101. Manchego Nights

I’ve had a lot of dreams recently. Most of them I can’t remember. Analysts used to like interpreting dreams, but now I think dreams are viewed as a kind of mental Pilates, rehearsing possibilities and dangers ahead.

I knew a patient once who thought that we were recording all his dreams and sending them to Disney to be made into cartoons. DIsney never replied to his letters. With medication and therapy he stopped believing his dreams were stolen, but sadly when this happened he also stopped dreaming altogether. I’m sending some of my new dreams to Disney right now before I forget them or get my medication increased.

Driving the bus

This one comes up quite frequently. I’m driving a double decker but from the upper deck, looking down the little periscope window at the right front corner. Sometimes it changes into a Volkswagen Variant station wagon which I drive from the back seat. The bus very nearly topples over round corners. Probably one for the Freudians.

Quantum of Amnesia.

In this one, no-one can remember anything about the Bond movie Quantum of Solace, even though everyone has seen it at least once. Even straight after watching it on TV I cannot remember any of the plot or characters. I find that others have noticed the same thing. Some anaesthetists in China are showing the movie in operating theatres instead of using gas. A news article finds that Quantum of Solace is the favourite movie choice for date rapists. The Alzheimer’s Society calls for the film to be banned.

Wisconsin Shuffle.

I am a professional gambler, working the Mississippi river boats, dealing the Wisconsin Card Sort Test. The other big players are all psychologists, some of whom I recognise, though now they all have moustaches and one of them wears the uniform of a Norwegian navy captain. 

The dream suddenly moves to an appraisal meeting where I am facing the Trust Board. They demand a share of my winnings and suddenly the medical director produces a Derringer from up his sleeve and the chairwoman comes at me with a tiny dagger. I protest that my gambling takes place in my own time and not one of the Trust’s programmed activity sessions. ‘We’ve changed the paradigm,’ laughs the chairwoman. As she lunges forward I see the little NHS Trust logo on her stiletto and then I wake up.

Prince Andrew

Prince Andrew arrives for his CBT session. He’s upset because he’s going down in the line of succession. He was eighth in line to the throne, now he’s ninth, overtaken by baby Lilibet Diana. How badly upset should he feel? Ninth out of sixty million, surely not too bad? 

‘In line to the throne’ is Andrew’s best top trumps suit, even though he’s now overtaken by a tiny girl.

As consolation I remind him he’s still Earl Of Inverness. ‘They can’t take that away from me’ he nods, though in his homework assignment he has found that some residents of that city are trying to sack him. It’s a title that’s been created several times, in 1718, 1801, 1892, 1920 and 1986. I make a note of the sequence to put in a pub quiz one day.

Ward twenty something

In this one I’m admitted to a hospital in Scunthorpe, left in A and E for 12 hours without any water or food, wrongly diagnosed and sent to an inappropriate ward. The other 3 patients in the 4 bedded bay appear to be zombies. Mrs EP visits me and asks if there is any food available. The nurse shakes her head sadly. ‘A long time ago we had vending machines but they have all been taken away’. On her way out, just outside the ward, my visitor sees an enormous bank of vending machines full of chocolate and pepsi. She has enough change for a Twix bar and Ribena, which she brings back for me. I try one finger of Twix, but the effect is like the wafer thin mint in Meaning of Life and I vomit till I explode.

Tower of Babel

This one is like a biblical epic movie, in letterbox format and starring Kirk Douglas. It’s meant to be a comment on the modern world, where there are too many words being uttered or written. But Kirk keeps saying things like  ‘I know there is huge merit in talking about your issues and the only thing about keeping it quiet is that it’s only ever going to make it worse’ and the director just keeps saying ‘cut’.

Be mindful

Its mental health awareness week yet again. I learn that stress affects exactly 74% of people. I take the Perceived Stress test and am surprised to find I score 16, which is described as moderately stressed. Apparently I could reduce it to 10 by taking a Be Mindful course.

After a cup of tea, I take the test again and score 8. Apparently I could reduce it to 5 by taking a Be Mindful course. I open up the Be Mindful course on a web page and a giant shark comes out of the screen and I wake up.

Spacey is exonerated

In this one the actor is totally cleared of any wrongdoing. As a recompense, the movie All the Money in the World, for which he was replaced by Christopher Plummer, has to be re-shot frame by frame with Spacey CGI’ed back in place. I wake up when Spacey seizes the Oscar from Plummer’s cold dead hands.

Learning points

Are any of these dreams food-related? Scrooge, in Christmas Carol, attributed his ghostly night fantasies to tyramine-rich products:

‘You may be an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of underdone potato. There’s more of gravy than of grave about you, whatever you are!’, he yells at the ghost of Jacob Marley. 

Dickens was quite advanced in suggesting a molecular basis for psychopathology, even though later Scrooge found plenty of meaning in his dream.

Scrooge changed his whole life around but I came up with two small changes from my dream work. 1. Avoid the combination of Manchego, Chianti and Amitriptyline before bed time. 2. Don’t go to ward twenty something ever again.

100. Slow train cancelled.

What does it mean to score zero in the Eurovision song contest? James Newman, the UK contestant, seemed quite cheerful about it; his reaction has been described as ‘iconic’, dancing in the crowd and raising a glass to the cameras. The British have a peculiar reaction to losing and still celebrate major military defeats like Dunkirk and the Charge of the Light Brigade. The word ‘plucky’ usually comes into play.

But zero, really? If Newman had pretended to set fire to himself with paraffin, or even, like Sophie Ellis Bextor, burned ‘this goddamn house right down’, he wouldn’t have scored any less.  

Newman’s fire-based song, Embers, was written as a reaction to the pandemic. Newman told the BBC ‘I feel like everyone wants a party and to have some fun so when I was writing, that’s what I had in my head’. 

Like many songs, from Fire, by Crazy World of Arthur Brown, to Firestarter, by Prodigy, Embers has fire-based lyrics, but is pyrologically under-researched. The fire metaphor suggests that love will grow back from the embers and light up the world (while remaining, strangely, ‘cool under pressure’). 

Which is the opposite of what happened after the song, which sucked all the oxygen out of the room, but not in a good way. There’s a lesson to be learned from master songwriter, Billy Joel, who famously ‘didn’t start the fire’.

There’s also a lesson to be learned from the paper, ‘We’re shit and we know we are’: identity, place and ontological security in lower league football in England’.  (Mainwaring and Clark, 2011). People at the bottom of the league, year after year are left with no option but to celebrate, see ‘red wall’, see ‘second highest death rate from covid’ (Poland have gone ahead again in extra time). 

I know people who regularly attend non-league football, grumble all the way through, eat a terrible pie and leave before the end. Perhaps it’s a reaction to getting judged all the time, from SATs and GCSEs to Masterchef and the Employee of the Week award. 

