The centre is there for the taking. Is Clegg the man to seize it?

James Forsyth's suggestion in the Spectator that Nick Clegg might be angling his party for a vacant cenntre ground is an interesting one. Since the recession and the dawn of "austerity" politics has become more polarised. The Conservatives have been pushed towards the Right to calm the grassroots who feel their party has been hijacked by a soft hoodie hugging green agenda. Likewise, Labour have been pushed Left (despite attempts by Ed Miliband to distance himself from the Unions). This has left a void at the centre between a party that blames our current malaise on a "benefits culture" and a party which berates the rich for being unfairly wealthy. If Clegg was able to establish the Liberal Democrats as a party truly of the centre, he might have a chance of capturing some Tory and Labour strays who don't agree with the all or nothing rhetoric of the Left and Right. It does feel like there is a centre ground to be captured, however Clegg is playing a risky game if he believes the Lib Dems truly are the party capable of capturing it:

1. A centre might exist but it is unclear how popular it actually is with the voters. Though it seems that the two main parties have shifted further outwards it is perfectly possible this has created a void rather than a space at the centre. If this is the case then the centre is actually a fairly unpopular place to be and one which there might be little electoral sense in trying to capture. 

2. The Lib Dems are still an extremely divided party. As Forsyth states possibly 3m Lib Dem voters have been lost due to the coalition. These voters are almost certainly of the Social Democrat persuasion. It is extremely unlikely that Clegg would be able to get them back. However figures such as Vince Cable recognise this and will resist any agenda which seemingly accommodates Conservative policy. 

3. Due to the polarised nature of politics currently, Clegg's "centrist" policy runs the risk of appearing like a "Tory lite" strategy which has too much similarity to basic austerity and benefits bashing. While his conference speech does seem to point to relatively clearly defined differences between his policies and those of the Conservatives, he needs to be careful to ensure he makes these fully clear by election day. Any vagueness will be punished by the electorate. 

4. "Add Yellow get Green" certainly appeals to alienated Conservative voters who voted Blue but got booted. There is little on offer from the other parties when it comes to Green issues and they have largely fallen off the agenda since the recession hit. The Conservatives certainly seem to feel that Green does not mean growth and Labour have been silent on the issue meaning there is space for someone to step in and offer a real alternative. The issue is whether this is really enough given current circumstances. Green growth is persuasive but unproven. It also runs the risk of seeming remote and irrelevant to people struggling to make ends meet. If Clegg can pull off orientating the Green agenda as a way to save money for individuals, while also promoting it as a way to kick start the economy then he might be onto a winner. Then he just has to hope enough people listen and care enough for it to get him the votes he desperately needs. 

5. Europe. This is the exact antithesis of the Green strategy for the Lib Dems. Nationally, escaping from Europe is being portrayed as a true solution to the economic crisis and it is winning over voters. I'm not convinced that it is a really answer and probably owes its prominence in the media to the fact that UKIP have campaigned more effectively than the Green Party, however it is certainly something toxic to the Liberals. There is no way for Clegg to escape his pro-European credentials (even a divorce wouldn't be enough!) and while the troubles in Europe persist it just looks painful for their fortunes. Here Clegg has two options, downplay Europe or fight for its corner. I believe the latter is his only real chance, but while riots continue on the continent, this might just be the issue which prevents him having success in 2015. 

Labels

Reading the blogs Not So Big Society and Being Here over the last few days, both have spoken about perceptions of various mental health problems (Dementia/Alzheimer's and OCD) and it has got me thinking about the labels we put on things and what they come to mean. It is a fact that humans like to label things and throughout our language development (especially in the English language) we have been relentless in our pursuit of finding more and more names to call more and more things. This progression has reached its height with modern branding techniques, where a carefully chosen name can be the different between financial success of failure. Similarly in the medical field, as more viruses, syndromes, ailments and bacteria have been discovered, so too has the language used to describe them. Sometimes a name change reflects a progression in the understanding of a disease, for example when someone is exhibiting extreme and unusual behaviour we no longer say that someone has been possessed by demons or evil spirits, but more likely describe it as a form psychosis or perhaps a virus which targets the central nervous system. At other times a name change has been as simple as a shortening of a term, for example from influenza to flu, or a more specific description of a similar virus from "common" flu to H1N1. 

However any name change, no matter how seemingly small and insignificant carries a burden of meaning and perception for those who read and use it. In the example of flu, to my untrained medical brain it sounds considerably less serious and life threatening than something as horrific as INFLUENZA! Of course this is completely illogical and flies in the face of the facts: that they are one and the same disease, however I cannot deny the feeling that bubbles up inside me when people refer to influenza rather than flu. The longer, more archaic term carries with it a more serious connotation and so my perception is changed. Tell me you have influenza and I might fear for your life, tell me you have flu and I'll send you to bed with a cup of hot cocoa. The point is that these name games are risky (people die from "just flu" every year) and constantly muddy the waters of the process of accurately "labelling" things.

So what does this have to do with mental health? Well with mental health we have a real issue of definition. Our understanding of the human brain is still far from complete and thus any ailments associated with it must therefore also lack a degree of understanding. Doctors and researchers try and pin a label to behaviours they observe but these labels have extreme and potentially dangerous limits. As was the case when demons plagued the mind, a case of mis-labelling can lead to a subsequent misdiagnosis. An exorcism of a non-existent evil spirit will certainly never cure a psychotic episode, though it might do permanent damage to the individual suffering from it. 

Applying this logic to a modern situation, trying to pin a label on a behaviour which has an element of compulsion and an element of obsession and calling it a disorder, doesn't necessarily help us to help the individual with the observed characteristics. By applying a definition of OCD you automatically apply a character to that person, you lose the individual and replace them with a medical term, an acronym and a set of "symptoms". Indeed as Being Here reveals, she has experience of a number of people who have a label of OCD but who clearly do not actually fit what she recognises to be the "real" definition. Outside severe mental health diagnoses but on a similar track from my own experience, one of my students has a diagnosis of ADHD and does indeed have a lot of energy and can't concentrate for a long time. He is a handful to teach but I was told from the outset not to really bother or try to control his behaviour because "his parents say he has a diagnosis of ADHD". However lo and behold, when his father came to watch a class he was a perfect student. Now it could be argued he was just trying hard and successfully fighting any urges to run about and be his normal hyperactive self on this particular occasion, however this hour of complete serenity seems to cast some doubt on the prudence of "not bothering". Whether he was trying hard or not, he was able to improve and we had a good class as a result, thus the label of ADHD did a lot to pass the buck of responsibility for improving his behaviour, but did little to actually help the poor kid learn some English!

Seemingly the need to find a label is often an excuse finding process, as much as it is a naming process, which is clearly misguided and unhelpful to the individual. As Ermintrude2 argues in a post about Dementia:

"the importance is the ability of services – as with all mental illness – to respond to the person and not to the diagnosis."

Thus, society has a duty to focus on the individual and not get caught up in definitions. A label, no matter how well intentioned, shapes the object in our minds and when that "object" is a person, this really changes that person too, potentially unfairly. It also changes the way we respond to that person and try to help them. Grouping, or often more accurately "lumping" similar but always different people together under one diagnosis umbrella, might be very neat and tidy from a spreadsheet perspective, but from a people perspective it can be downright useless. Labels are helpful, but they must be used with caution.