Monthly Archives: June 2013

21. Judging. Not.

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This panel comes with price tags.

I feel a bead of sweat run icy cold down my forehead, even though it is baking hot in the room. The inquiry is not going well.

My inquisitor puts down his stack of documents and looks at me accusingly.

‘So you were eating a chocolate bar in your car?’

‘That’s correct.’

‘While driving it along the A46 at 60mph?’

‘That’s correct.’

‘Could you tell the panel please, what kind of chocolate product was it?’

I hesitate for a moment. There’s no point – they probably have forensic evidence.

‘A Cadbury’s flake, I believe.’

There is a long pause. The chairman is polishing his spectacles. The scribe is making notes on a yellow pad. Its time for the killer blow.

‘What slogan is generally used to describe the Flake bar ?’

I shake my head. I tell them that slogans are outside my field of expertise.

‘Just answer as a layperson then,’ I am directed, but I decline to speculate.

The inquisitor asks whether I have heard the slogan: ‘the crumbliest, flakiest chocolate in the world’?

I nod.

‘I’m sorry, I didn’t hear you. Did you say you were familiar with the slogan, the crumbliest, flakiest chocolate in the world?’

I ask the chairman whether that might be a leading question but I am directed to answer. I agree that I have heard the slogan, and I agree that the slogan is probably accurate. I am careful to mention that I have not studied any systematic evidence that has reviewed chocolate products on a global basis and stress tested them with crumble and flake gauges.

The inquisitor is on a roll. I’ve seen enough Perry Mason to know that this is the point where I could easily burst into tears and confess.

I drink some of the tepid water from the glass in front of me. I try and shrug in a French way, supinating both hands and making a pffffff noise with my lips. The panel don’t like it.

‘Yet you drove one handed along the A46, eating a flake. And as a result, now, we have a very difficult…’ he pauses for effect, ‘a very ugly…,’ again he pauses to pull out a ball pen and tick a box on the document in front of him, ‘an almost indelible mark. A stain, if you will. On your front seat.’

We have already heard from expert witnesses that ivory cloth isn’t the most durable seat material. We’ve heard how, recklessly, I turned down the Scotchgard treatment when I bought the car. Clearly, I was an accident just waiting to happen.

My mind started to wander for a moment, as I awaited the verdict.

Just how long had car service departments been holding panels of inquiry?

I wondered whether this was just BMW*, or whether all the dealers had taken this high handed approach to customer behaviour.

The answer of course is that there is an inquiry panel going on pretty much everywhere  nowadays, as some kind of convulsion of guilt and recrimination shudders through our society.

During the recess, I walk to the newsagent to look at the cards in the window. I could do with a little inquiry work myself, something small, that would only take a few hours and not cost the taxpayer millions. Preferably I won’t have to wear a wig and gown.

I wonder if there are any small domestic inquiries going on, like the spills and stains tribunal at the car service department.

I prefer spills work to be honest. I am pretty familiar with the Spills Police and their activities, having followed the cases against Macdonalds between 1982 and 1992.

I’d probably attribute my fear of spills to a genuine scald at Macdonalds, although much earlier in life I remember being told off furiously by Sister Clare for leaving ink blots on the school savings bank ledger. Rorschach tests and banking just don’t mix.

The Spills Police will be very happy today, as it is reported in The Times that someone has invented a ‘Floating Mug’ that is also a coaster, and therefore will not leave a ring stain, even if it drips.

One of the inventors, Tigere Chiriga, apparently was ‘terrible at putting coasters under mugs and so kept leaving stains on furniture’.

I notice there is no lid however. Not even the little fold-over ‘that’s torn it’ spout device. Hmm…. Not sure about the Nobel Prize without a lid.

Many of the Spills Panels recommendations over the years have yet to be implemented. For instance, there are still a large number of small ‘comedy teapots’ in circulation at motorway service areas and  tea-rooms, the ones that seem to defy both gravity and surface tension effects, in order to pour tea over your fingers.

Everyone is on some kind of panel or another at the moment, as society heaps blame on itself. Ever since the McCarthy period, inquiries seem to be an excuse for a bunch or people getting together for a bit of bullying.

