29. Growing cress heads for no particular reason.

This morning, the council came to collect the 3 bins I leave outside on Tuesday mornings, and I think they have brought another new bin – to dump your Guilt into. So much better to have it safely disposed of rather than giving it to another person. Guilt just doesn’t compost down.

I’m hoping for more metaphorical bins in the future, now that local government has taken over public health. In hospitals we have sharps containers coloured yellow, which is a safe place to put barbed comments.

Today, just as The Times reported that health checks for the over 40s were a complete waste of money, I received a letter from my local surgery asking me to come in for a health check with the practice nurse.

Though I am a supporter of evidence-based medicine, it took me less than a minute to make myself an appointment. I am also a hypochondriac.

To be honest, evidence-based decision making can conflict with common sense. Everyone knows that a stitch in time saves nine. As far as I know, there is no equal and opposite proverb to cancel this one out. My strict adherence to the evidence based approach probably doesn’t go much deeper than the occasional casting of nasturtiums on the alternative sector.

So many decisions we have to make are based on intuition rather than double blind randomised control trials. For instance, choosing what we eat. I start with the null hypothesis as follows: nothing that you eat – within reason – makes any difference to you. There are occasional bits of conflicting evidence, but in general nothing to disprove the hypothesis, which is based on the sound principle that the human body is a chemical factory.

I have yet to see any convincing evidence for the five fruits a day policy, nor the arbitrary alcohol consumption limit of 21 or 28 units per week. Which leaves me with a bit of a dilemma over what to tell the practice nurse about my lifestyle. I don’t want to come across as a fanatic of any kind. Like an NHS Trust, or Everton FC, its safest to be half way up the league table rather than at the top or bottom. But there is no real ‘gold standard test’ for lifestyle to pass or fail, apart from a few aspects of what we consume.

Like everyone, I find it very difficult to explain the increasing numbers of people who suffer with obesity. I watched a recent documentary attributing this to the corn syrup industry, but was not entirely convinced. Maybe it is a virus or other infection we have yet to identify. The concept of ‘food addiction’ has gained some adherents, certain products turning out to be incredibly ‘more-ish’, such as chocolate, pizza and ice cream.

Since obesity has increased rapidly over the last 30 years, we could attribute it to any or all of the social trends of the last few decades, from computer ownership to the decline of progressive rock. Psychiatrists have made their own contribution, in the form of atypical antipsychotics, which have doubtless added to the lard mountain.

My own hypothesis – no, really my own intuition, is that obesity is inversely related to pottering.

Pottering has been defined as: ‘to busy oneself in a desultory though agreeable manner’. Pottering behaviour should be largely unplanned, enjoyable, unhurried and diverse. Crucially, pottering does not derive from a work ethic, but from a natural tendency to interact with one’s environment. It’s roots are probably in thousands of years of hunting and gathering.

The habit of pottering has been hard hit by lifestyle changes toward electronic media and industrialisation, and away from localism, arts, crafts, hobbies, games and sport. Home made food is fast going the way of home made clothes.

What is surprising is the lack of a response, either from mental health services or the pharmaceutical industry, to the obesity epidemic. Surprisingly, there is a lack of evidence about what treatment to offer.

As anyone knows who has been on one of those treadmills with a calorie counter, you have to run about a thousand miles to counteract the effects of one Mars Bar. So its hard to see how increased activity alone could be the answer.

CBT does embrace ‘behavioural activation’ and ‘activity scheduling’ and mental health services do employ a small number of occupational therapists. We could begin to rehabilitate a pottering based lifestyle, but we need badly to find a new word for ‘potter’. It’s just too old-bloke-in-a-shed-based. And we need new pottering clothes, instead of tracky-bottoms and cardigans.

So here’s my five point plan:

Pottering should be re-named Freestyle Active Behaviour – fabbing, for short.

Village Shows to be re-named ‘Fabathons’

Stella McCartney / Adidas to bring out a new fabbing range, using a tweed / kevlar fabric mix.

A new talent show, called Britain’s got Knitting.

A new ‘more modern’ penthalon event, consisting of: repairing a stuck window, making a cake, learning the saxophone, growing cress in old eggshells with a face drawn on them and visiting granny.

(Yours may be different).

So far, none of this is evidence based, but neither, it seems, is going to the health centre for a check-up.

