58. Just asking: what would Englebert do?

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Robin Hood: should have stayed out of Nottingham

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Byron: should have stayed in Nottingham

Is it possible to develop a phobia of a specific town or city? If so, what is the correct term for an acute fear of Nottingham?

Don’t forget, a phobia, by definition, has to be irrational. However, there are plenty of genuine reasons to be afraid of Nottingham, in particular the possibility of making an unwanted left turn onto the Trams only zone, punished by a £30 fine and a humiliating picture of yourself, grinning foolishly, in your car, on a tramway.

We all know there is only one way of treating a phobia, and it’s not multivitamin tablets or fish oil.  Determine what the fear is, then – as Nike would have it – just do it. Which is why I find myself in Cafe Nero, near Nottingham station, shaking and hyperventilating and palpitating, as I type my negative thoughts into the Nokia: If I run as fast as I can, I will still be in Nottingham for half an hour before I reach the edge. It feels like being on a submarine or space station, without an escape pod, other than East Midlands Trains. I look round, but I can’t see a defibrillator handy, nor anyone who looks trained in immediate life support. For a moment I wonder if caffeine might really have a discernible effect on the nervous system – I’d always assumed this was a myth.

And then, right in front of me, I notice there is a discarded copy of the Daily Mail health supplement. Which is when I get distracted from my behaviour therapy program and morbid thoughts about sudden-adult-death-in-Nero-syndrome. Until Michael Gove puts more basic medical science onto the school curriculum, we have to make do with the health pages in newspapers to find out how our bodies work. As I read through, I learn the following:

Under the headline, ‘The allergy delusion’, it is reported that many people who think they have allergies, or have even  been diagnosed with allergies, are not really allergic. There’s a long story about someone whose GP has told them they had dairy and gluten sensitivity, only to find out from a proper doctor, with a labcoat and microscope, that they had Crohn’s disease the whole time.

Next, I learn that International Singing Superstar, Englebert Humperdinck, (ISSEH for short) suffered from asthma which completely went away after four sessions of acupuncture. Without acupuncture, ISSEH would never have been able to achieve 25th place in the Eurovision song contest. ISSEH’s mother was told she had just a few weeks to live, but following acupuncture, lived on for years.

There are many other fascinating stories. A Psoriasis sufferer had been cured completely by Cognitive Behaviour Therapy. It can be dangerous to suppress a sneeze. Vitamin D is unlikely to do any good for most people. Central heating makes you fat. Lifting weights can harm your eyesight. Migraine can be managed by a magnetic machine about the size and weight of a house brick. It has a handle at either end and is applied to the skull.

I learn that it could be bad for you to keep pressing the snooze button on your alarm clock. Snoozing only makes you more tired. By rights, the button should be called ‘procrastination’, but there isn’t room to write the proper word.

Medicine as reported in newspapers represents an entirely different, yet parallel speciality. In the Hospital of Newspaper Medicine there are several floors devoted to alternative medicine. There is a huge department of Bogus Nutrition. These patients all appear to be slim young females in gym outfits. The mental health floor is convinced that CBT and Mindfulness can cure any condition. The upper floors are filled by keyhole surgeons and computer controlled robots. The medical wing is full of machines the size of house bricks that go beep. Again, all the patients are slim young females in gym outfits.

Yet in the basement of this hospital there is a well resourced Debunkology Department, where last years miracle drugs are revealed to be the stuff of nightmare. Last year Statins were supposed to make us all live till 120. Everyone should take them.This year the Guardian tells us that Statins have become ‘a monster that no-one can kill’.

I think I’m beginning the get the hang of Newspaper Medicine. News has a kind of cycle with a fast turnover – build things up, knock them down. It’s the same treatment as celebrities and football managers. By comparison, Dr Google and Dr Wiki seem like paragons of truth. Something seems to happen to journalists that makes them bitter and twisted. I’m guessing it’s the fact that any old person with a computer and $20 for a website can be a writer nowadays, even an escaped psychiatrist. Newspapers seem to suffer from excess bile, which is probably why they go yellow after a few days.

