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Showing posts with label The Guardian. Show all posts
Showing posts with label The Guardian. Show all posts

Saturday, 20 August 2016

Beginning, not with the birds and the bees, but the psychiatrists and the psychoanalysts…

More views of - or before - Cambridge Film Festival 2016 (20 to 27 October)
(Click here to go directly to the Festival web-site)

16 August

An article in The Guardian (@guardian) sets out to tell us something that its writer thought of serious import, about, despite the elapse of seven decades, the static representation of ‘female shrinks'…

Perhaps, in its tag-line, the description ‘female shrinks’ might just have left it ambiguous whether psychiatry per se is what was really meant here.

However, the words below the tag-line, which introduce the piece, and its opening words (both as quoted¹), plainly use the word ‘psychiatrist’ : yet Dr Constance Petersen, in the person of Ingrid Bergman², is repeatedly and consistently defined by reference to the professional term ‘psychoanalyst’.

So, sadly, referring to 'psychiatry', in this article now, is not exactly interchangeable with talking about psychoanalysis – even if it might once have been in the mid-1940s, with a lesser emphasis on medication ? – and is probably almost on a similar level to calling an astrologer an astronomer (or vice versa)… ?

More to come, where we may actually review the film, or come onto the question whether films ever really represent – or set out to represent – psychiatric practice…

When Matt Damon and Ben Affleck wrote Good Will Hunting (1997) (and both appeared in, the latter as ‘Chuckie’ Sullivan), can we any more just take at face value that Dr Sean Maguire (Robin Williams) really is literally to be taken to represent even some sort of maverick psychologist ?

Can we do so any more than view Dr Constance Petersen (Ingrid Bergman) in Spellbound (1945) as really being a practising psychoanalyst of whatever age, who has never been in love before, but falls for John Ballantyne (then in the mistaken guise of Dr Edwardes) within a matter of hours ?

This piece may have ended abruptly, but see also Whatever you mean by calling something ‘sexism’, take a look at Spellbound (1945)

End-notes :

¹ Respectively, Seventy years separates the Hitchcock’s film with [sic - on both counts] the DC blockbuster, but the social attitudes towards women psychiatrists they exhibit have barely altered, and A sexless female psychiatrist, devoted to her work, encounters a fascinating mentally ill man. Suddenly, she is awakened to the joys of love and devotes herself to her patient, abandoning her profession in a sensual ecstasy of criminality. Women psychiatrists : they’re driven mad by love.

¹ If, just if, Alfred Hitchcock had ever meant us to forget for a second that this was Ingrid Bergman on screen, would he have cast her – and not someone relatively anonymous – to be utterly convincing as this psychoanalyst, who breaks (as far as one can judge, but somehow actually gets away with it) all the professional rules in the book ? !

Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)

Saturday, 27 June 2015

Doublethink in Mecca : being devotional despite inflicted modernity ?

This is a Festival review of A Sinner in Mecca (2015)

More views of or before Cambridge Film Festival 2015 (3 to 13 September)
(Click here to go directly to the Festival web-site)

27 June (29 June, Post-script added)

This is a Festival review of A Sinner in Mecca (2015), which screened at Sheffield Documentary Festival 2015 on Tuesday 9 June at 6.15 p.m.

This remains the most perplexing film from Sheffield Documentary Festival, with its themes almost at poles away from each other (please see below) having tumbled around in one’s head, in search of supremacy, throughout the screening. Although, in fact, none ultimately found any, and one’s hopes for a considered response were then jostled by a good deal of immoderately detailed criticism, and even hostility, in the Q&A* (so what one first wrote please see below was not an ideal appreciation) : it was painful that there was the palpable affront to, and taken by, director Parvez Sharma (@parvezsharma) at being asked why he had made A Sinner in Mecca, and what it was about (as he pointed out, to these people who had just watched his film, there was insult in so doing).