28. Removing labels, without toxic chemical solutions.

Cows are basically hippies.

Who are those people hiding behind the boiler house, just outside the strict boundary of the Foundation Trust premises? Are they common or garden smokers? Are they A and E attenders, who have finished all the books they brought to read while they wait? Or are they escaped but tagged dementia patients?

If you go near them they shy away, like geese, toward a small clutch of untidily parked Fiats and Volvos. Finally, I realise who they are – they are my colleagues who work in community psychiatry.

They are hiding for a good reason though. People are pursuing them, ‘wanting a diagnosis’. And those people are angry.

The history of mental health tends to characterise psychiatrists as predatory. The accepted wisdom is that psychiatrists are part of the forces of social control. Their traditional prey, according to folklore, is a harmless eccentric or political dissident. Their modus operandi is to label these folk with an invented illness concept in order to render them powerless in the eyes of society and the law, so as to drug them or lock them up or both. Such is the myth of ‘anti-psychiatry’.

People used to fear the psychiatrist like a 70s DJ fears the child protection team. But now the tables are turned. Some people are desperate to get labelled as mentally ill. None of my colleagues know why, but they mutter about the internet, celebrities and the drug companies, not to mention the benefits system.

The world seems to have turned upside down, like Twelfth Night. Not as regards boys playing women on stage whose characters are pretending to be men. Rather, more in terms of poacher turning game-keeper.

The story usually starts this way. A short GP letter ending with the words ‘this man thinks he has bipolar disorder, please do the needful’. A patient with a large bundle of papers downloaded from the net. Stating that the description of bipolar disorder fits him perfectly right down to the last semi colon.

The psychiatrist tries to explain that diagnoses are merely conventions about what to call things, that in the UK at least people are rather conservative about the use of diagnostic labels, that labels in their own right can become dangerous and lead to people thinking of themselves in an unhelpful way, even getting stuck in a sick role and benefits trap.

That he doesn’t really seem to have bipolar disorder, at least according to the absurdly narrow conventional diagnostic system that bow tie wearing people in Geneva have written on our behalf in quill pen on parchment.

Finally the meeting ends under a cloud, unless the psychiatrist gives in and recommends a tablet with Q or Z in its name.

It’s tempting to blame our cousins in the US and /or big pharma. There is money to be made from atypical antipsychotics, but only if a group of people can be convinced they need to take them. I have not tried this (Your Honour), but I’m pretty sure atypical antipsychotics and mood stabilisers have practically no street value.

Last time I went to the US I saw some hilarious direct to public advertising for these substances, where the baritone disclaimer tag – ‘may cause impotence, heart failure, convulsions coma and sudden death, take with caution’ – was longer than the advert itself.

I’m not sure why labels are fashionable now. Labelling theory was all the rage in the 1970s and we were all taught not to label people and put them in pigeon holes. Perhaps it started with designer clothes, where the Nike swoosh added $20 to the value of a $2 tee shirt. People who took labelling theory too literally even got tattoos. When we make a diagnosis, we always play it down – we say it’s just a name people give to this type of problem area.

My proposal is that we use a barcode instead. This is a cheap shot, but I think one or two of my colleagues would be happy to advise people where to stick it.

27. Saying sorry, properly, to Desmond.

Everything is permitted.

One of the projects that Blue Peter never attempted was to set up your own Truth and Reconciliation Commission. That’s a pity, because a TRC in your own home would be a lot more useful than, say, a separate dining room or garden shed.

Taking the example of South Africa, it looks as though we need three subcommittees: human rights violations, reparation / rehabilitation and amnesty. The first one looks at what went wrong, the second at what can be done to put things right, and the third invites further business from those who want to confess.

It’s worth making some space around the home for the proper infrastructure. Very few people, even catholics, go to confession in church nowadays, and the shortage of mobile priests has led to a decline in the domestic confessional box market. Modern architects wouldn’t even know how to design a priest hole. Most people consequently don’t get much opportunity to take a long look at their behaviour, with the help of a moral philosopher in antiquated neckwear.

Whereas the confession box requires a twin booth, soundproof module with a tiny curtained window – even Homebase seems to have stopped selling them – a TRC unit can be much more transparent and even Scandinavian-looking, in light wood.

