92. Doing without experts, or even people who wear spectacles.

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The CEO presents his new organisational structure, shown here as a Venn diagram.

 

A cat is out of its bag. Not Kevin, the actual cat – he can’t get through Kevlar sacking – but metaphorically speaking.

There’s a book out called ‘Where there is no psychiatrist’. Though the phrase ‘developing world’ occurs somewhere in the description, and the front cover depicts a place where people carry water in stone jars on their heads, so probably not Mexborough, in actual fact this manual is meant for Britain itself. There is no psychiatrist in your town or mine. That fellow with the beard is just a hipster. That guy with the carefully-crafted-designer-vagrancy look you admired so much is just a vagrant. Though some people are pretending otherwise, for better or for worse, mental health is going DIY.

There are exactly ten reasons for this:

  • Very few new doctors are choosing psychiatry as a speciality
  • A lot of psychiatrists are retiring to open artisan cheese shops
  • Psychiatrists who don’t use a medical model are more expensive than social workers
  • Psychiatrists who use a medical model aren’t cool enough at parties
  • Psychiatrists have to wear a T shirt that says ‘in case of disaster I am to blame’
  • People have noticed that the NICE guidelines for mental illnesses are the same ones for every single disorder
  • Illegal drug dealers have got more and better new drugs than we have in the NHS
  • Maplin have got more and better electrical treatments than we have in the NHS
  • The GMC now require you to cut down the mightiest tree in the forest, with a herring, in order to get revalidated
  • Conspiracy theorists have stolen all our best delusions

Now that we have youtube to show us how to do every task, the main constraints on DIY are statutory regulations rather than not knowing how to do things. But where there are severe penalties for unauthorised gas fitting, there is no penalty at all for pretending to be a mindfulness therapist, or for lighting candles in people’s ears.

Surely, before we start selling prozac and zyprexa in Poundland, before we legalise ketamine, before we hang special magnets from our earlobes, there should be youtube videos on how to interpret evidence and follow logic? No mate – this is England. No-one likes an expert round here.  

88. Making sense of everything that’s ever happened.

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A service user, just hoping the CQC will make an unannounced visit.

There’s a backlash against drug therapy and a lot of people hate the fact that life expectancy has increased and there are effective treatments for cancer and diabetes. It’s just not natural is it? It’s no work at all just to take a tablet once a day with a glass of chilean merlot. It’s just inherently non-puritanical, especially as medicines don’t taste horrible any more.

Sadly pharmacists and drug companies won’t pretend their products are made out of tree bark or geranium leaves, they won’t put them in medicine bottles, they won’t colour them green – apart from Methadone, which still comes in a retro package – they won’t use the word Potion and they won’t make it taste like socks. Instead they almost celebrate the industrial origins of medicines, so that they are packaged and named like computer parts. Try a course of Celeron, and move up to Radeon if there’s no improvement after 6 weeks.

The market is wide open for a no pain no gain therapy, like the training montages from the Rocky movies, but instead of physical punishment, experts have come up with a therapy that’s more like school detention: History Therapy.

‘Historian and broadcaster Dan Snow and psychologist Richard Bentall get to the root of 21st century melancholy, and propose a cure’, we are promised

They will ask: Does meditating on the lives of our ancestors help us get a better sense of perspective toward our own problems? Can history nourish and console? Is the study of history, in short, a form of therapy?

They are putting History, in a bottle, on your tablet shelf, between Vitamin G and Vitamin I. It’s only £30 to attend the history session, which is less than the price of 100 Prozac tablets. Just remember that history is far more difficult to flush away.

I didn’t say this about Dan Snow and I’m quite scared about repeating it online, but some historians don’t think he’s a proper historian:

‘he routinely refers to himself as a historian when he doesn’t have a PhD or equivalent and therefore has not done the years of original archival research that professional historians have undertaken and then he takes our research and re-hashes it without any credit. And gets his facts wrong but still continues promoting himself as an expert. I think he is a dick and every time I hear the BBC refer to him as a historian I shout “No he fucking isn’t!

