a way that girls less frequently are

McCraney – intelligent, gloriously articulate, handsome, elegant, funny, charming, polished, self-deprecating – is also frank. On the platform he acknowledged that he knows how people see him, which is pretty much the way I saw him, as listed above. It wasn’t just me. The room was full of love for him. However, he says, this is not at all how he sees himself. Instead, he is “terrified”, has “intimacy issues”, sometimes can’t bear crowds and has to be alone, and sometimes finds himself drifting away from feeling present in the world. He has survived his upbringing and thrived fantastically well. But the psychological scars are there and he is aware of them.

McCraney says that he doesn’t find writing about his past cathartic. Instead, it depletes him. It costs him a lot. I think that while some men, men like Lee, fight with their fists, McCraney fights with his creativity. It’s a much healthier way to do battle with trauma. But that’s still what it is – a battle with trauma.

I find myself thinking that while both Lee and Chiron are extreme examples, a lot of the cliches about the transformation of boyhood into manhood centre on the suppression of trauma. Boys are told not to cry, told to fight back, told to toughen up, in a way that girls less frequently are. (Although girls do toughen up. I did.) Sure, this can result in creativity like McCraney’s. But our experience of the world and its history suggests that very often it results in bombast and aggression, anger and violence.

We are used to hearing about theories of gender as a performance. I wonder if that’s too glib. Maybe gender is more of a neurological response, with hyper-masculinity a pathological response to trauma, and hyper-femininity a defence against an aggressive masculine pathology. Or maybe I’m barking up the wrong tree. Who knows?

The crucial thing is that these films are urging people to look hard at these profound issues around human behaviour, and really think about what makes people who they are. I’m thankful for both of them, and for the pain and struggle sometimes involved in “being a man” that they so sensitively portray. Especially Moonlight. I don’t think there’s ever been another film quite like it.

It’s painful watching the male crisis onscreen – more painful in real life | Deborah Orr

Carrie Fisher showed the way. I want to acknowledge my own mental struggles | Deborah Orr

Lots of people said Carrie Fisher was wonderful. Lots of them said she was wonderful not because of the achievements in her career, but because she used her fame to talk and campaign about how she managed her bipolar disorder, and about mental illness generally. I agree. Yet, while I’m no Carrie Fisher, all this makes me feel guilty about my own silence. Feelings of guilt are one of my symptoms.

I started being treated in October for a mental illness I hadn’t even heard of: complex post-traumatic stress disorder. I realise now that it’s been there, thickening, worsening, for many years. Essentially, it comes about when you suppress traumas and carry on regardless, failing properly to address emotional distress, which you also suppress.

I have trouble remembering. Even after I’ve looked it up, which I often do, I have trouble remembering the year my father was first diagnosed with cancer, or the year he died; the year I was diagnosed with cancer; the year a huge chunk of masonry fell off our terrace of houses; the year my mother was first diagnosed with cancer, or the second time, or the year she died; the year my first son crashed out of school; the year my second one did; the years when I got them back into education; the year my then-husband was diagnosed with a chronic blood disorder. Basically, I barely remember the last decade. I’d thought my perfidious memory was the result of chemotherapy, or just of ageing. But it’s another symptom.

People tell me I’m “intimidating”. I’ve been told that for all my adult life. I’ve accepted it without understanding it, sometimes explaining what a shy child I was, how endlessly susceptible to bullying, in every context I ever found myself in. I’ve always been too scared really to question how it could be that other people saw me so differently to how I really felt (I even intimidated myself). I told myself it was just because I was someone from a working-class background in an upper-middle-class milieu. Anything to protect me from my secret shame – that I found everything intimidating.

I kept that shame entirely hidden, especially from myself, by pretending that I found nothing intimidating. I even called it “pride”. That “pride” has stopped me throwing up my hands, and truly admitting I’m beaten.

The illness can make you appear to other people as someone who is tough, who can cope with anything. You take on responsibilities you struggle with, and look after other people without looking after yourself. But when you suggest you can’t take it, people often don’t even hear you. They think you’ll cope because you always cope. That’s who you are. That’s what you’re for. Which is not to put blame on others: it’s a natural and rational reaction, the logical thing to say to the person they want to see and think they know.

So you carry on coping, and somehow you get through. You thrum with stress, take your anger out on the random dude who does the tiny thing that makes you crack; or become listless, unable to focus, panicked every time the phone rings, every time a letter arrives, a letter you instantly recognise as pertaining to the hellish, complex negotiation that no one but you knows the intricacies of.

You look like you’re managing things that would floor other people, sensible people. Though nothing could be further from the truth. You become a person for whom it is second nature to find courage or aggression in yourself because you are frightened and vulnerable. Or you resort to passive-aggression, which is often my miserable chosen defence. Anything to avoid addressing the fact that you are terrified.

