December 2008

‘Look on the Taunton Deane website and see what they are intending to do with your father’s house,’  Judith wrote in her card.   I did – and, with a growing sense of outrage, viewed the plans for a large brick and half timber stockbroker house, the sort you can see on the slopes overlooking the Pacific between LA and San Francisco. . 


Restharrow, the old house that dad bought in 1958, is to be demolished, though the rare breeding colony of Brown Long-eared Bats in the attic are fighting a rear-guard action.  English Nature and the Environmental Agency have insisted that the current owners create a space in their new house to resettle the bats.  I can imagine the purchasers’ frustration and allow myself a slight smile of satisfaction.  They will get round it of course, but I like the idea of the bats being offered a new home. I wonder if they will have en-suite as well.  It would certainly be less messy! 


But my predominant emotion is sadness.  They are going to bulldoze an important part of my identity.  Over the years, the old house has seemed to settle into the hillside, as the wood encroached, the trees grew taller to envelop it and hedges concealed it from the road.  It seemed that Restharrow would never be destroyed; it would just become more overgrown and ultimately disappear into the woodland.  The flints that it is constructed from would return to the soil.  The woodpeckers and nuthatches would continue to whistle and chuckle about the stone flags, where the bird table was, in hope of nuts.  The owls would call on warm summer evenings, and the swallows would still nest in the ruined tool shed, flying through the gap above the sagging door.      


I grew up in that house.  I didn’t actually live there for very long – just a couple of years when I was a teenager.  Mum had already formed an attachment with our divorced next door neighbour in the town and felt exiled on the hill.  Perhaps I sensed the parental tension and needed to escape. I spent many hours alone walking through the woods where the reservoirs were. I plotted on graph paper the birds I saw on my daily peregrinations and in early spring wrote precociously to the Somerset County Gazette to report the arrival of chiffchaffs, blackcaps, swallows and the first call of a returning cuckoo.  I kept an eye on the badgers setts, worrying lest the farmers would dig them out.  I knew the glades where the roe deer liked to feed.  I collected pellets from the barn at the bottom of the wood by the reservoir and dissected them to create complete skeletons of shrews and voles.  One spring, I discovered a tawny owls nest in the boll of an ancient oak.  It contained two chicks;   fluffy bundles of white feathers with glaring eyes of the deepest blue and bright yellow beaks which they clicked like castanets.  And in the summer, before the bailiff went on patrol, I would surreptitiously remove my clothes and swim in the reservoir. 


I have been back on every available opportunity in the intervening years.  Dad married again and was happy there, decorating the house in his idiosyncratic style, which included Chads in the garden loo, quaintly named ‘Mellors’.  And after he died, I stayed in the house by myself, lighting the log fire again and absorbing the feeling of the place as the mist rolled in from the sea and the trees huddled closer.


If  I can feel such a strong connection to a place I have known for half a century, how much more must the Cavendishes feel.  They can trace their connection with Chatsworth back over five centuries, ever since William Cavendish sold up in Suffolk and moved north to marry Bess of Hardwick.  Bess’s Hunting Tower still dominates the escarpment overlooking the big house and Queen Mary’s Bower, where that sad prisoner was allowed to ‘tak the ayre’, still stands in the middle of the last remaining fish pond. 


Chatsworth was never allowed to be preserved as a historical vestige.  As Her Grace, The Dowager explains in her book ‘Round About Chatsworth, every incumbent has impressed the estate with their personality, employing the best architects and artists including the greatest landscape artist of them all, Lancelot ‘Capability’ Brown.  This is a landscape that has grown by accretion with passing fashion, consolidating its character as an extension of the family.    


Last spring, I rented a tiny up and down cottage on the estate, no bigger than a caravan according to Her Grace. I am beginning to absorb the spirit of the place. 


During our walks around the estate over Christmas, my brother, Simon, alerted me to the idea of landscape as memory.  ‘There is hardly a landscape in the United Kingdom that has not been shaped and influenced by generations of inhabitants’, he said,  ‘and when the same family has occupied the same environment century upon century, the place is as much about their character as the portraits in the great hall.’ 


Simon has spent the winter creating new flood defences on the River Deben opposite the town of Woodbridge where his 1924 Dutch motor barge is moored.  With the assistance of inmates of HMP Hollesey Bay,  he has hammered two parallel rows of timbers into the mud, connected them aslant with plastic mesh and will start to fill the gaps with discarded Christmas trees nest week. This will baffle the ebb tide and should prevent further erosion while at the same time allowing the waders direct access between the mud and the salt marsh.  Woodbridge has always waged war with the sea. His is the latest in a sequence of flood prevention schemes going back centuries. At low tide, it is possible to see the blackened stumps of piles that were erected in the 14th century to support a double row of timber revetments.  It connects Simon to his environment – so essential at a time of crisis and such rapid change.      

Christmas is the celebration of the birth of Jesus Christ, but who was he?  Did he ever exist?  I, along with most of the billion or so people who celebrate Christmas, don’t know.  So perhaps we shouldn’t get too hung up on whether Jesus was a historical figure and focus more on what his life and his birth represents for us.         


