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Notes:

1. Anyone who reads this blog regularly may have noticed that I’ve been reading a lot of books recently; I am allergic to the summer you see and am on a quest to read every book ever written about psychiatry ever…
2. If you can’t be bothered to read this long review there’s a summary paragraph at the end. (But make sure to read the quote about Nixon)
3. I’ve not found any other psychiatrists’ reviews of this book. If you know of any please add a comment!

Medically trained and Foreign Secretary to the Callaghan Government, David Owen must have felt born to write this book, an exploration into the ailments of heads of governments during the past hundred years. It’s part insiders’ guide, part medical sleuthing and Owen admits to playing his own version of ‘guess-the-disease-of-the-person-opposite-on-the-bus’:

In February 1984 when attending Andropov’s funeral and after shaking hands with the new President, Konstantin Chernenko, at a reception in the Kremlin, I mentioned to a journalist that it was clear to me that Chernenko, then seventy three, had emphysema. The aside was soon flashed around the world, somewhat to my embarrassment.

‘In sickness and in power’ breaks down four ways. There are two round-up chapters detailing the problems of leaders 1901-1953 and 1953-2007 respectively, four in-depth case studies where Owen judges that leaders’ ailments may have landed them in particularly hot water, a detailed breakdown of the events surrounding the war in Iraq and finally Owen’s recommendations for the future.

The first two chapters are strongest. Did you know for instance that some American psychiatrists consider it highly likely that 26th US President Theodore Roosevelt suffered from bipolar affective disorder? Or that Ronald Regan was showing early signs of Alzhemier’s disease whilst still President? In the 1901-1953 chapter we learn of France’s clearly mentally deteriorating President Paul Deschanel:

Soon after his election … rumours of extravagant behaviour started circulating. He surprised crowds, for instance, by enthusiastically kissing the mouth of a First World War Soldier who had a severely mutilated face. Then, on 23 May, Deschanel disappeared from his presidential train while travelling from Paris during the night. He had either fallen from an open window … He ended up in this night clothes and with blood on his face in a gatekeeper’s house at a railway crossing. His assertions that he was the President of the Republic and had fallen off the train were met with hilarious incredulity until a doctor, who was called in, recognised him.

Around the same time 28th US President Woodrow Wilson had a stroke leading him to develop a paralysis of the left side of his body and a neglect syndrome. Rather than standing down, the obvious thing to do for a man who was subsequently unable to hold a cabinet meeting for seven months, Wilson’s personal physician informed his colleagues that he was simply suffering ‘nervous breakdown, indigestion and a depleted nervous system’. Owen speculates as to the consequences of this action; thinking that, had Wilson resigned, his healthier Vice-President may have been able to persuade Congress to ratify the treaty establishing the League of Nations and that this in turn might have helped prevent the Second World War.

The Nixon in Owen’s book appears dangerously unhinged; here’s Owen quoting journalist James Reston:

Between 9.22pm on 8 May and 4.22am on 9 May 1970, Nixon made 51 telephone calls to members of his Cabinet, his staff, magazine editors, Foreign Service Officers, newspaper reporters, repeating calls to one or the other, talking about his family, his grandparents, the civil war – sort of a sleepless, compulsive nightmare of a talk – after which, to the consternation of the Secret Service, he got into his car at dawn and drove to the Lincoln Memorial to argue with the startled young people who had come to Washington to demonstrate against the invasion of Cambodia.

The case histories are of Anthony Eden’s illness during the Suez Crisis, US President John F Kennedy’s Addison’s disease, leukaemia affecting the Shah of Iran and President Mitterrand’s prostate cancer. In all four cases the voters were unaware of the state of their leader’s health.

For Eden a botched cholecystectomy lead to severe pain and he was hospitalized with a high fever at the height of the Suez crisis. JFK was taking cortisol replacement for adrenal insufficiency, strong analgesia for chronic back pain and had a rather shady doctor who provided him with amphetamine on demand. Owen makes a direct connection between JFK’s shambolic medical treatment and the Bay of Pigs fiasco, and contrasts this to his much more measured performance during the Cuban Missile Crisis, when his care was much improved.

