Why Pudsey Bear is Awful: This story. AGAIN.

Acceptable generic injury bear

It’s the most wonderful time of the year. Though people can’t leave their dwellings, I’ll still be retelling why I hate a bear. It’s the most wonderful time of the year. It has been 40 years since Children in Need began and Pudsey Bear is still awful. I have no particular opinion about Blush.

Some people who know me (let’s call them friends, despite their arguments) state that they wouldn’t feel that Children in Need was complete without me telling them about why I dislike Pudsey Bear. They’re humouring me of course, but humouring me represents 97% of the work of being my friend, so that’s fine.  My apologies if you started reading this for some reasoning behind why Children in Need as a charity is still important (some of that later), some psychology of altruism (some of that later) or a serious exposé of some behind the scenes scandal (none of that later). I’m afraid my story is still just a short, bitter, pointless grudge against a monocular bear.

As a much younger man, a CHILD you might say, I had been unwell and as a result had been to the see a doctor. I can’t remember what the illness was. Possibly news had spread about the time I asked the biology teacher why they directly taught us about diffusion instead of letting the idea spread out to us gradually and the medical profession were worried my body was degrading due to being too cool.

After leaving the clinic, in fact just outside the clinic, I fainted. On my trajectory towards the ground, I decided it would be safest if my head should take a slight detour towards the wall, using the bricks to cushion the blow and add a jaunty angle to the proceedings. I broke my glasses too, so that was a bonus.

Artist’s recreation of the event

As I lay there regaining consciousness, bewildered and pathetic, head hurting and glasses broken, I notice a blurry figure approach out of the blurry distance into the slightly less blurry foreground. It was Pudsey Bear! He was obviously out collecting money for Children in Need that being the time of year it was and the main thing that he is into. I was saved! Who better than the mascot of Children In Need to help a child, in need, outside a healthcare professional’s building? Pudsey stepped over me and carried on walking.

I’m not a fan of Pudsey Bear.

“Perhaps Pudsey didn’t see you, his vision can’t be that good.”

“Why did he step over me then instead of tripping over me and landing beside me on the pavement?”

I’m not a fan of Pudsey Bear.

Psychological studies into altruism have demonstrated that whether someone stops to help someone else is influenced by a number of factors. For example, if people feel they are short of time, see someone is bleeding, think there are lots of people around so one of them will help instead  (diffusion of responsibility) or simply don’t identify with the person who needs assistance, then they are much less likely to engage in altruistic behaviour (the bystander effect).

Perhaps Pudsey was late for an important bear appointment, was put off when he saw I was losing haemoglobin, thought one of the other people would help me and noticed I wasn’t a bear like him, so didn’t help. Perhaps Pudsey’s just awful.

I’m not a fan of Pudsey Bear.

Acceptable bear demonstrating the bystander effect. Probably.

However, Children in Need do take part in good work that shouldn’t be necessary. Recently, you will have no doubt heard about or experienced the negative impact of lockdown on children’s mental health. Some research suggests that as a result of increased social isolation and the loss of the normal structure of their lives, a large number of children experience disturbed sleep, nightmares, poor appetite, agitation, inattention and separation-related anxiety. Even during this second lockdown, despite schools remaining open, lessons and daily structure are disrupted due to social bubbles being sent home with positive COVID-19 cases and due to teachers being absent with infection or instructed isolation. Some stress is important for healthy psychological development, but intense, frequent or prolonged “toxic” stress can lead to cognitive impairment and stress-related disease. So children suffer with isolation if schools are closed due to lockdown, but suffer due to lack of structure if schools are open but continually disrupted, for example, if they had been made to stay open for political reasons rather than being given time to come up with a blended approach that works well for pupils and staff. Or something. Regardless, children will suffer. Children In Need do a reasonable amount to assist children with mental health difficulties, so maybe donate?

Or there are lots of other good charities, so you can pick one of them if you like. You might as well, otherwise reading this stupid story about my ridiculous grudge against a visually-impaired ursine has been a complete waste of time.

Stigma and mental health: a one-sided conversation

A man diagnosed as suffering from melancholia with strong suicidal tendencies. This is what people thought people with mental illness looked like before they all started looking out of windows with their heads in their hands. 

What is stigma?

Stigma is basically a word for discrimination. Slightly more technically, stigma has been described as a sign of disgrace that is perceived to set a person or group of people apart from others. It’s also a Greek letter, although everyone that uses it in that way is rubbish. Stigma can affect many groups, including people with mental health problems, the elderly, and a third less serious group that I was going to include as a joke, but didn’t because it would increase stigma too much.

The casual use of language stigmatising mental illness is exceedingly common. If you’re a bit angry you might be described as mental or psycho. If you put a book away you might be called obsessive compulsive. Media portrayals reinforce stigma by constantly associating images of violent and homicidal individuals with mental ill health. The Eurovision song contest recently got in on the stigmatising act by parading a person in a Eurovision-themed straitjacket for so called crazy fans and having one of the hosts proclaim “You know what they say – crazy is the new black.” Which is definitely saying like, “Half a cup of thunder makes the bears look at the handbag” and “You don’t have to be crazy to use stigmatising language, but it…oh…I see…I’m sorry.”

Even children’s television seems to have gotten in on the act. A study in the British Journal of Psychiatry found that during just one week’s worth of children’s television, 59 out of 128 programmes contained one or more references to mental illness. Terms like “crazy”, “mad” and “losing your mind” were commonly used to portray that a character was losing control. Six characters were identified as consistently shown to have a mental illness. These characters were almost totally devoid of positive characteristics. Luckily, children aren’t impressionable and don’t learn or pick up attitudes easily.

Does it really matter if people are offended?

In the great scheme of things, not really. Overall, it’s probably not good to upset people, although that largely depends on context. If you’re using abusive language and someone says your awful because of you’re abusive language and this upsets you, then you’re upset doesn’t matter a Katie Hopkin’s opinions worth. If someone with severe anxiety is offended because you’ve told them to “stop worrying”, then that does matter. You’re belittling a potential illness, and ignoring and heightening their distress. We’ll deal with these cases of offence on a case by case basis until we’ve Gervaised the lot of them.

I really wouldn’t recommend searching for “prejudice” in order to find images for your blog post.

However, this isn’t really about people being offended. It’s about the harm that can be caused by language and attitudes. Stigmatising attitudes towards people experiencing mental illness are responsible for substantial additional distress, as well as reduced employment and social opportunities. In addition, stigma can lead to hate crimes, a decreased ability to access appropriate healthcare and reluctance to seek appropriate help (if that help is even available). In fact, the stigma surrounding mental illness has been identified as the primary barrier to providing mental health care and the delivery of treatment. It turns out that if large portions of society hold negative beliefs about a group that aren’t necessarily true, then that group suffers.

So I’m banned from using certain words?

