Category Archives: Health

Health, Mental Health, Psychology, Wellbeing

Gratitude: Is it understood properly enough?

HEALTH & WELLBEING

THE word “gratitude” is ubiquitous and everywhere these days. On mental health leaflets and in magazine columns, it is also emblazoned on mugs and seen often on motivational posters. All this is the result of more than two decades’ research in positive psychology which has found that having a “gratitude practice” – such as jotting down three to five things you are thankful for most days – brings a host of psychological and physical benefits.

Most of us will not want to seem, well, ungrateful. Even amongst sceptics, it is likely that they too would have been persuaded to take up the gratitude habit. When we remember to do it, we will feel better: more cheerful and connected, inclined to see the good already present in our lives. Counting your blessings, whether that’s noticing a beautiful sunset or remembering how your neighbour went out of their way to help you earlier, is free and attractively simple. But there underlies the problem. In our eagerness to embrace gratitude as a cure-all, have we lost sight of its complexity and its edge?

In positive psychology, gratitude is generally defined as a wholly good thing, a spontaneous feeling of joyful appreciation. But back in 1923, the Harvard psychologist William McDougall believed gratitude – especially when directed towards another person, rather than an experience in the more abstract way of, say, being “grateful to be alive” – was more difficult and complex to understand. Of course, there was awe for the generosity of the human spirit, and tender feelings towards the person who had given up their time to help. But there were also quiet feelings of envy or embarrassment, a sense of the “superior power” of the helper and even what McDougall called “negative self-feeling” (which today we’d call “low self-esteem”). The Japanese expression arigata-meiwaku (literally: “annoying thanks”) gets to the heart of what he meant. Arigata-meiwaku is the feeling you have when someone insists on performing a favour for you, even though you don’t want them to, yet convention dictates you must be grateful anyway. There’s a reason all this feels so annoying: being grateful throws off the balance of power and increases feelings of obligation. There’s your benefactor at the top, bathed in a sunshine glow of generosity. And there’s you, at the bottom, doffing your cap.

It might seem mean-spirited to focus on how being thankful can also obligate, diminish, or even confuse us. But as #feelingblessed becomes a performative norm, these aspects of gratitude are even more important to understand, particularly for the role they play in how hierarchical structures are reinforced in our world. A bleak tale about compulsory gratitude is that of the 13-year-old orphan Eyo Ekpenyon Eyo II. In 1893, he travelled from his home in British-occupied west Africa to take up a scholarship in a missionary school in Colwyn Bay, Wales. Less than six months after arriving, Eyo wrote to his patron, expressing thanks but begging to return home. The cold weather had made him poorly, and he feared for his life. It was a reasonable worry since three west African pupils had already died at Colwyn Bay.

Some time later Eyo did secure a passage home, but not before the British press got hold of the story. In a vicious outpouring of anger, they called him “spoilt”, “ungrateful”, and a “little prince”; their language soaked in colonial assumptions about who ought to feel grateful to whom. Not much has changed since. In The Ungrateful Refugee the author Dina Nayeri describes how, as a child refugee from Iran, she was expected to feel “so lucky, so humbled” to be in the United States. Only later did she understand how this “politics of gratitude” had subtly worked to transform her human right to refuge into a gift, one that had to be repaid by staying submissive and uncomplaining, being a “good immigrant” who stayed firmly in her lane.

This connection between power and the demand for gratitude reaches into many parts of life. When people in high-power positions are made to feel insecure, such as by having their failings and shortcomings pointed out, they commonly berate those who they perceive as inferior to them for being ungrateful. Consider the recent incident in the White House when Donald Trump and JD Vance took Volodymyr Zelensky to task for failing to show sufficient gratitude earlier this year.

These costs are part of what psychologists now call the “dark side” of gratitude. One common objection to the gratitude movement is that it risks “toxic positivity”, encouraging people to ignore and repress more painful feelings. But feeling thankful can lead to other dangers, too. People are more likely to transgress moral codes on behalf of someone else if they feel grateful to them. Members of historically marginalised groups, including women and LGBTQ+ people, are less likely to complain about unfair treatment if they are reminded first how lucky they are compared with the past. And, as studies with women in abusive relationships show, when people have been gaslit into believing they cannot survive without an abuser, gratitude makes them feel obliged to stay. Is it apt to ask, then, whether all those motivational posters should come with caveats and health warnings?

