Welcome to my blog

Hello. I am Sherlock and this is my diary. My job title is "osteopath", and my work is problem-solving. This involves detective work, hence my name. Detective work involves reason and science, but is not limited by them. It also involves the eye of experience, and "hunches". Thus, some would regard my activities as those of a quack, a title I assume here with irony. I am writing this blog because I like writing. I am quite opinionated, and perhaps I suffer from a repressed need for expression. I have no particular prior "agenda"; if I have any bees in my bonnet, no doubt they will make themselves apparent by their buzzing. All names and identifying details of any people featuring in these anecdotes have been changed. Thank you for reading.

Friday, 11 April 2014

A walk in the quarry, with reflections

The bay is still in shadow as I wind a way down from the cliff edge, choosing my own combination of the various paths that have been trodden through the stunted pine and juniper and thorn bushes. In places the path is rocky but in others the underlying sandstone has broken down to produce areas of fine sand. The cool early morning air stings my skin and I feel fine and exhilarated to be abroad in nature on this fine day. A lone fishing boat glides softly in the bay way over to the east, and two cormorants scud away low on the water at my approach. At the bottom of the descent a wide table of flat rock extends to the edge of the sea. It is beautiful here, not the most beautiful bay around here, but surely the strangest. I regard the many little cairns that have been built, the New Age patterns laid out with piles of rocks, the carvings made in the soft stone depicting faces, or ancient Chinese or Sanskrit symbols.

I sit and reflect on man and nature and reality and symbolism and magic, as what must one reflect on sitting alone in a place like this. I am fascinated by man's fascination with magic, this being ever evident in the field of health and healing, my professional interest. I remember a conversation with an acquaintance, an enthusiastic advocate of homoeopathy. Homoeopathy is one of those things the belief in which more often than not is primarily a lifestyle choice rather than a reasoned choice. You believe it or you don't, and I am not a believer, at least so far as its classical formulation is concerned. I reflect instead that I am a believer in the workings of nature and in the power of the human mind. I have found no reason to believe that the sugar pill, homoeopathic or not, has any specific curative action in nature over and above that perpetrated by the power of the human mind. Or why indeed it should be more potent than the latter. But homoeopathy, I think, is not a science, it is magic.

Then again I reflect that while I find it unconvincing, the theory of homoeopathy reflects an attempt to describe an aspect of reality, such that reality may be manipulated to achieve practical ends. Magic too is such an attempt, and so is science. But though some such attempts are more sophisticated than others and more practically useful within their domains of application, ultimately all are fabrications of our minds. The further in one looks, the deeper or the wider one sees, our certainties about what constitutes reality crumble further, as the sandstone I am sitting on has crumbled into the sand I have left on my path. I have an insight that the people who carved these marks into the rock have found themselves in awe of this place, and, struggling to place the wonder and affinity they feel for it into some kind of understanding or scheme, they have embodied it in symbols. Their system of beliefs, here affirmed by the marks they have left, creates a kind of personal and communal reality. And these things, in the mind, are powerful catalysts. At this thought I feel a little ashamed for holding my advocacy of science superior to these more animistic approaches to our world.

The name of this strange place means “the quarry”, and at the western edge of this flat sandstone is a rectangular area almost like an open topped room, with high walls, straight corners, and extraordinary regular geometric patterns carved out of the rock. Here the patterns and the graffiti continue, some profound, others banal, some poetic. There is nearly worn-down dragon. A phallus. Poseidon's trident. People's names or initials with a date. Somebody has carved in the stone that he or she is the starlight the other's path. A beautiful sentiment.

I walk to the other, eastern side of the flat rock, where it drops five metres into wide inlet of the sea forming a bay between two promontories. Cormorants sit on the rocks below the cliffs, turning and craning their necks, and regarding me warily as I sit on the edge of the rock shelf regarding them. Voices come from back above. It is only 10 o'clock. Usually on my morning walks nobody else appears until at least 11. This place I think will become crowded in the summer. I am glad I came now to experience it alone. The people in this region are gregarious, but I am not. It's time to go.

