37. Rejecting the Domino’s Theory.


This creature’s camouflage is poorly suited to the urban jungle that is Hull.

My iron is warmed up and the fire extinguisher is ready, but my Ironing Coach is late today. Let’s hope we can stick with simple shapes again and not attempt anything complicated like pleated trousers. I was never that good at thinking in three dimensions, which is probably why I am not a surgeon.

One of my theories is that Specialisation has been very bad for us. I can understand how such a thing came about, following the industrial revolution, the invention of production lines, and the division of labour.

But every time a specialism is created, such as Pastry Chef, Tyre Fitter, or Middle-Third-of-the-Duodenum-Surgeon, a potentially useful activity has been taken away from the rest of us.

Not only are we all deskilled, but also we now have three very bored people, doing the same thing all day. Nowadays it is possible and probably lucrative to have one very finely honed skill, particularly if it is one that has been professionally colonized and denied to amateurs.

Professionals, and by this I mean the old professions like Law, Medicine and Accountancy – I nearly said Prostitution – were the first to stitch up areas of activity which would become highly rewarded and restricted to club members.

More recently we have seen Plumbers and Electricians get in on the act. Fair enough. These are occupations that need special skills and equipment and could represent a danger to people if done carelessly. But have we overdone it? Couldn’t the plumber do the electrics and vice versa?

Couldn’t someone more like a blacksmith – a person with a large shed and no backache – do tyre fitting, along with general welding and repairing? Why for instance is the person who mends shoes uniquely the person allowed to cut keys and change watch batteries?

Dominos seem to have developed an extremely narrow niche product. It’s for people with a motivational level just above the point for making phone calls but just below the point where they can put a frozen pizza in the oven for 13 minutes. A surprisingly large section of the population inhabit precisely this energy zone.

Ivan Illich was an influential writer in the seventies. I went to see him speak once in Leicester. I mainly remember that he refused to use a microphone, because he believed this invention had stolen the power of public speaking from the non-miked. However Ivan had an extremely loud speaking voice, so hardly needed any further amplification. He was easily able to drown out his opponents, which is the essential skill for a one-liner polemicist.  His message was to criticise doctors and teachers for stealing areas of expertise away from ordinary people.

As regards Medicine, there are pros and cons in his argument. It’s true that many areas of normal life have been falsely medicalised, such as insomnia, addictions and obesity. But it’s also true that high tech procedures such as coronary artery grafts have become massively more successful, providing the person carrying them out has done a large number of them, uses the right equipment and follows a strict protocol.

This week on the front pages of our newpapers we find a report about Depression supposedly commissioned by Nuffield Health. Whatever the report actually says, what has come through the press releases are some of our favourite chestnuts:

Depression affects one in four people.(Why not one in four hundred or everybody – it depends merely on where you draw the cut off point?)

GPs dish out antidepressants by the bucketful. (Who is this Willy Nilly and why can’t we stop him?)

Exercise would be just as useful as antidepressants.(As though obese people didn’t have to carry round an extremely heavy weight all day round their tummies.)

Not surprisingly, we find that Nuffield Health has taken over a lot of gyms recently. The more thoughtful papers go on to say that a Cochrane Review has shown that the value of exercise in Depression is doubtful to modest.

No-one much has a bad word to say about exercise, but lets inject a note of caution. Exercise might be an excellent pursuit, but very few people persevere with it. Much as they don’t persevere with Cognitive Therapy. Because they are hard work.

As opposed to swallowing a small tablet once a day, which is easy work. Our problem I think is in expecting either exercise or tablets to do miracles.

At the present time we have a situation where a professional person presides over getting hold of antidepressants, whereas we are still theoretically free to run upstairs or lift bags of potatoes.

However, the fitness lobby has made significant progress in colonising exercise-taking. Are we seeing the development of what could be called Big Exercise, where gym companies, sports gear and food manufacturers team up with coaches and personal trainers to create a new orthodoxy of fitness?

I predict that we will soon be able to buy antidepressants in Tesco, but if we want to take any exercise we will need expert supervision. Much like Ironing. It’s going Corgi-registered soon.


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