(http://gasheadau.blogspot.co.uk/2015/05/a-delightful-discussion-of-self-made.html)

Please, proper historians, try being a psychiatrist, a field where absolutely everyone you meet is an expert.

Anyway, where you stand on Dan is likely going to indicate where you stand on the treatment of Depression.

Is Depression:

  1. A major common medical condition with a high level of morbidity and mortality, that should be treated by experts in the NHS with proven treatments? Or:
  2. A medical metaphor for the stresses of modern living, that should be treated by creative people broadening one’s outlook?

Those of us sensible enough to realise that our bodies are made of molecules still enjoy putting things into them to help them work better and we would use computer parts if we had ports on our bodies, like Jude Law in eXistenz.

For us, if you’re walking away from the GPs without a prescription in your hand, at some deep level you feel that your mission has failed. Now there’s a win / win solution. Regardless of your condition, however big a hypochondriac you might be, you still collect a script. But instead of taking it to Boots and running the gauntlet of their ‘counter intuitive’ queueing system, now you can take it to the library instead and exchange it for some Bibliotherapy, aka books.

The downside of this is that you are at the mercy of your GP in terms of reading material. The other downside for the library is that it becomes a germ exchange and none of the staff use alcohol gel, not externally anyway.

Quite likely your GP, in the last of your eight minutes of consultation time, will rush the all important choice of book and palm you off with The Hunt for Red October. I can just see a bit of confusion ahead, down to the fact that doctors call collecting information from patients ‘taking a history’. e.g:

Patient: I want to take some History

Doctor: That’s my job.

Patient: Can you prescribe me a bit of Dan Snow?

Doctor: No, but we do have some Dan Brown left over.

70. Reporting soap shortages, before they get serious.

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A poster reminding people, in several ways, that they are too old.

 

The techno-thriller genre gave readers a thirst for irrelevant information. It wasn’t enough to say someone travelled on a Boeing 707. You had to hear about who made the engines, how the landing gear was inspected by a man with a set of tuning forks and how the pilot’s socks were monogrammed in alpaca by a silent order of nuns in Seattle.

The behind-the-scenes stuff became obligatory for thriller writers – quite a feat before the days of google. Presumably, Forsyth and Clancy spent huge amounts of time visiting airports, submarines and arms factories, asking people, ‘what does that yellow handle do?’

The most obvious spin-off has been the increased number of adjectives we find in grocery products. It’s not enough to say Oven Chips. You need to give them a bit of character development:  Maris Piper, thrice-fried, goose-fat oven chips, at the very least. And even then, you’ve said very little about the goose. People want detail nowadays.

Another consequence of the increased audience for background information is the ‘Troublehooter’ style of TV series, started by John Harvey Jones and continued by the likes of Gerry Robinson and Digby Jones.

A man in a striped shirt and hard hat wanders round a huge factory, shaking his head slightly, asking every now and then: what’s that thing for? As a TV show, it’s a tired formula. But, as a metaphor for personal growth, it’s got potential. The striped shirt man is a therapist of sorts. He’s an independent expert, but he’s neutral and polite. He’s robust and challenging, but he’s kind and might even hug you, though you’re still getting fired. Like a certain type of clinical psychologist, he’ll make you a flow chart, showing you which arrow is missing, such as the one between Theakston’s Old Peculiar and poverty.

It could be helpful to get someone to troubleshoot your life. But what about businesses – can an outsider really understand them? Does expertise in the field really matter?

Troubleshooter appeals to people who like to look behind the scenes and are disappointed that Arthur Hailey died before he could write ‘NCP Car Park’. Ironically, the Troubleshooter himself is not the slightest bit concerned about forged composites or digital motors. He’s looking at the system as a whole. He’s drawing Venn diagrams and talking about Synchronicity, just as though it wasn’t the worst Police album.