The Shah of Iran was diagnosed with leukaemia in 1974, but this was only known to a very small number of people for the next five years. Bringing in a personal dimension, Owen states that as British Foreign secretary from 1977-79 he would have encouraged the Shah to stand down had he known of his condition. He links the Shah’s inability to handle events to the Islamic Revolution, and thereon a potentially avoidable government that has contributed to the continuing instability of the Middle East.

Mitterrand gained the French Presidency on the understanding that there would be full transparency regarding this health. Of course ‘transparency’ as others might know it and ‘transparency’ to a man who had a secret second family who followed him around in a second plane on state visits, proved to be two different things. ‘The Sphinx’ managed to get his personal physician to sign a clean bill of health, presented to the French people, for many years before coming clean.

Part three is called ‘The intoxication of power’ and there’s a chapter on Iraq, which is a distillation of Owen’s other book The Hubris Syndrome. Here Owen painstakingly charts the discussions and resolutions of major players in the run up to the conflict. This was rather dull, full of the minutiae of the interactions of diplomats and politicians. In this chapter as well as throughout the book, Owen is not content merely to document events and maladies but instead proposes his own syndrome – ‘Hubris Syndrome’. A half way house between a medical condition and a rhetorical device, from the man who almost called the SDP ‘New Labour’. Hubris syndrome is all about people in positions of great power getting too big for their boots. In the introduction Owen gives us a list of symptoms which characterise this. Here are the first four:

A narcissistic propensity to see the world primarily as an arena in which they can exercise power and seek glory rather than as a place with problems that need approaching in a pragmatic and non-self-referential manner

A predisposition to take actions which seem likely to cast them in a good light – i.e. in order to change their image

A disproportionate concern with image and presentation

A messianic manner of talking about what they are doing and a tendency to exaltation.

There was something about Hubris Syndrome, which every time it was mentioned almost compelled me to throw ‘In sickness and in power’ out of the window, or at least turn to the person next to me in the bus for solace. I don’t doubt that powerful politicians may act in particular ways. I, for instance, might start to think I was superhuman if, like Tony Blair, I didn’t have to wait at a traffic light for ten years. I do not think that his counts as a disease, as to make a convincing case any proposed illness should have (at least a stab at) an aetiology, an incidence, and a population distribution to name but three. Owen makes almost no attempt to frame hubris syndrome in this way and, irritatingly, always refers to it as if it were something that had an existence outside the confines of his book.

The book finishes on some sensible and interesting points on how illness in heads of government can be protected against by the use of independent medical assessments and, in the case of hubris syndrome, strengthening democratic checks and balances.

So, if you’ve read the first two paragraphs and are now skipping to the end: This book has some fascinating chapters about illnesses suffered by heads of state and the effects their maladies had on themselves and on their governments. Towards the conclusion it loses its way and has a very boring chapter on Iraq. Throughout Owen compares his protagonists for signs of a set of behaviours he calls ‘Hubris Syndrome’. I am not convinced that he makes a strong case for this being a disease.

Margaret Cook review A Doctor in the House in The Guardian 5 April 2008

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I am forming a theory that, rather like a stew left in the fridge, the longer one leaves a book on a shelf, the better it becomes.  For instance I left Jonathan Coe’s ‘The Rotter’s Club’ on my shelf for four years before reading it and it turned out to be brilliant.  By contrast I acquired its sequel ‘The Closed Circle’ and read it without leaving it to languish at all, and it turned out to be most disappointing.

