Mary, Mary, quite contrary

How does your garden grow?

Do you appreciate authorities telling you what to do with your life?  No? Not in any situation? What if you had a bad accident and felt pain in your neck. Would you want an orthopaedic surgeon telling you what to do? Sometimes direct authoritarian instruction is very good for you and this is certainly the case when it comes to emergency medicine.

In the world of counseling and psychotherapy however, direct advice is often less than useful. Most therapists and counsellers are aware of this and avoid giving it. But what if someone – far from giving sensible advice – would take the side of your problem and warmly order you to do things that clearly would not serve you well?  What if they offered you absurd solutions to your problems and with a twinkle in the eye and genuine affection in the heart,  ‘advised’ you to do more of the very same behaviour which hasn’t helped you get what you want in life?

Provocative Therapy is the cutting edge in the use of humour and reverse psychology in brief therapy. Sessions start with you giving the Provocative Therapist permission to say absurd things – all in the hope of ‘provoking’ you to implement the real solution to any issue in your life. Where is that solution to be found? Why in you of course!  The idea is to use humour and reverse psychology to provoke you (Latin: pro vokare – ‘to call forth’) to locate, articulate and finally implement that solution.

Provocative Therapy embraces the use of paradox and contrarianism in psychotherapy. Interestingly, the central idea of homeopathy ‘let likes be cured by likes’ is also contrarian. I’ve written about this connection here. and I was pleased to see that Frank Farrelly, the founder of Provocative Therapy, has a note on this on his website.

I studied the therapeutic effects of laughter for many years and formulated Kaplan’s Mnemonic to remember them. There is no doubt that laughing at anything or nothing is good for you. When you laugh at your Inner Joke (the funny side of how you, yourself are sabotaging your own chances of fulfillment in life) you get much more than these physical health benefits. You are provoked into making the necessary changes in your behaviour to give yourself a good chance of getting what you need in life. This is how Provocative Therapy works.

Provocative Therapy is not suitable for everyone and a Provocative Therapist will assess your situation before accepting you as a client.  You also do need to believe that your sense of humour can help you change for the better and give the Provocative Therapist explicit permission to provoke you therapeutically. Nobody is ever ‘ambushed’ by this unususal approach and patients are always made fully aware of the contrarian nature of Provocative Therapy.

Make sure you use this Christmas to have as many family fights as possible!

Sorry I should have asked permission before saying that!

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The recently released and well-reviewed film, The King’s Speech, tells the story of how King George VI overcame a crippling speech defect with the help of an unorthodox and unqualified speech therapist by the name of Lionel Logue. Directed by Tom Hooper from a screenplay by David Seidler, the film features the cream of British acting talent including Colin Firth (as George VI), Helena Bonham Carter, Derek Jacobi, Timothy Spall, Michael Gambon and many others. Geoffrey Rush is cast perfectly as the Australian speech therapist.

As portrayed in the film, Logue employs three main strategies in helping George VI drastically improve his speech which proved to be very important for both a monarchy wounded by the abdication of Edward VIII and a country facing war with Germany.

1. Standard speech therapy exercises (of the time): He gets the King to swear, to sing, to relax, to breathe better etc. The film portrays these to be of some use.

2. Psychoanalytic Psychotherapy: He seeks a source of the problem by exploring the King’s early childhood in which he was clearly intimidated by both his father and elder brother. As portrayed in the film, this approach has little effect.

3. Techniques of Reverse Psychology and Provocative Therapy: I cannot say whether this happened in real life or not, but in the film itself, Logue uses many of the tools of Provocative Therapy (reverse psychology and contrarianism) to provoke his patient therapeutically to assert his voice clearly and confidently. In the film we see the King respond dramatically to classic Provocative Therapy tactics. Here are some examples:

a. Logue ‘disrespectfully’ sits on the coronation throne during a rehearsal for an address by the King at Westminster Abbey.

