42. Staying hermetically sealed outside Primark.

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Recently a golf pro asked me whether I did any sports psychology. The only advice I could think of was the idea of treating every shot as a ‘hermetically sealed unit’.

‘Oh, you mean, the bubble’, came the reply. I nodded. Someone had obviously thought of my idea first –  Professor Woods, I expect.

On reflection though, I like the phrase ‘hermetically sealed’ better. Imagine being able to extract a single item of behaviour from its context. Imagine taking the item into the lab for a while, looking at it carefully, brainstorming the possibilities. And finally taking the shot, just exactly as you have practiced a thousand times.

Breaking down analogue behaviours into single digits is an attractive way of avoiding the effects of anxiety, or other emotions – like sadness and humiliation – found so frequently on golf courses.

The idea of living in the moment is not new, even though the mindfulness brigade have latched on to it. Sure enough, a brief excursion into google reveals a huge literature on ‘The Power of Now’. Forget about the past, forget about the future.

It’s a 6 foot putt breaking left to right on a downhill slope. Take that putt like Leonardo painted the Mona Lisa’s eyes. Give it everything. Make it perfect.

Golf is of course a flawed analogy for life in general, although for some people, golf is life in general. Golf lends itself to a model where a sequence of discrete events, strokes, make up a sum total. The scoring system is numerical and precise. Even better, there is a handicapping system to compensate the less fortunate. It’s the only game with its own system of social security. It’s like getting a GCSE upgrade on the strength of a Doncaster Postcode.

The same system cannot be applied to more complex behaviours where the scoring system is fuzzy and subjective, for instance, telling a joke, or interacting with someone selling the Big Issue outside Primark. Do we make eye contact? Do we say anything? Do we stop? Do we even buy the paper? What do the NICE guidelines say?

Luckily there is a simple tool to help us live in the moment, one that we have all used. I am referring to the Multiple Choice Questionnaire, or MCQ. If we could think of our day as a series of MCQs, then we could really start to focus on the Now.

MCQs have become the stalwart system for exams. They have several advantages, such as subjecting themselves easily to statistical analysis, but the main advantage is that they can be marked by a machine rather than a teacher after pub closing time.

MCQs are best at testing factual knowledge, but they have been developed to test logical reasoning and other skills. Like crosswords, MCQs have their little quirks and habits that students get to know. For instance if it says ‘Never’ or ‘Always’ then the answer is False. Though some events do occur 100% of the time, such as the sun rising in the East, or England losing penalty shootouts, such events do not trouble the world of exams.

There are other quirks. Some questions have one option that is plainly silly. It’s unclear whether these are designed to reveal a stratum of candidates who are also plainly silly, or because the examiners have been a bit lazy creating proper options:

Q) A 20 yr old female is nervous of being focus of attention in public, so she avoids parties & canteens. Develops palpitations, anxiety, tremors during social engagements. Diagnosis is

One answer only.

    a) Panic disorder

    b) Social Phobia

    c)Anxiety disorder with Panic attacks

    d) Measles

The silly option is usually the last one, supporting the lazy examiner hypothesis.

Instead of the silly option, some examiners prefer a twist of surrealism:

Q)  A 22 yr old male is arrested for sexual harassment of a girl & is found to have tachycardia, dilated pupils, hypertension, sweating, increased psychomotor activity, elated mood , pressure of speech & inflamed nasal mucosa. Diagnosis is

One answer only.

    a) Bipolar disorder type II

    b) Manic phase

    c) Cocaine intoxication

    d) Rock ‘n’ Roll

 

The art of turning our day into an MCQ test, may reveal, sadly, that there are surprisingly few choices we get to make. The biggest one is probably between Macchiato and Flat White. In daily life, the silly and surreal options – trying a fish foot spa or keeping a pet iguana – outnumber the sensible decisions. Such is the ‘choice architecture’ in the modern world. The main trick, like thought – catching in CBT, is to identify a decision point when one occurs. Realise there’s a choice to be made and hit it with an MCQ.

But what about the Big Issue itself? How are people behaving outside Primark? Here are some specimen answers I got from the web:

  • The woman who sells it in our village is a thief. She has been in court more  times than i have had hot dinners. The last time she took her child /  buggy into Peacocks and stole tonnes of clothes, using the buggy

 

  • I give them some money, but I don’t take the magazine. I used to give money to one seller quite regularly, and he was a nice guy but he was really  troubled. I haven’t seen him for a few months so I think his situation  finally got the better of him

 

  • So      what makes you think he’s not genuine? Because he’s a tw*t? tw*ts are  homeless too. In fact, IME, the proportion of tw*ts amongst the homeless is far higher than the general population

 

  • I buy the magazine. It sometimes has some interesting articles and interviews, but that’s not what I buy it for.

 

  • ‘To avoid buying it, i once told a ‘Big Issue’ seller that i got it delivered. The next time i passed him, he punched me’

 

It looks as though the silly and surreal options are both included, but which one is which? Try and stay hermetically sealed while you decide.

39. Dropping hammers, more carefully, onto mobile devices.

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Do you wake up sometimes, look into the middle distance through the dull overcast November weather- 10 degrees Celsius, wind speed 9mph, 50% chance of rain – and wish that things were just a bit more extreme?

On the one hand, political correctness limits what can be said or done on the traditional left and right of the political spectrum. On the other hand, some religious factions – you know who you are – have ‘gone off on one’ with terrible results. Single-issue campaigning represents a window of opportunity, but even the most popular campaigns, against badger culling and wind farms for instance, tend to lose traction.