When clearing out an office at one of my placements eighteen months ago I requisitioned Jeremy Laurance’s book ‘Pure Madness’ and it’s been kicking around my flat ever since.  Subtitled ‘how fear drives the mental health system’ it’s a really interesting examination of the problems with the UK’s mental health system, and how these problems have come about.  Laurance is the health editor of the Independent newspaper and took nine months off to write the book.  A noble effort, considering that he can’t have been expecting to sell many copies. 

Throughout the book Laurance’s journalistic skills shine through, as the book is both informative and interesting, a not inconsiderable achievement given its potentially dry subject.  In large the book deals with current culture in the mental health field where the predominant concern is risk management rather than patient care and where the care of patients appears to lurch from crisis to crisis, with limited resources available for long term work.  Laurance also discusses that dissatisfaction that many people who use the service feel towards the care that they are offered. 

In chapter 11 ‘The new meaning of community care’ Laurance sets out the problems as he sees them:

‘In reality, over the past decade, mental heath services have been driven by public and political pressure to adopt the risk avoidance agenda.  Facing a chronic shortage of resources, community care has never been realised in its full scope and the services have been narrowly focused on securing the safety of the public rather than meeting the needs of the individuals.  The result is a service which:

Provides help in a crisis for people with mental health problems but offers little in the way of prevention to stop the crisis occurring, or support after it is over

Is medically driven and focused on drugs with little choice of other kinds of treatment

Relies on containment and compulsion with a 50% increase in the sectioning rather in the past ten years and increasing use of medication. 

Is strongly disliked by users and…

Has been heavily influenced by carers’ organisations

Is being driven to be more coercive and controlling by Government proposals for legistation which highlight dangerousness.’

How did this all start?  In terms of the risk model, Laurance identifies a turning point at which the debate about mental health treatment changed.  This turning point was the fatal attack by Martin Clunis, a man with a diagnosis of schizophrenia, on Jonathan Zito, a unfortunate bystander knifed at random.  Following this tragic incident, Laurance contends that, in terms of the care of those with mental health problems, concern for the welfare of the (non-violent) many was replaced by the fear of the risk posed by the few.  The result was an ‘inquiry culture’ and press frenzy.  Whist ignoring society’s most prominent cause of violence – that of people intoxicated by alcohol, suffering no mental illness – papers continually printed stories of unprovoked attacks of on strangers by ‘nutters on the loose’.

Clunis lived in the community, but fifty years earlier he would most likely have been in an asylum.  These places were more about containment than treatment and lead to the institutionalization of many people.  During the 1960s social and economic pressures, as well as the advent of anti-psychotic medication lead to their gradual closure.  At first this went smoothly – there were many people in hospital that shouldn’t have been there in the first place – but discharging patients with more severe problems proved more difficult and often the appropriate care for them in the community was lacking.  The money saved by closing asylums was diverted into physical medicine rather than being invested in mental health provision. 

In 1998 Frank Dobson, Health Secretary, stood up in front of the House of Commons and declared that ‘community care has failed’.  This view is disputed by Professors Graham Thornicroft and David Goldberg.  They contend that community care has only been half implemented and so this cannot be said to have happened.  The reduction of the number of psychiatric beds was achieved by closing the vast majority of long stay psychiatric beds but the number of acute beds has remained stable.  However no provision was made for the possibility of short term admissions for the previous long stay patients who are having a crisis.  The result is immense pressure on acute psychiatric wards, with occupancy rates often exceeding 100%. 

Community care is popular with patients, but standards are low with psychiatric wards being unpleasant places and community care without the resources for long term work and geared towards dealing with crises.  But the argument that community care has lead to increased risks to the public cannot be sustained; Laurance says that figures show that there has been no increase in killings by people with mental health problems in the forty years that mental hospitals have been emptying. 

The new president of the Royal College of Psychiatrists Dinesh Bhugra, was recently very critical of UK mental health provision.  Thornicroft would agree and is quoted in the book as saying: ‘There are ways in which the mental health services we have got used to wouldn’t be accepted in other forms of care’.  Laurance illustrates this schism whilst talking of suicides ‘imagine if cervical cancer patients, screened and treated on the NHS, were still dying at a rate of 300 a year with shortcomings in the service blamed for the deaths of a further 900?’