These themes in the film [its official web-site is], which refuse to stay together and be quiet, are fairly simply stated (though it is not intended to be reductively done) :

(1) The desire to complete a Hajj to Mecca and show that one is a good Muslim

(2) How the traditional elements of a Hajj (specifically the environment and manner in which they are carried out) have been influenced or even changed by the Islamic tradition to which the ruling Saudi royal family adheres (the Wahhabi form of Sunni Islam)

(3) A prohibition on filming at Mecca and the other religious sites (whereas we have footage, and much contemporary audio, of everything that Sharma does to complete his Hajj)

(4) Recent executions, by beheading, of men just for being gay

It is partly in the interaction of themes (1) and (2) that tension arises within the viewer : Sharma is clearly sincere in wanting to carry out the traditional steps of a Hajj, and seek acceptance from God for his pilgrimage, but he in no way refrains from doing so and at the same time pointing out how a shopping-mall, for example, complete with a branch of Starbucks, is a matter of a few hundred metres from the most sacred Islamic site, The Kaaba (or Ka’aba), in the mosque Al-Masjid al-Haram [the link is to the Wikipedia® web-page]. It feels like a remarkable doublethink on Sharma’s part, trying to engage with the significance of all these ritual acts (and their meaning to him), but at the same time as criticizing what the ruling family has done to holy sites (or, later in the film, seems to have allowed to happen to them).

One is reminded that, in the Christian tradition, all four Gospels have accounts of Jesus driving the money-lenders out of the Temple (e.g. Matthew 21 : 1217, 2327), and Islam has equivalent passages of zeal for God’s house :

At the culmination of his mission, in 629 CE, Muhammad conquered Makkah with a Muslim army. His first action was to cleanse the Kaaba of idols and images.

Narrated Abdullah: When the Prophet entered Mecca on the day of the Conquest, there were 360 idols around the Ka'bah. The Prophet started striking them with a stick he had in his hand and was saying, "Truth has come and Falsehood has Vanished.. (Qur'an 17:81)"

Sahih Al-Bukhari, Book 59, Hadith 583

Since, from what Sharma says in the film, we do not know whether theme (3) is a religious prohibition (or an administrative one), and in the light of a harsh state religious penalty from theme (4), one might imagine and hence be anxious that he risked execution to take his footage (please see below). Here lies what appears to be a further conflict : even if a person decides for himself, irrespective of such a penalty, that a good Muslim can be gay (or lesbian), why would he (or she) flout a prohibition not to film in sacred places ? As with the pull between themes (1) and (2), so, in that between (1) and (3), one spends time not quite fathoming why Sharma has chosen to film his Hajj and that gnaws at one, as one watches the film :

Is he if a real distinction is being made here filming it as proof for himself that he did it, or to show us ? (Although, if he is showing it to us, we may not (easily) understand what this series of acts means to him spiritually, especially the final one, which is alarming.) If he had not filmed, of course, there would not be a documentary (not in this way, at any rate), but does the film, as we watch, leave us with the uncertainty how he can be both sincerely pious and simultaneously documenting his experience, if (and we do not know) filming is against a religious ordinance ? Or do we maybe need to throw ourselves into a world such as that of Chaucer’s pilgrims in The Canterbury Tales (or of Gide’s Les caves du Vatican), and not try to separate religious experience from humanity from human nature ? (With the example of Jesus and Muhammad, after all, we see how they concentrate on what is holy about the Temple / the Ka'bah, and dismiss the unworthy human additions : does the pilgrim, too, undertake certain steps to reduce his or her unworthiness ?)

Quite often (maybe through not being a Muslim ?), one wonders whether Sharma must be ‘going through the motions’ in his Hajj (or, in part, feel that he is ?), since he is commentating so pointedly on what has become of its elements in modern Saudi Arabia that, though, does not quite identify our question, but is an attempt at understanding what it must be like to be in locations that have now been ‘reinterpreted’ so radically (not his word, but a euphemistic analogy). For example, Sharma tells us of the history that gives symbolic significance to the activity of running between two mountains (and we are shown a moment of animation) : they are mountains, now that the space has been enclosed, that we cannot see, but only what resemble (again, not his word) ‘soulless’ modern corridors.

Using the word ‘soulless’ is not, of course, at all meant to denigrate the inherently sacred nature of this spot (for Sharma himself indicates that he does not relish what has been done here). It is an attempt to say what it looks like, as a space that one would think lacked significance, and even much humanity as when we castigate planners for giving us an unwelcoming underpass, or a corridor that we have to tramp down to get to platforms on an Underground line. Sharma, however, must somehow keep everything holy in his soul and heart, despite the fact that this and other settings for elements of the Hajj have been changed so much that we wonder how the religious acts themselves can remain. (Likewise, he shows us what disgusts him in traffic-jams on a coach that last for hours, and in having to make devotions in a city full of discarded rubbish that no one deals with.)