Gerry Robinson wants the NHS to have more centralised reporting systems, like the food industry:

‘Imagine a McDonald’s in Leicester, say, where things are going wrong. Perhaps the wrong number of chicken nuggets are being handed out, or the washrooms aren’t supplied with soap. These problems would show up immediately via a weekly reporting system which compared its performance against every other McDonald’s in the country, and you’d have a senior manager down in days to sort out the problems’.

Gerry’s background is in catering, so he’s comfortable with that model.

But, senior managers never visit NHS units, partly for fear of infectious disease, but largely because it would never occur to them to do so. Boards and Hospitals are different planets, with different atmospheres and gravitational fields.

Whereas the coffee available to senior managers comes out of a capsule machine, the coffee provided to wards comes out of industrial size tins labelled Maxwell House. It’s Maxwell House, Jim, but not as we know it.

Whereas NHS management premises are carefully protected behind air-locked entry systems and fierce receptionists, anyone can walk, unchallenged, into most hospital departments, including intensive care units and even operating theatres. This fact is portrayed in countless thrillers, where assassins get a second chance to finish someone off by stealing a white coat and strolling in.

As further evidence that NHS Boards and Hospitals are separate worlds, consider the fact that boards comprise upwards of 12 members, only one of whom is a practicing clinician. Does Gerry not think this is a bit odd? Does he not realise that Boards and Clinicians, like matter and antimatter, must never come into contact with each other and if they do, the universe will be annihilated?

I am not a management guru. But even I can spot the key differences between Macdonald’s and the NHS, such as Product Range. Which leads me to ask: who troubleshoots the troubleshooters?  It suits managers to propagate the notion that it doesn’t matter much what the company does or makes, that you can move between Catering, Television, NHS and it’s all the same. But often, the detail is what matters most. John Harvey Jones forecast the demise of Morgan for instance – he just couldn’t understand how cars could be made of wood. It’s not a mistake Tom Clancy would have made. He’d have known all about the aerospace properties of ash.

Whereas thriller writers regard craftsmanship in awe, managers regard it in contempt. In a techno-thriller, the emperor’s new clothes would be made of kevlar. And the boss would know what the yellow handle did.

To be fair to John Harvey Jones he did tell the Chief Constable of South Yorkshire that his strategic plan was ‘a load of bloody cobblers’. This comment pretty much ended their foray into footwear repairs.

 

67. Choosing exactly the right cakes, by law.

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A guard tried to stop me taking this photo. That’s Sheffield for you.

 

I’ve picked up a tail on the way to Costa. When I order a Flat White and the enormous jaffa cake, a person behind me in the queue nods, makes notes and ticks boxes. Someone is looking through all my bank statements and receipts. My texts and emails are all copied and filed. My cupboards have all been disturbed. My relatives are being interviewed about my habits and desires. Someone’s been at the pub asking what beer I like.

Am I a character from a John Le Carré novel?

Am I a teacher at an Islamic school?

Or have I just missed my Risperdal tablet today?

Is it a song by the Alan Parsons Project? Somebody out there…

None of the above. In fact all this snooping is to my benefit. I am being assessed to see what are my Best Interests.

Admittedly, to have got to this point, I have to fall within the protection offered by the mental capacity act, which means I must have a disorder of mind or brain. There has to be some doubt over whether I can make decisions properly. I have to spend some of my time being supervised in an institution. And people would probably stop me if I chose to leave.

It applies to nearly everybody then.

Carrying out a ‘Best Interests Assessment’ under the mental capacity act is estimated to take about 25 hours of social work time. Since a Supreme Court ruling in March, tens of thousands of institutionalised people are deemed to be deprived of their liberty and are awaiting assessment under the ‘DOLS’ procedure. One of the cases was called ‘Cheshire West’, which would be a good name for an stage actor. If the assessments are delayed, those deprived of their (Article 5) rights will be lined up for compensation payments. At 5pm every day your phone will ring showing an 0843 number and an automated message will ask whether your right to liberty has been infringed. It’s the new PPI.

What will social services do about the pile of referrals, which if stacked end to end, would stretch from all the way from Purgatory to Hell?:

Manager: How long does it take you to do a best interest assessment?

