Author Archives: ep2012

17. Giving feedback without using the hairdryer.

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The characters seemed a little two dimensional and transparent in places.

For a long while, every time I filled the kettle with cold water first thing in the morning I thought I heard someone upstairs scream. I wondered at the time whether this might be an interesting kind of hallucination.

A ‘functional hallucination’ is a false perception that occurs at exactly the same time as a real perception, such as the sound of running water. I had assumed till then it only occurred in old German text books and multiple choice exam questions.

It turned out there was a more mundane explanation. The reduction in water pressure caused by turning on the kitchen tap caused the person having a shower elsewhere in the house to experience a sudden water temperature change, first quickly upwards followed by quickly down. The culprit was and still is a poorly operating thermostatic mechanism in the shower unit.

Although the shower over-reacted in terms of temperature control, I am careful to state that the showering person reacted completely appropriately.

The thermostat is our basic model of a feedback system. It senses the temperature of the water. If the temperature goes too hot or too cold, it responds by cutting or increasing the power to the heating element.

The same sort of negative feedback system occurs in most devices, throughout our bodies, and more generally through social systems.

It requires two prongs – a sensing device, and a device that effects a change.

When we come to try and understand the word ‘dysfunctional,’ that seems to describe certain behaviours or relationships – sometimes even applied to an individual – most often we are looking at a faulty feedback mechanism.

In British culture we have a great deal of trouble knowing how to react to things. For instance, it seems the height of bad manners to criticise someone directly. That would be like sounding a car horn. Instead, we tend to use a low key grumbling approach via third parties – like trip advisor, or writing a rude letter and not sending it.

There are a few exceptions, such as talent shows, and the army. If you want a more challenging annual appraisal, perhaps Alex Ferguson would oblige, using his famous ‘hairdryer method’.

But in general it is very difficult to get honest feedback.

If you write a reference for someone who is absolutely terrible at their job, the custom is to write a glowing reference with the tiniest hint of faint praise, e.g. ‘may lack ultimate commitment’.

One guide to how to behave in a crisis is watching drama. Millions watch soaps like Eastenders on a regular basis. How far do people model their social behaviour on such programs?

Whereas stage actors tend to exaggerate voice and gesture, movie actors have to play it deadpan. TV is somewhere in between, perhaps to do with the size of the actors face relative to real life. If shows get made specially to be viewed on a smartphone, they will probably star Brian Blessed.

Like actors in Greek tragedy, people with Depression tend to ‘catastrophise’ in reaction to events. Odysseus’s mother apparently committed suicide after hearing flimsy evidence that he had died.

In drama, Greek or Soap, no-one ever responds to a crisis by calling a helpline.

British people are more likely to under-react to a crisis. David Beckham found out one of his tattoos had misspelt the word Victoria, written in Sandskrit, as Vichtoria. History records that he was not unduly concerned, merely resolving to stick to Latin for further etchings.

A gentleman with OCD I used to know told me this story. One day he had taken his long suffering ‘good lady’ to the seaside, leaving early to avoid the traffic. Having driven 120 miles to the coast, he was confronted by a completely empty car park with hundreds of spaces. He drove around several times, unable to choose a space and eventually had a panic attack. After recovering, and still not in a parking space, he drove home again.

‘I’ve been a bit silly again’, he finally told me.

I should perhaps have anticipated this kind of eventuality and suggested a simple algorithm for parking. Recently I discovered that elevator systems in large buildings have just such a system for deciding which lifts should go to each floor.

Apparently, according to Mitsubishi Electric, a person becomes irritated immediately he presses the lift button and nothing happens. However, the level of irritation is proportional to the square of the waiting time. From this we can begin to understand how people can develop rage attacks surprisingly quickly.

Remember Christian Bale’s outburst on the set of Terminator? Apparently a technician walked across his sightline during a scene.

I know the feeling, from trying to talk to acutely psychotic patients in the same hospital room where builders are operating pneumatic drills and ripping up the lino with Stanley knives.

There are a number of ways to explain why certain people seem to ‘lose it’, experiencing an acute change in mood and behaviour.

Steve Peters would call it ‘letting the chimp out’, meaning a switch in mind-set, allowing a different set of brain pathways to take over control. Thankfully, Mitsubishi have not included a Chimp Mode in their elevator systems. Though Beko appear to have included a ‘Surrealist Mode’ in their washing machines.

A more neuroscience-based model still, is the possibility of positive feedback, or kindling, where the response actually goes the opposite way from restoring the norm. This is often called a vicious circle.

One theory of panic attacks uses a vicious circle model, where mild signals of distress from around the body are over-read, cause anxiety and thus further physical distress signalling, such as breathlessness, palpitations or chest pain. Finishing with a slightly embarrassing visit to the coronary care unit.

A behaviourist could explain ‘losing it’ in terms of social learning. Previous tantrums or losses of control have been rewarded by parents or others, either in terms of letting the upset person have his way, or by way of reducing ‘messing’ with that person. Having a ‘short fuse’ can be quite useful in certain situations. I once worked for a consultant who was completely benign 99% of the time, but the word about him was, ‘watch out, he goes berserk every now and again’.

One of the triggers seemed to be handing him a post it note with a poorly worded or scribbled message and a phone number. It was not that he had been hypnotised previously and made to react this way, although this is possible, knowing the hospital involved.

It was just that being handed a post it note is a metaphor for being handed a problem, but without the information needed to act on it properly.

I’d like to think that his reputation would have worked to reduce the number of post it notes he got handed, but I never saw any sign of this. Post it notes continued to flow like confetti. Perhaps he should have set fire to them immediately or eaten them.

In the NHS, feedback loops operate comparatively slowly, so it would have taken about 20 years to see the post it notes’ eventual downturn.

Remember the film, ‘Falling Down’? Here, the character, D Fens, is played by Michael Douglas, who is a screen actor and therefore tends to play deadpan. D Fens progressively loses it after a ‘rare morning’, ending up in a spree of violence across LA. The trigger event appears to be a shopkeeper refusing to give change.

An older theory of ‘losing it’ relied on the notion of a repressed or over-controlled person, which I think is what the director had in mind. D Fens had seemingly suppressed his anger by being extremely tidy and organised, never allowing himself to become emotional, and therefore never setting appropriate limits on people.

Here I suppose the systems analogy is the pressure cooker. This has a very primitive feedback loop, so that a massive degree of change from steady state is needed before the feedback occurs, in the form of opening a safety valve.

Here the feedback loop is too coarse to make rapid enough corrections, necessitating an external over-correction, such as being gunned down, albeit reluctantly, by Robert Duvall.

CBT is designed to improve a person’s feedback system: on the cognitive side to make sure the right information is collected; and on the behavioural side to make the appropriate responses.

Luckily the government has given us a new way to make sure we react appropriately.

We’ve been used to making a 999 call, for moments where we identified a very serious crisis. However, the 999 system is abused on a daily basis. One of the problems is that TV never shows anyone calling a helpline appropriately, so we don’t know what constitutes a 999 level emergency.

People have rung 999, for instance, to ask ‘how to dial 111’; because they were not being served in Macdonald’s; to try and obtain a laptop password, and to report the theft of parts of a snowman.

Now, to create a kind of crisis scale, at the milder end, we also have the 111 call.

That gives us the potential, provided British Telecom goes along with this, to fill up the numbers in between, 222, 333, etc, with a sliding scale of catastrophisation.

Let’s put in some examples to test the system.

You are Henry VIII, the most powerful king England ever had.

You have some marital issues, and in particular no male heir to the throne.

I’m thinking 333 would be about right.

Instead of which Henry over-reacts massively, dissolving the monasteries and the catholic church, divorcing his wife and executing some of his best pals.

There is no indication that the younger Henry was overly ‘buttoned up’, casting some doubt on the over-control theory. Although if he really had cerebral syphilis, that might have damaged some of his feedback loops.

Or try this one: Confronted with a pompous email from NHS management you write a reply you misguidedly think is witty, accidentally pressing the Reply to All button, so that every person in the whole NHS gets a copy.

555, agreed?

You eat a yogurt from your fridge mistaking the sell by date 2003 for 2013?

Not even 111, I don’t think. Yogurt never kills.

We are going to need an advisory panel of some kind as arbiters of how to interpret and assign a crisis to a number scale. This would be an efficient resource, especially if we can charge a premium rate for the crisis line. I hope the NHS is working on this.

Failing that I think Mitsubishi could run something up. For indecisive parking, press 111. For misspelt tattoos, press 222. For incorrect change, press 333…

What if the elevator seems awfully slow today? Press 444. Pressing using the fingers is sufficient. It is not necessary to use the axe.

16. Looking Out for Charlie’s Men.

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We could just wait and see. Or we could try taking these.

A man goes into Wetherspoon’s and orders a pint of Ruddles. He is handed a yellow Smartie instead. ‘Its a placebo’, says the barman. ‘We’re running a trial and it looks as though you’re in the control group.’

He winks, ‘don’t worry though, its probably just as effective’.

Few people realise that the naked emperor in the ‘Emperors New Clothes’ story was simply taking part in a controlled trial of Nylon.

King Canute famously tried to turn back the tide by issuing a command. Many think he was using irony to demonstrate the point that he had limitations. Even this would surely have been a massive mistake, in as far as the Vikings operated a ‘sticks and stones’ approach to verbal aggression, finding the axe more reliable than sarcasm.

In fact, misunderstood Canute was simply conducting a controlled experiment in Tide Management. Since kings used to think they might have divine powers, this was probably more reasonable than it sounds now.

Its a bit like Prince Charles testing whether he can destroy the South Bank Centre by telekinesis. From the look of the place he is slowly succeeding.

Sadly, modern Royalty don’t value controlled trials so much. Prince Charles, for instance is a big fan of Homeopathy.

Writers such as Ben Goldacre have issued warnings not to say anything rude about Homeopathy, for fear of ‘Charlie’s men’ finding you in a dark alley and rearranging your kneecaps.

Be assured, they can do it with a billionth of the force usually needed.

But now, there is no need for alternative practitioners to feel defensive, as we are entering the Age of the Placebo.

The reason is that it has become too difficult and expensive to invent ‘proper’ drugs and bring them on to the market. And it may not be necessary.