In Eurovision the scoring section takes as long as the musical part. Some people just tune in for the scoring, the same people who loved to watch the football results come in on the BBC teleprinter as hors d’oeuvres to the Full Classified. 

These people, who love making assessments, have been in control for the last century. They are the people who make children compete in local music festivals and adjudicate best artichoke awards in the village show. They are the people who opposed the European super league, because no-one could be relegated and what was left was just ‘a series of exhibitiion matches’. Like, who wants to see an exhibition?

Flunking a song contest can maybe be seen as a reaction against scoring systems. 

Perhaps then, James Newman, an Eddie the Eagle for the 2020’s, is ahead of his time in overturning the notion of attaching a number value to a subjective judgement.

When he wrote ‘Down herе in the ashes, yeah, thеre’s something growing’ was that a sexual innuendo, or something more fundamental – is he imagining a popular revolt amongst the underclass? 

Sadly, the euro judges didn’t get any of these deeper meanings. Many of the songs are super-ironic, but the performer has to look as though they are totally serious and 200% into the performance. Any glimmer of insight, like Newman showed, a this-is-a-bit-silly look, then all is lost. Newman and the audience seemed to enjoy his losing far more than performing the song.

Newman has done for songwriting what the Light Brigade did for cavalry tactics; what Dunkirk did for running away; what Count Binface did for democracy and what Gainsborough Trinity have done for football.

Rather than a simple story about the end of the pandemic, Embers was quite subversive. It might have succeeded if the song had been any good. Unfortunately, The Guardian analysis was ‘began like a Daniel Beddingfield B side and went downhill from there’.

As such, Embers was a protest song, but it was no Blowin in the Wind. 

No-one, not even Bob Dylan, ever managed to include the word ‘ontological’ in a song, but I think Supertramp could do it. Next year?  

Mainwaring E, Clark T (2011) We’re shit and we know we are’: identity, place and ontological security in lower league football in England

Ed Mainwaring &Tom Clark 

Pages 107-123 | Published online: 19 Dec 201

99. Duplo Men in a world of Lego.

Thanks to Mr Belton, our young, dynamic English teacher, (nicknamed ‘Sexy B’) we studied the novel ‘1984’ when we were 12.  We found out that George Orwell wrote 1984 in 1948, that it had something to do with propaganda and quite a lot to do with Stalin’s USSR.

Amongst many gems, Orwell coined the term ‘doublethink’, meaning that people could hold two diametrically opposed views at the same time.

Because Orwell was a writer, the concept of doublethink was largely ignored by psychologists, who were still trying to understand how genocides could happen.

In 1957 Leon Festinger coined the term ‘cognitive dissonance’ meaning a situation where two opposed beliefs or behaviours could co-exist. 

In Orwell’s idea of doublethink, there was no tension or anxiety involved in holding opposing views. There was no need to bring in moral-based concepts like hypocrisy, deceit or plain lying. You just had two different views at the same time.

Whereas with cognitive dissonance there is a tension between the two beliefs, so that a person tries to reduce the tension by pumping up one of the beliefs and diminishing the other. Many (quite unconvincing) experiments took place to show cognitive dissonance happens, at least in samples of carefully selected American college students. 

Also in 1948, the WHO made a statement defining the concept of ‘health’: 

‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. Health became an entirely different thing from not being ill. More recently people are using the term ‘mental health’ in all kinds of contexts, often stretched or inverted, so that people ask me things like ‘was Trump a bit mental health?’

Trump does not seem unhappy with himself in any way.  Also psychiatrists are not supposed to diagnose people they haven’t met, even if those persons are famous, for instance suggesting certain politicians fit the profile for Narcissistic Personality Disorder. 

According to the ‘Goldwater rule’ in the American Psychiatric Association’s (APA) Principles of Medical Ethics, ‘it is unethical for psychiatrists to give a professional opinion about public figures whom they have not examined in person’.

Shouting at the television probably doesn’t constitute giving a professional opinion so it’s probably OK to keep yelling abuse. The TV can’t hear you, or so we thought.

Despite the rule, in 2019, ‘The Independent’ reported that 350 mental health professionals had written to warn Congress that ‘Trump’s mental state is deteriorating dangerously due to impeachment with potentially catastrophic outcomes’. 

Conversely, “Trump Derangement Syndrome (TDS) was proposed as ‘a mental condition in which a person has been driven effectively insane due to their dislike of Donald Trump, to the point at which they will abandon all logic and reason’’. 

TDS is a refreshed version of BDS, Bush Derangement Syndrome, invented by a psychiatrist, Charles Krauthammer, in 2003.

Notice that TDS affects everyone apart from Trump, including the 350 mental health professionals who wrote to Congress, leaving Trump the only person coming out of the situation looking completely healthy. 

We should look at Trump and BritainTrump (and the other world leaders that Pink Floyd would have consigned to the Fletcher Memorial Home) and instead of asking why they are deranged, ask instead why they seem so well.

Along these lines, we need to revisit doublethink and ask, is doublethink a step forward in human development, a special power of some kind?

BritainTrump for instance wrote two articles within days of each other both opposing Brexit and promoting it. There are websites devoted purely to recording his lies. The Marcus Rashford related lie, June 2020, went as follows:“I talked to Marcus Rashford today and congratulated him on his campaign which to be honest I only became aware of, recent … erm, today.”

Simon Hattenstone, in the Guardian, wrote at the time that this was a new kind of non-useful lie:

‘on Tuesday he appeared to have taken his lying to a new, worrying level – he now seemed to be lying just for the hell of it’

Yet he seems happy with himself and so far the voting public seem reasonably happy with his behaviour. 

Let’s assume Britain’s PM has evolved beyond cognitive dissonance into ‘dual mode’ so there are no signs of mental tension. Attempts to see the problem as ‘pathological lying’ or ‘mythomania’ are plainly judgemental. All we know is that there are two versions streaming at once. 

Double thinking, sometimes called double-bookkeeping, tends to be regarded as pathological, whatever the motivation. Whether it’s unconscious or deliberate, whether it’s delusional or magical thinking, we’re suspecting, in the words of Tokyo Blade, a ‘Head full of Bad Wiring’. That’s in contrast to everyday observations of doublethinkers, suggesting they are very happy indeed, having their cake and eating it.

Could it make sense to belong to several political parties at the same time? While you’re in town on Sunday morning, could it make sense to attend the catholic church and then the Friend’s meeting house gatherings, if the timings are favourable and you’ve paid for a whole morning’s pay and display? 

You can’t join the labour party if you’re a member of another party. Churches, on the other hand, don’t employ bouncers. Many are nice places to hang out and some offer low price coffee and biscuits. The methodist church even has a capsule coffee machine. Would you give up Hail Marys in return for Lungo Intenso? Maybe you don’t have to.