Along the street, I find there is an inquiry at No.38, regarding poor use of spelling and grammar. Apparently someone has been spelling ‘liaison’ wrongly for many years, and has been saying ‘infer’ instead of ‘imply’. Somehow the Mixed Metaphor Commission got involved.

Over at the arts centre the drama group are looking into suspected over-acting at their Gilbert and Sullivan festivals, and some abstract expressionists are answering questions about the massive carbon footprint they left behind.

A whistleblower at the council has revealed that billions of wasps were slaughtered in the decades before it was realised that wasps were our friends. At the library, a panel struggles to unravel how Grapes of Wrath got filed in the gardening section.

I wonder if any inquiries take place out of doors now its the summer? Badgers seem to be facing awkward questions and / or awkward firing squads at the moment. I’m sure Brian May needs help defending them.

Inquiries are so stodgy and they drag on for years. As an antidote, I’m thinking of starting a ‘street inquiry’ movement – I will call it ‘Knee-jerk Reaction’ – where fast moving, dynamic and punitive panels work with mime and street artists to create impromptu, judgemental scenarios, probably on skateboards and posting their findings with graffiti.

If you suffer from Depression you probably have an inquiry panel in your mind a lot of the time. One of the worst things you can do if you are depressed is dig out an item from your own past and go over it again and again.

Its unlikely that your memory of the event is accurate and it’s unhelpful to ‘ruminate’ the same material over and over. Any judgement you make is likely to be over-punitive and self deprecatory.

Like Sister Clare, your panel is likely to maximise your misdemeanours and minimise your achievements, as well as knock you on the head with a special ring used as a knuckle duster.

If there’s a stain on my car seat, lets try the little steam cleaning machine I got at British Heart Foundation before we bring an inquiry upon ourselves.

Oh dear! The steam machine has spouted out some rusty water. But we have Vanish. And Stain Devil for chocolate, and now one also for rust.

But something is wrong with the Stain Devil. Instead of colourless solvent, the can releases material of the deepest scarlet. Quickly, the scarlet stain becomes a hideous creature, with a forked tongue and dragon’s tail….

‘My name is on the can,’ it screeches.

That’s when I awake from the inquiry panel nightmare. Coming to my senses, I realise I am not on trial at BMW any more.

But from now on, ‘issues around chocolate’  are going to be included on the risk assessment form I complete each time I use the car .

Best practice guidelines seems to suggest Twirl is 90% as good as Flake with only 10% of the scatter. And 7 Up is a thousand times less staining than Coke, yet equally wholesome.

Some people have even learned to drive short distances without eating anything.

Do not Judge, says the mission statement, this from the organisation that gave us the Spanish Inquisition.

More accurately perhaps, the message is not to apply standards to others that you could not live up to yourself.

Even more accurately than that, the message is to stop lawyers – and talent show judges, for that matter – pocketing huge sums of public money.

We could have a Truth and Reconciliation Commission. Or we could just accept that we are humans, we make mistakes, and move on. Which, really, is the same thing.

Sister Clare, you are forgiven.

*No cars (or chocolates) were really hurt in the making of this article.

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20. Choosing Love, Zero, or the Egg.

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Trying to see the big picture.

Does it make any sense at all to go to the National Gallery, look at Turner’s The Fighting Temeraire for a few moments, and state, ‘I’ll give it a 7’?

This week we read that the NHS has produced a series of 8 commandments. Some of them are a bit basic, like patients having the right to food and drink. It also seems they have to be given ‘the right amount of  medication, when they need it’, which is an excellent idea, rather than using random number tables.

Whether the commandments will be on stone tablets or not depends on Health Secretary Jeremy Hunt. If he spends too long carving them, NHS staff might make a golden effigy of his predecessor, Andrew Lansley, and pray to that instead.

My first thoughts are that eight is an unusual number. Did they start with 10 and drop two of them? Which two didn’t make it? Consultants should wear top hats? The layer of butter on toast should be exactly one molecule in depth?

