The best and worst of the NHS

A&ED-G-Seamon [CC BY-SA 2.0 (http://creativecommons.org/licenses/by-sa/2.0)%5D, via Wikimedia Commons

Warning: this is a long post, but I feel the story needs to be told in its entirety.

The NHS has no bigger fan than I, and that’s why I support our junior doctors in their desperate fight to save our most treasured national asset from being stuffed into the trouser pockets of the Secretary of State for Health and his cronies.  Two of my daughters owe their lives to the NHS after being born prematurely.  And while it can have its faults (my ex-husband’s treatment while he was dying was utterly disgraceful) when I compare our lot with that of friends living in the USA I know how vital it is that we rescue this precious boon before it’s too late.  I have never had to beg friends to help fundraise for my child’s wheelchair.  I’ve never been threatened with having to sell my house to cover the costs of the local hospital having saved my spouse’s life.  I’ve never had to marshal all my friends to donate blood on my behalf because I hadn’t the means to pay the hospital back for the blood transfusions that had saved my life – all things which friends and family of mine in the USA have had to do.

But there is one area where the NHS is letting us down badly – specifically, letting down one group of patients, but ultimately letting society down, too, by teaching us not to value or esteem the worth of this particular sector of our community.  I am talking about patients with learning disabilities.  In over 32 years of parenting someone with a learning disability, I’ve seen the best and worst of treatment meted out.  I’ve seen orthopaedic surgeons whose eyes light up at the chance of getting another operation under their belt in the race to become the acknowledged expert in that procedure.  And I’ve seen orthopaedic surgeons patiently, over a number of appointments, taking the time to get to know my child really well and make the best informed judgement that they can about what is really in her interests, including at times deciding not to operate.  I’ve seen planned appointments done so well that everything possible was put in place to mitigate my child’s fear and anxiety in the unfamiliar and terrifying situation that she found herself.  I’ve seen consultants fight with every weapon at their disposal to stop a social worker forcing through a decision that would undermine my child’s medical treatment.  I will forever be grateful to our local ophthalmologist who moved heaven and earth to save my daughter’s sight, and to the orthopaedic surgeon who took the trouble to learn her “trigger” words and avoid using them in front of her, leading to highly entertaining conversations about a “sharp pointy thing” to avoid using the word injection!

But my experience also bears out the stories that we hear again and again from families, that when their family member with a learning disability presents with a medical emergency, the system lets them down, partly because of a lack of training of A&E doctors and partly because of a culture that devalues the lives of people with learning disabilities.  The shocking statistic has recently been revealed that people with intellectual disabilities are three times as likely as the rest of us to die prematurely from preventable causes, and that hospitals are refusing to investigate these deaths.  I am regularly invited to write “do not resuscitate” on my daughter’s medical notes, something I have never been asked to do for her sisters whose general health and life expectancy is the same as hers, but who have no disabilities.  (See https://www.change.org/p/health-secretary-stop-asking-families-of-disabled-young-people-to-discuss-do-not-resuscitate-directives).

One of the features of autism is an inability to cope with change, and often the response to this is an autistic meltdown, sometimes accompanied by self-harm, which can lead to a medical emergency.  Autistic people in mid-meltdown are generally treated as if they are having a tantrum and ought to stop the behaviour at once.  But what is little understood is that when an autistic person is having a meltdown, it is not something she is doing, but something that is happening to her.  Brain scans have shown that an autistic person in mid-meltdown displays the same electrical brain activity as someone in the middle of an epileptic seizure.  They can no more control what they are doing than the seizure patient.  Yet I have heard care staff refuse to sympathise with meltdown injuries because “it’s her own fault” – something they would never say about an epilepsy patient who fell and sustained a head injury during a seizure.

The first time I realised my daughter was blind in one eye was when she developed a cataract which suddenly appeared over the course of a fortnight.  She had recently changed school and was now boarding away from home and came home at weekends, a major life change which an autistic child would find exceptionally hard to deal with.  Frequently, during the course of a meltdown she would punch herself in the eyes, often resulting in extreme swelling of the eyeball.  Because she continued to drive herself competently in her powered wheelchair, no one realised that she had lost the sight of her right eye.  When the cataract developed, she was passed from the doctors near our home to the doctors near her school and back again until finally, after a lot of shouting on my part, she was seen at a hospital near her school.  Examination revealed that her retina had obviously been detached for a long time, and she had probably had no sight in that eye for months, if not years.  It was decided, correctly, I believe, not to remove the cataract as this would now be a purely cosmetic procedure.

