Saturday, September 10, 2011

Belated RIP

This is a bit behind the times, but I've been busy. Sad to say, I have to add a correction to the previous post. The BBC Ouch! Messageboards were discontinued. Much to the dismay of the regular readers/posters/lurkers. But their opinion did not matter; they were only the public: "civilians", in celeb-speak. The BBC needs to save cash (for important peoples' salaries, for spending money sending presenters all over the world on first-class, because they couldn't possibly use the word "Rome" for example, without they are standing in front of the Colosseum, now could they?, for yet another turgid ahistorical costume drama)- and the Messageboards were seen as an easy target.

By removing the Messageboards and expecting users to be content with the blogs, podcasts, etc, the BBC did this: they removed forums where "ordinary people" (celeb-speak again) could communicate publicly, and handed to site over to celebrity crips telling the rest of us what life is like. Please, don't bother.

Tuesday, April 26, 2011

"They're coming to get you, Barbara!"

He came into the office, beaming. "I got my ESA [Extended Support Allowance, formerly Incapacity Benefit] back," he said, "the appeal was successful. Thank you so much."

One for the good guys, I thought, but at what a price. This chap had been living in stress and worry for weeks, while the mills of the DWP ground exceeding small and finally, rightly, spat out his ATOS disqualification and restored to him his rights. Just the kind of pressure you need when you have a life-threatening heart/lung condition (which, incidentally, has qualified you for DLA, but ATOS don't take any notice of petty details like that). And just the kind of humiliation you need when you are a middle-aged man who has worked all his life, doing what a man's gotta do, and keeping your self-respect thereby, only to find that the system into which you have paid since age sixteen, for just this kind of eventuality, rejects you as a sponger. I know that's how he felt, because he told me when we were discussing his appeal.

Why should he have to scratch around for help to retain what he has earned? Why should he have to be grateful to me or anyone else for that help? And what of those who because of their impairment(s) have never been able to cope with the demands of paid employment? How are they supposed to feel, that their whole life has been a sham and a waste? Gandhi (I think) said that the test of a civilization lay in how it treated its disadvantaged members. God help ours, on that criterion.
I remember these begging statuettes from my childhood. Is this what we are going back to?

For anyone who has been living in a cave these past forty years, the title of this post comes from the beginning of George A Romero's incomparable Night of the Living Dead. I think it is apposite: that is how I view the designers and operators of our present UK health-related benefits system. Not the interviewers, necessarily; in the classic phrase, they are only following orders. But the politicians, senior civil servants, managers. As mindless, knee-jerking, grasping, humongous ghouls. Someone behind them again, some cold-mouthed bean-counter, has seen a "soft target", and that's not the miniscule amount of benefit fiddlers either. Even as I write, the news media are salivating over one egregious fraudster, Mary Grace from Liverpool . What they consistently fail to recognise, or admit publicly, is that the reason these cases make headlines is that they are so rare. In over ten years doing this job (community health and disability advice) I have met one (count em, one) person who I thought might be swinging the lead. The other clients, with their various physical and mental disabilities and associated difficulties, have without exception been ordinary, decent people struggling to do their best, invariably unrecognised, with the hand that life has dealt them. And it is that very decency that is the soft target.

It leads them to feel misery and fear when a health-related benefit is withdrawn, not only because of the poverty, but partly because someone must be thinking they don't deserve help. Must Try Harder. Pick Up Thy Bed And Walk. If Stephen Hawking can manage, with all his MND, why can't you others? (That last is a paraphrase of an actual quote from a UK politician.)

Pride, initiative, self-respect - they are indulgences that are not allowed to the ill and/or disabled people in this country. Or, we can indulge in them, at a price; some people do. They say, "I'd rather do without that than go through that interview/panel/tribunal process again." Once, in the Great Depression years of the 1930s, my great-granny, with a sick husband (no sick pay in those days) and three kids (no child benefit in those days), was forced to approach the Poor Law Guardians for financial help. She was put in front of a panel of Charitable Gentlewomen who turned down her appeal without charity or gentleness. Apparently she wasn't destitute enough. "You could sell your wedding ring," they told her. There are those amongst our political masters (on both sides) who regard those as happy days, once this unconscionable experiment with a Welfare State is safely buried.

This mindset, you see, infests the benefits system today. No doubt they'll get around to me, too, sooner or later. And to you. Listen, the ATOS interview is a farce. It's box-ticking. They are paid for failing claimants, and even when the fail is overruled on appeal, ATOS get to keep the money. What knothead thought that was a good idea?

All the advice I can give is, in the short term we are stuck with this crap (the long term is down to the workings of democracy, ha! ha!). So play it out as if it's a game, but a game with real consequences. The initial interview is a nonsense. Some of the interviewers, I am reliably informed, can't even speak English, and as far as I know none of them have any medical training apart from what is provided by ATOS, but no matter, all they need to hear is "yes" (preferably) or "no", so they can fill in their little form. Someone, somewhere, must have heard of the Social Model of disability - they probably read it on the back of a box of matches or some such, because the only bit they seem to have grasped is that about focussing on what you can do, rather than what you can't. This, translated into modern benefit-speak, means that if you turn up for the interview alone, then you can't need any support because you have negotiated traffic/public transport all by your tiny self.....if you are a part-time wheelchair user like me, you better attend in one, however you are feeling on The Day, or they'll say that you obviously don't need to use one at all, and its associated reasonable adjustments. Save your energies for the appeal, because if they brought in Jesus Christ fresh off the cross, ATOS would fail him. He'd still be bleeding, you see, so he must have a pulse, and he'll get points deducted for that. For the appeal, gather your evidence and support - GP, consultant(s), nurses, social worker, whatever. Including, if necessary, an advocate. (It's a good idea, anyway, always to have a witness to what was said.) Contact your nearest community advice centre, Age UK (for those over 50), specialist disability action group, Citizens' Advice Bureau - those that haven't pre-emptively been deprived of funding and closed down. Keep an eye on the BBC Ouch! messageboards - they often have useful threads. Above all, keep your sense of humour and your sense of self-worth.

This post was written to contribute to The Goldfish's Blogging Against Disablism Day, May 1st 2011.

Saturday, August 11, 2007

The Snark Was A Boojum

Thanks friends for your kind comments. I should have put the Comments Barred sign up but I forgot.

I have completely lost the art of blogging, I'm afraid, but can't resist sharing with the world, one great insight I have been gifted with just recently.

Listen: the people who write the forms for official claims, have gone to the same school (probably Hogwarts) as the people who write the algorithms for computer helplines.

You know how if you need to call a helpline, they won't proceed unless you can produce some godforsaken ID number, which is invariably located at the back of the tower unit or underneath the laptop/monitor/keyboard?

Right, well, claim form designers have the same training. I have been attempting to extract some needed money from a Certain Organization, to do with my disability; seduced by the come-on that it's my right to have a bit of the folding to offset the disadvantages conferred by a caring society on those of us less handy (pun intended) than others.

Why in hell do they always want to know those little details that involve a grunting search in the depths of the documentation? Grunting because you think you've extracted every little thing and put the stuff away again, then you come to Question 98 subsection 99 and have to get it all out again.

For a start, to prove you are native-born British these days, seems to involve the most abstruse questions about When and Where; I am just waiting for some bright Civil Servant to start asking Why.

(Well, my dad mistakenly thought it would get him and mum a Council House, is Why, but that was many years ago and there's nothing to be done about me now, I'm afraid.)

Furthermore, these forms are designed by sadists. There is always one question to which, if you give the wrong answer, up comes the Go Straight to Jail pointer: "You Are Not Entitled To This Benefit!"

Yes, but couldn't you have asked me that question before page 20? One is tempted to send the form in anyway, just to make some Established creep waste his time working all the way through it as well.

Jeez, I've spent years urging other crips to take advantage of their rights: "Why not just fill out the form? You've got nothing to lose; they can always just say No," and all the other bromides. Now I am beginning to realize why people blow up in flames and sink in despair.

And another thing: all these questions: I don't remember any such inquisitions during the years when I was paying money into the system. About all they ask then is, Are you breathing? coupled with, What is the maximum we can screw out of you?

Thursday, July 26, 2007


Tuesday, May 22, 2007

Here be Dragons

Well now, I have been minded to close this blog down for quite some time. Although I've enjoyed writing it, and some few have enjoyed reading it apparently, it had grown into a huge jumble-sale of opinions, facts, personal reminiscences. So I started tinkering with it months ago, but gradually it has been borne in on me (the operative word is "tenosynovitis") that rejigging it, and even just keeping it going, is taking more and more of the time and energy that I no longer have to spare.