Very valuably, Laurance lends much of his book to providing reports as the feelings and wishes of people with mental health problems who use the service.  There is much dissent. 
‘the biggest change in the last decade has been the growing protests from people with mental health problems who use the service.  There is enormous dissatisfaction with the treatment offered with the emphasis on risk reduction and containment and the narrow focus on medication.  They dislike the heavy doses of antipsychotic and sedative drugs with their unpleasant side effects and a growing number reject the biomedical approach which defines their problems as illnesses to be medicated rather than as social or psychological difficulties to be resolved with other kinds of help’

With this in mind, we hear of Bradford consultant psychiatrists Phil Thomas and Pat Bracken who published a well known paper in 2001 entitled ‘Postpsychiatry: a new direction for mental health’.  Their attitudes are popular with user groups and Laurance finds them ‘prepared to take greater risks than many of their colleagues to protect the autonomy of people with mental health problems and are less in thrall to the ‘safety at all cost’ culture that dominates the profession’. 

This reminds me of Rufus May, who works in Bradford, and this site’s postings about his television programme ‘The doctor who hears voices’.  One of my major criticisms was that May did not manage the suicide risk of his patient adequately.  I still think that May took a big chance in the way he approached ‘Ruth’s’ treatment, but I can recognise here in my approach the effects of the culture in which I have been immersed. Like a creature of my training I was horrified at what I saw as May’s risky approach, whilst May took an approach that valued the autonomy of his patient over all else.  Rufus May features in the book, in a chapter in which Laurance details the ‘life stories’ of several people with mental health problems.  What stands out in all the stories are the difficulties people face in receiving the care that they might wish, but also the broad nature of the problems with which mental health services must deal. 

In conclusion Laurance reports that the Government has reacted to the problems of patient care and public safety with two opposing agendas: firstly they have identified mental health as one of its three health priorities, making new money available.  But they have also proposed more coercive laws to deliver a safer service.  Psychiatry has always had within it an element of social control, but the question is to how far these powers should extend. 
Laurance finishes:

‘The argument of this book is that the most effective way to increase satisfaction and at the same time improve public safety is to devise services that genuinely engage mentally ill people and meet their desire for greater involvement in their care so that they are encouraged to lead stable risk free lives.’ 

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I have been reading ‘Psychology A Very Short Introduction’ by Gillian Butler and Freda McManus.  It’s part of an interesting series published by Oxford University Press, which seek, via compact little books, to introduce readers to subjects as diverse as the fall of the Soviet Union and Indian philosophy. I’ve tried to tackle a few of them now, with varying levels of success.  The VSI books with which I’ve had the most success are the ones dealing with subjects with which I am most familiar and that I have chosen to read in order to brush up on my knowledge.  By contrast the VSI publication concerning fascism had defeated me by page 6.

‘Psychology A Very Short introduction’ starts off solidly: ‘What is psychology? How do you study it?’ is the title of the first chapter.  We are introduced to William James, American philosopher, physician and one of the founders of modern psychology who defined psychology as:

‘The science of mental life’ 

Early psychologists used introspection as a way to study psychological questions; James was unimpressed and displayed a talent for the epigram when he described this method as akin to ‘turning up the gas quickly to see how the darkness looks’.  In 1913 John Watson was even more sensible, when he stated that if psychology was to be treated as a science, the data on which its conclusions were based should be available for inspection.  We’re taken through the methods used to study psychology and the main braches of the subject.  There’s a helpful bit on the difference between psychology and psychiatry which is quoted elsewhere on this site. 

With this over the meat of the book starts with the subject ‘What gets into our minds? Perception’.  There’s a discussion of the Gestalt psychologists and some of those pictures that demonstrate their conclusions – the devil’s tuning fork, the Necker cube and Rubin’s vase.  Important to perception is attention and the discriminatory skills necessary to identify the things in which we are most interested and ignore the rest. 