The South African prototype required at least 18 people. The domestic version has to make do with a few co-opted members. Its unlikely you’ll get Desmond Tutu, but a distant relative from Canada, or another country with an impeccable human rights record, might be available. Failing that you can try a community psychiatric nurse, mobile hairdresser or peripatetic guitar teacher.

The agenda is to bring to light all the mistakes you have made and the transgressions you have committed; admit you would have done things differently if you had thought about it a bit more and hadn’t drunk so much; you’ll mend anything that you broke, once you get your giro and if there are replacement parts available; and you’ll accept a reasonable penance suggested by the committee.

Something similar has been developed by therapists, in particular so-called ‘Acceptance and Commitment Therapy’ or ACT. Instead of conducting a battle against negative thoughts, ACT helps people forgive themselves for their human frailties in return for a positive attitude toward the future. It looks like an attractive antidote to all the hypocrisy and finger – pointing we are seeing nowadays.

It’s a bit like confession, but it has to be said, confession has several advantages. Firstly the church has a ‘walk in centre’ approach to confession, so there is no waiting list. Secondly, anonymity is preserved, unlike Therapy, where you will be shopped if there are public safety considerations. And thirdly, the penalties – typically two ‘Hail Marys’ – are really very minor in comparison with those a domestic TRC will hand out, such as taking everyone out to Prezzo.

In confession you are really pleading guilty to Original Sin, but with ACT it turns out your sins are entirely unoriginal.

26. Irregular conjugating with The Boss.

EP is on vacation this week, so this piece is being carved painstakingly onto an Android phone. I’m hoping that predictive text will take over at any moment and finish the last few paragraphs. If it works as usual the message will mutate dramatically and suddenly – for instance changing the word ‘many’ to ‘knuckle’ and ‘stifado’ to ‘Ericsson’. Most likely it will choose to finish off this piece with stock text such as Portia’s speech from The Merchant of Venice.

As a remedy for insomnia I watched a BBC World program about the dismantling of the German nuclear industry. Surprisingly, I found it completely fascinating. And it was then I realised that I am just about ready to start attending school.

Unfortunately, during the years I attended school, I was not ready for it. The problem seems to be this: education, work, sport and entertainment have been artificially separated and parcelled out unevenly to different age groups. So we have no entertainment at school, no work for young adults and no sport for older people.

For depressed people we recommend a mixed diet of behaviour, to include physical, mental and social stimulation. Such a mix is hard to achieve for large sections of society. Perhaps we should start by merging the goverment departments for Universities, Science, Employment, Culture and Sports to create a giant Ministry of Constructive Pastimes. Think David Willets, on a bobsleigh, playing flute.

In anticipation, universities are putting famous professors and lecturers on line, so that thousands of people can benefit, rather than just the few dozen students that can fit into a lecture theatre. The movement is called MOOC, or massive line open courses.

Educationalists have gone against the lecture as a means of communication, apparently because the average student retains only about 10% of the content. However, this figure can increase substantially in certain conditions, such as when exam questions are being ‘hinted’, when the lecturer is particularly charismatic, or by interweaving multimedia.

For instance, if Bruce Springsteen could be persuaded to lecture on irregular German verbs, strumming gently and occasionally singing a line or two, we would not be such dunces at language.

The trend toward mass market lecturing means a blurring of the traditional boundary between education and entertainment. For me, the importance of this is the prospect of a better deal for schoolchildren.

At present, children’s rights are subordinated to those of adults. For instance, chidren are compelled by law to attend school. They are forced to follow a national curriculum. Large group teaching is the norm, mainly because it is very cheap. Children endure a bargain basement approach to education that has increasingly sold out to child minding.

Adults no longer tolerate compulsory military service and cannot be compelled to work in mills. Many more are watching natural history or discovery channels and starting to enjoy finding out new information.

The coercive approach to schooling is relatively recent and followed the industrial revolution. In the UK children start school as young as age 4, so they are exposed to harshness, compulsion and judgementalism at just the wrong age. Here, for many, begin the roots of fear and helplessness that darken their perception of the world.

Children might prefer a mixture of activities, including a bit of paid employment, . It seems absurd that there are no teenagers in the house of lords and that there are no toddlers on the boards of large companies, even as non-execs.