I must confess, these latest posts have been those I had in hand anyway, written in easier times, awaiting opportunity to put them up, so I've been able to delay the end.

Then, on top of that, I have noticed that the blogsphere is not immune to the difficulties that beset other internet communities.

A fellow blogger has expressed the conviction to me that internet friendships are not "real" friendships. They are different, certainly. My ex, who had to do a lot of business over the net, used to complain that different standards of behaviour applied in the virtual world. If you wrote someone a letter, she said grimly, or even just left a message on an answerphone, you usually got a response; but an email or a text message could get completely ignored and you'd never know why.

I know people who flatly refuse to take part in internet conferences or symposia; they say that it is impossible to get a "feel" of what's going on, what the consensus really is, what people really are thinking.

Lucky those who can progress from virtual contact to personal, and find that their hopes were not dashed. (I can't say, instincts. There's nothing for the instincts to work on, in virtual contact. The tiny changes in facial expression, in tone of voice, the infinitesimal pauses in response, the whole-body language, all the things that give welcoming or warning signals.)

Same with internet forums and messageboards. I shall always owe a debt to ouch! talk because I stumbled across it at a stage when I was not adjusting at all to the notion of being disabled for the rest of my life, and there, at that time, I found those who were patient with newbies and willing (after the obligatory lurking and first ignored postings period) to stretch out a friendly hand. B W-F, CP, JQ, AH, and many more whose "real" names I never knew, I salute you and I keep you in what passes for my heart in gratitude. But sadly, those boards became overrun with trolls (so did most of the BBC boards at that time) and the BBC proved helpless to do anything about it. Well, you can to a degree put up with unpleasantness and bullying at work - look at The Apprentice - but who invites it into their own living room? So I drifted away, as did many of those who had been regular posters, and in my case have never bothered to return, though I hope all is well there now. It is so easy to let go: there are no meetings to be cut, no social arrangements to be altered, you don't even have to write a letter of resignation. And so it goes.

One of the BBC boards was so thoroughly destroyed by trolling that a new, privately-run forum was set up and worked well for a long time. Then it got religion - oh my paws and whiskers, if you want to plumb the depths of nastiness on the internet, go to religious sites - the BBC's own were pretty terrible, modding or not (usually not). But then there was a clampdown on bullying, and it's up-and-running as good as new again. These things change and pass.

Even in the blogsphere, I know two or three others who have in plain English been driven out of their blogspace, either by being outed against their express wishes (Gimpy Mumpy, for example), or by abuse after airing unpopular views (Al Masters, for example), or by having their URL hijacked (several, but I'm damned if I'm going to publicize stolen goods). None of these are what the "real" world would call decent behaviour.

I was once hiking through Castleton, in the Peak District, which is a little old town with narrow streets and lots of tourist in the season: result, traffic jams. There was one fat little guy sitting in his car, pounding his horn, scowling and mouthing insults at pedestrians and motorists who presumed to delay his majestic progress. I always remember that scarlet, pouting face, and my immediate thought: I bet you don't carry on like a two-year-old outside your car. The closed car is a kind of protective shell, a mini-world permitting behaviour that the individual would be inhibited from perpetrating in the "real" world. Same with the internet, I think. Normal courtesies do not always apply and will not be resumed after the break.

I am grateful to those who have read this blog and commented, it's the communication that has made the effort worthwhile. Who, apart from a few dedicated diarists, writes into a vacuum? So, my thanks and good wishes and keep blogging.

Whew! Glad that's over at last!

Hic dracones, indeed.

Defining Moments

There are some times in a life when you come up against a realization. I'm not talking about a moral choice, here, or a recognition of what is the Right And Noble Thing To Do; I'm talking about experiences where you realize, helplessly, whose side you are going to be on, take it or leave it.

It once happened to me years ago, when I was about sixteen or seventeen in fact.

Our school, like most in those days, had a Policy on Smoking. (It had to have, because just about everybody puffed away then, watch old films and you'll see.) The policy was, of course, that there was to be no smoking in school uniform, on or off the premises.

Anyway, one afternoon two lads on the bus home from school lit up (you were allowed to smoke on the upper deck of buses, then.) And a third lad saw them and remonstrated with them, so naturally enough, they told him to fuck off. After a bit of to-ing and fro-ing he said he would report them, and he did.

Now get this, this lad was not a prefect or a monitor; had not, as far as I am aware, any right at all to go enforcing regulations against all and sundry, so why he did it, apart from being a creep, I do not know. And what he didn't know, was that Authority, aware of the enormous social example and peer pressure involved, was desperately turning a blind eye to the flouting of the rule.

So Authority, next day, was not at all grateful for this information, which put it in a bit of a bind. It did what Authorities always do when someone blows an inconvenient whistle: it ratted. The two miscreants were promptly suspended, but instead of smuggling the informant out the back door, Authority then let it be known who had grassed, sat back and washed its hands.

And there was a riot. I didn't know any of this at first; I was Library Monitor that day, which was the sort of dumb job they landed on senior pondlife who were regarded as too unreliable/too little imbued with the School Spirit, to be promoted prefects. I had to stay in the Library, stamp out books and try to enforce the No Talking rule, while the teacher in charge skived off for a well-earned fag and a cuppa up the staffroom.

We could hear this sort of dull roaring from a distance. The Library, which was usually full of people avoiding the cold, wet playground, emptied rapidly. I sat like Horatius at the bridge wondering what the hell was going on, until two lads burst through the door. They'd had a tremendous experience and they couldn't wait to share it.

Apparently the sneak had been rapidly surrounded by a vengeful, baying crowd and was only protected physically by a reluctant ring of prefects as he was hustled into safety and then sent home. Not a teacher to be seen. The two witnesses vied with each other in recalling the episode, what they had shouted at him, how one of them had spat in his face, on and on. Their eyes were gleaming, their faces flushed, their mouths were wet. I've never assisted at a bullfight or a fox-hunt, but I guess you would see the same symptoms there. And these were young lads, who had nothing to do with the original offence, weren't even friends, I found out later, of the smokers. Goddammit, there were people in that crowd who, as they talked about it later, you realised didn't even know the origin of the row. They'd just joined in the baiting out of....?

Well, it all simmered down as these things do. I can't even remember what happened to the main protagonists, whether they all returned to that school or not. But what I do remember, looking at those exultant faces, was feeling in my gut, "Well, I don't think much of the creep who started this, but, by God, I like your sort even less."

Sunday, December 17, 2006

Cruel As The Grave

Here is a public health warning: beware, beware a thousand times of righteous anger. It is righteous anger, not jealousy, that is as cruel as the grave. Righteous anger crawls out from the sewer when someone permits themselves to say "I'm not angry for myself. I'm angry for this other group (whether or not I have consulted them about being their spokesperson). To reinforce my case I will use their name (and with any luck, I will start a witch-hunt)." Thus fortified, the individual then engages in words and in actions which s/he would be bitterly ashamed of - one devoutly hopes - if they were on his/her own behalf, but feels that the displacement onto another entity somehow sanitizes them. If you doubt that, consider the Animal Libbers, or the people who lynch under the belief that someone is a paedophile.

The blogsphere is mercifully free of the worst trolling, mostly because we can all moderate our own blogs, unlike the hapless administrators of forums and messageboards who have to balance cries about censorship against outright abuse.

So, in case there are any bloggers about who fancy a spot of troll tiuition, I here present my very own Guide To Trolling, ©me.

Suppose some unsuspecting party posts an innoccuous coment or story, to which the apprentice troll bleeds to reply. Point one is: don't answer what s/he said. Twist or distort what they said and repeat that. For example, I remember a long-running row on ouch! because one person reported that they had a problem with an over-attentive shop worker. This chap would not be told that our poster didn't want his assistance; he followed the poster around, meddling in what the poster was trying to look at or pick up, and generally making a thorough nuisance of himself. Rather than be rude, our poster said, he had tried repeatedly to explain politely, but in vain, and would have to stop dealing with that store.

The immediate reply he got from the resident troll was, How nasty of you to rudely throw offers of help back in the poor man's teeth! Next thing, the troll said, you will be whining because no-one helps you.

Second point arising from the above: always use offensive language. Attribute to your victim "whining" or "moaning" or "whingeing" or some such: never a neutral term such as "say."

Third point, by now you have hopefully got your victim bewildered and on the defensive, despite the fact that it is you who are being rude and you who have invented the attributed remarks. But be careful: your victim, or a bystander, may sneakily attempt to spoil your fun by re-stating the original, innoccuous, remark, in such simple terms that nobody reading could be confused. Don't be discouraged: shift your ground. In your reply, attack your victim for something else. In the real-life example quoted above, the argument then meandered off into the claim that the victim was moaning because nobody ever offered him help. Soon everyone reading the thread was totally confused as to what the original poster had really said.