Ten years later, in the course of struggling to adapt to change, with leaving college and moving permanently into a care home just five minutes from home, she again blinded herself, this time in her one remaining sighted eye.  I rushed her to A&E.  Incredibly, the doctors weren’t interested.  I’m convinced that anyone else presenting with a detached retina in their only sighted eye would have been admitted and operated on within twenty-four to forty-eight hours.  No amount of pleading on my part made anyone in the A&E department treat this as an emergency, even though it was obvious that she could see nothing at all, even familiar objects held quite close to her, and was beyond terrified at being plunged into this world of darkness.  It was December 9th.  In the end I was sent away with an outpatient appointment for the end of January.

Back home, I made frantic phone calls, trying to speak to the ophthalmologists’ secretaries, desperately trying to get someone to see that if this was left untreated for 7 weeks it would be too late to save her sight.  Finally, in desperation, I loaded her into the car and, together with her keyworker, drove to Moorfields eye hospital, only to be told that they could not see her because they were not equipped to operate on someone whose disabilities increased their risk for anaesthetic.  However, they did phone our local hospital and at last we were given an appointment for the following Monday.

That was when we met our wonderful local ophthalmology consultant who immediately grasped the urgency of the situation, admitted her as an emergency, and in a 3 hour operation delicately repaired and reattached her detached retina which was also torn in five or six places.  He has followed her up every six months since then, has removed a cataract from the eye which developed a couple of years later, and makes sure to see her frequently enough to pick up any problems at a very early stage should they begin to develop.  I cannot praise this consultant highly enough but what a contrast to the casual attitude in A&E which appeared to assume that sight does not matter if you’re already intellectually impaired.  The stress to a parent of realising that your child has become blind and no one thinks that it is important to try to restore her sight is unimaginable.

This month we’ve had a parallel experience.  About 5 weeks ago she suddenly started asking to go to the dentist – unheard of!  Because of her extreme fear of medical procedures she was reluctant to let the dentist look, but the dentist did manage to spot a gum abscess, and prescribed antibiotics.  Over the next week, her pain spiralled out of control, with a massive increase in self-harming behaviour.  The antibiotics were doubled, still with no effect.  At the next dental appointment the dentist could see the sepsis spreading, and warned that it could encroach on her eye (the sighted one).  Mild painkillers were prescribed.

A week later, another dental appointment.  This time the dentist could clearly see loose teeth, a sinus draining pus and an abscess. She took her temperature which registered at 40.  She got the care staff to take my daughter out so she could have a quiet word with me without alarming her, and explained that the loose teeth would have to be extracted and the gum cleaned out with antiseptic.  Obviously a patient who was too anxious even to let a dentist put a mirror in her mouth would have to have this done under general anaesthetic. She wrote a letter then and there, gave it to me and instructed me to go to A&E and hand the letter to the A&E doctor.  We duly showed up at A&E with my daughter quiet but highly anxious.  The young A&E doctor looked very uncertain as she surveyed this patient in the wheelchair with the odd way of talking and the unpredictable reactions.  She read the letter and attempted an examination which had to be abandoned because of my daughter’s reaction of extreme fear.  I explained that the high risk of self-harm included the risk of permanent blindness, as she had been hitting her eyes again.  The doctor said she had been able to see the draining sinus and loose teeth and added, in front of her, “We’ll have to take those teeth out.  I’m not sure if we can admit her now.  I think we’ll probably send her an outpatient appointment, I’ll go and see.”  Then she flounced out of the room, leaving those words “We’ll have to take those teeth out” sinking into my daughter’s consciousness.  Of course this possibility had never occurred to her. She didn’t know it was even possible to take teeth out.  And I had avoided telling her because I wanted to be able to explain the procedure to her in simple words at the last possible minute, to minimise her anxiety. We were left sitting in that room for an hour and a half with my daughter screaming, hitting, biting and scratching herself with a combination of terror and dental pain.  It took the two of us desperately working together to try and keep her safe.  At the end of that time, the doctor reappeared and told us to go to the pharmacy to collect another prescription for antibiotics which she would drop off there, and then to go home and await an outpatient appointment through the post.  Later the dentist phoned me and just could not believe that, despite her letter, her patient had not been admitted for urgent treatment.