As the managers would say, there are a lot of potential synergies in merging education and entertainment. The mind’s operating systems for music and speech seem to use different brain structures. People often remember the words of songs much more easily than prose or poetry. Some stammerers can get words out much more easily if they begin them as though singing.

We are used to opera and musical theatre, where drama can occur as a mixture of words and music. Far more people go to musicals like Les Miserables than ever read the book.

Movies like ET, Gladiator and Close Encounters attracted enough customers to support orchestral music by top composers.

So adding a musical dimension to a learning experience is likely to etch deeper and longer lasting memories.

The scale of MOOC seems to present an opportunity to incorporate a quality musical soundtrack into lectures. Whereas Horizon programs make do with incidental music, MOOC lectures could afford to have a house band at the very least, if not a full orchestra in the pit.

If it looks as though I am merely suggesting replacing school with television, something that seemed to suit me perfectly during my tonsillitis years, then my answer is this:

The quality of mercy is not strained. It droppeth as gentle rain upon the Ericsson Stifado.

25. Taking a creative powder.

The golden age of pharmacology.

There is probably a link between bipolar disorder and heightened creativity, but this occurs mainly during the periods of elated mood. One of the first things to go when the mood dips is concentration. For creative types that’s a major hazard.

There’s only one solution for writer’s block. And that’s to write about it.

I just checked with the local NHS and apparently there is no rapid response team for this problem, unlike, say, blocked drains or blocked arteries.

The mental health service is interested in ‘thought block’, but only in the context of schizophrenia.

What I’m envisaging is a group of experts, probably led by a retired army major, who would arrive in a pimped day van, set up their equipment and get to work straight away.

The first thing to do is to remove any loaded weapons and / or bottles of whisky from the writer’s desk.

Next comes a thorough examination of the writer’s body, particularly the orifices, just to check he has not begun ‘disappearing up himself’. If there are signs of this, a Dyson cleaner makes an ideal suction device.

That also includes checking his ego boundaries, to ensure he is still able to separate himself from his characters. Clues to this can include wearing a flying helmet or shoulder holster while he types.

Psychedelic drugs should be removed, keeping samples for the lab, except for science fiction or fantasy writers, when they should be cautiously continued and titrated with Bourbon if necessary.

There are no NICE guidelines for writer’s block, though the author is probably poised over his keyboard and has been for years. But there is some expert guidance on the subject.

Dan Brown for instance likes to hang upside down in gravity boots. This could explain some of his thinking, in terms of reduced cerebral blood flow. Lots of writers prefer to be horizontal when they write, and many others like to pace up and down. Some are quite obsessive about stationary and pens. Others like to chew their pencils. It’s important to ensure they put the right end in their mouths.

Having attended to posture, the team looks toward some kind of psychological jolt. Firing a gun is often helpful, and if there is space, the team like to set up a row of porcelain figurines to use as targets. Royal Doulton seems to work best.

Coercion, blackmail and torture don’t seem to work. This is probably because anxiety levels have gone just beyond the optimum level for concentration. Writer’s block is mainly a result of ‘performance anxiety’. It is when the automatic mind makes the mistake of calling in the reflective mind for advice. Whether it’s writing, sex, walking a tightrope or putting, self monitoring can be catastrophic. The interventions are mainly to create a distraction.

For instance, waving a wad of cash under the nose brings about a rapid reaction similar to smelling salts. Not only does money talk, it speaks most eloquently.

Claims are made for psycho-stimulants and antidepressants which some people think enhance performance. Thomas Hardy might have benefitted from a little light turbo-charging, for instance. I’d like to have seen more of an action thriller conclusion to Mayor of Casterbridge, possibly involving Farfrae and Henchard shooting at each other with blunderbusses, from hot air balloons.

More useful is a gentle workout for the parts of the brain that write. A trip to a gritty location such as a Ladbroke’s in Rotherham might bring just the change of emotional tone that’s needed, but obviously the danger is melancholic overload.

Sometimes a little ‘power pottering’ is necessary, such as re-organising the tea bags or melting a vinyl record to make a flower pot. An encounter with an overloaded kitchen sink has helped many angry young men keep it real.

The most difficult thing is finding an ending, if that’s where the block has happened. If all else fails, a revision test can serve as a makeshift conclusion, e.g

Which blockage is not a medical emergency?

Heart

Arteries

Thought

Writer’s

Intestines

Which endings are valid?