What would they make of someone who had become phobic to a whole city? My guess is one quick article about Total City Allergy Syndrome, with a tip from ISSEH suggesting acupuncture got him over the problem he had going to South Wigston. Only to be followed by a rapid debunking exercise making it clear that City Allergy Syndrome is a delusion or possibly a benefits fraud.

Along the lines of the Tintern Abbey joke lets try this one:

Patient: Doctor, I have an irrational fear of a large industrial city in the East Midlands.

Doctor: It’s Nottophobia.

Patient: Yes it is a phobia.

No? I’m sure Stuart Lee could make it work.

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57. Selecting the right animal charity, and other questions.

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Another Free School fails OFSTED.

Some people seem to question everything and some seem to question nothing. And then there are those in between. This week EP attempts to address some of your burning issues, so you don’t have to. Why not send in some more for next week?

Q. Is thinking driven by continual questioning?

A. No, it is driven by nicotine, chewing gum and certain types of chocolate.

 Q. Is Mindfulness the new Mom’s apple pie?

A. That’s probably a bit too concrete and  three-dimensional. It is perhaps more the new Angel Delight, or Dream Topping.

Q. My son has built a scale model of Stockport with fingernail cuttings. Should I call the early intervention team?

A. I’m afraid it’s too late. Try entering him for the Turner Prize.

Q. Should I give more money to charity or try Random Acts of Kindness?

A. It’s best giving to a highly specific charity, rather than one where most of the money goes to a bloated bureaucracy in Chelmsford. Some of my favourite charities are animal related, for instance, Pyjamas for Llamas, and Maracas for Alpacas. The latter is based, I think, in Caracas. If you want a random act of kindness, give the lollipop lady a bullfighting outfit. Tell her it’s just a question of reframing.

Q. Most people assume they are healthy unless they have symptoms of an illness. I’m the other way round – I need constant proof that I am well. Should I be worried?

A.This is called the Inverse Health Cognition. It may just mean you’re American. Otherwise, Kindles and Ipads have very long battery life nowadays – these will get you through long periods in doctors’ waiting rooms.

Q. Why do medical students ask questions all the time, instead of the old system, where I ask them questions?

A. Because the signal strength in hospital is too poor for google to work properly. You are the next best thing. Take it as a compliment.

Q. I’m having trouble understanding the changes to the NHS. Can you explain them?

A. It’s a complicated model, based on the old British Empire. It’s a mixture of colonial administration, piracy and gambling. Don’t forget, the British Empire never went away – they just moved the headquarters to Washington.

Q. What can I do about writer’s block

A. What I do is write in the form of Questions and Answers. If that doesn’t work try Lactulose.

Q. Is it true there is no real person called Ted Baker? My beliefs are shattered.

A. Nothing is as it seems. Compared with faking the moon landings, this was a pretty easy deception. Colonel Sanders was real, but he wasn’t a real colonel. The chicken doesn’t come from Kentucky either. Does it even come from chickens? I bought a Giant bicycle, only to find it was the same size as all the other bicycles. Same thing with Tiny Computers. As Peter O’Toole observed in Stuntman, King Kong was really only six feet high. The list goes on…

Q. If World War Three happens, where shall we hold it?

A. The middle east, during the summer, is completely stupid, see World Cup 2022. Conversely, Russia is too cold. It all points to Belgium, if there’s room.

Q. Have you had any more ideas for blockbuster movies?

A. It so happens yes. My latest idea is a sci fi / historical / heist movie: A team led by John Sentamu, Archbishop of York, mounts a daring raid in an attempt to steal the bones of Richard III from Leicester University’s high security archaeology wing, reclaiming them for York. Only to find, when they break into the lab, that the genetics department have actually re-created Richard III himself from traces of DNA. He’s angry. He wants his kingdom back. And the last place he’s going is Yorkshire. That’s all I can give away at this stage, Brad.

56. Making the Co-op a bit more Hendrix.

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An early attempt at the anatomy pop-up book.

