Why do we do what we do? The poverty of individualist explanations

Why do we do what we do?  The poverty of individualist explanations.


Photo by Sofiya Levchenko on Unsplash

We all like cake don’t we? Oh, and beer…and yes wine…and…and


In common talk around health issues, we hear and read a great deal about ‘taking individual responsibility for health’ or the need for ‘helping people to make better choices’  and we hear explanations for ill health based on people’s choice of unhealthy lifestyles. Papers like the Daily Mail like to focus unhealthy working class ‘chav’ cultures in a bid to promote outrage and to garner support to reduce the Welfare State. Every New Year, gym membership rises, dry January is embarked upon and resolutions to quit smoking are made. Failure often follows. The UK population is getting fatter, it drinks excessively and takes little exercise. We are also a nation consuming antidepressants as if they were smarties. Some individuals of course are ‘paragons of virtue’ in terms of health and the question is asked “if they can do it, why don’t the rest of us?”  Often this is framed within personal success stories as “I did it, so you can too (you fat lazy bastard)”. Celebrities are often promoted as role models for a “leaner, fitter, healthier you”.

Most people probably know that eating better and taking more exercise is better for health. So why do we see continuing patterns of chronic ill health, patterns which show social class differences, i.e. the  ‘social gradient’, and unequal health outcomes. Those in the lower socio economic groups die younger, experience more chronic illness and have fewer disability free years.  Is it really all down to individual moral failure? Why don’t millions of us get up off our fat arses, do something positive and take responsibility for health? Why don’t we as a population exercise our agency to act for better health? After all, we are all free autonomous people able to choose courses of action.

The complete freedom to think and act may be more complicated than adherents of the ‘autonomous sovereign individual’ may have us believe. The model of the ‘free sovereign individual’, so beloved by libertarians, neoliberals and most hues of conservatism in their political stances, is a flawed and incomplete model of human behaviour. It is a model of human behaviour that arose in Enlightenment modernity, and results in the creation of ‘homo economicus’, the free instrumentally rational being, who weighs up the pros and cons of action independently of social or cultural influences or internal psychological drivers,  and is 100% result responsible therefore for the consequences of their action.

Max Weber introduced the word ‘Verstehen’ (German for understanding, perceiving, knowing) to describe the sociologists’ attempt to grasp both the intent and context of human action. While the ‘man of modernity’ was increasingly using instrumental rationality to guide action, Weber described 4 ‘types’ of social action:


  1. Zweckrational – means/ends rationality
  2. Wertrational – values based rationality
  3. Affective action – emotion based
  4. Traditional action – based in custom and practice.


Today, many ignore or forget all but ‘zweckrational’, assuming that is our only way of thinking. We know from experience however, that we choose courses of action not because they are always meeting a certain goal, but because of a mixture of all 4 types of reasoned action. Many also think about these types (if at all) as existing independently of society. Weber’s insight was to link these types to changing social conditions. He argued that modern societies differed from those of the past because of the shift to zweckrational thinking rooted in the growth of bureaucracy and industrialism. This might explain why today, in bureaucratised, industrialised societies, that instrumental, technical, means ends thinking came to dominate. The error for many is that the ‘is’ of the dominance of zweckrational becomes the ‘ought’, the only way to think and it becomes the assumed method of human thinking. I suggest that those trained in scientific, technical and logical (means-ends) occupations are apt to think using ‘zweckrational’ but assume that is how everybody else does and ought to think. They then become one dimensional in their own thoughts, unable to grasp the complexity of human decision making.

The social theorist Margaret Archer also describes this ‘man of modernity’ as “a being whose fundamental constitution owes nothing to society” (2000 p 51) and (following Weber) who is increasingly driven by instrumental rationality or ‘means-ends’ thinking. This is the ‘ready-made man’ who turns up out of nowhere to impose his own order on the world and applies rational thought to social concerns. It is a view of humanity that believes that our ‘self’, our individuality,  exists totally separate from society, that it is not constituted at all by society or culture. The free acting self is an independent of society and culture free thinking and rational being. We will hear echoes of this man’s voice when we hear such statements as “only the individual should and can take responsibility for health”, “there is no such thing as society, just individuals and families” and “eat less  – move more” injunctions to reduce weight. Any idea of social structure or social forces is completely denied. In this view there are no social mechanisms operating ‘behind our backs’ that might be guiding free choices.


This model of the self assumes the primacy of agency devoid of social structure or cultural or language contexts. It not only assumes the primacy of agency, but elevates it into a core aspect of the political project (neoliberalism) to reduce any action on poverty or welfare beyond that of individuals, families and charities. If there is no society, then there is nothing society can or should do.


Those who adhere to this model might think that obese and overweight people merely freely choose to eat more than they need, that their inability to lose weight is down only to their weak moral character and lack of will power. The obese should “just say no” to a second pork pie. Against this I suggest that they eat and move within the structures and cultures of the ‘obesogenic environment’ (Foresight 2007) and within cultural practices around food that becomes aspects of who they are, that they build into their self-concept. Veganism for example has been seen as the preserve of a slightly effete (?) minority and for many men especially, just cannot be built into their own notions of self as ‘red meat eating males’. Their self-concept as a man excludes this food choice as viable. They are of course free to act as a vegan but the structural and cultural context militates against men many doing so. Some men will be able to draw upon their material, psychological, biological, social, cultural, spatial and symbolic assets to exercise their agency to become vegan. Many others will not be able to exercise the same degree of freedom to do so.


There is not the space to fully explore this idea of the ‘free, pre-existing, independent from society’ view of self, other than to suggest that extricating human agency and the ‘self’ completely out of the effects of language, culture and social structure is erroneous. I emphasise however, the pernicious persistence of this idea in current culture, politics and health policy as it underpins much understanding of, and pronouncements about, human behaviour towards health.


I also suggest that those whose knowledge is non-existent, or superficially grounded, in philosophy, the humanities or social sciences cannot exercise their agency to begin to understand this argument. Their ‘ways of knowing’ and sense of self  is in violent opposition to it. They will be so embedded in certain social structures and cultural assumptions and values that the self they experience is unable to grasp the concepts. They will read the words but will feel an instant visceral hatred of the challenge to sovereign individuality because it shakes the very foundations of who they think they are and the basis for success and failure. Current ideal types would be Boris Johnson, Peter Thiel the PayPal billionaire, Rupert Murdoch, Donald Trump, many in Silicon Valley and the alt-right. In fact most of the powerful world leaders would fall into this category including Putin, Erdogan and Modi. They all feature varying degrees of narcissism and the assumptions of what Graham Scambler calls the ‘Greedy Bastards’.


Part of the answer to understating why we do what we do,  will be found by exercising our sociological imaginations to gain a fuller understanding of human behaviour. We need to think beyond the action of an individual, to consider the wider actions of society and culture that provides the context for individual choices at this point in history..