Reprising earlier parts of the piece

Suddenly dying of TB

A dream sequence with exploding figurines

Throwing a badge into San Francisco Bay

Reader, I married him.

24. Dangling from the last helicopter out.

What a lowly position feels like.

Sometimes Depression is a sign that your predicament is poor. Surveys show large numbers of people think about quitting their job, but very few actually do so.

A life-time ago, I can remember spending Monday afternoons in an operating theatre, assisting my boss, who was a vascular surgeon. Every week, at about 4pm, there would be a commotion in the theatre next door, as the very temperamental colo-rectal surgeon working there went slightly berzerk. Sometimes he would hurl items of equipment at the wall. Usually he would announce his resignation and storm out. He was always back next week though.

Remember the last scene in Dirty Harry, where Clint Eastwood’s character, Harry Callaghan, throws his police badge into a pond?

What symbol of your job would you throw into the water if you decided to quit in disgust, as the camera zooms out and the credits roll?

If you are a gynaecologist, perhaps an laparoscope would do, an old style – rigid model, thrown like a javelin. The butcher could throw his white trilby hat like a frisbee. But what about the Timpson’s shoe repair and key cutting man, who looks increasingly fed up? He’s big, but how far could anyone throw a lathe?

I have just the thing, which is a John Major era ‘Chartermark’ badge. The citizen’s charter was a policy intended to elevate the concerns of ordinary folk, like the increasing numbers of traffic cones. The problem was, there were no ordinary folk left. The baby boomers were all special.

The badge is made of bronze and about the size of a broad bean. I could skim it far out onto the river on a calm day. I’m sure though, if I went to the river there would be a queue of disgruntled workers hurling various emblematic work items.

What expression should one choose for the camera, just before the zoom-out? Sad inevitability? A mixture of guilt and relief? Or – it’s video remember – deadpan? As though all the life has gone out of you?

More and more people are fed up with work and a lot of them have suffered ‘burnout’. Neil Young said ‘its better to burn out than to fade away’, but in a sense the two things are the same, just different types of oxidation reaction.

The phrase burn-out, which was hyphenated in those days, apparently derives from Graham Greene’s book, The Burnt-Out Case, which features an exhausted celebrity architect who goes to work at a leper colony. The parallel is between architecture and leprosy in terms of their effects on people, which is to make them quite interesting and very thin.

The ‘Whitehall’ studies looked at sickness in various groups of workers within the civil service. They seemed to show that the more lowly paid the job, the more stressful it turned out to be, which is the exact opposite of the commonly-touted belief that high-flying jobs are the most vexing.

Nevertheless, even in medicine, which is quite rewarding in many ways, my impression is that an increasing number of people are walking away, sometimes after a dozen or more years of training and dedication.

I tried to research the number of doctors who are qualified but don’t work in medicine, but it is hard to get these statistics. A sizable number are still registered and licensed by the GMC but will quit as they come up for revalidation (or to give it its proper name, The Cull.) Many more work part time or intermittently, via agencies.

Whatever the number in work, if you look around your locality, ask yourself: are there any more GPs than there were 20 years ago? And: how easy is it nowadays to sign on with a GP?

As far as I can see, the answers are, ‘No’ and ‘as easy as getting through Tintwistle’. I’m not sure where the GPs are going, but its probably the same place as the bumble bees. Studies have shown that GPs have the highest burnout rate of any professional group, up to 40%, at least in Holland.

Not been to Tintwistle? Let me explain:

The giant industrial cities, Manchester and Sheffield sit about 35 miles apart on either side of a small set of hills called the Peak District. Because they are in the north of England, there is no proper road joining them up. Things start well enough, as you leave Manchester on a fine new highway called the M67. After five miles, the M67 ends abruptly and you are frozen in traffic, as though liquid nitrogen had suddenly been sprayed over the road from a giant cartoon airship flown by Mister Freeze.

During my time at Tintwistle, which was longer than many prison sentences, I reflected on the notion of helplessness, and how it affects the nervous system. The most accurate description I can think of is that helplessness hits the human organism like a rubber hammer. There are no wounds, no broken bones, not even ruptured internal organs. Just a sense that something deep inside of you is broken.

I can remember similar effects from going on fairground rides with inappropriately high and sustained circular motion. What initially seem to be expressions of happiness on people’s faces turn out merely to be rictus grins caused by G force.