Not at all, but it would be nice if you thought about what you were saying and the impact it might have. Unsurprisingly in a matter involving language and society, there’s a lot of nuance involved. If I privately say “my cat is going bananas” while my cat does something adorable like climbing up the curtains or becoming non-fictional, then I’m probably not doing any harm. If I loudly proclaim to a crowd that another person who is shouting “has gone schizo” then that’s another matter. I don’t know who’s listening, who might be upset and who might avoid social situations or potentially getting help to avoid similar judgement. If you don’t believe in the potential impact of your words in this setting, perhaps you should look at the research, or at least have more confidence in yourself. You can make a difference!

Well, what other words can I use?

I’m pretty sure there are quite a few words that aren’t stigmatising towards people with mental health problems. There’s probably a word for that situation. I’ll check the dictionary. Anyway, a bit of variety in your insults will make you look more intelligent, which is always nice.

A good source of awful words.

Why are people so thin skinned?

It’s not really about being offended (as discussed previously), but if we’re talking about people with certain diagnoses then there is evidence that negative terms can have greater impact than in people without those diagnoses. For example, much research has shown that people with clinical depression have what’s called a negative cognitive style. That is to say they’re much more likely to focus on or attend to the negative aspects of any personal experience and to an extent may be unable to focus on positive or neutral aspects. Conversely, other studies claim that this tendency differs across individuals with the depression with some people focusing on negative information, while others pay equal attention to negative and positive information but remember negative information more efficiently than those without depression. Either way, telling someone with this problem to just ignore the bad stuff isn’t helpful. Like telling someone with their foot caught in a bear trap to just walk it off.

I have a mental illness and it doesn’t affect me like that!

That’s good. However, there are other people who it does affect.

Isn’t this just being pedantic about language?

“Just”?!

But you got several phrases regarding mental health wrong!

Probably, and I apologise for that. I daresay I’ll do it again, but I’ll try and do better. Which is hopefully what we’re all trying to do. Not you though. You’re perfect. You’re hair is particularly good.

In fact, a bigger problem is that throughout this post I’ve essentially referred to people with mental illness as a homogenous group. This obviously isn’t true, just as it wouldn’t be for any large group of people. It also potentially marks a large proportion of the population (1 in 4 is often bandied about, although I can’t find a good reference for that figure) as an outgroup. I certainly don’t want to do that, and a large part of reducing stigma should probably be in getting people to consider that the group they’re stigmatising contains as much variety in personality as any group they consider themselves a member of, that that group contains people just as capable of experiencing harm as they are (more so in some cases) and that their words have the power to impact real-world events. Easy done.

Are you finished yet?

Yes.

 

Image credits: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org A man diagnosed as suffering from melancholia with strong suicidal tendency. Lithograph, 1892, after a drawing by Alexander Johnston, 1837, for Sir Alexander Morison. 1837-1892 By: Alexander Johnstonafter: Alexander Morison and Byrom BramwellPublished: [1892]

By Ilja.mos – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=46665757

 

Does stigma against mental illness increase as people get older?

Want to feel old?
Then continue living.

Some say that children are our future. This seems like nonsense given that in the future, all the children will be old people. Are old people the future? This is clearly a facetious point, albeit one with tangential relevance given the trend in Western society for people to live longer. In the United Kingdom, there are currently about 10 million people who are over 65 years old and it is predicted that this number will increase to 19 million by 2050. The phrases “grumpy old man” and “grumpy old woman” may just have to become “grumpy man” and “grumpy woman” simply due to commonality. Or ultimately, “man” and “woman” as grumpiness becomes the ground state. This is rubbish and I hate it.

One concern in an ageing society is mental health care. There are an increasing number of older adults in need of psychological care and it has been identified that cultural and organisational aspects of mental health care in later life present some of the main barriers to quality services. Stigma can be described as a sign of disgrace setting a person apart from others and Erving Goffman, defined stigma as “the process by which the actions of others spoils normal identity.” Stigma against people with mental illness can result in a lack of funding for services, and difficulty gaining employment, a mortgage or holiday insurance. Feelings of shame from perceived stigma can also cause people to delay seeking help or even deny the existence of their symptoms. Stigma surrounding mental illness has therefore been identified as one of the primary barriers to providing sufficient mental health care.

It seems obvious that attitudes and perspectives change throughout life with identifiable trends. The perspectives of a 20-year-old are unlikely to be exactly the same as those of a 90-year-old, whether this is due to differences in lived experience or due to age itself. So perhaps attitudes towards people with mental health change as we age. If attitudes towards people with mental illness improve as we age, then great. Let’s see why and see if we can use what we learn in anti-stigma interventions for younger people. Older people really are the future. Someone should write a song. If attitudes towards people with mental illness worsen and become more stigmatising as we get older then not great. Nobody should write that song. Not even if it contains the line “Oh. Think twice. Just another day for you and me with prejudice.” However, at least if it is known that stigmatising attitudes against people with mental illness worsen with increasing age then interventions against stigma can be targeted towards older people. Why? Because of the reasons we’ve discussed e.g. stigma is bad and causes bad things to happen to vulnerable people.

To investigating these issues, a study was carried out with the aim of determining whether stigmatising attitudes towards people with mental illness increased with age. This study will be described here.

Method

Three surveys were given to German citizens aged over 18 years in 1990, 2001 and 2011. Individuals taking the surveys were selected randomly and once they had provided consent, were interviewed face-to-face.

Data were collected through face-to-face interviews. This picture probably isn’t representative of that process.

During the interviews, participants were presented with short stories describing either a person with schizophrenia or major depression. The stories did not specifically state the diagnosis of the person, although the symptoms described fulfilled the criteria set out by the World Health Organization’s (WHO) Diagnostic and Statistical Manual of Mental Disorders (DSM) III. During the 1990 and 2011 interviews, the sex of the individual within the story was varied at random. However, during the 2001 interviews, only responses to stories describing a male with mental illness were recorded. As a result, only responses recorded in reaction to stories containing males were included in the analysis. Once again, there doesn’t seem to be much that men won’t try to take control of.

Stigmatising attitudes against people with mental illness were measured using a social distance scale. That is to say, the participants’ willingness to engage in various everyday activities with a person with a mental illness was measured. Such activities included working together, being a neighbour, recommending for a job and letting them take care of a small child. Willingness was rated on a scale of 0−5 and combined across all activities into an overall social distance score out of 28. A higher score indicates a higher desire for greater social distance, and potentially greater stigmatising attitudes.

The effects of age, birth-cohort (group that was born at a similar time) and time period on social distance (the measure of stigmatising attitude against people with mental illness) were then analysed. Maths was involved. What are the chances?

Results

Participants

• 7,835 participants aged 18 to 93 years
• 3,925 participants heard the story describing the person with symptoms of schizophrenia and 3,910 heard the story describing the person with symptoms of major depression.
• Age groups included were 18 to 30 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, 60 to 69 years and equal or over than 70 years.
• The number of participants within each age group were reasonably evenly matched, with slightly fewer within the equal or over than 70 years population.

