From atom-splitting to mind-healing
I had to miss a session on The Two Cultures, at last month’s Literature and Science conference in Oxford, because I was myself speaking in a parallel session (see previous entry).
Never having read CP Snow’s original 1959 lecture before, I did so, and was struck by several things which seem to have been filtered out in the huge amount of media and academic commentary it has spawned over the last five decades.
Barely having made a few opening remarks, Snow the promoter of science and scientists puts the boot in to ‘literary intellectuals’ by saying that uncritical admiration for fascist sympathising poets such as WB Yeats, Ezra Pound and Wyndham Lewis was an important cause of Germany’s extermination program in the Second World War.
Well, I happen to have looked at some rather large books on the historical causes of the Holocaust recently, and they did not mention Yeats, Pound, Lewis, or any other poets. That doesn’t necessarily mean that Snow was wrong, of course, but his judgement does not seem to have ‘stood the test of time’.
When he talks about scientists, Snow mostly mentions physicists, such as the atom-splitting Nobel-Prizewinning Rutherford, who he had known personally. Perhaps that just reflects how the wider role of science was discussed in the 1950′s, but it’s interesting that having mentioned the Holocaust and its causes, Snow does not make any point about the very dodgy biological and medical science of Nazi Germany, or the rather less dodgy (and also quite often Nobel-Prizewinning) biomedical science which meant that Britain had little resembling an extermination program itself.
I’m fairly sure that Bad Science, rather than allegedly Bad Anglo-Irish-American Poetry, was more prominently in the minds of those who thought up the Final Solution. To some extent this relies on hindsight, as it was only in the 1980s and 1990s that the British Historian Michael Burleigh more fully outlined the importance of German biomedical eugenics, sterilisation and ‘euthanasia’ of the mentally and physically disabled, as necessary steps which then led to racial genocide.
And as euthanasia (or ‘euthanasia’, as the medically-dominated pressure group Care not Killing might still write it) is very much part of today’s public biomedical discourse, I think that a proper updating of Snow’s Two Cultures argument about ‘literary intellectuals’ would have to properly take account of the general shift of public interest in science, away from atom-splitting and towards …(allegedly) disorder-mongering mental health professionals, perhaps?
My 2012 conference presentations on Benjamin Franklin and ‘Poor Richard’ in Dickens’ fiction
What does this have to do with a psychiatry blog? Look at just about any character in Dickens (especially from the middle and later period) and there are likely to be hints of psychological problems, at least. In these presentations I will be looking at how different aspects of Franklin’s life and works are alluded to in several of Dickens’ works from Martin Chuzzlewit to Little Dorrit.
12th April 2012, Oxford, British Society for Literature and Science annual conference, ‘Benjamin Franklin’s phrenological presence in Bleak House and Little Dorrit’
6th-8th July 2012, Portsmouth, The Other Dickens Conference. ‘Little Dorrit, letters from America, and biographical tracklaying’
10th to 12th July 2012, Edinburgh, Carlyle Conference. ‘Benjamin Franklin as a Carlylean ‘Demigod’: an under-recognised influence on Charles Dickens’s fiction?’
10-12 September 2012, Queen Mary, London, Emotions, Health & Wellbeing Conference. ‘Phrenology, mesmerism and the reptilian personality in Little Dorrit’
Mental health lessons from the 1890’s
“Health is the primary duty of life”, according to Algy’s domineering aunt in The Importance of Being Earnest; and such is the unhealthy effect of the aunt and other relatives on his mood, that in order to see them no more than once a week, Algy invents a friend who is in such poor health himself that he requires frequent visits.
Earnest was written and first performed in 1894-5. So, appropriate to the last decade of the nineteenth century, during which logical paradoxes were explored by scholars in mathematics and psychology, Algy’s approach to life is both serious (good mental health is necessary) and non-serious (he rather enjoys the deceptions involved) at the same time.
The play involves the eating of cucumber sandwiches, bread and butter, and muffins. Algy eats so much, in fact, that one wonders how well his ‘imaginary invalid’ strategy really works. Were it not for the romantic ending where he gets engaged to be married and then presumably is happy thereafter, concern about Algy becoming obese due to what we might now call ‘comfort eating’ would be justified.