I do not retrace my steps - I want to avoid other human beings right now. Looking up I see high above two rocky bluffs rising out of the cliff edge, and decide that I can climb up and, going between them, come out on the other side at the top of the cliff. After half way the going gets rough and tough: the gradient increases, the sandy soil and gravel will not afford grip to my my feet, and the dry, dead juniper branches trip me up repeatedly. My arms and hands become covered in scratches from my attempts to negotiate the juniper thickets. I like the scratches though. I am of the opinion that scratches are good for you (as long as you are not debilitated or a bleeder or the source of the scratch is not a likely source of infection): they prime and condition the immune system, and they tell the brain to start a healing response, in much the same fashion as I think acupuncture does.

Further up still it is rockier and in places very steep. Do you know that moment of sustained exertion when you feel there is not another cubic centimetre of air left in your lungs, or a mousepower of strength left in your muscles? But, you know, there always is. There's always one more step. So far at least. And the views over the bay and to west and east are stunning, worth all the effort of discovery a hundred times. At the top the rocky bluffs and cliff edge are weathered into stupendous formations and hollowed with many small caves. The way along the cliff just below its lip is at times precarious. An improbable natural bridge arches over a deep gully. Round another rocky outcrop, I come over the hill and the scent of warm pine off the warm earth takes me by surprise. Now the way is gentle, and meanders through the pine wood down to my starting point a little way below and to the west.

I walk up the large hill to the west of the bay and sit on the roof of the ancient watch-tower, where I imagine the watchman looking out over the sea, watching in trepidation the approach of a pirate fleet. I can see the fire burning to raise the alarm, and runners making headlong for the settlements and villages to warn the villagers. To arms men! Women and children to the hills! Offshore at this point a vast rock, as big and craggy as a whole mountain, rises out of the sea. The Greeks thought mermaids lived there. People I know think flying saucers come out of it from deep in the Earth. Myths to suit the times. I think again of all the symbolism inspired by this place. Somebody has left a cardboard Big Mac box on this roof. Another sign of the times.

Saturday, 1 March 2014

Bottom-dwellers shall inherit the Earth

I write with a philosophical question which I will arrive at with a little context.

It is written that the meek shall inherit the Earth, and there is not much meeker than the bottom-dwelling invertebrates that some scientists believe have ensured life has continued on Earth despite cataclysmic disasters of the kind that wiped-out 90% of marine life and 70% of terrestrial vertebrates in the Late Permian period.

There are people I know who hold a firm conviction that human ingenuity and technological advancement are able to solve all practical problems faced by humanity. I do not share their faith. I think it is entirely possible that human life on earth will be decimated due to its own self-harming.

Just one example among a great many. We throw poisons into the sea and then we eat the toxic fish, and we think that's normal and acceptable despite dying of nasty diseases. This video from an Italian television programme succinctly explains (unfortunately for the uneducated masses, in Italian) how:

  • Toxic and carcinogenic fish are freely and commonly sold in Europe.
  • Mercury is toxic, it causes cancer and neurological diseases, and accumulates in the body over a lifetime.
  • High levels of mercury are found in large carnivorous fish such as tuna and swordfish.
  • All tuna fish on the market contains mercury, often at levels far exceeding the legal limits.
  • "Legal limits" means "accepted", it does not mean "compatible with health".
  • No level of mercury in foods is safe, because any amount that is ingested adds further to the accumulated mercury that is already present in the body.
  • All this mercury ends up in fish because human beings throw it into the sea.

Mercury and other toxic heavy metals are used in many industrial processes and technological components. Despite systems to prevent or reduce their escape into the environment, it is inevitable that they will do so. Human beings accept this because it is more important to maintain this way of life (wealth, "progress", "development", consumerism) than it is to live in health and safety.