Take the choice to eat insects. In the UK we are free to do so. We could exercise our ‘free agency’ as sovereign individuals. There is no biological reason why we don’t. There is no legal barrier to doing so. There is no trade barrier, tariffs or taxes in importing insects as food. What prevents us eating insects is a combination of cultural barriers with a lack of social institutions that values eating insects, no social institutions providing access to insects. Psychologically we might think that the eating of insects is not part of our ‘self-concept’, there is no social learning going on because no one is doing it, the mental short cuts bypass rational appraisal and go straight to the ‘yuk’ factor. We live in an obesogenic environment and not an ‘insectivorous’ environment.

Why do fat people eat pork pies? Why don’t thin people eat insects?

Graham Scambler in wishing to establish a theory of agency in sociology argues:


Humans…are simultaneously the products of biological, psychological and social mechanisms while retaining their agency…socially structured without being structurally determined


I think this means that if you want to know why some people can resist eating the pork pie and most in the UK resist eating insects, you have to think holistically rather than individualistically. You have to avoid the temptation to be reductionist and instead think ‘systems’.

A biologist would focus on physiological processes and raise the importance of body chemicals such as leptin, dopamine, serotonin and endorphins in stimulating behaviour. They might acknowledge the physiological role of sugar and processed carbohydrates in providing very satisfying, but unhealthy, eating habits. This is perhaps the first hurdle that ‘will power’ has to overcome.  ‘Willpower’ is of course the ‘go to’ mechanism for those with individualist understandings.

A psychologist might explain eating patterns from a variety of perspectives: cognitive psychology might outline the role of mental short cuts that bypass rational thinking; behavioural psychology emphasising the conditioned nature of responses; social psychology which asks us to consider the power of social learning upon choices and psychodynamic psychology which would raise deep seated emotions as drivers for behaviour e.g. food playing the ‘comfort’ role. All have explanations that down play the power of rationality.  Key concepts within psychology which could be linked to why we eat as we do include:

  • Self-Efficacy.
  • Body Image.
  • Locus of Control.
  • ‘What the hell’ effects.
  • Future Discounting.
  • Classical/Operant Conditioning.
  • System 1 and System 2 thinking.
  • Self and self-awareness.
  • Adult, Child, Parent Ego States.


Both biology and psychology examine the individual body and mind. They seek explanations for human agency within ourselves. For some people, that is enough. Yet both disciplines cast huge doubt on the idea of ‘free thinking sovereign individuals’ who use rational thought, and the exercise of sheer willpower in achieving their aims.

If you have not eaten for three or four hours, and you pass a shop selling freshly baked bread or pasties, or foodstuffs you very much enjoy, your will power to lose weight is severely challenged first by your biology as the body reacts to sight and smell of delicious food and then by your psychology as the ‘what the hell effect’ kicks in supported by ‘future discounting’. Your future self as a slim lean athlete is discounted by your immediate self’s need for food.  As you go through your day you are immersed in social and cultural invitations and opportunities to eat and to eat too much. Against this is will power, unless you can actively design your social and cultural environment every single day to support will power, you may well crack. Do you have the material, psychological, social, cultural, spatial and symbolic assets to do this day after day after day for years? For the rest of your life? Some also have poor biological health assets in this regard as in utero processes may well have pre-set a certain weight for you that your body will always want to get to.

We are not completely free autonomous agents beloved of neoliberal ideology. Our lives are highly structured, but not determined. We are the result of a complex interplay of our biology, our psychology and the social. Underpinning much of the common discourse in our media is the idea of the ‘liberal human self’, and failures to live healthy lifestyles are to be found in the individual. This belief, and it is a belief not a scientific fact, often leads to a ‘Moral Underclass Discourse’ (MUD) to explain health inequalities. The MUD focuses on cultural and behavioural explanations, rather than sociological, for health inequalities. It is a discourse that leads easily to victim blaming.

We need to think a little more critically about this explanation, particularly as it has a great deal of political and social force in terms of policies we design to tackle health. We need to bring the social (structure) into the individual (agency). We need to ask to what degree are we free agents who can take 100% responsibility for our lives, we need to examine what social structures exist in which that agency operates.

Margaret Archer has published a series of books on this central problem of structure and agency, i.e. the relationship between our personal actions as free agents and the societies and social structures we are born into.

We know that smoking is linked to illness and disease, we also know there are patterns to smoking which show prevalence is not spread equally across class or age. If we want to more fully understand smoking behaviour we require not only the sociological imagination but also why people as ‘free agents’ continue to smoke despite knowing the consequences. The answer is of course complex, situated in and mediated by a matrix of the biological, social and psychological. Smoking occurs in a social context in which people are enabled or constrained in their behaviours by the structures of society and mediated by their and others’ ‘reflexive deliberations’ and to a degree, their biology (the ‘substance’ (nicotine) theory of addiction).

Archer’s theory suggests that our individual actions are predated by the existence of social structure of, for example, class relationships. Class structure, and the culture associated with it, are transmitted to individuals. In smoking’s case, the culture of smoking was once widespread across all social classes and therefore to take up the habit was not to be seen as a social pariah. Quite the opposite. George Orwell in both ‘Homage to Catalonia’ and ‘The Road to Wigan Pier’ describes vividly the valued place of tobacco in people’s lives. Today however, smoking has a class characteristic to it, the middle classes apparently are more open to health warnings than those lower on the social scale. This ‘predates’ any individual coming into puberty today. The ‘cachet’ associated with smoking, or its status as a rite of passage, has to be factored in to understanding why some people shun the habit while others embrace it.

Archer however does not wish to over emphasise how such social structures affect action, rather there needs to be a focus on how agents respond and act to those circumstances. There is a causal efficacy to agency, we are not automatons responding to class structures or obesogenic environments. We can make choices to act in certain ways to not buy the pork pie.  We do so by having internal conversations which are mediated by our ‘mode of reflexivity’ which at this point in history is particularly salient.

You and I are confronted in our daily lives by social circumstances, and we have a choice of action. We bring to that choice of action our own priorities, our ‘projects and concerns’. What we then do is mediated by the type of internal conversation, or reflexive deliberation,  we have. Archer’s thesis is that in the past social structures were such that little self reflexivity occurred. We ‘knew our place’, we knew what our role was and what status we had.  However, as societies modernised, cultures and structures confronting us are far more open to change and critique, and are so by the actions of the people involved. Women for example, no longer took for granted that their place was to rear children and to engage in domestic labour. They thought about the franchise and employment and some decided to act differently to ‘break the mould’. Why do some act to challenge social structure and why do others conform and thus replicate social structures?

“The subjective powers of reflexivity mediate the role that objective structural or cultural powers play in influencing social action and are thus indispensable to explaining social outcomes’ (Archer, 2007: 5).

In other words, your inner voice is confronted by the facts of the obesogenic environment or of social class or of gender relationships in the work place, but that fact can be acted upon so that action can for example be fatalistic towards that circumstance or instead might confront it in an attempt to overcome any perceived or actual disadvantage.

Agency is necessarily contextualized, it occurs in a context of social structure and culture. That is the objective fact the people confront every day.

