Greek

The Towy this morning - you can't actually see its normal banks

I got absolutely soaked yesterday walking west up the Towy Valley but it was better today walking east, though I needed my wellies to trudge on the valley floor much of which is still under water. You can see how the river changes its course over the years as it finds a quicker route and digs away at the banks during the floods. Presumably the familiar pattern of meandering and stranded oxbow lakes is caused as much by flooding as by routine erosion - I can't remember as I gave up geography aged 12 (it was that or Greek).

While I am walking I hear on the news that it has been the wettest January since 1767 - clearly they say an indication of global warming (sorry I mean "climate change" - since it got colder they have moved the goal posts and kept their options open).

On that logic there must have been a lot of greenhouse gas around in the mid-late 18c. That would have been all the smoke and soot coming out of those up-and-down pumping steam engines - they didn't invent steam engines which could actually turn a wheel until the 1780s.

For the record I am not myself a "climate change denier" (a cleverly coined, pejorative label sounding a bit like "holocaust denier") but a neutral observer with no knowledge of these things - it's all Greek to me (as it were).

What I observe is that there are vested interests of big business on the one side and shouty environmentalists (and, increasingly, other big business) on the other, debating about what remains circumstantial evidence (nothing wrong with circumstantial evidence but it tends to leave things somewhat unresolved); I also observe that "respectable" institutions have been caught out telling porkies or making false claims about the science. Humankind probably is affecting the climate but it is very hard to tell how much, whether for net better or worse, and whether it is worth trying to do anything about it.

But step forward the Prince of Wales to arbitrate this difficult matter. This week he addressed a conference of "sustainability entrepreneurs" (story here) where he called the sceptics "headless chickens". An odd choice of words as the expression is usually used about the people who are panicking. Right or wrong the sceptics are surely saying that we should not panic. Still, you get where he stands on this.

But then the Prince of Wales also campaigns vigorously for precious NHS resources to be expended on homoeopathy instead of (for example) mental health. Now that is one debate where the science is completely clear. There is no more evidence for the effectiveness of homoeopathy than there is for witchcraft or tarot cards.

Listening to my tiny mp3/radio while out walking - multitasking in action

Be More American

The City of Coolidge, Arizona, founded by my great uncle Dick - I don't know why

Sound advice for patients from Professor David Haslam, the boss of NICE (the UK Government's gatekeeper approving drugs and other treatments for NHS use - not the safety check but the benefit-versus-cost check if that makes sense) - see the story here and coverage on Hafal's Facebook platform here.

The Prof says we all need to behave more like Americans when we talk to our doctors. This means that instead of sitting quietly and being grateful for whatever the doctor decides to do for us, we should engage in a proper discussion and negotiate the best treatment available having regard to our own preferences.

The Professor says: "The fundamental point is it’s your body - and the more you understand about the drugs you are taking, or what you might be able to have, the better you are able to work with your doctor."

The Professor previously worked as a doctor near an American air force base and contrasts how his American patients engaged with him compared with the British:

"Americans tended to want to know more about their treatment than the British who tend to be much more ‘thank you doctor, I will take that’."

This is really important stuff. We hear a lot of debate about drugs and other treatments which NICE may or may not approve but this testimony proves that if you don't ask for the ones they have already approved you likely won't get them. I can understand the Professor's frustration.

We all know that this problem is much worse in mental health where several obstacles prevent patients getting the best treatment:

(1) Many patients struggle to articulate their needs because of their mental illness

(2) Doctors, like the rest of society, often have a problem with the idea of listening to mental health patients

(3) The complexity of so much of the medication, especially the antipsychotics - that difficult mix of variable effectiveness, unpleasant side effects, and difficulties in managing dosage etc

(4) Cost - even where NICE has approved we know that NHS Boards are keen to avoid using the more expensive drugs

(5) Access to psychological therapies - where do you start? Often not even considered by doctors and frequently unavailable if they are considered

This year Hafal is committed to working with our partners the Mental Health Foundation and Bipolar UK to help patients get the best possible treatments (this is in addition to our joint summer campaign on physical health).

Watch this space and other Hafal media - especially our next Mental Health Wales magazine which will have a special focus on treatments. You heard it here first.



Postscript:

Welsh people make good Americans as George Washington remarked - eighteen out of the fifty-six signatories of the Declaration of Independence were of Welsh descent.

Another fascinating view of Coolidge - there are more of these but I don't want to spoil you...

Wheedling And Pathetic

Longbow arrows - the Kalashnikov of mediaeval Europe

I've just finished reading Dan Jones' The Plantagenets in an effort to consolidate my knowledge of mediaeval history.

