31st January 2006
I was very disturbed by Robert Drummond and Alexander Linklater's article "Beautiful Madness" (February). My disturbance was not caused by the "tragedy" that the authors found so uncomfortable, but by their interpretation of Nia's story. Why was it considered so important that Nia was pretty, and why was it so troubling that during her recovery she put on weight? The authors refer repeatedly to Nia's "loss"—about which neither Nia nor her parents seemed particularly concerned—rather than focusing on the success of her treatment. I was staggered that health professionals would place such an emphasis on a patient's appearance and even more shocked that the objectification of a teenage girl by male doctors was thought a fitting article for Prospect. I love Prospect—it has a unique place among British media—but this story, alongside the lack of women to choose from in the list of top British intellectuals (July 2004) leads me to question whether there is perhaps a whiff of old-fashioned sexism among the editorial team.
Rosie Campbell
Birkbeck
Beautiful madness 2
8th February 2006
The real tragedy of the "Beautiful Madness" story is that even psychiatric professionals accept the "beauty at any cost" ideal of today's society. Would the authors have felt the story as tragic if the girl had been anorexic? Or if they had had to watch her vibrant beauty slowly eaten away because she thought she was fat? Yes, this poor girl gained some weight—and found she was able to function.
Rachel Voglesong
Harderwijk, Netherlands
Beautiful madness 3
9th February 2006
I find it strange that the psychiatrist in "Beautiful Madness" put so much store by Nia's beauty. Beauty is a curse as well as a blessing—and in my opinion something well worth giving up for emotional and mental wellbeing. I am a 22-year-old woman who is on lithium and olanzapine to treat my bipolar disorder, and I have gained 10kg since beginning my treatment. This brings me from the borderline of "overweight" (BMI=25) to the borderline of "obese" (BMI=30). However, thanks to my improving mood, I am a far more attractive, pleasant person to be around. I would happily gain another 10kg if needed to maintain this level of stability.
Sarah
Details supplied
Beautiful madness 4
1st February 2006
I admired the immense compassion of this article. It focused upon the experience of a doctor and psychiatrist working with vulnerable young women, and highlighted the problems associated with the women's social and healthcare needs. This is a particularly acute issue within the mental health sector, where very few clinical approaches actually turn out completely cut and dried as once believed. I feel reassured that psychiatrists like Robert Drummond still possess an enviable level of empathy and insight into the uncertain realm of adolescent female pathology.
I have a personal interest in this testimony, as many years ago, aged 19, I found myself on a psychiatric ward. My situation was slightly different to Nina's, as treatment for psychotic disorders at that time did not stretch to the administration of "atypical" medication, so I did not encounter any significant problems with weight. It only became a problem when my condition became too difficult to manage on a negligible amount of Stelazine, and was advised by my psychiatrist to try Amisulpride. After a brief amount of time on this drug I became aware of rapidly accelerating weight. Since being discharged from hospital, I have managed to finish my education (I now have an English degree) and I have also attempted a series of jobs. It therefore seemed appropriate to conclude that my remission was complete. But despite this, my weight gain, coupled with unbearable nausea and digestive discomfort, was too unpleasant to continue with the treatment. I changed to Quetiapine and my weight seemed to plateau, and my stomach settled back to normal.
Psychiatrists should consider other underlying health conditions that prevent acceptable weight management—thyroid activity, pituitary disorders or other endocrine or gynaecological conditions). I know that in my case at least, a hormonal condition certainly hinders my weight control. Nonetheless, my exercise routine and diet has kept me within an acceptable level of fitness, and I am just grateful that my mental health condition is more manageable than before.
Deborah Brookes
Solihull
Beautiful madness—a response
21st February 2006
In response to the many letters we received about our article "Beautiful Madness," we would like to offer the following clarifications. Some readers perceived a suggestion in the article that the patient (whom we called Nia) would suffer as much from being overweight as from being psychotic. This is to miss the point. Naturally, such a patient should be treated in the best way possible for a very serious condition—as she was in our account. The point is that even the best treatments available come at sometimes considerable cost. The cost is both physical and psychological. The dilemma raised in our article was not whether schizophrenia is somehow equivalent to being overweight (which we were not suggesting), and certainly not whether Nia would have been better off psychotic—but whether a patient can be seen to have fully recovered who shows little sign of self-awareness after such a dramatic transformation. We ourselves suggest that it might be a blessing for Nia that she ceases to be concerned with social pressures about weight and appearance, though we suspect this does not comprise a full explanation. There is more to the case than just image-consciousness. Olanzapine does not cause patients merely to put on a few pounds. It can precipitate gain of 4 or 5 stone (56-70lbs) and, in some cases, much more. Putting on three stone in three weeks would represent just the beginning for a patient such as Nia. There are serious health risks involved, as well as psychological implications, and the side-effects of antipsychotics are a grave issue for modern psychiatry. We refer readers to a letter in the American Journal of Psychiatry on the problems of Olanzapine, which describes an 85lb weight gain in an adolescent.