Archer’s (1995, 2003, 2007) way of articulating this is in terms of a three-stage model.

  • Structural and cultural properties objectivelyshape the situations that people confront involuntarily; the structural and cultural possess powers of constraint and enablement in relation to
  • People’s own constellations of concerns, as they define them.
  • Courses of action are produced through the reflexive deliberationsof subjects who subjectively determine their practical projects in relation to their objective


Think about the social structures that produce, advertise and market and then distribute food  – how that this currently characterised by the industrial production of delicious, tasty and cheap foodstuffs packed with sugar, salt and calories. The objective cultural context might include aversion to walking and cycling as we perceive these as impractical, dangerous or too slow.  Think about the culture of eating food and the sociability that surrounds certain foodstuffs. What currently does wine play in the cultural life of many women and beer for men? These objective conditions provide ‘enablements’ to eating easily too many calories. It is made easy to do so. What constraints do we have in eating too much? Well, against the above we have health injunctions not to do so, we have body images that emphasise thinness with attractiveness. If the various constraints to eating too much are not as strong as the enablements, then the individual has to work hard  on clearly identifying their ‘concerns’ – one of which is to lose weight. This has to be turned into a project, something that they focus on every day to combat the many opportunities to fail at achieving the goal. People will tell themselves if the daily project of losing weight is achievable given the reality of their working and social lives. They will draw upon their health assets to help them do so. If their health assets are very poor across the board success is not impossible (they are after all free agents) but it will be harder.


Agency operates within certain social and cultural contexts, so consider how agency operated by an A list actress and a struggling in debt mother. What social ‘forces’ propelled them into two very different circumstances and how much is down to personal achievement, luck or circumstance? Consider they now give birth to daughters. What are the chances of either girl using personal agency to radically alter their circumstances. Yes, it happens (e.g. Oprah Winfrey) but who will have the easier path?


The following table are ideal types to illustrate just some of complexity of the interplay between biology, psychology and sociology in understanding health choices and health outcomes. These factors are not be thought of as a simple cause effect relationship, there are feedback loops and emergent properties from the whole. Nothing is predestined, all is possible. The list is not exhaustive either. There may be other confounding variables that will change outcomes. The actress may develop a cocaine habit, Vicky may become an ‘Educated Rita’.


Asset A list celebrity Actress Vicky Pollard “yeah but no”
Biological Ectomorph

Non variant FTO gene

No chronic illnesses


Variant FTO gene


Psychological High self-efficacy

High self esteem

High body image (body reality matches body ideal

Internal locus of control

Emotional and sexual support

Depression free

Positive outlook

Low self-efficacy

Low self esteem

Poor body image (body reality far from body ideal)

External locus of control

Emotional and sexual abuse

Bouts of depression

Suicidal ideation

Social Similar looking thin peer group

Network effect positive

Social support for domestic needs

Child care easily affordable

Food prepared by nutritionist

Supportive parents and spouse

Socially popular

Wealthy successful peers

The 0.01% Global elite

Private School and Drama school paid by parents

Similar looking fat peer group

Network effect negative

No social support for domestic needs

Child care expensive

Food prepared by Greggs

Parents both dead, absent partner

Social pariah

Poor just about managing peers

The local Precariat

Left at 16 with no qualifications.

Cultural Ambitious

Health high priority

Non smoker

Gym membership

Non violent


Health discounted


Daytime TV

Emotional, verbal and physical violence common/expected

Spatial Beverly Hills, Sunshine, Sea View and palm trees Concrete high rise, Rain, Industrial Units and burned cars
Symbolic ‘A’ list Chav

This asset is paramount as it feeds into the others

High Net worth


In debt.






Graham Scambler, emeritus professor at UCL, has written a series of blogs based on the work of Margaret Archer. His work can be found here: http://www.grahamscambler.com/sociological-theorists-margaret-archer/.

Archer,M (1995) Realist Social Theory: The Morphogenetic Approach. Cambridge; Cambridge University Press.

Archer,M (1998)  Realism in the social sciences. In Eds Archer,M, Bhaskar,R, Collier,A, Lawson,T & Norrie,A: Critical realism: Basic Readings. London; Routledge.

Archer,M (2003) Structure, Agency and the Internal Conversation. Cambridge; Cambridge University Press.

Archer,M (2007) Making our Way Through the World. Cambridge; Cambridge University Press.

Archer,M (2012) The Reflexive Imperative in Late Modernity. Cambridge; Cambridge University Press.

Archer,M (2014) The generative mechanism re-configuring late modernity. In Ed Archer,M: Late Modernity: Trajectories Towards Morphogenetic Society. New York; Springer




Cycling back to fitness

Mont Ventoux

Tommy Simpson rests on Mont Ventoux. The cyclist died (on my birthday – 13th July) while attempting this stage of the Tour de France in 1967. One passes his memorial on the way to the top with only 1 kilometre to go. This fact became particularly salient as I passed it while experiencing chest pain on 29th July 2017.

After a further 500 meters, I had to stop due to the chest pain. Sitting astride the cross bar, gasping for breath, I could look up and see the weather station at the summit which was a mere 500 meters away, including a hairpin bend with a 20% ramp. I had completed this ascent just the day before and so I knew what I was up against. My friend, Sean, was already up at the top no doubt enjoying the views. We had already cycled from Chartres down to the Alps (via Alpe D’Huez, Izouard and Galibier) and therefore had quite some miles in our legs. After about 10 minutes, I cracked on to the summit.

Angina. Chest pain. When coronary arteries become ‘clogged up’ they no longer can deliver enough blood to the heart itself when demand rises for oxygen during exercise. A complete blockage will bring on a heart attack as blood flow becomes occluded resulting in cell death. Angina can be a precursor, a warning, if you like that something is wrong with your heart. Being told by your GP that you might have had a heart attack and being prescribed drugs to address the issue, is a life changer. In my case, scans revealed the extent of the occlusions which meant that I needed an angioplasty with the insertion of a stent to improve blood flow to the heart.

Now I am in need of returning to fitness after a 7 month rest from cycling. This time however, the challenge is very different given the new medical condition. Few of you reading this will be in the same position as I am. You hopefully do not have a heart condition. Before I comment on getting back to fitness, i need to outline the medical bit just so that you are aware so as not to make false comparisons. I am 59, now overweight coming in at 12st 6lbs. I need to take the following for the heart: Clopidogrel (only for 12 months following the angio as a blood thinner), Aspirin (same but now for life), Bisoprolol and Ramipril (to slow the heart and reduce blood pressure) and finally a statin to reduce cholesterol. My resting heart rate is 50, and my blood pressure has been reduced to about 125-75.

The challenge is training using heart rate zones. Normally we can estimate my maximum and threshold heart rate to set up a training plan using something like training peaks.com. Grant (Cycle for Fitness) provides these structured plans using training peaks. A problem is that my heart rate zones have been reduced by 30 bpm by the the NHS’s cardiac rehabilitation team due to the medication I am taking. My new zones are 64-101!   This in practice results in a very very slow regime of exercise. You might already know what level of movement will take your heart up to 80-90. believe me, it is not much.