Given these arguments there is a lot to think about while trying to jot down three things you feel grateful for so you can retire peacefully at night.

Yet, the lessons of the latest research remind us that, like all emotions, feeling grateful is neither wholly good nor wholly bad. Too little, and we risk being entitled or rude, alienating those who try to help us. Too much, and we may leave ourselves open to exploitation by amplifying the power someone holds over us. Context, as always, is necessary and should always be relative.  

There are strategies that help mitigate the risk. Focusing on circumstances rather than individuals (broadly, feeling grateful for or that, rather than grateful to) can side-step the issue of power. And if you notice someone – a boss, parent, friend, or partner – expecting more gratitude than you want to give, you might ask yourself why. What might seem like ungrateful behaviour in our hierarchical world may really be an act of self-preservation, even one of political defiance.

And sometimes gratitude does need to have an expiration date. For all we may feel thankful, sometimes we have to release ourselves from the burden and move on with our lives. Gratitude is important. But so is paying attention to its limits.

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Britain, Government, Health, NHS, Politics

The abolition of NHS England

HEALTH

Intro: The Labour Government’s shake-up of the NHS in England aims to cut waste and shift resources, but the looming funding gap raises doubts about its impact

THE UK Government’s decision to abolish NHS England – the world’s largest quango – was cast as a bold strike against bureaucracy. The move is designed to cut waste, “shift money to the frontline”, and by placing the NHS in England under direct democratic control. It is a declaration of intent from Sir Keir Starmer who wants Labour not to be the party of bigger government but the party of smarter government. That’s the theory, at least. The reality, as with most things in government, is more complicated.

The announcement happens to be less of a grand health reform and more a strategic positioning exercise. Wes Streeting, the Health Secretary, and the architect of this plan, is engaged in a delicate balancing act: convincing the Treasury that the NHS can stay within budget, while simultaneously lobbying for more money that he knows the health service will inevitably require. The cull of NHS England is a useful and headline-grabbing moment. It is one that will allow Mr Streeting to claim that he is shifting cash from managers to patient care, a necessary concession when preparing to argue for more Treasury investment.

The problem is that the numbers don’t add up. The savings from axing NHS England will be modest. The organisation’s cost to the Treasury is £2bn, a tiny fraction of the NHS’s £183bn budget for 2025/26. Of this, about £400m is spent on staff who work directly with local NHS bodies, and these roles will probably continue in some form. The savings come nowhere near enough to fill next year’s estimated £6.6bn funding gap. At best, it frees up a few hundred million pounds. At worst, it shifts costs elsewhere while causing months of upheaval in an already overstretched system.

The NHS faces mounting pressure to cut costs, with the Chancellor, Rachel Reeves, insisting that it must live within its means. Hospital trusts will need to tighten their belts even further. It does not take a health economist to recognise that when resources are cut, patient demand does not magically disappear – it simply resurfaces elsewhere. If community services shut-down to balance the books, then the pressure on GPs and A&E departments will only intensify. If the health service is told to do more with less, the risk is that it simply ends up doing less with less.

Sir Keir’s embrace of Mr Streeting’s reform agenda is a calculated gamble. The PM is backing an NHS overhaul that may not deliver as promised. His endorsement, however, bolsters Mr Streeting’s standing with the Treasury, which faces a looming fiscal shortfall. With tax rises off the table, and Ms Reeves’ fiscal straitjacket firmly in place, spending cuts after 2025/26 seem an inevitability.

The NHS may have won big in the last budget, but as the Darzi report warned, it remains in “serious trouble”. Years of under-investment and overcrowded hospitals, with no relief from an overstretched social care system, have left it desperately struggling. Without greater funding, it cannot meet the rising demand of an ageing population, let alone expand its workforce. The Health Secretary must keep pressing the Treasury for the resources he needs, cloaking each plea for cash in the fashionable language of “modernising reform”.

