54. Looking at parallax, from a slightly different angle.

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Electric horses – the next big thing in personal transportation.

A man talks to a phone-in show on Piccadilly Radio. He says the TV aerials in the next street are of an unusual type and point a different way, not towards the transmitter. Finally he mutters the word, ‘aliens’. The radio host asks him whether he has checked for seed pods under the stairs. The joke is a bit lost on those unfamiliar with ‘Invasion of the Bodysnatchers’. The host finally grows inpatient and cuts off the most interesting guest of the day, before I can get an impression of whether he is psychotic or not.

One of the intriguing questions in public health is how many psychotic people there are hidden away who have no contact with the NHS. Surveys suggest that 1% of people have schizophrenia, which is a much higher number than we see in clinics. Have these surveys over-included a lot of people who, on the face of it, seem deluded, but on closer examination, simply share widely held beliefs about conspiracy?

On a long plane flight this week I read a book by Andy Thomas, called ‘Conspiracies – the facts, the theories, the evidence’. One of many questions that occurred to me, was why had this book suddenly been reduced in price from £6.99 to 99p? It’s hard to believe that Amazon doesn’t form part of the New World Order, the secret power said to be behind many attempts to deceive us. Maybe this book is in itself a diversionary tactic, or a tiny wink of knowingness that Big Brother gives us from time to time.

A surprisingly large number of people believe that Princess Diana was murdered or that the twin towers were brought down by some faction within the USA. In fact a surprising number of people believe both that Diana was murdered and that she is still alive. Chalk that one up to cognitive dissonance theory.

If some or all of these theories turn out to be true, it would definitely change a person’s view of the world, from that of a relatively safe place to a dark, dangerous and threatening one.

The fact that there are so many people who believe in conspiracy, and that certain conspiracies, such as Watergate, turned out to be true, raises a lot of interesting questions for clinicians.

As psychiatrists, we are taught not to get delusions mixed up with religion, politics or superstition. To be called delusional, a belief has to show a clean break in its logical development. Conspiracy theorists work with an alternative chain of logic, rather than a deluded person’s new canvas of meaning. Though many people who are psychotic suffer from persecutory type ideas, it is very rare to confuse a psychotic person with a ‘truth seeker’, as conspiracy theorists are now known, despite some very bizarre truth seeking theories, such as thinking the royal family are lizards.

There is probably very little point in trying to work out why people develop strong beliefs. The answer is ‘all sorts of reasons’. As far as delusional beliefs go, the best answer we have come up with is ‘because of a disease process’. Although delusions are held strongly, most non-delusional belief is held lightly and easily changed in the face of further inquiry. For instance, it is reported that when faced with medical need, many catholics will opt for a termination of pregnancy and that many Jehovah’s witnesses will change their minds in favour of blood transfusion. Most opinion surveys test only the topsoil of belief, and are designed to do so, by whatever vested interest is controlling the survey.

Psychiatrists are not in a hurry to identify beliefs as delusional, and despite what is said about the old Soviet Union etc, it has not been necessary for oppressive regimes to use tame psychiatrists to label dissidents as psychotic. Oppressive regimes are able to lock people up or have them disappear without pretending they are ill.

While psychiatrists don’t seem to be playing much part in locking up dissidents, they may be complicit in some more sophisticated subversions. In particular, psychiatrists play a major role in the drugs pipeline, the one that runs from a chemical works in Hull to your meso-limbic system and mine.

For instance, a steady stream of people come to outpatient clinics ‘wanting the diagnosis’ of bipolar disorder. (See Post 28). The exponential growth in the Bipolar Industry has been well described by David Healy, in his book, Mania: A Short History of Bipolar Disorder. Tellingly, this book has not been reduced by Amazon, so it probably contains some sinister truths we are not supposed to hear.

The key parts of this conspiracy are as follows: No useful new drugs have been developed in mental health for 20 years. Instead, the pharmaceutical industry has chosen to expand the market for drugs already on the market. Hence we saw a complete re-branding of ‘manic depressive disorder’ into ‘bipolar disorder’, massively expanding the diagnostic concept by including so called ‘bipolar II’ and ‘bipolar spectrum disorder’.

The outcome was a massive increase in the numbers of people with miscellaneous temperamental problems being given so called ‘mood stabilisers’, either atypical anti-psychotics or anticonvulsants, both being items from Boots’ ‘fat and sleepy’ aisle.

It took a lot of time and money to do this, and large numbers of psychiatrists collaborated in the process. There is a strange relationship between certain academics and clinicians and the drug companies and by strange relationship I mean free lunch – in Belgium.

In fuddy-duddy Britain, there is now endless conflict between psychiatrists and wannabe bipolar patients, but the signs are that the psychiatrists are surrendering. The customer is always right, especially if he is persistent, sharp-elbowed and well-googled.

We saw the same pattern in children’s mental health services. Once upon a time it was extremely rare to be diagnosed with Hyperactivity in the UK. A child had to be hyperactive all the time, not just between 4pm and KFC time. Even then, the use of psycho-stimulants like Ritalin was rare, and couched in cautionary warnings, like ‘use only as part of a carefully controlled therapy package, including social and family interventions’. Today’s community paediatricians basically fly crop dusting planes over the countryside, spraying Ritalin wherever they see a school.

Does someone have an agenda that includes more and more people taking mind altering drugs? It’s hard to imagine that a proper dictator would like to see cohorts of drunk women staggering round York on Friday nights, or lines of people queuing up for methadone outside Boots every morning. But then its hard to work out why the existing drug laws are not enforced, or why more and more heroin came out of Afghanistan despite the war in that country, or why our ward has a filing cabinet full of confiscated ‘legal highs’. Is it feasible that legal highs cannot be controlled by legislation, when there is legislation that makes Tesco throw away half its food, and legislation that stops me from connecting a gas fire?

Would a genuinely repressive regime be happy for millions of its citizens to take antidepressants, in some misguided hope that they would become more docile or cheerful in times of adversity? Marx is quoted as saying religion is the opiate of the masses, but perhaps the word he actually used was Ritalin.

The culture of propaganda has a lot to do with the rise of conspiracy theory. In the public sector we are routinely spun false statistics and like to pretend we are providing an excellent service. In mental health Trusts we want to pretend we are offering psychotherapy, when really we are offering only a nice chat, checklists and tablets. Its a kind of cover up, but we’re not in Jason Bourne territory. It’s obviously a lot cheaper to fiddle the statistics than to provide real therapists or policemen.

My colleagues are probably sitting tight, waiting for the Bipolar II epidemic to subside. Just like the Ritalin kids, the new wave ‘bipolar twos’ will soon be be stuffing their tablets behind the radiator. At the moment some people view a diagnosis of bipolar disorder as a get-out-jail-free card, in case of a minor indiscretion. These will get devalued if more people use them, instead of throwing doubles or paying £50 . Even now, fewer celebrities are coming forward purporting to have Bipolar II, and they are probably going back to having narcissism instead.

The conspiracy between Big Pharma and eminent psychiatrists will find a new condition supposedly amenable to antipsychotic drugs, such as food intolerance, or somatic symptom disorder. Then the experts and drug reps will be back in their Audis again at another round of conferences.

Sadly, most conspiracies don’t involve lizards or the CIA. Nor even do they involve a secret Mister Big, played by Morgan Freeman . They are just about drumming up trade. How boring is that? The new world order is just business as usual.

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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.