Social Worker: At least 25 hours.

Manager: From now on, you’ve got 25 minutes, and I’m being generous because it’s your birthday.

Social Worker: There are 56 pages of forms to fill out.

Manager:  Then you better get started right away.

Social Worker: We’re supposed to find out all about that person. We wouldn’t want them to get the lemon tart instead of the big jaffa cake.

Manager: Save that cake routine for the Supreme Court, why don’t you? I’m guessing Baroness Hale of Richmond will set fire to your ass and mine too.

Social Worker: Whatever happened to you, chief? You’ve taken down the picture of Shami Chakrabarti too!

Manager: If it’s toasted on one side it’s still toast. Three little letters son: G4S. And now you’ve got 22 minutes left.

It’s easy to blame the supreme court, but all they seem to have said is that someone should look out for people who have lost their mental capacity and have been locked up by the state. No-one expected the Spanish Inquisition, except perhaps Dan Brown.

 

61. Punching above your weight, with Britney.

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Robot Archie is a comic strip character waiting for a revival. He was amazingly strong and intelligent, but he had one career limiting weakness – he had a control panel that was clearly visible to others. This made him vulnerable to assailants creeping up behind him and pressing the clearly labelled off switch. Nevertheless, having labelled buttons, or even dials to control aspects of oneself would be a huge asset for humans.

Imagine setting your mood state or attitudes with a mode switch, like the ‘Dynamic’ button on Toshiba televisions, which gives an altered visual experience similar to hallucinogens.

One control we really need, besides air con, is a self-confidence dial. Most people set their level a bit too high, much like the heating on trains. The average person is over-optimistic about life in general. Psychologists have identified a cognitive bias towards overestimating things like how intelligent and attractive we are, whether our predictions will come true and how long it takes to get served at Costa. It has been argued that all trade works on this basis, where both parties in a deal overestimate the value of the item they are exchanging.

One peculiar exception to this rule seems to be life expectancy – people, including experts like actuaries, are underestimating how long they will live, which is a major nuisance for the pension funds. Another exception is people suffering from Depression, who tend towards pessimism, as well as a negative evaluation of past events.

Setting the confidence level a bit high is viewed as a defence mechanism against life’s upsets and affronts. But there are certain situations where it’s an issue, such as medical training. It is well recognised that the worst type of doctor is the overconfident one. The sort of person who thinks ‘see one, do one, teach one’ should read the other way round. The sort of person who says loudly, ‘bypass grafting – how hard can it really be?’ on his way into the operating theatre. Trainers recognise that the overconfident doctor is the most difficult one to put right. It looks as though overconfidence or even arrogance is relatively impermeable to feedback, which is perhaps why it’s such a good defence against self-loathing.

Another aspect of the overconfidence debate is whether doctors should give a completely accurate account of the likely benefits of treatment, or apply a little positive spin. Surveys have shown that service users appreciate an upbeat attitude, as well as honesty.

Modern life has removed some of the old certainties, such as how long we will live, or whether the older professions are the best careers. The employment market has too many graduates and not enough artisans. Large companies like Tesco and Microsoft, which we assumed would carry on for hundreds of years, like the Roman empire, seem to be on the decline. This has led to a situation where people change career more frequently.  Many candidates for jobs think of themselves as overqualified. And the orthodoxy within firms is not to hire the overqualified person on the basis that they will become disgruntled quickly.

That leaves a serious self-calibration problem, in the absence of a human dashboard. To an extent, CBT (Rational Emotive Behaviour Therapy in particular) is an attempt to assign the correct emotional value to aspects of oneself. Otherwise it’s clear that people are just all over the place when it comes to self-evaluation.

Take a look at these small ads for instance, which illustrate some form of extreme cognitive bias – the disorder usually known as ‘Ron Hopeful syndrome’:

Elderly gentleman, heavy smoker, slightly racist, seeks supermodel for company, trips to garden centre, kinky sex and possibly more.

Nissan Micra, 1997, beige, some damage to interior due to poorly cat, looking to exchange for holiday villa in Cornwall or Devon. No time wasters.

