STRESSED?

It was reported today that people in Yorkshire are most likely to suffer from stress. Stress can be used to drive you in the direction you desire and can be channelled to generate energy, utilized as a useful tool rather than a treated as a foe. However, the feeling of stress develops when there is mismatch between what you think you can do and what’s expected of you (including expected by yourself). The message is that you need to take stock and evaluate this mismatch.

Society can often exacerbate this situation with extra pressure. Consider the example of the ‘superwoman syndrome’ where women of today sometimes seem to be expected to do everything. They may be expected to be the main carers for the husband, children, parents and friends, to be successful in business and to keep the house. All whilst recycling the waste, being fashionable, fitting energy saving light bulbs and every other societal expectation. Do you think this is expecting too much? Even Cherie Booth, mother of four children, top barrister and wife to a world leader was forced to tackle this expectation syndrome and knocked it on the head by saying “I am not superwoman.” Men, too, can feel the pressure of expectations. Perhaps expecting to be strong, sensitive, successful, wealthy, good cooks and emotionally supportive.

So, perhaps we should all remember that it's alright to be human and not super human.

To be remembered...

As this week's blog has been dedicated to eating disorders, it seemed only fitting to remember that eating disorders often affect young people. This link offers a somewhat chilling insight into those who unfortunately lost their battle against the illness.

Do Role Models Matter?

The short answer is 'yes'. Modelling is the copying of certain behaviours of others which have proved successful, another way of putting this, is to create a short-cut to the end goal.

Nature vurses nurture
The human brain develops long after nature’s unique genetic code has been allocated and subsequent embryonic growth. The brain continues with the capacity and the necessity to develop and learn via nurture. Children learn their behaviour and coping strategies, in part, by copying and mimicking. Learning from people around them; parents, siblings, friends and society in general. Therefore your brain develop as a conglomeration of an infinite source of memories; a bank of situations that you and those around you have found themselves in and how those situations were dealt with.

Imitation and reinforcement
According to social learning theory, behaviours are part learned by imitation of others and via reinforcement, progressively built upon. In fact, throughout life each social situation is uploaded into the brain and the brain has the potential to lay down, modify or reinforce its own hard wiring. Hence, the information the brain gets given is important and perhaps especially so whilst children, as the child’s brain is very rapidly developing social hard wiring.

Brain hygeine
Whatever the precise answer to these issues, there is little doubt that the continual inputs the brain receives from the outside world are important factors in shaping decisions and actions. On a more political level, there is the issue as to whether the media itself should actually regulate some of the messages it sends out given the power which role models can have on people’s lives. This has recently come to the fore in the debate about underweight models being used by modelling agencies, and whether role models actually change society's view as to what is normal or not and what effect this can have on the vulnerable. It's definately food for thought in this blog week I have dedicated to eating disorders.

A Mental health Icon

Kate Elizabeth Winslet (1975 – present)
She is a modern icon and a BAFTA-winning and multiple Oscar-nominated English actress. She is noted for playing a wide range of diverse characters over her career, but is probably best-known for her role in the highest-grossing film of all time, Titanic (1997).

The media, particularly in England, have enthusiastically documented her weight fluctuations over the years. Winslet has been unusually outspoken about her refusal to lose weight in order to conform to the Hollywood ideal. In February 2003, the British edition of GQ magazine published photographs of Winslet which had been digitally enhanced to make her look dramatically thinner than she really was; Winslet issued a statement saying that the alterations were made without her consent.

Kate Winslet considers images of "size zero" models and actresses "unbelievably disturbing." She is known to keep magazines with pictures of unhealthy body images out of her house, in case they are seen by her 6-year-old daughter, Mia.

Quotations from Kate Winslet:

"It's so disturbing, because young girls are impressionable from 11 up to 19 or 20, even. Women are very impressionable at those ages…They're trying to figure out who they are, and they want to be loved, and what I resent is that there is an image of perfection that is getting thinner and thinner, and it's truly upsetting to me."

"I hope that in some small way I'm able to say 'I'm a normal person, I'm doing all right, I've got a lovely husband and children and I didn't lose weight to find those things, and those things are what should be important."

Perhaps London Fashion Week could consider her as a role model.

Thought of the Week

After receiving an unprecedented large number e mails following concerns about eating disorders - ‘thought of the week’ is dedicated to the impending ‘London Fashion Week’ which starts on 11th February.

Eating disorders including anorexia nervosa, bulimia nervosa and binge-eating disorder, affect a staggering 12% of the UK population. The sad fact for anorexia nervosa sufferers is that as many as 20% may die as a result of their illness. This puts anorexia nervosa as one of leading causes of death amongst young girls.

In September 2006, Spain introduced rules banning models with a Body Mass Index (BMI) under 18, from appearing on the catwalk in Madrid. This followed growing concerns after the death of the model Luisel Ramos, who died of heart failure after eating nothing for days.

Unfortunately, this week London Fashion Week announced they would not be following the Spanish lead. Instead, under weight models will be allowed to appear on the catwalk. Susan Ringwood, chief executive of the Eating Disorders Association said "It's a mixed message [the public] get, when they are being told they are damaging their bodies and yet see other people being celebrated for it."

