World Mental Illness Day

This week is World Mental Illness Day or Mental Health Day or some such (I think it varies from place to place, like the various state Cancer Foundations, locked in deadly struggle with their mortal enemies, the various state Anti-Cancer Foundations).

Anyway, I have given this World Mental Illness Day thing some thought and I have decided what I want. I am aware that it is not customary to receive gifts on World Mental Illness Day, but I am more than willing to swap this for Christmas. And if we did have gift-giving and parties and so on on these kind of days, it would do a hell of a lot more to increase awareness than many other measures.

Anyhow - my wants. And the following is focussed on BPAD, not only for the obvious reason, but because a lot of the patients I have seen, and a number of those I have lost, have had BPAD.

So.

I want a cure.

And I know there isn't "a" cure because it isn't "a" disease, because everyone's bipolar is different, but even so:

I want a cure.

I want it gone, like smallpox is gone, like the vapours and frigidity and green-sickness is gone.

I want bipolar dead.

What I want is to open the obituary pages and read "today, bipolar affective disorder lost its long battle with so-and-so", or "After a long and debilitating stuggle, bipolar disorder slipped peacefully away." Or violently away, I don't care, I'd settle for a car crash on a rainy night, a fall in the bath, a glassing outside a pub, police being called to a boarded up house.

Hell, I'd even settle for a combination of auto-eroticism and silly string. I am not fussy.

But I want it dead. It kills people, and it wounds those it doesn't kill, and it inconveniences a hell of a lot more, and if it's BPAD or us, - and for too many people I know, it has been - if it's it or us, I'm going with us.

Freedom

Hail,
First off, have a look at this:

http://www.huffingtonpost.com/jd-samson/i-love-my-job-but-it-made_b_987680.html

It's an interesting article, and the comments are fairly vigorously written as well. Now, the situation in which JD Samson finds herself is not the same as the one in which I, and the majority of my readers find themselves. She is, and I am not, a tattooed lesbian punk musician living in New York.

But the reason you should read this is because the question she raises is important, and it is the question every single writer faces, and how you answer this question, and how you come to terms with your decision, may screw with your head for the rest of your life, if you do it wrong.

The question, depending on who you ask is "Do I dare to live my dream?", or alternatively, "Who's paying for this shit?".

This is a complicated issue, and I know that I am not the most objective about it. I have taken one path, and many people whom I greatly admire have taken another, and I am not foolish enough to think that I never regret choosing the low-risk, low-return strategy of part time writing. There are works within me that will never see the light of day because I am spending hours writing when I could be spending days.

Then again, I suspect many full time writers, if they are ever faced with the inability to buy something or do something expensive - and more acutely if it's for someone who depends upon them than if it's for themselves, some child or spouse or parent - sometimes wonder if they should have taken the day job.

There is no simple, one-size-fits-all answer to this. I know there are always roads not taken. And work is art and art is work, there is drudgery for pay in your art and there is creative expression and wonder in your work, and it all changes from day to day.

My intial response to reading about the whole issue is "you do your homework and you make your choices." I chose one option, to work full time and write part time. That means I don't get to whine about not having time for writing because no-one put a gun to my head and said "work full time or I shoot the kitten". I chose this option. Parallel-universe-full-time-writer-Brendan doesn't get to whine about not having financial security, because he chose the other option.

The thing is, I don't know that that entirely holds. Like the author says, the women's dollar is less than the man's dollar, the gay is less than the straight, and as a straight male Anglophone writer, it is likely that my rewards for choosing work (and quite probably choosing art) are a lot more than hers would have been.

And the whole issue of choice in a lot of this is something with which I feel some disquiet anyway. There are societal, and intrafamiliar, and economic issues. I wonder if "I" could have really chosen differently if I wanted to. Doctors have needs - sometimes the need to be important, often the need to be needed, always the need for coffee - and I wonder if writing would have satisfied all of them. Additionally, there are people for whom the full time work option is just not possible - a number of people with full time mental or physical illnesses, for example.