The following evening I received a call from the care home.  My daughter was completely beside herself with pain that was totally out of control.  She had destroyed her computer and was hitting herself so badly that they had no choice but to sedate her for her own safety – very much a last resort.  I contacted her GP who prescribed stronger pain killers – so strong, as it turned out, that my daughter couldn’t keep them down.  The next few days were a nightmare of trying to get enough paracetamol and ibuprofen down her to at least take the edge off the pain.  Her temperature hovered around 39-40.  The care home instituted a round-the-clock watch to try and prevent her self-harming.  Nonetheless, by the time the outpatient appointment came round five days later she presented in the clinic with black eyes from self-harm.  I pointed them out and described her history of severe self-harm.  The consultant confirmed the diagnosis of the dentist and A&E doctor (the care home staff had been getting her to practice opening her mouth wide, so though she wouldn’t let him near her, he still got a reasonable look).   The consultant agreed that this needed treating urgently but added that urgent meant weeks rather than days.  I pointed out the black eyes again, and warned him that if this was left for weeks she would in all probability be permanently blind before it was treated. He was unmoved.  Again the dentist phoned later in the day, and again was utterly incredulous that the patient hadn’t been admitted and treated as an emergency.

The appointment came for 2 weeks later, but in the meantime her pain and anxiety was so completely out of control it was becoming impossible to keep her safe, even with sedation, which had completely stopped having any effect.  On the Friday the care home manager phoned 111.  They contacted the GP who came to visit at lunchtime, then went away to phone the hospital and request immediate admission.  The oral surgery department promised to phone back.  The doctor waited at the surgery until 9pm but the call never came.  The manager called 111 again in the afternoon, and the on call GP rang back.  Again she contacted the hospital.  Again they promised to return the call but never did.  Finally the manager rang 111 again.  The on call GP spoke to the oral surgeon and explained the situation and the need for an immediate admission.  The oral surgeon was just going into theatre and said he would phone the care home as soon as he had finished.  I waited at the care home half the night for the call that never came, and finally went home and slept with my phone in my hand but it didn’t ring.  My daughter was given a sedative at 7pm because of the degree of self-harm, and finally fell asleep at 6am.

The next morning we again dialled 111.  We were told to take her to A&E at our local hospital.  We objected – as there was no maxillofacial department there, it would be pointless to go there with her.  We were told we must take her there.  The care home manager, who had given up her bank holiday Saturday off to try and sort this, came with me to A&E.  On arrival we were told there was no point having taken her there because there was no maxillofacial department and we replied, “We know.”  We were told to take her back to A&E at the hospital where she had already been seen.  The manager explained that she had already phoned them and been told the department was closed and no surgeons were present.  The nurse replied, “The department may be closed, but I guarantee there’s an on call oral surgeon available, and you need to take her there.”

At this point my patience completely ran out.  “Why would I take her there?”  I asked.  “Their maxillofacial team has made it abundantly clear they don’t give a toss about her.  Why would I trust them to operate on her?”  I suggested taking her to another nearby hospital which I knew had a maxillofacial department.  The nurse persuaded me that if we went to A&E there, they would ascertain that she had already been seen at another hospital and would refuse to treat her but insist on sending her back to the hospital that had already seen her.

Reluctantly we went back to A&E at the first hospital, where we were told that they probably wouldn’t treat it as an emergency and we would probably have to wait two weeks for the appointment we’d already been given.  I reiterated my fears that she would have blinded herself again by then, and that it was inconceivable that someone could be condemned to lose their sight just because no one would treat their oral pain and the sepsis which was, by now beginning to affect her ears and throat.  At this point, the care home manager added that as soon as the weekend was over she would be reporting the hospital to the CQC.  And suddenly – hey presto!  There was a space on the emergency list and she could be taken to theatre within the hour.

I’m sure it doesn’t take much imagination to realise that life with a disabled child is harder than life for other parents and doesn’t stop when your child grows up.  So I would like to know why families already under much greater stress than other families are constantly subjected to unbelievable additional stress at the hardest times of their lives.  And why is it acceptable to subject people with intellectual disabilities to suffering that no one else would be asked to put up with?  Imagine if you or I walked into the dentist with raging tooth pain, an abscess and spreading sepsis.  Do you imagine we would be told to suck it up for six weeks until someone could be bothered to treat us?  So why is that acceptable for someone just because they can’t be treated simply, in the dentist’s chair?

My daughter is normally a joyful soul.  She has a fierce loyalty and devoted affection for her carers, family and fellow-residents.  She has a very witty sense of humour and is wonderfully gifted musically, including having perfect pitch.  She takes a keen interest in trains and hand dryers and can tell you a great deal about how they work and what are the differences between different brands and types.  To see this lovely young lady with her cheerful disposition reduced to a screaming heap of terror literally trying to bash her own eyes out with pain and distress is something no family should ever have to be put through.  But it is happening, every day, to people with learning disabilities.

As said at the beginning, the NHS can be brilliant at meeting the needs of disabled patients when the treatment is elective and carefully planned.  But we have to improve the management of emergencies for these patients.  Someone in the Clinical Commissioning Group has asked me to issue a formal complaint about the hospital.  I think that instead I’m going to offer to run training workshops for their A&E doctors in how to work with patients with learning disabilities.  Let’s hope they take me up on it.

