A Book Review for the New Year

In 2009 a fellow psychiatrist's book will be on the shelves - ‘The Meaning of Madness’ by Dr Neel Burton. This book aims to explore what mental disorders can teach us about human nature and the human condition. For example, what is schizophrenia? Why is it so common? Why does it affect human beings and not animals? What might this tell us about mind and body, language and creativity, music and religion? What are the boundaries between mental disorder and ‘normality’? Is there a relationship between mental disorder and genius?

The book looks behind the usual categories to ask: why does this mental disorder exist and what adaptive or evolutionary advantage, if any, could it have? It’s an interesting way of looking at things, and one that puts a much needed positive spin on illnesses which are usually portrayed as being nothing but negative.

According to Professor Bill Fulford of Oxford University, ‘The Meaning of Madness’ contrasts from other books on mental disorder in that it neither polemical nor over-technical. Instead, it provides a highly readable and at the same time authoritative account that, by combining literary, philosophical, and scientific sources, shows the deep connections between ‘madness’ and some of most important attributes as human beings. The book’s central message that mental disorders are an expression of our deepest human nature is both important and timely, and one that can make a real difference to the perception, experience, and outcome of mental disorder.

Well done to Dr Neel Burton, it certainly makes an interesting read. Hot of the press it can be pre-ordered here.

A Bipolar Economy?

During the present glum destructive nature of the economy, histrionic panic should be avoided. It’s similar to treating an economy with bipolar disorder. Suffering a crash after a prolonged ‘high’ or manic episode. Going from euphoria to despair. During the years of boom and mania, there was inflated opinion, increased self-esteem, carefree joviality, boorish behaviour, over-optimistic ideas and reckless acts without thinking of the consequences. Now we stare in the face of depression. The market suffers the bipolar opposite feelings of recession. Suffering with guilt, lack of self-esteem, feelings of worthlessness and a bleak and pessimistic view about the future.

Politicians need to communicate and co-ordinate. Any psychiatrist will tell you, inconsistency and uncertainty are to be avoided. Casino party capitalism has no chips left to place on the table. Initial stabilisation must occur, and confidence in the Treasury is now paramount. I hope they prescribe the correct treatment at the right dose!

Conservative Health Debate

Last night I was kindly hosted by Beaconsfield Conservatives and spoke with Dominic Grieve MP (Shadow Home Secretary). Many thanks to all the people who came along to join in the health debate.

Doctors Car Stolen

News from Greater Manchester Police is that a doctor left the car running whilst she did the decent thing and rushed over to help a man in his 70's suffering a serious head injury. Being a good samaritan she pulled up in her red Renault Clio leaving the keys in the ignition.

Unfortunately, a thief jumped in her car and drove off! The incident happened at 4.50pm on Wednesday, on Eccles New Road, near Hope Hospital in Salford, Greater Manchester. The car's registration is NY05 RZN and police would like to hear from anybody who has seen it.

Book Review

‘Why Lawyers Should Surf’ has been reviewed by:
Times online and Swordplay.

The Future?

Barack Obama and David Cameron share political dreams with confidence and the audacity of hope. Perhaps the next time they meet, both will be elected leaders.

A Brief History of Childhood Behaviour

As childhood knife crime is dominating the headlines, perhaps it's worthwhile remembering the words of Jean-Jacques Rousseau. He believed infants were born infinitely malleable with the potential for moral goodness that experience of life corrupted. "Everything is good" he wrote in 1762 "that leaves the Creator's hands: everything degenerates in the hands of man."

Since the end of the eighteenth century, the concept of childhood as a time of extreme impressionability, and of crucial significance for personality development, has been a powerful force politically and socially. Descriptions by Charles Dickens of the terrible living conditions of the poor were meant to move politicians, and they did. It was known then that only social reform and active measures could solve the problem.