Senior scientist wanted, PhD or post doc, nanotechnologist preferred, fluent Russian desirable, for general warehouse duties.

Wanted: chief executive officer for large healthcare organisation, should have English Language GCSE or equivalent, shovel and forklift training provided

General Medical Council seeks lay member. Performance artist preferred, e.g George Formby impersonator; street theatre, statue man, juggling etc desirable. Ukelele provided.

Crime fighting robot from 1960s available for general do-gooding and big society fieldwork, unpredictable at times. Good with dogs.

Historical footnote – contrary to my first impression, a little research shows that Robot Archie has already made a number of career comebacks. According to Wikipedia:

‘In Zenith, he was a burned out 1960’s acid casualty (renaming himself Acid Archie). Archie is apparently killed by Ruby Fox in Phase IV when she short circuits him whilst he is trying to rip off her head. Archie also appears in zzzenith.com in the special Prog 2001 edition of 2000AD. Zenith explains that rust in the brain-pan has caused Archie’s personality to change from anarchist Acid-House aficionado into a vigilante, hunting down sex offenders with a lethal vigour. He is last seen in the story escaping on a bus in a false beard after sexually assaulting pop star Britney Spears’.

It’s also possible that he gained weight with age so that he wasn’t able to reach his own controls any more, located as they are in the middle of his back. As a literal ‘locus of control’ problem, this was probably what gave Julian Rotter the idea in the first place.

To some extent, he never learned to push his own buttons properly. Like most fictional robots, his downfall was caused by getting too human to control himself.

47. Predicting the New Year, without proper guidelines.

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Psychiatrists are able to read the future. That’s why there are very few about – most have made a killing on the stock market or at the bookies and have retired to Tahiti. Or so our managers think.

Just to prove the point, here are some predictions for the New Year:

1. Badgers will launch a surprise counter attack on David Cameron. They are already digging a tunnel towards Downing Street. Badgers are classic terrorists, with long memories and sharp teeth. In panic retribution measures, Brian May will be blamed and sent to the Tower of London.

2. People will begin to notice that google searches are getting more polluted by advertising. Google will offer a premium service where you pay a subscription for an ad free version.

3. Universities will begin a series of mergers and takeovers, so that eventually there are only four big players, as with supermarkets, petrol, energy etc. University Challenge will start at the semi finals.

4. There will be an upsurge in Placebo based treatments of all kinds, and NICE will issue lengthy guidelines on how to choose and use them, with a forward by Prince Charles.

5. Private GP practices will develop in the larger cities. They will give you the sleeping tablets, painkillers and Betnovate cream that you have longed to obtain, without any tut-tutting.

6. Building regulations will be tightened up, so that new buildings will have wider letterboxes, to accommodate take-away pizza.

7. Swiss cheese makers will be stopped from injecting carbon dioxide into the holes to make it weigh heavier on the scales. Conversely, Ryanair will check for Helium in your hand luggage.

8. The forces of social control – police, probation, mental health and social work – will increasingly blur together. The new force will be re-branded as Lifestyle Services. The uniform will look suspiciously like G4S.

9. Further updates in nomenclature. G4S to G5S, E45 cream to E46. Boots 7 goes to 7.1. Players No. 6 are re-launched as Players Number Free. They pre-empt the packaging ban by going for a plain white carton. It worked for the Beatles after all.

WD40 surprises everyone by going straight to WD million.

10. Liverpool FC will embrace Mindfulness. Their new kit will be orange robes.

If you want a more accurate prediction, and you don’t know any psychiatrists, you can do equally well or better yourself, using a set of dice or random number tables. Please note, NICE do not recommend the use of tea leaves, bones, fund managers or even physicists. Prediction is very difficult, said Niels Bohr, especially about the future.

From Tahiti, I wish you a Happy New Year.

43. Deciding whether to decide, or not.

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Some KFCs are quite opulent on the inside.