Much is familiar but it is enjoyable to trip through this series of kings (oh, and the Empress Matilda of course) most of them a bit thick frankly but alternately brutishly effective or wheedling and pathetic.

It is however painful to re-rehearse the Welsh campaigns of the all too brutishly effective Edward I. By chance I was in N Wales as I read about the English army's push west down the A55 and Llywelyn ap Gruffydd's escape down the A470 - only to be spotted and killed at Builth (perhaps he was fatally held up by farmers crawling along the road as I always seem to be? Though I only lose the will to live rather than life itself).

Familiar stuff but still moving considering they had held out against Saxon and then Norman invasion for nearly a thousand years since the Romans left believing the cause of protecting Romano-British (ie Welsh) civilisation was lost!

For the record the main other "hold-outs" against the barbarian hordes were the Hen Ogledd (in the north of what is now England) until about 730 AD and Dumnonia (now S West England) until about 930 AD though the Cornish tip survived after a fashion until the Norman Conquest.

The surprising survival of Welsh sovereignty almost to the 14th century has always been put down to geography but the history of the Plantagenet kings of England, both before and after 1282, suggests to me something else possibly more significant...

It is clear that throughout this long period the survival and success of England - I mean the English state - relied on two things.

First (and this is well known) wool: the huge economic benefit of trade in wool (everything else was just subsistence) bankrolled everything the English did - fighting the French to hold onto their territories down the west of France, fighting the Scots, fighting the Welsh, fighting Muslims while on Crusade, and fighting each other in routine civil war (when the kings fell into the wheedling and pathetic category and the barons got fed up).

The other thing the English relied on was... Welsh mercenaries.

On almost every page of this book you see the evidence that whenever the English contemplated fighting anybody their first instinct was to use the wool money to hire Welsh mercenaries (at very high cost - the Welsh bowmen at Agincourt earned the equivalent of £1,000 a day). Evidently it was understood that you weren't going to get far without these specialist, crack troops.

So the Welsh mercenaries crop up over and over again fighting for the English against the French, Scots, and on behalf of the English king against the barons (and vice versa and at the same time). Incidentally "English" armies marching against the Scots had to proceed carefully as they found that the Welsh would start fighting their English allies and employers at the drop of a hat.

Like many self-employed, highly-skilled specialists the Welsh could not always be relied on for punctuality - both Edward II and Richard II (both of them in the wheedling and pathetic category) lost their crowns and their lives because their Welsh "contractors" failed to turn up on time.

So no wonder the Welsh held out so long, and no wonder the last Princes of Gwynedd did not come to terms (or pretended to and then broke their word contemptuously) - they knew that no English army could hope to conquer them.

But, I hear you say, that is exactly what happened? But in fact there were more Welshmen fighting on the English side than on Llywelyn's. As I say, if you wanted an effective army, you had to hire the Welsh - Edward had learnt the hard way but he did learn).

The modern equivalent would be Chechnya, a tiny country which thought nothing of fighting the entire Russian military machine in 1996 - and won. But the Russians swallowed their pride, recruited Chechen mercenaries, and came back and overwhelmed them.

Lightly-armed Chechen rebels who destroyed 2,000 Russian tanks while successfully freeing their country in 1996. They have been deserted by the West since 9/11 after which these heroic freedom-fighters were unjustly "reclassified" as terrorists

The Piece Of Cod That Passeth All Understanding

I'm in North Wales for our quarterly meeting which brings managers and trustees together informally to compare notes, share ideas, and plan ahead to address specific challenges here and to ensure that the voice of Hafal's Members and staff in North Wales is heard loud and clear on national issues.

This week we have news of further repercussions from the difficulties encountered by the Local Health Board up here with their in-patient facilities - see the story here. Hafal Chair Elin Jones spoke up for Hafal's North Wales Members and clients last night on Radio Cymru (here).

We must be worried that patients are paying a further price in disruption and diminished service and we trust the Board is doing its best to minimise the affect on patients and return rapidly to a point where services are fully in place, settled, and operating to a satisfactory standard. The big clue when these difficulties occur is to be transparent and involve patients in working out solutions.

Meanwhile earlier in the week we observed Deputy Prime Minister Nick Clegg's major speech on mental health which certainly made the right noises. The most interesting bit - actually a reannouncement - was about the extension of choice in the English NHS to mental health patients (it's already in place for other patients). This is a continuation of the previous UK Government's move towards empowering patients to choose who provides their care and treatment.