Generally, the psychological vulnerability starts in childhood, not necessarily with dreadful abuse or neglect. I was not an abused or neglected child except in the usual, Larkinesque way. (My parents were neurotic and moralistic: I think of my childhood as like growing up in a religious cult without the religion.) But I was a sensitive child, in a pretty rough-and-ready, rust-belt culture. Early memories, recounted in therapy, have taken on a significance quite different to the meaning they had for me.

They include seemingly small things, such as being sent out to play on my own for the first time, aged three. A bigger girl asked to see my gold christening bracelet, then ran off with it. When my dad went round to confront her mother and get it back, the woman said the bracelet was her daughter’s and refused to return it. This was my first solo encounter with the outside world, and I see now that, rather than accepting it and learning from it, I defied it, even then.

I stride boldly into situations for which I am ill-prepared. I trust people very easily and very completely. I find it hard to show that I’m hurting. Another memory, aged about seven: I stood on a platform while other kids threw bricks at me. One struck me on the temple, but I wouldn’t show them it hurt. It’s a habit that gets me into trouble, again and again. Anything rather than acknowledge my debilitating fear, of the world and the people in it. I’m an idiot. Or I was.

It’s hard, at 54, to find the time and energy to reassess your whole life, take responsibility for all the mistakes, and still embrace the part of you that did OK, even if it betrayed the part of you that actually needed the attention.

It’s hard to see that you’re interested in, and opinionated about, the world outside yourself because it distracts you from the churning insecurity inside – the anxiety that eventually shoots up and convulses you with the shakes and hammers at your heart, the dissociation that has you stepping out in front of cars – unless you bang your chest to bring yourself back. That, you thought, was normal. Feeling these things is good (kind of). They are manifestations of stuff you didn’t even know was there, because it was all stuffed down so deep inside. They tell you you’re in trouble.

It’s also hard not to start sounding like a victim: and that’s why people such as Carrie Fisher, Ruby Wax or Stephen Fry are so important. They reassure you that you feel worse before you feel better. They help you understand that while all the emotions you suppressed – the fear, the guilt, the grief, the shame, the anger, the self-loathing – now feel overwhelming, this too will pass.

The guilt is especially hard: guilt that you soldiered on and didn’t sort matters out sooner. But with courage you can let it go. Because you still have the courage you always found, even if you acknowledge at last that it always had a lot of competition from other emotions.

For me, I know, 2017 is going to be the most fruitful and honest year I’ve had for a long, long time. I’m going to be spending it getting to know myself at last and maybe even learning that I’m actually not so awful. And I’m going to carry on saying what I feel, and writing about it. I think there are a lot of people out there, struggling with emotional trauma that they don’t acknowledge. England calls it the stiff upper lip. But it’s your whole being that ends up getting stiffed. Enough.

Carrie Fisher showed the way. I want to acknowledge my own mental struggles | Deborah Orr

Generation snowflake is not failing us: we’re failing them | Deborah Orr

A healthy society, surely, is one that helps its children feel safe and secure. If this were a banal proposition, it wouldn’t even have to be stated. Yet there are plenty of people who would contend that it’s not up to society to make kids feel safe. That, they will announce with tremendous self-satisfaction, is the job of their parents. It’s as if they don’t even know that humans are social animals, and that it is the ability of humans to think and act from social motivations that fostered civilisation.

For these folks, any sign that children are struggling in Britain today is sneeringly dismissed as more evidence of generation snowflake’s feeble lack of resilience. This aggressive, sloganeering refusal to engage with the feelings of vulnerability of others, but instead to mock and belittle them? That in itself is a statement of intent. It is an assertion that helping young people to feel safe and secure is not in the least their business. On the contrary.

Research by the NSPCC, gathered through freedom of information requests, warns that serious cases of self-harm among young people have jumped by 14% in the last three years, with 19,000 children and young people treated in hospital in England and Wales in the last 12 months. People self-harm when they crave the primitive distraction of physical pain from the insistent complexity of emotional distress. The respite is brief and dangerous. Often, it piles shame and guilt on to a chaotic heap of negative emotions that has already proved overwhelming: snowflakes dissolving in their own sticky blood.

The fact that these children choose to harm themselves rather than others is a sign that they feel plenty of shame about their fears already, for which they blame themselves. Often, children report that they couldn’t talk to their parents because their parents were too busy. What they tend actually to mean is that they’re worried and upset because they know their parents are worried and upset, and they don’t want to add to the burden.