‘What Stays in the Mind Learning and Memory’ deals with what for many is the very embodiment of psychology: conditioning.  Classical conditioning, whereby associations are learnt between events was discovered by Pavlov.  Operant conditioning was first described by Skinner, who wrote about the role of reinforcement in learning.  Different flavours of memory such as short and long term memory are also dealt with.

‘How do we use what is in the mind? Thinking, Reasoning and Communicating’ is about no less a subject than how we ‘organize our perceptions so that they make sense, recall information when it is needed and use it to think, reason and communicate with, then we can make plans, have ideas, solve problems, imagine more or less fantastic possibilities and tell others about it’.  Discussed is different sorts of reasoning, alongside a number of tricky puzzles to illustrate concepts

The chapter entitled ‘Why do we do what we do? Motivation and Emotion’ concerns human drives and quickly mentions Maslow’s hierarchy of need before moving onto emotions, and the difficulties they present for psychologists.  ‘Is there a set pattern? Developmental Psychology’ is concerned with psychological development and the way this is used to advise parents about the progress of their children.  Bowlby’s work is cited and there’s some inevitable talk about the effect of depriving monkeys.  The case of Genie gives some weight to the theory that there is a ‘critical period’ for language development.

‘How can we categorize people? Individual differences’ is concerned about ways in which psychologists seek to group people together in terms of their similarities and differences.  There’s intelligence and intelligence tests, and the problems inherent in these.  Also covered are assessments of personality, for example Eysenck’s personality types. 

‘What happens when things go wrong? Abnormal psychology’ discusses what abnormal behaviour is and how we can classify it.  This is a thorny subject and several different approaches are mentioned.  This of the all chapters is the most psychiatric, and psychiatry’s attempts to classify abnormal behaviour using ICD-10 and DSM-IV are here.  Also covered is how psychodynamic and behavioural approaches both have their place in understanding and treating abnormal traits.  ‘How do we influence each other? Social Psychology’ covers subjects like obedience/conformity and Miligram’s experiment, as well as whether ‘born leaders’ exist and the origins of prejudice. 

Finally, the book ends with a chapter entitled ‘What is psychology for?’  Here we have a discussion of the many uses and abuses of psychology.  Clinical psychologists work in health care settings, whilst particular ire is reserved for those involved in corporate team building courses.  For this they quote:

‘Psychologists, past masters at convening conferences in order to state the obvious, have at last turned their attention to this most bizarre manifestation of late 20^th century corporate sadism’

Which makes me pleased that I don’t work in an office.  They finish with directions for possible psychological research and also a glossary of terms used in the book.

As you can tell from this quick run-through, this is an interesting little book which manages to cover a lot of ground over a relatively modest number pocket-sized pages.  For someone with a little bit of psychological knowledge it would be ideal consolidation material.  For a complete novice it is recommended, but there may be gentler introductions available. 

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I’ve just finished reading Simon Singh and Edzard Ernst’s book on alternative medicine entitled ‘Trick or Treatment’. 

Written by a best selling science author Singh, who boasts a PhD in particle physics, and Ernst, a professor in complementary therapy, and subtitled ‘alternative medicine on trial’ Singh and Ernst clearly hope to set a standard in the genre.  They set out their stall early, first by dedicating the book to the Prince of Wales, whose sympathetic views on alternative medicine are well known, and then by quoting Hippocrates as providing their guiding path:

‘There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance.’

They themselves are not modest:

‘Although there are plenty of books that claim to tell you the truth about alternative medicine, we are confident that ours offers an unparalleled  level of rigour, authority and independence’

Any treatment which cannot stand up to the rigours of scientific enquiry, by which Singh and Ernst mean a well conducted controlled clinical trial, has no place calling itself medicine and is simply hocus-pocus with good PR.  At best such therapy is simply no better than placebo, at worse it is positively dangerous.  But even if it is harmless, it is far from costless, as the annual global spend on alternative medicine is in the region of £40 billion, money that could be spent on more fruitfully, should alternative therapies prove to be ineffective.