I am now finding cycling to those zones to be a nonsense. It is for me a non starter as far as training goes. The plan now is to complete the 8 week very gentle exercise regime given to me by the medical team before I make plans to whizz up Mont Ventoux.

A lesson here is that we should not under estimate what having coronary artery disease is, the effect of having a stent inserted, the effects of the drugs and the time it will take to recover. I have heard stories of bravado – men rushing back to work only to find fatigue setting in. Honestly, just don’t do it.

At one point in January, before I had seen the cardiac team to set down new heart rate zones, I thought I’d go for a cycle. Feeling great along the flat, I pushed the heart rate up to 135-140. I suddenly felt dizzy and had to stop for 10 minutes. Knowing now that my new upper limit should only be 101, it is not surprising that I felt ‘off’. I have had 1 more episode of dizziness while merely sat at the table.

So, for all you macho types that want to blast away getting fit again..great. Just don’t rush it. Discuss this first with your cardiac rehab team…then access Cycle for fitness to co create a training plan right for you but you must do this with your medical team.

Having a stent, an angioplasty, is not the end of your life on a bike. Well, I hope so because I have plans to return to France. First, I have to lose the weight gained and get fitter. I’ll be posting progress.



Down and Out

In the spring of 1928, aged about 24, Eric Blair (aka George Orwell) moved to Paris, a city in which the cost of living was very low. He tried to earn a living by writing and giving English lessons, but it hardly paid. He was then stripped of his possessions and money by “a little trollop he’d picked up in a café” leaving him with very little cash. His parents back home in England were spared the knowledge of his predicament, possibly due to his concern for their middle class sensibilities. He could have returned home to Southwold, but having previously chosen to leave a career in the Imperial Indian Police in Burma, that was not an attractive path. He had little option but to work in the foul kitchens of the Hotel Lotti on the Rue de Rivoli. His final impecunious 10 weeks in Paris provided the material for his book, Down and Out in Paris and London, the first draft of which was completed in 1930. This was no journalist’s assignment, research or a gimmick.


The following are observations on poverty in the early chapter of the book and reveal something of the life he led.


“…it is altogether curious, your first contact with poverty….you thought it would be terrible, it is merely squalid and boring. It is the peculiar lowness of poverty that you discover first…the shifts it puts you to, the complicated meanness, the crust wiping.


You discover, for instance, the secrecy attaching to poverty…you dare not admit it, you have to pretend that you are living quite as usual.


You discover what it is like to be hungry…everywhere there is food insulting you in huge wasteful piles…a snivelling self pity comes over you at the sight of so much food.


You discover the boredom…you discover that a man who has gone even a week on bread and margarine is not a man any longer, only a belly with a few accessory organs…


…but you discover the great redeeming feature of poverty: the fact that it annihilates the future…


And there is another feeling that is a great consolation in poverty. It is a feeling of relief, almost of pleasure, at knowing yourself at last genuinely down and out. You have talked so often of going to the dogs – and well, here are the dogs, and you have reached them, and you can stand it. It takes off a lot of anxiety”.


(Chapter 3, Down and Out in Paris and London 1933)



Squalor, boredom, secrecy, hunger, future discounting and relief from anxiety were the key features, for Orwell, of poverty. In 1930 in Paris there was no system of welfare benefits to fall back on. In London , the casual wards (‘The Spikes’) provided some refuge, although the conditions were far from salubrious. Orwell went hungry, and at times had absolutely no money. One lack, which was sorely felt, was that of tobacco, something he again experienced on the front line in Spain when he later joined the POUM militia (Partido Obrero de Unificación Marxista, or Worker’s Party of Marxist Unification) in the civil war in Catalonia. The privations in the front line caused by the conditions and the absolute lack of resources for the militia was another form of poverty.


“In trench warfare five things are important: firewood, food, tobacco, candles and the enemy. In winter…they were important in that order” (Homage to Catalonia 1938, p23).


Winter in the Catalan trenches, Spring in Paris, but in this list we can note the reduction of human need to Maslow’s base of his hierachy of need. Apart from the ‘enemy’ in Spain the similarity is of course there to see. Orwell in both books mentions the centrality of tobacco, and of course of alcohol, in daily life.


It might be tempting to dismiss Orwell’s observations as belonging to another age and therefore of little relevance to the experience of poverty today in modern Welfare States. That I think would be a mistake. The psychosocial sequelae of poverty remain the same; what it does to self, self esteem and the setting of priorities.


The ‘secrecy’, the ‘dare not admit it’, alludes to what Erving Goffman called ‘passing’ in his theory of Stigma. People with a stigma try to ‘pass’ as normal to avoid oppressive acts.

Poverty was and is a stigmatising condition. Orwell tells of sitting in parks in Paris but being very aware of the distaste expressed by women particularly, towards him.

A source of stigma, for Goffman, arises out of an actual or perceived ‘character blemish’. Another source is membership of a ‘tribe’. Poverty provides both sources. Currently, many believe the poor to be at fault for their poverty due to their poor moral choices and character weaknesses. The Moral Underclass Discourse emphasises that the fault lies within the individual. The poor may also be seen as members of a ‘tribe’ who live apart from the deserving and hard working families; they are the chavs, the skivers, the welfare scroungers.

Poverty can be a discrediting stigma as it might have an outward appearance, or it could also be a discreditable stigma as an internal invisible ‘mark’ known only to the poor themselves. It can, of course, be a felt stigma and an enacted stigma as society exercises certain sanctions and behaviours towards the poor. Family members and friends of those on hard times may feel courtesy stigma on their behalf.

Thus, as a highly stigmatising condition, those who today are in poverty may wish to hide away or use ‘maladaptive coping mechanisms’ such as smoking, drinking or drug taking. Orwell’s continual descriptions of the need for and centrality of tobacco illustrates this point. Many today would see tobacco as a dangerous luxury. His fixation with food illustrates the shifting of priorities, and the collapse of time to orientate to the present. Future discounting might explain why the dangers of smoking and the future threats to health just do not impact on present behaviour.  It also clearly illustrates is the exercise of one’s personal agency being highly mediated by (and mediating) the culture and the social structures one lives in. It may seem to today’s sensibilities that tobacco use would or should be resisted if poor. However, Orwell makes it plain to see how one’s psychological state gets reduced and focused in both time and space. His ‘annihilation of the future’ and ‘boredom’ are telling. It might explain why we make what seems to be irrational decisions in the face of hardship. Orwell of course would have a way out, but if one believes that the future is set, the discounting of the future to deal with the present may be a highly rational strategy.

The fear of poverty disappearing, because one is actually poor, is another seemingly irrational mind set. But if the dogs have turned up you at least know you can sink no lower. There is no such thing as status anxiety, or keeping up with the Jones’. The ‘psychosocial comparison’ thesis of poor health outcomes no longer applies to you because the fear of being compared and of comparing has been assuaged by the surety of the lowliness of status. What is left is survival today, not tomorrow, because tomorrow never comes.