 

Church – what did Jesus have in mind?

My church, having just sold its building in response to a call from God to “walk out to walk on” is in the middle of a conversation about how to be Church in a radically new way.  We want to bring the kingdom of God to bear on the society in which we find ourselves, but to do it in a way that, while retaining the things God has built into us over the years, does not seek to hold on to any of the external trappings of what we have created, of the church we have built perhaps in our own image rather than looking like the Body of Christ.  That conversation is ongoing, and we are still at the place of having buried the seed of the past without knowing exactly what the harvest will look like which springs up in its place.

Jesus had a few specifics in mind when He dreamed of what His church would be.  The details, He left to us to fill in, with cultural variations and allowances for differences of temperament.  But there were a few non-negotiables.

One was that it would be a body of people with the power to bind or to loose certain things in heaven and on earth.  (Matthew 18. 18)  This can be interpreted in different ways, and certainly it refers to our authority in a spiritual realm.  But I think it also has much to do with our interactions with each other, coming, as it does, in the middle of a passage where Jesus sets out how we are to forgive and reconcile our differences.

In particular, I wonder do we loose, or release, the disabled members of our churches?  Do we set them free to be everything God has called them to be?  Do we give them permission to be our teachers, our pastors, our soul-deep friends?  Or do we bind and restrict them?  Do we hold them back, keep them in their place and expect too little of them?  Could it be that in placing restrictions on people here on earth in our churches we are binding them in some heavenly sense, hindering them from developing spiritually into all that God intended when He created them?

Secondly, Jesus made it clear that reaching out to disabled people and drawing them in to be part of the church was an essential element of the Great Commission which He left as a mandate for the church to fulfil.  In Luke 14. 16-24 He gave an analogy of the Church as a banquet to which all are invited, but not all are willing to come. The invitation is rejected by the landed gentry, the respected businessmen, the young and attractive, but accepted by those who cannot see or walk, in order, said Jesus “that my house may be full”.  The Lausanne Committee for World Evangelization estimates that between 90% and 95% of disabled people die without ever getting to hear the Gospel; and yet Jesus says that without them His house is not full.  Surely, whatever church looks like, it has to be intentional about inviting disabled people to play their full part.

But perhaps the most radical thing we could do in shaping the church is to take note of Jesus’ words in Luke 9.48.  I travel to quite a few churches these days, speaking about disability.  The churches who invite us are great churches, keen to be more pro-active in fully integrating disabled people into all aspects of church life.  But there’s something I’ve noticed about most of the churches I encounter (actually most of the churches I’ve ever had anything to do with, including the one I’m a part of and the ones I grew up in).

There’s a kind of unspoken understanding that the people who matter in church are the bishop/priest/minister/pastor or whatever the person exercising oversight is called in any given denomination.  Then come the lay members who are really committed, the eldership or diaconate, those who volunteer to run the church’s activities or take on lay pastoral roles such as visiting ill or elderly members.  Next in importance are the busy people, those with families, who don’t contribute so much because of other commitments, but nevertheless are loyal and turn up most weeks on Sunday.  And the ones who are given least weight are the ones who are seen as contributing nothing – maybe homeless people who wander in looking for warmth on a wintry Sunday morning, addicts or those whose lives are chaotic, refugees who haven’t yet learned the language, and people with profound learning disabilities.

But in Luke 9.48 Jesus says these words: “It is the one who is least among you all who is the greatest.”  I wonder how church would look if we really took that seriously?  If the ones who are relegated to having the least say in church life were put at the centre, with their needs, gifts, vision and ideas seen as the crucial focus around which we design how we do church?

We see Jesus do this again and again – He abandons a busy schedule to touch a leper whom no one else will touch.  He breaks off in mid-stride to come over and speak to a blind beggar whom everyone else is shushing.  He sees his disciples squabbling and selects a small child as the example of the kind of spirit they should display (in a culture where no one pays any attention at all to the opinions or actions of children).  He strikes up a conversation with a woman who is alone because no one else will associate with her, and confides in her the information that He is the Messiah, before He has made this revelation to anyone else.  He interrupts a ministry trip with his disciples to extend compassion to a widowed mother whose only son has died, at a time when widows are the lowest in the social pecking order.

The pattern is so striking and so often repeated that it’s impossible to avoid the conclusion that Jesus really meant what he said in a very literal sense – that those who are considered to be the least among us are, for Him, the greatest ones in the Kingdom, the ones who become central to all that God wants to bring about in the world.  I wonder how our churches would look if we used that as our model?