Nevertheless I see the makings of a scoring system with a maximum of 8.0, maybe more if there are sub-scales for each commandment.

Does it really help to measure everything? Today we were urged to catch ladybirds in a net and report them using a special app. At school, children dig up one square metre, to count the number of earthworms. On the main road, other children wait with clipboards, counting the number of cars that go by, so the distribution of car makers can be made into a bar chart.

I’m forced to conclude there is something in the human mind that likes to assign numbers to concepts. Perhaps its a desire to bring order to the universe.

People love scoring systems, often far more than the activity that is being scored. The ultimate ‘scorathon’ is the Eurovision Song Contest, where the scores are luxuriously accumulated over a half hour period, layer after layer of numbers added to a chart.

The shipping forecast gives scores for both wind speed and visibility, for exotic parts of the North Sea, which are given a name and a number, like ‘forties variable four’. Its incredibly atmospheric.

As far back as 1964 Eric Berne wrote ‘Games people play’, introducing his theory of Transactional Analysis. The book contained nothing about Monopoly or Risk, let alone Cribbage or  Texas Hold’em, which were games people played at the time, making it something of a swizz to my mind, but nevertheless it became a best seller.

Unfortunately Eric’s games were relatively light on scoring, mainly win or lose, comprising self defeating scenarios like, ‘why don’t you yes but’.

Psychologists had been using numerical scores since the early 1900s, when IQ tests were invented. Psychometric testing spread like plague in schools, more so than in clinical psychology or psychiatry. Most of the summer term in schools and universities is taken up with exams. You don’t grow onions by weighing them, as they say in Yorkshire.

Nevertheless, around the time Bob Dylan ‘went electric’ (psychologists and psychiatrists had gone electric in different ways many years prior to this), Max Hamilton introduced his Depression Rating Scale, the HDRS. In Yorkshire.

Everyone has their own scoring favourites. I like the ones where stern-looking judges from Eastern Europe hold up cards with numbers between 5 and 6. For some reason our exams at medical school used a similar system, where everyone scored between 50 and 60. All those numbers, above and below, just wasted.

The scoring system for football is reassuringly simple, being based merely on goals scored. There are no subscales for creativity or artistic interpretation, gentlemanly behaviour, nor even hairstyle. Tennis has an unusual non-linear scoring system: Love, 15, 30, 40, etc. ‘Love’ is probably the odd one out in this list, especially if translated from French to mean ‘the egg’. For some reason the French say ‘zero’ instead of ‘love’, and ‘egalite’ instead of ‘deuce’. Social historians, please discuss why.

One of the most comforting rituals of Saturday afternoon is the ‘full classified’ football scores, which is very similar to a long prayer, such as the Rosary, but without beads. How many families gather together to find out how Hamilton Academicals have done? (Is there also a non-academic Hamilton team, such as ‘the pragmatics’?) The trick is, you know who has won, before the second score is stated, from the intonation of the first score. Its the one job that could not be done by Robert Peston, or King George the Sixth, for that matter.

The academicals were not named after Max Hamilton, who was not even Scottish, although he was an academic – a medical statistician as well as a psychiatrist. Hamilton invented the HDRS for Depression in 1960. It is still the gold standard today, despite many alternatives. Its freely available, so you can use it on someone in your kitchen to see if they are depressed. If you want to use one on yourself you need a self report scale such as the Beck Depression Inventory.

They don’t work on pets by the way.

Its hard to believe that as recently as 1960 people already had electric guitars and long playing records, but didn’t use rating scales for everyday decision making. The notable exception to this was the Michelin star rating scale for restaurants, which had been around since 1936.

Rating scales for mental health problems were born out of the need to establish whether treatments were effective or not. Antidepressants for instance, started to come out in the sixties. To do this, some kind of yardstick was required that allowed people to compare treatment A with treatment B. The Hamilton scale was more ambitious than the Michelin guide, using 17 items instead of 0 to 3 stars. It was made in Leeds, instead of France, so it did not contain any items about truffles or vintage champagne. (It was before they had Harvey Nichols).