Alternative medicine used to be accused of being an expensive placebo. Now it is acclaimed as being an expensive placebo. The change has been an acknowledgement that placebos can be effective. Further, the more they cost, the better they work.

Even if the patient is told explicitly that the tablet contains no active ingredient.

Even if we write ‘placebo’ on the side of the tablet.

At least as shown in one study on Irritable Bowel Syndrome (IBS):

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0015591

Think of that. You go to the doctors with a bad knee. Using a pin and a copy of the British National Formulary, he gives you an injection of vitamin B12 and tells you there is no possible way this should help.

But it does.

The word placebo is being rehabilitated slowly, in the light of evolving knowledge that our mind has a life of its own away from consciousness.

In fact the part of the mind that we think of as the Executive Board is more tiny and isolated than we thought and much less in control than we expected.

Much like the government really.

Depression is one of the conditions that responds quite well to placebo, making it difficult to test antidepressant treatments.

Some research has shown that brain function changes occur in depressed people as they respond to placebo treatment. This has been shown by the technique called QEEG, which is a special EEG technique designed to show regional brain activity.

All this comes as no surprise to regular readers of EP, who ‘got over’ the mind/brain problem several weeks ago.

We also know that people with Depression like their doctor or therapist to strike a positive and hopeful tone, but stop short of hype.

Much as we love evidence-based medicine, many of the treatments we offer do not have a strong evidence base. This is particularly true for resistant depression, where various combinations of antidepressants are added together.

Proving a drug therapy is effective is a tough challenge.

Firstly we need to be able to measure the condition itself, using some kind of rating scale that is valid and reliable.

Once we can measure it we can do a randomised controlled double blind trial, either against placebo, or against an established treatment. This is the gold standard test.

However, if the effect of the drug is small, a very large number of patients will be needed in the study to show a statistically significant difference.

Even then, the effect is usually only measured for a short period of time, say 3 or 6 months, before the trial ends.

This process is open to several kinds of bias, some intentional and some accidental. For instance, only trials which show a positive result tend to get published. And if we do enough trials, 5% of them will show a significant difference by chance.

If the trial contains 20 different measurement scales, one of them is likely to be significant by chance.

This has allowed companies to select data and use it out of context in support of their products.

All these problems have conspired to stop people testing products properly and led to the false conclusion that all antidepressants are equally effective, which is not as amazingly effective as we would like.

Randomised controlled trials are a relatively recent invention, so we have only recently discovered how powerful placebos can be in certain situations.

It is probably ethical to prescribe a placebo tablet if we tell the patient what they are getting. Presumably some part of the less-than-conscious mind responds to the treatment paradigm, even though another part has put on its sceptical face.

So, instead of developing new antidepressants and other drugs, we could try and develop better placebos. We might still need to test them though, if we are to suggest they are evidence based.

The reason is that some placebos might be more effective than others.

Instinctively, I know that a tiny purple tablet is better than a big white one. I would expect anything involving electricity, magnetism or machines that go beep to be more effective than anything made of plastic.

I’m sure there is scope for ‘steampunk’ designs, such as the old ECT boxes in mahogany and brass. Obviously, don’t plug them in.

Working specifically on the placebo effect rather than on supposed antidepressant properties based on neurotransmitters seems an easier way forward.

This is a highly convenient position for the alternative therapists, who can now argue that they are the reigning experts in the use of placebos. How long till we have a Professor of Placebo Studies at the University of (e.g) Mexborough?

This is a much better argument than trying to prove their therapies have specific active ingredients, such as water having a memory.

Even memory foam can’t remember anything – I’ve tested it. You don’t want your mattress knowing too much anyway. I subjected it to ruthless interrogation and can assure you it knows nothing.

‘Bigging up’ the treatment with a bit of hard sell seems a good idea.

Referencing a bogus system of how the body works – meridians, humours, animal magnetism, endorphins etc is always popular.

And, as mentioned, charge more to get more benefit. Money doesn’t just talk, it shouts loudly and eloquently.

A few years ago some friends and I devised the ideal placebo treatment, that would use tuning forks. The forks would be tuned precisely to resonate with the person’s brain waves.

This would enhance certain frequencies in the brain. The forks themselves would be very expensive, made of precious ceramics and metals and probably jewel encrusted. The pre-treatment diagnostic test would be an EEG.

Now we know, if we used QEEG instead of ordinary EEG, (note the Q) we could actually predict those likely to respond.

This gives us a business model similar to Harry Enfield’s ‘I saw you coming’ shop, which itself was based on the emperor’s new clothes principle.

How worried should ‘Big Pharma’ be about placebos? After all, if you can knock something useful up in your kitchen out of artichokes, why do we need huge research laboratories in Macclesfield?

Before you sell your Astrazeneca shares, note the Z, be aware that there are very few studies to support the use of explicit placebo.

The most famous is the Harvard study of IBS mentioned above.

With all due respect to IBS sufferers, this is quite a subjective type of health problem, which is very hard to measure. But not unlike Depression or Pain in this regard.

How far would a placebo go in treating a more biologically measurable disease, like hypertension or diabetes?

And attempts to give opiate addicts placebo instead of methadone failed to hit the spot. Opiate addicts are connoisseurs when it comes to pharmacology, much like the man in Wetherspoon’s.

He immediately discerned that the yellow Smartie did not have the same effects as the 22ml of ethanol contained in a pint of Ruddles Best.

The choice of a yellow Smartie is controversial, since yellow foodstuffs have been accused of toxicity. Yellow and blue Smarties were even removed from sale for a while in 2006, as the dyes Quinoline Yellow and Brilliant Blue were replaced with natural dyes.

Please, how can anything called ‘Brilliant Blue’ be bad for you?

My own preference for medication is a bit contrary to all this.

Firstly, if I am looking for placebo power, a bit like Scrabble, I’d go for a tablet with X, Z or Q in the name.

This is probably why ‘Xanax’ was so popular.

Otherwise, my favourite drug therapies are ones that were discovered by accident. The effect was not expected by anyone, it just happened.

That doesn’t really mean the effect was so barn-door obvious that it must be genuine, since people are very open to attribution errors.

Iproniazid was a TB drug that turned out to be an antidepressant, and Chlorpromazine was an antihistamine that turned out to be an antipsychotic. Note the Zs.

The history of drug therapies is fascinating and riddled with such discoveries.

Most of these were spin-offs from the German dye industry, so ironically the Yellow Smartie and mental health tablets share a lot of  heritage.

In the study of explicit placebo for IBS the patients were not told simply that they were taking sugar pills.

They were told they were taking ‘placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self- healing processes’.

That statement serves to stimulate the Suggestiveness Receptors.

So here’s the plan. In our kitchen, we count out Smarties, in non controversial colours like red and place them in proper tablet bottles with child-and-most-adult-proof lids.

With an eye to the potential central Asian market, we label the tablets QOZZAX.

In the small print we say: ‘These tablets contain no conventional western medicine. They work by lexicographic forces, based on the ancient Scrabble system’.

Going one further, for publicity, we get people to go on Radio 4, stating that their life had been ruined by scrabble tablets. They are trying to sue games giant Spear & Co.

I wonder how many placebos are already being used in different walks of life.  I’ve noticed that supermarkets can enhance the quality (and price) of foods simply by adding adjectives. Rhubarb would become Bohemian Wild Rhubarb for instance. As though rhubarb could ever be straight-laced or tame.

I’m certain (OK, I have no evidence) that one Honda garage I visited used to do nothing more for an annual service than apply bright red grease to the door hinges, so you could assume something had happened to the car during the day, apart from being raced along the ring road a few times, to KFC and back.

I spent a lot of time trying to convince our last pharmacist that he should make up a ‘proper mixture’ for each patient in a good strong colour, with a bit of bitter flavouring, in a proper fluted brown bottle with a glass stopper.

Sadly this suggestion was not met with the enthusiasm I felt it deserved.

I was not suggesting a complete sell-out to Charlie. Active antipsychotics and antidepressants are available in colourless liquids that can mix together, so this mixture would not be a placebo. Just an existing treatment with a bit of pzazz. Note the Zs .

It was just that I so wanted to make it Brilliant Blue.

But if the Mexborough department ever gets going, the  first development I would like to see is a dermatological version of Shake N Vac.

15. Searching for Weapons of Mass Distortion*

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In Glasgow, its safety in numbers.

Every Sunday morning I see the same lady in the newspaper shop buying lottery tickets. I’ve always wanted to ask her why she didn’t just send her money straight to Chancellor George Osborne, cutting out a chain of middle men and reducing the queuing time in the shop for the non-gambling section of the public.

I expect her reply would be something like, ‘I know my chances of winning are statistically not significantly different from zero, however the excitement of watching the draw and the possibility, however remote, of coming into sudden riches, beyond my wildest imagination, taps into a part of my mind that believes in dreams and miracles’.

Or, she might say, ‘I won a small amount once or twice, and it seems that intermittent reinforcement is one of the most powerful conditioning paradigms. I am simply powerless to resist’.

Or she might just say, ‘you cant take it with you, you tight git!’

Or, the killer retort: ‘why don’t you send the £2.50 you just wasted on the Sunday Times directly to Rupert Murdoch?’

Secretly, I ‘d love to have a go on the lottery but I cannot begin to understand how you go about it. People ask for things like, ‘two butterballs and a blingo’ and receive mysterious cards, some of which you can scratch. They seem happy with their purchases, even though they have exchanged real money for imaginary money.

It’s the same kind of cellophane packaged trinket as a cigarette packet, something that lights up the anticipation of  reward pathways, if you still have them.

It strikes me that Lottery Behaviour illustrates the theory of ‘cognitive dissonance’. This means that people have sets of thoughts that conflict with each other, but find some way of reducing the disparity.

Gambling provides a bit of a buzz, but goes against the value of prudence. The mind works to justify the behaviour.

For example, the lottery is ‘for charity’. So it is OK to give money away. The lottery company will help you with this argument by not telling you how much of the take actually goes to charity (28%). And of the 28%, how much is left for the actual good cause, after the charities have employed their staff and paid their overheads?

What does it matter anyway; the money is all recycled within the economy, generating employment?