Jesus’ story has a powerful symbolic significance.  It is a story of an ordinary man from humble beginnings, who became a teacher, an orator who preached understanding and forgiveness in a divided culture.  He was the Barack Obama of his time;  his open air sermons, like Obama’s political rallies, could attract multitudes.  Forget the loaves and the fishes, they feasted on his rhetoric. Growing up in occupied Palestine, he had the courage to stand up for the rights of ordinary people. He inspired compassion, his very touch could make the sick and unhappy feel well. His homespun philosophy of understanding and common sense had direct appeal.  He would care for them, understand their frailty and weakness – forgive their sins.  Jesus was a maverick.  He never attempted to ingratiate himself with the authorities.  On the contrary, he supported the outcast, the leper, and protected the woman who was about to be stoned in adultery. ‘Let him who is without sin cast the first stone.’  He had the courage of conviction. He opposed the rigid, harsh dogma of the religious leaders, but lost his rag when he saw how they allowed the temple to be used as a place of commerce. 


To set himself up as The Son of God was, however, a dangerous delusion and would, in our time,  call into question his sanity and that of his followers.  Psychoanalysts today might understand his narcissism and delusion as the compensations of an isolated and vulnerable individual to parental deprivation. It can’t be easy believing you ae the son of God and growing up with the burden of having to save mankind. But this is stuff of leadership. Even our current prime minister, who is going through something akin to resurrection, has delusions of saving the world. 


The Jesus myth appeared out of the desert, a symbol of hope in a time of oppression.  It was the kind of narrative that creates Gods out of charismatic teachers and politicians. But perhaps his was a less cynical age when people understood little about the nature of the world and our place in it and were all too prepared to believe in the supernatural.  His death as a martyr ensured the legend.  But Christianity would have remained a minority cult, an object of curiosity for latterday academics, were it not for the peripatetic teachings of Paul and the ultimate espousal of  Christianity as the official faith by Byzantium. 



To dismiss Christianity as myth would deny its importance.  We are creatures of imagination.  We have to believe in something. Otherwise life is meaningless.  And when we break it down, everything, even what purports to be scientific ‘truth’ is a product of our imagination, because we have invented the rules that govern it.  It’s the way we try to make sense of the world.  Fact is meaningless; it’s the fiction we make out of it that’s the thing. 


So we read how the birth of a saviour, God incarnate, was foretold by the prophets.  We understand how it took place in mean surroundings but accompanied by cosmic symbols. We learn how the leaders of the tribal lands to the east, wise kings, recognised his birth as having political significance and gave him gifts.  And we are encouraged to believe that his mother was a virgin, married to a much older man, but impregnated by an angel.  Hmmmm!  Well, if you believe that …….!  But the fact that this stretches our credibility is not important, it’s what the story represents that matters. 


So what can we take from Christmas?  Well, above all, it’s a family story.  There’s nothing like a birth, a new baby, to bring the family together.  The act of creation carries with it the seeds of what has gone before while ensuring the continuation of identity,  the survival of meaning into the future.  Christmas survives because, as the basic unit of human society, the family survives as a symbol of hope.  The Christmas story emphasises the importance of family, and through family to the whole community.  We are social animals.  Without society of family and friends, we fail to thrive.  This is why the family comes back home at Christmas to eat together, to exchange gifts and play.  It’s the consolidation of a collective identity in a fragmented world. 


I went to the carol concert this year, because I believed in the symbolic importance of the Christmas story and wished to join with others in the village to support it. And it was a touching counterpoint when The Duke from the big house read a lesson after a five year old girl from the primary school.   


So I don’t think we should be too precious about the materialism of Christmas.  Presents are the currency of relationships at Christmas these days and if that’s the way it works, so be it.  And I don’t think we should worry about eating too much.  It’s a day for feeding the soul and Lord knows how much it needs nourishment these days. 


As a celebration of family,  Christmas exaggerates the dynamics. If the family is peaceful and content, then Christmas will be all yule logs and plum pudding,  but there are tensions in all families and these are always exaggerated at Christmas. It’s like August in Osage County – or the omnibus edition of Eastenders. 


This Christmas, with our own children scattered and distant,  my brother and I entertained our increasingly querulous and confused 92 year old mother, maintaining her buoyancy with the aid of mince pies, photograph albums and a commentary of upbeat anecdotes, and avoiding topics that could sink her, like her first husband, our father who must now be nursing a pint in comfort of some celestial ‘Queen’s Arms’.  And afterwards, we drove her home to her flat in Sheffield by way of Bedminster Down while the bombs rained down on Bristol city centre.  Firework night!  But that was her Christmas story! 


So you and your partner have been invited to a dinner party.  Do you respond with alacrity, eager in the anticipation of an enjoyable evening with friends?  Or does your heart sink at the idea of another evening being polite, listening to jokes that are in poor taste and tolerating opinions that are half baked?  It may be just the parties I’m invited to, but it seems that we have lost the art of entertaining.  


A dinner party is not just about food and drink, it’s a whole nourishing experience;  the atmosphere, congenial company, social grooming and relaxation.  A meal requires a relaxed environment in order to facilitate digestion and when a meal is properly digested this releases chemicals in the body that induce relaxation and contentment.  Psychology and the gastronomy must work together, not too rich, not too dominated by one flavour, a blend and mix that lifts the spirit and nourishes the soul.   