Now we have rating scales for all kinds of everyday activities, such as Trip Advisor, so we can know whether hotels cook sausages properly or choose tasteful enough wallpaper. This is presumably the way the NHS is going, with the commandments system.

Perhaps the major religions missed an opportunity for developing rating scales for the actual ten commandments. It seems likely it would not have been as simple as just a mark out of 10. It looks as though some of the commandments are more important than others, for instance not killing should be allocated more marks than not coveting your neighbour’s donkey.

Then there is the problem of setting the time frame for making judgements. Is it at the end of the person’s life, or at the end of time, or at a cross sectional point, such as age 34, when you are just old enough to know right from wrong? Or could it be a random point in time, like in musical chairs, when the music happens to stop?

There are other problems with a whole of life scorecard. One of these is whether a handicapping system is needed, as used in golf. People dealt a poor hand by nature or circumstance ought to get some kind of start over people who were born rich and brainy.

The system for football clubs seems a bit unkind. If the club goes into administration a further 15 points are deducted, something that co-incidentally also happened in Leeds. If that’s not kicking someone when they’re down, I don’t know what is.

I stayed at a hotel last week, where a rating of 8.2 was proudly displayed at reception. How would the rating be affected by price? I paid half the ‘proper’ price, so that should put the rating up somehow, but surely not to 16.4?

No-one states these scales are linear, and in fact the distributions they relate to are probably bell shaped or skewed in some way, like the people who invented them. Many of them are called Likert scales, which typically offer a five point scale, from strongly disagree to strongly agree, or from nought to stupid, as Spinal Tap would say. The more abstract and subjective the concept, the more people try and impose a number scale. Ten out of ten for irony.

The most interesting thing about Likert was his first name, Rensis, which is in the top 12 ‘most unusual real names’ according to the experts at Nancy’s baby names. Five point Likert scales are everywhere now, from Amazon to Army Generals.

Should we use a scorecard to measure our life? We’d have to set the goals and the scoring system as early as possible. Strokeplay, matchplay, Queensbury rules, tiebreakers and sudden death play offs all need factoring in. I’ve a feeling the goalposts might get moved at times, certainly widened.

The ten commandments seem like a starting point. The deadly sins and corresponding heavenly virtues could form the basis for a seven item linear analogue or Likert scale. But that might be overly religious for many people.

We may have to stick with our old friends, the annual appraisal and the personal development plan.

Or we could use the 360 degree appraisal, as in the NHS, where we give feedback questionnaires to family members and neighbours on a regular basis.

I’d give one to hotels and shops so they could get their own back on me. (I really regret asking why one hotel had attempted to cook the breakfast with a hairdryer. But sarcasm doesn’t seem to be a deadly sin, so I haven’t lost any points, technically.)

To my knowledge, no sports have brought in a feedback based scoring system, not even cricket.

As they say in golf, and at the National Gallery, and now in the NHS, there are no diagrams on the scorecard, only numbers

19. Queuing like you really mean it.

ImageYork’s new rapid transit system.

After the weather forecast comes the Pollen forecast. For some reason I expect to see it presented by a giant bee, in bee language.

Its pretty difficult to get a GP appointment nowadays, certainly for hay fever. I read in The Times that some GPs are averaging 66 consultations per day. If so, the situation is crying out for a production line system like they use in car factories, where patients move slowly along a conveyor belt in a giant shed.

In fact I see no reason why hospitals shouldn’t operate like this, making so called ‘care pathways’ something of a reality. There would be a faster track through the A and E department, in the same way as East Coast trains fly past First Capital Connect at Potters Bar.

If we have a track for Depression though, lets not make it a tunnel.

Recently I made a GP appointment – I couldn’t really say it was urgently needed, since, like most doctors in fact, I am a bit of a hypochondriac.

Also I made the big mistake of saying ‘its probably nothing’ to the receptionist.

I got an appointment more than 3 weeks later. Of course, like most self-limiting conditions, which is most conditions, it had already got better by the time I got to see the GP. I went in with a grovelling apology and came out in less than a minute. I felt I had blown a bit of credibility though, in case I get a genuine illness one day. Several Cry Wolf points thrown away.

