Dreadlock

Dictionary-

Dreadlock

/ˈdrɛdlɒk/

noun
noun: dreadlock
  1. The experience of dread leading to an experience of freezing up. Occurs in a threatening situation or when encountering a person who often microbullies (v). Usage. After my holiday, I walked into our toxic office, saw Gerry and went into dreadlock.

    What do you think?

Doppression

In 1998 I wrote about something I called “doppression”. Here’s an update inspired by an article in Medical Republic today  #doppression

DOPPRESSION

There are several models for viewing the experience that is popularly known as “depression”. The current dominant model consists of a collection of popular memes combined in a narrative something like this…

  1. Our natural state is not to be distressed
  2. Deviation from the natural state is a disease (pathology)
  3. Disease is predominantly caused by internal factors (genes, predisposition, biochemical disturbance)
  4. Although depression can be precipitated, the development of the disease reflects some internal deficiency or lack of coping skills.
  5. The deficiency can, to some extent, be treated with medication’ and the coping skills can, to some extent be leamt
  6. The best way of learning coping skills is through intellectual processes (cognitive behavioural therapy)

Some benefits of this model are that there is a widespread faith in the view that “a suitable medication, when found, can bring relief of suffering”. Many medications have been found that are helpful. The process of prescribing is viewed by doctor and patient alike as a significant step toward “recovery”.

Some drawbacks of the chemical deficiency model are that the person for whom medications are prescribed, or cognitive therapy instructed, are left with the idea that the illness was consequent to them being deficient or abnormal or misinformed or crazy. Context is acknowledged, but kept at a distance.

Strangely, this model dominates the landscape, despite lots of evidence that the microbiome might be more important than the brain in regulating emotions and neurotransmitters. Finally the connection between stress (particularly at work) is being made, and the complex interaction between sleep, stress, eating and activity is being explored.

In order to make meaning from the experience, there are many alternative models:

  • Depression is a spiritual crisis and an opportunity for spiritual growth or awareness
  • Depression is the result of some karmic misdemeanour
  • Depression is a test of one’s mettle
  • Depression has no meaning and is a consequence of the random occurrence of pain and Suffering.
  • Depression is consequent to loss and represents to some extent a personal loss of self
  • Depression is consequent to oppression (physical, verbal) , by either people or bypeople’s critical ideas which have been internalised as self-truths.

Being highly interested in language and its effects, and being disillusioned by the application for 10 years of the dominant model and my belief that it disempowers the “sufferer”, I have devoted much of my time in recent years to exploration of the latter model which has been articulated by several people. Most cogent for me is the modem articulation of these ideas in the context of so-called “narrative therapy”.

The strengths of this narrative model are that they give rise to options for any individuals who have contact with someone with depression to look at their own possible contribution to the perpetuation of the “disease”, by inadvertent oppression through the use of advice, judgement, inability to understand or accept what the “sufferer” is reporting, and give us also a chance to consider the possibility that in a dominant culture we are all trained so well to dominate that we often oppress others. Hence “doppression”.

Consideration of this model provides many answers, and might help us move past a current “obstacle in thinking” about depression; We seem to be way behind the eight ball in detecting, and modifying microbullying which I believe is a root cause of depression through explicitly delivered oppressive narratives (work performance review anyone?) and more subtly internalised self-oppressive narratives .

As Michael White points out, our culture has moved towards this acknowledgement by putting the “post traumatic” in “post traumatic stress disorder” which was previously known by several labels which pathologised the individual including “war neurosis”.

If you accept that the narrative model may have some merit, then I would invite you to consider the possibility that the ways that we usually relate to someone who is “doppressed”, actually generate and keep alive the condition. These ways include.. Pitying, advice giving, rescuing, refraining, ‘ criticising, confronting, neutral listening, reflecting back (without checking), indulging, ignoring, labelling (officially with “diagnosis” or unofficially with pathologising lay judgements (laybels [sic]) including “immature”, “weak”, “fragile”, “overemotional”, “angry” amongst a multitude of other labels.

I have become less interested in criticisms of the narrative model, as they often rely on dominant paradigms such as “evidence leads to truth” and “of all explanations, one must be more true than others” which is extended to “unless model A can be demonstrated to be more watertight than Model B, it is not valid”. I am not disinterested in such criticism because I think the underlying assumptions are flawed, but because they are unhelpful. inasmuch as they may lead to the dismissal of possible options for change. My assumption is that any approach which broadens options for action is worth privileging.

Much about the possibility that the way we treat others, especially by the language we use (“power words” such as “too” “but” “just”, “actually” and many more). More about Power words soon. I hope you find, as I did, that serious consideration of our language opens new doors for you and the people you relate to, and opens doors to freedom from doppression.