Getting stuck at Tintwistle has much in common with being in a low paid job in the civil service. You have little control over your destiny. And its too late to wonder what you were doing there in the first place.

The truth is, no-one gives much advice about the really important choices in life. Things like which partner to choose, what career to follow, or which team to support. These often start out like the M67, wide and promising, and then, suddenly, the road just runs out.

It’s easy to see people who have chosen completely the wrong jobs. There’s the lollipop man who attacked someone with his lollipop. There’s the science teacher who battered a pupil with a 3kg dumbbell, shouting ‘die, die, die’. There’s Tony Blair as peace envoy to the middle east. And there’s the man at Tesco who prints the yellow price stickers, who should be a master villain in a Bond movie.

In Thinking, Fast and Slow, Nobel prize – winning psychologist Daniel Kahneman reveals that he and his team of experts were quite unable to predict who would succeed as army officers, despite all kinds of aptitude tests. So it seems unlikely that the school careers teacher will succeed in putting everyone on the right path.

Perhaps people are more likely to change job nowadays in mid life, giving a chance of redemption.

Otherwise I think I have a solution, based a bit on Prime Ministers’ cabinet re-shuffles. My idea is to put someone like the town mayor or an official psychologist in charge of employment. He would be able to shuffle people from one job to another if they are looking burned out.

So the Timpson man becomes the science teacher. The butcher becomes the gynaecologist. The science teacher gets to cut keys. And the gynaecologist gets to kill serial killers in San Francisco.

The civil service can be moved to Tintwistle, so that everyone is always late and the activities of the government will be frozen, like in Italy.

There was no scene showing Harry Callaghan with a snorkel and flippers, retrieving his badge for the sequels, but he returned several times. Even worse, none of the sequels allowed him to move to a less bureaucratically-frustrated role, such as running the police pottery workshop, and the body count continued to rise.

Perhaps the GPs will return for a sequel one day, or even turn up at the end of the movie, like the old naval warriors in Battleship.

Or, just as all hope is abandoned, the bumble bees will swarm back over the horizon in giant black clouds. They have made enough honey not only to feed us but to run our cars too.

23. A little less conversation and a little more action. Please.

I look good, don’t I? Unfortunately, it’s all I do.

There are more pictures about than ever before. The digital revolution means that an almost infinite number of images can be created, stored and accessed within seconds. Its easy to see that the introduction of video recording has proved to be a hazard for narcissists, being massively more versatile than mirrors or pond surfaces. People can video themselves all day long and send the videos to the friends they inevitably don’t have. Yet it is only 150 years or so since artists relied on watercolour and charcoal for a flattering self portrait. People who like to look at themselves have plenty more opportunity nowadays, plus Photoshop.

Narcissus himself fell in love with his own reflection and somehow died. There was no coroner’s inquest in those days, but legend has it that he was tricked into this by a vengeful goddess, after he spurned the advances of a local nymph.

Since then everyone knows ponds – and nymphs – can be dangerous. Shop windows and plate glass are also hazardous for those who like to gaze at themselves. Budgies know about this, locked as they are in an eternal battle with their mirrors, never seeming to realise they are just attacking themselves. Luckily they have millet and cuttlefish to distract them from their eternal struggle with their hated double.

More recently, narcissists have attracted a range of unflattering self-reflexive terms, such as being ‘up themself’ or ‘disappearing up their own arse’. The message seems to be that Narcissism is something to guard against and brings with it anatomically impossible challenges.

Some species, such as whiptail lizards, have succeeded in having sex with themselves, creating an all female population. Whiptails have been called – unkindly, it seems to me – ‘pseudocopulators’. There is very little political correctness in the lizard world.

If you are feeling a bit useless or redundant, imagine how a male whiptail must feel, particularly if it is made to attend diversity workshops.

In the DSM classification system, Narcissistic personality disorder (NPD) is included in the notorious Cluster B, whose other members include Sociopathic and Borderline personality disorders. Cluster B are known as the ‘dramatic, emotional and erratic’ characters, the ones who populate all TV soaps, most prisons and half the queue at A and E.