Fourth point, recruit allies. The BBC board above at the time was playing host to (notionally) three trolls, though they were all so stylistically similar that I wondered myself if they were all one person posting under different usernames. But that way, you can back yourself up and agree with yourself as much as you like, and the you can use your aliases to repeat and consolidate your mis-statements.

Above all, fifth point, it is important to destroy the credibility of your victim. You can make whatever outrageous statements you like, but be sure to trumpet loudly that your victim doesn't know what s/he is talking about. Then you are in a win-win situation. If they ignore this, your calumny goes unchallenged. If they reply by stating their qualifications for holding their opinions, yoicks! tallyho! there's a whole new route to attack open to you on the "you think you're so holy/so clever/so noble" line. You've put them in the wrong again, haven't you?

It is amazing how well this tried-and-tested technique works in derailing any discussion. The only thing the victim can do is refuse to play, or respond at all, in which case you've effectively gagged them, but then, what other function does a troll have?

Wednesday, November 08, 2006

Voltaire, Thou Should'st Be Living At This Hour!

A fellow disabled blogger recently published some opinions which met with considerable disapproval.

I myself disagreed with what he said; I thought he was mistaken in his assumptions; so I replied to his blog, politely, with my reasons for thinking so. So did several others, all of us using our Blogger names.

He was not inciting racial hatred, not being blasphemous or defamatory, not inciting sexual violence. He is entitled to his opinions.

But the further response he has had, largely from annonymous correspondents, has led to him deleting the whole discussion and closing his blog to further input.

Fellow Bloggers, this is not on.

I can think of three reasons why anonymous abusives crawl out of the woodwork:
1. They can get on the net but are so mentally challenged that they cannot acquire a Blogger ID, a procedure which is hardly a proposition from Wittgenstein.
2. They have a Blogger ID but don't wish to use it when they are behaving in a way which they know themselves is shitty, in case they get identified.
3. They had a Blogger ID but have gone so far outside the rules for decent behaviour that they have had it withdrawn.

I don't accept anonymous input myself. If you haven't even the guts to sign your Blogger name, then I am not bothering to read you.

Wednesday, September 27, 2006


I found this on the net - I don't know if it's copyright or not, but I trust the author will not object to me posting it here in the hope it may give some comfort.


That sunlit patch where I used to wait for you -
I am still there, but for me it will always be summer,
That sudden draught about your ankles
Is the brush of phantom fur.

Do not grieve,
There comes a time when we all must leave
For better things.

That warm rug where I drowsed through winter's chill,
Before a fire lit to warm old pussy cat bones,
You may not see me, but I drowse there still,
No longer cold, but not really gone.

-Sarah Hartwell

Saturday, September 09, 2006

Father, Dear Father, You've Done Me Great Wrong

I recently read a very courageous blog on the subject of emotional abuse - although the writer didn't call it that, and I don't even know if the writer fully recognised what was being written about - and I was going to reply privately to this, out of my own experience.

Then I thought, partly because of some of the replies the writer got, that there are many, many people on the receiving end of this kind of abuse, and there are many of those struggling to know what to do about it. So I decided to blog about my own experiences, in the hope that it may help the original writer and readers in some way.

This is not an easy blog to write, so excuse the lack of my normal polished Augustan prose. And note also that I am going to employ some hard words, like "abuse", "sadism", "cruelty", "self-protection" and the like, which people who have never been there may think excessive, even unjustified; I don't think so. I said many blogs ago, about a mild example of sadism, that there may be differing degrees but there is no difference in kind. And there is no percentage, ever, in refusing to give things their proper names, least of all because it feels uncomfortable to do so, the perpetrator being a relative, a friend, a lover or whatever, who we feel ought to wish us well.

"My dear Sir, clear your mind of cant. You may talk as other people do: you may say to a man, 'Sir, I am your most humble servant.' You are not his most humble servant. You may say, 'These are sad times; it is a melancholy thing to be reserved to such times.' You don't mind the times. You tell a man, 'I am sorry you had such bad weather the last day of your journey, and were so much wet.' You don't care sixpence whether he was wet or dry. You may talk in this manner; it is a mode of talking in Society: but don't think foolishly." (Boswell's Life of Johnson).

I was only physically beaten once by my father, as a small child; I can still remember it nearly fifty years later, so it must have been something really special; in fact, I suspect that the fact of it was held over his head by the family, as some kind of threat, because he never laid a hand on me again. He knew a trick worth two of that.

My father was an abuser, of me and of my mother, till the day he died. Emotional violence. It took me years to recognise what he was doing for what it was, and I came to the realization mostly by listening to and reading about other victims' experiences: children bullied at school, people bullied at work, battered wives.... The symptoms are always the same, the difficulty is to force yourself to recognise them. The effect on my mother was the classic one: despite repeated opportunities and advice to get away from him, she never did - we build our own cages, the bars constructed out of the destruction of our self-confidence and sense of worth, our isolation and our sapped initiative. I left as soon as I could support myself, at just eighteen. And still I remember, a few months into that first year of freedom, a moment of epiphany when I thought: I have got friends! People like me, they fancy me, they are happy to be with me! I had never believed that before, my old man had convinced me other wise.

The scenario is always the same, too. You are talking about something that engages you: maybe a person you admire, a belief you have , an experience you have enjoyed. Or maybe you are happily absorbed in some activity: reading, watching a film, playing a game. Or maybe a third party is praising you for something. The abuser takes advantage of this. They break in on what you are doing or saying, not by attacking you directly - at first - they attack what is occupying you or giving you pleasure. "That belief is puerile - that activity is stupid - that person you admire is rubbish" and so on. If you attempt to engage with this on a rational level, then the personal attacks start: "You are like a hysterical old woman - you have never known a days' hard work in your life - you can't take teasing - you are spoilt, immature, ungrateful, irrational" and so on.

This has achieved several things for the abuser. In the first place, all your attention has been diverted to them; in the second, your pleasure, your self-confidence, your faith in your own judgement, has been destroyed; in the third place it is you, the victim, who are on the defensive about your own reactions. Why they need to bolster their own sense of identity by destroying someone else's is beyond me and I leave it to the psychologists. Quite often, like a two-year-old who has had a tantrum, they then, satisfied, lose interest in the whole thing and happily return to what they were doing/saying before, while you, emotionally shattered, try to make sense of what has happened. And any attempt to pursure the matter is just brushed off: "oh, don't keep on, can't you take a joke/an argument, I am busy" and so on.

JB Priestley called appeasement "the victim's bewildered retreat towards the edge." You cannot appease them. You cannot please them, ever, because what is acceptable, even praiseworthy, becomes the focus of attack on another occasion when you are unguarded. You cannot appeal to their reason because reason is not the motive for their attacks. Sadism is.

Elaine Dundy, writing about her father's abuse:

"What I felt was not the fear caused by seeing a person spin out of control as a result of some physical ailment. My father was mercilessly in control and therefore far more frightening." (Life Itself!)

It is very rare for onlookers to be of any help. Friends, relatives, lovers, partners, workmates, schoolmates, have stood by and watched people driven literally to suicide by this bullying without once comprehending what is being done. Often they deny, quite sincerely, that anything untoward has ever happened. You can't even convince them by saying "How would you feel if your father/teacher/husband etc etc did that to you?" It's as if, never having been on the receiving end, it's just an incomprehensible experience. It is, however, one more nail in the cage of the victim and one more handle given to the abuser: no-one believes you, no-one will help you. It's all your fault.

I suspect that the impulse to savagery is in all of us, even the holiest. In some people it's so deeply buried that they never have to recognise it; happy they. But I remember myself, when I was in my early teens, my father was having one of his jeers about my mother's literary tastes; poor woman, she had a shelf-full of Georgette Heyers. I wonder why she chose such escapist literature; no emotional cruelty there. And I, casually, agreed with him, comparing them to Mills and Boon pap or some such; not, be it noted, because I despised Heyer or indeed M&B that much, but to hurt. And seconds later I felt such a wave of self-revulsion, because I realised that I had done what he was always doing. For no reason, I had hurt someone who was emotionally vulnerable to me just because I could.

I have never, I swear, done anything like that ever again. And it was my first step towards recognising the abuse we both were receiving for what it was.

It's nice to have emotional power over someone. Children and teenagers play with it, first with parents and then with suitors. Having sulks, promoting rows. But some people, and I really don't care why, keep on and never grow out of a taste for this. They have found something that excites them, gives them a dirty pleasure, even if they themselves wouldn't admit ever to this, and they get addicted.

