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Is enthusiasm the opposite of depression… August 15, 2010

Posted by janehaynes in : Atomies of love, Becoming..., dogs, Holistic health, Thinking skywards, Uncategorised, Uncategorized , 2comments

I haven’t felt like sharing my thoughts or logging in for months, but today there is something I want to share.

I have been struggling, wading or fumbling into the pages of Love in the Western World by Denis de Rougement. His thoughts are dense and intense and it's easy to give up the effort to think these sentences through. But twice now he's thrilled me and most recently it was with his elucidation, via Plato, of the original meaning of the word, 'enthusiasm'. It seems that to be enthusiastic is to be possessed by the Gods, I love that thought and get it because at the same time it fires another unthought thought in my head, and my sensory memory confirms it. When I am enthused about something I'm inhabiting my environment, I'm being fed by the universe and the mortal world is enough. I sparkle and my enthusiasm might even be contagious. The other thought is that when one stops being enthusiastic, one is, if not sad, depressed and I have been trying to figure out for a long time what might be the opposite of depression, which I often elucidate to my clients as losing desire for the world, and that explains to me why enthusiasm is so irrepressible and when something is irrepressible, whether it's my dogs enthusiasm for her walk, or my irrational devotion to my dog's feelings, it means that repression is absent. And, repression, whether it is anger, or denial, or love, yes we so often repress our love in the fear that it will not be returned is a broad walk to depression.

My enthusiastic dog, Lucy the Viszla in Regents Park, 2009. Copyright John Haynes

Quote/Word of the week August 28, 2009

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QUOTE OF THE WEEK: The sorrow that hath no vent in tears makes other organs weep. Sir Henry Maudsley.

WORD OF THE WEEK: Qualia: (from Quale 1675: The qualities of a thing).

These are recognizable qualitative characters of the given, which may be repeated in different experiences, and are a category of universals. They are ineffable ; that is, they cannot be communicated, or apprehended by any other means than direct experience.

For example as in Proust's discussion of sensation in The Prisoner and The Fugitive:

'Sometimes I thought that the reason was that the things we feel in life are not experienced in the form of ideas, and so their translation into literature, an intellectual process, may give an account of them, explain them, analyze them, but cannot recreate them as music does, its sounds seeming to take on the inflections of our being, to reproduce that inner, extreme point of sensation which is the thing that causes us specific ecstasy we feel from time to time and which, when we say, 'What a beautiful day! What beautiful sunshine!', is not conveyed at all to our neighbour, in whom the sun and weather set off quite different vibrations.'

Quotes of the week August 20, 2009

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An excerpt from my doctor’s e-mail when I complained to him about the side effects of a medication:

‘Dear Jane,

A very famous American Professor of Pharmacology,  Prof. Oliver Wendel Holmes Sr. (1809-1894)  said over a hundred years ago:

“If all medications bar seven were thrown into the sea it would do much good to the human race and much harm to the fish".
 He was a clever man as he never mentioned which seven drugs were good for the human race! However my Professor of Pharmacology use to often ask us in our final examinations as to which seven drugs would we keep in our "doctors bag? This medicine is clearly not for you and we might even consider 'throwing' it into the Thames." 

When I expressed my appreciation it was followed up by another quotation by Mark Twain:

"Be careful of reading health books. You may die from a misprint."