Almost every medical problem in some way boils down to a faulty feedback cycle. The simplest examples are endocrine diseases like diabetes, but the model can be applied to cancer cells, where cell division fails to switch off, and immune diseases, where antibodies mistakenly attack a person’s own tissue. A lot of economic or political debate falls into this same category of trying to fine-tune a system. For instance, using higher interest rates to reduce borrowing, or tougher sentences to reduce crime. Sometimes a system breaks down, failing to respond to feedback, like the heating systems on East Midlands Trains, which have fallen victim to the fashion for Hot Yoga.

Today, we learn that the Co-operative Group is ungovernable. That seems like an over-reaction, based on my experiences at the local Co-op supermarket. But when I think about it more carefully, the signs have been there for a while. Firstly, the car parking spaces went from impossibly narrow to Humvee size. Then there were the yellow sticker reductions – from £2.99  to £2.97. Not enough action there to clear a pile of steak pies facing a tight sell-by date. And when the pet food and pet product aisle became longer than the people food section (I accept there’s an overlap), we should have seen the writing on the wall. As well as the actual writing on the wall, which says ‘Laura H is Easy’.

During its flirtation with electricity, Psychology showed an interest in Biofeedback. This was an attempt to exert conscious control over a supposedly unconscious function, like blood pressure or heart rate. To learn this, a person needed a machine that would continually measure and reveal the reading concerned, and a system of relaxation. You can still buy biofeedback machines, but they are competing with tablets like beta blockers that don’t need plugging in. There could be a biofeedback revival once access to Functional MRI gets easier, for instance if you can get one on your android phone. For Apple you’d need the £25 adaptor.

I just got back some feedback on myself, from colleagues and patients, in the form of a so-called 360 degree assessment. We have to do one every five years. It seems like a slow process, but that’s about 20 times more frequent than the Cooperative Society. Alleged ‘crystal methodist’ and adult-content-consumer Paul Flowers, who chaired the co-op bank until last year, apparently did very well in aptitude and psychometric tests prior to his appointment in 2010. I suspect he’d have passed his 360 with flying colours too. Flowers was said for instance to have been excellent at engaging other people’s views. History may yet regard him as a great chairman. If he’d worked in the NHS he’d have been reinstated by now in a different branch at twice the salary.

To make feedback work we need to make the sampling frequency higher and the amplitude lower – a process that cuts in as soon as someone goes ‘off message’. Something more akin to the kind of feedback Jimi Hendrix achieved in his version of Star Spangled Banner. Imagine a system for instance that connects a politician or corporate giant to a brain imaging device. This could display his brain activity as he goes along, either to himself on an autocue, or to the audience, on a powerpoint display. Similar techniques have been applied to audience feedback during political speeches and even movies, using appreciation buttons.

Amazon apparently know which are the best pages in novels, based on how quickly they are read. Imagine what the great novelists could have done with this technology. Maybe it would have stopped characters suddenly dropping dead from a chill, or selling their wife at a market. Or making Laura H, suddenly, ‘difficult’.

It’s said that people who become habitual liars fail to notice whether they are even lying or not and even come to believe their own lies. Yet lie detectors have been around for decades. We already have a host of biological measurements such as EEG and skin conductance. We already have heads up interactive displays such as Google Glass. We already have portable electric shock devices. And somewhere in the world there is probably a large pile of testicle electrodes. Surely it won’t be long before someone connects up these technologies?

55. Saving the early intervention service, till later.

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An uneasy meeting at a fancy dress party.

It’s official. Children cost too much. Childcare costs more than a mortgage. If you have children they might stop you going to work, and they eat a lot too. Shouldn’t people be told this sooner? Worse than that, children don’t come with any kind of guarantee, and more of them seem to be going wrong. If Toyota had made them there’d be a recall. And soon a Commons Committee on young people’s mental health will start its proceedings.

Though there are rumours that mental health problems among teenagers have increased, there has not been a proper survey since 2004, when the world was very different. It’s hard to believe, but they didn’t even have Instagram in those days, let alone Whatsapp. People wore top hats and tail coats and travelled by horse, particularly the women.