But if it’s the job of parents not to be worried and upset, so that they can help their children, then you have to ask why it’s such a great idea to consider human competition rather than human collaboration as the magic fountain from which all good things gush. It’s always too simplistic to theorise about how a vast range of individual and particular crises are all down to one thing. Yet the list of the usual suspects that’s aired when mass psychological struggle hits the headlines does include a lot of stuff that has competitive elements.

Any sign that children are struggling is sneeringly dismissed as more evidence of generation snowflake’s feebleness

There’s the pressure to look attractive, the pressure to succeed at school, the pressure to be popular, the pressure to get a job, to get a home. If I were growing up now, I’d be terrified. I was pretty terrified in the 1970s, when I’d no idea how much more demanding and complex life was going to get. Are children wrong to feel these pressures? Can any parent honestly tell them that none of it matters and that life has a way of turning out OK?

Yet all this is just a backdrop to the existential struggles of life. Children still have to deal with private catastrophe – bereavement or abuse, illness or trauma – as well as global horror: the horrific evidence of human aggression and the suffering it causes, there on your phone all day, every day. All this, alongside the sheer effort of becoming yourself in an era that idolises individualism.

Left and right, politically, they both do this. The left champions identity, the right champions robust economic self-sufficiency. Do we give children time to find out who they are, among the blanket demands that they should Be Themselves? We don’t give them time and we certainly don’t give them much in the way of psychological tools or support. After all, therapy costs money in this economically competitive world.

We need to feel part of something bigger than ourselves, and sometimes I think Brexit is best understood as an expression of that yearning. Young people, on the whole, felt like part of Europe because they’d grown up with it. Maybe older people just felt like their own place in the world had just become so much harder to locate in their hearts once they weren’t simply British. And how people viewed Europe in their daily lives also raised the spectre of competition; people coming here looking for work, and helpless employers, themselves governed by competition, quite unable to do anything other than pay the lowest wages possible.

I’m not saying that vulnerable young people self-harm because hashtag Brexit. That would be too simple. But I am saying that it may reflect the fact that there is too much competition in the world and not enough caring support. Competition can be a great driver of achievement, but so can collaboration. The corrosive thing about competition is that it fosters fear of failure, which has to be countered. Balance is everything, and that’s what we don’t have. People are afraid and ashamed of their fear; so it festers, and explodes in anger and resentment. It’s fertile ground for demagogues who offer glib, bogus answers and, boy, do they plough it.

You can choose to see “generation snowflake” as a bunch of wimps, or you can observe that there is plenty going on in the world to traumatise a sensitive child – or adult. Then you can think a bit about how traumatised people make bad decisions, and conclude that the aggression, the fear, the shame, the self-harm – it has to stop. The very essence of what it is to be human – to be able to look after one another and help one another find solutions to our problems – is what is at stake, and children feel it.

Generation snowflake is not failing us: we’re failing them | Deborah Orr

Cryonics may be a fantasy. But who would begrudge a dying girl that? | Deborah Orr

There is so much that is distressing about the case of JS, the 14-year-old girl with terminal cancer who wished to be cryonically preserved after death, in the hope that she could be revived when a cure for her rare illness had been discovered. Her mother supported the girl in her wishes; her estranged father did not. So, without the consent of both parents, the child had to apply to the courts for permission for the procedure to take place.

JS and her mother both seem to have been determined to secure the preservation. JS got in touch with a Michigan storage facility and also with a UK charity that offers cryonic preservation and makes travel arrangements. Her maternal grandparents raised the estimated £37,000 to fund the process. After the death of JS, her hospital sent a note to the court, saying that their patient’s mother had been too preoccupied with complex postmortem arrangements to be “fully available” for her daughter as she died.

It seems cruel, placing that observation in the public domain, in reference to a woman whose daughter lost her life just a month ago. A lot of people will be familiar with the weird displacement activities that are indulged when a relative is dying. As my father died of cancer, his family fretted over whether he was eating enough and drinking enough water. The last time I offered Dad water, he said to me, very crossly: “Deborah. Enough.”

When my mother was dying of cancer, I got rid of the piano to make space for a bed in the living room, called private ambulance companies and contacted local hospices and care homes, trying with immense futility to arrange for her to be brought the 400 miles from Airdrie to London. Would I allow myself to be taken over by my child’s fantasy of future life? I fear I might.

How easy things were when we all agreed that all good children – and adults – go to heaven. My parents had always seemed to me very pragmatic in their atheism and their belief that this life was all there was. I was hugely shocked when my father, faced with his own death, said: “I didn’t think this would happen to me.” If anything, I was even more shocked when my mother said the same thing, just six years later. I’d had cancer myself in the interim, and had stared hard at the prospect of my own death. I’m absolutely certain that it’s going to happen to me. My doleful preoccupation is with how long I’ve got.