Somehow (or mentally somewhere : as if in a minimal area of overlap between themes (1), (2) and (4), in a Venn diagram ?), despite being critical that Saudi cemeteries / monuments have been destroyed (because the Wahhabi faith of the royal family discredits praying to idols), Sharma sees himself as capable of making a Hajj that is acceptable to his God yet, in so doing, rejecting / critiquing what has now been done to the religious centres, including the fact that his sexual orientation stands condemned and that filming is banned (theme (3)). This seeming confusion of attitudes is why, early on and for the round-up portal-page for Doc/Fest coverage, this comment was made :

Despite director / cinematographer Parvez Sharma’s hope that his film was not self indulgent, and the insights that he wished to share through going on a Hajj about Mecca and other holy sites, and the ruling Saudi dynasty and its attitude to the past, how he pursued, and attained, the object of his quest seemed to stay very personal to him and his experience

The more reflective step, before starting to analyse the film’s themes (as attempted above), was to consider the case of Arthur Koestler, who (in the summative Bricks to Babel, which probably excerpts an earlier work for this material) reported his experience of being so far ‘inside’ the ideologies of both first Communism and then Christianity that objections to them could be heard, but never penetrate to or undermine belief : the internal logic of each belief-system had a self-sustaining answer for everything that challenged it. Here, one needs to come to a realization that none of the negative associations involved in what we see of Saudi such as the Wahhabi accretions / rulings / modernizations affect Sharma’s core relationship to his faith, and, more importantly, what he ends up telling us that he has nevertheless taken from the Hajj : He feels accepted by his God, and he is vindicated as a Muslim who is also gay.

However, for us as viewers, that part of what happens in the film is utterly internal to him, with (especially, again, if we are non-Muslims) only his words as mediation between his experience and us not least if we do not relate to the notion of, or what is needful in, a blood sacrifice [in the tradition of Ibrahim / Abraham]. Moreover, the path that Sharma is shown having chosen, to travel to Saudi (despite being gay), and intending to film, is a very narrow one : on account of a sequence at the opening of A Sinner in Mecca, which, quite from choice, seemed to front-end what followed, but never to be returned to**, one was left, as one watched (despite the fact that, flesh and blood, the film-maker had introduced his film), more and more anxious at the risk that he had run to make it (and whether there was still a possibility of reprisal, against him or those who screened his film ? on which, please see the Post-script).

In the event, perhaps it could have helped one focus on other aspects of the film, if one had known beforehand what one came to learn in the Q&A : one device that Sharma had been using to film had actually been confiscated, and what he had filmed was deleted (so he had had to replicate it later on), but nothing worse had happened***. Even so, it may be that the nature of the themes that Sharma is handling here (as teased out above) just inevitably mean that it feels in conflict with itself, and that we are likely to stay external to his understanding of himself in relation to Islam and his God ?


Synergistically with working on the above review, and en route to and from The Stables for a folk gig last week, Richard Thompson’s album The Old Kit Bag was being replayed.

One had forgotten that, in part two (The Pilgrims Fancy, titling tracks 7 to 12), was a song called ‘Outside of the Inside’. It begins provocatively with God never listened to Charlie Parker / Charlie Parker lived in vain, and calls his jazz ‘monkey music’, and him ‘Blasphemer, womaniser’ the first of several take-downs of Western figures such Albert Einstein, Shakespeare, Isaac Newton, Van Gogh and Botticelli.

Towards the end, we have these rather chilling lines :

I’m familiar with the cover
I don’t need to read the book
I police the word of action
Inside’s where I never look

The review of the film that appeared in The Guardian (by Safa Samiezade’-Yazd), now read, tells us : Parvez, who is gay and Muslim, has had death threats for making the film, leading to increased security at the festival screenings. (In retrospect, then, the search of our bags in the way into the screening at Doc/Fest had been nothing to do with trying to restrict pirating…)

As the review also has a short interview, at the end, with the reviewer as a sympathetic questioner, it is well worth a read to give the film’s director a chance to talk about A Sinner in Mecca, without (as we had twice in the Doc/Fest Q&A) a point-by-point insistence on the ways in which he had misrepresented Islam and its tenets, for example :

This is a film about the change that needs to happen within Islam. It’s a direct challenge that has never been mounted to the Saudi monarchy. It’s a call to action to all Muslims to take back singular authority over their faith.