Perhaps there should be a special ‘disloyalty card’ where persistently not attending earns you extra points. Every now and again these could be traded for a free consultation without prejudice.

This set me wondering whether anyone knows how to use the health care system properly. And if so, how can we learn how to do it?

After all, most illness behaviour is determined by social learning.  But no-one ever properly teaches us how to ‘do healthcare’.

We all have a huge stake in the NHS, but, amazingly, the NHS comes with no instruction manual.

Its the kind of thing Michael Gove definitely hasn’t put on the schools’ national curriculum, revealed today. But should he?

At the end of every human interest piece on the news, such as spontaneous combustion in sheep, the damage done by carrier bags or how yogurt can become dangerous under certain circumstances, the answer is always a call for ‘better education’.

This must be hugely irritating to teachers, whose curriculum is already big enough and struggling to cope with constant tinkering.

But along  these lines, instead of say, History, or Geography, why not some basic Medical Sociology?

We could learn about the pernicious effects of the private sector, the inverse care law that affects poor people, how health care systems struggle to constrain costs and how it took the French Revolution to smash the four humour system.

We could learn the difference between Disease, Illness and Sickness, and how the sick-man has disappeared from Medical Cosmology*. Perhaps he will turn up in the cafeteria or X Ray.

We could learn about the sick role and how to play it. We could have a field trip to the Broad Street Pump, where Snow discovered how cholera got transmitted.

Maybe answer the question, why isn’t holistic spelled ‘wholistic’?

We could look at screening programs and learn – very quickly – which ones are worthwhile. Borrowing a few sessions from Science we could look at Causation versus Association and show improving movies like Moneyball. (Subtitle: the art of winning an unfair game.)

If that’s not better than learning the details of World War One peace treaties, I don’t know what is.

We seem to have an insoluble problem in the UK. It is free to go the doctor or see a specialist. Although if we need to get medication it costs £7.85 per item, plus 90p to park. If it involves driving into Nottingham then there’s a £30 charge for getting in the tram lane by accident, and by accident I mean by being careless.

If we try and impose any charge, it looks as though we will discourage the very people who need to see the doctor most often, and the people who most need to drive over tramways. A number of famous studies suggest the most deprived people are those who have the highest rates of illness and shortest life spans.

But being free, the NHS system seems to attract a large number of people whom car dealers would call tyre – kickers.

Perhaps the fairest and most effective way to ration health care would be to create a giant lottery for appointments, or to make them transferable, so that slots could be traded on the open market.

In the GP waiting room, as I cowered in my corner, peering over a 1998 edition of Auto Express magazine, it looked as though the other aspiring patients needed a bit of weeding out, or triage, as it’s called in health care.

With images of Taksim Square in mind, I imagined a military type person coming out with a loud hailer every few minutes:

Anyone whose temperature is 37 or less, please leave.

Anyone with a bad cold or flu, out!.

Anyone with backache, headache, neckache, tennis elbow, golfers’ elbow, or any other kind of elbow – out!.

Anyone with a twinge.

Anyone with insomnia.

Anyone with indigestion.

Out, out, out!

Anyone here for a screening test not based on sound epidemiological evidence?

(Pauses for a moment) It’s 95% certain you should leave.

Now we are seeing a definite thinning in the crowd and a line of people heading for the Cooperative Pharmacy or the alternative practitioners ghetto. No need for the water cannon and rubber bullets after all.

The military style triage is unlikely to prove acceptable in the era of consumerism. Tesco don’t use it, even for the people who turn up at 9pm to get the reduced loaves and then ride around the car park in trolleys.

Instead we have had NHS Direct and 111 – who tend to ‘direct’ you to A and E.

The A and E department have their own filtering system, using time and, to a lesser extent, squalor. More recently they have taken a lead from Heathrow and created a stacking system for ambulances, which circle the hospital, waiting for a landing slot.

I made the mistake of trying to reach Leicester Royal Infirmary by car recently. Like the health care system in microcosm, there is no way in and no way out. I felt like an Apollo space capsule, orbiting the moon, but I had no lunar module to send down.