Effects

Age

For both illnesses described, there was a significant effect of age, with a higher social distance score with increasing age.

Attitudes towards people with mental illness become more negative (higher social distance scores) with growing age.

Cohort

Cohort only appeared to have an effect in relation to the story describing someone with symptoms of major depression and not regarding the story describing someone with symptoms of schizophrenia. People born in later years showed lower social distance scores towards the person with symptoms of major depression, regardless of the effects of age or time period.

Time Period

Time period effects were examined for 1990, 2001 and 2011. Time period appeared to have a significant effect on social distance, with people from more recent time periods displaying higher social distance scores against people with symptoms of mental illnesses.

Conclusions

The authors concluded that over the life-span, social distance scores and therefore attitudes towards people with mental illness become more negative (higher social distance scores) with growing age. The effect of cohort seems to differ across disorders, although only two sets of diagnostic criteria were examined within this study. People from more recent time periods tended to display higher social distance scores (and therefore potentially more negative attitudes) against people with symptoms of mental illnesses.

The authors state that the findings of increasing negative attitudes towards people with mental illness with increasing age is due to a tendency for conservative attitudes to grow with age and to the preference of older participants to prefer familiar social partners who are less likely to trigger negative feelings. It may also have been the case that as the person featuring in both stories was of working age, social distance score may have increased with age simply due to a perceived age difference between the participant and the person being described.

It’s ultimately concluded that stigma against people with mental illness in old age is amplifying burden in a population that is already vulnerable to social isolation and that this is likely to contribute to more negative health outcomes.

Limitations

No “control” story describing a person without symptoms of mental illness was included as part of the interviews.

Only one story was presented to each participant. Attitudes recorded may therefore represent those held towards the individual within the one story with that particular set of symptoms rather than stigma towards people with mental illness as a whole. Having said that, people with mental illness represent a highly varied population, you know, because they’re people, and asking a study to narrow down one particular set of attitudes towards this entire population may be too much to ask. However, it may have been useful to include responses to more than one story, describing symptoms of more than one recognised mental illness diagnosis to attempt to capture attitudes to a broader range of people.

No “control” story describing a person without symptoms of mental illness was included as part of the interviews. As such, there is no baseline score for social distance score and how it changes with increasing age. For example, it may be that social distance score increases with age due to the greater risk of social isolation that has been reported with age. There is no way to determine from these results whether attitudes relate specifically to people with mental illness.

As the study was conducted solely in Germany, the attitudes concerning people with mental illness that were revealed at most may only hold in similar cultures e.g. Western industrialised countries, or at least just within Germany. Further study across varying cultural groups would be required to determine whether the attitude trends identified exist cross-culturally.

The study doesn’t mention the composition of the participant population in terms of sex. This seems an oversight given that only stories featuring males were included and attitudes regarding gender and/or sex from different genders and/or sexes can be highly complex. In addition, we can’t necessarily assume that the participant population was approximately 50% female and 50% male, as the study includes people across a wide range of ages. In Western cultures, with increasing age, the proportion of males tends to decrease. However, as it stands, there is no way to determine whether the attitudes towards the person with mental illness within the story were influenced by the sex of the person described or the sex of the participant.

There seems to be no attempt to describe whether participants in the study had any history of mental illness or any experience with people with mental illness. This would undoubtedly affect attitudes towards mental illness. The authors state that the effect of contact could not be included as information regarding this variable was not consistently elicited. Given how common mental illness is, it could be argued that with increasing age, probability of encountering someone with experience of mental illness and/or experiencing it personally increases, and examining how this interacts with attitudes and increasing age is vital for future studies.

Summary

Take two of these twice a day and stop being prejudiced.
Seek doctors’ advice if you’re a member of UKIP.

The findings describe how attitudes towards people with mental illness become more negative with growing age. However, the limitations of this study mean that this cannot be stated from these results with any degree of certainty.

Ultimately we do know that stigma against people with mental illness is a real problem with real negative impact in terms of mental distress and various life and health outcomes. While more research is needed to examine whether stigma towards people with mental illness increases with age and if so, why, the growing proportion of older people within Western societies means that tackling stigma in more elderly people may be a priority regardless.

References

Schomerus G, Van der Auwera S, Matschinger H, Baumeister SE, Angemeyer MC. Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis. Acta Psychiatr Scand 2015;1−8 [PubMed]

Sartorius N. Iatrogenic Stigma of Mental Illness. BMJ 2002:324:1470−71 [PubMed]

The Evidence for Drinkable Sunscreen

The Daily Mail and The Telegraph featured adverts for drinkable sunscreen so I looked for evidence that it works.

Here it is:

I couldn’t find any. Because it’s water.

Here’s a picture of a goldfish instead.

Too much sun exposure without the RIGHT protection can harm the skin and increase the risk of skin cancer.

Here’s some information about skin cancer.

Here’s some stuff about the drinkable “sunscreen.”

Stay safe.

I’m going for a lie down.

Comedians Are Not Psychotic

Comedy mask outside a theatre. There’s also a tragedy one. This isn’t proof of anything sciencey.

“Successful comedians display symptoms of psychosis, study says” went the headline. “Psychotic traits in comedians” said the title of the study the headline was referring to. “Bang” went the foreheads meeting the desks of many psychologists, psychiatrists and humans who’d thought for five seconds about what this headline could do for science, psychology, psychiatry and mental illness stigma.

The scientific study, which in this case is apparently Latin for “press release based on a journal article”, states that the popular belief that creativity is related to mental illness is borne out in comedians, who showed higher levels of psychotic traits than actors, who both showed higher levels of psychotic traits than “normal” people. The word normal was the article’s rather than mine as obviously actors and comedians (and by association people with traits of mental illness [?!]) aren’t “normal”. At least the authors are thematically consistent with their description of their research methods and their conclusions.

Is this what the research really suggests though? Spoiler alert 1: Bananas release an enzyme that causes other fruit to go off quicker so keep them separately. Spoiler alert 2: No. No, this isn’t what the research really suggests. This isn’t going to be a painstaking dissection of the research. This isn’t the place for that kind of analysis, the research isn’t particularly hard to critique and I’ve got important slamming my hand in a car door to do. This will be a brief look at how the headline changes as we look at the research and what can be inferred from it.

The authors claim that humour often involves the ability to compare normally incongruous frames of reference. For example chickens don’t normally have complicated reasons to cross roads, elephants shouldn’t be wearing Grouch Marx’s pyjamas, Michael Gove is somehow a politician in a position of power. Thinking in people with schizophrenia is often characterised by disorganisation of thought and speech containing ideas that are not logically connected or “word” salad in one of its more extreme forms. In a leap worthy of when Indiana Jones walks across that canyon to get that magic cup, it’s then argued that because humour can involve comparing disconnected ideas and schizophrenia can involve disconnected ideas that comedians are therefore more “psychotic” than people who aren’t comedians. They chose poorly.