 

Bullying is now so common it’s normalised. Let’s solve this now.

For the sake of our mental health, we need to redefine bullying in the workplace.

Here’s one proposed definition:

Bullying is asking, expecting or telling someone to do something that you wouldn’t feel comfortable requesting if you weren’t in the position you are in.

And here’s a definition to help ascertain if you are being bullied.

Are you on balance spending more than acceptable time or energy, doing or supporting something that you feel morally uncomfortable with, compared with activities that create good, bring joy, or align with your values, because to do otherwise would be too scary?

Hang on. Have I just defined the modern workplace, the political or education systems or even maybe patriarchal society itself?

Maybe that’s why we elect leaders based on all other criteria than morality and compassion? To do otherwise would bring on a disruptive rebuild.

Houston we have a problem.

The slow death of Universities?

There’s a lot going on in education at the moment. As someone who home schooled our son I spent a lot of time looking at the pros and cons of a traditional education. As parents we didn’t come to a solid conclusion..one of our children was schooled traditionally and the other wasn’t.

There have been many people recently bemoaning the cuts to higher education. Consider the contracting job market, the availability of high quality online resources and the realisation that genius is only loosely associated with educational achievement. You don’t need a college degree to work out that college degrees have diminishing relevance. Enter Google and Apple to make that conclusion a valid one:

https://www.axios.com/google-apple-college-degree-hiring-a290bca8-65a7-4de2-8fa9-d93b4c30457a.html

If we are serious about suicide prevention… what about this conversation?

I find myself constantly despairing about the missed opportunities to change our ways of thinking in order to prevent mental illness and suicide.

I’m worried we are taking a less than optimally effective approach to suicide prevention.

I was reading about Australia’s  “you can talk about suicide” launch.

I found no reference to shame in the document and that concerns me, as shame, I think, isn’t far from self-loathing if it’s not talked about, shared and normalised.

What about “How to have conversations which disclose and normalise the experience of shame, and self shaming internal dialogue?”

I don’t believe we can have an effective conversation about suicide until we are skilled up in having this conversation. 

I think it’s not that hard, but the principles of the conversation are counter-cultural.. let’s start on that project ASAP rather than conversations which assume that depression or anxiety have an internal locus (diagnostic model) with a biochemical basis, on top of causal genetics and experiences and therefore respond to fortification or medication.

The diagnostic model is struggling to achieve great results in primary prevention. It’s had an OK effect on secondary prevention but I strongly believe that looking at the social construction of mental illness might be more fruitful. 

Let’s start the conversation with the question “We all suffer from shame in some form or another. What would I need to do differently so that you and I/we all can talk about our shame and work together against its effects?”

What do you think?

Unorthodocs beliefs- prove me wrong.

I’m watching medicine undergo a transformation as we reach an explosion of new understandings. Unfortunately it’s later than it could have been because of the diligent and dogged attachment to evidence based medicine with all its inherent delays. Unfortunately this is costing lives. Here are some of the things I believe we could have acted on some years ago. Prove me wrong.

  1. BMI is a horribly crude risk indicator and should have been replaced by indices of central adiposity (unhealthy obese vs healthy. TOFI vs healthy thin) years ago. Fat that is overwhelmed with energy stores gets sick and leaks toxins causing disease (see next point). We need to store and use. Cyclical feast and famine is our only hope even if the “famine” is your weekly fast, or extended overnight fast.
  2. Type 2 diabetes, coronary heart disease, pcos (and its subclinical partner – the majority of female infertility), dementia, a lot of depression, and a lot of autoimmune disease are probably caused by a caloric overload, dysfunctional microbiome and immune dysregulation. Serum glucose is only a surrogate marker. It’s the inflamed fat that causes most of the damage, and few medications alter that (but metformin fortunately does)
  3. Your brain needs healthy saturated fat, because that’s what comprises it. Starve it of that and instead feed yourself manufactured oils and you will get membrane changes that aren’t so good.
  4. If we eat “empty calories” (pure energy sources- sugar, refined carbs, modern nutrient depleted wheat) and your body will crave vitamins and minerals. You will probably overconsume causing energy storage overload, leading to chronic disease. We should avoid processed foods.
  5. Most of the conclusions about unhealthy fats, serum cholesterol were based on simplistic and false assumptions, poor stratification of food groups in comparative trials and many studies were highly influenced by vested interests.
  6. We’ve only just started to realise the effects of pollution- air, water, food and environment. The effects are huge and the diseases complex and some defy current understandings. Avoid cities. Wash food. Don’t trust many “safe” additives. Recent examples- emulsifiers, additives to sunscreens.
  7. Randomised trials and well conducted studies can’t save us now. Too many variables. Artificial intelligence using big datasets, associations and algorithms are our main hope.
  8. A lot of diagnosing relies on pattern recognition. Humans can’t have a big enough dataset to keep ahead of machines (dermatologists, radiologists for example are a threatened species) Google will become a better diagnostician than your GP.
  9. Machines will never be human enough to do empathy. Humans can enhance the benefits that AI will bring to medicine by providing spirit and connection.
  10. We waste most of our health budget on monitoring or treating preventable disease. We are poor at motivating people because our culture undereducates us in health literacy and outsources that to “experts”, and we by training blame others or ourselves for our “failures” rather than recognising and growing our agency.