As for the father in the case, who also has cancer, he seems to be the ultimate example of a man who is clever but not wise. His objections included worries that she might be revived in the future and be unhappy and isolated. He thought it through. Unbelievable, really. He took a dying child’s complete fantasy, of a rebirth that medical science does not offer and is never likely to, imagined how things might pan out if this wasn’t a fantasy, and decided he was going to deny his child because his verson of this fantasy didn’t end happily. Also, he’s on benefits, and expressed concern about becoming liable for costs.

Yet one feels for this man too. Even this brief vignette of his psyche explains why he was bitterly estranged from his wife and daughter. Neither mother nor child had seen him for many years. Yet still, when they asked something of him in their baleful situation, he said no. Eventually he came round, saying he would agree if he could see his daughter’s body after she died; they said no, in turn. That’s how high-conflict family fractures go: one person says no and the other says no right back, the first chance they get.

It’s possible too, that it was the need for a court order that made the whole thing real to the mother and daughter, encouraged them to pin down details, check out logistics, make costings, seek funding. The case has certainly made things real for the rest of us.

The judge in the case, Mr Justice Peter Jackson, was at pains to emphasise that in granting permission he was not endorsing cryonics. Rather, he suggested that there was a need for regulation to be drawn up. I can’t help feeling that the regulation of a few exploitative, science fiction-based companies can only give an imprimatur of seriousness to ghastly people who exploit the human fear of death. These places don’t need regulating. They need exposing as morbid confidence tricksters.

In the absence of religion, humans still have philosophy to help those in distress make sense of life and death. At its best, religion is just a theatrical version of philosophy with a comforting final act. Even the resolutely irreligious understand the importance of a funeral – because funerals are for the living.

That’s why it’s easy to see the mother as even more tragic than the daughter. Perhaps she believed in her daughter’s fantasy too. In that case, she is likely to spend the rest of her life tracking progress in the treatment of her daughter’s illness. If that cure ever comes, this might be the point at which she will have to accept that her child is really dead. It’s a miserable thought. One can only hope that she knew what she was doing – offering false but compassionate hope to a child who didn’t want to die.

Cryonics may be a fantasy. But who would begrudge a dying girl that? | Deborah Orr

A male pill matters because both partners can share the side-effects | Deborah Orr

An experimental male contraceptive jab has proved just as effective as the pill is for women. Trials were abandoned, however, because side-effects included depression, raised libido and acne. Which is weird, because the pill has similar side-effects – although sometimes it can cure acne. The pill’s other common side-effects include nausea, headaches, breast tenderness, anxiety, weight gain and, sometimes, decreased libido. However, suggesting that the pill isn’t an almost perfect form of birth control tends not to go down very well.

This is understandable. The pill has given women agency over their own lives like nothing else. And women don’t want that great freedom to be tarnished. The advantages of an equally reliable male contraceptive, of course, are much less direct. If anything, the pill freed men from worry about contraception or “getting a girl pregnant” to the extent that an unwanted pregnancy is often looked on as something that’s entirely the fault of the fool who’s enceinte. It’s hard not to look on all those anti-abortionists and morning-after pill killjoys as people determined that foolish women should pay for their own singular mistakes.

Yet a male contraceptive is simply more sensible, in biological terms, than a female one. In her book, Sweetening the Pill, and in numerous articles, Holly Grigg-Spall points out that men have no fertility cycle, while women are only fertile for six days every month. Women take a lot of responsibility for those six days, while the constant risk is not from their ova but from ever-ready sperm.

Grigg-Spall, who is a passionate advocate of raised awareness about the pill’s risks to women, believes that its side-effects are minimised not just because of feminism, which cannot help but see the pill’s advantages as outweighing its disadvantages, because they do, but also because of sexism, which tends to dismiss female problems as trivial and male advantages as important. It’s hard not to agree with her, when comparing this latest research, in which side-effects were given such emphasis, with Danish research published last month that linked the pill to depression and gained little more than shrugs.

‘Shared responsibility for reproductive freedom still seems so far away.’ Photograph: Garo/Phanie/Rex/Shutterstock

Yet it’s precisely because hormonal contraceptives have side-effects, and that these vary from person to person, that a decent male contraceptive would be such a good thing. If one partner finds the side-effects unbearable, then the other can take up the mantle. If one partner has been on contraceptive hormones for a long time, he can give his body a rest and ask his partner to take her turn. A male pill would promote the idea of shared responsibility. Which in matters of sex and reproduction still needs a lot of promoting.

The pill unleashed sexual freedom on a grateful world. It took a while for feminism to realise that this was not by any means always to the advantage of women. Ever since that time, discussion about the male pill has tended to focus on casual sex – whether a woman would trust a man who said he was on the male pill, since a lie wouldn’t leave him up the duff. But the truth is that barrier methods remain necessary for casual sex, to protect against sexually transmitted diseases, whether other contraception is being used or not. Hormonal contraception for both sexes is at its most positive as a goal in stable relationships, where it is so important for responsibility and risk to be shared.