Open letter to the new Work and Pensions Secretary

On 20th March I wrote to the new Work and Pensions Secretary. I was particularly concerned by the appointment of a man who laboured under the misapprehension that in voting to cut £30 a week from people too sick and disabled to work, he had in fact voted for a cut to the benefits of people who are capable of work.  I was not writing as a political militant but as a concerned mother whose daughter is being adversely affected by the casual, uncaring policies of a government which would rather not have its attention drawn to the pain it is inflicting.  Since he has not yet deigned to reply to my email (and nor has my own MP, Sir Gerald Howarth, to whom I also copied it) I have decided to publish it here as an open letter.

Dear Mr Crabb,

Congratulations on your appointment as the new Work and Pensions Secretary.

I would like to draw your attention to an anomaly and an injustice in both the working of your department and the way it is presented to the public.  Mr Osborne has been able to claim to have increased spending on disability benefits by £1bn.  This is not really true.  If, as in this claim by Mr Osborne, only DLA/PIP is included in this figure, it is possible to claim a cash increase, although in real terms this represents a decrease when inflation is taken into account.  But if all those who were moved from Incapacity Benefit to ESA are included there has been a very real fall in the amount of benefits paid to disabled people.  Cutting a further £30 a week from ESA for new claimants is only going to make this worse, and is based on the illogical assumption that if someone is too disabled to work, adding starvation to their disability will make them suddenly recover enough to get a job.

But much of the spending allocated to disability is being wasted in a manner which is both profligate and discriminatory.  People who have congenital, incurable, degenerative conditions and who were awarded DLA indefinitely, are having to go through the stress and humiliation of a reassessment.  For the second time in a year I am being asked to prove to your department that my daughter has not suddenly miraculously recovered from her congenital quadriplegic cerebral palsy, autism, learning disability and partial sight.  Apart from the immense waste of the time I have to devote to this and the distress caused to my daughter who has no understanding at all of the system, I cannot imagine how much your department is wasting on this ridiculous and futile exercise – money which might, with a little creativity and forethought, have been spent on improving the already very dificult lives of disabled people.

Along with the rhetoric in the media which portrays disabled people as skivers and benefit scroungers there has been a 213% increase in reported disability hate crime, with the unreported figure believed to be far higher, according to the Crown Prosecution Service.  The government has always pretended to distance itself from the language used in the media, but who can forget Mr Osborne’s disgraceful remark about the shift worker “leaving home in the dark hours of the early morning who looks up at the closed blinds of their next door neighbour sleeping off a life on benefits”?  As a result of unthinking, prejudiced remarks of this kind, people severely disabled by reason of conditions such as Myalgic Encephalomyelitis, Fibromyalgia or terminal cancer who cannot bear the glare of broad daylight have found themselves stigmatised and abused.

It is time to end this dreadful persecution of disabled people, and to ask what are their real needs, and how can these be met?  And it is long past time, as Mr Duncan Smith so belatedly recognised, to stop raiding the pockets of disabled people to line the pockets of the well-off.

I hope that as you begin your new job you will take these points into consideration.

Yours sincerely,

Rosamund Bayes

Some musings on the past and present, inspired by Andrew’s birthday last week

So many endings – thus it seemed to me;
The closing of the door that day I left;
A termination, settled with one deft
Stroke of a judge’s pen; an elegy,

Lamenting while rejoicing to be free.
Then, bowed beneath the unexpected heft
Of your untimely death. A callous theft;
You might yet have become all you could be.

And now I hear, not something being shut,
More like a wind that blows through open doors.
The past has sunk from view; I raise my head:

The sight before me is a mound, a glut
Of ripened opportunities, the shores
Of distant isles; I’m risen from the dead.

On friendship

friendship

I had seldom seen her quiet and calm, this friend of my daughter’s, her fellow-resident in the care home.  She was non-verbal and had only the most limited means of making her needs or discomfort known.  She would scream or wail or stuff her hands in her mouth and lament, because she had no words with which to indicate that she was hungry, thirsty, cold or lonely.

But one day recently I turned up and she had no unmet needs and was quiet and content.  I paused in front of her, then on impulse stooped down to the level of her wheelchair.  She tilted her head to one side and raised an eyebrow.  I tilted my head to the same side and raised one of my eyebrows.  A broad grin broke over her face like the sun dissipating the clouds.  She tilted her head and raised her eyebrow again.  I mirrored her movements, and this time the grin she flashed at me was cheeky and conspiratorial.  She raised a hand to the side of her face and waggled her fingers.  I raised my hand to the side of my face and waggled my fingers right back at her.  She giggled with quiet delight.