That’s enough for now. More to come. Prove me wrong, or let’s get together to shift the paradigm.

Try this reflective exercise.

Recently I found myself at a gathering of health professionals. I felt a little out of my comfort zone. Increasingly commonly I think I have something valuable to share and I get blank stares. I thought it was me.

But then it hit me.. it’s not only me. There’s a paradigm out there that’s pretty self contained and if you say anything that exposes or challenges its assumptions you often get the “you’re a bit mad” look, or blankness.

Since we were doing exercises and workshops at this gathering, I mused about testing my theory that I’m in a minority group.

Here’s my proposed exercise- designed for groups of up to several thousand.

Run this cold… any explanation or pre-loading will corrupt the results.

“Turn to your neighbour/s. In pairs or small groups have a discussion where you ask yourself “How patriarchal is my thinking?” Use your group to help clarify your answer. You have about 2-3 minutes for this.”

“Then, when I ring the bell move into one of four groups”..

Group A – “Not very”

Group B- “About average”

Group C- “Quite”

Group D- “Don’t know”

I think I’d be in Group A, but I’m not sure. I wonder how many would be in Group D?

A followup exercise- How ready are you to subvert the dominant paradigm? (groups based on the same answers)

The patient is NEARBY

I’ve been to a lot of stuff recently. Health stuff. Conferences, workshops, discussion groups. I’m hearing a lot about the need for “culture change” and “paradigm shift” in healthcare. It’s certainly needed. The system is half broken and propped up by energetic, exhausted, committed wonderful people, many of whom are working beyond their capacity, unsustainably. They feel bullied by the system or in some cases by individuals.

They need help, but somehow lack the skills to ask for it from the public, who are demanding change, and are willing to help.

But when it’s suggested that we get patients involved in the change, embedding them at every part of the healthcare and health education system, this is resisted. Yet this is the culture change we talk about. It’s ironic.

I propose an acronym to help with the shift to a true patient centred healthcare system where patients are the experts who are consulted whenever policy, curriculum or practice is designed or change implemented.

The patient is NEARBY.. It’s an acronym. yay!

Notice– is the patient present? token? how visible and valued  and voiced are they?

Empathise– what are they feeling or would they feel about what’s just been said, just happened, how people are behaving?

Ask and advocate. If the patient is there.. consult them. If not, reflect and imagine what they would say. If they are absent, represent them with your best guess.

Reflect and resist temptation to rationalise it away. Notice your excuses for not having the patient involved. this might involve –

Biases, behaviours, blaming– its ok because……..

eg.

“we don’t need them.. we do patient centredness well already.”

the noisy consumer is too much of a problem.

“this is too hard for x reasons.”

“You can’t trust patients to represent health fairly- they just want a forum for their own experience.”

“if we explain it to them, they will understand they are actually represented here. They should have trust in us”

Yell. The patients voice might require you to make a scene, be the unwitting target of reaction to change. You might feel isolated and sense being labelled as difficult or a pest. Better you than the patient!

From evidence based medicine to safe plausible medicine.

I just want to say it… evidence based medicine has had a good run, but it’s declining in what it has to offer in its current form. We need to move to another model, and it’s called safe plausible medicine.

Among the reasons for the decline of usefulness of evidence based medicine are-

1.Expense. The so called “gold standard” randomised controlled trial (RCT) is incredibly expensive to do properly

2. Strident eligibility restrictions in the modern RCT exclude most “normal” people in favour of those with virtually no other conditions, confounding health factors or medications. That’s not many people. At the end of the trial, you get something like.. this treatment had a 30% better outcome than alternatives. When you look at the study, it hardly applies to any of your usual patients. The findings apply to the lucky 3% of people who are just a little unwell, and isn’t relevant to those with comorbidity. Furthermore the conclusions are possibly invalid regarding your patients, and worse still, could be harmful given that the proposed treatment hasn’t been tested on patients like them. A stark example is those on multiple medications. Good luck with interactions between your test medication and drugs A B C and L, when your trials are done on people who are medication free, or nearly so.

3. Studies are corrupted by all sorts of financial imperatives and biases. Some are obvious, but some are very subtle. Ben Goldacre has documented many of these.