The principles of uncertainty July 26, 2009

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My friend Christopher gave me a quirky book for my birthday called The Principles of Uncertainty by Maira Kalman, which I adore. It even makes me laugh out loud, which I often don’t do and sometimes I don’t even know whether to laugh or cry because it’s full of paradoxes and pains and pleasures. Her illustrations - which are sweet in the word’s refined meaning and their thoughts - are like a box of liquorices allsorts (that I happen to hate) in their elucidation of Kalman’s alchemy of erudition, wit, nostalgia and pathos. Maira Kalman is Jewish and so am I. In shorthand, I could say her book conjures the bitter-sweet herbs, (though they are mostly bitter) of the Passover table that I haven’t sat at for years: And they made their lives bitter with hard service, in mortar and bricks, and in all kinds of work in the field; in all their work they made them serve with rigour. (Exodus 1:14) Sad, to think that I value that quote because it’s work that makes my life bearable: work, family and one or two friends that I love. Oh, I forgot nature. Although, just now I’m in a state of emotional mourning because I’ve seriously fallen out with Dan, (the grandson I was having the Dionysian debate with; he’s so arrogant and I’m so hurt that I can’t see a solution, at least not yet. Of course he would see it the other way around.) Freud got an awful lot wrong, amongst one or two genius insights, except I suspect that most of those were cribbed from the Greek myths, Coleridge and Hazlitt, and the eighteenth century anthropologists, but I go along with him when he says the two most important things in man’s life are work and love. I loved Kalman’s outrage at Freud’s hypocrisy, (who - by the way - in his forties told his wife that they must live together celibately, because he needed to sublimate his libido in order to have more creative energy) but as Kalman reminds us, he was probably having a marriage-long affair with his sister in law Minna. Roll over Freud. Illustrated right next to Freud is her tragic-comic evocation of ‘Sexy Wittgenstein’ who lived around the same Viennese corner and contradicted Freud when he declaimed, ‘Whereof we cannot speak we shall remain silent.’ After all, it’s just as important to understand silence as talk. I adored the page with an illustration of a donut trailer, which condensed everything that I think about my loved ones: Sometimes when I imagine my own death I believe I will be reunited with my loved ones. All floating around in a fluffy sky. I get a delicious cozy feeling. But then i remember that even my loved ones are sometimes very irritating and even infuriating so what is that about? And what would we DO all day together? (Except, it doesn’t look nearly so much fun in this font.) What provoked me to write this blog, when I thought I would never, ever, have anything else to say, were the pages on the choreographer Pina Bausch, who is illustrated as a small child being lifted high in the air by her father.  Kalman asks, ‘If Pina was lifted up in the air as a child did she laugh? Or did is seem dangerous? Very dangerous?’ These questions link up with the reason why Christopher knew that the book was my cup of tea. Not only am I full of uncertainty, at least when I dare to stop thinking that I know everything, but I have also signed up to my own post graduate course in Negative Capability, also recommended to us by John Keats in another famous brotherly letter, to learn not to strive after certainty and to study how to endure uncertainty without becoming irritable. (I’m feeling very irritable today, as more than two months have passed now, not knowing if Dan and I will find a way of resolving our angst. He’s capable of producing an illustrated page as witty and off the wall as Kalman and my birthday was the perfect opportunity. I wish he would treat me like Proust treated his Grandmother whom he seems to have loved more equivocally than his impinging mother! Don't be deceived by all the talk about the famous maternal good night kiss.) It’s the illustration of Pina being lifted out of gravity and into a bird’s eye view that provokes memories and thoughts in me. The memory of taking our small daughter Tanya, Dan’s mother, to the South Bank and John lifting her up and securely dangling her over the Thames, and her excited terror. Terror too of fireworks; and more terror after I read her Peter Pan and she realized that some people could fly. It’s almost human nature to want to keep one’s children safe, to keep Lilith out of the nursery, to close the curtain on the night terrors. The story has been told, the curtains arranged, the door left ajar, as Nabokov describes in Speak, Memory, and the child feels as if  ‘Everything is as it should be nothing will ever change, nobody will ever die.’ That’s the biggest lie ever. I’ve noticed in my consulting room that some people never recover from it. In fact, how we approach the process of disillusion - and depending on how early we have to face it, or understand it - might become the crucial measure of our subsequent emotional health. When I think of the word proportionate I think of justice, Portia (also the name of our grand-daughter), the injustice of our balloting system, but more importantly it applies to emotional health, and the daily struggle to keep things in proportion. Kalman’s book helps me to do that. The Principles of Uncertainty: Maira Kalman, The Penguin Press, 2007.

Dan and me in France in happier times.