They have found something that works for them and they are going to go on doing it. Some people believe that you can change such fundamental character by an act of will, or with psychoanalysis, or religious conversion, or some such; I don't. The most a potential abuser can hope to do is recognise an impulse to cruelty and power and stifle it at birth. If they haven't that self-awareness, or don't see why they should stop, secure as they are in the emotional link with the victim, what does the victim do?

Don't forget - most abusers are fully convinced that they love their victims and that the love is securely returned. "I'm only saying this for your own good so you've no right to be hurt - I'm only stopping you doing this for your own sake so you've no right to be disappointed."

In my own case, all I could do to protect myself was withdraw. I think this is what most victims do. I never confronted my father; frankly, I was too scared of him. Tracks in the mind laid down in early life and constantly reinforced, can never be erased completely. So, in self-protection, I was in his company as little as possible. (This resolution was hardened when it became apparent that, given any opportunity, he would get up to his old tricks.) And when I was in his presence, I watched myself. As far as feasible, Do not admit to any admiration, any enjoyment. Do not arrange any social occasion that can be disrupted.

It's called behaviour modification. You don't open up to someone when they are behaving badly; you back off and refuse to engage. You only come forward when they are behaving well, and then you reward them for this by being extra responsive. Sometimes it works. Some people confront. Good luck to them. They say, "Do you realise how unkind you are being? Why do you want to hurt me?" Mostly this is met with uncomprehending denial.

But you have to do something in self-protection. Otherwise you will find yourself, years down the line, disappointed and isolated, with the abuser saying self-righteously, "I don't know why s/he is lonely, can't make friends, hasn't made anything of his/her life, never married, had kids, a career, a serious hobby even.." Enduring the cruelty poisons, too, the relationships you do have. Dundy again, on her mother: "I couldn't trust her. She was his accomplice."

Just keep, right there, in the centre of your head, the uncomfortable truth that Rudyard Kipling, abused throughout his childhood, never forgot:

"....since most bullying is mere thoughtlessness - "
"Not one little bit of it, Padre," said M'Turk. "Bullies like bullyin'. They mean it. They think it up in lesson and practice it in the quarters." (Stalky & Co.)

Tuesday, July 11, 2006

Mindful Of Th' Unhonour'd Dead

This is a true story. My great-grandad told it to my grandad, my grandad told it to my mother, and my mother told it to me. They didn't want to let the memory of such an unrecorded incident die; and since I have no children, I am doing the next best thing and putting it on the web, so that he who runs may read.

My great-grandad was the son of a farm labourer, born in the West Country at the end of the nineteenth century. He left school at twelve, like all his ilk, and went to work for the landowner who employed his father and owned their cottage. What else could he do? He'd been educated at the village school, owned (and its syllabus dictated) by the same landowner, attended (whether he liked or not) the village church, owned ditto. He'd learnt to read, write, and do simple arithmetic; maybe a few dates of kings and battles, for history, and the British Empire countries, for geography. Course, he was a freeborn Englishman, he had a choice: he didn't have to work for the man who owned all the land as far as he could see. He could have joined the Army or the Navy, or left home to work in the industrial Midlands or North, in even worse conditions, or starved. Which was also the choice of anyone unwise enough to upset the squire. Greatest Empire in history, right?

He may not have had that much initiative, but he wasn't stupid either. He didn't just unthinkingly accept things: The rich man in his castle, The poor man at his gate, He made them, high or lowly, And ordered their estate, sort of thing. That may have meant All Things Bright And Beautiful for the landowning class, but my great-grandad had a different experience.

When walking back home from work one evening with the other labourers (children worked the same hours as adults, and you worked when farmer needed you, no nonsense about unsocial hours, Bank Holidays, Holydays, or weekends) my great-grandad noticed one of the other guys, an old man - in his seventies; no retirement age nor Old Age Pension before 1911 - crying. The child was shocked, and asked why.

The old boy replied that farmer had taken him aside and said, "You are too old and infirm to be worth your wages to me any more, so I am letting you go at the end of the week."

Now this old chap - his home, a tied cottage, belonged to his employer. He would have to get out then and there. The cottage was in lieu of cash wages, all but a few shillings, because he had the use of its garden to grow vegetables for his family, and maybe keep a pig. Milk he might get from the farm, if the employer was generous, likewise leather for shoes; he would be allowed to collect wood for firing (cooking and heating and washing) but there would never be enough cash money to save anything. And there was no other employer around, apart from the fact that he had no other skills. No Unemployment Benefits, Disabled Benefits, Income Guarantees then. Trade Union? For farmworkers? You must be joking. Any children he might have would be as poor and trapped as he.

So what was his future, after a lifetime of service? To go to the workhouse, where he and his wife would be separated, placed in communal dormitories, and allowed to see each other for maybe an hour once a week, at compulsory Sunday church service, and to stay there until they died. To see his children and grandchildren even more rarely, possibly never. Their few possessions sold, given away or scattered, even their clothes replaced by the shameful compulsory uniform of the indigent.

That scene took place in the twentieth century, just before the First World War. Over and over again, probably. In a country which was then a world leader, rich and powerful, able to command the luxuries of the earth for its ruling classes. And people wonder why working people left the countryside for the towns in their thousands, why trades unions were so militant, why after the Second World War, the Conservative Party was thrown out of office despite Winston Churchill's war record.

What happened to my great-grandad? The First World War came along; he got drafted, as did every man who could be spared by the landowner, who thought the least he could do, being patriotic, was send "his people" off to war. He survived the Western Front, unlike most of his peers, but he never went back to the village. And he never forgot those tears.

Saturday, June 17, 2006

O Frabjours Day Calloo Callay He Chortled In His Joy

Most important link I have yet published.

Very many congratulations from a humble admirer.

Saturday, June 10, 2006

The Wilder Shores of Arthritis: Fit the First

I would like to thank The Goldfish without whose patient expert advice this blog would have no pictures.

Non-steroidal anti-inflammatory drugs. The very phrase is like a bell, to toll me back to my arthritic self. For reasons with which I won't bother anyone, I've been off my usual intake for a while now, with the result that I am slowly but surely stiffening up, especially in the mornings. Where would we be without them?

Arthritis is as old as mankind, huddled miserably in damp pigskin loin-cloths and dripping mammoth-hair overcoats around the cave fire. Bones showing arthritic changes go back millennia. Oetzi the Iceman had not only bones with arthritic changes, but also tattoo-like puncture patterns suggesting that he might have been treating the pain by acupuncture*. So, although it seems to have been accepted as part of life's rich tapestry to a degree - there are not nearly as many old recipes for arthritis or rheumatism cures and treatments as there are, for example, for the pox, or even mad dog bites - mankind put their heads together and observed that some things made it easier, some worse.

The ancient Egyptians certainly knew about arthritis. Ramses II (1279-1213 BCE) suffered from it, as evidenced by his mummy. There is nothing like a royal connection to concentrate the doctors' minds on an illness; look at porphyria and haemophilia.

The Ebers Papyrus, from 3,000 BCE, deals with gout, and also with neck stiffness: "Another remedy: When you see a man in whose neck is mucilaginous matter and he suffers from the joint of his neck, he suffers from his head and the vertebrae of his neck are stiff, his neck is heavy. it is impossible to look at his belly or very difficult.
Then you shall say: someone having mucilaginous matter in his neck.
Then you shall cause him to anoint himself and to apply ointment, so that he will improve at once."

The diagnosis of sciatic pain was described with precision in the Edwin Smith Papyrus (1700 BCE): "If thou examine a man having a sprain in a vertebra of his spinal cord, thou shouldst say to him: extend now thy two legs and contract them both again. When he extends them both, he contracts them both immediately because of the pain he causes in the vertebra of his spinal column in which he suffers. Thou shouldst say concerning him: One having a sprain in a vertebra of his spinal column".
- This method of examination is what medical students today know as Lassauge’s test.

Painful joints were treated by ointments which had, as a base fat, oil, bone marrow, gum or honey. To this they added flour, natron, onion, cumin, flax, frankincense or pine. (Flax seed (linseed) or animal fat is still used today in Egyptian and European folk medicine as an ointment or poultice for rheumatic pains). Poppy and thyme were noted as analgesics. Myrrh was the treatment prescribed for backaches, whether internally or externally I don't know.