Obviously not all comedians have mental distress indicative of schizophrenia of another mental illness. This is where the O-LIFE Personality Scale comes in. As well as being a song by Des’ree, the O-LIFE (Oxford-Liverpool Inventory of Feelings and Experiences) Personality Scale is a measure developed from the idea that symptoms/characteristics of mental illness exist on a spectrum and therefore traits which may predispose individuals to schizophrenia can be identified in non-clinical populations. In other words it looks for traits that everybody has that aren’t symptoms of mental illness but potentially would be if they were substantially exaggerated. It’s a bit like saying that people who really think dusting is important could have obsessive compulsive disorder if this trait were amplified.

A vacuum. Science hates these.

New headline 1: Professional cleaners display symptoms of obsessive compulsive disorder.

New headline 2: Successful comedians don’t display symptoms of psychosis but would do if the traits they possessed were very much exaggerated. You know, like with most people.

The O-LIFE questionnaire through getting you to answer YES/NO questions on around 160 questions (versions vary) gives you a rating in four different personality traits, identified as aspects of schizophrenia (or as the study more broadly calls it, psychosis. The two are not the same, but that’s an argument for another time.)

• Unusual Experiences: tendency for magical thinking and to experience perceptual distortions.

“I believe in telepathy and sometimes think I hear people telling me telepathy isn’t real.”

• Cognitive Disorganisation: distractibility and difficulty focussing.

“I never listen to them though because….oooh biscuits!”

• Introvertive Anhedonia: reduced ability to feel social and physical pleasure.

“I wish to be alone to eat my biscuits. Your presence makes me uncomfortable.”

• Compulsive Nonconformity: tendency to impulsive, potentially antisocial behaviour.

*Punches potential biscuit thief. Wanders of to watch Derek Acorah for 2 minutes.*

In terms of the O-LIFE (Ooooooh life! Oh life, doo do do doo) questionnaire, the higher your rating in these four areas, the more you possess traits related to psychosis. I’d rather have a piece of toast.

The study asked online for people from online comedian agencies, comedy clubs, comedian associations and comedian societies mainly in the UK, USA and

Australia who said they were comedians to complete the O-LIFE questionnaire.

New headline 3: People on the internet who say they are comedians might have traits similar to psychosis if the traits they said they had online were exaggerated.

“Actors” were recruited in a similar way through acting agencies, clubs and so forth. The sample of people saying they were comedians consisted of 523 individuals (404 men and 119 women) The control sample consisted of 364 people saying they were actors (153 men and 211 women) and the “normal” control group consisted of 831 people (246 men and 585 women). It should be noted at this point that there is clearly a big discrepancy between how many men and women are in each group and the men and women studied were different in terms of O-LIFE personality traits in the comedian, actor and control group. However they did their statistics all up in it and there was no interaction between sex and being a comedian that affected O-LIFE score so this potentially massive confounding variable gets ignored. Do men who claim to be comedians rate their own personalities differently to women who don’t? We’ll never know.

We do know.

New headline 4: More men than women say they’re comedians and also rate their own personalities differently. Information is used unwisely and incorrectly for jokes and “banter”.

A tragedy mask at a theatre. It’s sad because of badly communicated science.

The much flouted results were that people who say they’re comedians had significantly higher ratings across all four personality traits than people who don’t say they’re comedians. This seemed to particularly be the case for Introvertive Anhedonia and Impulsive Nonconformity. The authors noticed these were opposites and claimed that this means comedians were more likely to have personality traits a bit like bipolar disorder. Spike Milligan was wheeled out which proves it.

New headline 5: Mental illness is common so it’s not that shocking that some comedians have mental illnesses.

The conclusions seem to be that these traits allow comedians to be creative in a way that leads to comedy. It seems reasonably logical to assume that you have to think slightly differently when trying to be funny than when you’re not, and that comedians can identify that they do this kind of thinking more often. Does this mean that comedians have psychotic traits? No. You’ll note that none of these new headlines are particularly good or attention grabbing. Does the headline that comedians have psychotic traits fulfil this function? Yes. Did they get my attention in that manner like some sort of chump?

New Headline 6: People who identify themselves as having a creative profession rate their own personality as having creative traits. Nobody is shocked until they claim it relates to psychosis which it doesn’t. I write about it like a chump.

The Awful Science of Going On Holiday.

This originally appeared as a guest post for Guardian Science’s Brain Flapping blog. It’s still available here http://www.theguardian.com/science/brain-flapping/2013/jul/16/awful-science-holidays and I’ve only put it here as well because I like having things in the same place.

Science has already ruined this holiday image by pointing out that pearls are solidified mollusc mucus and shells are monuments to the corpses of marine animals

It is reasonably well known that long term stress with its (among other things) associated raised cortisol levels can damage the immune system. As such anything reducing stress might be seen as a good thing. There are many ways people choose to relax. Some people enjoy sports; others sit in front of the television, while Frankie mainly seemed to enjoy telling others to “RELAX!” At this time of year many people will be looking to getting away from it all and getting closer to different bits of it all on a holiday. Is there any science to this and what should a scientist do on holiday? Sort of and whatever they like. Let’s make a short list containing some facts loosely pertaining to holidays anyway.

Vaccination

The world is awful and full of death and disease so when you’re heading to certain bits of it for a good time you might want to consider vaccinating yourself. Health experts advise preparing for a holiday four to six weeks before travelling, especially if you need vaccinations. Diseases you might catch depending on destination include but are not limited to hepatitis A, malaria, yellow fever, polio and a deep sense of regret that you didn’t organise your travel vaccinations. Traveller’s diarrhoea is the most common illness contracted in people travelling abroad from the UK. It’s best to be careful with water and food that you consume lest you want a dispiriting case of “both ends”.

Jet Lag

Travel itself can make you feel less than spritely. Jet lag is a chronobiological problem. Before science fiction fans get excited this is not related to time travel. Such problems include the trauma of becoming your own grandparent and stepping on a prehistoric butterfly and finding out Hitler is now your librarian, but not jet lag. When you travel East to West (or vice versa) across time zones, taking your body with you as one does, your body clock will not be synchronised with the time of your destination. Your holiday will subject your body to patterns of night and day in opposition to the its normal rhythm. Biological processes dictating times for sleeping, eating and hormone regulation will no longer correspond to the usual time of day, resulting in jet lag. Symptoms include sleep disruption, worsened cognitive performance, fatigue, headache, irritability and a deep sense of regret you believed the Pet Shop boys and went west. Or east, but they don’t have a song about that.