Knife Crime in A&E

This picture was taken during the 'doctors march', March 2007. It illustrated how the then health secretary Patricia Hewitt treated junior doctors over Modernising Medical Careers (MMC).

In 20o8 may I remind the Home Secretary Jacqui Smith that A&E is for an accident and/or an emergency. It is not, and never will be, part of the criminal justice system.

The Quango Theme

Today Kathy Gyngell discusses quangos, see here.

Quangos Cost More Than Our Armed Forces.

Alan Duncan today announced that Regional Development Agencies (RDAs), are evolving into an executive arm of government instead of being “a business-led force for good”. He fears RDAs have become “increasingly politicised” and that the government’s plans to give them strategic planning powers is “a huge mistake...ingraining a tier of regional government with no mandate, no legitimacy and no accountability”.

To me RDAs sound like yet another unaccountable, unelected, undemogratic quango. Perhaps it's worth remembering that the Labour government spend more on quangos, than on our own armed forces.

Gordon Brown's NHS

Gordon Brown celebrates 60 years of the NHS.
Check out this clip - a must see episode of Yes Minister with a hospital full of administration but no patients. Is this an example of life imitating art?

Why Lawyers Should Surf

The book 'Why Laywers Should Surf' was reviewed this week in surfing magazine Drift.

NHS - Happy 60th

Yesterday I was at Guy's hospital, celebrating 60 years of the NHS. David Cameron spoke about how the Conservatives were going to reduce targets and focus on outcomes. He also gave a personal account of how his son Ivan has frequently used the NHS and how grateful he was to the hard working health professionals.

A Lost Labour Generation?

Today I started my day by buying breakfast and a latte in local coffee shop. A pleasant young lad served me and said “£6.50 please”. I handed over £10 and then gave him another 50p. The extra change made him look nervous, and he called over to the girl making the drinks. He said, “So, how much change do I give?” The reply “£4” was spoken in a Polish accent. Has anyone else experienced a similar situation recently?

This simple but telling interaction is on the same day as Sir Peter Williams, (chair of the ‘Government’s Advisory Committee on Mathematics Education’) expressed concerns over how poorly equipped primary schools are to teach maths. He raised concerns that a quarter of eleven year olds are failing to meet the expected standards of numeracy. He highlighted the importance of combating the “can’t do” attitude to mathematics that appeared to be unique to Britain.

I concluded this morning that Poland must have a “can do” mathematics attitude and wondered if we need to open the doors of his proposed ‘summer mathematics courses’ to all the children who were educated during the last ten years of Labour administration. Their slogan ‘education, education, education’ seems to be over ten years behind schedule.

Polyclinics annd Health Localism

Today I wrote a piece about Polyclinics over at Conservative Home.

Prisons and Drugs

This clip is of Mr Djemil who will launch a blistering attack on current drug prison policy on Monday. This is his first ever television interview where he says that drugs in prisons are "everyone's problem and no-one's priority". Lets hope everyone can make it a priority to tackle the drug problem within the prison service.

Blogging Friends

The other day I had the pleasure of meeting fellow blogger Ellee Seymour. I’ve always been a fan of her blog and she’s even more delightful and kind in person. Today she reports about the state of mental health provision.

Gordon Brown: Time for Palliative Care

A necrosing, fungating, pungent mass may be excised by a surgeon’s knife, using a wide margin excision. The histological report and analogy with Crewe and Nantwich could return terminal for Gordon Brown; as the Labour stronghold was voted out in favour of the 165th target Tory seat. A wide margin of resection, by any measure.

So, does that signify the end for Gordon Brown, or will more surgical misery ensue? Surgeon Lord Darzi, has suggested that traditional GP surgeries could soon be replaced by new ‘polyclinics’, which house GPs alongside other health professionals, all under the same roof. If a trial of these new centres in London is successful they could be enforced across the country. However, if they take after Gordon Brown any honeymoon period they enjoy will have no happy ending.