If I’m asked what football team I support and I reply, ‘Man Utd and Liverpool’, am I facing a beating? 

My argument is that such thinking is commonplace, but also that it is extremely rare.

98. Monstrous carbuncles revisited.

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People had been working on measures of social deprivation for decades before Donald Trump invented the shithole scale.

Sadly, the Donald didn’t colour in the broad canvas between Haiti on one end and Norway on  the other. Africa and El Salvador were reported somewhere in between, but where for instance would he place Mexborough? 

In the UK people love to write satirical articles slagging off their towns, including architecture, town planning, the appearance of the inhabitants and their behaviour. There are a few reasons for this, beyond what Jeremy Corbyn might call ‘english irony’.

The project ‘Crap Towns’ was an attempt to say something about urban deprivation in the UK. Crap towns featured in a series of publications associated with The Idler.

Most of the crap towns identified  would also rate as deprived on scales of social deprivation such as Townsend or Jarman, but Crap Towns is more subjective and much more fun. 

People nominate their towns and surveys are carried out. The process has not been tightened up or ‘operationalised’ as much as social scientists might like. As a result the essential notion of the crap town has been far-fetched to include entities like London, York and Chipping Norton. These places are not face-valid as crap, even though some of their inhabitants know better. There are plenty of aspects to criticise, even in affluent towns. Try walking past the Grafton Centre, Cambridge late on a Friday evening, where the cast of Mad Max has reassembled.

In another survey  conducted by iLivehere.com, Peterborough came out as the worst town. Runners up to Peterborough include traditional favourites like Halifax, Doncaster, Rochdale and Rotherham. ILiveHere self-identifies as satirical but its findings seem broadly valid. In most of those towns over a quarter of general practice patients are depressed and taking cheap generic fluoxetine.

Most of the Crap towns voted Leave in the referendum, and in general the Leave vote was closely correlated with the CQ (crap quotient). Crap towns are all about self-flagellation.

I lived in crap towns, including Peterborough, most of my life and I enjoyed them greatly. I have to say Peterborough is not a proper crap town. It has a John Lewis store which may reopen one day and a fine cathedral, not to mention an excellent road system. It does not have a branch of Boyes (the nearest one is in March) though it does have three B & M stores. There is a large suburb called Eastern Industry, telling it like it is. 

For me, in a proper crap town the shops will include Boyes, B and M, Superdrug (not a proper Superdrug, but its poor relation, Savers) and at least 5 charity shops. The charity shops will have hundreds of DVDs and Jack Reacher books. There will always be a CD copy of Misplaced Childhood, by Marillion. There may be a branch of Heron Foods, which is a portal to a Waitrose in a parallel universe.

Greenwood menswear, Weigh and Save and Bargain Booze are now boarded up, having teetered off the top end of the CQ scale. 

There are often shops that specialise in outdated food items. You don’t have to be a food scientist to know that cream sherry will never deteriorate during your lifetime.

The post office has usually been transplanted to the corner of a Spar Shop. People tend to travel by electric scooter. These move silently along the pavements catching unwary people lumbering out of Martin McColl’s scratching lottery cards.

If it’s a particularly cold and windswept day, four TalkTalk reps will be in the market square, trying to make you feel sorry enough for them to engage in light banter. One of them is usually nice looking enough to have attracted the attention of two big girls with prams. There’s a hairdressers that charges £4.99 for a cut and the barber looks like Liberace.

Crap towns should have poor Air Quality. Crap towns to the West have less pollution, with the exception of Port Talbot, which has the worst air in the UK. Crap towns to the east have less rain, but what rain there is gets more acidic. Scunthorpe is an Industrial Garden Town, or so it says on the signpost, telling it like it isn’t. Scunthorpe has the worst air quality in England. It might be worth spraypainting over the word Garden if you’re passing the town sign. 

I don’t go there now, although I can thoroughly recommend the colonoscopy department. I don’t imagine there’s a better colon imaging experience anywhere in the world – I still treasure those intimate photos – which goes to show, there is much more to a town’s amenity than its deteriorated retail area. Many facilities that we used to think we needed are now obsolete, following the harsh judgement of the Covid crisis: 

Pubs – like your living room, but with more infectious particles, and drinks three times the price you pay in Lidl.

Cinemas – like your living room, only someone is sitting behind you crunching popcorn and someone in front of you is staring at a very bright phone screen, scrolling down ebay items. You can’t skip the trailers by pressing a button.

Shops – like  your living room (using Amazon) but you have to drive, park, pay and display and not find the thing you want.

Cafes – like your living room but tea is 200 times as expensive and you need a code for the toilets.

Libraries – like Amazon but without the book you wanted 

Schools – like your living room but without proper IT or chocolate biscuits.

This change toward online living is another reason for shrugging off some of the aesthetic limitations of one’s town centre. Since most retail and many services went online, does it matter any more where you live, providing you have robust lungs, a smartphone and noise cancelling headphones?

For instance, when you’re asleep – does it matter then where you live ? Or when you’re watching TV, does it matter then? Or staring at a computer screen?

What about the neighbourhood, what about crime, what about those yobbos on mopeds? What about those hot hatchbacks parked window to window, exchanging little packets of not very legal substances in the leisure centre car park?

Granted, some areas are a bit too clockwork orange to feel comfortable, but in general, the real risk of violence is far lower than the subjective risk. Even in a crap town, you are far more likely to fall down stairs texting or get hit by a scooter than get knifed in the subway.

There are many more subjective accounts of terrible environments, such as featured in Failed Architecture and the long running Private Eye column Nooks and Corners. Everyone has their own ideas about which towns truly suck. After a while it becomes obvious that none of the towns are as bad as people make out. Writing about crap towns has become a genre. The writers more often love their towns than hate them. Rather than paint the towns ‘warts and all’ this genre just paints the warts. Finally The Telegraph runs an article called ‘Crap towns and why we love them’. Most people get the joke. We learned to live with concrete and steel. Prince Charles never did. That thing he called a monstrous carbuncle was an art gallery extension, something we’d have celebrated if they’d built it in Stirchley.

Which is surprising. Charles came from one of the most privileged families in the world and yet was sent to a prison-like boarding school where the dormitory windows were always kept open and he was systematically bullied. He should have written the definitive textbook on family sabotage, a book called ‘how and why we make rods for our own backs’.  Instead he went on to attack modern buildings, usually ones that were made of concrete, forgetting that they were often very useful, warm and nice inside, like the crap towns they formed. 

97. Snakes and ladders, without the ladders.

 

Physician heal thyself / the tailor is the worst dressed man.

This is for my friends who keep asking what’s happened to EP.  I can’t promise it will be a good read, unless you’re one of those rare people who like to hear about other people’s medical problems without getting paid to do so. But, as ABC put it, excuses had their uses, but now they’re all used up.