Culture

 Once you’re immune system has been primed and your body agrees with its surroundings whether its time to sleep, eat or wail mournfully at an unfamiliar sky, the location of the holiday can have unexpected psychological effects. In some cases too much culture can be damaging. Stendhal syndrome is a psychosomatic disorder with symptoms including fainting, dizziness, tachycardia (rapid heart rate) and in some cases hallucinations, when the individual is exposed to particularly beautiful art or large amounts of art. It should be noted Stendhal syndrome is not included in the Diagnostic and Statistical Manual of Mental Disorders IV, although this may change with the increasingly creative approach the DSM seems to be taking. Stendhal syndrome was named in 1979 when an Italian psychiatrist, Graziella Magherini, described over 100 cases among visitors to Florence, often rushed to the hospital as emergencies from local art galleries. Luckily the treatment appears to be relatively simple and involves a retreat from the sublime to more a mundane reality.

Similarly, Paris syndrome is a transient psychological disorder encountered, as you might expect, by people visiting Paris, France. Symptoms include delusions, hallucinations, anxiety, and perceptions of persecution as well psychosomatic symptoms including dizziness, tachycardia and perspiration. Japanese tourists appear to be particularly susceptible with over 12 Japanese tourists a year falling foul of the condition. With Paris experiencing over 6 million visitors a year, the syndrome is hardly epidemic, although the Japanese embassy reportedly has an emergency hot-line for dealing with this problem. The cause is argued to be the shock of Paris not meeting unrealistic expectations of its idealised image of high culture. If this is the case then the lesson appears to be not to get your hopes up and expect perfection from a perfectly nice and beautiful city. Actually I guess in France it is Nice that is “perfectly nice”. The Nice tourist board are welcome to use this.

Helping Local Wildlife

If you’re going on holiday to observe wildlife, whether on safari or one of those places where you can watch fish through a glass floor, then you may be helping in unexpected ways. Social facilitation is the tendency for people to perform better at simple tasks when being observed by other people. For example cyclists’ speed will increase if they are racing against other cyclists rather than alone against the clock. The phenomenon isn’t restricted to humans. Psychologist, Robert Zajonc found cockroaches completed a maze quicker when they had an audience consisting of other cockroaches compared to when they were unobserved. Biologist, Shisan Chen found ants will dig three times as much sand when working alongside (without cooperation) other ants than when working alone. Unfortunately it appears that social facilitation occurs when observed by member of one’s own species. So if you want the tropical fish you’re observing to be more productive then you may have to disguise yourself as a large, voyeuristic clownfish. You then need to question how fish can be more productive and whether the costume is worth it.

Activities

From what I’ve said, the various aggravation of going on holiday might turn you to drink. Perhaps this is why a refreshing cocktail by the pool is such a staple of many vacations. Additionally thirst and enjoyment. If you are committed to the idea of a science holiday then you might try a science-themed cocktail. These might include The Large Hadron Colada, Mitosis on the Beach, Long Island Environment Causing Speciation Ice Tea or a Haematology Mary. Alternatively you might turn your gin and tonic into a liquid laser. Basically lasers emit light because electromagnetic radiation has undergone stimulated emission and optical amplification i.e. electrons release energy as light. If you subject your G&T to a blast from a 20-watt carbon dioxide laser, your drink will lase and its electrons will be stimulated to emit approximately 0.00001 watts of light. The laser may be dangerous, too much gin has health risks and the light of your drink is invisible to the naked eye, but you will be drinking a laser. So that’s cool.

Home Time

So overall it seems a science holiday involves disease, fatigue, despair, dressing as an animal and consuming difficult to obtain laser gin. I might just stay at home.

A Bad Case of the Zombies: Could a virus really cause World War Z?

A zombie playing the sousaphone. I wanted one playing the trombone because of the tenuous trombone/bone/zombie connection. Ho hum.

The other day I went to see the film, World War Z. It was fine and thus ends my review of my enjoyment of it. Anyway, the real World War Z will of course be between those who pronounce it “zed” and those who pronounce it “zee”. World War Z is based on the 2006 novel by Max Brooks (a follow-up to his 2003 book, The Zombie Survival Guide). Both books are excellent and if you’re not too bored of zombie-based fiction then you should read them. I say this because there seems to have been a recent upsurge on things about zombies of some kind. The zombies are everywhere, which I suppose is ironic. The film stars Bradley Pitt as a retired United Nations employee who must travel the world to find a way to stop a zombie-like pandemic.

In the film being a zombie (Zombieism? Esprit de corpse? Zombosis?) appears to be caused by a viral infection, primarily caught by being bitten by a zombie. Those who are bitten appear to die within about 30 seconds and then reanimate with slightly cloudy eyes. They then become very aggressive and begin to chase down victims to bite them and spread the infection. They do not appear to eat their victims; rather keep on going just generally being runny and a bit bitey. I say runny as in they run a lot rather than hinting at any advanced state of decomposition. Although eventually the zombies do appear to go a bit rotten.

I accept that all this doesn’t have to be dead-on realistic (ahem) but there are a few problems with the concept. It’s assumed that the mass zombification is caused by a viral pandemic. Yet time from being bitten to turning into a zombie appears to be too rapid for this to be the case. It would take a bit longer for whatever virus it is to circulate, invade cells, hijack their genetic machinery and start producing copies of the virus and manifest symptoms. Especially given that the virus appears to completely take over the host’s central nervous system and musculature while leaving the rest of them deceased. Like a more infectious version of Britain’s Got Talent.

While viruses certainly can be deadly they generally need the thing they’re in to be alive to make more virus and spread them. This might be by sneezing in their co-worker’s face, not washing their hands, licking fruit bowls etc. The zombie virus doesn’t appear to need this. It kills the host and still somehow has them running around. Where is the host’s energy coming from? Could the humans all just hide and wait for the zombies to fall apart? Granted this would make the film quite dull. Nobody wants to watch a film where people eat sandwiches in a bunker waiting for their enemy to decompose. Although Panic Room is OK.

The idea however that an infection can control its host’s behaviour to help its spread is well established in nature. For example, malaria is an infectious disease spread by mosquitoes, caused by one of five species of the Apicomplexan parasite, Plasmodium. Most deaths from malaria are caused by Plasmodium falciparum. It really is an awful disease with the WHO estimating that in 2010 there were 219 million cases of malaria resulting in 660,000 deaths. As I’ve hinted, Plasmodium can change the behaviour of mosquitoes to spread itself faster and wider.

The common Plasmodium Puppet. Also known as the mosquito.

Once in a mosquito, Plasmodium needs time to move to the mosquito’s gut to mate and reproduce to form ookinetes. These are a sort of mobile egg. The story of Plasmodium really ruins Humpty Dumpty. Ookinetes develop into sporozoites (Literally: “animal seed”. Don’t go planting your hamsters though!) and travel to the mosquito’s salivary gland. Prior to this it doesn’t do the Plasmodium much good for the mosquito to bite someone with the risk the mosquito might get killed during the attempt. So Plasmodium tries to alter the mosquito’s behaviour to prevent this. For a mosquito to get your blood it has to drive its proboscis through your skin and find a blood vessel. The longer this takes the greater its chances of being noticed and squashed. Like if McDonalds killed you if you queued too long rather than years later of heart disease. If a mosquito finds it too difficult to draw blood they’ll quickly give up.  A mosquito with ookinetes in it will abandon biting quicker than an uninfected one.