Oscar-nominated actress Kate Winslet has said she refuses to have any magazines in her house that show skinny celebrities because of the damaging effect it could have on her six-year-old daughter, Mia. She described the trend as "unbelievably disturbing". Perhaps we should all consider following Kate’s lead and avoid buying magazines during London fashion week which are celebrating underweight models, and use our consumer power to make a health statement.

News Flash - new book - Why Lawyers Should Surf

A new book entitled Why Lawyers Should Surf is now available to pre-order. It has been written by myself and Tim Kevan.

In an attempt to prempt the question "why lawyers?", the following offers insight as to why we chose the legal profession to write a book regarding work-life balance.

In an early 1990s a John Hopkins University study compared the rates of depression among 104 occupations and found that lawyers were 3.6 times above the average rate of depression. This then begs the question ‘why do lawyers have such a high level of depression’? There are several hypotheses for this, well beyond the explanation that law is a stressful and busy job.

Professor Martin Seligman argues that the key thing about lawyers is that they tend to have pessimistic personality types. When lawyers are asked the famous question: ‘Is the cup half empty or half full?’ most respond by saying half empty. This somewhat pessimistic response may be seen as an actual advantage in the legal profession, because seeing troubles as pervasive and continuing, is at the heart of being a prudent lawyer. The inherent and honed ‘scepticism skill’, enables the lawyer to see every conceivable snare and catastrophe that might occur in legal transactions. Therefore, the ability to anticipate any pending or possible snag or disaster gives a positive legal outcome, as the lawyer can then help clients defend against those negative eventualities. Hence, ‘pervasive pessimism’ and possibly ‘catastrophizing’ can be seen as powerful tools in law, helping to anticipate disaster, and encouraging lawyers to think the worst before it has happened. However, on the flip side of that same coin, is that if you take the same pessimistic mindset home with you from the office, it may form part of the answer as to why lawyers are more likely to suffer with low moods.

Another hypothesis is that lawyers tend to express ‘high-dominance’ as a key feature of their personality; again something which aids successful legal careers. Key features of a ‘high-dominance’ personality include people who: interrupt others, talk longer, take charge of conversations, decide when to change topic, state strong preferences and opinions, have an unyielding manner and tend to enjoy giving instructions and advice. ‘High dominance’ personalities also tend to believe in statements, such as, ‘winning is more important than playing the game’. This may be an integral part of being a successful lawyer who never looses a battle, however, when this mindset is extended outside the workplace it fits less well with life’s challenges. When things have not gone the way high dominance personalities have planned it can be a time when they struggle to manage.

The risk of the inherent pessimism in many lawyers means that they have to be particularly careful not to bring that perspective into every area of their lives. How circumstances are translated in any particular person can have enormous effects on the way they react and ultimately on the effect those circumstances have on their lives. This book will hopefully assist in finding a perspective where even the most difficult times can be seen in some sort of context which can also provide something useful, something to learn or grow from. As Shakespeare said, “There is nothing either good or bad, but thinking makes it so”.

The above photograph was taken by and is copyright of Dr Heidi Tempest.

More Inspiring Medical Stories

William Harvey (1578-1657) and the foundations of physiology.

Back in the seventeenth century science began to looked towards measurement rather than magic. William Harvey having studied at both Cambridge and Italian Universities, took a post in London full of new ideas. One example he gave was that veins contained a series of ‘little doors’ – valves, in fact, which only opened one way. He went onto to start his own department of anatomy and was importantly given the position of Lumleian Lecturer to the College of Physicians.

As part of his duties he was to give public lectures. It must have been a very strange scene on the day he first made public his discovery in a public lecture. On the table lay the corpse of a criminal who had been executed the day before. Harvey, a little dark man proceeded to say things which staggered his listeners claiming that veins carry blood to the heart. He declared; blood is returned by veins to the right side of the heart, is then flooded into the lungs, cleansed by the air in the lungs and passed over to the left side of the heart, and then pumped into the arteries and around the body again. The same blood over and over again. In just one half-hour, he pointed out heart physiology. However, the audience stirred restlessly as Harvey was overthrowing the knowledge that arteries contained pure spirit which had been held by all mankind for two thousand years!

Angry at his reception about his theories which he had worked on for 14 years, Harvey ran out of the theatre. Back in his own laboratory, he continued with his research and another thirteen years after that lecture room day, he published his book with a long Latin title – Exercitation Anatomica de Motu Cordis et Sanguinis in Animalibus. Its publication brought to a head the controversy between the old school of traditional thinkers and the new men of science. His book challenged the old ideas; as result William found his private practice dwindle as his patients shied away from his new talk about bodies.

There were things whispered against him, but despite this, he remained focused on his work. A few years after his death, men of science began to use a microscope and everything which Harvey had said was proved beyond all shadow of doubt.

“It were disgraceful, therefore, with this most spacious and admirable realm of nature before us, and where the reward ever exceeds the promise, did we take the reports of others on trust… Nature herself is to be addressed; the paths she shows us are to be boldly trodden; for thus and whilst we consult our proper senses shall we penetrate at length into the heart of her mystery.”
William Harvey

Obesity - Be SMART

Once again the daily newspapers are filled of stories about obesity, with MP's describing current policy as "confused" or "dithering".