Those with self limiting conditions have probably got better by the time they are seen. Even those people who are seeking healthcare mainly to meet other people who are seeking healthcare and chat to them, have had enough social contact after 3 hours in a hot little waiting area with a very expensive Coke machine and a silent, armoured television showing volleyball from Belgrade.

Using time as a subtle disincentive is an example of the ‘British’ way of filtering access to healthcare, which is called ‘implicit’ or ‘covert’ rationing. For example, many people who are referred to primary care mental health or substance misuse services receive a letter asking the prospective patient to ring up and make an appointment. Sometimes this also involves filling in some forms and rating scales. A really off-putting one is asking an open question like, ‘what would you say are the aims of this appointment?’

This little change in the Choice Architecture reduces the number of people given appointments significantly. Perhaps these not-very-motivated patients are the right ones to weed out. Or perhaps not. Maybe those who are least forthcoming are most in need.

Because mental health services are very limited, and mental health problems are very common, there is a massive amount of covert rationing for psychological treatments.  Which brings us to the pressing issue. If it’s that difficult to get an appointment for something concrete and medical, like muscle cramps and twitching, oops I gave it away, how much more difficult must it be for a depressed person to enter the system?

Most people with Depression have reduced energy and motivation. Often they are ashamed of seeming weak or useless. Studies have shown that it takes most people a long time to get round to making an appointment. Often it takes a crisis of some kind to bring people into contact with services.

Recently I’ve seen people turned away from blood-doning sessions because they had not made an appointment, even O negative donors, like myself, who should be given the red carpet and chocolate digestives.

I heard would- be donors say things like, ‘I just like to come down here when I’m able to, I just can’t plan that far ahead’. The person in charge assured them that the new appointments system was much more efficient.The Times (10.06.13) reports that the number of blood donors has fallen by 23% in the last ten years.

NHS blood and transport are apparently looking to attract young donors, so perhaps this should also be included in the national curriculum. I’d have given more blood if doning had been offered as an alternative to PE.

It would perhaps make sense to abandon or reduce the system of making appointments in favour of just turning up. We seem to like walk in centres and A and E, where we go when we need to.

In fact I seem to remember GP surgeries used to be like this, before appointments took over. I am sure GPs can produce evidence supporting the idea of appointment systems. And further evidence to support their recent system of the mad telephone rush for slots, jamming the  lines at 8.30 am.

But there has been a massive change recently in the number of things you can do while you wait. This has transformed public transport and it could transform access to healthcare.

If you have a tablet computer, or smart-phone even, you can listen to music, read a book or two, watch a movie and play a few games.

You can skype your relatives and buy a new cardigan online.

This is quite different from even 10 years ago, when you had to be content with old copies of Golf Monthly, collections of curling pucks and a fish tank.

Somehow we have created a system where people’s time is felt to be incredibly important and they can’t be released from work. Did planners fondly imagine that people would pop out of work during their lunch break to have a quick endoscopy?

It looks as though ill people will seek help, providing they know which queue to join and where it starts. All they need is a sign saying, ‘Stagger this Way’.

The biggest crime in the NHS is to make covert rationing ‘explicit’. It’s a bit like a magician showing how the tricks are done.

Perhaps there’s something more honest and straightforward about a queue. A bit like Stargate, we’d call it a ‘Portal into Care’.

Take your iphone. And the charger. Food and drink also. And if you see the sick-man, please send him back to Medical Cosmology*.

*The disappearance of the sickman from medical cosmology, by Nick Jewson,  Sociology May 1976 vol. 10 no. 2 225-244

18. Steering Clear of Tulip Futures.

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Blue daffodils – the next big thing.

If psychiatrists were football managers we’d have been fired hundreds of times over. Depression is still the biggest cause of disability in the developed world. Like football, Spurs in particular, our treatments don’t seem to have advanced much since the 1960s.

Nevertheless, we continue to live in a world where we feel the big breakthrough is just round the corner.

