A change is going to come

British society is in a peculiar place in its attitudes to diversity. This apparent confusion does not just involve multiculturalism and migrants. It is evident with respect to all types of difference.

There are certainly signs of real progress. The Last Leg, long one of the funniest programmes on TV, is now also one of the most popular. The Rio Paralympics have been embraced as a major national achievement, just as the London Paralympics were. Most of the sport-loving population enjoy the competition as a major international event where Britain excels. Our successful Paralympic competitors are increasingly treated in much the same way as medal-winning Olympic competitors. It grates when you hear words like ‘brave’ in reference to overcoming physical impairments. It is condescending at best. Journalists are making this kind of remark less frequently than they used to, facilitated by the employment of former para-athletes as commentators. We all seem to understand that women and men compete separately because they are physically different, and that it is just the same with the athletes in the Paralympics. If journalists said that women athletes were brave for competing, in all probability they would be sacked. I can see a day coming when the same will apply with respect to para-athletes. Then we will know that we have finally moved on from old bigotries. We are definitely on our way.

Autistic spectrum traits may be helpful in developing computer expertise, but they are not essential. Last week, Lauri Love failed in his legal challenge over extradition to the USA to face charges related to hacking computer systems belonging to the US missile defence agency, NASA and the Federal Reserve. According to websites supporting him, he has a long been involved in political activism.

The USA has a long reach, and its approach to extraterritorial justice is highly controversial. Their criminal justice system sanctions sentencing regimes that are sometimes so severe that they are almost preposterous; in this case up to 99 years. This may be intended to encourage guilty pleas and plea-bargaining.

Mr Love’s defence team argues that the case should be heard within the UK legal system, as this is the jurisdiction where the alleged offences occurred. They are punishable under UK law. Much of the media coverage has been dominated by the fact that Mr Love was assessed as having Asperger’s syndrome in 2012. There is concern that he might become suicidal if he were incarcerated in a US prison.

Throughout the Western world, prisons are populated by men with multiple vulnerabilities. They tend to have had difficult childhoods. Most have grown up in poverty. The social factors that create a risk that they will show criminality as adults also lead to high rates of educational failure, mental health problems and substance misuse. Nearly everyone comes out of prison with worse problems than they had on conviction. Suicide in prison is a major problem. This is not surprising given that prison contains vulnerable people living in an environment that is intended to make them unhappy. The minority of prisoners who like prison life become institutionalised rather than rehabilitated. They fail to cope on release. Although there is some concern about the cost of maintaining a very large prison estate, there is no significant public debate about the morality of our penal system. It seems significant to me that Jonathan Aitken appeared sanguine about the prison system when he was a Tory cabinet minister, but had a change of heart after he was convicted and jailed himself. On release he campaigned (ineffectually) for prison reform.

Unquestionably, Lauri Love will be vulnerable if he is held in a US prison, but I am not certain that he will be unusual amongst the prisoners in having a neurodevelopmental vulnerability. What will be more unusual is his Anglo-Finnish origin and being the son of an Anglican priest.

His case turns on a rejection of the USA’s sense of global entitlement. It seems wrong that the USA can declare jurisdiction over crimes committed in other countries, especially when those countries have a legal system that could appropriately deal with the allegations. There are other examples of America’s disregard for the principles of justice. The USA celebrates its use of extrajudicial execution on foreign soil (for example, Osama Bin Laden) and is unapologetic over drone strikes on foreign nationals resident in non-combatant countries (such as Pakistan). All the while, America berates other nations for human rights abuses.

The emphasis on Autistic Spectrum Disorder in media coverage of Lauri Love’s case seems to me to be similar to the ‘bravery’ trope in Paralympic coverage. It completely misses the point and plays on themes whereby people who differ from an abstracted ‘normality’ are infantilised.

Stigma and prejudice have tangible effects on people and on public policy. The belief that violence and mental disorder are synonymous has a wide range of adverse consequences. On Thursday, Kam Bhui, Adrian James and Simon Wessely had an editorial published in the BMJ. It concerns mental illness and terrorism. I wrote blogs on the subject in May and June. I am pleased that, although the editorial is more cautious that I was, the points made are very similar. Linking mental illness and terrorism is misleading, and we need to be very careful about asking mental health professionals to identify those at risk of radicalisation until there is evidence that this is possible or necessary. We also need evidence that intervention can make a difference.

There is nothing surprising about senior psychiatrists making sensible points in a major journal. It is well recognised that this can happen from time to time. However, Kam Bhui is the Editor of the British Journal of Psychiatry, which is published by the Royal College of Psychiatrists. Adrian James is Registrar of the College, and Simon Wessely is President. What we have here is three of the most senior officers of a Royal College counselling caution over a Government policy that has human rights implications for people living with mental illness. In the process, they seek to defend patients against the propagation a stigmatising and false association between mental disorder and organised political violence.

On the one hand, this shows how much the medical establishment has changed over the past 50 years; on the other hand, it is a hopeful development. I would like to think that, in the face of very difficult times, service users and psychiatrists will increasingly work together to overcome the deep confusion that arises from public values that are in transition from old prejudices.

The evidence that we are moving towards something better is ambiguous. For me, this video of Sam Cooke’s great civil rights anthem captures something important about that ambiguity.