There are lots of theoretical reasons why it’s got worse to be a teenager. Legal highs are widely available, the Harry Potter series came to an end, and no-one is far enough beyond suspicion to take over hosting Jim’ll Fix It, unless Desmond Tutu can be persuaded. Large numbers of youngsters have been sent to remote labour camps, or universities as they are now known. Employment opportunities as footballers and TV presenters, the only jobs worth having, have largely dried up.

Sadly, if a generation of teenagers became psychotic or depressed, no-one would really notice. Part of the blame belongs to British psychiatry and its strange tradition of age discrimination. For some reason we have different specialists for young, adult and older people, as though they were totally different forms of life – like eggs, caterpillars and butterflies respectively.

There’s a kind of reason for that, in that young people don’t really get the same kind of mental illnesses as adults. Psychotic conditions are very rare in children, or so we thought. ‘Early intervention’ services were an attempt to plug the gap, at least for older teenagers who seemed to be showing signs of schizophrenia. Early intervention was a laudable aspiration, but didn’t get much beyond that, since there was no litmus test for psychosis. The services were overwhelmed to an extent, by the numbers of children with emotional disorders, such as so-called ‘borderline’ personality; problems that,in a sense, flow from children being treated as commodities instead of people.

To cut a long story short, another tonne of anti-psychotics wended its way to the sewerage system, some of it via people. The early intervention services have been pruned back rather savagely, before they had a chance to flower. Doubtless the Commons Health Committee will come to regret this. In the meantime, services for teenagers are largely restricted to a skateboard area and free condoms at the library, for those who are brave enough.

When the large mental hospitals were closed down, some people warned that community services would be much easier to cut. It’s to do with visibility. Some of the asylum hospitals were the size of aircraft carriers; quite likely some of them had their own Harrier Squadron. They certainly had farms, ballrooms and cricket pitches. Everyone has noticed they’ve gone.

The coalition government has been quite tough on aircraft carriers, and luckily there won’t be one to send to the Crimea. But having a carrier with no aircraft to go on top is a major embarrassment. It’s like a Christmas cake without the marzipan, let alone the little decorative church and snowman. Similarly, having a hospital full of closed wards looks a bit wasteful. But if a care assistant only comes half as often, for half as long, or doesn’t visit at all, no-one really notices.

And if your psychotherapist turns out to have one years training at a community college, rather than the 25 year apprenticeship in Vienna and the multiple doctorates you’d expected, it’s hardly a big deal to anyone. Low tech services have a soft underbelly, as do many of the people who work in them – too much driving about eating petrol station sandwiches.

As the community mental health services are scythed back, we hear only a few muffled squawks from politicians. Nick Clegg (deputy prime minister and Britain’s answer to Al Gore) popped up in January, stating that mental health must be given parity with physical health. ‘We have got to take this out of the shadows’, he said. And we can expect a further survey on teenagers’ mental health, probably conducted by social media. But does the government have any coherent plan for teenagers, or are they considered, as a Bond villain might say, ‘expendable’? After all, they don’t vote and they don’t pay much tax. As a species, humans have a reasonable life expectancy at birth, which is a miracle, considering we ride bicycles, but perhaps this is set to change. It’s a bit ominous that youngsters are now being told that world war one was a useful outing.

With the demise of early intervention teams, there should be a move for adult and child psychiatrists to work together more closely, but I see no signs of this. They just drive a totally different kind of Audi.

During vacations I always got a child psychiatrist to cover my work, which he did brilliantly. I doubt whether I’d fare so well with his patients, unless he wanted half of them put on depot injections, and a tonne of complaint letters from parents. And I’m not sure if they still have sandpits to play in, so I wouldn’t know whether to bring my own bucket and spade.

Maybe a reverse takeover is in order, where children’s services take over and everyone is regarded as a child. This is perhaps the only way that children can get treated equitably. The danger is Ofsted staging a coup and taking over the government. And everyone would have to have a CRB check, just to meet anyone else at all. Treating everyone like children has worked well in lots of countries – you know who you are, nanny states.  Perhaps Nick Clegg could consider this. Otherwise, teenagers, like Hank B Marvin, are just going to have to ‘stay in the shadows’.