Before we thus rush to judgment on the choices the poor make, or provide theories of why there is poverty based on individual failure, Orwell’s exposition provides a window into their world and might make us think twice.










The English Patient

“You’ve heard of a French letter, yeah? Well, what’s a Dutch letter? A condom with clogs on so they can hear you coming” (boom boom).

“Did you hear about the two queers in a telephone box? They were ‘ringing’ (geddit?), ringing each other”.

And so I found myself transported back in time to when Jim Davidson was allowed, the mini metro was cutting edge technology and sexual assault was regarded as a little light flirting. A time when the classification of ‘rape’ was reserved for activities including the actual blindfolding and torture of young ladies in darkly lit back alleys in Whitechapel.

The ‘joker’ lay almost flat on his back on the opposite hospital bed. He wore, or rather was draped, in an NHS gown which barely covered his legs. The flap of the gown rode up so high on his thigh that it invited a shrivelled walnut shaped hairy scrotum to make its appearance, but thankfully we were spared. His dark sunken eyes and sallow complexion, his wrinkled turtle necked skin upholding a blotchy, mottled liver spotted complexion which, thanks to hair loss, covered his whole pate, were all testament to years of smoking. He rasped his jokes in between sucking in oxygen through plastic nasal speculae, while his rheumy eyes, long devoid of sparkle, attempted to project wit, but utterly failed to do so. Instead, Death’s bony fingers drummed impatiently on the bedside table, perhaps waiting for his cue, and certainly waiting for the end of the jokes.

“OH, DO SHUT UP”, Death silently boomed into his ear, “YOU ARE ALREADY LATE”.

Why it did not occur to Death to merely sever the plastic oxygen tube with one wing of the scythe is something to regret, no doubt, and to take to his grave, always supposing Death has a grave.


A hospital ward is not always a happy place.

It might be something to do with the people who go there. It might be something to do with the amount of forced cheer amid the pools of blood, piss and broken dreams. It is often a place in which a lifetime’s aspirations, vision and long hoped for achievement smash into the reality of desperation and blood flecked sputum often spewed out through clouds of alcohol infused breath and fag ash. A place where one hoped to live but come to die, where the milk of human kindness is not supposed to curdle, and where faith, hope and charity are not merely long faded memories or the names of a trio of white doe eyed fluffy kittens the vet accidentally put down after mixing up the lab results with that of a cancer riddled mutt with rabies.

The patients are not much better. especially when they tell jokes.

So, I find myself admitted for investigations and treatment after spending a brightly lit and noisy night in the ED. Ah, sleep, perchance to dream of fluffy pillows, soft warm duvets and dark peace. Imagine, if you can, being in a K hole but with operating theatre lights trained to hit your retina with the brightness of a thousand Hiroshimas. Noise assaults your every sense, you can even taste it. It’s not the EDs fault…for how else can they help assess, diagnose and treat humanity’s fear, stupidity and decrepitude. The only people at peace here are the near dead (and the actual dead).



I’m keeping my witticisms to the minimum over the next few days.

A scientologist homeopath in a K hole.

The Nursing Times reports on the falling number of nurses and midwives registered to work in the UK over the past few months.

Perhaps this does not matter to most of us as we worry about whether to buy our Christmas from John Lewis or J D Wetherspoon, or before concerning ourselves with the searing injustice and travesty that is some prancing git in a sparkly shirt being being shown the door before he has had the chance to enthral us with his pretty feet. Perhaps we believe that the real life Holby Cities truly are staffed with the beautiful, if very flawed, people who can perform miracles with just a twitch of a stethoscope, frowning and cries of ‘morphine stat’ before being covered in projectile vomit. Perhaps we think NHS staff smile through the mask of emetic substances dripping from their faces as they perform miracles every hour.

To take our minds off the future, when many of us will face our last days in some piss stained, overcrowded brightly neon lit corridor being looked after by an alcoholic doctor, and a Zimbabwean care assistant whose slim grasp of English is matched only by a desert dwelling Uzbek goat fucker with access to a torn, half copy of the Beano in which to learn verb conjugation, we stare at the TV screen promising us youthful skin, a drive on an empty mountain road and the chance to vote on some nonentity whose song we will not remember, will not buy and will merely momentarily dose us to kill the pain of ennui that is everyday life in consumer capitalism.

Nursing is being reduced to running around with a bucket, a mop and some hope, all aimed at stopping the bleeding. We all have orifices that need plugging from time to time lest we leave a trail like a pissed up slug on a mission to the next lettuce. However Florence Nightingale had higher hopes for the successors of her young ladies in training than being reduced to cleaning wounds with their own tears and the silk of parachutes from the nearby war museum. The measures of success on many shifts includes having the same number of live patients that you started with, avoiding a fight with a drunk (it is a bonus if the drunk is not the consultant) and being sprayed with non infectious urine. The great vision for the NHS includes the provision of care by families and a few care assistants. Registered Nursing, you know…the sort that includes people who might be able to spot if your babbling and loss of consciousness is not the result of being given the bill for care but is in fact the early stages of sepsis, is on its way out. Family care is fine, if your family is more Waltons than Addams. Do you really want your old mum, or your wife, poking her finger up your anus in order to clinically examine your tonsils? What your wife does in your spare time at home is your own business, but is she the right person to be prostate tickling in the intensive care unit when you are actually complaining of a headache?  Imagine Grandad, after a six pints of mild and bitter, pushing his way through the throng around your sick bed shouting; “stand back, I’ve got this” while brandishing a toilet brush and barely concealed menace?

This is what the ‘Austerity’ actually means. Hunt will blather about more training places…but we know ‘more’ is not the same as ‘enough’. Austerity, we should remember actually means the ‘dissembling of the protectionist state in order to facilitate the transfer of public services to private ownership’. Hunt know this…it is part of the plan. He once called the NHS a ‘great commercial opportunity’. Why should Hunt et al give a toss about hospitals and schools that they will never use? They are as disconnected from our social reality as a Scientologist homeopath in a K hole.

I’m sending Granddad over to Richmond House.

Socio-Political awareness among undergraduate student nurses.

Socio-Political awareness among undergraduate student nurses.



“For the remainder of this century, the most worthy goal that nurses can select is that of arousing their passion for a kind of political activism that will make a difference in their own lives and in the life of our society.”


(Peggy Chinn, 1984, quoted by Beall 2010).



Nurses have a history of engaging in health promotion and public health and both roles are reflected in the Nursing and Midwifery standards for education. However, current and future issues such as population ageing, new medical technologies, war, food security, health service access, equity and comprehensiveness  and climate change, suggest that their current understanding need to develop to adapt to a very different future. Nurses need to quickly move beyond adopting individualistic and behaviour changing perspectives (Kemppainen, Tossavainen and Turunen 2012), to that of also adopting an ethico-socio-political awareness and analysis (Falk-Raphael 2006). This should be based on a wider understanding of what health and health promotion may mean.