I do not say this glibly. I recognise that individual people are sometimes stuck between a rock and a hard place with this compromise. The glass-makers of Murano island in the Venetian lagoon colour their glass with dyes made from toxic heavy metals. Their kilns blow these into the air for their children to breathe in, and from there they also enter the lagoon and out to sea where local fishing fleets fish it up and bring it back onto their dinner plates. These glass workshops are small-scale, family affairs, and the craftsmen say: "This is the way we've done it for centuries and lived to tell the tale", and "To change would be too costly". So the organisations responsible for ensuring that environmental pollution is kept within legal limits (but remember, NO amount of mercury, lead, arsenic, cadmium, etc. that can be taken into our bodies is compatible with health) are hampered by resistance all the way. Nevertheless, people see their livelihoods at stake.

Yet this kind of resistance is nothing compared to that put up by large industrial sectors or companies, whose raison d'etre (self-preservation) depends absolutely upon the maintenance by human society of a highly dysfunctional lifestyle driven by novelty, greed and ever-growing consumption.

I repeat: this is just one tiny example among many, the accumulative effect of which means we're all doomed. On the other hand there are those that point to the fact that despite all our environmentally-damaging activities, in modern societies the average human lifespan is higher than it has ever been since records were kept and is continuing to increase, an increase only partially accounted for by the fall in child mortality in the first half of the 20th century. This is a serious objection, but I see this stay of our self-imposed end as a passing phase.

Another objection is that as societies become wealthier, the birth-rate drops, and so environmental degradation slows. Which leads me to ask then why the Mediterranean, a sea bordered on one side by wealthy industrial countries with low birth rates and on the other side by poorer countries without much in the way of polluting industries, is so toxic we can't eat its fish? Who put more mercury in the sea, the rich ones or the poor ones? One thing is certain in my mind: if the whole world tries to follow the road to wealth taken before them by the so-called "developed" world, it would be wildly unrealistic to expect them to achieve equivalent levels of wealth before the sky falls in under the weight of heavy metals.

Now let me confront the reader with my philosophical question: Does it matter?

In the wider scheme of things, if human beings did wipe themselves out through their own folly, would it really matter? The world would go on regardless. There are species of bacteria which have been found living in all kinds of extreme environments: under Arctic ice, inside volcanic vents, in radioactive waste. There are marine creatures that live in near boiling geothermal outlets in pitch-blackness and extreme pressures at the bottom of the ocean. These creatures or ones like them will survive. I'll wager they'll let out a collective sigh of relief at our disappearance and say to each other: "Good riddance to bad rubbish". And if not them the plants, some plants, will thrive.

In this context I can think of only a few reasons why we ourselves should feel sorrow for our forthcoming plight i.e. non-existence.

  1. We are sorry that our children and grandchildren may suffer. I agree, but this will probably not come to a head in their lifetimes. And how far do you want to take it down the blood-line? Great grandchildren? Great great grandchildren? There comes a point down through the future generations where the emotional attachment fades, does there not?
  2. We have a highly egotistical and vain regard for the permanence of our own genes. Narcissistic personality disorder is the technical term for pathological self-regard.
  3. We have a sentimentalised view of future human life on Earth: joyful children laughing and skipping through sunny, flower-dotted meadows, etc. That is probably an unrealistic view, as if they survived, they'd all be glued to their latest technological gizmos. Anyway, if that sunny and happy picture is what you want, the current plan ain't the way to achieve it.
  4. We feel we have some ethical imperative to prolong human existence, an entirely irrational feeling, in the wider scheme of things, if in the absence of (5) below.
  5. A belief in some spiritual design that is served by our continuing existence. Because, for example "...God saw every thing that he had made, and, behold, it was very good." 
The last, if you hold to it, seems to me to be the only good reason why one might worry about our collective fate.

Wednesday, 19 February 2014

Don't Be A Leech

Terms such as “energy vampires”, “emotional vampires”, “psychic vampires” have come into use to describe people with negative personality traits which make them an emotional burden to be with.
I think they are rather unkind terms, as the vampires of myth are malign beings, whereas emotionally draining people are usually simply unhappy, their effect on others unintended and unwitting.