King George VI: Get up! Y-y-you can’t sit there! Get up!!
Lionel Logue: Why not? It’s a chair.
King George VI: Th-that… that-that is Saint Edward’s chair.
Lionel Logue: People have carved their names on it. (and something about not caring about how many ‘royal arseholes’ have sat on it)
King George VI: L-listen to me… listen to me!
Lionel Logue: (cheekily) Why should I waste my time listening to you?
King George VI: Because I have a voice!
Lionel Logue: (with genuine respect) Yes, you do.

b. The King lights a cigarette (He was a heavy smoker and died at 56 from lung cancer)

Lionel Logue: Don’t do that in here.
King George VI: Why not?
Lionel Logue: Sucking smoke into your lungs will kill you.
King George VI: My physicians tell me it helps to relax the throat.
Lionel Logue: They’re idiots.
King George VI: They’ve been knighted.
Lionel Logue: Makes it official then!

And later when the King finally thanks him for his services and asks if there is anything he can do for him, Logue replies: “How about a Knighthood?”

This is very much the kind of thing a Provocative Therapist would say and Logue does seem to obey the Golden Rule of Provocative Therapy – Only ever therapeutically provoke when you have affection in your heart and a twinkle in your eye. The rule he doesn’t obey is to ask the King’s permission to say things that could be seen to be provocative or offensive. Provocative Therapists must never ambush patients and always gain explicit permission from their patients before using the unusual techniques of Provocative Therapy.

Interestingly King George VI was treated by the Royal homeopathic physician, Sir John Weir, who was knighted for his services to the Royal Family by the father of George VI, George V. At the funeral of George VI, Dr Weir used the homeopathic remedy, Ignatia, to treat no less than 5 kings and 3 queens, a feat that is unlikely to be repeated in these days where homeopathy is relentlessly smeared in the media. Here is a rather unorthodox photograph of the good doctor, taken at the Royal London Homeopathic Hospital over 50 years ago.

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I found a recent documentary on Homeopathy made by BBC Scotland particularly biased and disappointingly undemocratic. You can see some of it here.

BBC Scotland will of course say something like they represented both sides of the argument but in my opinion the programme can objectively shown to be against the provision of NHS homeopathy. For example the programme casually mentioned that a parliamentary committee in England had ‘recommended’ that funding for NHS homeopathy should be withdrawn. This is true because the Science and Technology Parliamentary Committee did indeed ‘recommend’ this. What the programme did not bother to say was that the Government comprehensively rejected all the recommendations of this committee on the 26th July this year.

So I thought to myself: How can I personally make a movie to show that the attack on NHS homeopathy (provided since homeopathic hospitals were invited to be part of the NHS in 1948) is both anti-democratic and illiberal?

Although I had a small script, I had no actors, no director, no producer, no editor, no set and most importantly a budget of zero. Undaunted by these apparent disadvantages, I managed to make this movie with the help of a wonderful website called xtranormal.

I am entering this movie for a BAFTA award in the category Best film made without any budget. Please wish me good luck.

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As the silly season draws to an end it’s time to turn to more serious matters. So let’s talk about laughter, humour, health and Provocative Therapy.

The current edition of The New Yorker (Aug 30, 2010) features a nine-page article on the world’s most famous advocate of ‘Laughter Yoga’, Dr. Madan Kataria, a celebrity doctor endorsed by Goldie Hawn and Andrew Weil, MD. Although laughter does not feature in the Yoga Sutras of Patanjali, the most succinct text on the practice of yoga, Kataria has apparently linked the term ‘yoga’ to his laughter practice because some of his exercises use controlled breathing – which could be construed to be a new form of pranayama.

Laughter clubs have sprung up all over the world and have even been promoted by the city council of Teheran. Perhaps Ahmadinejad and Obama should have been invited and the world could have laughed its way to peace? Or maybe not…

The title of Kataria’s book, Laugh for No Reason, makes it clear where he stands on the issue of laughter and health: Laughter is good for you physically, mentally and spiritually and it does not matter why you laugh – only that you laugh. He is by no means the first to point out the therapeutic benefits of laughter. William Fry, Norman Cousins, Patch Adams and many others have spoken and written of the physiological benefits of laughter – the most important of which I have encapsulated in the mnemonic SMILE.

So what makes Dr. Kataria different? Khatchadourian describes Kataria as an ‘exceptional fake laugher’ and this is probably the key to his international success. But can satire, farce, burlesque and theatre of the absurd be utilised to help us overcome psychological issues in ways that ‘laughing for no reason’ cannot?