However once the sporozoites reach the mosquito’s mouth, it benefits Plasmodium for the mosquito to bite as much as possible.  The Plasmodium at this stage appears to make the mosquito “hungrier”, causing it to drink more blood and visit more hosts to get it. In these ways and more Plasmodium is manipulating its hosts behaviour to reproduce itself and spread more easily.

Some species of tapeworm live in the three-spined stickleback but also spend part of their lifecycle in the birds that eat these fish. The tapeworms can alter the behaviour of the fish making it more likely they’re caught and eaten. As you’d expect, sticklebacks try to keep away from heron. They stay away from the surface and if a heron appears they dart away. Sticklebacks infected with tapeworm appear to become more fearless, staying near the surface to feed even if a heron is about. These are more likely to be eaten and the tapeworm gets where it wants to go; into the heron.

Similarly, Toxoplasma gondii, a protozoan of “don’t go near the litter tray if you’re pregnant” fame, needs to move between rats and cats and back again to complete its lifecycle.  A healthy, uninfected rat will normally become anxious when it smells cat urine staying away from where they smelled it.  They will literally piss off. Rats infected with Toxoplasma however do not become anxious when they catch the scent of a cat, do not avoid it and increase their chances of becoming dinner.

Toxoplasma also appears to alter the psychology of humans it infects. Men infected with Toxoplasma become less willing to follow rules and less worried about being punished for breaking these rules. Women infected with Toxoplasma become more outgoing. Toxoplasma: the party protozoa! I probably shouldn’t get into marketing. It is not fully known how this occurs although there is some evidence that Toxoplasma increases production of the neurotransmitter dopamine and in males, increases testosterone levels.  It should be noted that this evidence is largely from rats. A lot of evidence is.

Afraid? Are you a man or a mouse? Or are you infected with Toxoplasma?

All of our examples have been parasites, but the infection is World War Z is cited as a virus, which I guess technically can be seen as a parasite. Can a virus alter its host’s behaviour to aid its spread? You bet your hot butter on toast it can! The baculovirus, infects the caterpillars of the European gypsy moth and causes them to climb to the tree-tops. Once there they die and liquefy, releasing thousands of viral particles to rain down and infect more unfortunate caterpillars. In this way Lymantria dispar forces the caterpillar to turn itself into a piñata and explode itself, raining down sweets i.e. a nasty virus, on other unsuspecting future piñata-pillars.

Rabies is another viral disease that manipulates its hosts’ behaviour. Rabies causes acute encephalitis in warm-blooded animals, including humans. More than 55,000 people, mostly in Africa and Asia, die from rabies every year. There are three stages of rabies progression. The first is characterised by behavioural changes and is known as the prodromal stage. The second is the excitative stage. This stage is also known as “furious rabies” as the infected animal is exceptionally aggressive, hyper-reactive and will bite with little provocation. The virus is present in the nerves and saliva and as such the route of infection is usually, but not always, by a bite. With the encephalitis induced aggression and biting, the virus’ manipulation to aid its spread becomes clear. The third stage is the paralytic stage (due to motor neuron damage) which is followed by death.

The excitative stage of rabies is the example we’ve seen that is most similar to our zombie virus and in fact in the film the zombie pandemic (a good name for a band) is initially mistaken for an outbreak of rabies. So could a virus cause the changes seen in World War Z and cause a zombie pandemic with Brad Pitt staring concerned across various international scenes? Probably not, but parasites and viruses can certainly manipulate their hosts behaviour in a variety of subtle and not-so-subtle ways. Although ultimately it might be preferable to have your emotions and behaviour manipulated by watching a film. Panic Room is OK.

Relatively Stigmatised: Mental illness stigma and its spread to family and friends.

I assume they’re laughing at a picture of a “stereotypical” family in the book they’re all reading.

(Originally written for Time To Change and available here: http://www.time-to-change.org.uk/blog/mental-health-carers-relatively-stigmatised-david-steele)

“You’ll be fine as long as you can avoid going native.” These were the words spoken to me when I said I might be interested in psychiatry. If we were being unkind (and possibly correct) we would say that this statement belies evidence of stigma against mental illness and those who deal with it professionally.  It even hints at the idea that mental illness is somehow contagious or catching. Who knows how such an “infection” could be spread. Be careful when sneezing while depressed I suppose their advice might be.

If we were being more forgiving we might decide that this person was merely showing a concerned attitude, highlighting the difficulties inherent in having a mental illness and in being responsible for the health needs of those experiencing it.  Either way, this brief conversational snippet can be used to highlight not only the stigma against those with mental illness but the spread of that stigma to those that care for them.

Stigma can be described as a sign of disgrace setting a person apart from others. Erving Goffman, noted sociologist, defined stigma as, “the process by which the actions of others spoils normal identity.”  It is common for people with mental illness to feel invisible or that their needs are not being met. They feel people assume they’re “benefits scroungers” and that they should “pull themselves together”. Casual language used to describe mental illness is decidedly negative. He or she is described as going “crazy”, “loony” or “psycho”. I haven’t seen the film, Psycho, but I suspect the emphasis isn’t on hugging. Media portrayals of mental illness reinforce stigma with images of violence with mental ill-health.

Family members of those with mental illness are affected with so called “courtesy stigma” or stigma-by-association. But when thinking about courtesy here, think less about opening doors for others and more about unnecessary guilt.  Many relatives feel it necessary to hide the mental health problems of their nearest and dearest. In one study of 156 parents and spouses of people experiencing a first-admission to hospital for mental health problems, 50% reported making efforts to conceal their relative’s illness from others.¹

Secrecy can act as an obstacle to presentation and to the treatment of mental illness at all stages. As such when social resources are mobilised, people with mental health issues and their families may be removed from potential support. It follows that poorer outcomes are likely.

Depending on the illness and its severity, the help and support provided by friends and family can be of great importance when it comes to successfully treating mental health problems. But families must remember there’s only so much they can do and that their own lives are important. Families must realise they are not to blame, that it is ok if they feel stress when a loved one has a mental illness. As such stigma by association must be reduced to aid this process. The Royal College of Psychiatrists and Rethink Mental Illness has some great resources for aiding families of those with mental illness with this in mind. So does Mind of course.

Logically an increase in the accuracy of information available would be an ideal way to reduce courtesy stigma. If it was widely known that stereotypes such as that of the “violent mental patient” or the “neglectful parent of a mentally ill child” were false then it would seem stigma could be reduced. However research on reducing mental illness stigma, highlights the importance of what information is used.