Yet shared responsibility for reproductive freedom still seems so far away. One reason why the development of an effective male contraceptive has been painfully slow is lack of enthusiasm for the idea. Money for research isn’t there because big pharma doesn’t think men will be keen enough. The prospect of more equality, empathy and understanding between the sexes just doesn’t thrill the market.

Unlike Grigg-Spall, who had a terrible time when she was on the pill, and suffered major side-effects such as panic attacks, I’m not against hormonal contraceptives, even if they are risky. I stayed on the pill for a long time, maybe too long, and eventually I couldn’t face it any more. I’d have very much liked it if my partner could have taken his turn too. That alternative wasn’t available. But that isn’t just scientific and pharmaceutical happenstance. I’m troubled by the idea that risks women are routinely encouraged to take are risks that men are not willing also to take. There are related risks that men won’t take either. Vasectomies are at a historically low level. Addressing this particular inequality is a huge step towards addressing many others.

With double as many people willing to take a contraceptive pill, fewer women would have to suffer in silence for the sake of worry-free sex. I’m sure that some men would be happy to take a hormonal contraceptive. But the market tells us that not nearly enough are interested, while research tells us that even when they are, they’re too risk-averse for the idea to be driven forward with enough urgency.

Reliable contraception is a Great Thing for humanity. It’s about time that half of humanity stopped shirking and joined women in engaging in the physical challenges that are undertaken in embracing it.

A male pill matters because both partners can share the side-effects | Deborah Orr

So, junior doctors, what exactly is it you’re striking for? | Deborah Orr

It’s hard to believe that the British Medical Association really intends to stage four five-day junior doctors’ strikes before the end of the year, one of them in just a couple of weeks’ time. BMA members, after all, are the people who warn that the NHS is already under intolerable pressure. How can they therefore believe that such huge, continuing disruption can simply be absorbed by their colleagues, bringing no harm to patients? It doesn’t make sense.

Nor does the BMA’s own position quite make sense. The strikes earlier in the year resulted in a renegotiation and new contract for junior doctors, which the BMA committee declared satisfactory. Yes, it was rejected by members. Nevertheless, the fact remains that the new contract did largely address the particular problems with weekend remuneration that junior doctors had initially identified.

Supporters of action will argue that the dispute is about much more than junior doctors’ contracts. But there has to be a worry, surely, that if the specific detail acting as a catalyst for industrial action isn’t perceived by the public as impeccably clear and strong then the wider message is also undermined.

Many people are concerned about the future of the NHS. And many people were dumbfounded that Theresa May opted to keep Jeremy Hunt as health secretary. But, to me, it’s beginning to look as if the junior doctor’s dispute isn’t really solid enough to carry the weight of such hefty concerns.

I have sympathy with the argument that the move to a seven-day NHS, without a proportionate increase in funding, is a dangerous one. It can certainly be interpreted as a way for politicians to actually cut funding while claiming to be increasing it, as they regularly do.

People have every right to be suspicious. In the 1980s and 1990s, public services were starved of funding by governments which then cited the mess that they were in as prima facie evidence that they were hopeless and had to be privatised. Not everyone has forgotten such cynical strategies, or persuaded themselves that they could never be employed again. They most certainly could.

‘Unless what they want is something that can be written into their contracts – rather than, say, the resignation of Jeremy Hunt – then they have few grounds for complaint when others question whether this latest stance is sensible, admirable or honest.’ Photograph: Carl Court/Getty Images

Yet there is also some sense in the thought that expensive buildings and expensive equipment are greatly under-utilised for two days in every seven.

There’s a sensible idea in there, for increased NHS capacity – a greater number of available beds at night, a greater number of appointments for patients. The question is really about whether the government is willing to pay for the kind of rise in payroll costs that increased use of facilities would entail. That’s an incredibly important debate to have – but it seems at the moment that the tight focus on the BMA and junior doctors is serving to dilute that focus rather than concentrate it.

There’s a sense in which junior doctors are the stalking horse of more senior medical professionals, who naturally enough would like to be generously compensated if they start being asked to turn out for weekend shifts themselves. Junior doctors, of course, are the ones who are already working at weekends anyway – which is the reason why they’re on the frontline of the resistance to seven-day working. Wise and venerable consultants, offering sympathy for those hot-headed kids, do actually have a horse in the race themselves.