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Overdiagnosis July 11, 2009

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‘Researchers in Finland concluded in a paper just published on bmj.com that one in three breast cancers detected in a population with a public breast screening program is overdiagnosed. Some cancers are harmless and will not cause symptoms or death during a patient's lifetime. The cancer grows so slowly that the patient dies of other causes before it produces symptoms, or the cancer remains dormant or regresses. Overdiagnosis refers to the detection of those cancers. Since it is impossible to tell apart lethal from harmless cancers, all detected are treated. As a result, overdiagnosis and overtreatment are unavoidable. Karsten Jørgensen and Peter Gøtzsche at the Nordic Cochrane Centre analyzed breast cancer trends before and after the introduction of publicly organized screening programs, in order to calculate approximately the degree of overdiagnosis. They studied five countries: UK, Canada, Australia, Sweden and Norway. For the sake of objectivity, they looked at information from seven years before and after screening had been completely implemented in each country. They included both screened and non-screened age groups. Other factors that may have affected the results were assessed, such as changes in background levels of breast cancer and any compensatory drop in rates of breast cancer among older, previously screened women. The study showed a rise in occurrence of breast cancer that was directly associated to the introduction of screening. A small proportion of this increase was compensated for by a decrease in incidence of breast cancer in previously screened women. Subsequently, they evaluated each country and the estimated level of over diagnosis: the figure  in the UK is 57 percent.'

This has been my own intuitive and lay opinion for years. I have watched friends and acquaintances being diagnosed with breast cancers almost as if they had contracted flu. It has felt more and more like an epidemic for which all sorts of phenomena have been blamed, and if anything caused more and more women to have annual breast screening.  I sometimes hear women  referring to passing their annual mammography as if it was an A level. I have also met women who have had a clear mammogram one week and then produced a lump the following one.

I have watched some of them going through the agonies of recall, and waiting for more test results and critical examinations with surgeons and discussions with oncologists. I have visited them in hospital.  Thankfully, I have also seen the majority of them recover and continue with their lives, and sometimes eventually forget their ordeal and find the confidence to believe they are well rather than in remission.

 I must emphasize that I have also witnessed mothers and daughters being diagnosed - sometimes simultaneously - with a genetic variety of breast cancer in which they have been well advised to have a double mastectomy. I have also seen other women, often tragically young, diagnosed with invasive and galloping forms of hormonal cancers which have required every treatment in the book to try and reverse their obduracy.

I have sadly known some women die from breast cancer, including one as young as my next door neighbour. Read about others, like Linda McCartney, Dina Rabinovitch, and Farrah Fawcett who video recorded her two year battle with anal cancer.

The people that I have seen die from  cancers are often the same people that I have seen receive the most advanced treatments available in the world which have tragically failed to make any difference to the fatal outcome. In other cases medical science has triumphed but I'm not convinced that anybody knows why. I can't help wondering whether for women diagnosed  as a result of screening rather than through the presence of symptoms  there is yet enough justification for invasive treatments. (Unless there is a genetic history to be considered.) At least not immediately. There is also the problem that once one manufactures a cancer diagnosis the anxiety and stress produced is also destructive. More and more, good treatment is equated with speed rather than any measured and expert period of observation. 

Like Germaine Greer, who has also written diatribes against the ever increasing screening processes that women are submitted to, I feel that we have mistakenly  elevated early diagnosis procedurals over my favoured  'watch and wait' process. Of course somebody very experienced needs to be doing the watching. Advanced screening techniques make it dead easy to record a tumour here or there, but  they are less schooled in recording how long the tumour may have been in situ. What scanners cannot do is provide the doctor with the critical information of what the tumour has, or is likely soon to be doing systemically. 

Not that long ago,  an elderly doctor friend of mine was invited by the Wellington Hospital to try out their latest scans to diagnose  the presence or absence of arterial plaque. At the end of the screening he was told that his arteries were lined with plaque and that he must hie himself to the Cromwell Chest Hospital for further urgent surgical interventions. Wise old owl that he is, he replied, 'You may be able to tell me that my arteries are plaqued, but what you cannot tell me is whether it is benign plaque that stays in situ, or killer plaque that  falls off.' He decided to wait and find out; now in his eighties he's still doing fine.

It's a different situation again when an undiagnosed breast cancer turns out to be due to secondaries, but by then it's sadly too late to do much at all, except palliatively.

My own experience of abdominal illness and surgery has convinced me of the importance of learning to stay in touch with my body, know it's general feel, so that should any new symptoms, or lumps or bumps, knock at my door I recognise their intrusion and know it's time to do something. Fast. On the occasion when I did require abdominal surgery several years ago, retrospectively I realised that I had been aware of the symptoms for months before they were diagnosed by scanning, but that I had buried my head in the sand. I didn't take the subtle messages from my body seriously.  I don't go in for mammography, not since my first appointment ten years ago, when I was called back for further investigations which turned out to be a false positive. As far as I know it's not in the family, which would make me think differently.