Perhaps the word “leech” is, if not exactly kind, at least nearer the mark. The leech is, unwittingly, a parasite, dependent for its being on other creatures' life-blood. It is unaware, beyond responding in its habitual way to its primitive sense of its environment. It is incapable of an alternative choice.

Similarly an emotional leech is also an unwitting parasite, albeit a human one, this time dependent for his or her own emotional status quo on other peoples' emotional attention. Like the invertebrate kind of leech, human emotional leeches lack awareness of what it can mean to be alive, they limit themselves to responding in their habitual way to their environment, as understood through limited perceptual and interpretative horizons. They are not happy with their lot, but their status quo is their widest horizon.

I have often read the advice to avoid “emotional vampires” (who I now call leeches). It is good advice if you are not one yourself. You may be a kindly person who feels sorry for a leech, especially if they have been a friend, but beware that if you try to help them overcome their state of malcontent you will likely fail, as well as being bled for your efforts. Four requisites are necessary for those who would help a leech (a) A full tank and plentiful reserves; (b) To have developed some form of protection; (c) Instruction in the dark art of psychology; (d) Sound good sense. Lack any one of these and you will be parasitised.

But what then if you are one yourself? What if you are an energy leech? Are you an energy leech?
  1. Do you complain a lot?
  2. When talking to people, do you find your conversations are most often about negative things?
  3. Do you frequently express your dissatisfaction to friends and acquaintances?
  4. Do you moan and whine more often than you laugh and smile?
  5. Are you frequently seeking others' sympathy for your woes?
  6. Do you take support from others more often than you give of your own?
If this describes you in whole or in part, the chances are your friends and acquaintances find you a bit of a leech.

What to do about it?
  1. Recognise it. (No, don't say “But...” and justify it. Just recognise it).
  2. Realise that you are harming other people as well as yourself.
  3. Know that optimists live longer, happier, richer, more satisfying lives (even though they may not be right more often than you). It's a proven fact. Ask yourself, do you want to be right or happy?
  4. Start to experiment. Count how often you have a negative thought and how often a positive one. See if you can substitute a positive interpretation for a negative one from time to time. Have a laugh. Smile at people. See if the sky falls in.
  5. Put an elastic band round your wrist and twang it whenever you find yourself having a negative thought. Allow yourself a smile (or occasionally, a chocolate) every time you substitute a negative thought with a truly positive one. Be freer with the smiles than the chocs though or you'll get fat.
  6. Watch others rather than speaking your mind. Do you admire the relentlessly negative people you observe? What about the sunny, positive, optimistic, resilient ones? Copy the latter.
  7. Don't hang around with other leeches. Hang around with sunny people.
  8. Learn to be wrong and enjoy it. Constant self-justification is a pain to all concerned, yourself foremost.
  9. Know that life is about metamorphosis and evolution. You can change. Difficult does not equal impossible.
  10. Are you really very unhappy? See a  professional psychologist/psychotherapist. It doesn't mean you're crazy, and he/she will not steal your soul.
  11. Great! You have done yourself and the world a big favour. Everything is connected.

How do I know this? I used to complain quite a lot but I learned not to do it and that has been good.

Tuesday, 18 February 2014

Love and "conservation"

Wounda hugs the woman who saved her life before returning to the wild.

Baby Marius slaughtered because "surplus to requirements", and then made into a spectacle "to educate the public" at a Danish zoo.

When love is gone, there's always judgement, and when judgement is gone, there's always science...
(Apologies to Lao Tzu and Laurie Anderson)

Pictures from The Daily Mail newspaper in two February 2014 editions.

Wednesday, 8 January 2014

The amazing secret of how to cure chronic back pain forever in one simple step

Sorry, there is no amazing secret and no one simple step. At least, I don't know it. However, this post does have a serious intent. All will be revealed in a future post.