I don’t know whether, next time I see her, she will remember this exchange.  But I do know that while it was going on, communication was taking place.  I reflected what she was saying, and she befriended me.  I know that when next I see her I will have a language in which to communicate with her – a language she taught me.  I’m not yet fluent but I’m a willing pupil and she is clearly a ready teacher.  T.S. Eliot once said that genuine poetry can communicate before it is understood.   If he was right then we were making poetry, she and I.  Nothing that she said to me got filtered through my mind before I absorbed it.  It spoke direct to my spirit, as, judging from her reaction, did my communication to hers.

I have been reflecting on this – on how the infinite Mind that conceived and then created the universe offers me friendship, not because my intellect is on a par with His, but because true friendship is not brain to brain but heart to heart and spirit to spirit.  So there is no reason why I should not form a genuine friendship with someone whose intellectual capacity is in a different ball-park from mine (be that a Stephen Hawking or a person with a profound learning disability).  Friendship does not depend on cognitive capacity but on the capacity to receive love.

People with intellectual disabilities are, worldwide, the most despised, neglected and lonely people on this planet.  Why should this be?  They have friendship to offer, they have a language in which to communicate their amity and joy, and they are ready to teach that language to us.  How much richness we miss out on when we pass them by without a second glance.  For that matter, why am I even talking about “we” and “they”?  There is no “them” and “us”.  We are all in this together, and it’s up to us whether we want to take advantage of the treasures of friendship together, or to go through life impoverished by the lack of that which we fail to esteem.

Playing with fire

This is a transcript of the talk I gave to the ladies of the church while I was in India.
A_flame
How do you know, when you start something, if it will become an addiction? Answer: you don’t. Some people smoke a bit of cannabis when they’re young and never touch it again. Others get so attracted to the “high” it gives them that they have to go on trying ever stronger drugs in search of a higher high until they are hopelessly addicted and end up ruining their entire lives and all their relationships. Some people can have the odd alcoholic drink on social occasions and go weeks without a drink quite happily. For others, the first drink they try becomes the first step on a path to alcoholism which can in turn lead to losing their job, becoming homeless, losing their relationships and destroying their liver. Some people can glance at a few pornographic magazines or online videos and think, “That’s not for me”. Others get hooked and sucked into a trap from which they never escape.

It’s a bit like holding a paper to a flame. You might think, “I don’t want to burn this whole piece of paper, I just want to singe the edge.” But before you know it, flames are licking over the whole paper and it is consumed until nothing but ash remains. (I demonstrated this by lighting the corner of a piece of paper – before long it was entirely in flames.) Psychologists who treat porn addicts say there are two things they all have in common: they hate using pornography, and they can’t stop.

Effects of pornography use:
Pornography depersonalises. Watch any porn video and you will see it is the woman who is being treated as a throw-away commodity. Even if a woman starts to look at pornography in order to take some pleasure from the male actors, if she looks carefully she will notice that the only function of the woman in the video is to give the man what he desires. Not only are her desires not attended to; it is not even acknowledged that she has any desires. Her sole reason for existing is to serve his pleasure.

Women who feed their minds on this will come to have a low estimation of themselves – because God did not create women solely for the sexual pleasure of men, and God does not want women to see themselves in those terms. Men who feed their minds on this will come to despise the women in their lives and will treat their wives, sisters and daughters with disrespect.

Pornography causes brain damage – it changes the part of the brain which is called the striatum. This part of the brain is affected by the chemical dopamine. Dopamine is the chemical that makes us feel good when we have worked hard and achieved something. Pornography gives that dopamine boost without doing anything to work for it. Because of this, it damages the system in our brains which produces a good feeling as the reward for hard work. We are no longer motivated to work for a reward because we have found a way of getting the reward without the work. Neurological studies have shown that the striatum – the part of the brain that controls motivation – actually shrinks with regular porn use. Someone who regularly watches porn is not just lowering their motivation, they are actually causing physical damage to their brain. In fact, it has been shown that masturbating to pornography floods the brain with more feel-good chemicals than snorting cocaine does. Pornography is more addictive than narcotics and can be a harder addiction to break.

Why does this matter? Studies of the effects of pornography have mainly focused on men since most users of pornography are men. Men who experience this change in their brain find 2 effects: firstly, they begin to compulsively seek out the substance (pornography) which gives them this reward, to the point that pornography addiction becomes the only important thing in their life. Secondly, because they have dismantled the brain’s motivation and reward system, they lose motivation in all areas of life. This is why successful, high-flying businessmen wreck their careers and relationships, because they can no long be bothered to put in the effort that such attainments require.