Recently, I heard a doctor colleague ask another, 'When a patient arrives with what you suspect to be early symptoms of a degenerating disease do you immediately want to impose diagnostic tests and spell out the bad news, or is it better to let the illness - at least begin with -  take its course, which might with any luck be one of several years, before zooming in with a frightening and irreversible diagnosis?' In this case they were referring to incurable and  terrifying diseases of the central nervous system.

I  fear that we have lost  faith in our bodies letting us know when something is wrong and we need to learn to prick up our ears. In the same way that so many doctors have stopped using their hands, eyes and ears, even their noses, in forming their diagnoses. I fear that too many people are losing touch, or forgetting regularly to dialogue with their  bodies. Doctors are always reminding us that ever more and more complex and expensive analyses of our blood are now the eyes of  our bodies. The doctors often omit to tell us that the credibility of many labs is contentious. Anyway, blood is another trickster and what looks like bad news one week might measure as normal three weeks later. At least it keeps the labs busy.

Flu The Trickster July 5, 2009

Posted by janehaynes in : Holistic health, Uncategorized , 1 comment so far

I cannot continue with my Dionysius debate until Dan’s with me and he's coming to London later today to go see Jude Law as Hamlet with his sister Portia. I got the tickets because Portia adores Jude and I thought that it might be the only way she would ever agree to see Hamlet. Her mother still hasn't forgiven me for taking her to see Jonathan Miller's Hamlet  (and I cannot remember who played Hamlet but it certainly wasn't Jonathan Price's, which is still limned inside of me) at the Warehouse when the temperature soared to over 40C. She only remembers that everybody wore grey and it put her off Shakespeare for life. I hope the Wyndhams Theatre has air conditioning because it's already very hot this AM. We have tickets for row B of the stalls and I'm hoping that being that close to Jude will console Portia for so many words, words, words.

This flu thing makes me laugh: the government wanted us to believe they had it under control, a Confine and Contain policy,  and  that the flu line was set up and ready to go when it was and probably still is in an  uneducated digital shambles. If the highly pathogenic avian influenza virus HPAI ever takes off we will anyhow get  mortally caught in our own man-made lines. (However what does not seem to be publicly discussed is that the Spanish flu of  1918 was also, like swine flu , an H1N1 virus which started mild enough but in its second coming it killed - at the most modest estimate - 40 million people.)

The people, if not the viruses, the government bullied into their control were the GP's who - for possibly the first time ever - were to begin with forbidden to write a prescription at their own discretion, in this instance for Tamiflu.  If the doctors had bothered to read the bullyings of changing instructions in the daily communications from the Department of Health they would not have had any time to see a patient.  The idea that flu can be contained is ridiculous, it has the unknown potential for a more devastating killer energy than any terroristic attack and those who are really in control of our health and safety in this country have known this for a long time. Not to begin to speak about the pharmaceutical companies.

Flu flirts.  Flu looks like one thing and then becomes another. Most people say they have flu when they have a feverish cold but anybody who's had a proper dose of any seasonal flu will remember that it's probably the viral illness that has made them feel closest to death. I can recall a description in one of Jane Smiley's books where the mother might as well have been dead for three weeks. Most of us only experience the real thing once, rarely twice in our lives,  but I remember when I got it in the last epidemic: I lay in bed for a week without eating or moving and if anybody had told me the house was on fire I wouldn't have had the strength to move. That was in 1989 when flu was responsible for 23,046 deaths in the UK.

It's intriguing to see how differently people's  defenses operate under threat and how most of us split into two camps: those who believe that they are invincible and have faith in the government and the medical profession to take care of us, and those of us who don't think but know that if the benign swine was to mutate into its avian cousin some of us, if not too many of us, would be done for by Mother Nature's fickle hour. A flu pandemic won't and can't be contained, and it's not interested in rank or riches, although age does seem to be a consideration, and when it strikes it can only be endured.

None of the doctors I knew were worried this time around, even though I was to begin with. One of my doctor friends, who is one of the most devoted GP's that I know, spent one  day early in May, when the Mexico stuff was still baffling, besieged by female patients in premature and hysterical terror about their families.  By the end of a day when yet another  patient had appealed for reassurance that he would take good care of her if the worst was to happen,  he heard himself, and not without some degree of shame, shouting 'For heaven's sake don't you realize that if the worst does happen I shall probably be dead  long before you.'