Surrounding all this negative talk about obesity, there seems to be little printed about any constructive weight reduction advice.

This blog offers a helpful weight loss motivational acronym SMART:
S - specific
M - measurable
A - agreed
R - realistic
T – time bound

Using the framework ‘Be SMART to be kind’, offers helpful motivational tips for weight loss:
Specific.
When setting a goal, be as specific as possible, don’t be vague. If you want to loose weight you must consider the details of your weight loss programme.
Measurable.
To be motivated to loose weight you need to know how much you weigh now, how much weight you want to loose and over what time period. Only by collating this information will there be a quantifiable scale to measure. This will help understand how to adjust performance in order to attain the set targets. Interestingly, tracking is unpopular as a motivational strategy, because it often involves receiving unpleasant feedback about how badly you are doing. However, unless you track then you have no idea how you are progressing, meaning you can not modify your behaviour to become successful.
Agreed
It is helpful to have an agreed and structured weight loss programme. Agree it by telling everyone about your plan to loose weight, as this makes it much less likely you will back out and also gives others the chance to offer support and encouragement. Involve others in your routine, this may include going to weekly gym classes with your friend. Link up with others with similar aims of weight loss and all learn form each other.
Realistic
Any plan must consider resources necessary to attain the goals, this is often overlooked as an important part of the strategy. For loosing weight this may include a budget for buying scales, healthy food, trainers and tracksuits etc. Also be prepared, there will inevitably be setbacks during the weight loss programme, but the key is not to let failure put you off persisting. Learn from failure. See setbacks as a resource and a learning opportunity, a necessary part of any journey. Be aware of your own weaknesses, as if you are aware of them you can think of strategies to overcome them. So, if for example, you know you have a weakness for chocolate midnight feasts, then you may decide upon a strategy of not keeping any chocolate in the house
Time bound
Goals need to have fixed timetables and timescale for success, and include sub goals within your timetable. Timescales add pressure to help you continue with your vision. Tracking progress is an essential step in goal attainment but it’s vital that you can be flexible, as any completely rigid timetable is unlikely to work especially if goals are totally unrealistic. Plans may need to be revaluated, but don’t get put off, keep up with the programme.

Finally, be kind to yourself, give yourself a break. Always remember to congratulate yourself on each success, this should be done throughout the programme, with lavish praise each time your sub-goal target has been achieved. This will help you continue with your next target. After all if motivation is analogous to a seed; you need to provide the right conditions and environment for the seed to develop and grow into a flourishing plant. So, don’t forget to provide yourself with the correct environment by praising yourself so this can lead onto a breeding ground for successful sensible weight reduction results.

More of these helpful tips will be available in a book published later this year entitled 'Why Lawyers Should Surf'. (publishing details)

Medico-Legal Expert Witnesses – The Start of a Reform

The Chief Medical Officer (CMO, Sir Liam Donaldson pictured left) is proposing a radical overhaul of the current medico-legal expert system to improve the quality of the service and to ensure a sustainable supply of expert witnesses. The report Bearing Good Witness: Proposals for reforming the delivery of medical expert evidence in family law cases has been launched for a period of public consultation ending on 28th February 2007. The report was originally commissioned in response to some very high profile court cases. One such case, involved the memorable flawed statistical evidence given by Professor Sir Roy Meadow that initially helped convict Sally Clark of killing her two sons.

The CMO’s key proposal is that the NHS should establish teams of specialist doctors and other professionals within local NHS organisations. These teams would be offered mentoring, supervision, peer review and teaching of skills required for court appearances. Currently, the proposals are focused on developing the guidelines for the family courts, however, it is easy to see how these proposals could be rolled out as generic guidelines for all medico-legal expert witnesses.

These proposals come in the wake of legal wranglings as to the professional position of experts in legal proceedings. In 2005, a High Court ruling offered immunity to medico-legal experts from disciplinary proceedings for evidence given in court. However, this has recently been overturned in the Court of Appeal. This was welcomed by the General Medical Council whose Chief Executive Finlay Scott said that they did not believe in any immunity solution “that placed doctors and other professionals beyond the reach of their regulator.”

Overall, it seems that combining accountability with support for medico-legal experts is a welcome combination.

This article will be published in the Medico-Legal Brief Update newsletter. If anyone wishes to receive this free e-publication please sign up at: MedicoLegal Brief Update

Memetag - A blog game

Having been sent a memetag, the result is to step up to the challenge and list five things on this blog that others might not know about me. So here it goes (all in the name of the memetag game!):

1) I have previously worked for a recording studio.
2) I manage the drum section in the band Stained Glass Heroes.
3) Whilst a student I was presented with the dilemma between continuing with my medical studies, or becoming a BBC weather presenter… your screen is safer that way.
4) I used to work as a ‘housekeeper’ in an NHS hospital. The uniform was old fashioned back then, yet even today the uniform remains unchanged.
5) I have been employed as a security guard.

Now it's my turn to pass on the memetag.