The Blair days of “24 hours to save the NHS” have long since departed, and the time has come to stop squandering billions of taxpayer pounds on NHS white elephants, such as electronic records that still don’t work. Despite Labour’s abysmal mismanagement of the NHS, they are pushing full steam ahead with the polyclinic idea. Yet, for many patients, losing their GP is not as easy as it sounds. Rapport and trust between doctor and client is built gradually and develops over time. It’s not always possible to pick up the nuisances of an illness in a ten minute consultation, especially if the service user is unknown to the GP and suffers with multiple chronic illnesses.

As Eamonn Butler suggests in ‘The Best Book on the Market’, if we trust the market, then polyclinics would not have to be enforced, but would naturally develop in areas where the local community wanted them. Although nobody expects markets to be perfect; it’s often their imbalances and imperfections that make them work. If information is the grit in the market oyster then GPs may be the black pearl. GPs already have access to the local information and health needs, so why not trust the professionals to be entrepreneurs? Trust them to lead and respond to changes within their community. Free them from bureaucracy, red tape and the centrally-dictated targets.

Rather than the institutionalised ‘learned helplessness’ of the NHS professionals, free them to build their GP practice like a business. Allow market forces to naturally develop according to need. For example, let services and client’s needs develop symbiotically; where the client dictates the opening hours and the surguries perhaps charge patients who do not attend and waste precious appointment slots.

In conclusion, I believe the NHS needs to encourage innovation, open the market and end central control from a dictatorial Prime Minister. Until that day, Gordon Brown is offering as much depth to the NHS debate as a flat screen television. He’s doing nothing more than imposing regulation like a sledgehammer that misses the nut.

Crewe and Nantwich

A necrosing, fungating, pungent mass may well be excised by a surgeon’s knife using a wide margin excision. The histological analogy with Crewe and Nantwich seems unmistakable. If Gordon Brown's party are excised in the Labour stronghold, in favour of the 165th target Tory seat, the voters would have excised him with a wide margin resection, by any measure.

Are you affected by the ‘Affluenza Virus?’

According to Oliver James in his book 'Affluenza', the Affluenza Virus increases your susceptibility to the commonest emotional distresses: depression, anxiety, substance abuse and personality disorder (like the me, me, me narcissism, febrile moods or confused identity).

He asks –Have you contacted the affluenza virus? Answer ‘yes’ or ‘no’ to the following statements.

I would like to be a wealthy person.
I would like my name known by many people
I would like to successfully hide the signs of ageing
I would like to be admired by many people
I would like to have people comment often about how attractive I look
I like to keep up with fashions in hair and clothing
I would like to have my name appear frequently in the media
I often compare what I own with what others own
Possessions can be just as important as people
Shopping or thinking about what to buy greatly preoccupies me
If a friend can’t help me get ahead in life, I usually end the friendship
I’m less concerned with what work I do than with what I get for it
I admire people who own expensive homes, cars and clothes
My life would be better if I owned certain things I don’t have now
The things I will own will say a lot about how well I’ve done in life
I want a lot of luxury in life.

If you answered ‘yes’ to any of the questions, then it’s said you have the virus. The more ‘yes’ answered, the higher the viral load.

A Vascular Surgeon to the Rescue

Today several newspapers reported how a retired teacher severed an artery after falling off her bike, and impaling herself on the handlebars. She was luckily saved by vascular surgeon, John Thompson, who just happened to be passing by. He not only treated her at the scene but then followed the ambulance to hospital and operated on her leg himself.

In a short time she had lost a quarter of the blood in her body, and unless he had been there to administer the acute care, she would have died in minutes. Mr Thompson, described his being there as, “an amazing stroke of luck.”

The political anology seems unmistakable. NuLabour have reinvented the NHS wheel so many times, they’ve fallen off and impaled themselves, wasting money on computer systems, red tape and quangocrats. However, for them, I doubt there’ll be a passing vascular surgeon to save the day. They’ve reduced training posts and medical training so radically, that their haemorrhage of support is critical.