Apart from the fact that Camelot, who run the UK national lottery, is wholly owned by the Ontario Teachers Pension fund. Nevertheless, I have nothing against retired Canadian teachers and have no problem with sending them any spare money we have. Its a way of thanking them for providing the current generation of Canadians.

Lots of people can help us reduce our cognitive dissonance, and make a good profit out of doing so.

The workings of the National Lottery mix a few different processes. Which is the odd one out:

1. Giving to charity?

2. Tax?

3. Gambling?

4. Profit for shareholders?

5. Pensions?

Clue: one of them is supposed to be a vice.

One way of reducing the difference between ideas is to soften the ideas and make them less distinct in the first place. Since ideas are usually written in words, if the words themselves are made meaningless, the ideas will get soft and fluffy enough not to jar against each other in our pockets.

Its a win/ win scenario.

Managers are people who make a living out of Cognitive Dissonance. Part of their job is to distort and reduce the meaning of language.

If you are working anywhere in business or the public sector you are  probably experiencing stress and frustration attributable to managers.

Take a typical scenario. You are sitting in a small hot room pretending to listen to someone giving a presentation. There is an ‘action plan’ to formulate. Something has to be written in 28 small boxes on a spreadsheet. People who are unable not to volunteer or avoid eye contact are given tasks to complete that will spoil their weekend. A pointless deadline is set for completion, leading directly to the affected person pulling a sickie that day.

Managers are people who like Audis, ties and bar charts, and I have no wish to offend any of them.

True, their claim to be a specific profession is undermined by the fact that the most successful managers of all have had no training whatsoever (e.g. Richard Branson, Alan Sugar, Steve Jobs…). The same cannot be said for eye surgeons or train drivers. Their main offence, however, has been to pervert the course of language. The question is, why do they do this?

Some people have suggested that there is something very sinister in the distortion of language. Gore Vidal, for instance, wrote:

‘As societies grow decadent, the language grows decadent, too. Words are used to disguise, not to illuminate’

George Orwell wrote about war propaganda as far back as the 1930s. I am sure he would not be surprised at the ‘dodgy dossier’ and other more recent examples of war related spinning of information.

People are pretty reluctant to engage in homicide, so to wage a war, some massive dissonance has to be bridged. Orwell noticed that those people creating the most extreme propaganda tended to be those furthest from the combat zone.

The more foolish the military regime, the more the medals and uniforms get brighter and shinier.

The paranoid theory of management is that it is a propaganda machine to pretend to people that capitalism is fun, like a game, and that companies are benign.

My own theory is less conspiracy orientated and more based on seeing managers as a cult. Their world is highly ritualised. They are very fond of assembling in groups, presided over by a priest-like person.

Their prayer-books and rosary beads are laptops and projectors and their altar is the Powerpoint screen.

They speak to each other in jargon, but they do not fully understand the meaning, much as Catholics used to say prayers in Latin.

Though lots of commentators have recorded items of management-speak few have attempted to explain the phenomenon.

Like any species, managers’ main purpose is to increase in number and safeguard their various niches in the social fabric. Sometimes they are parasitic, but parasitism is only one of their methods of survival. They often prosper where there is chaos and decay, since they promise to create structure and harmony, mainly on diagrams.

A recent survey of 2000 managers, carried out by ILM, found that management jargon is used in two thirds of offices across Britain and nearly a quarter of workers considered it to be a pointless irritation.

The incredibly frightening interpretation of these findings is that one third of offices had not noticed they are jargon-infected.  And over 75% of workers did not think it was an issue.

That’s like 75% of people not regarding bubonic plague as a serious health problem.

The same survey listed the most – hated phrases, such as Blue Sky Thinking, Going Forward, Touching Base, Close of Play, Drilling Down, Right Sizing things, etc.

Is such misuse of language a harmless eccentricity to make dull work seem more exciting, or does it have a more sinister purpose?.

Many professions have invented their own jargon, doctors being prime offenders. It’s much more fun to call a male person ‘a 46XY’ than ‘a man’, for instance.

The main difference is that professional jargon usually serves to sharpen a meaning, whereas management jargon does the opposite.

In IT for instance, we have become used to acronyms like RAM, LAN and WiFi, not to mention Killer Apps. In sport, we know exactly what a Try, or a Birdie means and we have strong views about LBW.

Engineers can tell us what a double over head cam does. In Costa, we have the Latte, the Cappuccino and the Flat White. All these terms are highly valid and reliable.

Compare the expression: ‘granularity’. Or ‘leverage’. Or ‘synergy’. Not valid or reliable at all.

Two explanations here: Managers are simply aping other professions’ use of technical terms in  pretending they are a distinct set of experts.

Or, management speak is actually a way of reducing disharmony by abolishing conceptual distinctions.

This leads me to a surprising conclusion.

Management is not an exclusive club at all. Almost anyone can join in. No special qualifications are needed. Management speak is a free for all. Like Esperanto, its an attempt to unite all the professions and none. Managers can go from one type of company to another without having to know that much about what the company makes or provides.

Managers don’t need to be able to do maths or write proper sentences, let alone buy lottery tickets.

The management icon, the Venn diagram, celebrates the easy maths we can all do in year 6. Management is like bingo or ten pin bowling. Anyone can do it and they’re glad to have you.

Maybe we need managers to provide this kind of unity that masquerades as conflict. To portray the world of work as an exciting drama, or gladiatorial contest.

Just as we need politicians to give the illusion of political argument and lawyers to give the illusion of adversarial justice.

Managers may function as a kind of ecumenical movement to stop people fighting about whose God is best. The penalty is having to sand down the theological edges.

In serving to reduce cognitive dissonance, managers are probably helping us survive in a hopelessly conflicted world.

Perhaps the problem, again like politics and religion, is not the profession itself, but rather the type of people it attracts. The danger of abolishing the meaning of words is people taking liberties with the rule-book. Bullies and narcissists love to hide in these kinds of hierarchies.

If you feel that management culture is ruining your life, try re-framing your managers differently. An old – school CBT technique was disempowering a tormentor by imagining him wearing a tutu or sitting on the toilet.

Try imagining your manager as a pirate.

The empire once needed pirates to advance its cause. This resulted in one of the best PR exercises ever done, in effect re-badging cut-throats and thieves as swashbuckling heroes.

Your company might need pirates of a kind, if only to fiddle the government targets.

Your manager is just a pirate who likes to dress up.

Like Captain Shakespeare, (Robert De Niro) in Stardust, he’s probably got a penchant for ladies clothing.

Watch that movie if you haven’t already. Your manager won’t have seen it. Beware of pirate copies though.

*Weapons of Mass Distortion was a book by Brant Bozell III about a supposed liberal bias in the US media.

Your manager won’t have read it.

Much better, it was a track on Crystal Method’s Legion of Boom album.

Your manager won’t have bought it.

14. Finding the Chimps in the Armour.

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Nice nails, nice hair, shame about the ears.

A chimpanzee dressed as a removals man takes a tea break with colleagues, only to have the piano they are moving crash downstairs.

The year is 2002, the last year Brooke Bond tea were able to use chimps as actors.

It is estimated that there are over 300 showbiz chimps in the USA. A study recently suggested that using chimps for advertising reduced people’s concern for them as an endangered species.

Perhaps the most famous showbiz chimp is Bubbles, who once belonged to Michael Jackson. Not many people know that Bubbles had a former career in research, from which he was ‘rescued’. Bubbles now lives in Florida. He has still not been told about Michael’s sad demise, so I hope he is not reading this.

It is reported that Bubbles has taken well to Florida, putting on a bit of weight and spending the day listening to music and watching television.

Peoples’ attitudes to anthropomorphism – projecting human attributes onto animals and vice versa – are pretty chaotic.

We no longer have TV shows such as Animal Magic, where a voice – over contrives to turn animal footage into mini – drama.

However, cut to 2012, where Ashleigh and Pudsy, a teenager and dancing dog, perform a slickly choreographed routine to the Flintstones theme, to win ‘Britain’s got talent’.

Simon Cowell remarked: ‘You know me, I love a dancing dog, and Pudsy is one of the best dancing dogs I’ve ever seen. My only criticism is I’d have put Pudsy in a prehistoric outfit as well’. (As well as himself perhaps?)

Nowhere have I read any suggestion that training Pudsy was unkind in any way. Contrast this with the kind of coverage with which circuses have had to contend.

Apparently, in the USA, there have been more than 35 dangerous incidents since 2000, where elephants have bolted from circuses, run amok through streets, crashed into buildings, attacked members of the public, and killed and injured handlers.

Time, surely, to send in Sting and maybe even Bono too, to set them free.

Psychiatrists are quite interested in animal behaviour. ‘Ethology’ features significantly in the membership exam multiple choice questions, being the ones that you throw dice to complete randomly, in the last minute.

Always looking out for similarities between animals and their owners, we expect, for instance, a Bubbles solo album in due course. More usefully, we know to beware entering the houses of people who have a) mental health issues and b) lots of pets.

Although, in such circumstances, most pets know that they should first bite the social worker, then the GP, before biting the psychiatrist. Its just a kind of ethological pecking order.

So, what counts as a day out for most people is a field trip for escaped psychiatrists.

Last week l visited a zoo, Newcastle, and my workplace, and its time to compare and contrast. First the zoo.

Nowhere is anthropomorphism more politically incorrect than the zoo.

One can only admire the dedication of the staff toward the welfare of the animals. The lions had loads of space, the lemurs got The Guardian delivered every morning and the reptiles were pampered, perfumed and stroked by two nice young ladies. Not for a moment did I wonder whether they had painted stripes on the snakes with nail varnish.

So, why was it I got this yearning for an old style zoo, where it was OK to throw currant buns at the elephants and dress the chimps up in tutus and cravats?

That kind of thing just isn’t allowed nowadays.

Surprisingly, London zoo haven’t dressed them like this since 1926. Though as late as 1962 Hints zoo dressed them up as decorators and gardeners and gave them bicycles to run round on.

I am sure if I tried to organise a chimpanzee’s tea party I would be struck off the medical register and censured by the district ethical committee.

It’s just that I get the feeling the animals are missing out on something too.