Various nursing theorists have suggested or implied that politics and political awareness and knowledge is, or ought to be, a component of nursing knowledge (Chopoorian 1986, Stevens 1989, Albarran 1995, Cameron et al 1995, Chinn 2000), and of nursing advocacy (Philips 2012) and leadership (Antrobus 1998, Cunningham and Kitson 2000).  Nancy Roper referred to the sociocultural, environmental and politico-economic factors influencing the Activities of Living, while also lamenting a lack of their application (Siviter 2002). Jill White (1995) developed Carper’s patterns of knowing to include the Socio-political domain; Jane Salvage (1985) argued that politics needs to be understood and acted upon and that nurses should ‘wake up and get out from under’. Celia Davies (1995) has written about the gendered nature of nursing and its ‘professional predicament’ and Michael Traynor (2013) has written a whole book on politics and the profession.


Other writers on the socio-political context include White (1985, 1986 and 1988), Lewenson (2000) and Falk Rafael (2006). Kath Melia (1984) illustrated the contextualised pressures on student nurses, while more recently Alexandra Hillman and colleagues (2013) has described how patient care can be compromised by the systems nurses work within. Tadd et al (2011) also outlined the context and its effects on dignity in care in acute hospitals. I have argued it is explicitly part of the sustainability agenda for nursing, while the social determinants/political determinants of health approach are predicated upon it. Other health concepts such as Barton and Grant’s (2006) health map, Lang and Rayner’s (2012) ecological public health domain and Ottersen et al’s (2014) focus on global governance for health centre it for health care delivery and outcomes.  The inequalities in health literature, for example “Fair society Healthy Lives” (Marmot 2010) and Danny Dorling (2013, 2014), refer to health being a matter for social justice and fairness.


Some authors have highlighted the health policy role for nurses (Ennen 2001, Fyffe 2009) which although advocating for nurse involvement in public policy making, does so probably within accepted frames of reference devoid of critical concepts such as Foucault’s ‘governmentality’ or deeper analyses of for example, managerialism, neoliberalism and the ‘capitalist class-command dynamic’ (Scambler 2015). Cameron et al (1995) argued for post structuralism and a focus on subject positions and discourse as tools for analysis, which could be usefully employed by critically aware nurses.


In the education and curriculum development literature writers such as Paulo Freire (1970), Carl Rogers (1969, 1983) Stephen Sterling (2001), David Orr (1994) and Peter Scrimshaw (1983) suggest that teaching and learning should go beyond skills teaching in an instrumental fashion to address personal growth and social transformation. Romyn (2000) discusses ‘emancipatory pedagogy’ in nurse education which accords with aspects of ‘provocative pedagogy’ (Morrall 2009). The sociological literature, for example critical social theory, marxism and feminism of course, are wholly socio-political in nature. For nursing, each has also something to say about the interplay between health, illness, society and gender.



Undergraduate Nursing – the missing link



It is my contention that undergraduate nursing education is one in which politics is largely absent in nursing curricula (Byrd 2012) and fails to equip student nurses with tools of analysis that renders them blind to social and political systems that are often unfair, unjust and oppressive. It also fails to politically socialise them. It is a self marginalised education denuded of any critical importance and ignores the vast sociological literature on health and illness. Nurse educators themselves, beyond a few ‘individual enthusiasts’ (Fyffe 2009), might lack the requisite skills or concepts to engage. This may result in the lack of politics or health policy in nurse education (Carnegie and Kiger 2009). This is not to say nursing education, as it currently is, lacks importance as the requirement for clean, kind and compassionate care will be emphasized daily in seminars, lectures and tutorials.


This assertion might be supported if it can be shown that student nurses lack a critical understanding of the socio-political context in which they work. This is not to say however that student nurses are not political or are not interested in politics. Rather that their interest and understanding especially in relation to health (delivery, funding, inequalities, access, outcomes and determinants) may be lacking and only slightly better than their peer groups. Further, that any student nurse who is active, interested and knowledgeable is so despite not because of nursing education. I take it as self evident that this matters and not merely for the reason that it suits the capitalist executive and political power elites to have a huge number of health workers (600,000 registrants in the UK alone) ignorant, confused, uninterested and inactive in regards to the eco, social and political determinants of health. We have nurses schooled in the biomedical aspects of health delivery (or rather disease treatment), but rather less in what I would inelegantly call the EcoPoliticoPsychoSocial (EPPS) approach to health. Student nurses are introduced to a BioPsychoSocial (BPS) model to health however, the curriculum process and learning experiences may often dilute this emphasizing the bio at the expense of the Psycho-Social while ignoring the Ecological. The ‘BPS’ becomes ‘Bps’.


To test the hypothesis that student nurses lack a critical understanding of a socio-political approach to health, a survey of student nurses in two or three HEI in the UK could be undertaken. Mccullough (2012) undertook a survey on politics in NI in which 81% of students claimed ‘not much knowledge’ of politics and 60% claimed either ‘never’ or ‘less than once a week’ to follow politics in the media. Of course a caveat in this must be that politics in this context may mean ‘Party, Westminster/Stormont politics rather than political issues.




What is Politics?


Chafee et al (2012) suggested that politics can be defined simply as ‘the process of influencing the scarce allocation of resources’ (p5). The RCN’s Frontline First, while laudable, is also a very narrowly focused campaign which is about resource (staff) allocation. However, this does not go far enough as it fails to engage with more critical analyses of power and the legitimacy of the exercise of power, concerning itself with more relatively mundane issues of resource allocation within uncritically accepted frames of reference. Politics is much more than knowing the manifestos of political parties or the internal machinations at Westminster. Political action is much more than the 5 year placing of crosses on ballot papers. Engaging in politics requires at least a critical understanding of power. Tony Benn outlined questions to ask the powerful: We should know who has power, what power they have, where did they get it from, in whose interest do they wield it, to whom are they accountable and how do we get rid of them? This does not apply only to Westminster, but in every organisation including an NHS Trust. Socio-political awareness also addresses the wider determinants of health as outlined in the Social Determinants of Health literature and in such books as ‘The Energy Glut’ (Roberts and Edwards 2010) ‘Lethal but Legal’ (Freudenberg 2014), ‘The Spirit Level’ (Wilkinson and Pickett 2010), ‘Unequal Health’ (Dorling 2013) and ‘Hard Times’ (Clark and Heath 2014).


If Russell Brand’s youtube site is any guide, or the interest in Jeremy Corbyn’s bid for the Labour leadership in 2015, many people are very interested in politics, just not the dominant media fed variety of political talking heads, and representatives of mainstream political parties. If we widen the definition of politics to include social movements around health, climate change and human rights then according to Paul Hawken (2007) there is a global ‘Blessed Unrest’ involving millions of people, a global ‘environmental and social justice movement’ that does not often appear in the mainstream media.