Twenty-five hundred years after the Ebers scribe, Hippocrates wrote an entire and very sensible, practical treatise (On the Articulations) about treating all varieties of fractures and dislocated joints, but seems to have lost it a little when it comes to "pains of the back, the loins and of the hip joint". Observing that these come on with walking, the good doctor suggests that they are therefore caused by the walking, so you should stop it, thus ushering in immobilization therapy for arthritis, which only well into the latter half of the twentieth century has been conceded to do more harm than good.

Hippocrates, unfortunately, also roundly declared that "All diseases are resolved either by the mouth, the bowels, the bladder, or some such other organ. Sweat is a common form of resolution in all these cases." (On Regimen in Acute Diseases) Again, these words were treasured by his successors down the ages and we shall meet something very like them published less than fifty years ago.

The Romans carried on the Hippocratic tradition. Dioscorides (c.40-c.90 CE) and then Galen (130-200 CE) were mostly concerned with preserving and transmitting the Greek theory and practice as they understood it; they even wrote in Greek, in preference to Latin; they were not innovators (although Dioscorides does advocate the use of gentian against muscle cramps, which I haven't seen elsewhere). Galen took Hippocrates' notion of illness being an expression of an imbalance and formalised it thoroughly into what became known as the Doctrine of Humours (see below).

Some of the things our ancestors tried - usually on the belt-and-braces principle that if two things helped a bit separately, they must be even better when combined - make the treatment seem worse than the condition, at least to modern eyes.

Bald's Leechbook is an Anglo-Saxon text which dates from about 950 CE. Bald didn't write it; he commissioned scribes to compile it from much earlier Mediterranean and English sources, now lost. He has an interesting cure for "healswærce" (pain in the neck): the lower part of a nettle boiled in ox fat and butter mixed with ox gall in vinegar. Interesting, because "urtication" is still used today as a sort of herbal TNS, akin to capsaicin therapy. Memo: don't try either of these yourself except under medical supervision. Mind you, I much prefer the idea of that to another of his ointments: pigeon's and goat's droppings dried, crushed, and mixed with honey and butter. Shoulder and arm pain are to be treated with betony boiled in ale (drunk) and an ointment made of wenwort, which was probably much safer than the recipe for a painful knee: "cnua beolenan & hemlic, beþe mid & lege on." (Grind henbane [active principle: hyoscyamine] and hemlock [active principle: coniine] [both powerful poisons], bathe with it and lay it on". It would certainly more than take care of the pain.

The Lacnunga, an 11th century collection of Old English recipes, suggests for "liðwyrce" (limb pain) an ointment made of elecampane, radish, wormwood, bishopwort, cropleek, garlic, holleek, celandine, and red nettles, ground and boiled in butter then stored in a bronze vat until it turned blue (?mouldy). Alternatively, you could say a charm Ad articulorum dolorem constantem malignantem: "diabolus ligauit, angelus curauit, dominus salutauit, in nomine, amen." (The devil bound, the angel cured, the Lord saved, in [His] name, amen." History does not report what you were to do when that didn't work either.

The Herbal of Apuleius was translated into Old English from Latin and isn't any the more appetising; it suggests you take six ounces of greatwort (?) and six of goat's grease together with eighteen ounces of oil of cupressus, grind and mix them together and use as an ointment. Alternatively, for "stiðnes on lichoman" (body stiffness) you could try wood dock and old pig's grease and breadcrumbs crushed and made into a poultice. People would certainly know that you were present.

When considering Anglo-Saxon remedies, it's important to remember that their theories of disease were not quite like modern ones. They certainly believed in restoring balance and harmony as a cure for some disorders, but also in the activities of malign supernatural entities: flying venom (fleogende attor),worms (wyrmas, burrowing entities), dwarfs (dweorh, no, not Tom Shakespeare, more like what we would call gnomes or trolls), and elves who were believed to shoot darts into humans and animals (ylfa gescot), the shot causing, especially, rheumatism, arthritis and stitch. The existence of tiny stone arrowheads (Neolithic or Mesolithic in origin) was held to prove this, and as late as the twentieth century, such arrowheads were also used in folk medicine to "cure" such conditions, as like cures like (an usage that would have appealed to Hahnemann himself - see below).

Pause for a rant here: the treatment of folk remedies by the medical establishment highlights one of the most irritating facets of a discipline that claims to be ruled by scientific thought: their persistence in throwing the baby out with the bathwater. In deriding and dismissing the old herbalists and wise women, doctors never seems to have grasped that it is possible for the former to be right for the wrong reasons. Just as Dr Withering gets all the credit for digitalis (extract of foxglove) as an effective treatment for heart failure (for which it is still used, incidentally, in its synthetic form, digoxin), despite the fact that it had been so used by wise women for centuries, so the Reverend Edward Stone's reporting of the anti-rheumatic and febrifuge properties of willow-bark was disregarded by the medical establishment for a hundred years.

*I am indebted to Sally for this information.

Thursday, June 08, 2006

The Wilder Shores of Arthritis: Fit the Second

Rev Stone and his predecessors adhered to the old Doctrine of Signatures, which said that every plant, being created for man's use (cf The Book of Genesis), had in its appearance or habitat something to guide one to its use. Willow, growing and flourishing in damp conditions, would naturally be a specific for diseases associated with such conditions. Felix Hoffmann later independently developed acetyl-salicylic acid for the Bayer Drug Company in 1899: aspirin. This is a synthetic form of the substance which naturally occurs in willow-bark, which had been recommended by physicians for its analgesic properties as far back as Hippocrates. A substance might be used for the wrong reasons; but the fact that it kept on being used might suggest that it did have some efficacy. Only now, driven by the need for new treatments, are medical researchers studying folk usages with an objective instead of a dismissive approach.

When looking at this early medicinal advice, it's important to remember also the Doctrine of Humours. This was a theory, going back to Hippocrates at least, formalised by Galen and still surviving unconsciously today in folk remedies. It's similar in essence to Chinese and other eastern medical theory: the body contains certain elements (the humours in this case) that can get out of whack for one reason or another; one comes to dominate over the others; disease results, and the treatment must consist of restoring balance and harmony. In Western medicine the humours were held to be: black bile, yellow bile, phlegm and blood, and each would have the qualities of cold/heat and moist/dry. So plants and, later, post Paracelsus, chemicals with these qualities were the ones to be used to sort things out. We are now drifting well into the realm of abstract philosophical theorising and to hell with what actually was wrong with or helped the patient.

Back to the story. In medieval times the situation wasn't much changed. A MS of the reign of Henry VII contains a recipe "ffor all maner ache yn senos [sinews] or juntys [joints]" which suggests that you boil thyme in wine to a concentrate, in which you then boil a red cloth. Then wash yourself with the hot herb water and cover the affected parts with the cloth. As a matter of fact, red flannel was supposed to have protective properties - the flannel certainly would be very insulating, although the colour choice is probably down to sympathetic magic - and petticoats made of it were in use well into the twentieth century in Britain.

(A propos sympathetic magic, I can't resist quoting two instances from Frazer's The Golden Bough: if your fingers are stiff, collect some long-legged spiders and roast them, then rub your fingers with the ashes. The suppleness and nimbleness of the spiders will be transferred to your fingers. Again, for a case of gout or rheumatism, rub Spanish pepper into the fingers and toes of the sufferer: the pungency of the pepper will be too much for the gout or rheumatism, which will then depart in haste.)

Our anonymous medieval scribe has a cure for sciatica also: "Take a sponnefulle of the galle of a rede oxe and ij sponnfull of the wat[er] of Culerage [water pepper] and iiij of his owne water [urine] and as moche comyn [cumin] as half a french note [nut] and as moche sewet [suet] as a small notte and breke and bruse thy cumyn then boyll all thes together tyll they be grewell [gruel]." The patient then warmed his bottom against the fire and the concoction was rubbed in and he was sent to bed in heated sheets. I don't think the heat treatment would do much for the sciatica but it would help the patient to relax and, if he had arthritis and muscle spasm, heat and massage would help those. The contents of the spice cupboard I'm not so sure about; maybe they were local skin irritants.

Nicholas Culpeper (1616-54) was an astrologer-physician (the disciplines were not mutually incompatible then) who wrote a hugely influential Herbal, firmly based in the Doctrines of Signatures and of Humours, and with the astrological qualities of the herbs conveniently specified. By which we learn that All-Heal (aka Self-Heal, Prunella vulgaris) is "under the dominion of Mars, hot, biting, and choleric.... helps all joint aches." While also effective against "the bite of mad dogs and venomous beasts", hence the name, I suppose. Oil of chamomile (Anthemis nobilis), which he says "is much used against all hard swellings, pains or aches, shrinking of the sinews, cramps or pains in the joints", is still much prized by herbalists today as an anti-inflammatory . Comfrey (Symphytum officinalis), similarly, has been investigated and found to have therapeutic qualities, particularly in wound and ulcer healing; Culpeper suggests a poultice of the fresh leaves applied to painful or gouty joints.