Chimps seemed to like using tools and being silly with paint. Dolphins seem to like acrobatic leaps out of the sea and splashing people in boats. Parrots seem to like riding a unicycle and squawking ‘Hello Keith’.

Maybe the problem is in the phrase ‘seem to like’. Critics might say the animals are trained to act this way by behavioural methods, such as rewarding a desired behaviour with a Malteser or a small fish. Not to say punishing an unwanted behaviour with devastating sarcasm.

Could it be that Pudsy’s seemingly ecstatic enthusiasm is simply a series of learned behaviours, conditioned and chained together during lengthy and gruelling training sessions, each new move heavily reinforced by food pellets? How closely does Pudsy’s behaviour resemble the naturalistic behaviour of dogs in their ‘normal’ habitat?

Possibly animals no more like to ‘go showbiz’ than your washing machine likes to spin at 1400rpm all day.

Pudsy is not an elephant, so is unlikely to pull off a break-out one day, or be rescued by Sting.

Its been said that dogs grow to resemble their owners, but chimps are the animals humans most resemble in terms of appearance and genetic code.

Chimps, like jazz, went their own way 4 million years ago, the split apparently caused by ‘creative differences’.

Chimps were being discussed at the Royal College of Psychiatrists Addiction Specialists conference in Newcastle last week. Though Escaped Psychiatrist is not an addiction specialist, he managed to infiltrate by not shaving for a few days beforehand.

Steve Peters was the big name speaker. His work in elite sport has generated a lot of interest, and his book, The Chimp Paradox, has become a bestseller.

Steve is a psychiatrist rather than a psychologist, yet has eclipsed sports psychologists with his recent high profile successes in cycling, snooker, several other sports and now football.

That’s gratifying for a psychiatrist – we secretly think we would be brilliant at any other career we tried, from hosting a chat show (like Anthony Clare) to chancellor of the exchequer. (Seriously, how hard can it be?)

In person, Steve is charismatic yet self effacing. He has been working on the Chimp model for many years and gradually refined it. Clearly he has incorporated it into his own thinking, resulting in well deserved fame and acknowledgement.

I think Steve has come up with the right model at just the right time, like the iPhone in 2007. The CBT bubble is bursting to some extent and people are hungry for a model with more practical bite.

The name Steve Peters is exactly right for a sports coaching guru. If you were to write a novel about a successful footballer or boxer you would probably call him Steve Peters.

Secondly, he looks fit and healthy, as though he belongs in the world of sport, which is unusual for a psychiatrist.

Most importantly, his ‘chimp’ model of the mind provides a useful metaphor to help understand aspects of human behaviour.

There is a certain amount of overlap with other models, such as Eric Berne’s Parent / Adult / Child system , the ‘seven kinds of smart’ from Emotional Intelligence and even Freud’s concept of the Id. In response to a question, Peters explained that the Chimp went way beyond what Freud would have expected of the Id, in terms of perceptiveness, calculation and dominance.

He also contrasted his model with the Type 1 / Type 2 scheme established by cognitive psychologists, in particular his construction of the part of the mind he calls ‘the computer’, which is paramount in sports performance .

Since Escaped Psychiatrist is mainly concerned with Depression, I am thinking about what this model could bring to the battle.

My first thoughts are that Depression is often associated with poor decision-making.

Whether this is cause, effect or co-incidence varies, but there is certainly a large group of depressed people who have suffered from internal sabotage.

Much of this self destructive behaviour is associated with poor impulse control- behaviours such as overeating, substance misuse, poor anger control and a failure to delay gratification.

A lot of the young people we work with seem to have made a series of terrible decisions, leading to the conclusion that sometimes, ‘misery is the wages of sin’. OK, for sin read ‘dysfunctional behaviour’.

This morning the Today program reported that deliberate self – poisoning in young people had increased by 40% over the last decade.  It looks as though the new generation are struggling with their inner chimps more than ever.

Though I struggled with a significant proportion of Peters’ book, particularly the notion of the psychological universe, made up of planets and moons, there are lots of useful behavioural strategies dotted around the chapters. Peters thinks that children ‘get’ the chimp model quite easily, which means it might suit schools and children’s services.

I guess my concern here is that there is a group of chimps somewhere discussing this, probably  wearing tutus and cravats, drinking tea out of china cups, concluding that what is wrong with chimps nowadays is that they just can’t keep their human side under control.

13. Less is More, more or less.

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Another shop you don’t need to go in.

A sunny, windy Saturday morning. A queue of cars waits to turn right into a muddy field, creating a hold up on the A60. Each car is full of junk. The people from the cars unload their junk onto trestle tables and tarpaulins. People exchange items of junk and money. This is not a film crew re-making ‘Grapes of Wrath’ on location. It is a car boot sale, and it’s a tragedy.

You have a car that is 99.9% working. The part that isn’t working is a warning light that comes on when it shouldn’t. Ironically, the warning light is a faulty alarm, giving warning only of its own falsehood, but it is enough to fail the MOT test and render the car worthless.

The car must be recycled, and it is not a tragedy. Gordon Brown used to pay people to dispose of cars, successfully stimulating the Korean economy. For a while cars could be handed in for a bounty, like coyote pelts.

In our town centres, piles of junk are decanted into vacant shops under the guise of charities and sold on for slightly more than you might pay at Primark, if only you weren’t phobic and dared go in.

No disrespect to charities. It is just a pity that they have been sucked into the landfill business.

One of the best things you can do to help yourself is to throw away half your stuff. So, lots of lifestyle gurus have latched on to ‘decluttering’.

However, as Tony Blair didn’t say, its not enough just to fight clutter – we have to fight the causes of clutter also, otherwise it will merely return in a new and terrible form.

Why do we have so much tat?

The economic answer is that our society values economic growth above all other measures of civilisation.

The evolutionary answer is that for most of human existence it has really paid to hoard stuff away. Our grandparents, who lived through wars, failed to adapt to the disposable society and proved unable to dispose of their empty yogurt pots and biscuit tins. Many of them were killed in hoarded item landslides.

The psychodynamic answer is that we invest emotion in objects, so that they acquire a sentimental value. Under this heading we include whatever defence mechanism is responsible for Collecting Things.

The cognitive answer is that we hate waste. In particular we hate to lose stuff that we already have.

I don’t doubt for a moment that already there are huge land fill sites, and that a lot of land fill should really be recycled, and that land fill is problematic from an environmental point of view.

It’s just that, judging by the state of many people’s houses and sheds, the land fill sites should be so much bigger. Somewhere around the size of Bedfordshire, as a rough estimate.

Borrowing a bit from Escape from New York, why not declare an area – such as Bedfordshire – an official landfill site and build a tall fence around it? Gradually, Bedfordshire would grow taller and mountainous and probably beautiful in due course – if you could find it.

I would like to see a huge re-cycling plant for vinyl records where they can be turned into food by a special fungus.

I’d like to see all the remaining cathode ray televisions collected, melted into a giant saucepan and made into comfy chairs .

And all the books – after digitising – can be made into a new Hadrian’s bookcase along the entire Scottish border.

All the coins and money could be melted down and made into the kind of shiny foil clothing people in the 1960s imagined we would all be wearing by now.

And most of all, I’d like to see all those cardboard crowns that litter the window sills in Burger King, collected, pulped and made back into trees.

Architect and designer Mies Van der Rohe is credited with the saying ‘Less is More’. He would have been a little disappointed to find so little evidence of minimalism or even room to swing cats in our houses today. Though modernists would probably have expected people to swing their cats in verdant communal parkland between the high rise blocks, or in high quality piazza spaces, rather than indoors.

Some architects have even gone as far as to question whether cats need to be swung at all.

Digitisation seems to give us the opportunity to miniaturise the storage of all our music, video, art and documents to a card the size of a postage stamp. Using ‘the cloud’, we do not even need the little card any more.

Sadly, one has the impression that the space vacated by digitising records, books and pictures will quickly be filled by gym equipment and antiques.

It is tempting to hold the media – particularly the Sunday Times – responsible for the clutter epidemic. For instance, yesterday, the paper carried an article about buying a Victorian bidet, allegedly haunted, for £325. ‘Its sad to part with it,’ the article concluded, ‘but I’m downsizing’. What, do without a bidet! However will you manage?

In truth the blame lies closer to home. Yes, psychiatrists are to blame for the landfill explosion and thus, soon, losing one of our treasured counties. This is the reason:

Some how or other, psychiatrists have convinced the world that tidy people have something wrong with them. Tidy people are called ‘anankastic’, which sounds suspiciously like ‘antichrist’.

The word ‘anankastic’ means something similar to obsessive.

Psychiatrists have not explained very well that the anankastic personality is not the same thing at all as obsessive compulsive disorder.

Implicit in OCD is the acceptance that the thinking and behaviour is silly. Whereas the anankastic person does not think there is anything wrong with what he regards as being extremely well organised.

Psychiatrists have hinted that tidy people are repressed in some way. Something to do with anal retentiveness.

Tidy people will never be competent painters, jazz musicians or good at sex.

Look at how they are portrayed in movies and television. Radar, from Mash; Dwight, from The Office; Mr Gradgrind, from Hard Times.

Psychiatrists have been generating bad press for tidy people for over a century. There is no range of perfume called Anankast, not even in Superdrug.

There is no Anankastics charity shop in town, though by now  it would have been renamed Spick and Span, to reduce stigma.

In the Mr Men series – pretty much the bible when it comes to personality classification – Mr Neat and Mr Tidy are only minor characters in the book devoted to Mr Messy.

Looking back to the late 19th / early 20th century context, when the analysts were most active, perhaps this is more understandable.

Freud and his colleagues had no PIN numbers to remember, no car insurance to renew, no DVDs to take back to the library.

They did not have to use mobile phones to pay for parking. They did not even have land lines. They had no need to keep a range of spare batteries, chargers and light bulbs, or gas cartridges for their Braun Independent beard curlers.

They had no need to use their Tesco voucher within a specific 7 day window.

Freud never had to find a 13mm ring spanner or a 30 amp fuse.

He never had to worry that Jung had hacked his facebook page.

Today’s world is so different. The need for organisation is so acute some households should think about appointing their own executive boards, complete with Venn diagrams and Mission Statements.