Lastly, all of this is predicated upon all of us having the unimpeded moral right to make all of our own choices - and I don't know about that. If I am the mother of twin toddlers, and the muse seizes me by the arm as I am standing beside the road with my kids, she can piss off. If people depend on you, you don't have that freedom. And if you choose not to have people depend on you, well, firstly, good luck with that, and second, if you choose to do that but depend on other people, well, I hope that that works out for you.

Anyway. Complicated topic. If anyone has any insights, do tell.

BDC

Thirteen. Fourteen. Fifteen.

This post has been deleted.

Maybe you should hire the arsehole

Hail,

The post that started this line of thought is here. It's Giles Coren, English humourist, restaurant critic and author, responding to a sub-editor editing some of his stuff. One word of his stuff, actually. It's from a few years back, but it's still worth a read.

I read this, and I sent this to a few friends, and hijinx ensued. Well, not so much hijinx as a moderate and reasoned exchange of views, but a signficantly larger proportion of people will read on if promised hijinx than if promised reason.

So - writer writes article, editor edits, writer expresses his displeasure, the email goes viral (or "virile", as I saw in another context), and among other things, my writery friends and I talk about whether or not this behaviour is what you would expect from a professional. Would you, if you were an editor of the Times, hire someone like that?

Well, I'm not, but heck yeah, as Coren did not say. I dashed-well would.

Why?

First off - it's an articulate letter. The structure of it, the rising cadence, the surgical scorn, even the way he ends it in such a way that it cannot be taken too seriously - he writes well. He's the guy on Supersizers, by the way.

Second, it was a private email. I don't know the relationship between the correspondents - obviously they are on first name terms, and have known each other for years, but aside from that I don't know - but this is not just the factory floor worker vs supervisor relationship, and it was not intended for publication, and the standards that would apply to him addressing his boss in public do not apply here.

Third, he's right. Scansion is important. Jokes like the ones he was making can be important. Structure and rhythm and content matter.

But most importantly of all, I think the things that make him a good writer and probably a very good employee are evident in this letter because they are the things that made him write this letter. The understanding of his language. The ability to express himself well. The "less vigorous than the rest of us" self-censorship. The need to be noticed more than the fear of causing offence. The care, the passion, the dedication with which he approaches what he does.

He's still quite employed, from what I can see.

Pretty close to all attempting writers like me have read about writing, and if they are able as well as willing, they have gone to seminars or write camps or something like that. They learn vital, crucial, fundamental things. One of the things they learn - if the tutors are any good, and the ones I have had have been very very good - is about the less intoxicating parts of writing. This is not a traditional area of strength for "arty types", the whole obeying instructions and keeping to deadlines and so on, and if you learn one thing from a more successful writer than yourself, learn professionalism.

We were taught it. I remember emerging from Clarion South with an idea that there were sortof three pillars to writing, like three legs to a stool. I am big on acronyms, so I came up with Words (you have to love them), Work (you have to do it) and Why Yes, I'd love to reply to this email/talk to your group/do something for someone beside myself. You have to be a professional, and you have to build connections with others.

(and no, there is no "have to". You can be an indolent prick who rises at eleven and stabs at passers by with a dinner fork. But you will be obscure, and what you say will be forgotten).

And the stuff about professionalism and decency is true, and it's what people need to hear.

But there is something else that is also true. For those of us almost pathologically unwilling to offend, for those for whom timidity is the dominant humour in our body, for those who want everybody to be right, there is something else. I don't know if it's part of each of the three legs, or if it's a hitherto unsuspected fourth leg of the stool, or if there's any way I can get rid of the whole stupid furniture analogy and pretend it never happened.

But both in the art and the profession, there has to be more. In the art there has to be some kick, some light, something you can't put words to. Something that moves you must, at some level, disturb you, and disturb others. You have to push.

And in the profession, sometimes you cannot just acquiesce. Sometimes you have to back yourself. Sometimes the love and the work and the getting on with people means there has to be a "Here I stand" moment.

Anyhow. These are my thoughts. I have published less than other people. I could be wrong. But I could also be wrong about saying I'm wrong about this, so I'll leave it at that.

BDC

PS: There is a (deliberately written for public consumption) letter of reply here.

BDC

Fat.