The authors say that the key theme running through their book is ‘truth’.  And not in any post-modern sense, but instead in the sense of the fundamental question: ‘is alternative medicine effective for treating disease?’.  With this in mind, the first chapter of the book is about how science establishes whether medical interventions are effective or not; that is, how the ‘evidence’ is put into ‘evidence-based medicine’. 

To explain this, Singh and Ernst take a historical approach, building the notion of the clinical trial as the gold standard for evaluating medical interventions.  They start by telling us of one of the casualties of the ancien regime; on December 13 1799 former President George Washington awoke with the symptoms of a cold.  He thought nothing of it, but by the following night he was gasping for air.  Serious, but potentially survivable, until bloodletters drained Washington of half his blood in less than a day.  These men weren’t witchdoctors, but Washington’s personal physicians.  They thought that they were working in the great man’s best interests, but alas the medical profession had yet to work out how to distinguish interventions that worked from those that didn’t. 

Typically, it was a British man who first came up with the randomized control trial, even more typically he then totally failed to capitalize upon his insight.  The man was a naval surgeon called James Lind;  Britain at this time was the world’s greatest seafaring nation, but any journey lasting more than a few weeks was blighted by scurvy, a disease we now know is caused by a deficit in vitamin C. Lind split twelve scurvy sufferers into six pairs, and gave each a different treatment.  He also observed another group of sailors who received no treatment; these acted as a control.  As a shot in the dark, to one pair he gave oranges and lemons; this group made a miraculous recovery.  Alas, in part due to Lind’s diffidence, his findings remained almost totally ignored for 33 years. 

Just as interesting, Singh and Ernst tell us about Florence Nightingale and her penchant for statistics.  Feeling a divine calling to become a nurse, Nightingale decided to work in the hospitals of the Crimean war, having read reports of the large numbers of soldiers dying there from cholera and malaria.  Upon her arrival at her chosen hospital she embarked on the mother of all spring cleans and within one week removed 215 handcarts of filth, had flushed the sewers nineteen times and buried the carcasses of two horses, a cow and four dogs all of which were found in the hospital grounds (I think that she had some help).  But, amazing to us now, the officers and doctors who were previously in charge felt that these changes were an insult to their professionalism.  Fortunately Nightingale also had a statistical education and used this to demonstrate that soldiers under her new order fared much better than those hospitalized in less salubrious conditions. By telling us of this Ernst and Singh also seek to demonstrate that, quite opposite to what alternative practitioners believe, scientists are willing to accept ideas which run contrary to the current received wisdom.  The clinical trail is such a strong instrument that it forces them to do so. 

In the next four chapters of their book, the authors take four of the main branches of alternative medicine to task: Acupuncture, Homeopathy, Chiropractic therapy and Herbal Medicine.  They take us through the history of each approach, its theory of action and assess the evidence for its efficacy.  

Acupuncture, is an ancient treatment, whereby the body’s ‘Ch’i', its vital energy or life force flows through our bodies in channels called meridans.  Illnesses are due to imbalances or blockages in the flow of Ch’i and the goal of acupuncture is to tap into the meridans at key points to rebalance or unblock the Ch’i.  Ernst and Singh cite the experience of James Reston, who was reporting on Nixon’s 1973 Chinese visit as key for acupuncture’s introduction into the west.  Whilst in China he suffered from appendicitis and was treated by acupuncture, bringing news of his treatment and recovery home. Unlike Reston, Ernst and Singh are unconvinced.  They demolish positive papers published by the WHO as having included too many trials, some of which used poor methodology, and conclude that the science behind acupuncture is implausible and totally without evidence.  They finish by saying that Acupuncture has inconsistent evidence to suggest that it has a use in pain and nausea control.