It seems that we are so used to being entertained by television that we have lost the art of doing it for others.  Conversation in our narcissistic age is less about listening and facilitation by relevant observation and pertinent enquiry and more a  competitive desire to make to retain attention through dramatic disclosure, amazing revelation or quirky perspective.  Dinner table conversation is hardly relaxing.  It’s a quick fire rally of one liners, a spicy bit of gossip, the exchange of  bias about The X factor.  And as the evening wears on, the stories become exaggerated, the jokes less funny, the laughter more forced, the noise louder. 


There is a feeling of desperation about it.  ‘We’re having a party.  We must have a good time.’  But really it’s all too much, too much for us and too much for everybody else.  Christmas is a time of excess, and excess soon becomes exhausting. People who are too full of themselves are tiresome, loud and, let’s face it, boring.    .   


Conversation should be measured, a reflective and thoughtful engagement of minds,  leading to creative solutions, new ideas and different perspectives.  It should enlarge us, make us more aware.  All too often it is defensive, a grandiose exercise for the protection of the vulnerable self from invasion and exploitation. We all know the party bore, the one that pins you to the table with their desperate need for validation.  We sense their vulnerability and feel sorry for them, but they can ruin an evening with their insistent demands.  It is so easy to feel trapped at dinner parties. 



So how can you make it more tolerable.  Well the secret to a successful dinner party, I’m sure, lies in the planning.   Good hosts plan the menu, choose the recipes, select the ingredients, work out the times so that each component is ready when it is needed and prepare as much in advance so that by the time the guests arrive, they don’t have to spend too much time in the kitchen.  We are familiar with that.  But few employ the same precision in planning the social aspects of a meal. 


So select your guests carefully. Avoid those that are so needy, they have to dominate the proceedings, and those who are too shy or quiet to join in.  Think about how your guests will work together, how the artist might compliment the physicist, how the gardener and the bird watcher might have a lot to say to each other, how the local politician and the environmentalist might find lots of things in common.  Although it may not be quite acceptable to talk about educational or social background these days, when planning a successful dinner party, it is important to ensure that your guests have sufficient in common to be able to converse meaningfully with each other. 


Do have a seating plan. Ensure that those who might complement each other are sitting next to each other, but also encourage people to move around between courses. 


When your guests arrive, serve drinks and aperitifs in another room and circulate to make sure everybody’s social needs are accommodated.  Put the first course on the table just before your guests arrive so that you can spend time making your guests feel at home. 


Timing is everything, as much for dinner as well as for other aspects of life. Make it clear when your guests are expected.  Don’t leave more than half an hour before gently guiding them into the dining room. Make yourself a time table.  7.30 aperitifs, 8.00 first course,  8.30 main course, 9.30 desserts, 10.15 coffee and liqueurs, 11.00 depart. 


Monitor the success of the meal by the gentle buzz of conversation and b prepared to step in and facilitate or change the interaction.  Do not leave it completely up to your guests,  you might have items or topics that might engage everybody – nothing too gloomy, nothing too controversial. 


Books on social etiquette say you should avoid sex, politics and religion.  My experience is that everybody has an opinion on these topics, but the conversation needs steering, breaking up with questions. To be a successful host, you must adopt some of the techniques of an interviewer.  Encourage your guests to be creative. Bring in people you know might have particular views.  Try to divert those who might have tendency to dominate.  Don’t just leave the conversation to find its own level.  This will encourage heirarchies. Some will dominate, others will be left out.  Be creative, even provocative.  Be prepared to spice up the social mix comedy, a degree of frivolity.  Avoid topics that are too self indulgent, like clever children, last years holidays or elderly parents.  They are closed ended and do not encourage a creative intercourse. 


Encourage the performers among your guests – there are always some – to tell a story, sing a song, recite a (small) poem.  You can never have too little!  Use it as a taster.  Leave people wanting more.  The same principle applies to the food and drink you serve.  Give people enough but don’t offer seconds.  Always control the wine.  Just put enough wine out.  For eight people, you will need four bottles:  two red, two white.  Keep an eye on when glasses are becoming empty and replenish them,  but subtly regulate the supply so that it is even and not excessive.        


And after the meal, serve coffee and liqueurs in comfort in the lounge, ideally in front of  an open fire. 


But the most difficult aspect of  dinner parties is to manage the ending.  Never allow a party to drift on.  Those who love the sound of their own voice will dominate, while everybody else will get bored and feel trapped. You must control the ending. 


When I was a medical student, my tutor used to announce the end of the dinner by appearing in his dressing gown and telling everybody he wanted to go to bed now.  While I would not encourage that – some might take it the wrong way – you need to find some way of bringing the proceedings to an end.  One useful ploy is to ask one of your guests, whom you know well, to announce that it’s late and time to go.  This will allow you to agree and  thank everybody for coming. Remain in control at all times.  Do not replenish the liqueurs and never offer to make more coffee.

Too much knowledge is a dangerous thing.  You should never try to diagnose your own illness.  Go to a doctor!      


That’s all very well, but gut symptoms are so common that if everybody went to their doctor for every abdominal twinge or bowel upset, our medical services would be swamped.  Warren Alexander, chief executive of Core, the Digestive Disorders Foundation, said: “One third of the population regularly suffers from digestive conditions such as constipation, diarrhoea, stomach-aches, nausea and sickness.”  The overwhelming majority of these are not the result of a serious abdominal disease,  but are probably caused by dietary indiscretions, a frenetic life style or the specific trials of their lives.  Although doctors may diagnose such complaints as Irritable Bowel Syndrome, the available treatments are all too often ineffective.  It is therefore important to learn how your gut reacts and to have strategies by which you can treat yourself, while not ignoring symptoms that may indicate pathology.            