From February last year my life changed from being a health care provider to a health care recipient. A service user perhaps, or a patient, or to what non-PC doctors used to call a ‘punter’. Seeking health care is very much taking a gamble.

Think of it as a long overdue field trip through the health services. Every doctor should be made ill and admitted to hospital for a few days. I’d bring it in as a short module in year five of medical school, between ethics and breaking bad news.

Early last year I started to get pain in the neck. It began as what felt like a sprained muscle just to the right of C7. It got worse, I went to the GP, he referred me to physio and ordered a lot of blood tests. He forgot to tell me there was a 3 month waiting list for physio, which had been privatised. He also forgot to tell me it was impossible to make an appointment to see him again, ever. 

The pain got worse again, I went back to another GP who prescribed Cocodamol and Naproxen and ordered an X ray. I spent a lot of time lying on the floor staring at the ceiling. 

The X Ray showed some degenerative changes and possibly a facet joint problem. The word ‘mild’ cropped up a lot, which was reassuring. 

But at the same time, a friend of a friend with neck pain turned out to have a spinal cyst which was not discovered soon enough. He developed multi-system failure following surgery and died tragically. An extremely rare occurrence, I was sure, but my subconscious mind didn’t see it that way.

So, seeking further guidance / reassurance, I got referred to the musculoskeletal service, or ‘MSK’ as it calls itself. MSK, whoever they are, have organised their services based on old kidnap movies. The ransom payer is forced to run between telephone boxes and directed towards a remote venue. MSK make a series of anonymous phone calls and lead you a long way down a symbolically pot-holed road, to an industrial area a long way from where you live, leaving you scanning the skyline for snipers. 

A letter arrived announcing that I will be phoned to discuss an appointment. The phone call happened on time and I was sent to a contracted out service in a contracted out building. The receptionist denied all knowledge of my appointment, but luckily I saw a man who looked like an orthopaedic consultant – by this I mean he was wearing a suit – and this time for once my stereotyping proved accurate. The orthopaedic consultant, who was also contracted out, did a test where he pressed my head downwards into my neck. The pain got worse when he did that and I think I am still an inch shorter than I used to be. 

He requested an MRI scan.  

Same process for the scan – a letter announcing a phone call. The scan is in a portable unit on the same site, sadly there are no toilets. I am phobic of closed spaces but by this time Mrs EP has taught me a lot of Yoga and I yoga breathe my way through the scan trying not to open my eyes or sphincters.

The MRI showed some mild degenerative changes consistent with age, just like the XRay but commenting on different bits of anatomy.  I saw a few different physiotherapists, two NHS, subcontracted, and two private. And I got referred to the outsourced pain services, also subcontracted to some agency you never heard of. I waited for the ransom demand phone call.

 

A short holiday in Scunthorpe 

Then came a huge diversion. At the end of May 2019 I took the prescribed dose of Cocodamol for 2 days which caused a massive abdominal problem, a closed loop bowel obstruction (as it turned out, months later, when my CT scan was reviewed). Cue a very interesting day in a urology ward, which will fuel another article once the PTSD has subsided.

Then a month of abdominal pain and a diet of fish fingers and white bread and very little fibre, surgical and gastroenterology appointments leading up to a colonoscopy and another referral back to the surgeons, thankfully postponed due to Covid.

The abdo pain seemed to dislodge the neck pain. I’m not sure how that works, perhaps there is limited bandwidth in the brain. Maybe pains have a rank order, like suits in Bridge. 

As the abdomen settled down, after about a month, the neck pain came back. 

Cocodamol was firmly off the menu, not to mention Tramadol, which another GP had prescribed over the phone, which Mrs EP observed made me mildly delirious. Luckily Mrs EP hid the tramodol, so I never encountered the biggest snake pit in the pain game, rapid addiction to opiates. So I was left with Ibuprofen and Paracetamol, neither of which made any difference to the pain. By this time I was beginning to realise that Pain doesn’t play by any rules and should be given a capital P.

 

The clinic at the end of the world

The Pain clinic was located at the end of a long cul de sac  along the river, in a former pumping station. Therapeutic nihilism had set in at the pain clinic. There was no sign saying ‘abandon hope all ye who enter’ but that was the vibe.

The Pain clinic does not believe there is much relationship between tissue damage and the experience of pain. They suggested I check out the work of Lorimer Moseley on Youtube, which I did. 

So Pain is mostly an illusion. A distorted and amplified rendering of a routine background noise. A warning of some kind, possibly false news, like the antilock brake light on your Ford Focus. 

Knowing  that Pain is mysterious doesn’t give you much direction. Thinking of Pain as a false warning signal suggests two opposite approaches, which are referred to as ‘recalibration’ or – in technical language – ‘building shit up’ and ‘calming shit down’. The former leads to challenging physical activity and the latter leads to lying down and meditating. It’s vague how you actually go about building and calming shit, but the whole thing is DIY by this time.

Mrs EP, who is the only person who comes out of this well, as a heroine in fact, taught me Pilates as well as Yoga. We went for long runs barefoot on the beach. We did meditation and relaxation exercises. We made rich fruit cake and pizza dough.

I kept a Pain diary for months. I gave the different pains silly names to try and diminish them. The ache to the right of C7 I called Boris. The Pain higher up on both sides I called Colin Blenkinsop. The worst Pain, a crushing sensation that sends you looking for the Tramadol capsules that Mrs EP has hidden, I called Agent X47. If that’s not CBT I don’t know what is!

I apologise if there’s a real person out there called Colin Blenkinsop. Or indeed, Agent X47.

 

The magic bullet fantasy

If I was into CBT, which I’m not, I’d mention an automatic thought that goes as follows: 

‘It’ll probably turn out that there’s a simple problem – mechanical or chemical –  that’s been overlooked.’

I was nearly convinced that the experience of Pain is brain based rather than due to tissue or nerve damage. And I began to feel very sorry for people with problems like fibromyalgia and somatoform Pain disorders.  I began to understand how angry chronic fatigue patients got after being consigned to light exercise and extra-light CBT.

In January this year though, the negative ‘magic bullet’ thought cut in again.  I started to believe the facet joints might be causing the problem. I looked at lots of youtube videos of facet joint injection and radiofrequency denervation. After going through another ‘something must be done’ day I made an appointment at a different Pain clinic. 

Luckily the clinic did not recommend facet joint injections or anything else involving needles or machines that go beep. The worlds of Pain perception and tissue damage are parallel universes. They never really meet, not even through portals in spacetime. 

Pain experience is made of Lego and the body is made of Meccano, the specialist told me. Perhaps not a brilliant metaphor, but one I distinctly remember.