Then there is loss of libido – pornography use is now believed to be the leading cause of erectile dysfunction in men. When a man becomes used to the instant gratification of masturbating to a porn movie or image, he becomes incapable of responding to the real-life interaction with an actual woman. Wooing another person takes time. It takes unselfishness. One of the main pleasures of marital love comes from giving enjoyment to the other. This whole aspect of pleasure is absent in pornography use – self-gratification is the only thing that matters. And after a while the person becomes actually incapable of responding in love to another human being.

I wish 15 year old boys at school could be taught that pornography results in erectile dysfunction. If you get into this habit now, by the time you’re 20 or 25 you may be impotent. If you meet someone and fall in love you may by then be incapable of having sex with her. I wonder how many would want that to be the pathway of personal relationships stretching out before them if they knew. But this doesn’t only affect men. Self-gratification always renders you incapable of normal loving relationships.

Sociological studies have shown that, once your basic needs are met, what makes you happy is not having lots of material wealth or lots of sexual partners. What makes you happy is having loving, trusting relationships. Pornography makes you incapable of love. It is focused on me, my needs, my desires, getting what I want now, no matter who gets hurt in the process. Such a person cannot enter into loving relationships. Pornography also destroys trust. It is a secretive occupation. It causes shame, and so people conceal what they are doing. They lie to their partners; they delete their internet history. Partners of porn addicts often feel a deep unease, a sense that all is not well in the relationship, but because of the secrecy and lying, they cannot point to anything that is at the root of their feeling, and they may come to mistrust their own judgement or even doubt their own sanity. It is a deeply disturbing way to live, and eventually leads to Post Traumatic Stress Disorder. In fact, in the UK divorce lawyers are reporting that pornography addiction is increasingly being cited as a cause of marital breakdown in divorce cases.

Pornography users develop tolerance – the more we are exposed to something, the less effect it has on us. We need ever more extreme stimuli to achieve the same effect. This is why pornography addiction always escalates. I knew one person who started out by looking at a few nudes in magazines. The person saw nothing wrong with this, and thought it was harmless. This person would have been horrified at the thought of watching something that harmed other people. But a number of years down the line, this same person was addicted to watching sadistic abuse of women and even children. Eventually, things that would have appalled and horrified this person at the outset became the minimum necessary for their stimulation. This is always the pattern with addiction.

Pornography is a gateway drug. If you examine the case of any sex offender in jail you will find that they started out by looking at pornography. Eventually merely looking at it is no longer satisfying. The person has to act out what they have been watching in order to achieve the same level of satisfaction.

Pornography use fuels and funds the people trafficking racket. As long as there are consumers of pornography there will be a lucrative market for women and girls. If you are looking at pornography online – whether or not you are paying for it – you are in some measure responsible for the trafficking of girls. If you think the women in these online videos are acting freely and of their own volition, listen to these quotes from female porn stars who left the business when they met Jesus:

“Guys are punching you in the face. You get ripped. Your insides can come out of you. It’s never ending. You’re viewed as an object—not as a human with a spirit. People do drugs because they can’t deal with the way they’re being treated.”

“We all took drugs. It was the only way we could get through what we were being forced to do. The drugs we binged on were Ecstasy, Cocaine, Marijuana, Xanax, Valium, Vicodin and alcohol.”

“My career ended in violence, fear, abuse, drugs, heartbreak, and almost death. From cutting my arms up to being choked in my own house, to a nervous breakdown that led me into a car accident from almost overdosing on prescription drugs.” (Quotes from http://www.shelleylubben.com)

When you become a consumer of pornography, you are personally responsible for women being trafficked into that kind of abuse.

God’s original design
We were created for relationships. How could it be otherwise, when we are made in the image of the God who is Father, Son and Holy Spirit? Anything that inhibits our capacity for relationships diminishes us and damages the image of God in us. The only things we can take into eternity with us are our relationship with Jesus and our relationships with the people He has given us in this life. If we have destroyed those relationships, what will eternity hold for us?

It’s interesting that Paul opens Ephesians chapter 5 by contrasting God’s way of love with a life tainted by impurity, as if the two are completely incompatible. He writes, “Follow God’s example, therefore, as dearly loved children, and walk in the way of love, just as Christ loved us and gave Himself up for us as a fragrant offering and sacrifice to God. But among you there must not be even a hint of sexual immorality, or of any kind of impurity, or of greed, because these are improper for God’s holy people.” A wise man once said, “The devil’s plan is to get couples to have sex before marriage and to have no sex after marriage.” Pornography is one of the tools he uses to achieve this.

Any addiction is an idol. It comes between us and God, and takes a place in our lives that only He should have. And as Jesus said, you can’t serve two masters. If you are giving yourself in secret to sexual impurity, you can’t have an open, trusting and worshipful relationship with Jesus. And you will become miserable, because we are designed to find our happiness and fulfilment in God, not in the things that draw us away from Him.