In one study participants who were told that mental illness had a genetic basis were more likely to assume that people with mental illness were dangerous compared to individuals told that mental illness was explained by social factors. Additionally those told mental illness had a genetic basis were more likely to stigmatise the families of those with mental illness.². If we are going to use an information-based approach to reduce mental illness stigma we are going to have to be very careful about what information is used.

Ultimately then we can see that while it is obvious that those with mental illness need support and would benefit enormously from stigma reduction, the same can be said of family and friends who will be providing the majority of this support.  The familial and social networks of individuals with mental illness are the backbone of their support and we mustn’t let stigma create an invertebrate system of isolation for these caring individuals.

References

1. Phelan, J. C., Bromet, E. J. & Link, B. G. (1998) Psychiatric illness and family stigma. Schizophrenia Bulletin, 24, pp115–126.

2. Read. J. & Harré. N. The role of biological and genetic causal beliefs in the stigmatisation of “mental patients”. Journal of Mental Health.  2001. 10 (2), pp 223-235.

Crazy talk: The language of mental illness stigma

I worry this may be the actual fate of some reality TV contestants.

 

It’s time to deface music! At the time of writing it was that time of year again. The musically talented and untalented alike had swum upstream (been selected in advance by producers) to spawn (sing a bit on television while people frown/smile at them).

Every Saturday night, millions of televisions blurted the selection of noises, shapes and primary colours that compose Cowell’s Cavalcade of Corporate Crooner Culling into the living rooms of the UK. The name of the particular programme has been changed for many reasons, i.e. x number of factors. During the initial stages of this singing and pointing competition the less-talented among the hopeful masses will be accused of a great many misdeeds. A simple internet search reveals contestants being referred to as dim, attention-seeking nutters, delusional, circus freaks, mad-as-a-box-of-frogs and violently breaking down.

The more astute among you may have noticed that these are intended to be derogatory terms belittling people for not using their vocal cords properly while some music is playing. Additionally these derogatory terms almost universally refer to mental illness in some fashion.

During the 2012 Paralympics, Channel 4 is showing a programme hosted by comedian Adam Hills. (The Last Leg with Adam Hills. It’s a pun, please don’t be wrong-footed. That was another pun (a much worse one). One section of this programme involves Adam discussing with Alex Brooker what you can and cannot say about the Paralympics: a frank discussion about the taboos inevitably involved when discussing disability.

Primarily their advice revolves around the content of speech. “Just don’t be horrible” – a seemingly simple piece of advice that needs to be tattooed backwards across the heads of whoever is writing THOSE comments on YouTube.

Hills and Brooker state that you probably will say the wrong thing and not to panic if you do. An example of such a wrong thing is given (source mercifully not provided): “In the Paralympic equestrian events, is it the horse or the rider who is disabled?”

The point is not to control what you should and shouldn’t say but rather to create an environment where people at least think about what they’re saying before being horrible or downright offensive.

Despite the first paragraph of this blog being about mental illness, I’m not trying to conflate being disabled with being mentally ill. Rather we should note that while people increasingly take care about the language they use to describe the disabled, the same luxury is often not afforded to those with mental illness.

You would correctly frown (I don’t know how you’d incorrectly frown, possibly a problem with your corrugator muscle) about someone with a stubbed toe saying “I’m a little bit crippled”. But you wouldn’t pay the slightest attention to someone tidying their desk saying “I’m a little bit obsessive compulsive.”

I can almost hear the cries of political correctness gone mad. Except if political correctness really had gone mad, we wouldn’t be allowed to use the phrase, political correctness gone mad. Possibly you’d be forced to say political correctness had become a little bit obsessive compulsive.

The casual use of language stigmatising mental illness is exceedingly common. Stigma can be described as a sign of disgrace setting a person apart from others. Erving Goffman, defined stigma as, “the process by which the actions of others spoil normal identity.”  For those with mental illness the stigma experienced can result in a lack of funding for services, difficulty gaining employment, a mortgage or holiday insurance. Ultimately, feelings of stigma cause people to delay seeking help or even deny they have symptoms in the first place.

Casual language used to describe mental illness is decidedly negative. He or she is described as going mad, mental or psycho. Media portrayals reinforce this with images of violence and homicide associated with mental ill health. It was rare to see a discussion concerning the recent shootings in Aurora, Denver, without comments about the shooter’s mental health status.

Even children’s television seems to have gotten in on the act. One study in the British Journal of Psychiatry found that out of a sample of one week of children’s television, 59 out of 128 programmes contained one or more references to mental illness. Terms like “crazy”, “mad” and “losing your mind” were commonly used to denote losing control. Six characters were identified as being consistently portrayed as mentally ill. These characters were almost totally devoid of positive characteristics. I’m not sure if one of these was SpongeBob Squarepants.  Why would a porifera even need trousers? Some sort of body dysmorphia ?

The sign “You don’t have to be crazy to work here but it helps” has become so common that it’s a cliché. People describing themselves as “a bit mad” usually mean that they’ve worn a sparkly hat at some point. Terms like mentalist, psycho, bonkers, insane and barking are thrown around like loose pennies in a conversational washing machine. Look at Terry, the mentalist. He’s bonkers. He’s so drunk he’s gone outside to punch the thunder for annoying the moon. Mad!

An argument could be made that these terms, while technically describing mental illness are not being used to specifically refer to mental illness. Rather they are referring to behaviour which they consider a little out of the ordinary. We can refer to this argument as Gervais’s Gambit. The problem is that if this language is making people with mental illness feel stigmatised, ashamed and isolated then the amount of thought behind it as it is used casually is largely irrelevant.

If you are so attached to using a word you don’t want to put any thought behind it before you use it that’s fine. I am more than happy for you to take your dictionary on a romantic weekend away if you promise to use your technical definitions in private without hurting anyone. “But nobody I know has complained about me using this language.” Well no, perhaps the people you know with mental illness are too worried you’ll call them crazy and laugh at their inability to sing.

And you will know somebody with mental illness. With estimates of one in four (most likely higher) people being affected it would defy statistics if you didn’t. And only Benjamin Disraeli is allowed to defy statistics. Ultimately people are not going to stop using these terms stigmatising mental illness. It could be argued that at least one comment I’ve made during this article does just that. They are as entrenched in language as the saying of “lol” is instead of actually laughing. As a side note, shouldn’t people who say lol instead of laughing, write it as lolol to describe laughing?

Like the thought that should go into that distracting parody of text speak, it would be enough that people thought about what they are trying to express and whom they will hurt. Especially as it’s likely to be someone close to them. You can still make your jokes and use the words, but consider whether another word might do and who you may hurt beforehand. Perhaps then we can move towards a frank and honest dialogue about mental illness and away from the disgrace and stigma.