But how do you know when you can manage your own chronic gut complaints with confidence and when you  should be concerned and seek medical advice?  My experience  is that the symptoms of  the Irritable Bowel Syndrome and other unexplained illnesses affecting the gut tend to be quite predictable within a given patient.  They have a pattern to them – quality of pain, type of bowel upset, association with other symptoms,  time of day, triggering factors, emotional reaction – that is as individual as a DNA profile.  People tend to know their symptoms; they have lived with them a long time. They learn what brings them on and what takes them away.  You may well realise that if you are upset about something it tends to go to your guts.  Perhaps there is a particular event that always induces symptoms, like when your mother comes to stay or your husband has too much to drink.  Predictable symptoms that have been going on for years are unlikely to be caused by serious pathology.  In most cases, they have been  investigated previously  and nothing found.  It’s the symptoms that are out of the ordinary, the illness that changes its character for no obvious reason, the unfamiliar and unpredictable and in particular what are often called ‘red flag’ symptoms,  that need to be taken seriously.   


‘Red flags’ are symptoms that may indicate inflammation or cancer or allergy affecting the gut.  They include the presence of blood in the stool, weight loss, fever and a disturbance in bowel habit coming on later in life with no obvious cause.  If you have any of these symptoms you should consult your doctor.   


But let’s assume there are no red flags.  You have Irritable Bowel Syndrome or an associated functional disorder of the gut. It has been going on for years and your doctor has exhausted all possibilities and is just offering bland reassurance. How can you help yourself?     


Ten top tips to manage Irritable Bowel Syndrome


  1. Keep a diary of symptoms, diet and life events.  This can help to identify those factors and life situations that regularly bring on the symptoms.   


  1. Reduce or eliminate from the diet any item that reproducibly causes symptoms.  Test this  scientifically by eliminating one item at a time for several days and noting the symptom  response


  1. Eat regular meals and allow time to relax and enjoy your food.  Do not skip meals and do not overindulge. 


  1. Remember that fatty foods, hot spicy foods, excessive alcohol and high consumption of fruit, vegetables and cereal fibre can all upset the bowels.


  1. Lead a balanced life – work, rest and play.  Take time out to relax each day and have frequent holidays. Take regular exercise.


  1. Know what medications do and try to find out how best to use them. Remedies for  indigestion, diarrhoea, constipation and abdominal pain can be purchased over the counter at all high street chemists.  Ask your chemist about them and look them up on google. 


  1. Bear in mind that all drugs have side effects and what may work for one symptom may make another worse.  Do not continue to take medications that do not help.  


  1. Talk to a friend or a counsellor or psychotherapist about anything that is troubling your guts.  Try to find a way through.     


  1. Consider alternatives.  Complementary medicine attempts to understand you in relation to your condition; the therapies provide a focus of confidence and healing.  They can help!     


  1. Join a self help organisation.  The Gut Trust ( is a charity specifically devoted to helping people with IBS and related conditions.  There is, on the website, a comprehensive Self Management Programme that includes all the resources you are likely to need to understand and manage your condition.



As Jonathan Blanchard Smith, chairman of The Gut Trust, said,  ‘Illness makes all of us feel helpless and scared, but if you can understand your condition, then you can learn to manage it, either by living within its limitations or most often by resolving the factors that underpin the symptoms.  This can then help you have a more informed and productive dialogue with your family, friends, line managers and health professionals.’      



This article was published in The Healthy Gut, a supplement to The Times, on Wednesday.  

‘My stomach’s upset; it must be something I’ve eaten!’  That’s the obvious conclusion.  After all, food intolerance is very common.  Forty-five per cent of people in the UK claim to be allergic or intolerant to food, according to Lindsay McManus, information manager at Allergy UK.  Yet clinical evidence of an allergy or biochemical intolerance to food is only found in about 5% of people tested. 


So what is going on?  Professor Ian Rowland, Head of the Hugh Sinclair Unit of Human Nutrition at Reading University, believes that although people attribute gut upsets to the food they’ve eaten, most cases of food intolerance are related to psychological factors causing a greater awareness of gut function.  People with unexplained gut symptoms tend to have an abnormally sensitive gut.  When balloons are inflated in the rectum, the intestine and even the oesophagus, they feel discomfort at lower volumes.  Just as  putting on your top is painful if you have been sunbathing for too long,  so the sensitive gut ‘feels’ the food  that goes through it.  And it reacts by going into spasm or adopting a posture of rejection, which may result in diarrhoea or vomiting.   


What might cause the gut to become sensitive?  Stressful life events are clearly implicated, but a previous infection can also sensitise the gut.  About 10% of  people develop Irritable Bowel Syndrome (IBS) after an attack of food poisoning – even though the infection clears up after a few days.  Research conducted in my laboratory several years ago demonstrated that those that developed IBS had more anxiety, more depression and more traumatic life events at the time of the original infection than the remainder whose illness had completely resolved.  It was as if the symptoms of gastroenteritis had been recruited to express the ongoing situation and would only disappear when that had been resolved.  A persistent connection between mind and gut is much more likely if the food intolerance has been caused by a particularly traumatic event.    