I’m hoping to acquire one of those official looking G4S-style jackets that parking inspectors wear, along with a peaked cap and mirror shades. The reason is, I live next to a school, and every morning the parking situation gets worse. The invention of the SUV has blurred the harsh boundaries of road, pavements and yellow lines and turned them into a mere probability distribution. There’s an Audi Q7 that behaves like a two tonne hippo, just setting itself down wherever it pleases. If I just stood outside, in my Parking jacket, maybe the madness would stop. Until I got arrested, anyway.

Parking properly is one of those skills, like cooking Yorkshire Pudding or wiring a plug, that 57% of people can’t do. Recently two surveys showed that modern school-leavers are no more literate than their grandparents were at the same age, and that they would lose a 100 metres race to their grandad. And that’s as he is now, aged 95, with advanced emphysema.

Surprisingly then, Britain, the country at the bottom of the skills league table, where only recent immigrants actually know how to do anything, introduced the Mental Capacity Act.

Luckily, like the parking outside the school, it is not enforced.

So called ‘mental capacity’ means that a person is able to make a decision. It depends to a large extent on how complicated the decision is as to whether the capacity is present or not. For instance a person could have mental capacity to choose breakfast, but not have capacity to make a will. In between these, somewhere, is capacity to have sex or get married, or both. If a person does not have capacity, they should first of all be suffering from a deficit of ‘mind or brain’. Then they must fail one or more of the following steps of decision making: Understanding the information, Retaining the information, Weighing the information up, and Communicating the decision.

Immediately obvious is the amount of greyness in the ‘weighing up’ part.

While the Mental Capacity Act makes it clear that making an unwise decision need not mean that the weighing up process is defective, it certainly leaves scope for an argument over the point where an unwise decision becomes irrational, and the point where irrational means lacking capacity.

Perhaps the intention of the mental capacity act was to give the illusion of clarity, while still leaving a huge judgement call to doctors or other professionals. The irony is that no professional person really understands the mental capacity act and certainly doesn’t retain it in his mind or communicate it well. The mental capacity act code of practice was written on the planet Zarg, in Zarg language, which is similar to Welsh.

So, only case law will reveal the dividing lines between unwise and irrational.  A series of judgements will set the goalposts for issues like leaving all your money to the scientologists, marrying your attractive but 70 years younger carer, buying a Porsche 911 to celebrate your 100th birthday etc.

For instance, last year, a judge ruled that an autistic woman with an IQ of 64 did not have mental capacity to have sex,

‘on the grounds she does not fully understand she could say no to such actions’.

Mr Justice Hedley said the 29-year-old lacked the mental capacity to consent to having sex, and made the order to protect her best interests.

He said she had to be protected from ‘potentially exploitative and damaging’ relations in the future, as she had already been involved in risky behaviour with people.

http://www.dailymail.co.uk/news/article-2096472/Judge-bans-vulnerable-woman-having-sex-lacks-mental-capacity-consent.html#ixzz28nA227ia

Would scientists or doctors have come to the same decision as the judge? I suspect that scientists would tolerate fuzziness better than lawyers, simply accepting that the person had some mental capacity but not as much as most other people. But the legal system is black and white, not grey.

Whether a person can choose to have sex or not soon becomes a question about how the mind and body work together. And this in turn leads to an examination of how the Automatic part of the Mind interacts with the Reflective Part. It would be nice to think that sexual behaviour falls to the Reflective Mind, but its association with the older parts of the brain and the older types of intoxicant means that it probably doesn’t. Whatever the IQ.

So rather than being a Parking Officer, perhaps I could be a Mental Capacity Inspector. Outside the school, armed with my new jacket, the Mental Capacity Act Code and the Oxford Dictionary of Zarg, it’s time to Stand up for Sensible.

Firstly, do these errantly parking motorists suffer from a disorder of mind or brain? Most of them look absent minded and some are clearly in a trance like state. Some seem distressed, shouting at their children. At least two are using nicotine. One appears to be wearing a dressing gown and slippers. In fact, none of them seems entirely well.