Pornography makes women not simply subordinate but worthless, a commodity to be used and thrown away. But God didn’t make women less than men. Eve was taken from a rib in Adam’s side, not from his head to be his boss, and not from his feet to be his slave but from his side to be his equal and companion. Jesus gave women great honour. He allowed Mary of Bethany to sit and learn from him along with the men – something no other rabbi would do. He told Martha, who was busy with so many things, that few things were needed – in fact, only one, and that was the one her sister had chosen – to sit at Jesus’ feet and learn from Him, alongside the men. He didn’t believe a woman’s place was in the kitchen, and He certainly didn’t believe women existed only to be used and abused by men.

Pornography gives you unreal expectations about how your husband should treat you. It tells you that you are of less worth than men, that you deserve nothing, that your needs and desires don’t matter or don’t exist. But the Bible tells us that a husband should live with his wife as joint-heirs of God’s grace. Peter even says that if a man doesn’t treat his wife as an equal co-heir in this way, his prayers won’t get anywhere. Paul says that a man should love his wife the way Christ loved the Church – and then he goes on to spell out what that means. Christ gave Himself up for the church – so a husband should give himself up for his wife. That means laying down his own desires and preferring hers. Christ washed the Church by the water of His word – so a husband’s words should have a purifying effect on his wife, cleansing her of the negative images the world tries to put on her. When you go out and see all those adverts that demean women, when you get insults shouted at you in the street, when someone at work loses patience with you and says mean things, you should be able to come home to your husband and his words should wash all of that off you and remind you of who you really are, a precious child of God, and beautiful and precious to him, too. Christ treated the Church in a way that made her radiant, holy and blameless – so a man should fill his wife with joy and enable her to lead a godly life. A man should care for his wife as much as he cares for his own body. He does not hate his body, but feeds and clothes it, and so he should show the same love and care for his wife as he does for his own body. This is the exact opposite of how pornography tells women they deserve to be treated, but we should base our view of ourselves on the Word of God, and not on what the godless world wants us to believe.

What can we do?
If you have already dipped your toe into the world of pornography, get out again as fast as you can. Don’t wait till the flames have completely consumed the piece of paper. What puts out flames? Water. (Here I again ignited the corner of a piece of paper , but before the flames could consume it, I put it out by pouring water on it.) Paul talks about the water of God’s word. Fill your mind with the word of God. Every time you are tempted to watch porn, pick up your Bible instead. Jesus is the living water. Draw near to Him – start with repentance for having been drawn into pornography and allow Him to cleanse you and give you a fresh start. Pornography causes shame, and shame always drives you away from God. Let your repentance and His forgiveness draw you right back into the heart of His loving embrace.

Remember that when Jesus first revealed that He was the living water, and that whoever drank from Him would never thirst again, He was speaking to a woman who had a string of broken marriages and was living in sin with a man she wasn’t married to. He had nothing but love, acceptance and cleansing for her. She didn’t fear his reproach – instead, she brought her whole village to Him so they could also receive His love and find the living water. When you turn to Him in repentance He won’t reproach you or tell you to go and do some penance and clean yourself up before you come to Him, He will just accept and welcome and cleanse you. “If we confess our sins, He is faithful and just to forgive us our sins, and to cleanse us from all unrighteousness.”

What are people searching for when they turn to pornography? For men it may be a quick fix, but for women it’s more probably a fantasy of romance and a happy ever after with a handsome hero. But these things are like a leaky well that very soon dries up. Deep down, every woman is asking two questions: am I loved? And am I beautiful? And in the arms of Jesus you hear those whispers you are longing for – yes you are loved, and yes you are beautiful. The buzz you get from pornography doesn’t last. It soon goes away, and you have to watch ever more extreme stuff to try to get it back. But Jesus is the living water that never dries up. Because He lives in you, you never have to go somewhere in search of something more to satisfy your thirst. He becomes in you a spring of water welling up to eternal life.

Perhaps you have never been tempted by pornography. Perhaps you loathe and avoid it. But you are married to a man who has been ensnared by it. What can you do? You can’t handle this on your own. He isn’t going to listen to you. You probably already know he has started to disrespect you because of what he’s feeding his mind on. So he isn’t going to take notice of what you say. I know it’s embarrassing for a woman to discuss such things with a pastor. But you are going to have to swallow your embarrassment and talk to a pastor. This is the first step towards getting help. Your husband is going to need men he respects who will challenge him and hold him to account. So please don’t suffer in silence, and please don’t wait until this rips your marriage apart. Go and talk to a pastor you trust before it’s too late.