58. Just asking: what would Englebert do?

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Robin Hood: should have stayed out of Nottingham

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Byron: should have stayed in Nottingham

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Doctor: It’s Nottophobia.

Patient: Yes it is a phobia.

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

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49. Saying no to Mister Kipling.

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My new laboratory

Outside Ladbrokes, it occurs to me that behavioural psychology, one of the greatest discoveries of the twentieth century, has fallen, like that other great Russian invention, the Kalashnikov, into entirely the wrong hands.

Clinicians have neglected behaviourist explanations and treatments for mental health problems, leaving these dark arts to commerce.

Though still called cognitive behaviour therapy, CBT has edged out the behavioural aspects, such as facing feared situations in real life, or reducing unwanted repetitive actions like texting during mealtimes.

The move towards Mindfulness has taken things even further in this direction. Whereas behavioural techniques can be applied successfully to animals, mindfulness cannot. Herein lies the problem. Therapists are most reluctant to regard the human being as an animal, whereas it suits some commercial interests for people to act like plankton.

In fields such as gambling, shopping, advertising and food, simple behavioural strategies have proven to be devastatingly effective. By placing rows of sweeties either side of the checkout in supermarkets, or sending a tinkling food cart slowly but surely up and down planes and trains, we are made to drool. Our sense of scale is disrupted, by selling massive chocolate bars for £1, next to tiny versions for 65p and three-for-two offers. Greater consumption seems to make sense.

Behavioural interventions like graded exposure and exposure response prevention are too dangerously similar to common sense to warrant an exorbitant fee in clinical practice. Whereas a gambling machine or a chocolate bar has no problem reducing you conceptually to the role of laboratory animal.

I’m just dreaming up another screenplay, which is for a re-make of Traffic, but with people addicted to sugar instead of heroin, with fat actors instead of thin.

I’m hoping it’ll get funded before the current moral panic about sugar dies down. The idea is to examine ‘the sugar problem’ from different perspectives, from politicians and big business on the one hand, to the crowds of diabetics camped outside Clinic 16 on the other, via the sticky pavements outside KFC.

Here’s the background theory as I understand it, simplified for the movie:

1. For some reason, the USA has a big corn syrup industry and puts corn in all kinds of food products.

2. Fructose, made from corn, is sweeter than glucose and has less feedback effect on the brain, leading to over-consumption and frequent trips to the Spar shop.

3. People get more tolerant to sugar, increasing their consumption progressively.

4. They may experience craving and withdrawal effects similar to chemically addictive drugs, leading to sugar addiction

5. Sugar tweaks the dopamine and endorphin pathways in the brain. These are shown diagrammatically as massive cables connected to the addiction box, which is sited just behind the nose.

6. Recognising they have an addictive product on their hands, the food industry takes advantage, increasing the sugar concentrations, fructose content and portion size. 500ml becomes the new 330ml. We are asked at food shops if we want to ‘go large’ and we say yes. Shouldn’t there be a consent form for such a far reaching decision?

7. Big Sugar runs a clever diversionary tactic, blaming Big Fat for everything.

8. The insulin manufacturers get richer.

9. Politicians propose a Sugar Tax, forgetting it was an OMD album and they probably still have copyright.

10. Grand Designs features an edible house made of Glacier Mints.

Did the mental health industry play its part in the great sugar rush? At first sight, it looks as though our hands are also sticky. Mainstream psychiatry demonised the use of amphetamines, barbiturates, benzodiazepines and antipsychotics as tranquillisers, while promoting ‘atypical antipsychotics’ that were strongly associated with weight gain. Psychiatrists promoted the concept of addiction and started applying it to things increasingly difficult to compare to heroin, such as chocolate, sex, darts and embroidery. As a result, the concept of addiction has become a metaphor for any repetitive pleasurable behaviour that has a downside.

The mental health industry is buying into the idea that drugs and even foods have power over us and may enslave us if we weaken. In terms of reducing the crowds at clinic 16, will it help to regard sugar as an addiction? More likely it will prove counterproductive to empower sugar by deeming it a chemical of substance. There’s no denying that sugar is a powerful ingredient – the taste for sugar is hard-wired. After all, it’s only competing with three other tastes, two of which are bitter and sour. It’s a taste that children seem to love, but that many grow out of. But in the end it’s just a molecule, not a mystical power. Food and drugs are tools for us to use, not the other way round.

I’m pretty sure, in a double blind trial, I could not tell Coke from Diet Coke. Yet everyone I ask assures me there is a massive difference. There’s an urban myth that sugar intake creates a ‘rush’ or increases energy, even risking overexcitement. Who planted that idea in popular consciousness? Mars, perhaps.

As a debunking exercise, I did a small field trial on the so-called Death By Chocolate. Suffice it to say I survived. Should I have asked for my money back?

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The Death By Chocolate, before the experiment

Maybe the marketing men did not envisage how strongly sugar would catch on, given a combination of chemical and social reinforcement and low pricing. Companies say they have increased portion size and fructose content because people are demanding larger and sweeter products. A kind of forward feedback has occurred, and the moral is, conditioning is a powerful motivator.

How to end this movie then? One idea is to have all the dark psychologists who manipulate our food preferences arrested in a raid on Tate and Lyle? Or an upbeat ending with scientists discovering Baking Canderel? Or a line of addicts at the sugar clinic, receiving treacle in little pots, instead of methadone?

Incidentally, please do not attempt the Death By Chocolate challenge without medical advice. Sometimes these urban myths have a grain of truth in them.

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.

Image

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.