Such rhetorical agility is a skill that Westminster normally rewards. Consider, for example, how Universal Credit came into being. But whether he delivers on his three big shifts – moving care out of hospitals, prioritising prevention, and digitising the NHS – remains to be seen. If the health service deteriorates further, the government will soon find that it has not only failed to fix the NHS in England but has taken ownership of its decline.

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Health, Medical, Science

Menopause misery. HRT isn’t the only answer

HEALTH

DR MAX PEMBERTON, an NHS psychiatrist and medical doctor, wrote recently on the significant shift in many doctors’ attitude towards Hormone Replacement Therapy (HRT). For far too many years, peri- and post-menopausal women have to had to fight hard for their right to access this medication.

An increasing number of doctors are now open to the idea that prescribing HRT can have real benefits for their patients – and, undoubtedly, this has made a life-changing difference for many women. Even though some 13million women in the UK are going through the menopause, it is estimated that one in four have to visit their GP at least three times before getting appropriate treatment.

Last year, official draft guidelines were issued to GPs which said alternative treatments should be considered. These included talking therapies “alongside or as an alternative to” HRT to help reduce menopause symptoms such as insomnia, low mood, and hot flushes. These guidelines have now been revised with health officials backtracking after accusations of “medical misogyny” – the implication being that menopausal symptoms were “all in the mind”. The guidance issued by NICE now advises that HRT should be offered as the first line of treatment. Some may believe this a positive development, but Dr Pemberton is unsure.

The medic is known to be a keen fan of HRT and he has seen many patients’ lives transformed by it. But he goes on to say that HRT isn’t suitable for everyone and that talking therapies can help those women presenting with symptoms that have a psychological component.

Dr Pemberton says that many women talk about no longer feeling like themselves, a disconcerting sense of something having changed, a vague undercurrent of unease, despair, and discombobulation. Trying to address what causes this turmoil is far more complicated than simply a blip in hormone levels. And neither can it be explained away by a woman’s dissatisfaction with life and her sense of loss and malaise as a chemical reaction.

That’s not to say that hormones don’t play an important part. Medical professionals know that fluctuations in hormones can be responsible for low and poor mood.

Over the years, Dr Pemberton has seen far too many women struggling to cope and for whom HRT has been hugely beneficial – helping them, for instance, to manage anxiety caused by the menopause.

But the medic also believes there are other factors that contribute to a woman’s sense of losing herself. He points out that low mood and anxiety are a result of complex social and psychological factors, rather than simple biology.

Changes to the body, disrupted sleep, hot flushes, and so on, he says, can make any woman feel out of control and depressed.

Dr Pemberton documents and records other issues he’s heard women talk about – for example, erratic mood swings and out-of-character behaviour. There are stories of women having affairs, quitting their jobs, or leaving their husbands around the menopause.

While some would seek to blame this all on fluctuations in hormone levels, the evidence for this isn’t that compelling.

The clinician says it’s not at all clear that drops in oestrogen and progesterone, the female sex hormones that start to decline in menopause, are entirely responsible.

Rather, the medic believes that the menopause acts like a ticking clock. It suddenly makes women open their eyes and review their lives. Much of the trauma and emotional turmoil that besets many women as they navigate menopause isn’t the consequence of fluctuating hormones but of a re-evaluation of their life’ situation. For many, their sense of self and identity is closely bound up with their roles within their family, particularly those who are mothers, who may feel bereft at the prospect of an empty nest.

It is also a cruel aspect of the inequality between the sexes that women have to contend with a society that’s more judgmental about how woman age than men. For a lot of women in their 50s and 60s, they have given the best years of their lives to other people and their careers, and now they’re not sure why. A vast number of menopausal women now feel invisible.

Dr Pemberton has had many menopausal and post-menopausal women attending his clinics and hearing the sad story that they no longer feel like a woman.

It is here, he says, that these people would surely benefit from having the time and space to explore and discuss their feelings and situation. That’s where talking therapies can play a vital role for many who have become desperately unhappy.

In the opinion of Dr Max Pemberton, the answer to many complex problems precipitated by the menopause aren’t always going to be found in HRT pills, patches, and gels.

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