Flu  can be a trickster and a tease but when push comes to shove it is indifferent to life  If that pathogenic virus HPAI decides to get going across Asia over the summer it wont make much difference which camp we fall into. I think the culture out of which we decide whether to adopt a naive optimism, or negative pessimism, depends on whether on not we have suffered premature bereavement in life. For those of us who have loved and lost in a too untimely way, we already know that those bolts from the blue, or Fate, or God's unconscious, are more powerful than Life.  All we can do is to watch and wait. Or pretend that everything will always end up being OK. I've just remembered how - many years ago - Milan Kundera attacked humanity for its inhumanity to other animals, was it in The Unbearable Lightness of Being, and now it seems an irony that these viruses incubate a revenge in the dark heart of animal abuse.

WATCH AND WAIT July 1, 2009

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Sometimes, when you are forced into the dentist’s chair – with a heightened dread because you either fear another root canal filling, or even worse that an expensively maintained canal is in more trouble – if you are lucky the dentist, well mine does, will use the term ‘Watch and wait.'This is because roots canals have a life and mystery all of their own, which requires a financial budget to match them. I have become fond of this term, and leave the dentist in a mild state of elation that no immediate intervention is called for, although watching and waiting is not a state  of being, which I easily apply to other areas of my life.

This morning I was up at about 5.30 to do my yoga, I haven't been regular for the last few weeks since I fell into the soap sud bucket in France when I was giving the floor tiles a farewell clean. I was lucky because I fell forwards and not backwards, else I might still be supine in the local Bagnols hospital. But, then yesterday a friend wrote and told me, not quite a boast, that he had managed to get his head onto his knees that morning and that whilst doing so he had the thought that I was probably doing it every morning. That provoked me to restart my morning ritual and despite a sore knee  I managed some yoga, which was good but when I saw how far away my head was from my knees, (I haven't tried that one for months to be honest, I broke out into mild panic and started to breathe out a long 'Aum'.)

At that point I looked out of the window and saw that a large car had imposed its body across our drive way and blocked us in and all my territorial adrenalin started to rise. How would we manage an early morning walk with the dogs before the heat became impossible again. I wanted to rush upstairs, to write an aggravated note and leave it across their windscreen. What a confounded  'Cheek'.

Instead, I decided not to react but to watch and wait. Recently I have been reading books on the neuroplasticity of the brain, in preparation for my own book. Catching up on ideas that our brains are not, as previously pronounced across generations hardwired, but even as adults open to negotiations with our minds. And, that learning how to extend our senses towards mindful attention can change the neuron activities  in our brains. Of course there are other ways of being mindful without resorting to meditation or a combination of Buddhism and the science of neuroplasticity, which is the direction that I am currently considering finding out more about. As a psychodynamic therapist it is only too easy to shut oneself up in a temenos, and I use that word with some deliberate criticism for its sense of elevated privilege, and not check out even the streams of knowledge that flow so close to your own. In this particular case it would mean giving more significant thought to whether or not cognitive behaviour therapy does have an important contribution, and perhaps more essential, a different contribution to make to the treatment of depression and anxiety.

The poet John Keats had his own technique which he called 'Negative Capability', by which I think he meant us to understand that the world is by nature uncertain and that when you are in the midst of one of its heaves you need to try work towards finding more acceptance and stay with whatever doubt or absence of comfort or whirlwind you  find yourself in without irritably reaching after certainty and fact. The terrors of many things - which include depression and anxiety - are not knowing when they will pass. If one was to receive a letter saying you are now entering into one of the depressive phases of your life and it will be over six months from hence, it would be much easier to endure. Likewise many women would be able to tolerate 'hot flushes' without resorting to filling their bodies with dangerous chemicals with unknown side effects. Perhaps, even contributing to the current epidemic proportions we now have with women with breast cancers.

But, we never do know and our worst fear is that it will just go on and on forever.

For the time being I am putting myself  on a watch and wait curve and trying to curb some - but not all - of  my characteristic impulses of spontaneity and action with patience; and an energy focus on accepting whatever passes into my path. At least until the end of the week.

Oh, yes by the time I had finished my yoga the car drove off; I saw it was loaded up with suitcases and allowed myself to enjoy the thoughts of strangers departing for an unknown holiday destination with all the excitement of a 6 AM departure.