18. Steering Clear of Tulip Futures.


Blue daffodils – the next big thing.

If psychiatrists were football managers we’d have been fired hundreds of times over. Depression is still the biggest cause of disability in the developed world. Like football, Spurs in particular, our treatments don’t seem to have advanced much since the 1960s.

Nevertheless, we continue to live in a world where we feel the big breakthrough is just round the corner.

What if mental illness really was caused by abnormal chemicals in the brain? Would a whole generation of counsellors and therapists become unemployed?

And what if a real ‘happy pill’ was invented, that improved people’s mood and behaviour, without being addictive or dangerous?

Some very powerful vested interests would be upset: brewery companies, organised crime and drug companies – arguably all  the same people – who continue to make mind-altering drugs and antidepressants, whose sales would slump.

It could happen, but we are right to be sceptical.

Clearly, Depression is not one of those diseases like Smallpox or Cholera, that could be eradicated with a vaccination program or antibiotics. Is it?

There has only been one such development, which completely changed the game. This was the introduction of Chlorpromazine in the late 1950s.

Since then there have been so many promising avenues, which have turned out to be mere dead ends in the history of ideas.

Or rather, as we say in Europe, Cul de Sacs. Or is it Culs de sac? Or even Culs des Sacs? And that’s before we decide whether to hyphenate.

Whichever way, a good name for a Belgian jazz musician – probably one who has taken up a defunct form, such as Scat.

Cul de sac appears to mean ‘the arse of a bag’. No-one seems to know if Cul is a rude word in France. People I ask tell me the French don’t really have a concept of rude words in quite the same way as in English.

Culs de sac have occurred regularly in the history of Psychiatry. The best known example is the so called Pink Spot.

In the early 1960s, scientists thought they had found an abnormal chemical in urine samples from patients with schizophrenia, which made a pink spot on filter paper.

Eureka! The spot was thought to be DMPEA, a possible brain chemical that had an effect like LSD. The theory was that an abnormal gene produced an abnormal chemical that caused the brain to malfunction.

Sadly, not true.

It led indirectly to a large number of patients being given high doses of B and C vitamins, which were unhelpful. To some extent the sixties was the vitamin era (though we did not have them in Derbyshire) and mega doses were made popular by chemists such as Linus Pauling and advised for all kinds of ailments, particularly cancer. Megavitamin sites are all over the internet, even now.

A more recent cul de sac, which is still running in self help literature, is the idea that people with Depression have a deficiency of certain types of oil or fatty acid.

Quite a number of studies compared types of fish oil with placebo, and a brief overview suggests that the more rigorous the study method, the more limited the benefits, with many studies showing no significant effect from oils.

I’m not saying don’t try these oils, by the way. There’s just something fishy about them.

Another occasional ‘winter visitor’ is the notion that mental illnesses are caused by a virus. This theory seems half based on the admittedly interesting finding that people with certain mental illnesses are more likely to have been born in the winter.

Many illnesses may turn out to be caused by viruses, especially if we use the word ‘virus’, like ‘allergy’, to mean ‘tiny nasty thing we can’t see’. Famously, stomach ulcers turned out to be related to bacteria infection much more than stress.

There are vast numbers of micro-organisms yet to discover, many of them found in our own gut. There are a number of scientists working on pro-biotic remedies, using specially trained bacteria to impact upon the nervous system via the GI tract.

Mice fed with Lactobacillus rhamnosus JB-1 for instance, showed significantly fewer stress, anxiety and depression-related behaviours than those fed with just broth.

Scarily, the biggest organ in the body turns out not to be part of us at all, but zillions of bacteria.

This might be another cul de sac, or it might be a big breakthrough. Time will tell.

When it comes to therapeutic dead ends, Insulin coma therapy probably takes the sugar-free biscuit. It was popular in the 1950s, probably didn’t work, was quite labour intensive and was definitely barbaric. It was abandoned pretty soon after the invention of Chlorpromazine.

Psychiatrists aren’t the only doctors to jump on bandwagons though.

During the twentieth century everyone suddenly decided that people should have their tonsils out, leading to millions of unnecessary operations. This was despite excellent evidence that most people grew out of tonsillitis by their twenties.

Now it is very difficult to get your tonsils done at all, even when they look like Jackson Pollock has painted them.