At the same time, it is important to be clear that antipsychotics such as Olanzapine can be transformative, bringing people back from nightmare states of mind, and saving lives. And the side-effects vary enormously, with some patients experiencing them only mildly. It is the trade-off between effect and side-effect that we hoped to express in Nia. For reference to the recent large-scale CATIE trials into the effectiveness and side effects of various antipsychotics, see this article?from the New England Journal of Medicine.
Our article has been doing the rounds on interested blogs, and we have been asked by Paul McAleer, creator of Big Fat Blog (a weblog about fat acceptance), to clarify the extent to which Nia was an actual case study. By necessity, Nia is a composite of different people and incidents, and it is not possible for Robert Drummond to comment on specific case histories. However, it is possible to say that one source for our writing is Alexander Linklater's brother, who suffers from chronic bipolar disorder. (He is a willing, open and engaged participant in our research.) During adolescence, Archie underwent much the kind of dramatic transformations in body weight described in the article, due to his medication. Like Nia, he was a beautiful child who underwent drastic, sometimes terrifying metamorphoses. It's not just a matter of putting on weight, but of physiological distortions in the whole person. It is important to understand that this is due to illness and medication in combination with one another, and that in extreme psychiatric cases the physical and mental conditions of patients are not separable.
The question of beauty itself remains firmly lodged in the eye of the beholder, of course. We had no intention of creating offence, but nor do we apologise for raising the issue. Beauty is a matter of perception, of feeling, and of social conditioning, but it is a powerful force nevertheless. It is a force which can play into the tragedy of what patients, family and professionals experience. "What has happened to my beautiful child?"—boy or girl—is perhaps the question parents of mentally ill adolescents have asked most often. What happens in psychiatric wards everywhere is that people lose themselves, in various ways, due to various problems and conditions. We were highlighting just one kind of scenario, about the loss and tragedy bound up in the often irreconcilable forces that play into the realm of mental disorder. It is difficult in psychiatry to discuss the full human dimensions of the medical treatment of madness, because they are painful. But that is what we are attempting to do by writing, in combination, from both professional and personal perspectives.
Alexander Linklater and Robert Drummond
Philosophical divide
27th January 2006
Chakravarthi Ram-Prasad (February) is correct to argue that most recent western philosophy ignores the value of "eastern" philosophies. However, there have been important exceptions, such as FSC Northrop's The Meeting of East and West, which was very influential on Robert Pirsig, author of Zen and The Art of Motorcycle Maintenance and Lila.
Ian Glendinning
Reading
Cruncher on climate 1
1st February 2006
I am puzzled by a statement from "The Cruncher." Writing about global warming (February), he says that a "very important new discovery" is that "aerosols, far from contributing to global warming, actually reduce it." This is not a new discovery at all. It has been factored into climate models for ten years or more. The IPCC scientists have long understood the phenomenon.
Further, it has long been known—for at least several decades—that methane is a powerful greenhouse gas. I guess Cruncher is thinking of a recent paper on methane emissions from trees, but how does this paper undermine existing climate models?
Caspar Henderson
Oxford
Cruncher on climate 2
10th February 2006
The Cruncher mentions two recent developments that he asserts have "thrown into confusion" the world of climate change modelling. The first, though hardly recent, has to do with the role of atmospheric aerosols in the climate. Cruncher mentions that aerosols reduce global warming, but fails to point out that they may also increase warming. This is because some aerosols trap both the arriving solar and the escaping terrestrial radiation, in effect acting as a global blanket.
The second advance in knowledge Cruncher mentions is that plants may be significant sources of methane, an important greenhouse gas. This insight is recent (Nature, 12th January 2006), but even if confirmed will probably not lead to markedly different climate model projections. Green plants have long been recognised as a greenhouse gas sink because of the photosynthetic process by which they metabolise carbon dioxide from the atmosphere. If plants are found to be greenhouse gas sources as well, then—as with the aerosols—we see another complex system displaying competing effects. But the impact of this new perspective for the climate models is unlikely to be dramatic because it does not alter estimates of how much methane is being added to the atmosphere—it simply helps us understand better where it comes from.