His friend Jack doesn’t overindulge, perhaps because he’s too busy with his own deception of being the carefree Ernest at weekends, while working hard and being a serious magistrate in the week. Unlike Algy, Jack is lucky enough not to have any domineering relatives to hinder his own dutiful pursuit of health. And he’s happy in the end, as well.
The Charles Dickens Bicentenary
Born 200 years ago today, in Portsmouth, what difference did Dickens make, in the nearly-180 years since he started writing fiction and journalism?
Scrooge, Oliver Twist and Fagin are so familiar to us, that it’s perhaps easier to imagine some other writer(s) coming along and filling Dickens’s place on the broad-brush social reform issues, if he had been prematurely taken away by cholera or some other early nineteenth century affliction.
But there are so many other eccentric, strange, mentally unwell and physically disabled characters, who were also very well-known to millions of Dickens’s readers, perhaps even more so after his death, and well into the twentieth century. No other writer of fiction came close to creating awareness of these kinds of human diversity.
Just one example: probably the most severely, clinically, depressed character in Dickens is Bleak House’s Mr Jellyby. He sits with his head “against the wall” and almost never speaks. He’s a failure, and becomes bankrupt.
Illness and death occurs in most Victorian novels, and it is tempting to draw conclusions about the conscious and unconscious motives of the author from who suffers what. I’m uneasy about Dickens’s portrayal of the alcoholic Sydney Carton’s suicidal behaviour in A Tale of Two Cities (1). Dickens himself, in A Christmas Carol, draws attention to the fact that the crippled Tiny Tim “did NOT die”.
And the overwhelming majority of his eccentric and unwell characters do live on, sometimes bizarrely, but never in my view wholly implausibly. Mr Jellyby finds a friend, who talks about himself all the time. Most people would find this friend unbearable, but for some reason Mr Jellyby doesn’t: he listens, and he cheers up. Probably not a complete recovery, but enough to enjoy life again.
(1) http://drnmblog.wordpress.com/2011/09/02/a-far-far-better-ending-for-a-tale-of-two-cities/
Cosmetic surgery: an anti-capitalist issue, a feminist issue, or what?
The current concerns about easily-rupturing and possibly toxic PIP breast implants do not seem to be leading to much debate on: (1) Should psychotherapy for body image problems be made more available? (2) Should cosmetic surgery, in general, be more restricted?
In 2007, the BBC3 series Say No to the Knife did attempt to address this issue. It is no longer available on the BBC’s iPlayer, so I can’t check my own recollection that it was fairly superficial, offering not much more than styling and clothing tips Trinny and Susannah-style. No disrespect intended to those particular small screen goddesses, who probably never intended their message to be a universal panacea.
There were only seven episodes of Say No to the Knife, and we may never know why. Perhaps a further series would have risked drawing attention to poor NHS mental health services, which is likely to be a factor for some people seeking surgery in the UK.
Susie Orbach, well-known for her 1978 Fat is a Feminist Issue, addressed breast implants, liposuction and similar procedures in her 2009 book Bodies. Usual suspects appear: mistaken female bodily ideals, the market-driven, consumerist Western society and its commodification of emotion. Well, I respect the choice of anyone to opt out, as much as they can, from all of those things. But I know lots of people living ordinary Western lives, who wouldn’t think of having cosmetic surgery, so I somehow think there must be other causes as well.
Asylum History 1, Recent History 0
Last month’s radio programme about lobotomy (1) is interesting because it slightly departs from the usual historical scripts, which are: evil psychiatrists used lobotomy as a destructive form of social control, or well-meaning but weak ones rubber-stamped the decisions of others, such as Nurse Ratched in One Flew Over the Cuckoo’s Nest.
It emphasises that the inventor, and two of the main promoters of lobotomy were in fact not psychiatrists. Politician and neurologist Egas Moniz started the ball rolling. Then, American neurologist Walter Freeman, and the British surgeon Sir Wylie McKissock, both continued to do thousands of operations despite evidence for uncertain therapeutic results.