There is more to Narcissistic Personality Disorder than just liking the look of yourself reflected in Gap’s window among the Jeggings collection. There is more to it even than the ordinary vice of vanity. People with NPD are said to be arrogant, lacking in empathy, manipulative and constantly seeking attention and admiration. They could really use a new PR campaign. How about, ‘narcissists are lovely people, even if they do say so themselves’?

There are plenty of narcissists in politics or running large organisations, but there are also quite a few in prison. If they are lucky they will work as a presenter on a high number digital channel where all the programs are about dating.

Narcissists present a challenge to a therapist. On the plus side, they love talking about themselves; on the downside, this is liable to make them worse.

The danger is sending people even further up their own nether parts than they were before.

Therapists of various kinds are reluctant to accept that therapy carries the risk of negative change, something which is taken for granted with drug treatment, i.e. side effects.

In full sceptical mode, (something I should leave to the ‘neurobollocks’ website as I don’t like to appear negative) I read The Times this morning (8/7/13) and find an article called ‘How to become an optimist’.

To describe a ‘mindfulness’ technique the author, Michael Mosley, writes, ‘I sit in a quiet place and focus on physical sensations such as the weight of my body’.

And in describing what is called ‘Cognitive Bias Modification’ he looks at successive video screens containing blank, angry or smiley faces, ‘the idea is to train the brain to look for positive images’.

Probably best not to read the rest of the newspaper then. In particular don’t turn to page 27 and look under the headline: ‘referee who stabbed player is beheaded by fans’.

While keeping an open mind about the value of mindfulness etc I hear a shrill voice in the wilderness, shouting ‘get a life mate’.

The Horizon program version of the article will, no doubt, show people looking in wonderment at their own brain activity shown on scanners and scientists will say things like the left side of the brain likes Snickers and the right side likes a Mars Bar.

Contrast this introspective approach with the movement called ‘Random Acts of Kindness’ (RAK). It’s hard to know quite how it started. Probably it was born in California, in the mid-eighties. Interestingly the same kind of location and era as CBT. Although I’m pretty sure as far back as 1968 the Bonzo Dog Band were advising people to do things like leave a packet of fruit gums on London Bridge.

Now we have a ‘one million random acts of kindness campaign’: http://www.4000saturdays.com/rak/

This is a strategy designed to improve society by introducing new positive behaviours within the framework of a social movement. There is still a cognitive aspect to it though, which is deciding what constitutes Kindness.

Is it really being kind, for instance, to give a policeman a helium balloon, or might it just possibly encumber him from drawing his weapon, should the need arise?

Is it really a kindness to feed an expired parking meter, or are you depriving the council of useful revenue, and possibly another driver who is looking for a space?

People who paid toll charges for those behind them in a queue of cars apparently caused even greater tailbacks because of the ensuing surprise and confusion.

It usually feels good to let someone in from a side road, and the traffic system relies on this to function properly. On the other hand, people who scream down the right hand lane expecting to muscle in at the end of the queue should, like murderous Brazilian football referees, expect no mercy, let alone kindness.

Religions – they have all tried – had quite a few problems sorting out the ‘treat others as you would like to be treated’ issue, especially if sadomasochism is thrown into the mix.

Could so called ‘tough love’ for instance be seen as a RAK? Is it OK to chase cats away from birds, or is that kind of intervention in nature rather colonial? Some of these world policeman roles have got confusing post-Iraq.

Should overweight people be sent away from KFC? Should you give elephants cream buns while the zoo staff aren’t looking?

Should the queue of people about to buy lottery tickets be dispersed by water cannon? When is it kind to be cruel?

To answer all these questions you really need your own ethical committee.

Also, the question arises: could RAK have an opposition movement, Random Acts of Unkindness? If so, it’s important these people never infiltrate dentistry.

So which is better, CBT or RAK? Should we sort out our own thoughts and feelings or go and help an old lady across the road before the Stealth Renault gets her?

Or is RAK just another kind of CBT, more biased towards behaviour?

RAK tends to take place on Fridays, so there is time to do both. For starters, go to your local pond and put up a ‘Danger: Nymphs’ sign.

Put another one up in the park: ‘No Pseudocopulating’.

22. Comprehensive dental planning for the gift horse.

Got away with a scale and polish!

Some people felt the recent ‘horsegate’ revelations amounted to an attempt – by ‘Big Food’ – to soften up the consumer towards more overt horse consumption.