Then, have they really decided where they want to park? Do they know what yellow lines mean? Can they weigh up the ethical trade off between blocking the traffic and parking on the pavement? Would they know that squashing cyclists can hurt them?

Enforcing Parking Capacity is just the start. Irrational behaviour is going on all over town, much of it in the context of mind / brain dysfunction, such as Special Brew Disorder.

Firstly, the National Lottery till at the newsagent. Anyone who doesn’t understand Probability – a GCSE in Pure Maths with Statistics will suffice – should be politely turned away in their own best interests.

Then Ladbrokes. Look at these other customers – do they look like rich people?

The tattoo shop – this sounds silly, but do you know that won’t wash off? And KFC. It’s chicken Jim, but not as we know it.

The mental capacity act can only do so much, since it respects unwise decisions, or any decision made by someone of sound mind. That’s why we still need the Style Police and the Fashion Police. It’s vital these functions don’t go to G4S, even if they have the jackets already.

38. Being nicer to donkeys by not talking their hind legs off.

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 Two people having lunch without smartphones.

Instead of  CBT sessions, the local mental health team are just playing Reasons to Be Cheerful: Part 3, over and over again. The cuts are beginning to bite.

Whenever I hear this song, the dark side of my mind sings an alternative version called Reasons to be Gloomy. (Earthquake in Turkey, Murder in Hackney, KFC…). Actually sad songs are much more uplifting, e.g. Girlfriend In a Coma. I know, I know, its serious.

A kind of Quantitative Easing has increased the supply of words, above and beyond demand for them. With QE, money goes into the economy, but where does it come out? I suspect the answer is HSBC, either that or Poundland in Mexborough.

Something similar is happening with words. Far more of them are being written or spoken, recorded and published. What will be the effect? In the words of John Major, they are probably coming out as ‘froth and bubble’. My argument is that the surplus words are emerging in the form of Chat. There are some obvious examples, like the Chat Show and reality television. Smartphone sales are through the roof. The new media has turned people who were already chatty into right-old-turbo-gobs.

Mostly the message from mental health experts – and BT – has been that it is good to talk. Communication, communication and communication, as Tony Blair didn’t say. But what about the quality? Is everyone, everywhere, just talking too much? Words are everywhere, spoken and written. Metro. Evening Standard. You can’t sell them and you can’t even give them away. People are carrying words round in wheelbarrows. Words are the new hyperinflation. Words are the new carbon footprint. Wordiness is the new Obesity. When word inflation occurs, language loses its meaning and no-one can really say anything properly.

Until finally Ronan Keating says it best when he says nothing at all.

Is verbiage damaging to psychotherapy? If either the client or the therapist seem to be making small talk, we are taught that something has gone wrong. What I look for when people speak is the signal to noise ratio. Certain groups of people use a lot of words where one or two choice words would be enough. I’m thinking priests and politicians. Or Alan Carr, the famous Chatty Man.

The practice nurse went a bit chatty at my recent annual health check. She had much worse health problems than I did. But that’s not the point, is it? That’s something for her and her own health-check-with-the-nurse. Chatty therapists tend to make the mistake of ‘early disclosure’. This is when the therapist gives away a few personal details to get things going. No doubt this is an attempt to break the ice and appear genuine and empathic. Unfortunately another person’s experiences are never that similar to your own, and even if they are, their take on them is different from yours. Even if they have the same take on them, you were there first. It’s a difficult trade off between Empathy and Genuineness, and no-one quite gets it right. In the worse case scenario the therapist will have disclosed his forthcoming trial for manslaughter before the patient has even got his coat off.

OK, the health check revealed that my back is not that bad, compared to yours. I found this out for certain at B and Q when I played my Sick Role Card to request one of the staff to carry some massive bags of compost to the car. As the very obliging man – an early discloser it turned out – struggled with them, he began to tell me about his own back problems, the account growing increasingly horrendous as he shouldered the bags from the giant pile. He’d had several operations and long courses of Physio, dallied with the alternative sector, TENS, hot yoga etc. Sometimes his legs went numb and tingly. In this case he should have disclosed even earlier, and I would have carried the bags myself and counted myself lucky to do so. I’d have taken over his shift if he’d let me. It looks as though B and Q have taken the rule book on disability and turned it inside-out.