Ground Pine (Ajuga chamæpitys) is, apparently, another martial plant, and is to be prescribed for palsy, gout, sciatica, rheumatism, scurvy, and all pains of the limbs. Palsy and scurvy are presumably in there because both of them can include joint and/or muscle pain in their symptoms. The root of horseradish (Cochlearia armoracia) (Mars again) is also recommended as a poultice for sciatica and joint-ache; I wonder if this would be yet another capsaicin-like counter-irritant? Raw horseradish certainly is, as is rue (Ruta graveolens) (under Leo, the sun, this time); rue causes extremely painful blistering of the skin, if gathered in sunlight. Tea made from tansy (Tanacetum vulgare) (Venus), a known, if drastic, vermifuge, if it didn't help the sciatica and joint-aches at least provided an urgent distraction.

The gardener's foe, Ground Elder (Ægopodium podagraria) (Saturn) is also significantly known as Goutweed; "it heals the gout and sciatica; as also joint-aches, and other cold pains."

Of course, Culpeper was a professional, licensed, physician. Thousands of amateurs, housewives, wise men and women of all sorts, had their own private recipes concocted in their stillrooms up till the end of the eighteenth century at least. One such, from Essex, is "Sir George Horseyes Green Ointment for Aches proceeding from a Cold Cause for Shrunke Sinews in Man, or Beast, & for Strains it's incomparably good & holds Perfection 40 years." It should; collecting the list of ingredients alone would take long enough: mallow, groundsel, strawberry, cotton lavender, birch leaves, chickweed, comfrey, parsley, sage, bay leaves, chamomile, adders' tongue [a fern], ox-eye daisy. But you haven't finished: roses, frankincense, pork lard, butter made in May and clarified in sunlight, salad oil, turpentine, verdigris. Blend and boil this lot, decant into closed containers and bury them three-feet deep in a pile of horse manure [I swear I am not making this up] for three weeks. Then boil them up again, strain, and add spike lavender oil. Apply to the affected place gently warmed. Well, it might smell nice.

This recipe illustrates what a pickle medicine had got itself into by the dawning of the nineteenth century. The professionals were increasingly distanced from reality into theories, while the laity were piling Pelion on Ossa in vain attempts to make sure that something worked, even if it was only the application of local heat and massage. Meantime the nineteenth-century arthritis sufferer found more emphasis placed on inorganic and less on herbal treatments, although the principles of heat and counter-irritant remained basically unchanged: "Rheumatic Plaster. Take one-fourth pound of resin and a like quantity of sulphur; melt by a slow fire, and add one ounce of cayenne pepper and one-fourth of an ounce of camphor gum; stir well until mixed, and temper with neatsfoot oil."

Those who rejected "chemical drugs", then as now, tended to retreat into a dream of "natural" remedies, like Sir William Withey Gull, Queen Victoria's personal physician (and one-time candidate for the rôle of Jack the Ripper); he wrote Rheumatism Treated by Mint Water, though whether he tried it on his Royal patron I don't know. She, by all accounts, preferred whisky, laudanum and cocaine. (How unlike, how very unlike, the home life of our own dear Queen.)

Tuesday, June 06, 2006

The Wilder Shores of Arthritis - Fit the Third

The eighteenth century had added the attraction of visits to spas and hot springs and sea-bathing (for the rich), and this survived until the Edwardian era at least. Hydrotherapy (hot or cold) and medicinal waters had been known since antiquity; certainly since the Ancient Greeks venerated the shrine of Aesculapius; now they were re-invented with the impetus of dubious scientific theories. Crounotherapy is the process of "drinking the waters", balneotherapy of medicinal baths, and thalassotherapy of medicinal sea-bathing (recreational sea-bathing didn't come in, in Europe, until well into the 19th century). Spa waters were usually either sulphurous, chalybeate (iron-contaminated, Sam Weller's warm-flat-irons taste) or saline (salt or brackish); the most effective for arthritic and rheumatic complaints was the saline, externally; it was the ancestor of the modern hydrotherapy pool.

Because bathers float better in a strong salt solution, they can mobilize inflamed joints and muscles gently and safely, freed of much of the pull of gravity. The "brine baths" at Droitwich were four times as salty as the Dead Sea and were much in vogue in the early 19th century.

St Ann's Well, at Buxton, goes back to Roman times. Thomas Cromwell tried to close it as a Papist shrine during the Reformation, but evidently did not succeed; Mary Queen of Scots, who had rheumatoid arthritis, paid several visits, and in the 17th century some anonymous poet wrote

Old men's numb'd joints new vigour here acquire;
In frozen nerves this water kindleth fire,
Hither the cripples halt, some help to find,
Run hence, their crutches unthank'd left behind. (1662)

It is perhaps necessary to remark, that the same waters were used for internal and external treatments, occasioning some temptation to the more economically-minded spa owners and risks to their clients, as one Christopher Anstey pointed out in 1766:

You cannot conceive what a number of ladies
Were washed in the water the same as our maid is...
So while little Tabby was washing her rump
The ladies kept drinking it out of the pump.

Not that that possibility deterred the arthritics, who will try anything once: Madame de Sévigné treated her aching joints to the cure at Vichy, which consisted of drinking water tasting of saltpetre and then being hosed down by hot douches of the same (which she describes as "a good rehearsal for Purgatory"). Jane Austen's brother Edward took his gout to Bath in 1799; "I fancy we are all unanimous in expecting no advantage from it," she wrote.

Cold hydrotherapy, reasonably enough, was much less popular with arthritics, although Sir John Floyer of Lichfield (Samuel Johnson's family doctor, incidentally) in the 18th century did build a cold bath for his rheumatic patients, accompanied by the standard bleeding and purging, just to make unpleasantly sure.

Homeopathy was also formally discovered in the eighteenth century, 1790 to be precise, by a German physician, Samuel Hahnemann (1755-1843). It remains a contentious subject, even today, with many ardent adherents and bitter opponents. The basic principle, which Hahnemann, a humane practitioner, developed in reaction to the increasingly aggressive and toxic treatments being inflicted on patients by his fellow doctors, was similia similibus curentur, "let likes be cured by likes": so that if you have a symptom, say, fever, you give a little of something which promotes fever, in order to stimulate the body into producing its own reaction. Like immunisation, in fact.

(Actually it was all based on a misunderstanding of a disease process. Hahnemann had observed that quinine "cured" malaria. He found that when he, not having malaria, took some quinine, he developed, and then recovered from, symptoms which he assumed were the same as those of malaria - they were not, they were his idiosyncratic reactions to the drug, which were alleviated as the drug wore off. Not for another hundred years would people know that the symptoms of malaria are caused by a parasite in the blood, and that quinine kills one stage of the life cycle of this parasite.)

Unfortunately the elaborations and rationalizations which have accrued to justify his theory have thoroughly discredited homeopathy in the minds of most mainstream scientists. Put brutally, the physical and physiological bases of these theories are nonsense. They are based on eighteenth-century knowledge and theories, pre atomic theory, pre microbiology and germ theory itself, pre any notion of the endocrine system, the lymphatic system, the immune system....

Nevertheless, homeopathy can work. I say that because I have seen it work, in people and animals, just as I have Bach Flower Remedies, and I don't know any reason why they should succeed either. For arthritis, some of the remedies used in homeopathic doses include Rhus Tox, Poison Ivy (Rhus toxicodendron), Bryonia, White Bryony (Bryonia alba), Ledum, Wild Rosemary (Ledum palustre), Ruta Grav, Rue (Ruta graveolens) and some non-organic compounds Calc fluor and Causticum. Take at your own risk; they are diluted so far that not one molecule of the active ingredient remains, anyway.

Aspirin is a useful anti-inflammatory, thrombolytic, analgesic, and febrifuge. The chemical basis was first synthesised in the 1850s but in that form it was dangerously irritating and it was not until the 1890s that, as I have said, it became available to the general public.Moreover, it's cheap and available off-prescription in the UK. Unfortunately, and this is a quality it shares with all subsequent arthritis treatments, it is also a gastric irritant. Take a lot of it regularly and you will probably not die, but you will have one hell of a bellyache and bleeding, ulcerated gastric mucosa. This is why it should always be buffered by enteric coating, food, or at least milk.