He did however refer me to a colleague to work on my posture, core and neck muscles. No guarantee it would help, but I’d have better posture and muscle strength and my shirts would fit better.  His colleague gave me some very specific exercises. She was positive and reassuring, a welcome change from the doom merchants. Things picked up from there. Co-therapist Mrs EP took over the regime as the lockdown hit and added deep relaxation. We built it up and we calmed it down, without even using the word shit.

 

Pain is an illusion, just like almost everything else.

The world is not what it seems. A lot of the news we receive is distorted or made up. A lot of pain we perceive is distorted or made up. The brain employs a cranky, alarmist and unreliable editor, just like the Mail on Sunday. 

Painkillers don’t really kill Pain. The NHS is not the NHS, it’s been outsourced, sliced and diced and provided by people you cannot ever meet or contact. Symbolically, Pain services are located in the dark places on the edge of town. But – don’t tell anybody – you can also find them in posh looking sports medicine clinics.

 MSK sounds like a terrorist group, and in many ways they do strike terror. Millions of people get addicted to opiates and millions more fall victim to bogus therapies and illicit drugs. Pain patients soon become outsiders to science and society.

Because pain is so common, and evidence based treatments are so few, Pain patients are filtered through a series of rationing devices, including waiting lists. These are really just holding areas for legions of desperate people. Sadly, the delay in assessment allows Pain experience and behaviour to set in, like Japanese Knotweed. 

Earlier this month, NICE issued some controversial draft guidelines for managing chronic primary Pain. 

On Planet Nice, problems are solved with kindness and clear communication. Possibly a little acupuncture, group exercise and a dollop of homespun wisdom aka CBT. None of those nasty tablets. On Planet Nice GPs are like Doctor Finlay or Doc Martin. You don’t have to wait a month before seeing them, you can see the same doctor more than once ever and they may have read your notes. If you see a specialist he won’t be an agency locum. No-one will give you a poor, skewed photocopy of some youtube weblinks and call that bibliotherapy. 

Sadly Planet Nice is an illusion too.

 

96. Watching their Rome burn.

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Sorry, I’ve not written anything for a while. The daily news has become so outlandish that the art of wry observation has been killed off. It’s like a weather report has been interrupted by an extinction event meteor strike.

People keep asking me to explain why the UK is shooting itself in the foot and I suppose the easy answer is that Britain hates itself deep down. Britain is one of the first industrial countries and is the first one to become sick of industrial endeavour. The jadedness is pervasive. No-one’s really facing it. Employment is historically at a high level, but most of what people do at work they freely accept is pointless.

If Britain turned up in outpatients we’d send it to the crisis café, where it would do breathing exercises and group drumming therapy. Britain is paranoid, but not in a psychotic way. Britain is using the primitive defence mechanism of projection to blame its problems on others, much as Gotham City eventually turned against Batman. Britain will not be given drugs and universal benefit; it will not be allocated to a care coordinator. Britain will be given a self help leaflet and ‘signposted’ to the Tuesday allotment project. Sadly there is no therapist designed to treat whole countries. Although we have Prince Harry ‘starting conversations’ and the government’s behavioural insights unit.

But will that be enough to rescue us from our angry self loathing? Or do we need a proper superhero? Or even a more universally hated enemy, now that ISIS is receding and Northern Rail have settled their strike?

Beneath paranoia lies a longing for there to be someone out there who is interested in us– preferably in a good way, like a guardian angel, or Nick Knowles from DIY SOS. If they care in a negative way, such as a stalker or the taxman, that is still better than the complete indifference of a dark, empty universe. If Brexit is a cry for help, rather than a death throe, it relies on someone taking notice.

We cannot rely on International Rescue since David Milliband took over. I seriously doubt whether David has got the time to monitor every radio network in the whole world 24/7 like the Tracey brothers used to do. The closest we can come to Thunderbirds is the Air Ambulance, which is why we love it so much and keep putting coins in the collecting tin.

Maybe the giant corporations will look after us. I know that Google Rewards checks up on me regularly, knowing which shops I have been into or near. Unlike my guardian angel or Nick Knowles, Google Rewards reveals itself to me regularly with short survey messages. At the moment it wants to know whether I have spent any money in the shops and in particular what means of payment I used. Quite often it asks me how I feel about Argos. I don’t think Google would come to my rescue in an emergency, but importantly it does pay a small fee for each bit of information I send in. It might only be 6p each time, but it means at last I can say I am a paid writer.

Up there somewhere, my imagination tells me, there’s a person at a monitoring station looking at a screen, looking at what I am doing, ready to beam me up out of any trouble spot – this is what I call the rescue fantasy.

If I break down in my car I will call the AA. If I’m in a road accident the ambucopter will arrive, circle overhead for a while and land in nearby school playing fields. If my tooth breaks off the dentist will fit me in the same day and fix it during the Ken Bruce Show on Radio 2, both of us muttering answers to the popmaster quiz.

The local GP surgery reached out to me recently, inviting me for my 5 yearly check up. It’s called Health Check with the Nurse, though it is a health check with a health care assistant nowadays. In some more prosperous parts of the world it’s maybe a Health Check with a Regional Dean of Internal Medicine, or an underemployed WHO ambassador like Robert Mugabe. Next time here I suspect it will be health check with youtube and a mirror.

Anyway, the point is there is someone out there who cares about you, even if they have ulterior motives, like targeted advertising or stopping you getting diabetes.

And we’ve looked upon our parliament and political leaders to take an overview and guard us from our own foolishness. In return for their efforts we scream ‘nanny state’. But now we find our elected leaders fighting among themselves. Our ambucopter has landed, only to reveal the pilot and paramedic beating each other unconscious in a fist fight.

Some good things are happening, like the minimum alcohol pricing in Scotland, limits on fixed-odds betting terminals and quiet carriages on LNER. The police are asking us to report motorcyclists without helmets, accepting they will be anywhere within a ninety mile radius by the time details have been taken on the non-urgent line.

If The Rescue Fantasy was a movie here’s how it could all still work out:

Prince Philip has a dream of a devastated Britain that looks ever more like the set of a Mad Max movie. No More Heroes by The Stranglers plays loudly in the background.

He sends for Harry and symbolically hands over the key to the Royal Land Rover and Harry’s old army pistol. ‘You’ve got exactly 40 days to save this country from its own danged-bone-headed foolishness. You’ve been talking a lot about starting conversations, Harry. (eyes narrow) Now I’m telling you to finish the conversation.’

Training montage of Harry ploughing through piles of books: Freud, Durkheim, Nelson Mandela; exchanging ideas with world leaders; mindfulness exercises with the Beckhams; in the lab with Brian Cox; and finally, on the firing range with Prince Philip.

Cut to Parliament. Just like in Crimson Tide, at gunpoint, Harry relieves the prime minister of command, ‘You’re unfit for duty madam. And that’s the end of the conversation’.

Epilogue scene, the truth and reconciliation committee, chaired by Ant and Dec, symbolically reunited, takes evidence from the perpetrators. Harry, in the background allows himself a half smile.