As a psychiatrist I feel guilty about what we have done to besmirch tidy folk, and offer the following solution:

Since we have invested a lot of emotion in objects, we cannot simply dispose of them as the de-cluttering guru suggests.

No, each item really needs a decent send- off, with a few kind words and reprisal of happy memories. This way the grief can be channelled and worked through.

The actual process would be quite like Antiques Road Show, but featuring a conveyor belt and incinerator.

That way Bedfordshire can be saved.

12. Grappling with the wrong trousers.

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What the well dressed tree is wearing this year.

A procession of girls moves jauntily down Oxford Street. Each girl carries an identical Gap carrier bag and wears brightly coloured skinny trousers. The legwear ranges through many colours and materials – there are 23 different types in the shop.

It took me a while to realise it was an advertising event. Initially I just assumed that ‘Jeggings’ had really taken London by storm, either that or Mayor Boris had passed a new bye-law banning big trousers.

How tempting was it to join that line? So called ‘modelling’ is one of the strongest determinants of human behaviour. But by the time I had got into those trousers the line would have reached Tottenham Court Road and disappeared.

Some animals are hard-wired to behave exactly the same as their neighbour, making possible formations like shoals of fish and flocks of starlings. Someone explained to me that starlings and fish do not need to be particularly clever to pull off this trick. All they need is the instruction ‘do the same as the one next to you’.

Humans like to create this effect too, in Busby Berkely movies for instance or the Red Arrows air display team.

We are used to seeing similarly clad people in other contexts, such as children in school uniform and North Koreans in boiler suits. We like to be wearing the right things.

A demonstration of modelling behaviour is one of many attractions to be found in the local shopping centre. Since social services closed all the day care facilities, shopping malls and libraries are the best places to hang out to keep warm.

Compared with the library, the shopping centre is quieter and more studious in atmosphere. Also there are more books to read.

This part is vital – before you visit the shopping centre – establish the goal. On this occasion the target is: 1.To experience the sensation of being out of place; 2. Not to respond to this sensation by buying something.

For your day out, start by re-framing the shopping centre as a kind of art gallery.

All the familiar shops / exhibits are there (not you Woolworths). There are lots of things you can do free: try out the mattresses in John Lewis, try on lots of jeggings, use the computers in PC world to look up reviews on the same model you are trying, so you can spurn the attentions of the salesperson, use the cameras to take pictures of other people testing cameras on you, try on tester perfumes and marvel at their interesting names.

Or go into Superdrug, and ask for a super drug, such as beta interferon. Ask why they call themselves Superdrug when the best drug they have is ibuprofen.

My hypothesis is that shopping behaviour is a sublimated form of hunting, or at least gathering. The important thing to remember is that all the fun is in the hunt, and once the quarry is cornered then the fun is over. It is all about the expectation of reward – pulling the trigger on a purchase is entirely unnecessary.

Buying something is like coming home from a day’s fishing with a small trout you could have bought in Morrison’s for £3. The trout’s dead eyes communicate to you: So what?

You should have thrown it back in.

Things are not always what they seem, and shopping malls allegedly have a purpose beyond amusement or art.

Shopping malls are meant to part people with their money, rather than act as a recreational facility for escaped psychiatrists. The architects and designers have put in some subtle influences to work on your mind.

One of these is the so-called ‘Gruen Transfer’. This is a place, within the centre, that is designed to disorientate people, by using a combination of unusual shapes and textures and lighting, often accompanied by Muzak.

Apparently the effect is similar to a unit of alcohol or other anxiolytic. People slow down through the Transfer, and co-incidentally this is where the higher priced items are located.

I am not convinced that there is a strong evidence base for the Gruen Transfer, or other devices perpetrated by the advertising industry. Certain low budget shops seem to generate the same emotional disruption.

The oddly named B and M store, sometimes sub-headed ‘Bargain Madness’ can induce such profound despair that it could probably be used as a testing lab for possible new antidepressant compounds. Here the store has been less discreet about its use of disorientation – the clue perhaps is in the word ‘madness’.

Agoraphobics, who tend to have panic attacks in shops, seem to dislike places where there is no clear sightline to the exit. The entrapment induces a sense of doom. Though Morrison’s have an excellent range of vegetables, the way they are laid out can set a person on edge.

Individually, fruit and veg items are not threatening, but when they gang up like this, piled high on all sides, it creates a kind of jungle effect reminiscent of Apocalypse Now.

Another piece of (probably bogus) psychology I have read, relating to supermarkets, is that people have an ‘innate tendency’ to gravitate anti – clockwise. This led to supermarkets placing their main entrances on the right hand side of the shop.

If it was on the left, people would just drift further leftwards into the vegetables section and beach themselves in the courgettes.

Staff would come out to spin customers into the next section, like fairground attendants on a waltzer.

I wonder if it is different in the southern hemisphere, or for the left handed?

It is perhaps a little frightening to think that someone has manipulated the environment in such a way that you have unwittingly bought yourself an expensive, weirdly named perfume.

I am not just referring to ‘Obsession’. What about ‘Hypnotic Poison’, ‘Crazy in Love’ and ‘Thallium’? The internet tells me there is a perfume called M-75, which is the name of the rocket Hamas fires into Israel.

Perfumes, like the Gruen transfer, and the clockwise supermarket, are designed to create an altered state, but what exactly is the state of mind called? In the case of perfume, if it isn’t the name, it is probably solvent intoxication.

Or perhaps it is the feeling of being out of one’s element, or out of step with others. A warning that you are on unfamiliar territory.

Behaviourally, it is supposed to trigger a purchase decision.

The purchase decision is a learned behaviour that creates comfort, possibly by stimulating the ‘anticipation of reward’ section of the mind. The unsettled feeling is briefly quelled, only to be replaced by regret that you have suddenly become poorer and the shop richer.

How comforting is it to be in a herd of people all dressed appropriately and behaving in the same way? Enough people must love formations of soldiers to make it worthwhile dressing thousands of people this way and arranging them in large city parks. Everyone seemed to love the Olympic opening ceremonies.

Lots of people like to be in queues, and will probably join the end of any queue if they find one. If other people are after something, instinct says there is probably something there to have.

There is often not much to be found at the end of a motorway queue, which is formed by the pulsatile dynamics of traffic flow rather than obstacles, but the queuing instinct has evolved over the lengthy period of human history before tarmac and has not yet abated.

The instinct to behave like the person to the left of you is deeply rooted and possibly imprinted at an early age. Experiencing the feeling of being in the wrong place or in the wrong outfit is deeply discomforting.

Many people hate the moment in a restaurant when they have to set out to find the toilets. The fear is not that they will never find the toilet, but rather they will make them-self look foolish to others by dithering round the restaurant.

That is why I think it is a very tall order for CBT to try and get people to fight the idea that it matters a lot what other people think of you.

In the golden era of CBT, pioneers tried to attack this set of cognitions using grand behavioural tasks.

Albert Ellis, pioneer of CBT and our hero, in his list of the top 12 Irrational Ideas, included this as number one:

‘the idea that it is a dire necessity for an adult human being to be loved or approved by virtually every significant other person in his community’

Loved? Maybe not. Approved? Maybe not? But thought to be wearing the wrong trousers? I’m afraid it’s a deal breaker.

Maybe it shouldn’t matter. Maybe not as much. Certainly try and test how much it matters. Certainly try and get it back into proportion.

But it just does.

That leaves us with a burning question. If it is so important to blend in with everyone, why do certain people do everything they can to attract attention to themselves? For instance by dying their hair a florescent colour?

This is perhaps the exception that proves the rule, since these people are relatively few in number, especially in professional groups like accountants or dentists.

Several answers to this – you choose the one you like best:

So that they are visible in traffic?

Reaction to feeling left out or insecure?

Mating ritual?

Group or gang identity?

Genuine lack of insight about how they look?

They are doing a CBT assignment to reduce the irrational cognition that it matters what people think about them?

11. Tackling hooligans with a simple checklist.

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Your quiet reflections while driving to work are rudely interrupted by an idiot screaming past you in a small hatchback, overtaking the whole line of traffic, narrowly squeezing back in, missing a Portuguese pig lorry by inches.

Hooligan.

Your colleague interrupts his outpatient clinic with a brief diversion onto the internet only to suddenly find he has bought a 1995 Harley Davidson Fat Boy on ebay.

Hooligan.

Such events interrupt our attempts to look at the world as a sensible and logical place that only needs a few tweaks to make it perfect. The mind tends to create a fantasy world to live in more comfortably, and this explains dogs, fluffy toys, scented candles and soap on a rope.

Plenty of people will help us build the world of our dreams, not least the media.

Imagine the mind as a daily newspaper. Though the mind probably does not have an editor in chief, it has an editorial committee made up of opinionated people like taxi drivers and Irish nuns.

Yours may be different.

Plenty of space is devoted to current events, but even more is devoted to gossip and scandal. Quite a bit is devoted to food, clothes and the pursuit of food and clothes. The sports and health pages are also mainly about food and clothes.

Depending on the make – up of the committee, the mind can create very different sorts of world view. The Daily Mail mind for instance is quite suspicious. The Guardian mind feels it is being exploited. And the Sun mind is interested in sex and crime.

Since the concept of Depression as an illness calls for a change in a person’s usual world view, we have to imagine an editorial committee whose usual members – Fiona Bruce, Jeremy Vine and Hugh Grant – have been replaced by Leonard Cohen, Salvador Dali and Rev Ian Paisley.

Suddenly the world is transformed; distinctly darker, and quite unbalanced. Instead of Animal Hospital, as a change to a our usual programs, we now have live cockfighting from Wolverhampton.

CBT is an attempt to create a new committee instead of doom-mongers. The idea is to cut out the stuff about war and pestilence and put in more restaurant reviews.

It is tempting to think that resetting the mind’s information filtering system can bring about a more positive outlook, and this in turn could brighten the mood.

An old fashioned CBT technique, I think it was called Mastery of Pleasure, (or was that a sex manual?) involved creating a written timetable of your whole week, giving each activity a score between 1 and 10 depending on how much enjoyment it generated.