Hail,

I am close to being fat. The guidelines vary, but if you look at BMI - calculate your own here, what is wrong with it at the end of the entry - I am just under obese. An obese man my height would weigh 90kg, and a few days ago I stepped on my scales for the ever-popular first weighing of spring*, and I am 88 kilos.

88.1, to be precise, but who's counting?

Almost everyone.

Now, as I explain later, a blunt BMI is not ideal, it does not take into account differences in race and muscle mass and so on, but twenty years ago I weighed seventy five kilos, and I wasn't twenty kilos less muscly or South-East Asian. I was thirteen kilos less fat.

Why has this happened and what do I do?

First off - the why. The two fundamental truths - and they are truths - is that weight is controlled by diet and exercise. Like many fundamentalist ideas, they don't do that well under even the most cursory analysis and reflection - in 1991 I ate appalling amounts of food.

I have vivid memories of my girlfriend's family driving by (her father was the Methodist minister, her mother the school music teacher) half an hour after I had left their house for Sunday lunch, and seeing me with my head inside a chicken. I had been overcome with starvation after their substantial three course meal, and had bought a four dollar roast chicken from Coles, and by the time they drove past I had almost eaten it all, and was trying to force my face into the ribcage to get to the last of the giblets.

And I regularly ate entire party sized pizzas for myself, and I cooked by boiling up three packets of those two minute noodles for lunch and coating them with cream cheese. And -

I don't think I can go on. But the truth is, and it is a truth to which almost everyone can attest, if diet and exercise was the secret to weight loss, how do you explain teenagers?

Well, for a start, there is more to it that that. There are a lot of other factors, some more intuitively obvious than others, that underlie the enfattening of an entire generation over a quarter of the world.

Air conditioning - if it's really hot, you eat less, if it's freezing, you have to burn more calories. If it's neither, maybe you get us.

Psychotropic drugs. God alone knows what proportion of the population is on these. They are life-saving and life-changing for a great many people - although it is interesting to look at, say, suicide rates in the US over the last fifty odd years and see the huge difference these medications have not made. Obviously, there is so much more to this topic that discussion could fill several internets. But if you're on antidepressants, or antipsychotics, or mood stabilisers, they may be making you fat.

Don't look so smug if you're using non-condomoid contraception, either.

Disruption of circadian rhythms. Again, if you're reading this, and the sun is down, you're not helping. Stress causes release of cortisol. Cortisol causes you to eat more, eat worse, and stack on the fat around the abdominal area (all of which is a really good idea if it's the Bronze Age, and you're stressed because you have to trek across the snow or something - it's less of a good idea now). One of the unrecognised causes of what I think of as sub-clinical stress is disruption of circadian rhythms. Shift work, for example makes you fat (as well as very definitely giving you cancer). Sleeping less quite possibly does the same.

And there are other non "diet and exercise" causes, but I am trying to keep to a time limit. Diet and exercise and medications and shift work and increasing maternal age and lots of stuff cause weight gain.

What to do?

Most of the research on weight loss is on diet and exercise, so I can briefly scroll through that. Diet and exercise work when we do them. Exercise alone maybe works, maybe doesn't, diet alone does work, diet and exercise work better than either alone.

There are caveats. The reason exercise alone does not work (although it provides very considerable health benefits, and it is a lot better to be a fit fat person than a skinny unfit one) - is that if you exercise more and get hungrier and eat more you may well weigh the same, or maybe even more. It's good and it's good for you and it's a damn fine thing of itself, but if your sole aim for exercise is to lose weight, and you don't control your diet, you may well fail. High intensity interval training appears to be the best, but basically, more and harder exercise works better - conditions apply.

Dieting works, when we do it. There do seem to be some tricks that make it easier - protein makes most people "fuller" than carbohydrates, it is very hard to get fat on non-starch vegetables, soups and spices and (for some people) dairy seems to play a role - but in the end, diet control is the single most powerful and safe intervention for weight loss we have. The health benefits from a good diet are startling.

And now the bit I actually started writing this for. There was an article in the latest Journal of the American Dietetics Association about why we are fat. It is called "Time to abandon the notion of personal choice in dietary counselling for obesity?" and it brings a lot of the stuff that underpins addiction medicine, that we have been using for years, into obesity studies. It's a big idea paper.