Provocative Therapy is the cutting edge in the use of reverse psychology and humorous insights in psychotherapy. Patients undergoing Provocative Therapy need to give the therapist permission to say things that might sound absurd, rude, inane, surreal etc. The idea is to provoke (ie.to call forth from Latin pro-vokare) the patient to locate the solution to his/her problem within himself/herself. Although laughter is not absolutely necessary for Provocative Therapy to have a therapeutic effect, its paradoxical approach to dealing with psychological issues often produces a great deal of laughter in the consulting room.

When a Provocative Therapist induces patients to laugh, this is very different from the ‘laughter for no reason’ of laughter yoga. When patients are warmly and kindly provoked into laughing at the absurdity of aspects of their psychological suffering, they can often liberate themselves from that suffering. Frank Farrelly’s Golden Rule of Provocative Therapy (Only do it with ‘affection in the heart and a twinkle in the eye’) ensures that the patient knows that the Provocative Therapist has a therapeutic objective at all times. As people are therapeutically provoked to laugh (and occasionally cry or just stare into space in semi-trance) a window of opportunity can open for them to locate, prescribe and enact their own solutions to their problems.

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Some years ago I coined Kaplan’s Mnemomic, S*M*I*L*E  to help doctors remember the health benefits of laughter. A year or two later a new study showed laughter also to be good for your heart. Now yet another study shows that laughter is an excellent form of exercise that can lower your blood pressure and normalize your weight.

Once again the man in the white coat was Dr Lee Berk (who in the study mentioned above, showed that laughter can lower blood pressure and prevent heart attacks) who conducted the following experiment on 14 healthy volunteers:

1. Everyone watched a distressing 20 minute video – the first 20 minutes of Saving Private Ryan. Blood pressure and appetite hormones leptin and ghrelin measured.

2. One week later (to prevent overlap of video influence) everyone watches their own chosen 20 minute comedy clip and the same investigations done.

Results:

Distressing Clip: no significant change to blood pressure or appetite hormones.

Funny Clip: Changes in blood pressure and appetite hormones occurred similar to what is seen after a bout of healthy exercise!

Conclusions: In addition to all its other physical health benefits as well as obvious psychological and spiritual ones, laughter is also good for regulating appetite. In Dr Berk’s opinion laughter or ‘laughercise’ could be very helpful for people suffering from wasting diseases who may find it difficult to do traditional forms of exercise.

And believe it or not ladies and gentlemen, this is bona fide EVIDENCE BASED MEDICINE! It really seems that the more scientists look for benefits of laughter, the more they find. Not all patients undergoing Provocative Therapy laugh in the sessions but many do – so it’s good to know that as patients are therapeutically provoked to prescribe their own solutions to their problems, they are also doing ‘internal jogging’ or ‘laughercise’ to benefit their physical health!

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One of the central tenets of Provocative Therapy is that people don’t like being told what to do. This is probably due to the fact that we often perceive advice (even when well meant) to be patronising and condescending. Thus Provocative Therapists utilise a variety of specially designed tools that use clinical reverse psychology to ‘advise’ patients to do the opposite of what will be good for them. Of course patients have to be fully briefed of the process before they are given ‘good reasons’ to put on more weight, smoke stronger cigarettes, exercise less, spend more and blame others for their problems. When this is done with a ‘twinkle in the eye and affection in the heart’ (Frank Farrelly’s  Golden Rule of Provocative Therapy) they seem to insist that they must lose weight, quit smoking, start exercising, be sensible about mone and take responsibility for their lives in general.

When patients are thus ‘provoked’ to articulate and own the solutions to a wide variety of problems, they really seem to insist on enacting those solutions in real life. This is the magic of the paradoxical effect of Provocative Therapy.

Advertisers and marketers have always recruited psychologists to help them influence the public to buy their products but the power of reverse psychology is surprisingly very seldom used. It was with interest that I noticed that Saatchi & Saatchi has resorted to using reverse psychology in trying to revive the Conservative Party’s election campaign.  The New Statesman promptly responded with a host of spoof posters attempting to give the Tories a dose of their own medicine. The whole story has thus injected a much-needed dose of humour into political campaigning. If this carries on maybe it will be The Official Monster Raving Loony Party that forms the next government!