Amanda was excited when Rick invited her out. He said he had something to say to her.  She felt sure he was going to propose at last.  The venue was perfect; a little fish restaurant in the next village. Rick was attentive as usual but seemed tense.  They chose the wild salmon with prawns and Hollandaise sauce and shared a bottle of sauvignon blanc. She had just finished hers when he told her.  He had been seeing Margaret, who worked in the office – and well – somehow Margaret had got pregnant. Amanda listened with mounting horror. How could this be happening? Suddenly she couldn’t sit there any more. She rushed through the restaurant to the ‘ladies’ where she was seized with the most violent spasms of retching. She didn’t stop vomiting for three days. That was three years ago. Amanda took a job in another town. She has been out a few times with other men, but always feels sick.  She has become intolerant of fish.   Even the smell of fish makes her ill. Other foods seem to upset her as well. She has lost a lot of weight. Her family is really worried.


If Amanda had been able to talk about what happened, perhaps the emotion and her bodily reaction would have dissipated, but she was too ashamed. So the emotional reaction established a memory loop, which could be activated by any association with that fateful meal.



For Amanda, fish had a special significance, but research has shown that most people are intolerant of a variety of different foods.  Some of these may carry a particular meaning.  Others excite the gut even in normal people –  hot spices, for example,  coffee and fats that stimulate a gastro-colonic reflex or beans, or some fruits and cereal fibre that are fermented to release gas in the colon.  People with sensitive guts should avoid or reduce the intake of such foods.      


It not always what we eat that upsets our guts but the way that we eat it.  The gut is designed to cope with three adequate meals a day; each takes about 4 hours to be digested before we feed hungry again.  Listen to your gut.  Don’t skip meals.  Only eat when you’re hungry and eat to fullness and no more.  Anxiety and greed can override satiety signals.   If you eat too much, then you will distend the stomach, overload the bowels and feel uncomfortable.  Too much fatty food will delay gastric emptying, induce nausea and cause cramping of the colon.  Alcohol is a gut irritant; indiscretion can upset the gut and other people. 


Take time to digest your food.  Eat slowly and in congenial company.  Never eat ‘on the hoof’.   Digestion is facilitated by the vagus nerve, which is active when we are relaxed.  If we don’t allow enough time for digestion, activity in the sympathetic nerves arrests digestion with pain, spasm and nausea.  Try to avoid difficult negotiations or arguments during mealtimes.    


As GK Chesterton  wrote;   


‘Our digestions ….. going sacredly and sensibly right, that is the foundation of all poetry …. 


We should all endeavour to lead poetic lives.   

This article was published in The Times yesterday. 

There can be nothing as embarrassing as gas. It gurgles and squelches through the intestines during pauses in conversations, sometimes squeaking like a rusty door and sometimes roaring like an express train in a tunnel. It gets trapped by spasms causing pain and such gross bloating and distension that you can look as if you’ve acquired a five month pregnancy within the space of half an hour. It can rise up in the mouth and be expelled with a cavernous belch but worst of all, it can escape downwards, silent and deadly at five paces or with a flutter or toot that instantly advertises your shame.


Gassy and other gastrointestinal symptoms are a taboo subject. A survey conducted in 2007 by Tickbox for Yakult revealed that 48% of women (compared to 32% of men) felt too embarrassed to talk to their GP about them. But what is so embarrassing about our guts?  Are they the vulnerable underbelly that we cannot control?  Do our bowels represent the dark, dirty aspects of ourselves that we can’t talk about.  Our guts have a hot line to the emotions.  They are supplied by sympathetic and parasympathetic nerves that translate what happens to us into bodily feelings.  Gut reactions are part of our emotional language.  ‘I can’t stomach this.  He doesn’t have the guts for it.  It gives me the shits.’ 


They can also reveal how people feel about their life situations.  Jane developed faecal incontinence when her teenage daughter became pregnant, repeating the shame of her own narrative, Chris’s rumbling tummy betrayed the guilt of his secret love affair.  And Stephanie was only able to go after she had left her husband.             


But such shameful symptoms might also suggest something wrong with the gut. All intestinal diseases can be associated with alterations in bowel habit and many with increased flatulence. As Dr Paul Cann, consultant gastroenterologist at the James Cook Hospital in Middlesborough said, ‘Bloating or farting can be caused by conditions that impair intestinal absorption, such as coeliac or pancreatic disease.  The pseudonymous, Mr Sutalf, claimed to be the world’s most flatulent patient by expert flatologist, Dr Michael D. Levitt, was scientifically recorded to fart 144 times in a single hour, generating enough gas to launch a weather balloon.  He had lactase deficiency and was easily treated by reducing his milk intake.    


Diet could well be the problem. Many fruits and vegetables contain sugars or starches that defy digestion in the small intestine but are fermented in the colon releasing gas.  The flatulent properties of beans were immortalized in the Hollywood movie, Blazing Saddles, but bananas, apples, pears, reheated potatoes, cereal fibre and Jerusalem artichokes are also very gassy. Unfortunately they are all components of a ‘healthy’ high-fibre diet. The art of medicine is balance. If it’s the offensive odour rather than the volume of gas that is the problem, cutting down the amount of meat in the diet can help.  