Some people are deluded that  the new Iphone collects all our fingerprints and stores them somewhere. Come to think of it, that’s not a delusion, its probably true. It probably knows where you went shopping and what salad dressing you chose. So what?  Finding any serious information in a sea of chatter must be nearly impossible. I feel sorry for the intelligence services trying to look through all this flotsam. A paranoid person perhaps supposes that some kind of task force is working night and day on every aspect of his life, sifting the bins and joining the shredded documents together with hired jigsaw experts. Almost disappointingly, there is no-one out there doing jigsaws with your Santander statement.

No doubt there is an evolutionary advantage offered by garnering, manipulating and disseminating information. Supposedly Tesco made money using the market research that came implicit with their Clubcard scheme. That seems quite a way from spying on people.  They are searching for wood but can see only trees.

Most people’s response to surveillance is that they don’t care. They are not bothered that Barack Obama knows which biscuits they bought. Preferably though he should not get to know that they bought The Ultimate Eighties Power Ballads CD. Barack, it was only £3, please don’t get all superior. Don’t forget you mixed George Osborne up with Jeff Osborne.

Instead of buying a car, I like to ‘build the car’ on the manufacturers websites. Usually the software is clunky, or there is something wrong with Quicktime or Flash, so the virtual car gets abandoned somewhere between the Milano Leather and Heated Support Tights options. Nevertheless, all the carmakers know, or think they know, what car I would specify if I had a better computer or attention span and some money. Is it realistic to think they care, or is such a notion mere grandiosity on my part? Do I expect them to ring any moment from Stuttgart – yes we now have the S class in purple, like you always wanted, should we send it round?

Is there some kind of representation of Me out there in cyberspace, based on my failed online build-a-car projects and grocery purchases? If so it’s hardly a finely sketched personality profile, unless Rorschach testing has moved on a long way. The truth is there is very little use in collecting masses of trivia, whether you are a therapist, a supermarket, or the NSA. Lots of noise, hardly any signal. Experts call it the Alan Carr effect.

In this cacophony of trivial information, there are islands of confidentiality, such as Confession and Psychotherapy. But do any of us really have much that is worth being confidential about? They have heard it all before. People have been plotting revolutions, visiting sex workers and buying Keane albums since history began.

Being a bit of an introvert, I’m wary of the Chatty Person. I know colleagues who never reveal they are psychiatrists to people they meet on a train or plane, to the extent of building an alter ego. It’s difficult for Psychiatrists to build a credible cover story, since they seldom have any experience of other careers. I knew someone who pretended to be a hospital manager, thinking they would know just enough to get by, only to be floored by a question about Lean Sigma or some such jargon, by a busybody from KPMG.

I try to avoid taxis and hairdressers, where the chat can be relentless and searching. Never make the mistake of thinking your hairdresser is not listening to your story, or won’t remember it in detail. Trivial information is hard currency in the world of Chat. Hairdressers are not bound by any rule of confidentiality and will not be struck off any register for talking out of turn. Quite the contrary. Why don’t the security services simply use hairdressers as spies? They’ll get the info one way or another – hot tongs if necessary.

Campaigning for greater secrecy seems ridiculous. Campaigning for Plain English has already been done. Campaigning for real psychotherapy is probably too late, now that Reasons to be Cheerful seems similarly effective. What we need is better editing. This piece, for instance, its much too long.

I once worked for a consultant who never allowed anything to go out that took up more than one side of A4.  And that was even before the invention of bullet points. Along these lines, instead of all the above nonsense, let me summarize as follows:

  • A high signal to noise ratio is vital in effective communication.
  • Barack Obama knows you like James Blunt.
  • Tesco use jigsaw experts to read your mind.
  • Beware the chatty therapist.
  • Wanted for B and Q: strong silent type.

29. Growing cress heads for no particular reason.

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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.

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.