Backing Boris for Mayor

When Boris was asked "What single achievement are you most proud of in your life?" he replied, "It is yet to come. I will be immensely proud to serve Londoners if I become Mayor." With an 11 point lead, his dreams may well come true.

A Novel Psychiatrist

Tony Blair's former spin doctor Alastair Campbell is to publish his first novel. 'All in the Mind' is described as "the compelling story of a psychiatrist, his patients and family, and the pressures they bring to bear upon each other".

Campbell, who has previously spoken about his struggles with depression, said that although he has himself required psychiatric treatment "this is a book by me, not about me". I look forward to reading it with interest.

Who Cares for the Caring Profession?

With thanks to Dr Crippen and Newsnight for highlighting these grave statistics. Next month Newsnight are showing a documentary, "Struggling in Silence". They explore the dark side of the profession, about the little-known and rarely discussed problem of depression and suicide among physicians. The unsettling truth is that doctors have the highest rate of suicide of any profession. They report:

“Every year, between 300 and 400 physicians take their own lives—roughly one a day.”
That shocking statistic speaks for itself.

Gordon Brown - Robin Hood in Reverse?

Has Gordon Brown become Robin Hood in reverse? With the 10p tax, he's taking from the poor to give to the rich.

NHS - Number 1 Battle Ground in the Next General election

As I wrote before, to Gordon Brown the NHS is 'Not His Specialty'. Hence, the NHS, is likely to be the number one battle ground in the next election. Today, David Cameron offered much needed direction to a health organisation that spends around two billion pounds per week! He has said:

"In a nutshell, GPs should control the budgets that NHS patients are entitled to. There is a good economic rationale for this. Budget-holding is a natural guarantee of efficiency, ensuring that money follows the patient and it is spent on frontline care rather than on bureaucracy. GPs - rather than remote managers - should be responsible for reconciling the available resources with clinical priorities and patient choice. And there is a good health rationale for GP budget-holding too: what's called the continuity of care. The family doctor service is the way to ensure that - even though the patients may see many specialists - there is always one doctor in charge: the doctor closest to the patient. This is especially important when it comes to preventative action or the management of chronic conditions, which require significant patient involvement.Five years ago Gordon Brown said that "in healthcare the consumer is not sovereign" - meaning that patients should not be trusted or expected to manage their own care. Well I disagree. Because I believe in general practice. With the GP to advise the patient and to commission care on their behalf from a variety of providers, then in healthcare the consumer can be sovereign."

I totally agree that GPs are paramount to patient care. As a psychiatrist, I daily rely on GPs knowing their patients. They provide vital information about both long term health and subtle changes in patient presentation. I'd like to thank all the GPs I've trusted to manage my patients after hospital discharge. If I trust them with life and death, I would certainly trust GPs to spent money wisely.

I believe GPs, like hospital doctors, want the funds to follow the patient. The time has come to stop following the dictum of management consultants or government quangocrats. The political tide must turn. The patient must be the put at the heart of the NHS.

Bulimia at the House of Commons

Well done to John Prescott for highlighting the plight of bulimia. In the words of Consultant psychiatrist Dr Ty Glover, an eating disorders specialist at Cheadle Royal Hospital in Cheshire, said: "It's hard enough for a young girl to confess to, but for a high-profile male politician approaching 70, it's especially impressive. It's believed that one in ten bulimia sufferers are men but I have never in all my years as a consultant specialising in eating disorders come across a man this old suffering from bulimia. It seriously makes me think that maybe we're completely missing a whole audience of middle-aged men who are too scared to admit they have a problem."

To Gordon Brown the NHS, is 'Not His Specialty'.

Gordon Brown seems to have had little grasp of the health brief either as Prime Minister or as Chancellor. He may have spend the money, but it's been shamefully squandered, and has not reached patient care. Money has been spent on useless projects, evidence that the NHS really is Not His Specialty. I've just found Sir Gerry Robinson trying to give Gordon advice on the NHS via YouTube. I have written about Sir Gerry before:
Here and here.