If acupuncture gets une point, then Homeopathy, gets null.   This was the work of a German physician Samuel Hahnemann at the end of the 18th century.  Hahnemann correctly realised that he and his medical colleagues knew nothing about how to treat people, but he then moved away from the then conventional medicine and contrived to establish his own brand of treatment.  Having taken quinine one morning he found himself having the same symptoms as if he had malaria.  From this he extrapolated a universal principle ‘that which can produce a set of symptoms in a healthy individual can treat a sick individual who is manifesting a similar set of symptoms’.  Even better, he went on to say that the potency of a cure could be greatly enhanced by diluting them.  Not just a little bit either; some homeopathic remedies are at the sort of concentration you might expect from putting a teabag in lake Superior.  Singh and Ernst find this all highly improbable, and put any positive effects attributed to this brand of alternative medicine down, amongst other things, to the body’s ability to heal itself. 

The founders of chiropractic therapy argue that ill health in the body is due to subluxations, slight misalignments of vertebrae in the spine.  These subluxations interfere with the flow of innate intelligence (a bit like Ch’i).  They are corrected by spinal manipulation, whereby the practitioner flexes of extends the neck beyond its normal range of movement.  There are some chiropractors called ‘mixers’, who are basically back specialists, however their ’straight’ colleagues believe that their techniques can cure the body of ills seemingly unconnected with the bony structures. 

My attitude to all this would be: not to my neck you don’t buddy.  And according to Ernst and Singh rightly so.  There is some evidence that chiropractors have a place in treating back pain.  This is something with which conventional medicine has struggled.  However in its treatment, chiropractors and conventional medicine come out as a dead heat, and a pack of ibuprofen is 35p in Sainsburys whereas a course of Chiropractic treatment costs a great deal more than this.  As worrying is that it is reported in the book that it is not unusual for chiropractors to spinally manipulate patients without their consent on their first appointment, and furthermore that this spinal manipulation has lead to vertebral artery dissections and death in patients.  

Before their finger pointing and conclusions and an interesting section entitled ‘Why do smart people believe such odd things?’ Singh and Ernst take as their fourth case study Herbal Medicine.  This is a more tricky area for them, as unlike their previous three methodologies, some herbal remedies, for example St John’s Wort, actually work.  Here the problems are more subtle.  Imagine this:  in order to get onto the shelf in your pharmacy a mainstream medicine has been exhaustively evaluated in a process costing millions of pounds and will have been produced in a sophisticated process whereby a manufacturer will be sure exactly of the contents of the drug they are selling you.  With a herbal remedy on the other hand, you may be getting something, covered in dirt, from someone’s back garden and they probably didn’t even wash their hands as they picked it.  There’s worse too, as herbal remedies can interact with conventional drugs with unpredictable consequences and if they are taken in preference to conventional medicines they won’t get you very far, as the authors tell us was discovered by several unfortunate, but trusting, cancer victims.  And beware, some herbal remedies are effective because they actually contain conventional medicines.

So whose fault is this?  Ernst and Singh propose that most alternative remedies trade on being more natural, traditional and holistic, three ideas they quickly dispatch.  Uranium is natural, bloodletting was traditional, and holistic medicine is not a preserve of alternative practitioners - GPs regularly give lifestyle advice. They go onto blame celebrities for endorsing alternative treatments, universities for providing alternative medicine courses to make money and thus legitimizing alternative approaches, the media for inaccurately reporting the benefits of alternative therapies and many doctors for prescribing alternative medicine to get difficult patients out of their consulting rooms.

There should be warning messages on alternative medical treatments like cigarettes they say, accurately reflecting the current evidence.  For Homeopathy this would read

Warning: this product is a placebo.  It will work only if you believe in homeopathy and only for certain conditions, such as pain and depression.  Even then it is not likely to be as powerful as orthodox drugs.  You may get fewer side effects, from this treatment, than from a drug, but you will probably get less benefit.

