A Doctor's Journal
Chewing the Fat
By MILES HOW.ARD ONE controversial question in medicine just now is whether an excess of fat in the food is an important determinant of coronary disease. MacDonald put his coronary patients on a strict rice-fruit diet, and measured the clotting capacity of the blood. He found that the platelets (micro- scopic discs which are one constituent of the blood) became less sticky, but the other tests showed no change. There was no evidence that this diet, free from all fat, improved the patients' symptoms or altered the course of the disease.
I hear from colleagues who practise in the West End that men in the over-forty group come along in droves to ask for low-fat, anti-coronary' diets. Some authorities defend this high-fat theory; others dericie it. A good deal more evidence will be needed before we can appraise it. In the mean- time, men will go on eating what they fancy. If they are waist-conscious, they carry around little tubes of saccharine, and put that in their tea in- stead of sugar. Doctors, a race said to be especially prone to coronary disease, are constantly being given tea by the Ward Sister, and patients, their receptionists, and even their wives; if they take - sugar in tea, they must get through half a pound a day. No wonder they are always weighing them- selves and looking worried.
* * *
H. V. Little, who is secretary to the National Society of Non-Smokers, writes to tell me that they have lately opened `the world's first-ever smokers' clinic.' A meeting was held at Caxton Hall and there was, he says, a large crowd of smokers so eager to be freed from their addiction that they had all booked places at the clinic. Advice was offered to all those who attended, and groups were formed under the leadership of doc- tors who were members of the Society, a psycho- therapist, and Mr. Little himself. Branches of the clinic were set up for various regions in the Greater London area.
I wish them luck. There must be many thou- sands of tobacco addicts who could be set free with a little help of the right kind. It might be that a group-activity, such as this, will be more effective than care of the individual. The most valuable single instrument in the therapy of alcoholism is a comparable society, Alcoholics Anonymous, known familiarly as 'AA.' That has achieved a more spectacular success in the States than over here, perhaps because the American is more gregarious and group-minded than the Englishman, who lives in his own secret world and tends to resent any intrusion into his affairs. More than anyone else, the alcoholic lives in .a. fantasy and denies that he is ill; as a rule he will refuse to be treated until he is really scared. This is, I in- lieve, a criterion for admission to AA; they don't encourage the ordinary social drinker to , join, but rather the man who is up against it and sees that his well-being, his job, and perhaps even his life are in hazard.
* * *
The News Chronicle lately commented on the cost to industry of mental breakdown. Next to the common cold, this is the biggest medical drag on production. And apart from the time lost, between a quarter and a third of industrial acci- dents are caused by emotional disorder. These facts, the Chronicle said, are not as widely known as they ought to be; the heads of the medical profession still tend to treat psychiatry as medicine's poor relation. More money for re- search is badly needed.
I entirely agree, with the proviso that the field for research is not only the cause of major mental disorders (such as schizophtenia), but the prevention and management of the common stress disorders (such as abdominal discontent). For every schizophrenic patient in his surgery, the family doctor .sees, I suppose, fifty with a dis- order of the skin, or the gut, or some other system, which has its origin in stress. The cost to the nation, in terms of industrial production, of these disorders has never, been calculated—it must be immense; and that is to say nothing of the cost in misery and sickness.
What happens to the state of mind of people who win a lot of money on the pools? I have seen no field survey of this important question. We know what happens to those who don't win : they are sustained by the fantasy of hitting the jackpot, and this keeps them going, through year after year of winning nothing, or twelve-and-six. One- hears of the odd case of the man who kills himself after a big win. Perhaps the contrast be- tween the dream-picture of what he would do with the money and the worry of actually handling it is too much. In the evening paper the other day I saw a story headed 'What £206,000 has done for Mrs. McGrail.' This lady, said the reporter, was the only one he knew who didn't want a mink coat. She had had the misfortune to lose her husband some six months before and felt that it would be disloyal to his memory to spend extravagantly on things he could not have afforded. `Now that you have the money to buy anything you want,' the reporter asked, `what .do you want?' To which she replied, `I don't know. Everything's gone topsy-turvy for me. But what- ever it is, money won't buy it. You just try telling people that! Money ! That's all people talk to me about now.' Of course, she, poor woman, had been bereaved and no amount of Money could make up for that. But I wonder if the dream of affluence, for the ordinary. person, is not more satisfying, and much less disturbing, than money itself?
* *
`Psychiatry is not the only branch of medicine —or of knowledge—to be pilloried for lax think- ing and complacent dogmatism. It has, however, troubles which seem peculiar to itself, and some ministrants who seem peculiarly indifferent to the scientific method as understood by the rest of the world. Nevertheless, I doubt if These are special characteristics; the troubles of psychiatry are those inherent in the study and improvement of human behaviour.'—Professor Aubrey Lewis id the Lancet, January 25.)
Previous page