Backing Boris for Mayor

The dangers of unlocking Alistair Darling from your unconscious

It is believed that dreaming about a politician, denotes 'displeasing companionships, and incidences where you will loose time and means'. So in our current economic climate, be warned, don't dream about Alistair Darling! We can't afford him to loose even more of our hard earned tax!

I’m Just No Jack in the Box

Sometimes the feeling of suffocation comes over me when I consider how imposed central government NHS services do not allow clinicians to breathe. Let's consider Jack, a young man who was admitted to hospital in delirium tremens (colloquially, the DTs). He admitted to drinking one and a half bottles of vodka per day and was also a heroin (opiate) addict. In the immediate short term, he could be detoxed on a medical ward. However, next came the problem.

He wanted to stop his addiction cycle. The medical profession also wanted to help him achieve this. However, the alcohol rehabilitation service is only contracted to treat alcohol addicts, not opiate addicts. And the opiate rehabilitation service is only contracted to treat opiate addicts, not alcohol addicts. The government has set up services within rigid boxes. But, just as Jack personifies, patients will never fit your boxes Mr Brown!

Guest Blog - Dr Eamonn Butler

Today I'm delighted to have a star guest blogger, Dr Eamonn Butler, director of the Adam Smith Institute. He explains a mixture of economics and healthcare:

The political enthusiasts of state-funded (and worse, state-run) healthcare make me sick. I'm sick of being told that "We don't want the free-market American healthcare system here. It leaves millions of uninsured people to die on the street."

But that's a caricature of America. The American healthcare system is deeply flawed, that's for sure. I wouldn't want to reproduce it here. But it spends more on state-funded healthcare for elderly and poorer people than we do, and (thanks to a helpful tax system), its medical and healthcare charities are larger and stronger too. American's simply aren't doomed to die in the gutter because they can't afford doctors' bills.

And it's hardly a free market. In fact, it's the most regulated system in the world. When – to show how pro-consumer they are – some state governments insist that insurers should cover absolutely everything, is it any wonder that insurance becomes unaffordable? You might want a Fiat policy, but you don't get the option: only Rolls-Royce versions are on offer.

Worse, the whole system is in thrall to the doctors. The mediaeval guilds built themselves cosy monopolies by getting legislators to outlaw their competition under the guise of 'maintaining standards'. And as I say in my new book on markets (modestly entitled The Best Book on the Market):

What’s remarkable is that exactly the same still happens today. The medical profession is the most powerful mediaeval-style guild in America. To practise, you need a licence from the state, and to be a graduate of an approved medical school. But it’s the profession itself that approves the schools and decides how many people will be admitted. So the number of potential competitors is limited, and fees soar. The cutlers and hatters of Elizabethan England would have been proud of them.

I fear that many people who deny the role of markets in solving our deepest problems – like the provision of mental health and other public services – don't actually understand how markets work and how to make use of them. I hope my book might enlighten them. And I've written it in a light, accessible, Freakonomics style that, with luck, even politicians should be able to understand!

To buy ‘The Best Book on the Market’ click here.

Caption Competition

Book Review

The Independent reviewed ‘Why Lawyers Should Surf’, by myself and Tim Kevan. To read the review click here.

New Book!

I highly recommend a new book by Eamonn Butler, called ‘The Best Book on the Market’. A synopsis is here and it can be bought from amazon here. The book explains how and why, all markets need to consider human psychology. In the business of minds myself, I concur that nothing is more important than the human brain in decision making.

Backing Boris

Clinton and Obama - take note of Shirley Chisholm.

In an address to congress on 21st May 1969, Shirley Chisholm, the first black Congresswomen (Democrat), said:

"I have been far oftener discriminated against because I am women than because I am black."