Yet there’s a real chance that junior doctors would bear the brunt of public revulsion if such big strikes took place and things went wrong. I don’t much like the idea of passionate young people full of vim and political commitment waking up one morning to headlines asserting that they were instead dogmatic provocateurs who killed innocent patients with their militancy. Who doubts such headlines are possible? Or that the personal pain and disillusionment such headlines could visit on individual junior doctors is not significant?

I understand that it’s awkward, bringing up the idea that what the mainstream media might do is worth bearing in mind. I know the established media is seen as “part of the problem”. But I also know that the BMA’s latest threat is not onelikely to fare well within that climate, which for better or worse is a climate it cannot blithely ignore.

Maybe the threat alone will get the junior doctors what they want. But unless they can make it clear to the public that what they really want is something that can be written into their contracts – rather than, say, the resignation of Jeremy Hunt – they can’t complain when reasonable people question whether this latest stance is sensible, admirable or honest.

So, junior doctors, what exactly is it you’re striking for? | Deborah Orr

Breast cancer drug Kadcyla is as well high-priced for the NHS not to pay for it is the right determination | Deborah Orr

Campaigners for Herceptin in Cardiff in 2006, one more instance of a cancer drug that became some thing of a trigger celebre. Photograph: Alamy

How do you place a cost on lifestyle? How would you know the place to commence? In the situation of the independent NHS watchdog, the National Institute for Health and Care Excellence (Good), there is a points method, which calculates QALYs, or good quality-adjusted daily life many years. If a new drug costs a lot more than £30,000 per QALY, then it truly is deemed too costly for use by the NHS. So it’s a bit wealthy for Roche, developers of the new breast cancer drug Kadcyla, to be acting all shocked that Great says it’s as well high-priced for use by the NHS. At the moment, remedy with Kadcyla charges more than £180,000 per QALY. Which is obviously fairly steep.

Nevertheless, as typical, Nice is getting portrayed as the villain. Negative decisions by Good are typically greeted with a response from the media that invites men and women to imagine how they would really feel if they needed a life-saving drug and bureaucrats denied to them. This one has been no various.

A lady named Kim Mawby, who thinks (but isn’t certain) that she was treated with Kadcyla right after she joined a drug trial in 2011, was interviewed by the Guardian this week. After her cancer spread to her lymph nodes, chest wall and lung, the mother of two faced the prospect of having six months to live. Now, much more than two many years on, there is no trace of cancer on her lung or chest wall and she’s even now going robust. It really is a great story, and Mawby is understandably optimistic about her therapy.

Reading that story, I couldn’t support contemplating back to the awful day I realized that my breast cancer had spread to my lymph nodes, and the even a lot more awful day when I was tested to see if it had spread to my chest wall and lungs. The relief that it hadn’t was indescribable. However, eternally grateful as I am for my NHS treatment method, I know that, had money been no object, less invasive treatments with fewer side-results would have carried out the trick, potentially rather greater. But, ghastly as the remedy I had was, I’d rather have been in a huge room with other people also obtaining that treatment than in a small area, otherwise empty, because all the funds was getting invested on me. That’s what Nice has to think about – the number of people that can be aided, not the definitely best way of helping 1 individual.

Had I been in Mawby’s footwear, even though, of course I’d have needed the treatment that could conserve me. I would have agreed with Mawby, who advised the Guardian: “It has given me back my typical lifestyle. You just can’t place a cost on it.” So, nasty previous Good, who do place a price on this kind of treatment, and a bargain-basement cost at that.

Except that Good hasn’t place this chunky price on Kadcyla, has it? Roche has. Roche explains that establishing new medicines is exceptionally high-priced, and they have to recoup their charges. Individuals expenses have not been unveiled, for business motives. But Roche would seem rather great at recouping them. It created a revenue of 11.4bn Swiss francs (£7.7bn) last year. As its chairman, Franz B Humer, mentioned in his 2013 letter to shareholders: “In a difficult, more and more price-delicate atmosphere, our concentrate on targeted medicines and diagnostic exams has permitted us to broaden our powerful industry place and to drastically enhance net revenue. In light of our robust performance, the board of directors is proposing – for the 27th consecutive year – an improve in dividend.” It’s well worth bearing in mind, reading through this, that a 2012 report known as The Study and Improvement Cost of a New Medicine reckoned that, on average, only about ten% of the all round expense of building a new drug is taken up by analysis and advancement. A lot far more is spent on attracting and servicing traders. Quite a bit is invested on PR.