For example, watching Manchester City would score 6, while loading the dishwasher would score 7. This created a clear overview of the week, both in terms of quantity and quality of time.

Then, by substituting more dishwasher loading for football watching, your week would be improved, and more importantly, you would have disproved the notion that you had no control over how you felt.

It’s lucky that Mastery of Pleasure (or was it a postgraduate degree?) was not widely disseminated, as I suspect it is a technique that could easily turn our world upside down.

Imagine, calibrating everything, and finding, as we would, that 90% of our time is wasted on completely unnecessary items.

Luckily, Mastery of Pleasure (or was it a porn novel?) teaches people to rate their activities for pleasurableness rather than usefulness or necessity. Nevertheless, it calls upon them to re-evaluate what they find pleasurable, and if possible, substitute more pleasurable activities into the schedule, so that the whole average pleasure rating starts to increase.

There is some very interesting psychology involved in how people summarise pleasurable experiences, but one example is the case of the CD with a scratch on it about a minute before the end.

Has the scratch ruined the whole experience? What about the previous 49 minutes of pristine music?

Pleasure does not work like kilowatt hours, where we simply multiply power and time to sum up the energy used. Pleasure does not total up like the area under a curve on a graph, because the rating is given retrospectively from memory.

We also know that the beginning and the end of experiences carry more weight than the middle bits, which is why brevity is the soul of wit and why ‘The Archers,’ even at 12 minutes long, can get away with an absence of dramatic content between minutes 2 and 11.

What are the implications of moving the calibration system for pleasure from the automatic to the reflective mind? The danger is that certain activities may face a downgraded credit rating.

Some activities are probably best left to the automatic part of the mind. We could include sex, jazz and the tennis serve, which can all be affected by performance anxiety.

Once you start to rate pleasure, you may risk killing it.

I have already commented on the illusory joy of pets. But what about clothes and the pursuit of clothes, the activity called shopping? What about old stalwarts, like watercolour painting, banjo playing or golf?

What about photography, now that it is all digital? Techniques like solarisation and bas relief, that in the old days needed hours of darkroom work, involved getting contact dermatitis from putting your hands in developer, ruined your carpets etc, now can be achieved by moving a slider on a computer screen.

It so easy to make absolutely beautiful artwork using Photoshop or similar, that, suddenly, it loses its appeal totally. Such is art. It appears to need ingredients of toil and hardship to make it valid.

The notion of suffering being necessary to bring any value to an experience is borrowed a bit from religion, and also from the series Fame. Work is the price you pay. No pain no gain etc.

But how can we include items like suffering and pain in our Mastery of Pleasure (or was it a pirate ship?) timetable? Would it do suffering justice to simply rate it as zero?

Religions are always having to try and explain why terrible things happen, and this must be a massive burden for religious professionals. Why did God allow David Bowie to make the Tin Machine albums for instance?

Along the same lines, and probably to answer the same questions – only about world war and genocide – Freud developed the notion that people had a kind of death instinct.

Possibly this inspired Michael Winner to make the Death Wish movies. Though Freud would probably have put more effort into developing the main character, Paul Kersey, played by Charles Bronson.

As well as being a vigilante, Kersey was an architect. His building designs are only shown briefly, but he appears to encourage clients to save a lot of money by using a cheap building method just a little embellished by post-modern decoration.

These short cuts mirrored the corner cutting he brought to the criminal justice system by acting as police, judge and executioner all at once. I do hope Death Wish gets re-made with a lot more architectural referencing (see Point Blank).

Kersey has to choose between a civilised, measured and incremental approach to justice, using proper channels, or facing his hooligans head on and shooting them.

It is difficult to accommodate a drive toward death and destruction within a model that attempts to micro-manage pleasure activities, unless we just accept it as an elephant in the room we have to work round, covering it with a floral throw and scatter cushions.

Unless we try and accommodate destructiveness as a more understandable behaviour.

Kersey, like many other movie heroes, became a hooligan himself, but the audiences tended to view him as a necessary evil. People seem to want to subvert the usual processes of justice every now and again by acting completely out of character and possibly violently.

Kersey’s violence was initially triggered by revenge, but turned into a social mechanism, like pest control.

Many acts of seemingly random violence, such as ‘Running Amok’, have been construed as social mechanisms that redress some long lasting injustice.

In updating the psychoanalytic model of the mind, the ‘object relations school’ coined a character called the ‘internal saboteur’.

As far as I can understand it, object relations concerns itself with the very primitive mind and its development in the first few months of infancy. This is before the time when a person knows that he is a separate person and can correctly assign his experiences to inside the self or outside it. Conflict can occur in processing the aggression / guilt feedback mechanism. The object relations school seemed to focus a lot on breasts, so their world view was somewhere between the Guardian and the Sun.

I have trouble understanding object relations theory (you can tell), but we need to somehow include in our model of the mind a person – like Dr Zachery Smith in Lost in Space – who works behind the scenes to sabotage the ship.

(Or, even more evil, the Ian Holm character, Ash, in Alien – why is it that internal saboteurs are found mainly on space ships?).

Up to a point self – destructiveness can be explained as an attempt to get back at others or redress the balance in a power relationship. Sometimes it may be better to explain it as a short cut in making changes happen quickly.

I am reminded of recent attempts to fix small electrical appliances such as toasters. There comes a point where the attempted repair turns into a post mortem, the turning point being recognition that the appliance was never designed to – and cannot – be disassembled.

Finally, pulling the two halves of toaster apart with bare hands or hitting it repeatedly with a rubber hammer bring about the desired outcome of an end to the toaster issue. A colleague tells me that this happens a lot with motorcycle repairs and is known as ‘the berserker phase’. Luckily, he is not a surgeon.

In fact people who harm themselves by cutting make the observation that the act focuses and resolves a moment of intense mental turmoil.

Not recommended and foolish, both for toasters and people.

Destroying motorcycles is probably a good idea though, in the wider scheme of things. In fact there is quite a lot of redundant junk and clutter in most people’s houses that is crying out for some rational hooliganism. If you have a cathode ray tube television for instance, you have probably wondered from time to time about throwing it out of the window. I worry about you if you haven’t.

Which brings us back to the problem of calibration of emotional states. It is very difficult to find the right frame of reference. If we subjected many activities to scrupulous measurement, we would have to categorise them as ridiculous and unnecessary, like carrot shaped trousers.

In using CBT to re-evaluate and re-schedule activities, we begin to ask ourselves some difficult questions. Why does everyone we know seem to spend all day looking at a computer screen? Aren’t they supposed to be an engineer / teacher /artist?

If they realised how they now spend their time, might they be tempted to destroy the computer with Greek fire?

And if we had to carry out a Mastery of Pleasure (or was it a Waddington’s board game?) exercise on, say, running a marathon, or digging the garden, or training a parrot to ride a unicycle, how would we measure the area under the curve?

When we encounter a hooligan in our mind there are several ways we can react:

Hug them (as recommended by the Prime Minister)

Shoot them immediately (as recommended by Michael Winner)

Run away

Using a wider frame of reference, attempt to understand the hooligan

Attempt to slowly reform the hooligan using metalwork and batique

Cover them with a floral throw and scatter cushions

Play them some Tin Machine

Depending on your editorial panel, you can choose any of the above options.

(Or was it a steam locomotive?)

10. Insuring the uninsurable.

ImagePendleton’s headquarters.

Might you get depressed one day?

If you answer yes to any of the following questions, this is quite likely:

Do you tend to play a Party App on your computer rather than attending a real party? Do you support a perennially unsuccessful football team? Has everyone in your extended family been treated for depression? Do you regard your pet snake as the best friend you have ever had?  Have you been depressed every single day of your life so far?

Depression is likely to affect a sizable minority of us at some point. I’m skeptical of surveys that tend to show practically everyone in some areas (Slough?) is suffering from depression, but suffice it to say it is a major common condition on a par with blood pressure or diabetes. So, is it worth insuring yourself against getting depressed? There are several reasons why not, at least in terms of popping into Swinton or calling Direct Line.

When we consider insurance we are embarking on what is now grandly termed Risk Management. By this is meant that we need to look into the possible future and explore some hypothetical events, such as burglary or fire. Whether we might get ill or not is rather hard to predict. And also it is something we are most reluctant to think about. Some people do take out health insurance, but most of us do not.  Perhaps the main barrier is thinking that it will never happen to us.

And people are right to be skeptical about the insurance industry. Everyday someone texts me to urge me to claim back mis-sold PPI. Please can we go back to Nigerian banking scams? I have never seen a specific Mental Health Insurance Policy, though some aspects of mental health may be included within a wider health policy. Why?

First – insurers tend to specialize in more concrete types of illness like cancer or heart disease. They like to know you have not had previous episodes of the same illness. They like to be able to say categorically whether the illness has happened or not, whereas a diagnosis of depression often falls within a grey area.

Second – depression is so common that the premiums would likely be very high and riddled with snags and get out clauses.

And third – it’s not as though you can really buy a guaranteed effective treatment with your payout. The treatment of depression is as much a lottery as selecting an appropriate insurance policy.

A policy might pay out to protect your income if you cannot work due to depression. But this can lead to a horrible situation where a person is locked in an insurance- perpetuated sick role, much like the benefits trap, where it makes sense financially to continue to act like a depressed person.

But there are other ways of insuring against depression, without troubling the man from the Pru, or his modern day equivalent, lurking in the dark recesses of a Sunderland call centre. (Just redressing the north south balance, having mentioned Slough earlier on.)

Be Prepared, as Baden Powell advised. I am sure he meant this in a specific and practical way, such as keeping a spare credit card in your sock. Preparing for very unlikely events, such as a Harlem Shake breaking out in the library, or the invention of punk rock, is beyond the scope of ordinary scouting.

Can we prepare for Depression? I am referring to getting the roof of the house in order before the rain comes, as David Cameron would probably put it.

When depression hits, the mental functioning is decreased in certain key areas such as reduced concentration and energy levels. That means, if you are stretched to function properly even when you are well, then when you get depressed you may go under. That will lead to a vicious circle of more stress caused by failing to keep up, leading to worsening depression. Finally comes a crunch point where things officially go to Hell and High Wycombe.