Seen at Sheffield : Doc/Fest films with full reviews


* Except that one did not wish to get caught up in the emotion behind these harsh comments, and see a film-maker who has brought a film be attacked, was it possible that the fact that, in themselves, they were being made almost provided sufficient justification for having made A Sinner in Mecca ?

** A little stagily, though, in fact, the staginess proved to help convey the sense of fear and desperation of the director’s correspondent, and thereby to leave one, later, in trepidation for his safety.

*** Even so, the fact that he had made A Jihad for Love (2007) connected him, as a film-maker, with being gay, so he had clearly heightened the risk of being identified, when in Saudi Arabia, by filming. (And, as was put to him in the Q&A, his film had been open about his marriage to his gay partner in New York City at the start of film, but, in some parts of the States, legislation against same-sex marriage was being passed, so the negative attitudes were close to home.)

Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)

Friday, 2 January 2015

A hasty little response to the latest cancer stories [incomplete]

More views of - or before - Cambridge Film Festival 2014 (28 August to 7 September)
(Click here to go directly to the Festival web-site)

2 January

On this day, there are Two ‘cancer stories’ for the price of one on Yahoo !

But how do such news items even get to us ? :

And, when people comment (who might stand to lose... ?), where is the bias (sc. ‘the truth’) ? :

Other than Woody Allen famously saying (through characters in his films, i.e. in the script) Hey, don’t knock masturbation. It’s sex with the person I love most ! [Annie Hall (1977), we also have this (from Sleeper (1973)*) :

Female doctor : What we have done, Miles, is highly illegal and, if we get caught, we’ll be destroyed – along with you.

Miles Monroe: Destroyed ? What do you mean… ‘destroyed’ ?

Male doctor : Your brain will be electronically simplified.

Miles : My brain… ? – (wistfully) it’s my second favourite organ…

To be continued…


* Both films were co-written with Marshall Brickman, as Allen has sometimes done (even recently) with Brickman and others…

Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)

Friday, 9 August 2013

Article in The Guardian as popular as Crocodile Dundee's snake in a lucky dip ?

More views of - or before - Cambridge Film Festival 2013
(Click here to go directly to the Festival web-site)

10 August

To my mind, such of the mental-health community as has been lashing out at Giles Fraser's article Taking pills for unhappiness reinforces the idea that being sad is not human has missed the point :

Typical comment on Twitter says that Fraser does not know what depression is, whereas I believe that those readers have not troubled themselves to understand what he is saying, and, therefore, he is just as misconstrued as those who experience / have experienced depression often are.

Far be it from me to defend Thatcher, whose beliefs and policies I despise, but I no more believe that her There is no such thing as society speech was given a fair press* than this article :

1. Fraser's first two paragraphs, i.e. setting the context for the rest of what he talks of, are about his behaviour at school, how children who behave like that now may be diagnosed with ADHD, and may even be prescribed ritalin.

2. Anyone who has watched the documentary Bombay Beach (2011) will have seen Benny prescribed with anti-psychotics, which I find even more horrifying.

3. The third paragraph I come back to, though the effective point is that, just as diagnoses of ADHD and prescriptions have risen sharply (there are nearly four times as many in just eleven years), so have prescriptions for anti-depressants.

I do not read what Fraser says here as saying that his experience amounts to depression, but the opposite, i.e. that it does not.

4. The fourth paragraph talks about how chlorpromazine (thorazine in the States) and other medications came to be used for the purpose of altering mood in psychiatry, and were originally used for treating infections.

I see nothing much wrong in inferring that, if a medication can be licensed, manufactured and prescribed for some other purpose, then the pharmaceutical industries have a motive for promoting them.

5. Fraser does not report them, but some recent studies have been quoted where it has been shown that the effect of anti-depressants is no better than a placebo. If true, that not only casts doubt on why the NHS spends money on them (or we take them), but also strengthens what Fraser is actually saying.

6. In his final two paragraphs, he brings together the industries' desire to make and market products with that of GPs to do something for patients (either because the patients are distressed and ask, or because, in any practice, there will be GPs who are 'more interested in' the physical side of health, and who maybe do not know better than prescribing when others would not).

7. Fraser has been demonized as if he does not know what depression is, whereas I follow him as saying that maybe things that are not depression are treated as if they are.