What if mental illness really was caused by abnormal chemicals in the brain? Would a whole generation of counsellors and therapists become unemployed?

And what if a real ‘happy pill’ was invented, that improved people’s mood and behaviour, without being addictive or dangerous?

Some very powerful vested interests would be upset: brewery companies, organised crime and drug companies – arguably all  the same people – who continue to make mind-altering drugs and antidepressants, whose sales would slump.

It could happen, but we are right to be sceptical.

Clearly, Depression is not one of those diseases like Smallpox or Cholera, that could be eradicated with a vaccination program or antibiotics. Is it?

There has only been one such development, which completely changed the game. This was the introduction of Chlorpromazine in the late 1950s.

Since then there have been so many promising avenues, which have turned out to be mere dead ends in the history of ideas.

Or rather, as we say in Europe, Cul de Sacs. Or is it Culs de sac? Or even Culs des Sacs? And that’s before we decide whether to hyphenate.

Whichever way, a good name for a Belgian jazz musician – probably one who has taken up a defunct form, such as Scat.

Cul de sac appears to mean ‘the arse of a bag’. No-one seems to know if Cul is a rude word in France. People I ask tell me the French don’t really have a concept of rude words in quite the same way as in English.

Culs de sac have occurred regularly in the history of Psychiatry. The best known example is the so called Pink Spot.

In the early 1960s, scientists thought they had found an abnormal chemical in urine samples from patients with schizophrenia, which made a pink spot on filter paper.

Eureka! The spot was thought to be DMPEA, a possible brain chemical that had an effect like LSD. The theory was that an abnormal gene produced an abnormal chemical that caused the brain to malfunction.

Sadly, not true.

It led indirectly to a large number of patients being given high doses of B and C vitamins, which were unhelpful. To some extent the sixties was the vitamin era (though we did not have them in Derbyshire) and mega doses were made popular by chemists such as Linus Pauling and advised for all kinds of ailments, particularly cancer. Megavitamin sites are all over the internet, even now.

A more recent cul de sac, which is still running in self help literature, is the idea that people with Depression have a deficiency of certain types of oil or fatty acid.

Quite a number of studies compared types of fish oil with placebo, and a brief overview suggests that the more rigorous the study method, the more limited the benefits, with many studies showing no significant effect from oils.

I’m not saying don’t try these oils, by the way. There’s just something fishy about them.

Another occasional ‘winter visitor’ is the notion that mental illnesses are caused by a virus. This theory seems half based on the admittedly interesting finding that people with certain mental illnesses are more likely to have been born in the winter.

Many illnesses may turn out to be caused by viruses, especially if we use the word ‘virus’, like ‘allergy’, to mean ‘tiny nasty thing we can’t see’. Famously, stomach ulcers turned out to be related to bacteria infection much more than stress.

There are vast numbers of micro-organisms yet to discover, many of them found in our own gut. There are a number of scientists working on pro-biotic remedies, using specially trained bacteria to impact upon the nervous system via the GI tract.

Mice fed with Lactobacillus rhamnosus JB-1 for instance, showed significantly fewer stress, anxiety and depression-related behaviours than those fed with just broth.

Scarily, the biggest organ in the body turns out not to be part of us at all, but zillions of bacteria.

This might be another cul de sac, or it might be a big breakthrough. Time will tell.

When it comes to therapeutic dead ends, Insulin coma therapy probably takes the sugar-free biscuit. It was popular in the 1950s, probably didn’t work, was quite labour intensive and was definitely barbaric. It was abandoned pretty soon after the invention of Chlorpromazine.

Psychiatrists aren’t the only doctors to jump on bandwagons though.

During the twentieth century everyone suddenly decided that people should have their tonsils out, leading to millions of unnecessary operations. This was despite excellent evidence that most people grew out of tonsillitis by their twenties.

Now it is very difficult to get your tonsils done at all, even when they look like Jackson Pollock has painted them.

How long before we see the Sunday Times run an exposé about backstreet tonsillectomy parlours? ‘A man with a huge soldering iron and bicycle pump sits in the half light of a tiny room in the alley behind Poundstretcher … etc’.