Nurses are a disparate group politically; nurses are not to be treated as an homogenous group for political purposes. For example, the free market nurse think tank Nurses for Reform (NFR):


“….long argued that the NHS is an essentially Stalinist, nationalised abhorrence and that Britain can do much better without its so called ‘principles’ (Cave 2010), although whether this group actually has a huge number of nurses supporting it has been questioned (Liberal Conspiracy 2010). Nonetheless the point remains that nurses will probably vote for all parties, and none, at elections. To what degree nurses are part of the ‘blessed unrest’ is unknown, Mcculloghs small survey does not answer that question.



Public Health and Health Promotion



Both of these two concepts are multi faceted, and nurses will draw upon their own definitions. If nurses are to ‘empower and enable’ people to increase control over and improve their health then this will require not only education to change individual behavior, but also a deep critical analysis of power and vested interests that often put profit before people and that result in inequalities in health outcomes. Nurses will then have to decide what their personal sphere of influence may be and work towards change in those areas. For some this will mean working on a one to one basis only, for others it may even result in taking part in organized political structures, be it pressure group or a political party.











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Dirty Money – Lovely Jubbly.

Photo by Les Anderson on Unsplash

Now, let’s get something obvious out of the way. Do I like a fiddle? Do I like to pick a pocket or two? Do I enjoy getting away with it? Well, if the opportunity arises to save a few quid I will take it laughing all the way from the pub to the bank. Have I been known to engage in activities that should ideally stay in a dark cupboard lest the very beasts of hell are let loose to defeacate upon the heads of babies? In short, am I cleaner than a freshly scrubbed and laundered starched white cotton cloth? Yet I have to admit that perhaps I have let slip my moral standards from time to time. My righteousness is as a filthy rag rather than crisp white linen. Jesus died to save sinners, but when he saw my track record on all things nefarious, immoral and perverted, it was too much even for the son of God. He was referring to me when, upon the cross, he cried up to God saying “Forgive him, for he not only knows what he has done, but he has encouraged others to do similar, only with less embarassment and more lubricant”. Jesus wept. Not for sinners, but for the complete waste of time his 33 years on earth was spent in order to redeem my wretched black hearted soul. As the last nail was banged in, all he could think about was my irretrievably ungrateful indifference to his suffering while I considered the next venture into silk pantied and lace lined debauchery with a sweet, cherry lipped vicar’s daughter and her vibrator on the lawn at the Queen’s garden party. “Christ, all that healing and vintnery for bugger all” he thought before letting out a wet fart.

That established, am I qualified to consider the implications of the ‘Paradise Papers‘?

First, let us not forget the ‘Panama papers‘. This was the leak of over 11 million documents from law firm Mossack Fonseca and shed a little light on over 200,000 offshore entities. They contained personal financial information about wealthy individuals and public officials that had previously been kept private. Some of the Mossack Fonseca ‘shell’ corporations were used for illegal purposes, including fraud, tax evasion, and evading international sanctions. The Paradise papers are a similar leak from law firm Appleby which again shed light on offshore tax havens and the avoidance activities of wealthy individuals and corporations such as Apple.

‘Only the little people pay taxes’. I forget who said that, possibly someone as wealthy as Croesus and the morals of a rutting dog with easy access to a pack of bitches on heat. They share the same disdain and indifference towards others as they fuck anything that looks like it needs fucking as long is it feels good. They are now fucking the great British public by stealing a decent education from children, kicking the zimmer frames away from our grannies and laughing in the face of the mentally ill.

As dogs sniff arseholes, the wealthy sniff loopholes.

They are aided and abbetted in their endeavours by lawyers whose attachment to ethics is as loose as a coke fuelled casanova’s commitment to celibacy at an orgy. They are advised by accountants whose devotion to public service is in inverse proportion to their devotion to gaining pecuniary advantage, and serviced by politicians whose obseqiousness in the presence of wealth would make an Edwardian butler blush in embarrassment. The rules of the game are so rigged that not only is the line between good and evil blurred, it has been erased, deleted, rubbed out and thrown away waiting discovery and study by some future historian of 21st century moral philosophy. Plutocrats, the 0.01%, the ‘super-rich’ are so detached from the rest of us that not only do they think we should eat cake, we should pay them for the ingredients, the recipe and the aga to cook them in while they insert a finger of fudge to milk our collective prostates for more cash. Their moral universe is so distorted that they would consider buggering schoolboys over the high alter in St Paul’s Cathedral acceptable if the price was right. To them, the general public are bovine, nothing but a source of capital accumulation, and when we have lost our usefulness we are thrown away like a snot damped tissue in the gathering winds of an October gale.

Why do only fools and horses work?


Health based on Poverty and its measurement.

Photo by Adam Jang on Unsplash

Health based on Poverty and its measurement.


One of the explanatory frameworks, or ‘discourses’, for ill health and health inequalities around access to health services and health outcomes, is that of the ‘material deprivation’ thesis, which underpins much of the Marmot Review Fair Society Healthy Lives. It sits within a ‘Redistribution discourse’, which suggests the answer is redistribution of material resources. Alongside this is the ‘Psychosocial Comparison Thesis’, which underpins such work as Wilkinson and Pickett’s The Spirit Level. This forms part of the ‘Social Integrationist discourse’ in which reduction of social inequalities and better integration of marginalised groups is important.


Material deprivation focuses on a lack of resources to support healthy living while psychosocial comparison suggests one’s position in the social hierarchy, and the level of inequality in society, create psychosocial stress harmful to health. They are not mutually exclusive and of course might work together for some individuals resulting in poorer health outcomes for them. Being poor in a very unequal society is thus very harmful to health and results in gross inequalities in health.


A third explanatory framework is the ‘cultural thesis’ which suggests it is the culture of certain behaviours, attitudes, values and norms that are the root cause of ill health. Another term for this way of thinking is the ‘moral underclass discourse’. The answer is to make better choices and improve lifestyle activities such as stopping smoking, reducing alcohol consumption, exercising more and eating better. Poor people are disproportionately ill because of their poor life decisions. The ‘underclass’ make poor moral decisions and therefore bring ill health upon themselves. The material deprivation they experience is a result of their own poor life choices, their parents’ life choices, or it results from being ill, preventing them from working or making better life choices (the deserving poor).


The Consensual Method of measuring poverty.


A link between all three is material deprivation resulting from poverty, but what do we mean by poverty and how is it measured? In the UK we do not use the concept of absolute poverty, instead some reports are using the term ‘relative poverty’, one measure of which is the consensual method. The research project Poverty and Social Exclusion (PSE) outlines what this is. In short this focuses on deprivation as:


“enforced lack of necessities determined by public opinion”.


In the consensual approach we first need to establish what those items are that make up our ‘standard of living’ and then identify which of those items most people view as ‘necessities’. Consider a mobile phone as an item, if most people think this is a necessity, then not having one begins to identify oneself as poor. The necessities are what most people think everyone should be able to afford and which no one should be without. Poverty is where these deprivations impact on a person’s whole way of life; to measure poverty we need to know how many people there are whose ‘enforced lack of necessities’ affects their way of living. Note that those who choose not to have these necessities would not count.