Brief shot of angry Putin, smashing his vinyl copy of No More Heroes.

The End.

Post credits shot of the new Nissan X Trail, made in Sunderland after all.

95. Acuphase wins by one vote.

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All this talk about plastic in the environment has made me think about our second favourite acetate (after vinegar). Acuphase, more properly known as Zuclopenthixol Acetate, has been widely used in acute mental health settings. For those unfamiliar with it, it is given in the form of an injection and its effect is that of an antipsychotic drug lasting between 2 to 5 days. Typically, the recipient becomes calmer and may sleep for a long period. The duration of its effect is particularly useful when treating acutely disturbed psychotic patients.

The alternatives, if the patient will not accept tablets, are repeated injections of shorter acting medications such as lorazepam or haloperidol, which need to be given at least twice a day.

Acuphase was widely used in the nineties but gradually fell out of favour.

Firstly, it is a ‘typical’ or ‘first generation’ antipsychotic. These drugs, for better and worse, were overtaken by second generation drugs such as Olanzapine and Aripiprazole. Olanzapine comes in the form of a ‘velotab’ which melts very quickly in the mouth. Aripiprazole does come in the form of an injection which theoretically lasts a few days, as well as a depot version which lasts a month. However, there are problems with both of these in terms of perceived effectiveness, or ‘street cred’. A substantial number of clinicians don’t believe that Aripiprazole is effective for rapid tranquillisation and the large majority still use lorazepam and haloperidol injections for this purpose.

Secondly, word got round that Acuphase could be a bit dangerous, causing cardiac arrhythmia or even sudden death.

And on a sub-cultural level, the use of Acuphase became associated with certain types of authoritarian ethos units, where the day staff look like nightclub bouncers and the night staff don’t like to have their poker game interrupted.

Last week I met a consultant who had wanted to use Acuphase, only to find that it was not on his hospital formulary and could only be used if approved by a Committee. On this occasion the vote in favour of Acuphase had gone through 4 to 3 in favour, continuing the Brexit – Trump trend of surprises. It’s hard to know which way the pendulum is swinging, especially with some of the older antipsychotics, which may be coming back into fashion.

You may be surprised that an NHS Consultant Psychiatrist doesn’t have the clinical freedom to prescribe a drug that has been widely used for over 30 years, but that’s another story. Some consultants don’t even drive Porsches nowadays.

This particular consultant did not work in Sussex. But if you google the word ‘acuphase’, one of the top results comes up as the Sussex NHS Trust Guidelines.

(If you google Sussex Trust what mainly comes up is headlines like:NHS trust criticised for underestimating risk of patients who killed 10 people’, but that’s another story.)

According to the Sussex Guidelines:

‘Acuphase has often been too widely and possibly inappropriately used, sometimes without full regard being given to the fact that it is a potentially hazardous and toxic preparation with very little published information to support its use.

There are many treatments in use where the evidence is not that strong.

Why pick on Acuphase then? After all, Zuclopenthixol is widely used in the form of Decanoate, where it is called Clopixol Depot Injection, and also in tablet form. Cannot one extrapolate to some extent that the acetate version will act in a similar way to the tablets or depot form? That is exactly what generations of clinicians have done, the distilled wisdom being that Acuphase works well in real life situations.

OK I accept that the distilled wisdom of clinicians can be entirely wrong, yes bleeding and cautery were in vogue for 2000 years, but in general…

The ‘finding no evidence’ game, ostensibly scientific, is highly politicised and has been used to exaggerate or diminish the fortunes of many treatments, from ECT and Lithium to psychotherapy and social treatments like day centres and walking pet dogs through care homes. Remember when our commissioners stopped the Badminton group?

The more you narrow down the focus of your question, the less likely you will find research evidence that exactly addresses the point. And if you refuse to generalise from research to your own situation, you will conclude there is ‘very little evidence to support’ treatment X or Y.

Sticking with Trusts that begin with the letter S, here’s a bit more Guideline, this time from South Staffordshire and Shropshire Trust.

These start a bit more positively than Sussex:

The (2012) Cochrane Review did not find any suggestion that zuclopenthixol acetate is more or less effective in controlling aggressive acute psychosis or in preventing adverse effects than intramuscular haloperidol and did not have a rapid onset of action. The use of zuclopenthixol acetate may result in less numerous coercive injections and low doses of the drug may be as effective as higher doses’.

But the same guidelines quickly go on to say:

Zuclopenthixol Acetate should only be considered appropriate after repeated injections of short acting antipsychotics e.g. haloperidol, olanzapine, aripiprazole.

Would you rather have one injection or several? You might get to choose though. Patient choice trumps even the drugs and therapeutics committee. If you want to have Acuphase if you get very ill, as I would, bearing in mind the alternatives, you can make an advance directive to this effect. Sussex again:

‘If used to good effect and the patient feels that they may benefit from its use in thefuture, then consideration should be given to the preparation of an advance directive’.

Sussex has the only Green Party MP in Britain. But I have checked on this and there is no evidence at all that the acetate from acuphase is affecting marine wildlife.

94. The road to Hull is paved with good intentions.

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It’s surprising how people you’d think would know better let their electronic stuff get covered in grime.

Although no-one got a Nobel Prize for inventing the microfibre cleaning cloth, one of these, plus a bit of solvent, is the answer.

Luckily Isopropyl alcohol can still be obtained legally in the UK. It’s an excellent way of cleaning computers, smartphones, spectacles etc

Or so I thought, until today, when I handed a pair of broken spectacles to the assistant manager of Specsavers. I mentioned they just fell apart while I was cleaning them. He asked me what I was cleaning them with and I replied, a little proudly, ‘isopropyl alchohol’.
‘That’s what killed them’, he fired back. ‘I’m afraid it’s smack on wrist time’. Specsavers haven’t been to the breaking bad news gently workshop.

Isopropyl alcohol should not be used on certain types of plastic, it turns out. When doctors make mistakes they are called ‘blunders’ in the press. But I’d prefer to call this one just an ‘adverse effect’. No-one is saying those spectacles weren’t clean.

There are probably other friends and relatives remembering that I cleaned their macbooks, wristwatches, phones etc and, come to think of it, they were never quite right ever again.

Isopropyl alcohol might just turn out to be everyone’s perfect scapegoat. ‘The first side of Scary Monsters never sounded quite right after you cleaned it’, people will shout at me. In the years to come the Brexit vote will probably be blamed on accidental exposure to cleaning fluid, rather than the usual ‘death wish’ theory.

To be honest, I cannot really explain my choice of solvent, except that it used to come in a tiny phial, with a cotton bud, for cleaning the heads on cassette tape machines. It seemed somehow so precious. But it was probably why cassettes never sounded very good, not even the ones called ‘metal’.