(An interesting sidelight on patient psychology: aspirin has no sedative or hypnotic action whatsoever, but in the first half of the twentieth century, it was very commonly taken as a sleeping-pill. Why? Presumably because, when taken by someone with some kinds of chronic pain, it eased the pain and allowed the person to sleep. So does morphine, but morphine does also have a sedative effect. The assumption must have been that aspirin works in the same way: the power of placebo illustrated.)

Sunday, June 04, 2006

The Wilder Shores of Arthritis - Fit the Fourth

Before leaping into the twentieth century, a word about painkillers in general, not just anti-arthritis drugs. (We'll get to the NSAIDs one day, I promise.) Pain is only a symptom that something has gone wrong. If you have acute pain from a single reversible cause, such as a fracture or an abscess, you can hope to relieve the pain by curing the cause. If, however, you have a chronic condition, such as arthritis, where the pain is due to multiple irreversible tissue changes and damage, you could, excluding surgery, relieve the pain only by (a) physically interrupting the sensory nerves which supply the information to the brain (b) distracting the patient physically (by counter-irritant) or psychologically (by analgesic, antidepressant, sedative or hypnotic) (c) continually damping down the inflammatory response which is causing the pain.

For most of history, option (b) has been the only one available. The daddies of all analgesics are, of course, opium, and alcohol. Opium goes back long before Hippocrates (fourth century BCE); it has been recorded by the ancient Assyrians, Sumerians and Egyptians, and appears in ancient Greek legends as well. Alcohol probably dates to when the first man ate a bit of rotting, fermented fruit and liked the sensation of getting high. The problem with them is that they are both potent CNS (central nervous system, ie the brain) depressants and they both cause habituation. A weaker ancient alternative to opium is lactuarium, extracted from the juice of wild lettuce.

Mandrake (Atropa mandragora) was used by the ancient Egyptians 1400 years BCE; it is one of the Solanaceae (potato family) as is henbane (Hyoscyamus niger). Cannabis (Cannabis sativa) was known to the ancient Chinese as an analgesic but seems to have been used recreationally by everyone else. Hemlock (Conium maculatum), the poison that killed Socrates, was used by the Romans and in medieval times in poultices and as "sleeping sponges" - a form of analgesic glue-sniffing.

Opium dissolved in alcohol became the basis of many analgesic/sedative tinctures, the most well-known of which is laudanum, the favourite tipple of Samuel Taylor Coleridge, Wilkie Collins, Branwell Brontë and many other unfortunates, who became insidiously addicted. In 1805 morphine was refined from raw opium. When its addictive properties were realised in turn, diamorphine was developed as a further, safer, refinement; ironically, although it is a much stronger painkiller, it is also many times more addictive. After the first world war, in the UK and many other countries, the opiates (except for codeine in the UK) were declared to be Dangerous Drugs and their use strictly forbidden without prescription; cannabis followed in the 1930s and the barbiturates in the 1950s.

Also in the 1950s came a Wonder Drug, the first of all the synthetic steroids - cortisone. Its discoverer, Tadeus Reichstein, and his co-scientists, got the Nobel Prize for its discovery. Corticosteroids are produced naturally in the body by the adrenal cortex; they are essential hormones involved in the stress response, immune response, and inflammatory response amongst other functions; the immune and the inflammatory are the ones that concern arthritics. They revolutionised the treatment of intractable disabling inflammatory and autoimmune conditions like Crohn's, ulcerative colitis, asthma, lupus, sarcoidosis, psoriasis. They also had horrendous and often irreversible side-effects, as may any drug, but this was not realized until quite some time later.

Meanwhile, over-prescribing ("Let's see what other conditions it will cure") and overdosage ("If one milligram works then two milligrams must work better") had done their damage: the loss of bone, the thinning of skin, damaged gastric mucosa, diabetes mellitus, behavioural changes, notably aggression and delusions.

When the side-effects of steroids became apparent, many alternative painkillers were developed: good old over-the-counter paracetamol, phenacetin (long-since banned); the NSAIDs: mefenamic acid, ibuprofen, indomethacin, naproxen, diclofenac sodium; the opioids: tramadol, pentazocine, buprenorphine....they all have their disadvantages to the continual user. Those that aren't gastric irritants or addictive tend to be hepatotoxic (paracetamol) or nephrotoxic (phenacetin).

But steroids were the first class of drug to tackle the problem of arthritis at a stage more sophisticated than just masking the symptoms. Everyone ever since has been hoping for the philosopher's stones: why does osteo-arthrosis occur in the first place, in some individuals and not in others (rheumatoid is certainly an autoimmune reaction); how exactly does it do its damage; and thus, what can be done to prevent, or if not that, reverse it?

These are still largely unanswerable questions in the 21st century.

Let's say there's going to be a genetic predisposition: even if (when) we can identify the gene(s) responsible, and if (large presupposition) it turns out that these genes don't also have a benevolent function as well which we can ill do without: what are we going to do about it? Is the arthritis gene to be added to the growing list of ills that flesh is no longer going to be heir to because they are going to be screened out at the pre-implanted embryo stage or by abortion?

It is now possible to detect the bony changes of arthritis much earlier and more easily. There is now a recently-developed technique called acoustic emission which can be used by any GP in his local surgery, to actually hear the noise made by the moving joint, before any symptoms of pain or stiffness have even become noticeable. Fine; but what do you do then, if you can neither limit the damage (because you don't know the why) or reverse it (because you don't know the what)?

Friday, June 02, 2006

The Wilder Shores of Arthritis - Fit the Fifth

In the face of this mainstream helplessness, alternative therapies have burgeoned. Some people swear by acupuncture, not just as a treatment but as a cure. Acupressure can also work, but for a while only; as soon as the pressure is released, back comes the pain.

People with rheumatoid have a list as long as your arm of food they should, and should not, eat. Studies show that fish oils, for example, have a beneficial effect, on both rheumatoid and osteo, so we all gulp cod-liver-oil until another set of studies casts doubt. Partly, of course, this is the fault of the modern media intrusion into areas of scientific interpretation they are just not competent to dabble in. For instance, I recall an excited news report a couple of years ago that some component of green tea had found to be useful in preventing/reversing the degeneration of osteo. So of course, I pricked up my ears. The truth is rather less dramatic. It is likely, that if you drank green tea every day for about forty years, you might slightly reduce or delay the damage to the joints. That's all. You might well also suffer some side-effects, such as hallucinations, from the green tea, which itself is mildly toxic in quantity, if you overdid it.

The media also never seem to be able to distinguish between osteo and rheumatoid; it never seems to occur to them that, if the causes and effects are quite distinct, the preventatives and treatments might be so as well.

Aromatherapy apparently traces its origins back to Ancient Egypt, specifically the use of spices and essential oils in embalming. Erm, yes, though I can't imagine an allopathic clinician would seek to win confidence for his ars longa by claiming skills and practices honed in the undertaking trade. Anyway, it is a branch of phytotherapy, or herbal medicine. I had not realised that it can be internal as well as external in application. It boasts an impressive list of essential oils that can be used externally for arthritis (which type? it doesn't distinguish), gout, and rheumatism, from Angelica, via Eucalyptus and Nutmeg, to Thyme. This means, of course, massage with rubbing alcohol or sweet oil; a treatment in itself. Internally, Garlic, Juniper, and Onion are among the oils recommended.

A recent report on osteopathy and chiropractic has concluded that the benefits they bestow, as far as these diseases are concerned, are no better than placebo, much to the predictable outrage of their professional associations. This seems to me to miss the point with admirable precision: if you have no effective treatment or cure, then placebo is what you use, allopath, homeopath or whatever. It may even help. I myself have got much benefit from reflexology, which the BMA doesn't even deign to recognise, much less assess; I am quite sure that the benefit is placebo-derived but what the hell? It relieves the pain for a while without giving me an ulcer, blood dyscrasia, or liver damage, and that, these days, is something to be thankful for.

Urtication, TNS and capsaicin therapy all work essentially on the counter-irritant principle. TNS is derived from the "gate theory" of pain transmission. The idea is that the spinal cord can transmit only so much sensory (pain) information; fill the fibres up with the impulses generated from the TNS machine, and there is no room for the signals from the complaining skeleton. It's a bit of a circular argument: TNS works because the gate theory is correct, and the gate theory is proved to be correct because TNS works. (It does, incidentally, but not for every kind of pain.)

Urtication (nettle-stings) and capsaicin (derived from capsicum peppers) are local skin irritants just like Ralgex. Probably it's the rubbing-in, the massage, which gives as much relief as anything. St John's Wort oil (Hypericum perforatum) is another rubifacient with a good reputation. They can all cause local skin allergic reactions.