Tuesday, 7 January 2014

Enmeshed with pain

For people who have suffered from constant or frequent intermittent pain for a long time, their pain comes to be part of themselves, in their own and in other people's eyes. 

To begin with, the experience of pain is a very personal affair – we all experience it in different ways that reflect what makes us us. This experience is influenced by as many factors that as are involved in the shaping of our general view of the world, factors such as the culture in which we live, our upbringing, personal beliefs, personality traits, past experiences, abilities, perceptions and sense of self worth. All these factors and others can influence how much pain we feel and how we describe and understand it. For human beings, long-standing pain is not just an unpleasant sensation, it is a sensation with meaning. We may attribute all manner of social, psychological, biological, philosophical and supernatural meanings to our pain.

Very often, we interpret chronic pain in terms of having an illness. It may have been given a name. We may have knowledge or ideas about what caused it, how it may vary over time, what its consequences may be, and how it should be treated or managed. We may consciously or unconsciously assess its seriousness, how much of a threat it is, how it affects us socially, whether we are to blame for its appearance, to what extent we are able to control it, and whether indeed it is modifiable at all.

Chronic pain, our attitude and responses to it become a part of the self. One reason for this is because its presence in our lives is woven into our wider understanding of the way the world works. But there are other reasons, too. Chronic pain influences our emotions, thoughts and behaviour not only in relation to the pain itself (e.g. avoiding things we know aggravate the pain), but also in relation to the deeper level of how we respond to the world in general (e.g. depression consequent to long-term pain may reduce our inclination to interact socially). Furthermore, we become identified socially with our pain, and people around us behave towards us in function of our pain and our own pain-related behaviour. In effect, our pain possesses us and takes over our lives.

This interweaving of different entities or spheres is known as the schema enmeshment model of pain (Pincus & Morley, 2001). A “schema” is a mental model: the notions and connotations we hold about a certain thing. Three schema that Pincus and Morley discussed were “pain”, “illness” and “self”, i.e. pain as a symptom, our notions of illness, and our sense of self within society. When our notions and connotations in relation to these things become closely interwoven, it is said they are “enmeshed”.

The strong enmeshment of mental constructs of pain, illness, and sense of self, as well as other schema, make treatment and management of chronic pain complex. Ways forward have to disentangle the dysfunctional interwoven webs which maintain pain. This is tricky, because it is not just “treating pain”, but asking of the person that they engender and permit change to what they have long regarded as their self.

People commonly say, "That's the way I'm made" (meaning they are immutable), but it is important to realise that learning and change are possible until advanced age, as well as being necessary to continued health and fulfilment. And then they say, "But it's difficult to change", to which I reply, "But not impossible".

Wednesday, 4 December 2013

Oh, my head, my heart, my stomach

Abraham Verghese, in his delightful novel Cutting For Stone, has Matron considering the most common complaint at the mission hospital's outpatient clinic in Addis Ababa, Ethiopia: 

'“Rasehn ... libehn … hodehn,” literally, “My head … my heart … and my stomach,” with the patient's hand touching each part as she pronounced the words.'

The hospital's internal medicine specialist Dr. Ghosh calls it the RLH syndrome, and it describes a general malaise with various physical symptoms brought on my the stresses and dissatisfactions of life. Verghese writes:

'It had taken Matron her first year in Addis to understand that this was how stress, anxiety, marital strife, and depression were expressed in Ethiopia – somatization was what Ghosh said the experts called this phenomenon. Patients might see no connection between the abusive husband, or meddlesome mother-in-law, or the recent death of their infant, and their dizziness or palpitations. And they knew just the cure for what ailed them: an injection.'