Like many interventions, from insulin coma therapy to prostate surgery, alcohol cleansing might do more harm than good. I thought that cleaning was improving the world just a little, sublimated baptism perhaps. Instead it was simply vandalism.

Such contributions are part of what I like to call the ‘behaving admirably agenda’, which I see as The Way Forward.

To be honest, I got the idea of behaving admirably from my cousin who lives in Australia. He is fantastically handy at fixing things, so that when he stays with someone, he likes to fix something as a kind of thank you note. For us, he sorted out the little wheels that guide the glass door on the shower. My cousin had taken the best aspects of the Random Acts of Kindness movement, and refined it into ‘specific and targeted acts of kindness’.

Combined with a few other thoughts I was having at the time I came to the conclusion that actions speak louder than words. Partly because Word Inflation has reached record levels. More words are being created and written down than ever before. So that the value of each written word is virtually zero. Take this blog for instance…

There are so many words about that people have taken to rendering them into cloud diagrams, so that words most frequently used get written larger and more often. Our leader, for instance, would just have the words Strong and Stable written over and over again in a very strong and stable font like Roboto Mono.

Our leader can’t even talk a good game. Which brings me to my point, which is that behaving admirably is far more difficult than initially meets the eye.

My idea of behaving admirably, while probably the same as yours, may not be the same as the lady up the road who keeps 14 cats in her bedroom, or the guy in the deerstalker hat who drives his disability scooter at 10mph round Tesco.  

That is perhaps why we have little aphorisms like, ‘the road to hell is paved with good intentions’. And phrases like ‘unintended consequences’. (A lot of aphorisms about this year – maybe the warm winter?)

While it is undoubtedly virtuous to pick up empty beer cans from the street corner and put them in the recycling, and indisputably evil to hang little bags of dog poo from tree branches, in between there are huge grey areas of ethical ambiguity. Many behaviours that are taken to be virtuous at face value, such as mindfulness exercises or prayer, could be seen as horribly self indulgent or even narcissistic, compared say with crown-green bowling or topiary.

One good intention that comes to mind is the current campaign to champion the cause of ‘mental health’. Lots of people have been piling onto the mental health bus recently, from the Royals and Prime Minister downwards, toward the self-congratulatory metropolitans who lead our Royal College.  

If we constructed a ‘word cloud’ from the mental health media coverage this year, what would it look like? The phrases ‘examination stress’ and ‘school mindfulness first aid’ would be in 96 font, whereas the words ‘schizophrenia’ and ‘psychosis’ would be written in size 8 Ubuntu Condensed. And you would need an electron microscope to reveal words like ‘Section’ or ‘ECT’.

Whilst accepting that the mental health discourse is a lot broader than that perceived through the half-moon spectacles of traditional psychiatry (smashed, as they are, by alcohol misuse) it looks as though the notion of severe illness has been drowned out of the conversation. Who would think that mental illness tends to affect older people, that it doesn’t always respond to talking a lot and sometimes disables people for years or decades?  

You could get the impression the government was piling money into mental health services, instead of shutting down all the day facilities, closing wards and sacking community support workers.

The mental health movement is well intentioned but it is all based on words. In particular the notion that the more a person speaks, the more his problems will be solved. Instead of talking, people should try behaving differently, or even admirably. Instead of shouting at your IAPT low intensity worker, why not clean the rubber bits around the washing machine door and the top of the fridge? I have just the solution for you.

Words are just clouding the picture, like the view you get through contact lenses cleaned with alcohol and cotton buds.

Sorry about that.

93. Schnauzers – they don’t need trousers.

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A family member is saving up for a Schnauzer. It turns out this is not a machine-pistol after all, but a tiny mustachioed dog. And that’s caused me to re-open the question: do dogs stack up? Not literally, but rather, are they a viable addition to the domestic panopoly, or would you be better off with a Macbook Pro, which has a similar price and processing power?

If you haven’t ticked either the box ‘visual impairment’ or ‘sheep farmer’ at first glance a dog looks like an encumbrance. It’s expensive to run, it doesn’t pay rent or tax and you can’t ride it. If it gets ill, there is only one treatment guideline, which rhymes with Millett.

The Schnauzer is supposed to be an expert in rat control, but the rat sector is well covered nowadays by enthusiastic amateur ratters like cats and owls, not to mention the contributions of big pharma, such as re-purposed warfarin.

Still, in the post-ratting era,  there’s an urban myth going round that pets are good for your mental health. Some of the advantages are probably non-specific, like gentle exercise and superficial social interaction with other owners. But I can see one big positive, which is that dog ownership, if supervised properly, is a practical revision course in behavioural psychology.

Readers of EP will already know that Behaviourism provides far more of the answer to life’s problems than people realise, diverted as they are by the false Gods Thinking and Feeling. The beauty of animal ownership is that behavioural methods are mainstream and largely unchallenged.

There is no visiting-occupational-therapy-student-from-Kidderminster to suggest trying hot yoga, no semi-retired-social-worker-who-does-homeopathy-on-the-side to suggest homeopathy on the side. Just people with big coats full of food treats.

Recently I found myself defending a dog that stands accused of being Nasty. It was alleged that the dog’s father had also been nasty. And there’s an implication, not unlike racism, that certain breeds are genetically loaded towards hooliganism.

You’ll understand that I have never owned a dog or spent much time with dogs or even studied dogs academically.

Against this, I know a man who spent decades training dogs for the RAF police, a man who travels around the world as something of a training guru. And he tells me that dogs are largely a blank canvas onto which the trainer writes a behavioural program.

So that deficiencies in animal behaviour are largely a reflection of poor quality ownership behaviour, such as giving mixed messages. The main enemy is contaminating  owner behaviour with Sentimentality. They don’t want to kiss you and they probably regard wearing a coat as a punishment, especially if it’s Tartan. Sentimentality is your problem, don’t make it the dog’s.

Which brings me to Jasmine Tree, which is near the scary butcher shop and the scary barber shop, next to the funeral directors. Jasmine Tree is a new gift shop which has opened like a poppy on a battlefield.

One person who won’t be shopping there is CG Jung, mainly because he died in 1961. Jung described sentimentality as ‘a superstructure that covers up brutality’. To be fair, he was talking about popular sentiment getting pumped up during war time. He’d have loved ‘ET’ as much as anyone else, if he’d lived to see it.

In fact he might just have seen ‘One Hundred and One Dalmatians’ if he’d ventured down to the Küsnacht Odeon in his final year.

Another psychiatrist who won’t be visiting our gift shop is Theodore Dalrymple, who wrote a book about modern life called ‘Spoilt Rotten: The Toxic Cult of Sentimentality’.

Both CGJ and TD, commenting on society, believed that Sentimentality went hand in hand with decadence and brutality.