In his other major point, Cruncher argues that an apparent lack of patterns in historical climate data make it almost useless as a guide to what we might expect in the future. Thankfully, climate scientists are not like those stock market analysts who massage past market data in search of the cycles that, once recognised, will prove efficient estimators of the future. Climate scientists try to identify the important physical, chemical and biological processes that drive the climate system, past, present and future. They admit the possibility that some factors, absent in the distant past, may be important drivers today. Leading that list is the human contribution of greenhouse gases from the burning of fossil fuels.
The Vostok ice core, referred to by Cruncher as the "daddy" of all climate datasets, shows that atmospheric greenhouse gases in the past few centuries have zoomed upward to levels not seen on Earth in the past half million years, if not longer. Might it be possible that one reason ancient climate data seems to offer little guidance for the future is that past climates did not have to contend with a large human population as an important factor in climate change?
Henry Pollock
University of Michigan
Too much connectivity 1
6th February 2006
William Davies (February) concedes that "converting the critique of digital exuberance into a policy agenda is… far from straightforward." Indeed. By conflating so many different issues into a single argument about "the digital model," Davies hardly makes his own job any easier. Amid elegant leaps from telecoms regulation to internet shopping, corporate IT investment decisions, planning regulations, personal communications, privacy and beyond, it's near-impossible to even identify the targets of Davies's critique. He believes that there is work for government to do, but is at a loss to say what that work is.
Davies's most tangible worry seems to be that the convenience of digital technologies is making us selfish and anti-social. But in the absence of policy prescription, wouldn't a slot on Thought For The Day be a more effective way of bringing this to the attention of society at large?
Jessica Figueras
London SE13
Too much connectivity 2
7th February 2006
William Davies starts from a muddled and self-contradictory premise and proceeds through a series of fallacious arguments to a complete non sequitur of a conclusion. Davies starts from the notion that connectivity can do harm to society—and so should be more strictly controlled—because it's somehow sort of like a highway and too much highway-building harmed some parts of the social fabric of some American cities. In practice, as most people now appreciate, moving information, communicating, is very different from moving things. Research indicates that it enhances community rather than disrupting it—see, for example a recent study by the Pew Internet Project, which surveyed 4,000 Americans and concluded "the internet helps build social capital."
Then, to help justify restrictions on the internet, there is an appeal to Wolfgang Streeck, who once argued that Germany's inflexible labour markets are in fact a good thing because they promote training. Davies blithely ignores the fact that these same restrictions have contributed to an unemployment rate of over 12 per cent. Well trained German workers may be, but they aren't working—and this hardly seems a worthwhile trade-off.
The list of errors and quarter-truths goes on. But where Davies's arguments turn from dumb to dangerous is when he starts to applaud the sort of artificial restrictions which entertainment companies are now putting on digital content as the harbinger of the "ethics of inconvenience" that he would like to see regulating the use of new technologies. Davies seems to be arguing that because new communications technologies have removed the scarcity of bandwidth on which the BBC and commercial broadcasters have based their businesses, new artificial restrictions need to be put in place to protect the status quo. He ignores the many downsides of such restrictions. Why, for example, is it a good thing for entertainment companies to technologically restrict DVDs by region, which seems mostly to enable them to sell Hollywood films in Europe six months late and at much higher prices? What is good about Sony and others putting copyright-restricting software on their CDs, which damages computers and makes them less resistant to viruses?
As to why the status quo in broadcasting is worth protecting, Davies can only lamely offer the notion that, because it offers less choice, it provides more shared experience. Never mind the fact that whenever people have been offered more choices in information and entertainment, they have embraced them. Never mind that the opposite of giving people more information is keeping them in ignorance. Even the BBC is busily creating new channels and new ways of using old content. But Davies feels it his duty to protect the people from themselves.
Ironically, and tragically, it was just this sort of sloppy, self-satisfied interventionism that created the sorts of problems that Davies is trying to blame on the internet. It was 1960s town planners, who also thought they knew best how people should live, who drove freeways through cities and built crime-sink council estates. The internet, by contrast, grew more from the grassroots, driven by popular demand rather than government fiat. While increased regulation is inevitable, and already happening, it is critical that it be informed by a proper understanding of both history and the present. Davies has not even attempted to achieve either.
John Browning
London N1