So far I see no signs of horse restaurants opening up, so I’m wondering if its really worth registering the trade mark ‘Horses for Courses’.

The main effect of the horse scandal was to cause a tsunami of horse-related jokes and puns, like the above example, and a welcome reprise of horsey sayings and proverbs.

We are, as humans, portrayed as horses sometimes.

A person might be described as a ‘workhorse’ for instance.

They may be compared to a mule, if stubborn; or a donkey, if they suffer with ‘bradythinkia’. People who throw eggs at talent show judges are exhibiting ‘horseplay’, though this is one activity that horses have never even attempted.

You could take someone to water, but not make them drink, and this is a major problem in pubs and cafes nowadays, especially where there is free wifi. We know from Prince’s commentary on the modern world that his cousin was ‘doing horse’ only nine months after trying a reefer ‘4 the very first time’.

Is a gift horse a person who gives gifts, or is the horse the gift?

Either way, don’t look him in the mouth, even if you are a veterinary dentist, not without a mask and safety glasses anyway.

My knowledge of horses is really very limited. I go past them very slowly on the roads, and the person riding usually acknowledges this with a friendly gesture. I know they cost a lot to run, in terms of vet’s bills and sugar lumps. I feel sorry for the ones I see confined to a box trailer, stuck on the A1(M) for hours on end. I have never known a real horse to be called Dobbin. If I had a racehorse, I would name it ‘nine to two favourite’, just to confuse the bookies.

They seem surprisingly fragile. Quite minor ailments seem to upset them, such as sleeping in the wrong posture or falling over a rabbit hole.They are sensitive to even the mildest ironic remark.

All the care pathways for horses seem to end with the box ‘shoot’.

Do horses like being whipped and raced over a series of fences? Probably the answer is the same proportion of horses as humans who like sadomasochism or hurdling.

Do they even like having people ride on them? For most of their evolutionary history presumably they just ran about when they felt like it. Western movies always depict the wild horse as reluctant to get involved in the transport industry. Horsey people will shake their heads and tell me I just don’t get it.

Horses and people, they tell me, have a unique symbiotic relationship, where horse and master blend into a sublime transport unit. Its a bit like the way obese bikers’ tummies meld seamlessly into the saddle of a Gold Wing or Harley.

This brings us back to the idea of harmonious relationships and fundamentally, the kind of environment that suits the human system.

Today there are further useful news items from the Mappiness project, which aims to survey people’s real time levels of happiness using a smartphone app and random sampling.

These findings are dangerously revealing and potentially subversive. It is revealed that work can be toxic for instance, and that its better to live in a green rural – type environment than in a tiny box high over an industrial northern city.

Also, 22 years after the LaTour single, the last reliable report on this, it is revealed that people are still having sex.

Most of human evolutionary history people have not worked, at least not in the way that has become the norm since the industrial revolution. People were hunters and gatherers for thousands of years. Accordingly, the natural state for human happiness seems to be ‘pottering about’.

Of course many people have known this for years. But oddly, the millions of ‘shed people’ have been portrayed as either lazy or autistic, not to mention shabby. Shopping is perhaps the one surviving pottering activity that remains fashionable, but all too often shopping behaviour is spoiled by buying stuff.

A clue to all this should have been the way ‘browsers’ like Netscape took off in the nineties. Browsing the web suits people better than watching television, even when ‘channel-hopping ‘is allowed.

Pottering about is the default position for human behaviour before ‘musts, haves and shoulds’ are loaded on people.

My impression is that horses are pottering animals too. Mainly they eat. But they are a bit curious to meet people. Sometimes they will get up and run for no apparent reason, to a similar bit of field.

Horses and humans have been the victims of a massive confidence trick. Basically this is that they benefit from carrying a burden.

Sadly for horses, they cannot operate smartphones, so their unhappiness cannot yet be measured.

Look, they are shaking their heads and saying ‘nay’. I think they have made their position clear enough.

21. Judging. Not.

This panel comes with price tags.

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

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

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

‘That’s correct.’

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

‘That’s correct.’

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

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

‘A Cadbury’s flake, I believe.’

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

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

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

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

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

I nod.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sister Clare, you are forgiven.

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

20. Choosing Love, Zero, or the Egg.

Trying to see the big picture.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

They don’t work on pets by the way.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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