How long before we see the Sunday Times run an exposé about backstreet tonsillectomy parlours? ‘A man with a huge soldering iron and bicycle pump sits in the half light of a tiny room in the alley behind Poundstretcher … etc’.

One of the longest running – nearly 2000 years – culs de sac was the idea that the body was made of four humours – blood, bile, black bile and phlegm. This itself was built on the philosophical dead end that there were four elements – Earth, Wind, Fire and Water.

Which must have made the Periodic Table very easy to learn compared with the version we learned in Chemistry.

And raises all sorts of questions. Did Earth, Wind and Fire ever think of getting Roger Waters to join? And were they formally known as Blood, Bile and Phlegm? And was that too similar to their horn – based rivals, Blood, Sweat and Tears?

The four humour system teaches us a lot about intellectual red herrings, just to mix up the metaphor for a moment. There’s a blind ending, but you can travel a long way down the road before you get there.

Like the M50 going west, there is just no destination.

We are probably still exploring a few, like the serotonin theory of Depression. But we cannot always know where these paths will lead.

Very clever people, like Isaac Newton, went along with humour-based medicine: ‘Trials are medicines which our gracious and wise Physician prescribes because we need them; and he proportions the frequency and weight of them to what the case requires. Let us trust his skill and thank him for his prescription.’

Isaac, you are most welcome in our clinic, with that excellent attitude. But please don’t believe everything you read on the internet. And watch out for Charlie’s men.

As mentioned above, Linus Pauling won two nobel prizes, and was the leading chemist of his generation. He became convinced that Vitamin C could cure cancer, even despite evidence to the contrary from large trials at the Mayo clinic.

Beyoncé is still looking towards the ‘four elements’ to inspire her new range of fashion: ‘we explore the different emotions of women represented by the four elements. Fire, water, earth and wind.’

If people like Isaac, Linus and Beyoncé can be taken in, what chance have mere mortals?

With a little hindsight though, generally we can see more clearly where trails have run cold. Such as the South Sea Bubble, or Soviet Communism.

My history advisor tells me that there was once an extraordinary Tulip craze in Amsterdam. At the peak of tulip mania, in March 1637, some single tulip bulbs sold for more than 10 times the annual income of a skilled craftsman.

Tulips of course persist, so they are not a cul de sac in terms of their role as flowers, but rather as investment products. Otherwise Spalding would be the financial capital of the UK, instead of just the style capital.

Shakers were a religious movement who mostly refused to procreate – the opposite approach to certain other religions – and hence died out. However, archaeologists have found a lot of illicit stuff in Shaker rubbish dumps, like whiskey bottles and tobacco pipes. No vibrators though.

On the commercial side, Sunny Delight was an attempt to create a modish new orange drink. It was launched in 1998 with a £10 million promotional campaign. Within months Sunny Delight had become the biggest selling soft drink in the UK behind Coke and Pepsi, with sales of £160 million a year.  Then it all went wrong. 8000 litres of Sunny D concentrate leaked into the River Parrett in 2006, creating a literal yellow river. A 5 year old child turned yellow after consuming 1.5 litres per day and the makers, Proctor and Gamble, had to put a health warning on the bottle advising moderation.

Sunny D seems still to be available, judging by its website, which makes the claim that it was ‘reverse engineered from the sun’. Wouldn’t that make it Hydrogen?

I don’t think we should be too hard on people for driving down blind turnings fast and furiously.

The reason we get carried away with a plausible new idea is our hunger to explain something very complicated with something we can grasp ourselves and even explain to others.

We are junkies for theories which seem to have Face Validity.

Writing in New Scientist recently, Prof Nick Craddock suggested that Psychiatry needs its ‘Higgs Boson moment’. He points out that mental illness research comprises only 5% of medical research. Despite this, he is optimistic that some of the newer strands of research are about to come together:

‘Psychiatry started the new millennium a few hundred years behind physics. But the decade that followed saw radical change, and set the stage for an intense period of catch-up. It is not fanciful to describe what will happen as the equivalent of some 200 to 300 years of progress being compressed into 20 to 30 years’.

So lets end on a positive note today, and enjoy waiting, as Spurs wait, for the Higgs Boson moment.

Meanwhile, don’t put all your money into Tulips, however plausible that might seem.