There is no simple solution to embarrassment.  All too often, shameful symptoms indicate a bowel that has been wrenched out of kilter by circumstance.  Relaxation, hypnotherapy and other complementary therapies can help restore emotional balance.  Psychotherapy might address the meaning of the symptom – guilt, shame, disapproval, anger or attention seeking, for example.  But the indiscretion might lie with the diet or the symptom might just indicate an undiscovered gut disease.  Gas leaks can be dangerous whatever the cause, so ‘swallow’ your pride and talk to your doctor about them! 

This article was published in The Times this morning. ,

When the author and sociologist, Ann Oakley, broke her arm outside her hotel in Colorado, she not only fractured her humerus, she ruptured her identity; the meaning of her life; her soul.  It was her right hand.  She was a writer.  It was her link with the world. She could not function as herself.  She had no role.  In time, she regained the function in her limb, but she has never regained the sensation.  Her ulnar nerve had been damaged in the fall. The lower part of her arm was like dead meat.  It worked – that was all the medics were worried about – but it didn’t belong to her.  She could touch it, stick pins in it, even burn it and she couldn’t feel anything.  It was like she had lost that part of her body.  Loss of sensation in the hands and the feet is a feature of leprosy.  The mycobacterium attacks the nerves.  The reason that people with leprosy lost digits is that the rats ate them during the night.  Perhaps the animals knew.  Perhaps the loss of sensation contributed to the status of lepers as outcast.  


We experience our environment through our bodies.  Everything we know is perceived through our five major senses, sight, hearing, taste, smell and touch but also by other, no less important senses like proprioception (where our body is in space), nociception (the detection of pain) and intuition (our gut feeling about what has or has not happened).  And all that we perceive is filtered by an intelligent computer, that has been programmed by our sensory experience to ‘make sense’ of our existence.  But that existence can only be experienced through our bodies.  Our identity is the embodiment of everything that has happened to us.  When something happens to our body, it changes us, alters our identity.    


Most of the time, we are unaware of the workings of our body.  We take our body for granted.  We only really get to know our body when something goes wrong.  I have often wondered how differently the blind ‘see’ the world or the deaf ‘hear’.  My mother suffers from deafness and I am only too aware how painfully this isolates her.  Her hearing aids do not permit the normal filtering and modulation of sound.  Mealtimes are torture; the conversation she wants to hear is at the same level of the scraping of forks, the clink of glasses.  And how dreadful it must be for anybody, let alone a vigorous young man, to lose all sensation below the waist.               


But if we lose sensation, do we also lose intuition?  Intuition is not what I would regard as a primary sensation.  It’s more an awareness of how our body reacts to what happens or might happen – the meaning of our lives as expressed the way our body ‘feels’.  But what if our body doesn’t feel, do we imagine or remember it ‘feeling?’  Can we still know  when something doesn’t feel right?  Patients with so called ‘locked in syndrome’, in which they feel nothing of their body are said to be strangely calm, but how can anybody else really know?  


If loss of sensation depletes our identity, what happens when our body is in pain?  The  answer is that it takes over our identity. If we have a pain in our tooth, we can think of nothing else.  We become the toothache. 


But pain is as much a psychic feeling as a physical sensation.  It is exaggerated and may even be induced by something dreadful happening in our lives.  The connection between mind and body goes both ways.  Whatever happens to us is given meaning by being translated into bodily sensations.  So a headache may be something that is literally blowing our mind, backache can be the sign of an intolerable mental burden, chest pain can be heartache.  If something is bothering us, it is our body that feels it and tells the story. 


So not only can damage to the body fracture the identity, but if the meaning of our life, what I think of as our soul, is fractured by the vicissitudes of life,  this has to expressed through our bodies.     



‘Fracture; Adventures of a Broken Body’ by Ann Oakley is published in paperback by The Policy Press (2007)

The temperature in Derbyshire has been around minus two degrees centigrade all week.  It’s been the same on the Ross Ice Shelf.  ‘Who would have thought that the one thing we have run short of is suncream?’,  exclaimed Will Gow in his daily audio report, ‘It’s just too hot!  We’ve stripped down to vests and tights and are still sweating buckets.’ 


Gow with his two companions, Henry Adams and Henry Worsley are descendants of the members of the Nimrod Expedition to the South Pole, led by Ernest Shackleton exactly a hundred years ago.  They are following Shackleton’s route – across the ice shelf, up the Beardmore Glacier and a final trek across the polar plateau.  Here the comparisons differ.  Shackleton took 4 men and four ponies for his push to the pole, but the ponies exhausted themselves; their hooves broke the ice crust at every step and sank a foot into the snow.  One by one, they failed and three had to be shot.  Socks fell into a glacier and nearly dragged their stores with him.  This meant that Shackleton and his men needed to drag their sledges up the Beardmore in relays, a climb of 8,000 feet.  Shackleton didn’t know the route.  Nobody had been there before.  He nevertheless found the only feasible access to the polar plateau by following a light in the sky – the reflection of The Beardmore on the clouds.  They were within 100  miles of the pole when they turned back. 


It is day thirty-one of The 2008/9 Shackleton Centenary Expedition. Gow, Adams and Worsley know the way and they been sending back reports and images daily.  I have been monitoring their progress. On skis, dragging 600lb sledges yet matching the pace of their ancestors, they have now reached the foot of The Beardmore.  Tomorrow they will climb Mount Hope, from which they should see their route to the pole. 