Historical radio and TV programmes about the bad aspects of the old asylum system (which I don’t advocate returning to, but will say it was always underfunded) are often a means, I think, of deflecting attention from current NHS mental health failings. Other occasional broadcasts about the mental health systems of second- or third-world countries generally have the same function.
At least this one is a little different. However, it seems to me that there is a clear parallel between lobotomy and another kind of invasive operation for a serious behavioural (and often psychiatric) disorder today.
Although obesity surgeons are not household names (yet), there has never been a proper trial of gastric banding or the more serious procedure of partial gastric reduction, despite thousands of operations being done annually (2). The rush to surgery is delaying the development of new non-surgical treatments, and the application of at least one recently developed and partially tested treatment (for obesity-linked ADD / ADHD).
The programme-maker did not draw attention to this obvious parallel. Was he or his boss warned off by England’s Department of Health, which for much of the last decade had surgeons both as chief medical officer and as a health minister? Or was it (perhaps more likely) BBC self-censorship?
BBC journalists don’t themselves seem to believe, any more, that the “licence fee” protects their independence because it is supposedly “not a tax”. But they continue to resist the suggestion that their work should be subject to the Freedom of Information Act.
So ordinary patients who have experienced poor results, infections or other complications from bariatric surgery, may never be able to discover the extent of any such BBC collusion. The same goes for relatives who, following one of the thankfully few deaths directly caused by bariatric surgery, may take a retrospective interest in how this surgical descendant of lobotomy was promoted.
(1) http://www.bbc.co.uk/iplayer/episode/b016wx0w/The_Lobotomists/
(2) See my previous pieces on obesity: http://drnmblog.wordpress.com/category/obesity/
Drafted 2nd December; final version 8th December
ADD / ADHD and cannabis
Some people with ADD / ADHD use cannabis regularly, and I have had patients who moved on to prescribed ADD / ADHD medication, finding it both more helpful and lower in unwanted effects than cannabis.
As the diagnosis of ADD / ADHD grows in the UK, I suspect this will become more of a factor in the debate about whether cannabis should be criminalised to a lesser extent, or even decriminalised altogether.
I don’t have a formal professional view either way on that issue, especially as I’m not a specialist in “Substance Misuse”. But I would say that the arguments of the leading UK advocate for reducing criminal sanctions on cannabis, Professor David Nutt, seem far from clear-cut.
On his Blog (http://profdavidnutt.wordpress.com), Professor Nutt suggests that the risk of increasing schizophrenia in young people, which could result from decriminalisation, is not of great concern. On his own figures, for every extra million young men using cannabis, about 200 might develop schizophrenia who wouldn’t otherwise do so.
His argument seems to be that alcohol use would probably decline (because of switching from alcohol to cannabis), and the benefits from that would outweigh any cannabis-related harms.
He might be right, but I think at least two aspects of the debate have not received as much attention as they should.
First, it does seem very difficult to compare the harm of an often devastating psychotic disorder, with alcohol-related problems. Is it really as simple as saying that improving and extending life for tens of thousands of people, by reducing their alcohol intake, logically outweighs the risk of ”only” a few hundred people developing schizophrenia?
Secondly, I think the wider debate about “harm reduction”, and Professor Nutt’s related view that UK medical doctors should be able to prescribe cannabis (as they can elsewhere in Europe) would benefit from an acknowledgement that medical prescribing of some mind-altering substances has been, and remains, too lax.
When UK general practitioners, from the mid-1990′s, were widely encouraged to prescribe antidepressants after little more than a ten-minute consultation, this state-approved practice was never properly tested. The concerns about misuse and harms of Seroxat and other antidepressants followed.
Of course, as a specialist prescriber of mind-altering substances myself (hopefully, always as a reasonable therapy), I have a direct vested interest. But it does seem to me that promoters of medication, whether natural or synthetic, branded or generic, freely available or eye-wateringly expensive, would generally be more credible if they listened to my (free) advice.