My mother was introduced to a similar disorder when working as a senior physiotherapist in a large city hospital in the UK. She was attending a lecture given by an eminent orthopaedic surgeon, who asked his audience how they would clinically manage the Undeer syndrome (so named after a “famous Hungarian physician”, he told them). All the physios looked at each other blankly and then contemplated their feet. “Oh, you know,” the eminent man said, “it's the one who comes in with a vague pain “here” ... , “und 'ere ... und 'ere … und 'ere”. Then they all looked at each other again with smiles of recognition. My mother often received patients with this complaint who had been sent down from orthopaedics, organic causes being considered insufficient to explain their suffering, with a note to “do something with this”. Only in this case the cure was not an injection, but a bottle of tender loving care and the placement of healing hands on each and every one of the offending parts. For, as Francis W. Peabody noted, “...the secret of the care of the patient is in caring for the patient”, which the physios in general were better at than the orthopods. Unsurprisingly, there is no Hungarian surname "Undeer" - I have checked.

Of course I would not wish to suggest that all presentations of multiple or diffuse, vague bodily pain are psychosomatic in nature – this is plainly not the case - and any clinician should guard against such a potentially dangerous prejudice. Neither would I wish to diminish the importance of the suffering involved when a condition is psychosomatic: I should know, I have suffered from troubling psychosomatic symptoms myself.

I have used the word “psychosomatic” here, a thing I have been pulled up for on occasion by a colleague or two. Some of my colleagues, more holistic than thou (or at any rate me), consider that the word either implies some kind of mental disorder (like somatoform disorder), or that it has overly Cartesian connotations, in the assumption that mind and body are somehow detached. However, I stand by my use of the word as being entirely appropriate when there are clear indications that the presence or extent of a person's physical ailments, with or without objectively observable physical manifestations, is heavily influenced by psychological processes. As to the Cartesian argument, on the one hand I think that while mind and body are clearly not detached entities, the counter-posed philosophical idea that “mind and body are one” runs up against some serious difficulties if taken to an equal extreme. On the other hand the very union of the Greek word roots “psych-” (mind) and “soma-” (body) into one whole word denotes a holistic perspective, does it not?

My own view is that the influence of the mind over bodily health is an extremely commonly observable phenomenon, existing in ailments common and rare, minor and life-threatening. Patients will readily recognise this (“I think it's the stress I've been under”) but will not always so readily wish to address the problem properly, the majority preferring to hope for a quick fix in the form of a pill (whether pharmacological, homoeopathic or a food supplement) or a nice massage. Conventional medicine has often over-diagnosed “psychological” causation, whenever, in fact, conventional tests and physical examination do not explain a person's symptoms. For their part, alternative practitioners have frequently disconsidered or denied the possibility that mental processes could be at the root of their patients' complaints, because they believe that the means and attitudes of conventional medicine are too limited to see what can be seen, have unfaltering belief in their own special system to discover and treat the “real” underlying cause, and because it is in their interest that the patient believe in a single, simple, clearly identifiable, physical cause. After all, this is what the patient has been looking for and their doctor didn't take them seriously. The reader might divine that I have a rather cynical attitude about much of this shaboodle, whether the colour is conventional or alternative.

It occurs to me that the RLH syndrome – rasehn, libehn, hodehn – is the ultimate description of a condition unifying mind and body: the head, seat of that miraculous organ the brain, whose workings provide us with awareness, awareness of ourselves, emotions, thoughts, behaviours, urges, dreams and nightmares, in a word “mind”; the heart, seen by many cultures as the seat of the spirit; and the stomach, gut, viscera, representative of everything bodily. That is rather a beautiful thing.

With apologies if needed - far be it from me to celebrate outdated prejudices (especially ones I do not share) - but I would like to end on a humorously pertinent note. Ever-loving Adelaide, in the wonderful musical Guys and Dolls, laments the bodily effects of her own major preoccupation in life as she reads from one of those popular medical encyclopaedias:

It says here:
The average unmarried female
Basically insecure
Due to some long frustration may react
With psychosomatic symptoms
Difficult to endure
Affecting the upper respiratory tract.

In other words, just from waiting around for that plain little band of gold
A person can develop a cold!