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In a discovery of cosmic significance, it has just been proved scientifically that men are more likely to suffer heart attacks and strokes after enduring great stress. Didn’t we already know this? Apparently not. Let me explain…

Organisations such as the British Heart Foundation (BHF) have until now claimed that ‘there is no evidence to suggest that stress causes coronary heart disease or heart attacks’ saying instead that: ‘Some people cope with stress with destructive behaviour – such as smoking, drinking too much alcohol and overeating. These increase your risk of cardiovascular disease.’ In other words stress itself is not really a standalone cause of cardiovascular disease, but can make you more susceptible to some of the known risk factors of obesity, lack of exercise, cholesterol and smoking.

The BHF may now have to revise that view because the men in white coats at University College London (UCL) seemed to have proved otherwise. The high priests of our so-called ‘evidence-based society’ (aka scientists) have finally proved that the stress hormone cortisol (which can lead to narrowing of the arteries) is raised during stress and the volunteers in whom this happened were more likely to have furred arteries. This suggests strongly that stress should join obesity, family history, smoking, lack of exercise, high blood pressure, diabetes and raised cholesterol as a risk factor for heart attacks and strokes.

So what can we do about this? To the understandable (if unforgivable) horror of dairy farmers, a heart surgeon who really understands the meaning of the term ‘medical authority’, has recommended that we ban butter! (sic) Good idea Mr Shyam Kolveka! As a Provocative Therapist I can only applaud doctors for using their superior intelligence, education and status in society to assert their inherent authoritarianism and to influence legislators to coerce people into health!

After banning butter, we should ration red meat, imprison and torture cigarette manufacturers (we cannot afford to lose the tax on tobacco at this point in time), make fat people pay more tax (and certainly higher air fares) and use cow prodders to shock the selfishly lazy into exercising. Government-provided exercise bikes linked to the interenet will be assessed by the Inland Revenue in relation to your tax bill as CPD (Continual Physiological Development) discounts are used to ‘incentivise healthy living’. Finally, all teetotallers should be force fed 2 units of alcohol a day because this has been proved to reduce the risk of heart attacks! Sorry if that offends anyone but Science Rules – okay?

And what about stress? I hear that the government is about to jump into action to help us become less stressful. Later this week Premier Gordon Brown and Health Minister Mike O’Brien (persuaded by a medical quango comprising Edzard Ernst, Ben Goldacre, Michael Baum and David Colquhoun) will announce that there will be free evening Autogenic Therapy (a proven form of stress proofing and stress releasing) at every general practice in Britain – not.

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In the history of anatomy, it is an extremely rare occurrence for a part of the body to be declared not to exist. Yet this week the Journal of Sexual Medicine will publish an article that claims that the ‘idea of a G-spot is subjective’ – which means that the much written and chattered about erogenous part of the vagina does not objectively exist.

The case against the G-spot:

The men in white coats at Kings College Hospital, London studied 1804 female twins (Who said medical research can’t be fun?) of ages 23-83. They found that if one twin claimed a G-spot this made it no more likely for the other to claim to have one. So now all women who have not had the ‘G-spot experience’ can relax and avoid feeling inadequate because the G-spot probably does not exist.

The case for the G-spot:

1. 56% of women say they have a G-spot.

2. A USA based study of 400 women did suggest the presence of a G-spot. Sexologist Prof. Beverly Whipple of Rutgers University (co-author of The G Spot and Other Recent Discoveries about Human Sexuality) unsurprisingly claims that the G-spot does indeed exist. The good professor was less than impressed with the design of the Kings College study because it excluded lesbians, bisexual women and the ‘effects of having different sexual partners with different love-making techniques’. Good point Dr. Whipple! Now what were the ‘Other Discoveries’ in your book?

So does the famous discovery of gynaecologist, Herr Dr. Ernst Grafenberg in 1950 exist or not? We need a better study and thinking in the spirit of Provocative Therapy, I’ve just designed the perfect one.