At the end of their book a further 36 alternative therapies are critiqued including colonic irrigation and ear candles - the latter of which I could tell you is bollocks just from the name.

So, having written a much longer review than I initially intended, is this book any good?  It’s certainly pretty thorough.  The first chapter about scientific method is very interesting, but the next four chapters wherein the authors examine acupuncture, Homeopathy, Chiropractic therapy and Herbal Medicine are interesting in a lot of places, but often come across as a bit dry.  This book may attempt too much aiming to be both an entertaining popular science book and one offering balanced medical advice to those seeking treatment. 

Naomi Klein’s new book ‘The Shock Doctrine’ has an interesting chapter on the techniques of Dr Ewen Cameron, Scottish born US psychiatrist and former head of the American and World Psychiatric associations.

The essential thesis of Klein’s book is that since the end of WWII America’s ‘free market’ policies have come to dominate the world through the exploitation of peoples and countries in the midst of upheaval.  At these chaotic junctures, wide ranging reforms which benefit the elite at the expense of the poor are much less likely to be opposed.  The new economic order established is massively lucrative for a few but is ruinous for the majority of the population, who are in many cases prevented from protesting either by a repressive state machine (Chile 1973) or by their preoccupation with another incident (UK post Falklands conflict). 

Klein draws a parallel between the intentions of interrogation – to breakdown and remake a person – with that of ‘Shock and Awe’ style regime change – to overwhelm and remake a country.  In the opening chapter of her book she tells of patients who had gone to Dr Cameron for treatment for relatively minor psychiatric complaints and were subsequently used, without their permission, in experiments that Cameron was being paid to do by the CIA in order to glean information about how to control the human mind. 

Descriptions of Cameron’s techniques make alarming reading.  Cameron is reported as contending that by way of an array of shocks inflicted on patients he could unmake and erase faulty minds believing that the only way to teach patients new healthy behaviours was to get inside their minds and ‘break up old pathological patterns’.  The first step in this was ‘depatterning’, for which the goal was to return the mind to a state as if it were a blank sheet of paper.  To achieve this Cameron used a device called, after its inventors, the ‘Page-Russell’ – an ECT device that administered six shocks rather than the usual one.  Page and Russell recommended that their machine be used on patients no more than four times – that is up to 24 shocks per patient.  Cameron used it on patient twice a day for thirty days – 360 shocks per patient. 

Cameron also disorientated his patients with a variety of drugs including chlorpromazine, hallucinogens and barbiturates, LSD and PCP.  Alongside memory – which he aimed to banjax with ECT – he felt that our sense of self is maintained by continuous sensory input.  With this in mind he aimed to further dent the his patients’ defences by converting the old stables behind the hospital and creating isolation boxes.  Cameron kept some of his patient in these boxes for weeks.  To make patient lose their sense of time, Cameron had the kitchens mix up the times and sequences in which meals were delivered.

Once complete depatterning had been achieved, the ‘psychic driving’ – rebuilding personalities on a ‘blank slate’ – could being.  In scenes which must have been reiniscent of ‘A Brave New World’ tape recorded messages were played to patients, often for days at an end.  These messages, it was believed, would be absorbed by the patients and lead to behaviour change. 

It didn’t end there.  Cameron also kept some patients in a ‘sleep room’ where a patient would be kept in a heavily sedated state for twenty to twenty-four hours a day for fifteen to thirty days.  Klein notes that there are several indications that Cameron was aware that he was simulating torture conditions, not least when in 1955 he openly compared his patients to POWs facing interrogation.

In 1988 the CIA were subject to a freedom of information act request and reluctantly produced the ‘Kubark Counterintellegence Interrogation’ manual.  This is a 128 page manual for the ‘interrogation of resistant sources’.  Klein notes that it had Ewen Cameron’s ‘marks all over it’.