Items that are necessary include the social as well as the material. The PSE have published data on what the public thinks those items are: for example, 96% of us think ‘heating to warm living areas of the home’, 94% think a ‘damp free home’ and 91% think ‘two meals a day for adults’ are some of the necessities. However some items go beyond ‘basic’ needs such as ‘visiting friends/family in hospital’ (90%), and ‘attending a wedding/funeral’ (79%).


What do you think everyone should be able to afford?

What do you think no one should be without?


Once we have these benchmarks, then we can start to measure the base line below which society considers people to be deprived. This is what is being attempted since 1983 and the ‘Breadline Britain’report.


The 2013 PSE first report ‘The impoverishment of the UK’ PSE first results: Living Standards’ indicates the scale and extent of poverty in the UK (the 6th richest country as measured by GDP per capita). One section of the report ‘Going backwards 1983-2012’ suggests that the proportion of households falling below minimum standards has doubled since 1983:


1. More children lead impoverished and restricted lives today than in 1999.

2. 5 million more people live in inadequate housing than in the 1990s.

3. 9% of households can’t heat their homes adequately today up from 5% in 1983 and 3% in 1999.

4. 33% of households experience below par living standards.


This is despite the fact that the UK is a far richer country now than it was in the 1980’s. The size of the economy has doubled over the last 30 years. This supports the claim that economic and wealth creation has benefitted the better off while families lower down continue to struggle to meet their basic needs.


Source: http://www.poverty.ac.uk/pse-research/going-backwards-1983-2012


If you emphasise that ill health and deprivation results from poor life choices, then you might not be interested that more and more families are experiencing deprivation of this kind. It is a case of them not taking up opportunities, not working hard at their education or not moving to where employment is higher, i.e. London and the South East. However, you might want to wonder why more and more families are making these poor life choices since the 1980’s, especially if during that time knowledge about what is the basis for a healthy life, is more easily accessible with the internet.


Or you might think that regardless of the fact that more people falling into this category, this does not mean that they are also more likely to experience health inequalities such as reductions in life expectancy. The data from such sources as the Community Health Profiles and that contained in ‘Fair Society, Healthy Lives’ and ‘The Spirit Level’ would suggest otherwise.




Source: http://www.poverty.ac.uk/pse-research/going-backwards-1983-2012



watch this video for a first hand account.



What are the implications of this knowledge for nurses? Is this a ‘social issue’ irrelevant to nursing practice?



“She’s a little cracker”

Photo by Anita Peeples on Unsplash


It was shockingly revealed today that a knee had been touched. Moreover, the perpetrator was a man whose grasp of dinner table etiquette was as firm as a weasel’s wet fart only less palatable. The sous table fiddling had followed nods and winks over the soufflé and not a little gentle innuendo over the cheese course. We have reason to be thankful that dessert was not a crème brulee lest it provoked the ardours even more, symbolising as it does how a superficial hardness later reveals a softer creamier extrusion after a short bit of agitation with spoon and finger. Reports have noted similar events at other gatherings where men in dinner suits, over inflated egos and unjustified self-confidence had mistaken large bulges in their trousers for indicators of sexual prowess instead of their wallets. It is generally accepted that where two or three, or more, are gathered together in an alcohol infused reverie, in which ego is in inverse proportion to actual importance or ability to deliver, that lines would be crossed and perhaps later snorted. To say this was revelatory is stretching it a bit, following as it does numerous sightings of woodland defaecations by the genus ‘Ursus’. Journalists at certain tabloids of course have made hay, splashing the story across their front page feigning faux indignation at such an outrageous and clumsy attempt at foreplay. On page 3, Sharon of Colchester (23) was quoted as saying that “although this appears to be an indiscretion, it by no means reduces the Honourable Member’s ability to be a thrusting bastion of Defence expenditure in the Cabinet, if he can control his member in number 10”. Her tits looked rather splendid as well.


Dr Archibald Creampie at the International Journal for the Promulgating of Advancement of Studies has conducted research into this area for quite some time. He has written extensively and recently published a paper ‘Tory Ministers, Their Trousers and Trifling Infidelities in the Neoliberal era: An ethnography in troubled times’, stated “The association between certain positions of power and incidences of knee touching are highly correlated. It has even been known that late night drinking in bars at Westminster has a causal relationship to fellatio, rimming and embarrassment the next day.” However, his ‘participant observation’ methods have been criticised for allowing subjectivity to cloud his analysis.


Boris Johnson was unavailable for comment.

Military Morality


And there was I thinking that the military was a bastion of middle class, middle england values, whose members would no more indulge in the seven deadly sins than Marks and Spencer would sell premium sex toys next to the baby food. The Army, Navy and Air Force are renowned for taking feral working class oiks whose career paths would otherwise include a little light fingering, assault as a matter of ritual (and avoiding picking up the soap in the showers at HMP Dartmoor), and then turning them into highly trained, disciplined, single minded targets for every passing jihadi with a rucksack and bitterness. Officers, of course, being drawn from the ‘respectable’ middle classes, already know the score and how to keep their little peccadillos from being dragged out of the shadows, blinking into the harsh light of justice. They are the moral backbone of the military, whose first principle is of course ‘don’t get caught’.


Our fabled military then is a supposed home to a solid conservativism, one which would no more recognize impropriety in the ranks than it does Imperialism in Whitehall.


And yet…turns out someone (and 8 of his shipmates on a nuclear submarine) likes a toot of Colombia’s finest white stuff, while two of his superior officers breach the ‘no touch rule’ designed to prevent intimate relations on board. There is now panic in the rest of the fleet as the Defence Secretary, Micheal ‘Fiddler’ Fallon, wants all submarine crews to be drugs tested. Is he mad? That’s like lifting manhole covers in London hoping to see sweet scented pink ribbon wrapped bouquets of roses instead of a fleet of fetid, feacal flecked fatbergs clogging the arteries of the city. What does he think will turn up?


Who does he think joins up and why they do so? The Royal Navy in particular was built on Rum, Sodomy and the Lash. Hearts of Oak joined up to serve King/Queen and Country, to go to other countries and shag their women, bomb their brothers and shout loudly for more beer. They went to avoid having to do the shitty zero hours, low paid, dead end bullshit jobs back home. Alcohol is the lifeblood that makes it tick over. Pusser’s Rum was the oil lubricating the penile pistons in whorehouses from Devonport to Sembawang. Adultery is always an option, especially now that Wrens go to sea.

So, there is of course a stonking great elephant here, wearing a big red sash called hypocrisy. The Navy is not the Church of England at sea.


If you ever find yourself in a huge metal tube, cut off from the outside world for very long periods of time with the coming apocalyse in nuclear form as company, and you don’t sniff a little, swig a little or shag a little to avoid facing up to the insanity of your situation…I fear for your soul.

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