The Definitive G-spot Trial:

The idea of using identical twins is a good one but it’s been flawed and floored by the simple fact that identical twins don’t generally have identical sexual partners. So what needs to be done is a trial that only studies identical female twins who live in a ménage trios with one man! I could have suggested a trial in which a researcher (male or female – see how pc I am!) with evidence-based ability to hit the G-spot, volunteers – in the name of Science – to work with identical twins; but this wouldn’t be ethical and I’m not sure how many identical twins would be equally devoted to scientific progress to take part. However it beats me why a co-author of the British study, Tim Spector, a professor of genetic epidemiology no less, did not think of these obvious solutions to the problem. They may sound cocky, but G whiz, anatomy, medical science and sexology need to have a definitive answer to an important question: Who should now feel inadequate? Women who don’t know if they have a G-spot or not – or their lovers be they male or female?

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Meditating on the decade that was, the words of the poet W.H. Auden came to mind:

The windiest militant trash

Important Persons shout

Is not so crude as our wish:

What mad Nijinsky wrote

About Diaghilev

Is true of the normal heart;

For the error bred in the bone

Of each woman and each man

Craves what it cannot have,

Not universal love

But to be loved alone.

Alas ‘the error bred in the bone’ is in no danger of being cured – least of all by the medical profession. Increased regulations, pressure on doctors to conform, comply and worship at the altar of the religion of Scientism and vicious attacks on independent thinking in medicine (eg on doctors using homeopathy) have dealt a blow to those most noble of virtues to be found in doctors – discretion, conscience and love.

But there is always hope as Auden points out later in the same poem:

Defenceless under the night

Our world in stupor lies;

Yet, dotted everywhere,

Ironic points of light

Flash out wherever the Just

Exchange their messages:

I love the phrase ‘ironic points of light’. Perhaps irony will be the road to freedom in the decade to come. In the year to come I intend to use the tool of irony extensively in this column and will certainly write more about my great passion in medicine – Provocative Therapy. However the detractors of homeopathy can ‘rest’ assured that the Pie Man remains on Red Alert to refresh the memory of those who persist in using evidence based medicine as a blunt instrument to attack homeopathy and CAM exclusively. So David Colquhoun, Ben Goldacre, Tracey Brown, Andy Lewis, Michael Baum, Simon Singh et al and particularly Edzard Ernst (who incidentally shares my love of Autogenic Therapy – more about that later in the year)  can look forward to my congratulations if  (post – O’Brien) they can still get their opinions (based on the politics of scientism and the philosophy of naïve realism)  published in reputable medical journals and other media. But for me irony* will be the way.

*Irony is one of the most misused words in the language. For a good working definition I turn to the King of English himself, H.M. Fowler: “any definition of irony—though hundreds might be given, and very few of them would be accepted—must include this, that the surface meaning and the underlying meaning of what is said are not the same.” (from The King’s English)

And with that I wish you all a very Happy New Year and I’m not being ironical – not yet.

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The Pie Man has the noble duty of delivering this pie chart to those who jeer at homeopathy and CAM because they consider them to be less than evidence-based. In the name of truth and beauty*, the Pie Man attempts to make it clear that most of common conventional medical interventions are far from evidence-based in the hope that people in glass houses will be less inclined to throw stones.

The pie (or pie chart) is baked (or compiled) by no less an authority than the British Medical Journal’s Clinical Evidence, a publication that could hardly be described as ‘alternative’.

What I’d like to point out today is that the pie changes as the evidence does or does not roll in to support common orthodox medical treatments.

Let’s have a look at some of the ways the pie has changed since the Pie Man first emerged some months ago.

Interventions of Proven Benefit: A fall from the embarrassingly low figure of 13% to 12%. Single figures soon? I find it amazing to read of the attacks on homeopathy by the likes of Baum and Ernst in the light of this figure in particular.

Interventions of Unknown effectiveness: another embarrassing shift – UP from the huge figure of 45% to 49%. ie: half of conventional medicine treatments are of ‘unknown effectiveness’. Side effects are far from ‘unknown’ though and obviously far more common with regard to orthodox medication than gentle homeopathic remedies whose most fierce critics would have to agree very, very rarely produce any side effects.

*When old age shall this generation waste,

Thou shalt remain, in midst of other woe

Than ours, a friend to man, to whom thou say’st,

“Beauty is truth, truth beauty,” – that is all

Ye know on earth, and all ye need to know.

(from Ode to a Grecian Urn by John Keats)

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