Conditions have been so much better than Shackleton’s expedition. Most days have been warm and sunny with excellent visibility and although the snow is ridged into sastrugi, these have been relatively shallow and the sledges have glided well. The men are fit and cheerful.  Their days fit into a pattern; heating snow for water,  packing up the sledges,  pulling for 8 hours taking it in turn to lead and then camping and cooking their fat laden supper.  They are each eating about 6000 calories a day to offset the energy they are burning off pulling their heavy sledges.  For the last week they have averaged 15 miles a day over safe ground, but ahead is a long climb over dangerous transected by bottomless crevasses concealed by the flimsiest of ice bridges. 


How I would love to be there!  In August, I responded to an advertisement for a volunteer to join the expedition.  Of course I am too old, but the idea captured my imagination, and now I am on their mailing list as a supporter.  It’s so symbolic; the idea of three ‘wise’ men travelling across a frozen desert following the stars to the South Pole for Christmas at a time when the collapse of credit is threatening the lives of millions and people are dying of cholera in Zimbabwe.  Their’s is a message of hope, an inspiration in the face of  disaster.


Today I shall run up the hill out of Edensor and over to Monsal Head.  Hardly The Beardmore, but as  inspirational as it gets in these parts.  Have a lovely Christmas and may you reach your south pole next year or at least catch sight of it!        

While blackspot gulls crouch in ice cold shallows,

a woodpecker drums out the text on an empty branch of

the route that’s inscribed in a frozen puddle


Decoding the signs, three ancient silhouettes

glide and tilt.  Wings stretch and feel, tails

spread and twist to catch a meaning as


they follow dim lanterns to an uncertain dawn.   

Some would say never.  ‘Thou shalt not bear false witness’ is one of the ten commandments.  President Jimmy Carter declared in his inaugural address, ‘I will never lie to you’, and to be fair, he probably didn’t, but like all politicians, he was certainly economic with the truth, and he got others to lie for him.  He was also not a very effective president. 


So lying is bad but misleading is quite acceptable. It’s all part of being a human being.  Deception is an indication of astuteness, a badge of diplomacy, and prerequisite for negotiation.  As I previously indicated in my blog, ‘The importance of deception; theatre and make believe in everyday life’ (31st August 2008), society would not function without it.  If we were absolutely transparent all of the time, then we would render ourselves open to manipulation and exploitation. Secrecy is power.  To have control over our lives, we must be able to negotiate with others.  That requires a degree of deception. Without it, the powerful would have all the power and the weak would have nothing.  


So deception is part of the game we all play.  It’s allright to mislead, to be clever with words, to keep secrets, to pretend, as long as we don’t tell an absolute lie.  And the more intelligent you are and if you want something badly enough, the more clever you will be at playing the game. 


Our legal system is such an elaborate charade. Lawyers use every trick in the book to mislead, coerce, compromise and misrepresent, but if a witness tells a deliberate lie, then he is held in contempt of court and threatened with imprisonment.   


Politics, as it is practiced in most western countries, is also adversarial.  The opposition will try to box the minister into a corner and he in turn will use every kind of deception short of actually lying to get out of it. 


Journalists are paid to exaggerate, to inflame public opinion with half truths and implications.  They compromise the reputation of public figures while they, themselves adopt attitudes of righteous indignation.  But it is a truism that the more uncompromising a person pretends to me, the more they try to compromise others.


Businessmen, salesmen, advertisers use all kinds of manipulation and coercion to try to force their competitors to sign crucial deals or their customers to purchase commodities they do not want.  I note that MFI have just announced another grand closing down sale.  Everything must go.  The amusing possibility is that now it might be true, but nobody will take any notice.   


Deception is all part of the game and is perhaps acceptable if all parties understand  the rules and if the stakes are not too high, but those conditions are rarely met.  All too often, it’s a cynical exercise in exploiting the naïve and credulous.   A prime example is the way the government and the banks have conspired to create a crisis in confidence in the financial markets, which threatens to have devastating effects on many if not most of us.   


So is there really any difference between lying and other forms of deception?  This was the question posed by Jennifer Saul, Professor of Philosophy at Sheffield University at the last meeting of Chapel Allerton’s Café Philosophique. She asked us to consider two scenarios. 


In the first, Dave has had a wonderful night out with Charla.  She has invited him back for ‘coffee’ and they want to have sex. He knows that Charla has a bit of a reputation and asks if she has AIDs.  She doesn’t, but she is HIV positive.  She answers, No, I don’t have AIDs. 


In the second, Ian, a man prone to episodes of violence, bangs at the door and asks if his partner Sharon is hiding in your flat.  He is drunk and looks dangerous and you are sheltering Sharon.  Do you tell an absolute lie or do you find a form of words that avoids it. 


In the first scenario, Charla does not tell a lie but her deception could have the most appalling consequences.  In the second, surely you would be more likely to protect your friend if you told a brazen lie.


So does the means of deception matter?  I don’t think it does.  Lies, misleading statements, concealment are all deception.  They carry the same moral burden.  In fact, there is a cogent argument that a deliberate lie is a more ‘honest’ response than disingenuousness or dissembling – honest inasmuch as you are not trying to fool yourself.    


So, accepting that deception is pervasive, what are the moral implications?  When might lying be acceptable?