No one who knows how little training GPs (primary health, as it is called) are required to have in mental health would :

(a) Go to his or her surgery without establishing which doctors lean towards it, or

(b) Believe that the fact a doctor has prescribed means that it was appropriate, or that a referral to secondary mental health services, pressed as they are, would even be accepted.

To suggest that Fraser's article is really of a Pull yourself together kind is, I think, a hasty and ill-judged reading, stemming from anger and disappointment at believing depression to have been written off.

However, he would have done well to make clear that he is not disputing that depression exists, only that treating people as if they have clinical depression (i.e. without their having symptoms such as anxiety, waking too early or sleeping too much, not feeling much - or anything - emotionally, etc.) is not really doing them a favour.


* Since I gather that she meant just the opposite of what people claimed - still, it all helped remove her.

Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)

Wednesday, 1 May 2013

The Answer to Everything ? (#ATEOpera)

More views of - or before - Cambridge Film Festival 2012
(Click here to go directly to the Festival web-site)

1 May

On Thursday last week, I went to the British Film Institute (@BFI) with the intention of watching a matinee and redeeming a complimentary ticket (issued because of the out-of-synch screening of Underground) : because of some conference, there was no matinee, and I couldn’t find the ticket, but none of that turned out to matter :

I bought a ticket instead to see Streetwise Opera’s (@streetwiseopera’s) production, with sections on film, at some venue, not necessarily NFT3, where we were all delegates together in some (seemingly) fictional conference, although many a one attempted, in character, to do such things as selling me a tie (I pointed out that I had one in my pocket, and that a T-shirt has no collar anyway) or asking me how I felt about the event.

To camera, when invited to say something inspirational, I came up with ‘Brick is beautiful’. It turns out that it would – if anyone had much been paying attention – have been seen on the screen of NFT3. Generating nonsense to order, as this blog as a whole is likely to evidence, doesn’t entail much…

In a way, I wish that I had bantered more with the Streetwise crew, rather than taking my seat, but, once in my seat, it seemed churlish to make the row rise again (to let me out) and, yet again, for my re-entry – the other end of my row was blocked off by the mixing-desk. (It seemed that no one else decided to join in with the ‘official’ delegates at the front, with their suits, briefcases, ability to sing.)

As a homage to Marcel (although spelt differently), I had chosen a name-badge with the identity of Pierre Duchamps, an Alternative Energy Intern. I hoped that something would hang on this, rather than it from the lanyard, so it was a disappointment that it might as well have said George Osborne, Financial Meddler. (No big deal, but there could have been a draw from those badges known to have been issued, and a game of forfeits...)

Ignoring the name, when one of the cast introduced himself by way of an extended arm from two rows forward, I claimed to be Peter Henderson-Smyth-Henderson-Smyth-Henderson, and he concluded that I sounded ‘quite posh’.

I hoped also that, in the style of I Fagiolini’s The Full Monteverdi my neighbour would turn out to be ‘a mole’. When I heard / saw that show (in Cambridge), one knew that, over a modest meal, one had one or more singers at one’s table, but not who he, she or they were :

A woman challenged me as one, and – fool that I am – I didn’t play my denial for all that it was worth. (Although, of course, it was self evident that a denial couldn’t mean anything, so I wasn’t believed anyway, since, as everyone will testify, I do look like a professional singer.)

No matter, as it merely meant that I could, more or less, relax in my seat without the obvious need for further participation. However, I did fail to reckon on the company song, and, at the best of times (silliness doesn’t help), I cannot co-ordinate words and any actions, not least when those words (and their music) were unknown to me minutes before !

Early during the run-through of this act of corporate worship, I gave up, and, standing inert, took much more satisfaction in seeing the cast sing and mime the whole song en masse (which, in the style of The Twelve Days of Christmas, repeated each one of the Ten Rules of Good Business), much more than coaxing my resistant abilities further could have achieved. (I have no doubt that few have my problems, and most would have taken pleasure in what, for me, was an exercise doomed to fail.)

That’s my hesitation out of the way, a strange (but usual) mix of wanting to be in a role-play, but on my terms. So, on to what this combination of filmed and live experience seemed to say. In doing so, I am influenced, after the event, by having read the programme**, which, I found, pulled together one’s appreciation of the overall narrative intent. (Such, of course, is the way – and world – of opera, whereas I am happy and used to making my own way in that of film).