4. What we call evidence has various “levels” and sometimes they are proving the obvious. For example.. why are we still doing studies to show that exercise improves condition X? I’ve rarely seen a condition that doesn’t respond favourably to exercise. But how much exercise, or what type? Who cares. Let’s just be more active. Some low intensity, some high, whatever. Mix it up. That’ll help

5. Results often don’t get converted into policy or taken up by our culture. We are busy longing for and indulging in “more important things” that light up our addictive centers in our brain, but probably don’t benefit us much. My screen addiction is an example. I know bright light at night is bad. But I love reading and writing using technology. It’s nearly midnight as I write this, and I’m dog tired. Knowledge from the studies on sleep deprivation isn’t helping me avoid all the diseases I know result from it.

I could go on, but rather than be so negative, I have a solution. It’s called “safe plausible medicine” and I believe it has a great advantage over much of what we call “evidence based”

Safe plausible medicine goes like this.

If it’s something that is very unlikely to cause harm, and has some pretty plausible explanation for why it might be good, let’s do it. Who cares if it isn’t based on rock solid studies?

The problem is there are lots of people who care enough to block this idea.. the people who are afraid of being blamed if something goes wrong. Their fear based (flawed) logic goes like this..

”Evidence based interventions are safe” therefore “interventions with poor evidence base are unsafe and we shouldn’t recommend them”. 

This is patently untrue, but I hear it daily in my interactions with health professionals, and it reflects poor training in critical thinking.

Let’s break it down.

Statement A. Evidence based interventions are safe. This is often true. There are many good trials out there that verify favourable risk/benefit ratios of medications or treatments but there are many exceptions too. Let’s ignore the exceptions and assume that statement A is true. But to then say statement B is true because of statement A reminds me of basic logic exam questions.. A is true, B is false and B does not flow from A.

There are many treatments that have been administered for decades, sometimes centuries, but have not been properly studied. Are they unsafe? No. They are just untested. Some may seem pretty shonky. Colonic irrigation was such a treatment back in the 1980s when I was a younger doctor. Faecal transplant was potentially laughable given our scientific knowledge at the time. It’s now working (some) miracles, but has a fair way to go before we can use it safely. I can’t recommend it yet.. too much uncertainty. For me it fails the “am I confident it’s safe for most patients?” test. But it’s certainly plausible now, given our knowledge of the microbiome.

Many traditionally accepted treatments are patently now proven to be unsafe. (Mercury bath anyone?)

What IS safe and plausible is the Mediterranean diet. I don’t really need to reference this.. just google it.

What is also safe and plausible is moderate carbohydrate reduction with a caveat that if you have diabetes you shouldn’t do this without medical supervision. We have zero need for added simple carbohydrates in the diet. It’s not possible to reduce carbohydrates to zero as they exist in many foods. Moderate restriction has been demonstrated to improve health, biomarkers of disease such as inflammation, cardiovascular disease, metabolic dysfunction markers and the microbiome. Plausible mechanisms for these changes abound.

Why do people who recommend low carbohydrate diets get persecuted? Beats me. Probably the whistleblower effect. Good luck Tim Noakes, Gary Fettke, Jennifer Elliott and Caryn Zinn. You are brave. Thankyou for pushing the safe and plausible. Thankyou for trying to help reverse the tide of harm we have caused by promoting (in our ignorance) dietary recommendations which are now demonstrably wrong.

Bring on the safe plausible medical revolution. The evidence is in.. Evidence based medicine is no longer God. It still has something to offer.. big data and complex causal analysis is looking pretty good- just a little expensive, and while there’s some low hanging fruit (no pun intended) to tackle, I can’t afford to wait for the results.

Safe and plausible. Let’s do it. If you aren’t on metabolic medications*, you can safely reduce carbs, fast if you can- even overnight helps.. early tea, late breakfast, walk after a meal, sleep long, exercise regularly, connect with friends, laugh, read, avoid screens, cover up in the intense sun, but make sure you get a healthy amount without burning, eat plenty of vegetables, fibre, nuts, legumes. Eat healthy unprocessed fats, and a little meat if you must, but make sure it’s had a healthy natural life and its natural diet. Minimise processed food, especially bread and other food from engineered grains. Eat food that rots, before it rots, and food that ferments, after it’s fermented. Keep animals and avoid antibiotics and caesarean sections. Reflect, slow down and practice mindfulness. Simple, Safe, Plausible. Oh.. and don’t have too many rules!

*if you have type 2 diabetes or are on medications that alter blood sugar, you can still do dietary change, but make sure your medications get lowered as you reduce the demand for insulin or the drugs that assist it. Your doctor can organise this. See this article too- Carbohydrates for people with diabetes is not cautious