The Royal College of Psychiatrists along with mental health charities Mind and Rethink Mental Illness have produced a video explaining more about mental illness discrimination and how you can support the proposed mental health (discrimination) bill.

That and some consideration before you describe your busy weekend as mental, would go some way to reduce mental illness stigma. I don’t think I’m crazy to think that would be a good thing.

Ill Judged: The faulty logic of judging the sick.

“That’ll be £10 please. You’re ill because of your bad choice in furniture.”

The greatest griefs are those we cause ourselves – Sophocles

                 I’m sure Sophocles thought he was being quite clever when he said the quote above. It’s one of those sayings (like most sayings touted on Facebook under a picture of a heroically sad cat) that sound like they should mean something but don’t.  The worst things that happen to us are the things we do to ourselves. This isn’t necessarily true. If an imaginary gentleman called Fred stabs me in the toe without provocation, then I think I can fairly correctly blame Fred for causing a major grief in my life. Bastard, no wonder he’s imaginary. The quote is especially surprising given that it comes from Sophocles, a man who wrote several plays about Oedipus. Oedipus accidentally killed his own father and married his own mother. When he eventually found out the truth, he wisely dispensed with appearing on Jeremy Kyle and blinded himself. Subsequently Oedipus’ family were said to be doomed for three generations. In conclusion we have three generations of people with terrible things happening to them that weren’t their fault. Good work Sophocles.  Sophocles wrote several tragedies where awful things were generally fated to happen to people. Fated. In that the people involved couldn’t help it. Perhaps Sophocles would have been better off saying, “the greatest griefs are those caused by uncontrollable forces of nature and destiny.”

Katie Hopkins probably thought she was being quite clever when she decided she knew how to fix the National Health Service.  Katie Hopkins proposes that those who eat, drink and smoke too much should pay more towards any additional NHS care they require. The delightful Katie then goes on to state, “Frankly if you don’t care about your body or your health, then as a taxpayer funding the NHS, nor do I.” Katie Hopkins must be a very wise individual, with years of research into healthcare, economics and politics to come to this conclusion. A cursory glance reveals that in fact Katie Hopkins is a former and repeated reality TV contestant. (The Apprentice, that celebrity in the jungle one and nearly Big Brother if you must know). To be completely fair she did study Politics and Economics at the University of Exeter. As such it seems we should rank her opinions on the matter alongside those of Fictional Fred the Toe-Stabber, who I have decided studied the Economics of HealthCare at the University of Toe-Stabbing. If it seems harsh comparing the opinions of an existing human to a fictional one, remember that the existing one was described as difficult to get along with by other contestants of The Apprentice.  A situation not too far removed from being described as “a bit green” by Kermit the Frog.

Ultimately it doesn’t really matter who Katie Hopkins is (a fact the BBC should quickly realise) as unfortunately her opinion is not an uncommon one. Member of Parliament and practicing GP, Phillip Lee had an opinion about doughnuts. According to Dr Lee, patients who have doughnuts for breakfast should pay for their prescriptions if they develop diabetes.  This was widened to a more general point that people of this generation were less stoic than previous generations, some vague hints that people should pay for illness resulting from their “lifestyle choices” and an astonishing quote on his desire to save money by getting GPs to dispense drugs. According to Dr Lee, there is no need for pharmacists to be involved because “it’s like counting Smarties.”

The last point can be dealt with fairly quickly. Pharmacy and pharmacology is a varied and complex field which takes years of training prior to being allowed to practice. Counting Smarties it isn’t. Although admittedly an ability to count is useful. Perhaps Dr Lee thinks medicine comes from sweet shops.

We also run into problems when deciding on how to charge people for illnesses they have been judged responsible for. Should people pay for medical problems resulting from obesity if they have an unhealthy diet? Lee and Hopkins would say yes. Should smokers who get lung disease pay extra? Again Lee and Hopkins would say yes. Heavy drinkers should pay if they get liver disease? Again that would seem to be a yes. But how much do you have to drink before you pay this premium? How much do you have to smoke or eat? Not everyone who drinks more than they should gets liver disease for example and the amount you have to drink before you’re at risk varies for what is likely to be genetic reasons. How is this accounted for? Does someone who injures themselves falling off a horse have to pay more? After all they decided to go horse riding. If anything choosing an equestrian hobby is more of a “lifestyle choice” than diabetes. The clue being that having diabetes isn’t a lifestyle choice.  Should someone who slips getting out of the shower because they chose not to buy a suitable bathmat have to pay more? You buy the wrong mat, you pay the health cost Lee and Hopkins might shout. And so we see that this system of judging others’ responsibility becomes complex and untenable. The number of injuries resulting from throwing stones in glass houses alone would be ridiculous.

Can people have responsibility for their own health? Of course they can. People should try not to smoke, not to drink too much, exercise, try to avoid being stabbed in the toe and so on. Should they be punished if they don’t do these things? I’d say if they become ill then that’s “punishment” enough. Diabetes isn’t a walk in the park, especially if you develop foot complications. The myriad other complications of obesity, smoking and the like are awful to have and live with. To charge people on top of this seems unnecessary.  It is likely to be argued that the NHS doesn’t have enough money to pay for all these illness and that those who have caused their own illness have a moral responsibility to make up the difference. Putting aside for one moment that people who are said to be ill because of overconsumption of a certain good whether it is food, alcohol or smoking have already paid extra in the form of taxation on those goods, moral responsibility in this area is difficult to judge.

In terms of enacting this strange financial justice we run into another problem. Many health problems and factors considered health risks increase with poverty. So suddenly people would be more likely to have to pay more when in fact they have less money. Julian Tudor Hart, former GP, noticed this tendency for good medical or care to decrease as the need of the population served increased in  his Inverse Care Law and that this especially tends to be the case when medical care is exposed to market forces. Put simply, in the system proposed, people who need medical care most are least likely to get it. If you have to pay extra for treatment and you have no money then you’ll have to stay home (if you’ve got one) and be sick. Perhaps I’m fussy but this seems like a bad thing.

Moral responsibility is the division of actions into those that are good or bad and the attribution of praise, blame, reward or punishment to the agent responsible. It is beyond the scope of this already too lengthy blog post to decide whether the broad spectrum of health acts fall into the simple division of good or bad. Is one glass of one morally wrong? Two? Eight? I’d argue that none of the options are morally wrong although eight is certainly worse for you health wise. That isn’t really the point. The point is that it’s too complex to decide and allocate financial responsibility and ultimately it is not for the health service, doctors, nurses or any health care professional to be judge, jury and financial executioner for health problems patients don’t want and almost certainly didn’t consciously choose. The NHS may be having financial difficulties but applying judgment and discrimination through the weapon of accountancy does not seem to be a viable or ethical way forward. Aneurin Bevan when spearheading the formation of the NHS did so under the belief that treatment “Should be based on clinical need rather than ability to pay” and this to me seems the only morally responsible option. But what do I know? I’ve never been on reality TV.