Kadcyla is described as “a Herceptin-like drug” – Herceptin currently being an additional groundbreaking breast-cancer drug developed by Roche. As a result far, in the British media, it’s also had a Herceptin-like reception. In his book Negative Pharma, Ben Goldacre describes how, from 2005, “accessibility to this drug grew to become a spontanteous cause celebre for the British press”. This kind of was the deluge of optimistic posts about the drug, with Good once again painted as the cruel and unfeeling master of the purse strings, that a group of academics analysed 361 newspaper stories on the subject to consider to understand what was going on. It located that “half of the stories have been about the troubles in acquiring a licence for Herceptin’s use in early-stage breast cancer, but they practically by no means mentioned that the producer, Roche, essential to apply for that licence itself, and hadn’t even carried out so yet.” PR businesses employed by Roche had a hand in placing many of the stories, as did charities with backlinks to the business.

Goldacre suggests that the PR work behind Herceptin was a response to forthcoming legislation that would enable “pharmacists to ignore brand names and substitute an identical generic copy of the drug”. (Herceptin will be dealing with generic competition come 2016.) You could say that whenever a branded drug gets a cause celebre, it is sending a message to possible patients and their family members that is comparable to the traditional one for the blended whisky: “Do not be vague. Ask for Haig.” Will not be a bad Nice-la. Inquire for Kadcyla. This is all good publicity for Roche and bad publicity for Great (and by extension the NHS).

The recent case isn’t quite so egregious. Good has certainly stated that Kadcyla is as well high-priced for NHS use. But do we really want the NHS to start using new medicines without even questioning the thought that the preliminary price tag presented by a hugely worthwhile multinational may not signify greatest value? Neither Nice nor the NHS is making an attempt to make a profit here. Roche undoubtedly is. And even in creating this piece, I have assisted them out, by referring to Kadcyla, Roche’s brand title, rather than its rather significantly less catchy generic title, trastuzumab emtansine.

It really is notable, also, that several reviews about Nice’s rejection of Kadcyla say that therapy using the drug is already becoming paid for in Britain making use of the dedicated Cancer Medication Fund, launched in 2010 to shell out for treatment not universally available on the NHS. They also mention that the fund will “cease to exist at the finish of March 2016″. The new entire body that is getting set up to replace it is described as “nebulous” and “ill-defined”. It strikes me that this is a much more critical story, as far as entry to pricey remedy in Britain is concerned, than this week’s story, which basically rallies the nation behind Roche rather than Wonderful, at the really commence of negotiations that aim to minimize the price of the drug for the NHS. It also strikes me that since Roche relies so heavily on cancer therapies for its earnings the organization must have far more than a passing curiosity in making sure people in the United kingdom are aware that the Cancer Drug Fund exists, and is in jeopardy.

So this flurry of reportage has been good for Roche. It has given the Kadcyla brand an superb airing, alongside testimonials from the health care profession declaring what a excellent drug it is. It has portrayed Wonderful as penny-pinching, although emphasising that there’s a entire body that will even now fund treatments not approved by Wonderful, but which may well not be there for much longer. It has portrayed Roche as trying to do the public a support, with only public companies standing in its way.

I keep in mind a time, back in the 1980s, when it was straightforward to argue that the massive, lazy, complacent NHS couldn’t be cost-effective, merely because it was a public physique, and public bodies have been by nature inefficient. Now, the NHS is amid the most price-efficient wellness services in the designed globe. It has not attained this, I’m afraid, by rolling more than and paying medication multinationals no matter what they reckon they can get away with.

Breast cancer drug Kadcyla is as well high-priced for the NHS not to pay for it is the right determination | Deborah Orr

Channel 4"s Big Ballet demonstrates that this is an art type that must be open to all | Deborah Orr

‘Big Ballet is fairly radical, a challenge to ballet as a grand, brittle repository of ambivalence about women’, writes Deborah Orr. Photograph: Rory Mulvey

There is, I think, a really critical level at the heart of Channel 4′s new 3-element reality present, Massive Ballet. That stage is not about becoming unwanted fat or becoming thin. It is about variations in gender attitudes to perform and leisure that go back centuries. Not that any of this is intentional or explicit in the show, which, if last Thursday’s opening episode is something to go by, follows the formula of an established contemporary genre. The contention of the show’s presenter, the former Royal Ballet principal dancer Wayne Rest, is just that anybody and everybody should have accessibility to classical ballet as a implies of enjoyment and physical exercise, even so they search. He is right. Why not?

The explanation why not is complex. It’s that such an mindset is alien to the culture of ballet. From the crown of its bun to the suggestions of its blocks, ballet is a substantial art, with its goal the achievement of aesthetic perfection. It is decidedly not just for exciting, mere entertainment or simple workout. Every single ballet teacher is a talent spotter, surveying her crew of tiny women in pink tutus in the hope of spotting one more Darcey Bussell. If she spots a boy, then that, of program, is an even greater deal …

Accurate, every single amateur football coach is also a talent spotter, surveying his crew of minor boys in Manchester United strips in the hope of spotting another George Very best. The variation is that no a single would ever dream of putting together a actuality demonstrate in which a bunch of tubby guys and a couple of tubby females struggled valiantly in direction of their socially unacceptable ambition of taking element in an amateur five-a-side match. That occurs all the time.