In some people, for example the late actor Jack Warner, bee-sting therapy has worked dramatically; the poison seems to stimulate the innate antiinflammatory response just right, and the stiffened, aching joints are released and move freely. Nobody knows how exactly it works.

(Incidentally, it was hoped that a dermal plaster of paracetamol preparation would be just as effective an analgesic as an oral dose while avoiding the gastric irritant effects; sadly, longer trials have revealed that any but the briefest usage reduces the user's response to the drug to the point where pain relief is inoperative.)

Herbal remedies, of course, persist, many of them never having been updated since Hippocrates, either in their materials or in the theory behind them. A sentence such as "constipation is almost always a factor in rheumatic disease, causing toxic overload" and recommending purgatives and diaphoretics, would have commended itself to all those ancient practitioners who thought that disease was down to mysterious malignant entities who must be physically expelled - by any orifice available - before curing could take place. I am considerably pro herbalism, but only if it is conducted in a properly scientific manner, accompanied by at least some knowledge of anatomy, physiology and disease processes, not a regurgitation of a couple of millennia's worth of exploded theories born of nothing but ignorance.

The book I am quoting from - I won't be so cruel as to name it, because it's only typical - cheerfully conflates rheumatism, fibromyalgia, osteo-arthrosis and rheumatoid arthritis as if they were all one and the same, then states "in all forms of rheumatic disease there are two main causes: stress, tension, and personality problems....and a poor, inadequate diet." We-ell, up to a point, Lord Copper. Stress and tension and personality problems generally are certainly factors in autoimmune inflammatory conditions, in that they make them worse, but cause....? Diet, again, can exacerbate these conditions by inadvertently providing allergens or excluding needed nutrients, but cause....? Face it, nobody knows precisely what triggers off such conditions, least of all the authors of popular herbals.

Willow, of course, is recommended, so are nettles (taken internally, as tea); and soothing rubs of chamomile; so far, so traditional. Other remedies include cowslip, onion, lemons, celery (seed) and seaweeds; more exotic are Devil's Claw (Harpagophytum procumbens) from Africa, which has been clinically investigated, mainly in Germany, and Guiacum (Lignum vitae) from the West Indies. Devil's Claw needs to be treated with care; I don't know how effective it is in treating rheumatism or the arthritises, but it has a potent effect on insulin metabolism, so diabetics beware. Guiacum, curiously enough, has a long history as a specific for syphilis; there is a form of acute inflammatory arthritis which is secondary to untreated syphilis, so perhaps that is the connection: it doesn't cure that either.

Wednesday, May 31, 2006

The Wilder Shores of Arthritis - Fit the Sixth And Last

Some hope appeared in the 1990s with the development of glucosamine and chondroitin as alternative drug therapies. Both have been investigated thoroughly, but not thoroughly enough for NICE; they're not in the British National Formulary nor freely available on the NHS. So information about them is somewhat limited. They are both substances that occur naturally in the body; glucosamine is an amino sugar and chondroitin a protein. Glucosamine is believed to be essential for cartilage formation and repair, while chondroitin gives cartilage elasticity. So far so good; it seems logical that supplements of these might help to repair, if not prevent, the tissue damage. The medicinal form of glucosamine you can buy over the counter is derived mostly from sea fish such as crabs, lobster and shrimps, and chondroitin from sharks (sharks, a very primitive life-form, do not have bones in their bodies, only cartilage).

Glucosamine has been extensively studied, and the general conclusion seems to be, that it gives results better than placebo in two respects: pain relief and slowing-down the degenerative process. For chondroitin the picture is considerably less clear. They both seem to be reasonably free of toxic side-effects at therapeutic doses, although studies of long-term usage have not yet been completed. They do not either prevent or reverse the damage, as far as is currently known. Wouldn't you know it, the commonest reported side-effects of glucosamine are gastro-intestinal; plus ça change.

In recent years several studies have been done on the use of music therapy in controlling, or at least alleviating, chronic pain. As far as joint pain is concerned, it is claimed that listening to music can have "statistically significant" effects on the level of pain experienced, "reducing pain, depression and disability and increasing feelings of power", although the British Pain Society is more cautious about such results, noting that the effects are of short duration and do not amount to much more than "distraction". As against this, clinical trials purport to have shown that music can release endorphins and change catecholamine levels so as to relieve pain, decrease blood pressure, heart and respiratory rate, oxygen consumption, and serum lactic acid levels.

If anyone is interested, a couple of useful references are listed at the end of this blog.

Surely the oddest prophylactic/treatment for rheumatism and arthritis must be the wearing of copper bracelets. Odd, because any effect is almost certainly pure placebo; I say almost, because there may be things about the role of copper in the human metabolism not yet discovered. The theory is, as I understand it, that traces of copper are absorbed through the skin under the bracelet and are in some way beneficial to the disease. The enzymes cytochrome c oxidase and superoxide dismutase are essential to normal cell function; both contain copper atoms which is why some copper (about 70 mg per average adult, with a daily intake of 1-2 mg) is essential to life, but copper is so ubiquitous in foods of all kinds that deficiency is virtually unknown.

There is a very rare condition, Menke's disease, where the gene responsible for copper use is lacking, but it is incurable and untreatable, and leads to death in early infancy. In any case, copper's function is principally with the liver, muscles, and brain; it is not, as far as is known, more than marginally necessary for the normal function of joints, bones and collagen. Deficiency, induced artificially in clinical trials, produced raised cholesterol, hypertension, anaemia and lethargy, not joint disorders.

Moreover, copper itself, in excess, is a poison. Wilson's disease is a genetic disorder resulting in the inability to utilise copper properly, so that it builds up in and damages the brain; it is treatable. Workers on fruit farms and vineyards used to be exposed to high levels of copper sulphate from sprays (Bordeaux Mixture) and suffered accordingly. They would be liable to inhale the sprays and absorb some through the eyes and mucous membranes. But it is, after all, unlikely that the wearer of a copper bracelet would absorb any of the copper at all, intact skin being a very efficient barrier.

The most likely derivation of copper bracelet therapy goes back to magic and the very ancient, still continued, practice of wearing of protective amulets and talismans. Nonetheless, if you think it is doing you good, then it probably is, psychologically at least, so why not?

I have deliberately left surgical intervention till last. This is, after all, a very recent option. Emergency orthopedic surgery, for fractures and battle injuries, is probably as old as mankind, but surgery for arthritis comes under the heading of elective surgery. Anaesthetics, blood transfusions, and antibiotics were needed to render surgery safe, especially the latter as bone infections used to be killers and are still very difficult to treat even today. Also needed was the development of modern hypoallergenic lightweight metal alloys, and plastics and glues.

The first elective orthopedic surgery was done, as early as the 18th century, on cases of bone and joint deformity due to rickets, polio, or TB. The first arthritic-specific prosthesis I can find was made of ivory, for the femoral head, and was developed by Ernest William Hey Groves (1872-1944) in the nineteenth century. Rejection must have been a problem in the days before immunosuppressive drugs. Modern total hip replacements date no further back than the 1960s, when Sir John Charnley developed prostheses of metal and high density polyethylene, attached to the existing bone with methylmethacrylate cement. Since then, uncemented arthroplastic techniques for the hip have appeared, and, in the 1970s, total knee replacements using similar methods. Nowadays, shoulders, elbows, wrists and ankles can also be replaced.

It is perhaps not always appreciated, though, that these replacements have a limited life. Anyone requiring them early in life is liable to be readmitted to hospital fifteen or twenty years later, suffering, quite simply, from metal fatigue.

One change there may yet be, and it's not medicinal. As was pointed out in The Summer of a Dormouse - one of the contributors to The Goldfish's BADD thread - ageism is a powerful factor in deciding which medicines get developed, which treatments get researched. Up until now, the diseases of age have got a very poor slice of this particular cake, and osteo-arthritis, traditionally, has been seen as a disease of the elderly. (Rheumatoid, being recognisably a disease suffered by younger people as well, gets a much higher profile.) So who cares if an eighty-year-old can't get out of bed in the morning? He's not an Economic Unit.

Well, first, it is becoming increasingly clear that osteo is not exclusively a disease of the old. Second, even eighty-year-olds may be needed in the workplace if current trends continue. So research into the "diseases of ageing" may well get an economic and political impetus at last.

McCaffrey, Ruth and Freeman, Edward: "Effect of music on chronic osteoarthritis pain in older people" Journal of Advanced Nursing 44 (5), 2003, p. 517-524
Siedlecki, Sandra L and Good, Marion: "Effect of music on power, pain, depression and disability" Journal of Advanced Nursing 54 (5) 2006 p. 553-563