In both of Professor Saul’s examples, the main issue was the severity of the consequence.  Dave could have got AIDS; any kind of deception is dreadful.  Sharon would have got killed, so you have to act out the most convincing deception.      


So is the context in which the deception is committed the crucial consideration?  Does the intention warrant the deception?  Does the end justify the means?  It can be an act of compassion to shield a person from the truth.  As a doctor, I do not always tell somebody they are likely to die in the next few weeks. As a friend, I would not necessarily inform somebody that their wife is deceiving them.  I rarely tell my colleagues that their research is rubbish even though I might think it.  Perhaps I should at least find a form of words where I can hint at the truth. But whether I tell them or not depends on their ability and readiness to accept the truth. It could be devastating to them. The young doctor in Anton Chekhov’s play, Ivanov is despised for setting himself up in moral judgement  (see my blog on Ivanov, when idealism leads to despair, 17th September, 2008).


Telling the truth can be the cruellest thing that anybody ever does.  It can also be the most cowardly.  Telling your husband that you are tiring of, that you have had a flirtation with someone else may assuage the guilt by transferring the pain and the responsibility for the relationship onto him.  But is it ultimately kind to protect him from the truth or are you trying to shield yourself from the consequences of being found out?  Sometimes the time is not right to tell all, like when a situation is evolving and delicate and revelation could compromise a successful outcome. 


Paul Ekman,  Professor of Psychology at San Francisco University until 1994 and the world expect on facial expressions and deception, proposed the following Kantian rule of thumb.  Ask yourself whether you care about a future relationship with the person you are about to mislead and then ask how would that person feel if they discovered you were lying.  Would they say, “Oh, I’m so glad you were trying to be considerate of my feelings,” or would they feel you had exploited and taken control away from them?  In other words think of the consequences of your action.   


This depends on levels of trust.  If you are in a long term intimate relationship with  another person, then you carry the responsibility of trust.  You are held to a higher standard of morality than you would be if you were dealing with a salesman, a colleague, a competitor or the lady in the greengrocers.  In the same way, our political leaders, our doctors, our priests, our line managers carry an obligation of trust, and we are quite rightly angry and appalled if they deceive us.  So the degree of deception also depends on the expectation you have on the person, who deceives you.  Bill Clinton’s clumsy attempts at deception during his impeachment,  There is no sex with that woman, Miss Lewinsky’  would not matter in France, where the peccadillos of presidents are tolerated, but American public regarded it as a dreadful moral failing.  If he could lie about that, what else could he lie about?       


But excessive credulity in the face of doubt might be considered a moral failure.  In the Dickens serial currently showing on BBC1, little Amy Dorrit seems such an innocent in comparison to the odd assortment of narcissists and villains that circle around her.  And I’m sure that in the current financial climate, most people would consider it an act of the most incredible naivity to accept unconditionally the opinion of an estate agent or financial adviser.   


The morality of lying also depends on how much you feel compromised, put into a position where you are forced to lie.  Compromise, blackmail, torture are on a continuum.  This is the world of James Bond, but we don’t condemn it.  Deception, torture even murder is a necessary part of national security.  Interrogation is the art of getting you to reveal what you don’t want to reveal.  ‘Ask me no questions and I will tell you no lies’.  


And on a personal level,  everybody is entitled to their privacy.   Philanderers and seductresses attempt to get the object of their desire into a position of compromise.  It’s all or nothing. ‘Give up everything for me or we don’t have a relationship.’  This can become a classic double bind.  If you do what is demanded, you are  disempowered, controlled.  If you lie, then it undermines your moral integrity and devalues the currency of the relationship.    


Deception starts early in life.  Children are encultured into the arts of deception.  It’s part of their education.  They soon become aware that Father Christmas and the tooth fairy are artifices and they know that when mummy says she has no money for sweets or that she and daddy are going to bed at half past seven too, she is telling porkies.  So when they are caught out and they say with all semblance of innocence that teddy ate the biscuits, they are regarded as cute.  They soon learn that deception is quite clever and can be rewarded.  Make believe is fun, but deliberate lying is bad and will be punished.  It’s easy to see how we have arrived at this double standard of deception.     


So is deception just make believe, the creation of a virtual existence that is only bad when it is done deliberately to damage or disadvantage someone else?  Can we conclude that the act itself is not reprehensible, but the intention and the consequences may well be?  If the motivation is bad, then lying can be like killing or injuring another person in effigy.  If it is done deliberately to defraud, exploit, deprive or undermine the other person, it should be condemned.  Or if the consequences of a lie are that somebody is hurt,  no matter how well intentioned the deception was, then the perpetrator has to bear the guilt and the responsibility.


In a perfect world, it is never right to tell a lie, but we don’t live in a perfect world.  Perhaps we never have.  As our society becomes ever more complex and self serving, it becomes ever more difficult to trust ourselves in the company of others.  It can seem that everybody is out to exploit and compromise us, to sell us things we don’t need, to persuade us to support a policy we may feel uneasy about, to encourage a course of action we may come to regret.  In a narcissistic society, where everybody is out for themselves, work, romance, friendship can become so easily become competitive and acquisitive, and deception is a trade off between social integrity and moral integrity.  The mode of deception is not important.  Is there really any moral distinction between lying, misleading, keeping secrets or dissembling?  I think not.  They are all lies.  The important issue is the intention and how much is invested in the belief.   So try not to lie, but if you have to lie, lie well!