That means if you are well at present you should be operating with spare capacity. What does that mean? I’m not your mum, but ideally:

You should keep at least a million pounds in your current account.

OK, that’s stupid, but: You should have a system for organizing and dealing with any paperwork including financial stuff. You should know where everything important is, like your birth certificate and passport. In particular some way of keeping the electronic passwords you need for online banking etc. You will never remember them if you get depressed, and you won’t even remember where you put the bit of paper you wrote them on. Then you will worry that you have lost the bit of paper or worse, someone has got the bit of paper and has taken your money. Morbid thoughts about poverty and ruin are common in Depression, and  suspicious ideas about others can occur.

So, strategy one is the tin box. Ideally take the biscuits out first and eat them.

Strategy two is more complicated, and involves working out your attitude to certain key issues. What is my policy on taking medication? What is my threshold for making an appointment with the doctor?

Strategy three is making sure none of the library books and dvds are overdue. Think how those fines could mount up.

It is clear that Risk Management is something of a myth when it comes to individuals. Actuaries – experts in statistics – work with very large sample sizes, for instance in predicting how long people will live. That makes it possible to run pension schemes and predict how much money will be paid out in future years.

When the sample size gets smaller, the effects of chance become much more significant. We have a similar problem when it comes to predicting the behavior of individuals. In particular we have been carried away with the idea that we can predict violence and self harm. We could probably predict a homicide rate for the whole population, but for smaller samples or individuals we might just as  well throw dice or read the tealeaves.

In fact a rather cynical movement has broken out within mental health work, which goes as follows: We are scientists of a kind, and we know that it is impossible to predict violence or suicide in individuals with an accuracy that could affect our practice.

Recognizing however that we work in a political context, we know that the standard on which we are judged will not be: Did a Homicide / Suicide occur? but rather: Was everything done, that should reasonably have been done, as judged by the man on the 7.15, to have prevented the tragic event?

Luckily, medical services tend not to give written guarantees, acknowledging that we are hardly in control of all the variables that predict how illnesses will affect people. Even Dixons, perhaps especially Dixons, do not guarantee that things will not go wrong. They only guarantee to fix or replace the  eg Beko if it eg explodes.

Patients cannot therefore expect infallibility, but only ‘reasonable care’.

Aware of the political context, clinicians have created an ingenious analogue of what looks like reasonable care, just in case something goes wrong. Take for instance the so called HCR20 scale, which purports to predict risk of violence.

It has a series of numerical scores, which must not be added up to make a sum total. The main function of the scale is that it shows you have considered the proposed risk factors and given some thought as to what might happen in a range of future scenarios.

Calling it ‘arse – covering’, as I heard an angry service user describe it this week, is inaccurate, as such a process is just as likely to create unexpected new buttocks.

Very few health managers and even fewer politicians are experts in statistics. It would be nice to see more actuaries in parliament. I can’t help thinking that actuaries need better PR compared with lawyers, such as a hit TV show. There was never a show called ‘Sun Life: Miami’, for instance. Or even ‘Canada Life: Canada’.

Based quite a bit on ‘Minority Report’ a theme could be a panel of (maverick) actuaries who have learned to predict actual events – sudden deaths – in individuals, rather than just rates in large populations.

Using the dark arts of prediction – going against the fuddy-duddy regime at the Institute Of Actuaries – they would race round to the person’s house just in time to stop the victim poking metal forks in the toaster, or mistaking the Paraquat for Green Chartreuse.

The hero would be called Pendleton I think, and he would drive a lightweight trail bike or use parkour to beat the inevitable traffic jams.

In the first episode Pendleton would skim a CD copy of Microsoft Excel disdainfully into the river.

Each episode would end with a party at Pendleton’s cool loft apartment, and include a minor accident he had foolishly failed to predict, such as a champagne cork hitting someone on the forehead, or someone breaking a tooth on an olive.  ‘I never saw that one coming’, Pendleton would chuckle.

Health managers and Inquiry panels would announce, ‘what we need here is a Pendleton’.

Preparation is not the same thing as insurance.

Both depend on subjective assessment of risks and putting documents in a tin box, but for insurance you need to haggle with another person and give them money.

Its quite likely that subjective risk assessment is impossible beyond simple and likely events in the very near future. Beyond that we might as well use random number tables or a horoscope (which are the same thing).

By the way, there’s a free copy of Excel floating in the river.  And is that a trail bike I can hear in the distance?

9. The Optional Illusion.

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Facing my inquiry panel.

It is bank holiday weekend and I am waiting for the news to show the usual rioting in Brighton, as rival gangs of philosophers – down from ‘the smoke’ – fight each other with motorcycle chains. The battle between Positivists and Constructivists continues more ferociously than ever.

It’s all to do with the way you like to see Reality. The R word is an issue for mental health specialists, since mental disorders are loosely defined as a breakdown in reality testing. Positivists like to measure reality with a ruler, whereas Constructivists like to feel it through their sensory experiences.

Positivists are quite certain you have a dining room table made of wood, whereas Constructivists aren’t even certain they are in your house at all.

Having watched the Matrix, there has to be a chance that we are all just brains in buckets being fed information via the higher number Sky channels.

There are times when Positivism is essential, like measuring the dose of insulin and checking the blood sugar level, or flying a jumbo jet. When it comes to appreciating a restaurant or a book, it is probably better to judge the overall experience than rate it with a star scale.

Consider this experience: a car goes past you. There is a large dog sitting in the passenger seat, facing forwards. The dog has the window slightly open and a serious look on its face.

Why is that funny?

The humour is at the expense of the dog. It thinks its a human. It probably thinks it is driving the car. Sadly, the dog probably does not possess ‘theory of mind’. It is happily oblivious to its station in life, which is having no rights whatsoever and certainly no vote, not even for the European parliament.

Pets are big business in the UK. How much of the supermarket is devoted to pet food? How much greenhouse gas is produced by pet related activity?

What are pets actually for, if we exclude working sheepdogs and guide dogs?

OK, horses are arguably a form of transport. And I believe ferrets play a vital role in carrying cables through underground pipes. I think there are mites that play a role in cheese production, oh yes, and the little worm that goes in Tequila, though I’m not sure what it does.

I ask just to get some comments from pet owners and tequila experts.

If the answer is ‘for company’ then I’m thinking do pet owners display the same kind of obliviousness as the dog in the passenger seat?

Treating dogs and cats as people is a strange distortion of what animals really are. But in a way, we are all like the dog in the passenger seat. We construct a view of the world, but the view has many blind spots, illusions and distortions.

If the world was presented to the senses in a completely clear and unfiltered stream, it would probably seem unbearably harsh. Nature can appear very cruel if we don’t give it a bit of positive PR, which is when it becomes all things bright and beautiful.

You would like more friends so you create an imaginary friend in the shape of a grey cat. It has a droopy moustache and its name is  Zorro.

How many movies, how much merchandising, has gone into ‘anthropomorphism’ – projecting human characteristics on to animals?

The brain seems to have a tendency to attribute human like characteristics to natural phenomena and even inanimate objects such as steam engines and curling tongs, so its not surprising that creatures with two eyes and four limbs are treated as though they had finer feelings.

How much are you really empathising with a dog if you regard it as your loyal friend?

By now you have guessed that I just don’t ‘get’ animals as pets, and not much really as food. Some time soon I hope the genetic engineers will be able to make fillet steak from cell culture on a giant loom in Milton Keynes, and our cows (and horses) can relax again.

Animals have a key role in the eco system and they are incredible in how they can look and behave. They are magnificent creatures. I nearly said they are magnificent pieces of machinery (they are). I love Disney films, and Tom and Jerry, but I think I have placed these firmly in the Fiction section.

I just don’t think Toads can really buy motor cars and get put in jail for dangerous driving. Not even in Hartlepool, where they allegedly hanged a monkey having mistaken it for a French spy.

Just to leave the pet lovers alone for a while, let us turn our attention to motorcycles. From a positivist perspective we find that these accelerate very fast in a straight line. They are very cold and noisy, don’t really go round corners as fast as cars, use more petrol and tyres than cars, and are quite dangerous.

That’s if you actually ride them outside their safe operating radius of one mile from Cafe Nero. As a form of transport they get only one star.

But to counteract this, using a constructivist method, we temper our initial experience of noise, cold and danger with a range of romanticised imagery borrowed from Marlon Brando, Bruce Springsteen and Ewan McGregor, that sets motorcycling into a grainy black and white arts movie with a working class hero.

So Pets. And Motorcycles. The fantasy does not match the reality. We use ‘sentimentalisation’ to reduce the discord between the ways things are and the way they really ought to be. War has probably been sentimentalised more than pets, and slightly more dangerously.

And luckily, there is an absolutely huge industry whose job it is to help us not see things correctly, spanning politics, advertising and business. Advertisers construct chains of feel good imagery and attach them to our perceptions. Yogurt and Skiing, for instance.

In the motor industry engineers try to reduce what they call ‘NVH’, noise vibration and harshness. Sentimentalism is a defence against NVH in the personal environment. It’s a cosy room with cats and cuddly toys, where Liberace plays Candle in the Wind.

Consider this statistic:

Of the 26.4 million households currently in the UK, 7.6 million – or 29% – are made up of only one person, with the growth in single occupant households owned by the middle aged creating extra demand for homes.

There are many reasons for this social trend, but it seems we are becoming increasingly intolerant of living with other people. This trend has also been termed ‘schizoid society’, where we all inhabit a little bubble, and our only contact with others is as spectators.

Such a process was well anticipated and described by Isaac Asimov, in his novels about the planet Solaria. People, in proximity, just cause too much NVH. People – most people – just wouldn’t fit in the yogurt commercial.

Some of the most attractive, well thought out and effective types of therapy have devoted themselves to seeing the world more carefully and sensibly. Some nice examples include rational emotive therapy, now called REBT; personal construct psychotherapy, and Karl Rogers’ person centred therapy.

Interestingly these were all developed in the 1960s and 70s. Sadly none of them are really available much now, not in a pure form at least, though they continue mainly through strands of CBT and counselling.

I don’t think anyone has invented an anti-sentimentality tablet. Nor can I find a sentimentality rating scale to measure its effects. The lifestyle advice is relatively simple however.