One of the longest running – nearly 2000 years – culs de sac was the idea that the body was made of four humours – blood, bile, black bile and phlegm. This itself was built on the philosophical dead end that there were four elements – Earth, Wind, Fire and Water.

Which must have made the Periodic Table very easy to learn compared with the version we learned in Chemistry.

And raises all sorts of questions. Did Earth, Wind and Fire ever think of getting Roger Waters to join? And were they formally known as Blood, Bile and Phlegm? And was that too similar to their horn – based rivals, Blood, Sweat and Tears?

The four humour system teaches us a lot about intellectual red herrings, just to mix up the metaphor for a moment. There’s a blind ending, but you can travel a long way down the road before you get there.

Like the M50 going west, there is just no destination.

We are probably still exploring a few, like the serotonin theory of Depression. But we cannot always know where these paths will lead.

Very clever people, like Isaac Newton, went along with humour-based medicine: ‘Trials are medicines which our gracious and wise Physician prescribes because we need them; and he proportions the frequency and weight of them to what the case requires. Let us trust his skill and thank him for his prescription.’

Isaac, you are most welcome in our clinic, with that excellent attitude. But please don’t believe everything you read on the internet. And watch out for Charlie’s men.

As mentioned above, Linus Pauling won two nobel prizes, and was the leading chemist of his generation. He became convinced that Vitamin C could cure cancer, even despite evidence to the contrary from large trials at the Mayo clinic.

Beyoncé is still looking towards the ‘four elements’ to inspire her new range of fashion: ‘we explore the different emotions of women represented by the four elements. Fire, water, earth and wind.’

If people like Isaac, Linus and Beyoncé can be taken in, what chance have mere mortals?

With a little hindsight though, generally we can see more clearly where trails have run cold. Such as the South Sea Bubble, or Soviet Communism.

My history advisor tells me that there was once an extraordinary Tulip craze in Amsterdam. At the peak of tulip mania, in March 1637, some single tulip bulbs sold for more than 10 times the annual income of a skilled craftsman.

Tulips of course persist, so they are not a cul de sac in terms of their role as flowers, but rather as investment products. Otherwise Spalding would be the financial capital of the UK, instead of just the style capital.

Shakers were a religious movement who mostly refused to procreate – the opposite approach to certain other religions – and hence died out. However, archaeologists have found a lot of illicit stuff in Shaker rubbish dumps, like whiskey bottles and tobacco pipes. No vibrators though.

On the commercial side, Sunny Delight was an attempt to create a modish new orange drink. It was launched in 1998 with a £10 million promotional campaign. Within months Sunny Delight had become the biggest selling soft drink in the UK behind Coke and Pepsi, with sales of £160 million a year.  Then it all went wrong. 8000 litres of Sunny D concentrate leaked into the River Parrett in 2006, creating a literal yellow river. A 5 year old child turned yellow after consuming 1.5 litres per day and the makers, Proctor and Gamble, had to put a health warning on the bottle advising moderation.

Sunny D seems still to be available, judging by its website, which makes the claim that it was ‘reverse engineered from the sun’. Wouldn’t that make it Hydrogen?

I don’t think we should be too hard on people for driving down blind turnings fast and furiously.

The reason we get carried away with a plausible new idea is our hunger to explain something very complicated with something we can grasp ourselves and even explain to others.

We are junkies for theories which seem to have Face Validity.

Writing in New Scientist recently, Prof Nick Craddock suggested that Psychiatry needs its ‘Higgs Boson moment’. He points out that mental illness research comprises only 5% of medical research. Despite this, he is optimistic that some of the newer strands of research are about to come together:

‘Psychiatry started the new millennium a few hundred years behind physics. But the decade that followed saw radical change, and set the stage for an intense period of catch-up. It is not fanciful to describe what will happen as the equivalent of some 200 to 300 years of progress being compressed into 20 to 30 years’.

So lets end on a positive note today, and enjoy waiting, as Spurs wait, for the Higgs Boson moment.

Meanwhile, don’t put all your money into Tulips, however plausible that might seem.