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.

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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.