Avoid sending cards for anything apart from birthdays and Christmas. Better still, avoid sending cards at all. Avoid most of Steven Spielberg’s output, and anything with James Stewart in it. Rationalise your yogurt buying to the 1000g ‘Eridanous’ pots from Lidl.

Sentimentalism is a kind of emotional clutter. There is a lot written about ‘decluttering’ your house, most of it rather obvious. First order a skip, then rescue ten things you really need.

Not you Tiddles.

8. The age of Sprocket Man.

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Is the modern world inherently toxic to our bodily systems? Niall Ferguson included Work Ethic as a killer app for society. It is certainly a killer, but in a more literal sense.

The body uses countless timing devices to regulate itself. Obvious examples are the night and day cycle, the heartbeat and brain waves.

Systems theory teaches us that everything has a point of equilibrium or natural balance. Most things have a natural frequency at which they like to vibrate. Some cars like to cruise at 50 mph, some like to cruise at 90 mph. Generally, the more German the car, the faster it likes to go.

Many systems have a feedback mechanism of some kind that puts them back to their default setting. On the road system, large potholes have been left like landmines to deter overenthusiastic driving.  Inspired by the ‘safety car’ concept in Formula 1, our government has paid an army of older gentlemen to drive at a constant 42mph all over the country, to keep speeds down. As a uniform, they wear trilby hats. These are only worn when actually driving at 42 and never outside the car.

Farmers have received grants from the EU to bring their otherwise redundant farm machinery out onto the major highways at peak times, similarly to check undue haste.

In our neighbourhood we have learned to beware a vehicle we call ‘the Stealth Renault’. Painted black, this innocuous 1980s model is driven by an extremely old person (or a person disguised that way), in second gear at a constant 30 mph. His trick is to give you the impression that he will stop or is stopping at your pedestrian crossing.

He never stops though. Like Sandra Bullock in Speed, he maybe believes a bomb will go off if he drops to 29.

He is a road safety bogey man. He never ratified the green cross code. He is there to teach children never completely to trust traffic lights. He may in fact be a dummy, the car actually being driven by remote control from a university psychology lab, as part of a learned helplessness experiment. Or maybe by the authorities, to keep us a little on our toes.

After all, we may be getting a bit complacent. Such close encounters with terrorists like Stealth Renault are relatively rare nowadays. It is surprising how routine most activities have become. The post office queue stands patiently, First Capital Connect arrives on time, the Sky box records your favourite programs. I appreciate that other societies and parts of the world are different, but the UK, with the possible exception of Doncaster, has adopted a ‘no drama’ policy.

Isaac Newton taught us that every action is met by an equal and opposite reaction. Every time I turn the heating control down another person will come and turn it up to a point slightly higher than it started originally. The body has a similar system in the hypothalamus, which can be used if thermal underwear is not available.

In larger systems, such as the NHS, an attempt to make a change will be resisted with significant force. Employees in large organisations tend to work like small cogs in a gearing system. If the small cog gets out of line the whole gearing system will crush it back into place, a few splines missing, but still turning.

A lot of ‘choice architecture’ is set up this way, large systems with high moment of inertia. Franchised models and low variance operating schedules ensure you will find the same shops and restaurants in every town.

Why not put the Hugo Chavez T shirt away and just coast along with things? People are living longer after all, and the television screens are getting bigger, sharper and cheaper all the time.

Why is it then that so many people seem to be unhappy? A recent survey by Unicef suggested that children in the UK are among the unhappiest people anywhere.

‘Pressured and commercially vulnerable, our kids are the most miserable in the industrialised world’ spoke the Guardian. People have blamed a mixture of possible causes, from inequality to the demise of the nuclear family.

Blur titled an album ‘Modern Life is Rubbish’ and I find myself quoting that to people whenever there is a spectacular system failure, such as getting stuck in a 20 mile traffic queue, or trying to pay for parking using a mobile phone.

Another line I find myself saying is ‘everything is relative’. There are many compensations in modern life.
It is the best time ever for ease of communication. Even Captain Kirk did not have a smartphone.

Food is at once the best and the worst it has ever been, depending on whether and how you choose your ingredients. I went to the Turkish part of London yesterday and had an amazing breakfast for £5.

A car made in 2013 is undoubtedly, objectively and measurably superior to a car made in any earlier period. It is faster, stronger, safer and more economical than before, and it is never mustard or beige coloured.

This is probably not the best period for music composing, which peaked in the classical period. But it is the best time for listening to Beethoven or Mozart, or any other music, because we have fabulous sound quality in concert halls and from hi-fi systems.

The best novels ever were probably written in the nineteenth century. But we can read them all free now on a device that weighs half a pound.

The renaissance period gets the prizes for painting and sculpture. But they did not have antibiotics or dentistry.

Teaching was probably better 50 years ago than it is now. And, as we know, History ended in 1989.

Different systems peak at different times. It s hardly likely that all systems will peak at the same time. That’s having your cake and eating it; or finding the M25 is completely clear all the way round.

If you happen to be lucky your system suits your natural frequency, and you will run smoothly. Your system will mesh with other systems and you will spin freely on your bearings.

If you are unlucky, like most UK children apparently, you are not in tune with your system.

For instance we know that children function better if they start school at 10 or 11 am, but our local school makes them start at 8am. The problem for children is that their system runs subordinately to every other system, so that they are made to fit in with adults rather than the other way round. The more your system is subordinated to others the less chance you will be in your own element.

The advancement of the system devoted to economic productivity has marginalised children, along with the old and sick, to the bus replacement services of life.

Children cannot vote, after all. They are just lucky that they don’t have to sweep chimneys any more. Worse than chimneys though, we have breakfast club and afternoon club, not to mention the dreaded school bit in between the clubs.

David Cameron said today that he wanted to place himself on the side ‘of hard working people who want to get on in life’.

What about those people who yearn for a life of recreation and entertainment? Shouldn’t all those machines and mechanised systems have made it possible not to work so much?

A big category of mental health diagnoses is the so called Adjustment Disorders. These come in various forms, including depression and anxiety. They are usually mild and transitory and reflect what many people loosely refer to as stress.

They can be seen as a wrench caused by a change of system, much like ‘frozen points at Guildford’ delayed Reggie Perrin by 11 minutes each morning. If frozen points cause a complete derailment, then the Adjustment Disorder is upgraded to a more serious diagnosis like Depressive Episode. A lot of depressive episodes also seem to follow adverse, or even positive, life events, which have caused a crunching in the gears.

The concept of mental health problems being stress related is attractive and easy to understand. But it only tells a part of the story. Most people are robust when it comes to negotiating changes.

Perhaps they have a wider tolerance to a range of operating conditions, so they are more often in their comfort zone.

A comfort zone is supposed to be a behavioural state where we are happy and confident and working reasonably well.

Some people work on their comfort zone more actively than others. Attributed to golfer Gary Player is the phrase: ‘the harder I practice the luckier I get’. Specifically referring to shots played out of sand, Player mastered the shot to the extent that he was equally comfortable in the bunker as on the grass.

Round about the time Player made that quote, in the sixties, psychologists developed the theory of Learned Helplessness.

Psychology nowadays keeps a bit quiet about these sorts of experiments -suffice it to mention the words electric shocks and dogs.

Later on, with the move from behaviourism to ‘cognitivism’, the negative effects of helplessness turned out to be more to do with a person’s pessimistic explanatory style than the actual experience of not being in control. This led to the idea of hopelessness, and the relationship of that state to suicidal thinking.

The issue is not so much whether we really have control over what happens to us, but more whether we think we do.

Studies in Ireland have shown that patients with Depression like their therapist to take an upbeat and optimistic stance with regard to whether and how much recovery will take place.

I remember a moment when, as junior doctors, we observed the arrival of a very senior colleague, in a severely dilapidated Ford Escort. It was trendy at the time for the psychotherapy – orientated type of psychiatrist to drive ‘crap cars’, such as this one or the Austin Maxi (mustard colour). As we watched, another SHO colleague put this scenario to me:

‘Imagine you’re in the depths of despair. You have been tried on every type of antidepressant. You’ve tried counselling and psychotherapy. You’ve had herbal medicines and homeopathy and transcendental meditation. The GP finally arranges a visit from the leading specialist at the teaching hospital. You watch through the window, and you see in the distance the Professor arrive in his Escort, which has large furry dice dangling from the mirror. Is that not the moment when suicide seems inevitable?’

Harsh perhaps. Equally, people might like to see someone eminent arrive in a non pompous vehicle like a 2CV covered in stickers or an original Beetle with vase. I can’t remember any specific training on what vehicle to drive, although an older colleague insisted that consultants should only ever have Michelin tyres, ‘never Goodyear my boy’.

To return to the point, the feeling of having a choice matters a lot, even if in the wider scheme of things, the biggest choice we really get is between Diet Pepsi and Pepsi.

The comfort zone is largely a place where we choose what happens to us. A lot of people want to move us out of our comfort zone.

It’s true that we will be more productive if we are challenged just a little. Coaches know that a mixture of support and challenge can bring about superior achievement. The same approach can work well in therapy, for instance treating a phobia. If the comfort zone has got too narrow then it needs to be carefully increased.

Unfortunately, in most organisations, the challenge is greater than the support. The pressure is always on to squeeze a little more out of the system. Supermarkets want to get the milk off the farmer for a few pennies less. The farmer turns the cows up to 11, giving them more food, or playing them some Led Zeppelin at milking time.

The effect of the larger and more dominant system on your system is felt as disharmony, or being slightly behind the beat, or as a little ping in the ears. Your system might be different.

Interestingly, this is exactly the kind of disorientated feeling that makes us purchase something – retail therapy – or consume some alcohol – drug therapy. The work ethic is all about ‘must’ ‘should’ and ‘ought to’.

It all depends whether we want to make superior achievements or just be happy with what we have. It’s not a choice we seem to get very often. Even the illusion of choice is worth a lot though. Turkish breakfast. Mozart. Thomas Hardy. And, today I think, Diet Pepsi.

The comfort zone is equivalent to driving at 50mph.

It’s better than 42. It might even be better than 52.

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PS: It looks a bit like this one.