Basically, what the paper argues, and what I have been saying for years, is that the idea of individual free will in this kind of stuff is not that useful. My own opinion is that the idea of free will is neither sustainable or useful in a lot of areas, but that's my opinion, not theirs. The idea of diet and exercise as being just about free will does not explain, for example, why we, presumably no less determined than our forefathers, weigh so freaking much more.

Perhaps - and I am trying to keep an eye on the word count here - there is more going on here. Perhaps there are issues like what could be called the obesogenic environment. Perhaps there is a complex interplay between increased availability of sweet, starchy food, and chronic circadian stress, and individual variation in things like inhibitory control, reward discounting and so on.

Perhaps just saying eat less and do more is not enough. Perhaps rather than saying eat less, exercise more - and as I said, those two things are essential - we should talk about what was going on when those approaches worked for us, and what was going on when they didn't.

Maybe we should talk about our food (and our ergonomic) environment.

Maybe we should talk about modifying the causes of circadian stress.

Maybe we should talk about medication, and reward.

Maybe we should talk about fun. One of the more startling things I read recently about health was a woman (fit, strong, athletic) saying she believed in giving her body what it wanted. The obvious response is "my body wants to lie in bed and drink chocolate and eat croissants", but your body also wants to be strong and attractive and fit, so there is a truth in that.

Maybe - and everyone is different - we should talk about things that aren't about will-power and just doing it and being good, because that whole approach has had a hundred year trial run over a quarter of the globe and has utterly, utterly failed. Sooner or later, we have to drive the stake through that ghastly, depressing, futile cycle of motivation and enthusiasm and frantic inner pep talks, followed a few days or weeks or months later by failure and guilt and self-loathing. And then saying fuck it, chuck on some pasta, because it's quick, and after the day you've had you deserve it, and tomorrow you start your diet, or alternatively, deciding to love your fat, as if love was something you decide.

Anyhow. Complicated topic. If anyone is interested in this, I will be posting links and maybe references and trying (amateurishly) to answer questions.

Thanks for listening,

BDC

* This is almost the only seasonal rite we have left. Our ancestors leapt over fires of thorns, or chased cheeses down English hillsides, we stand, naked, on small squares of steel and shriek in the early morning.

BMI is height in cm squared divided by your weight in kilos. It's used as a measure of fatliness. BMI of 25 to 30 is meant to be overweight, BMI of 30 or over is meant to be obese and so on. There are different cut-offs for South East Asians and older people and bodybuilders and so on, and it doesn't predict who will die when (overweight people live as long as normal weight people, while underweight and obese ones die early). It's not the best measure of fatness, but there isn't "a" best measure, and the big thing the BMI has going for it is ease-of-use.

ASR

Hail,

I am on Facebook, but... it's complicated. I try to keep FB fairly entertaining, fairly upbeat, fairly interesting. I don't want FB people to log on and have to be confronted by post after post of my pointless whining about my problems.

I'll save all that for here.

Now, for those who don't know, my wife, Katy, had surgery in 2008. She is young, and beautiful, and the light of my life, but like a maiden in a Greek myth, or a woodsman's daughter in a fairy tale, she is so perfect that she arouses the envy of the gods, and to punish her for the good things she has been struck with a Very Bad Thing.

The Very Bad Thing in this case is a combination of a weird-arse immune disease (Common Variable Immune Deficiency, present in about one in two hundred thousand people, as opposed to the Freakishly Rare Immune Deficiency, which is so rare we're still waiting for someone to come up with it), and "an arthritis". When you cobble together the five in a million immune disorder with the fact that there are over two hundred and seventy causes of arthritis (including one you can catch from drinking infected walrus milk - always check the use-by dates), you can understand that things are on occasion difficult for her.

Now, there is a lot here I am unwilling to say, and there is a lot more that it would be unwise to say, so all I will say for this next bit is in 2008 Katy had both hips surgically replaced, using a new, impressive sounding artificial hip things called the ASR hip resurfacing system, and it went less well than she had hoped, and in August 2010 the company recalled the product world-wide, because it seems not to be quite as good as they perhaps originally hoped, and in a few months she goes under the knife again for re-replacement.