But how does this relationship work? Is sentimentality a diversionary tactic, does it actually cause decadence, or is it an antidote to the harsher realities of existence? Do we need less sentimentality or more?

Sentimentality is by definition disproportionate. Implicit in the definition of sentimentality is that the emotional tone is overloud and wrongly focused, like the sound from a ghetto blaster. Sentimentality distorts logical thinking. It’s the force that keeps the card and flower shops flourishing, not to mention your uneconomic local hospital and those little trains with no passengers that go to Cleethorpes.

Humans attach emotions to objects but I suspect dogs only attach emotions to food items. So why do they go after an old stick or rubber ball? Because they are suckers for social approval, or have they just associated social approval with getting fed? Dogs are just one jump ahead of us in chaining together rewards.

When humans invest an object with an emotion it takes on a sentimental value. When the sentimental value brings a sense of comfort, the item is called a comfort object. We can easily delude ourselves that animals like comfort objects, but we might just as well dress them up in clothes and pretend they talk.

Originally considered as fetishes, comfort objects were officially deemed ‘OK’ by Bowlby and his colleagues, who came to regard them as a healthy and normal way of dealing with separation. After this liberation the trinket industry ran riot.

According to the object-relations school, we start to need comfort objects at the age of 4 months. It starts with an old J cloth and ends up – via a one-eyed teddy bear, and a plastic luger pistol – with a iphone 7 plus.

According to Today’s Parent,  it’s always wise to introduce toddlers to a rotating repertoire of comfort objects right from the start, like in ‘The 12 days of Christmas’. Since the legalisation and slow destigmatisation of security blankets, championed by Linus van Pelt, society has created more and more comforting items and showered them everywhere.

For every stress in life there is a comfort to cancel it out. There’s a card for every occasion, even high number birthdays, like 97.

The concept of a comfort object started out as fairly useless item such as a piece of cloth given to a baby by its mother. The power of the object can be increased by making the item attractive to touch and hold as well as by belonging to someone significant.

 

If we make a list of sentimental objects – pets, flowers, cards, fountain pens, vinyl records – we soon find that sentimental purchasing accounts for  90% of GDP.

Pretty much everything in fact, except barbed wire, rat poison and drain cleaner.

My hypothesis, which can’t be tested very easily, is that comfort objects have been created in greater numbers and greater potency as a kind of quantitative easing approach.

This has been needed because of the increasing number of discomforting objects that insult our sense of wellbeing, like news bulletins, call centres, crowded places and harsh materials like concrete and polyester.

My contention is that people have only been able to put up with the ridiculousness of modern life because of the compensatory tidal wave of comfort objects and food.

Unfortunately, we are increasingly exposed to harshness, in the media and in daily life, and there are signs that traditional comfort objects like the iphone 7, even the jet black version, may soon fail to calm us.

Tried and tested products are beginning to let us down. There aren’t enough small electronic devices left on our shopping lists that we covet so much that we’d exchange our spleen for one.

People used to lust after a Sony Walkman or an ipod. People queued all night outside the Apple shops. But that magic has died down and there is nothing new coming through. Big stores weren’t that keen on spleens anyway and rumour has it, just stacked them in recycling bins.

If there is hope, then it probably lies in the direction of Turkish Barbering and possibly now the new craze of Hygge.

In terms of physical objects, there are many suggestions on the web, like this one:

A hammerless short-barrel revolver, which you clean and oil daily, give a woman’s name to, and keep always loaded, under your pillow while you’re sleeping.

 

Or this list:

 

  • egg of Silly Putty
  • stress ball
  • unusual object or keychain attached to keyring
  • glass or stone marble
  • smooth pebble or “worry stone”
  • a couple of ordinary dice
  • a small metal or wooden figure or animal
  • tactile keypad pulled out from a broken calculator
  • your own thumbnails
  • hooded sweatshirt
  • pair of socks, gloves, or mittens
  • sunglasses
  • Koosh ball
  • miniature Slinky
  • small metal spring (round the ends off)
  • a good ink pen
  • pack of chewing gum
  • anklet, neck chain, watch, or bracelet
  • rosary or worry beads
  • piece of telephone cord
  • Monopoly game piece
  • metal bottle cap
  • shampoo bottle top
  • rubber bouncy ball or other small object from children’s vending machine
  • packet of small round candies
  • Livestrong or other similar “cause” bracelet
  • strip of cloth
  • empty cigarette lighter
  • Swiss Army-style pocketknife or pocket toolset
  • lump of sea glass
  • smooth-worn seashell
  • ankle jogging weight
  • toy figurine
  • one preferred paper clip
  • small eraser
  • guitar pick
  • mini-flashlight or LED keychain

Jasmine Tree doesn’t sell the revolver, but most of the rest is available. The Schnauzer won’t be interested in any of it though. In fact he’d prefer an amnesty on gifts, so he can get back to his ratting work.

92. Doing without experts, or even people who wear spectacles.

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The CEO presents his new organisational structure, shown here as a Venn diagram.

 

A cat is out of its bag. Not Kevin, the actual cat – he can’t get through Kevlar sacking – but metaphorically speaking.

There’s a book out called ‘Where there is no psychiatrist’. Though the phrase ‘developing world’ occurs somewhere in the description, and the front cover depicts a place where people carry water in stone jars on their heads, so probably not Mexborough, in actual fact this manual is meant for Britain itself. There is no psychiatrist in your town or mine. That fellow with the beard is just a hipster. That guy with the carefully-crafted-designer-vagrancy look you admired so much is just a vagrant. Though some people are pretending otherwise, for better or for worse, mental health is going DIY.

There are exactly ten reasons for this:

  • Very few new doctors are choosing psychiatry as a speciality
  • A lot of psychiatrists are retiring to open artisan cheese shops
  • Psychiatrists who don’t use a medical model are more expensive than social workers
  • Psychiatrists who use a medical model aren’t cool enough at parties
  • Psychiatrists have to wear a T shirt that says ‘in case of disaster I am to blame’
  • People have noticed that the NICE guidelines for mental illnesses are the same ones for every single disorder
  • Illegal drug dealers have got more and better new drugs than we have in the NHS
  • Maplin have got more and better electrical treatments than we have in the NHS
  • The GMC now require you to cut down the mightiest tree in the forest, with a herring, in order to get revalidated
  • Conspiracy theorists have stolen all our best delusions

Now that we have youtube to show us how to do every task, the main constraints on DIY are statutory regulations rather than not knowing how to do things. But where there are severe penalties for unauthorised gas fitting, there is no penalty at all for pretending to be a mindfulness therapist, or for lighting candles in people’s ears.

Surely, before we start selling prozac and zyprexa in Poundland, before we legalise ketamine, before we hang special magnets from our earlobes, there should be youtube videos on how to interpret evidence and follow logic? No mate – this is England. No-one likes an expert round here.