It will be interesting to see how this plays out. It should begin to change the top-down, take-it-or-leave-it approach which makes services not only unresponsive to individual need but, more importantly, less respectful of patients.

Juxtaposition of these two stories is entirely uncoincidental.



Postscript:

Excellent cod, chips, mushy peas, bread (white naturally) and butter, and a big pot of tea - £5.49 at Gillies Plaice on Abergele Road, Colwyn Bay, served with old world charm, a friendly smile, and great care to check that everything was to my liking. I don't suppose it would be like that if they were a monopoly and so the only place you could get dinner...

Quelle Horreur!

Madame de Pompadour (1721 – 1764) - but is it okay under French law to publish a picture of Louis XV's mistress?

Out walking this morning I listen to New Yorker journalist Adam Gopnik on my device discussing President Hollande's alleged infidelity. He repeats the line that the French are much more tolerant than the British.

This of course is so much hocus. There is no more popular politician in the UK than Boris Johnson (like him or not) and there is no other politician to rival Bojo's colourful and complicated sex life.

Of course there are people in the UK who disapprove of personal behaviour outside traditional norms but so there are in France - there are plenty of practising Catholics who would find their leader's antics unacceptable.

The difference is that the French have draconian privacy laws restricting people from telling the truth about matters which the politicians have decided are none of the public's business. Further, the French press is much too close to the political establishment - witness the embarrassingly deferential, pre-prepared question put to the President at his news conference.

It isn't up to politicians to decide what aspects of their behaviour are relevant to the public's decision about whether they trust those same politicians. Personally I don't judge politicians' personal infidelities as especially important but, if others do, who are the politicians to tell them off?

All politicians point to their personal trustworthiness as a reason to vote for them. I should have thought it was up to individual voters to decide whether evidence of untrustworthiness by a politician towards their own family might cast light on their wider trustworthiness.

Privacy law from Europe has already been used in the UK to suppress truthful reporting of public figures using prostitutes. I find that extraordinary and it raises questions about how other vulnerable groups, including people with a mental illness, could be exploited under the shadow of restrictions on press freedom.

We don't need lessons from the French about the public's tolerance - we are much the same on that one - but they badly need a lesson from the UK about supporting an independent and unafraid press, warts and all. And incidentally we in turn need a lesson on this from the US who find our acceptance of creeping press restriction alarming.

Wacky And Fun

"The Lad": Tony Hancock is today more famous for his troubled life than his comedy - a shame, he was very funny

I have previously on this Blog drawn attention to studies which establish the bloomin' obvious and today's news that Oxford University health research wonks have found higher than average signs of mental illness among comedians might fall into this category. Certainly the comedienne wheeled out on Radio 4 this morning as I drove to work was quick to ridicule the researcher - who took it rather well and with good humour.

But actually I thought the detail behind the research was at least quite interesting. The research specifically found a high incidence of both extreme introversion and extreme extroversion which are associated with psychosis. This leads you to wonder whether these traits are a cause of illness or a response to or consequence of illness?

Probably the story will disappear quickly but I think the risk with these things is that they somehow glamorise mental illness, giving the public the impression that mental illness can be wacky or even fun. I know many people with a serious mental illness who are indeed wacky (in the sense of zany or eccentric) and fun but these are not necessarily characteristics of illness but of their personalities, surely? But of course "wacky" has a secondary, slightly rude meaning of "mentally ill", rather illustrating the problem.

Breaking News - Pope Is Catholic

Interesting item in The Scotsman here suggesting that men's mental health can be enhanced by going to the pub. The theory (carefully circumscribed by warnings about alcohol abuse of course) is that men can open up in the pub to their friends especially if their inhibitions are diminished by a pint or two.

And the Pope's a Catholic. You wonder if the research was commissioned by somebody who had never been to a pub? But perhaps that is unfair as there may be nuggets of more subtle wisdom to be learnt from the study.

I confess I am a bit wary of research and project work which treats men as an ill-adjusted and endangered species not able to work out how to socialise or get their emotional needs met. I think that you can trust most men to work these things out for themselves even if they haven't embraced their metrosexuality just yet (and they wouldn't thank you if you tried to help anyway) but we should concentrate rather on helping people of either gender who are struggling - and, yes, there may be some gender-specific types of support which can be offered.

Postscript:

I was appalled by the story this week that a zoo is stopping giving bananas to monkeys! Read the shocking story here. Not fair to stop them conforming to normal monkey behaviour - next they will ban those delightful tea parties which they enjoy so much.