Shouldn’t Brian May be more concerned about bringing out a brilliant solo album, people ask? Shouldn’t any form of electricity be gratefully received, taking form, as it can, as light, music and warmth?

As the day goes on, opportunities to do anything extreme are surprisingly limited. True, Ladbrokes seems to be open all hours, but some kind of pheromone operates to keep people out. There is no fragrance called Loser.

One of the easier outlets seems to be Sport. It’s not uncommon to see someone running several miles before breakfast. It’s not unusual to see a cyclist powering his way round the peak district. Most of us would be exhausted just putting on the Lycra. Let alone even consider proper extreme sports, like snowboard chess and water cribbage.

The psychological roots of extremism are probably highly varied. One likely culprit is the mechanism of Denial, where the mind tells Reality, quietly and firmly, to shove off. It’s the mentality that puts a cup cake display on the gym reception counter. (Yes you, Hilton by Doubletree, Chester.) It’s the approach that leads to dropping hammers on mobile phones to test their durability. As though Isaac Newton had never existed.

Most people with Depression or other mental health problems resort to extreme therapy at times. In fact there’s a massive history of ‘heroic remedies’ in medicine, mostly deriving from the (bogus) four humour system, which ran for nearly 2000 years, from Galen to Beyoncé. Favourite approaches included purgatives, bleeding, cupping and cautery. I’m not sure what cupping was and I’m too squeamish to look it up. People still do ear-candling, which sounds similar, and this could lend itself to extreme versions, now that we have petrol.

The military have contributed enormously to extreme thinking. They have highly disciplined physical training programs, but also extravagant headwear, like the Busby. The military tend to suffer from PTSD, which is an extreme type of anxiety disorder, and they favour gung-ho treatment options, like eye movement desensitisation, instead of the gym and cupcake regime preferred by anxious civilians.

Treatments for mental health have of course taken extreme paths at times. Insulin coma and ECT are two obvious examples in terms of physical treatments. There are still psychiatrists who get fanatical with antidepressants. While most people with Depression struggle to get even adequate drug treatment, there is a small group who get battered with mega doses and multiple combinations that would leave the NICE guidelines in tattered shreds and probably smouldering.

Psychological treatments have also got extreme from time to time. For instance Primal Scream Therapy, which led to John Lennon’s worst album. And Flooding therapy, where phobias are treated by facing the feared item full on (one of the few occasions when tame spiders have found useful employment.)

More recently we had so-called ‘Assertive Outreach Teams’, who visited you whether you liked it or not. Like the doomed squad in The Wild Geese (ditto Clear and Present Danger), Assertive Outreach have been abandoned by HQ and stood down, with some still behind enemy lines.

Most people have a little voice in their ear that says, ‘I wouldn’t do that if I were you’. It’s enough to stop ordinary impulses, like pressing Amazon’s very frightening ‘buy with one click’ button, buying anyone’s second album, or biting a green chilli. It would be nice to have a health advisor along similar lines, possibly in the form of a mantra or an app. Luckily, there are warning labels everywhere, like the one that says not to put cigarette ends in your petrol tank.

CBT gives us a framework to collect our thoughts and examine them from different perspectives. CBT will tend to reduce extreme thoughts and move them back towards a sensible perspective. As such one criticism of CBT is that, if implemented on a massive scale, it could bring about a very bland society. Someone will say, not Tony Blair this time, that there are three basic values – moderation, moderation and moderation.

In which case how will resistant depression get treated? And who will seek out and follow up our reluctant service users? Above all, who will test our phones against the laws of physics?

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.

21. Judging. Not.

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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.

17. Giving feedback without using the hairdryer.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I’m thinking 333 would be about right.

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

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

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

555, agreed?

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

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

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

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

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

15. Searching for Weapons of Mass Distortion*

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In Glasgow, its safety in numbers.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1. Giving to charity?

2. Tax?

3. Gambling?

4. Profit for shareholders?

5. Pensions?

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

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

Its a win/ win scenario.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This leads me to a surprising conclusion.

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

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

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

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

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

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

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

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

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

Try imagining your manager as a pirate.

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

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

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

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

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

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

Your manager won’t have read it.

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

Your manager won’t have bought it.

14. Finding the Chimps in the Armour.

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Nice nails, nice hair, shame about the ears.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nowhere is anthropomorphism more politically incorrect than the zoo.

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

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

That kind of thing just isn’t allowed nowadays.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

12. Grappling with the wrong trousers.

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What the well dressed tree is wearing this year.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You should have thrown it back in.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Behaviourally, it is supposed to trigger a purchase decision.

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

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

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

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

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

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

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

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

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

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

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

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

But it just does.

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

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

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

So that they are visible in traffic?

Reaction to feeling left out or insecure?

Mating ritual?

Group or gang identity?

Genuine lack of insight about how they look?

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

11. Tackling hooligans with a simple checklist.

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

Hooligan.

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

Hooligan.

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

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

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

Yours may be different.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Not recommended and foolish, both for toasters and people.

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

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

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

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

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

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

Hug them (as recommended by the Prime Minister)

Shoot them immediately (as recommended by Michael Winner)

Run away

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

Attempt to slowly reform the hooligan using metalwork and batique

Cover them with a floral throw and scatter cushions

Play them some Tin Machine

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

(Or was it a steam locomotive?)