These two are actually bigger operations than the first two, and the first two, believe me, were monstrous. They knock you out and cut through your hip to the bone, and dislocate your hips so they can saw the ball part of the ball and socket off one bone, and chisel or whatever the socket out of the other. Then they replace it with metal, and sew you back together, and you're cured.

That is not why I am writing this. I am writing to draw people's attention to the recent article in the British Medical Journal about the whole issue. The BMJ is one of the Big Four Medical Journals (similar to, but different from, the Big Four Outlaw Motorcycle Gangs, or the Big Four species responsible for most of the snakebite deaths in India). The BMJ article is available free online, but for those less inclined to read the entire ghastly story, I have listed some highlights below.

1. The ASR joint replacement is a disaster. It "fails" - either fractures, or comes loose in its cup, or wears out, or causes such pain and disability that it has to be replaced - a lot, lot faster than it was meant to. It was meant to last thirty years. One in twenty don't last two years, one in seven don't last five, it may be one in three don't last six. This is vastly more than the devices they were meant to replace.

2. The ASR joint replacement wasn't really tested much at all. New medications and devices have to go through an incredibly long and involved process to get onto the market - stage I to III trials take close on ten years, and involve thousands of people and millions of dollars. Modifications of existing drugs or devices don't go through that, they get fast-tracked. The good part of this is you, the patient, get access to new, improved medications and devices. The bad part is stuff like this.

DePuy (I'm not sure how to pronounce that, if it's De-POY to rhyme with "Shady Marketing PLOY", or Du-PWEE, as in "Unnecessary surgeRY", or even DuPIE, as in "Some of the people who have the repeat surgery will DIE". Someone help me out here...)

3. DePuy seem to have marketed this in a way that would make drug barons in Columbia look askance. They seem to have paid off some surgeons - bribes in Greece, Poland and Romania, kickbacks in Iraq under the UN Oil for Food programme. They appear to have offered to pay people to do nothing, rather than investigate this. There are suggestions that they tried to blamed failure and complication rates on bad surgery, that they produced faked photographs that they used in their advertising campaigns, and that when doctors and patients in one area expressed concerns that the implants were actually poisoning them, that DePuy representatives blamed this on illicit ships covertly dumping heavy metals in the river.

4.... actually, I reckon I'll stop there. Have a look. It's a bloody depressing read. As I said, there is a lot more that I could say, but there are lawyers involved, and I don't understand the inner workings of the law, and so I am going to keep quiet. It is all very complicated.

Repeat surgery is soon. More news as it comes to hand.

Thanks for listening,

BDC

*49% actually, which is very very nearly one in two, but let's not be pessimistic here.

Infidelity

Hail,

Having been on twenty-four hour call, and gone to a glorious book launch, and seen my patient in hospital, and written all afternoon on ears (upon the subject of ears, that is, not the organs themselves), I am now able to get on with the serious part of the week - writing.

One of my characters is a man who is being unfaithful.

This is a difficult topic to write about. There is an idea - I don't know about "laws", these things are more of what you call "guidelines" than actual "rules" - about writing. One of them (that someone made up) was that if something doesn't make the reader or the writer uncomfortable, it shouldn't be written (and maybe shouldn't be read). I don't know about that, but I do know that you do need a certain courage to write. You need to care, either love or hate or fear, and that caring is at least as important as knowing. You need a certain emotional risk, you do need to look at things that affect you in some disturbing way, and without that effect, without that risk... well, maybe your superlative craftmanship and unerring sense of what matters will get you through, but maybe what doesn't move you won't move your reader, and maybe you'll be boring as batshit.

Anyway - infidelity. If you've ever done it, or it's ever been done to you...

One of my male characters is being unfaithful. I don't know that he's a bad person - I don't think the others around him think of him as particularly bad. He is liked and loved and respected. The way I see things, how someone is seen says less about what that someone is like than about the effect that someone has on others. My suspicion is that people who are well-thought of are at least as likely to be charismatic, or attractive, or articulate, as they are to be moral paragons.