In some respects, the causes for this are obvious. Visual perfection is an integral aim of top-degree ballet, whilst it is just one particular of the glorious by-goods of top-degree football. Only those with the potential for perfection can go to ballet school. If you’re also unwanted fat, also tall or too brief (however Sleep himself defied the latter rule), then you’re out. The high incidence of eating disorders among dancers suggests, counter-intuitively, that you can in no way be too thin.

What’s not evident, even so, is why ballet should be so single-mindedly in thrall to professionalism, while football comes in all shapes and sizes, available to all. Offered that so numerous little ladies want to go to ballet courses, and that it’s great exercising, why is it that dance remains so peripheral to physical exercising at college, for illustration? There is certainly a huge gender element here, but possibly it really is even greater than we very realise.

Ballet originated in Renaissance Italy, solely the protect of aristocratic amateurs, and spread quickly to other European courts. It was France that professionalised ballet, and founded the first ballet school in the 17th century. Crucially, all this occurred at a time when it was not acceptable for educated females – aristocratic women – to operate. We all know that throughout this time period younger men took the parts of females in plays and that as women did start going into theatre, it conferred on them the excellent status described so nicely in Mrs Jordan’s Occupation, Claire Tomalin’s biography of Dorothea Jordan, the 18th-century actor. Actors had been offered a cultural dispensation to be much more socially totally free than other ladies – they could have lovers, be single mothers, and so on, when usually females just couldn’t.

For a ballerina, although, a racy enjoy life and the typical pregnancies this tended to generate definitely would not be very the factor. Perhaps here lie the origins of that extremely circumscribed variety method, whereby ladies are picked or rejected at a youthful age for careers in ballet – whisked away to strive for perfection nearly in the manner of nuns, residing a cloistered existence devoted to art, but denied the freedoms of other female theatrical artists. It’s notable that neither of Britain’s prima ballerinas assolutas, Alicia Markova and Margot Fonteyn, had young children.

It really is surely a concept that fits with that wonderful melodrama of ballet, Powell and Pressburger’s 1948 movie, The Red Footwear, in which Victoria finds it impossible to decide on among ballet and marriage. More not too long ago, Darren Aronofsky’s 2010 film The Black Swan explored the concept of a dancer becoming haunted by a a lot more assured and liberated double, which could be read as being the woman the ballerina had been obliged not to be.

These psychological melodramas are disliked by ballet professionals perhaps exactly due to the fact they contain unpleasant truths about the origins of the occupation and the restrictions it sought to spot on ladies. Ballet professionals tend to be quite touchy when it is suggested that the prevalence of anorexia in ballet dancers is an aspect of the febrile strain placed on them. But given that eating ailments are frequently interpreted as currently being indicative of a refusal to embrace womanhood, this too helps make sense.

Seeking at the display in this light, Large Ballet gets very radical, a challenge to ballet as a grand, brittle repository of ambivalence about ladies, in which perfect females express archetypal femininity by rejecting such definite facets of womanhood as the ability to procreate, itself related ridiculously closely with “obtaining fat”.

The close scrutiny of female bodies is considerably debated, with limitless discussion of the detrimental results on youthful ladies that such publicity has. The media’s obsession with “shedding that child fat” is specifically irksome. It’s as if 17th-century suggestions about girls and ballet have been writ massive, with girls who wish to wear figure-hugging clothes or place on a bikini for the beach getting warned that reproduction will place it all in jeopardy. Mothers with younger children carry on to find it a challenge, getting accommodated at work during those years, to the lifetime detriment of their careers. But what females are “allowed” to seem like is only the superficial element of a significantly a lot more deep-seated impulse to control how girls are “permitted” to behave.

So excellent on the women who want to do ballet for enjoyable, even though they are not the form that is deemed ideal for it. Like all fat men and women, they lay themselves open to ridicule by the shallow, unhappy and suggest. If they’d been encouraged to exercise by way of dance at school, rather than forced to do the sport that so many schoolgirls loathe, then there’s each likelihood that they would not have piled on the lbs in the very first place. It’s weird that the enthusiasm of tiny girls for dance is not utilized at school as a conduit to a lifetime of fitness and physical exercise. This, as well, could date back to the days when an training at a college was the preserve of males.

The pursuit of skilled ballet as a high-artwork form need to usually have a pre-eminent area in human culture. But ballet should be far more universal, too, embracing amateurs with gusto. Ballet, in short, could and need to be a lot, a lot larger.

Channel 4"s Big Ballet demonstrates that this is an art type that must be open to all | Deborah Orr