There is a reason why baddies look different to good guys in movies. We are wired to think that evil is as evil looks, and to trust and welcome and follow the gorgeous. That is why being hot is one of the only true superpowers, why it is more important to be beautiful than to be smart or strong, why it is the chic, in the final analysis, who will inherit the earth.

But my character is being unfaithful. He has no real "reason" - his partner is smart, and beautiful, and (what is often as important) she needs him. She has what modern doctors would call multiple health issues. While this all goes on, she is sick.

And yet he does what he does. The secret meetings, the hidden communication. If this was now, it'd be pseudonymous email accounts and having to stay back after work.

She suspects. She knows what he is like. In some ways she does not blame him.

He, if questioned, would blame him. He is a man with a violent past - even for a Viking - and he is generally regarded as a very ethical man. He does not tolerate deceit in others. He would agree that a man is responsible for what he does. He would agree that a man should not betray his partner, and that a man who would do this when his partner is sick is not the kind of man he would like to be. If he saw himself doing this, seeing himself from the outside, he'd stop himself.

But he does not. His friends are wondering whether to speak to him, but none of them have yet. Partly because they are not without vices, and partly because they know absolutely nothing they say will make any difference whatsoever - stones fall to earth, the earth falls around the sun, the unfaithful man is in the grip of forces as strong and singleminded. Love, or inloveness, or lust, or whateverthefuckyouwantocallit, is madness, and it's not the benign, "singing about little goblins" or "dressing as a teapot" kind of fictional madness. It's the psychotic, manic, obsessive-compulsive breed of madness, every few seconds you think of her, can't get her out of your head madness. It is the fixed belief, neurochemically (or humorally, in my character's case) printed on your brain. For the lover/luster/whatever, nothing else exists.

Also, his friends haven't said anything because it's none of their business, and also because he's scary.

My understanding is the transgressor (as opposed to the one transgressed against, or the one transgressed with), like the rest of us, can hold two or more diametrically opposed thoughts in his head at once. Most smokers believe smoking kills people, most smokers believe it won't kill them - that kind of thing. He has what we would call "unmet needs" - although the term "needs" assumes a great deal.

I read, to change the subject slightly, superhero comics. In one such comic, someone had tracked down the Hulk (you know - big, green, not a tree). The Hulk and his alter ego Bruce Banner form what in the old days we would have called a split personality. In the old days it was smart, puny Banner and stupid, strong Hulk. In the more successful modern writings, the split is between the Superego (the skinny, rational, moral Bruce Banner) and the Id (the bestial, arational-if-that's-a-word, carnal, Hulk). In the old Comics Code days the Hulk was the Inner Child. In the modern version, he is the Inner Monster.

A monster, by the way, is not necessarily a bad thing. Monsters dot the edges of the mediaeval maps. They are the inhabitants of the unknown, the mediaeval Id - things we know are there but cannot glimpse. They are disturbing, but that is because they are real, not because they are bad.

Anyhow - the Hulk, who is the Id, the hidden part of all of us, is tracked down in this comic, and after a protracted hunt, we finally get to see him. It is a remarkable image. The monster is sprawled on a throne. There are countless naked women draped over him. He is being worshipped and adored and gratified constantly. It seems he is at peace.

And the image is laughable and childish and it's also true. There's a part of all of us - essentially all men, although I suspect the differences between the sexes are not absolute - that will not be satisfied without that or a variation of that. That's the part that "needs". It's not a "need", but by God, it's a strong pull, and to completely deny its existence is as stupid as to indulge or satisfy it. Because if you can live in a comic, that's all well and good.

But in the real world, you have to come out some time. There are people there who depend on you, who trust you and need you and to whom you have promised your life. They - and there's more than one - they get hurt. No matter how good the sex is - and in my book it's good - the hurt and the guilt and the trying to get back the trust last longer.

Anyhow. Enough Viking stuff. This all may not make the final cut, because I have three or so months to go - I suspect this will all end up in book three. Which won't get finished if I don't get on with this.

Thanks for listening,

BDC

*The book launch of the marvellous Lisa Hannett. Check it out.