Not to try to summarize what happened, save that the film interspersed with the live singing and action, the arias from Christopher Lowrey (counter-tenor) and Elizabeth Watts (soprano), interacting on screen with members of Streetwise from all over the country, were exquisite. Indeed, as I Tweeted :

I can confidently (wonder whether I should) state that @streetwiseopera's #ATEOpera had a good take on company manners, @catherinebray...

Can't stop humming (in public, and singing elsewhere) Lascia ch'io pianga after @lizwattssoprano and @streetwiseopera plus Sacconi Quartet !

The filmic aspect was in no way subservient to the role and action of these clips, but portrayed the alienation, isolation and heartfelt humanity at work in a response to the clinicality of company lore, which dictates shaking hands with the client not because one feels that one wants to, but as part of good business.

I have seen the Watts aria several times over (as my attempt to support Streetwise and download from the iTunes platform failed, after posing insurmountable problems), and it stands that repeated watching, because it is composed entirely in the idiom of cinema. I imagine the same to be true of the aria sung by Lowrey, of which my impression was that the wholly musical performance of the Vivaldi was respected in the service of the message that rapacity to invest threatens to overcome what matters, and what we should really value in this life.

Informed by the programme, I apprehend the arch that these and the other filmed sections sought to erect, but I do confess that I was lost in following how the scene from Peter Grimes, which, I now gather, led into a Streetwise commission from Orlando Gough, brought about the degeneration of the dream of Locateco Solutions : throughout, this cinematic work, the execution was brilliant, and the closing scene of rejection, liberation, and immersion in the natural world was evocative and poignant.

It was merely that the step that took us to where the façade began to crumble was not clear. Arguably, though, for those who felt the movement for the Berlin wall to collapse, or for what is shown in the powerful documentary The Miracle of Leipzig (2009) (Wir Sind das Volk) not to happen, the feelings were stronger than an exact notion of why what was tipping had become unstable.

So the filmed episodes I do not seek to fault : David Pisaro (tenor) singing Grimes in the church setting was marvellous, as was how the scene – with Britten’s skilful writing – built to his expulsion, but – rightly or wrongly – I felt that I did understand, at the time, why everything was unravelling. The programme addressed that, and this is – if a concern at all – a minor one, since I had had the time to read ahead, but chose not to.

The Streetwise singers in NFT3, interacting with the projection, gave an overall feeling that conveyed how important the voice, music, the human spirit is. All in all, a stunning experience, and a tribute to all in any way involved with it !


After this Tweet (and following the link) :

StreetwiseOpera ‏@StreetwiseOpera 21m
Lovely review of #ATEOpera in @spectator

I commented this:

Everything that this reviewer writes about @StreetwiseOpera's The Answer to Everything is spot on : it was timely, its parody of the corporate world (and its tics) was telling and amusing, and the music was of a very high quality, not least that passage from Grimes.

And if any Minister for Culture couldn't understand or relate to it, maybe that person's in the wrong job... !

I have now followed a link to a review in The Guardian, as Tweeted by @StreetwiseOpera... The reviewer found the event dramatically 'confusing', which mirrors what I attribute (above) to not having read the synopsis.


* I tried to explain that I was there on the strength of knowing that Elizabeth Watts (@LizWattsSoprano) was involved, whose single with Streetwise I knew (from Splatter) had just been released.

My neighour thought that I said ‘Watson’, and, her not knowing EW, it didn’t seem to help that I said that she is a soprano. I ended up mumbling something about she was probably one of many, as I was, sadly, suddenly not sure, in the guise of being a delegate, how sopranos could fit in a corporate structure…

** It had two front covers (a style of presentation that I gather to be called tête-bêche).

Monday, 29 October 2012

Miliband on mental ill-health - 29 October 2012

More views of - or before - Cambridge Film Festival 2012
(Click here to go directly to the Festival web-site)

30 September

A series of what I see as key messages in Tweets

Then, in a comment on @MarkOneinFour's (Mark Brown's) piece in The Guardian, I said :

I think that the issues raised in this article need to be related to others that were mentioned in the speech:

What Miliband called 'the artificial divide' between physical health and mental health (as if, to one with experiences of stronger cases of either, it were not obvious that poor physical health can affect mood and morale, and how poor mental health impacts on immunity), because if people (GPs included, whose apparent desire for better training was highlighted) appreciated that they are not separate, more might give in the bullishly unforgiving attitudes of those such as Clarkson (much as he wanted to portray Brunel as a great man and for us to vote for him, when it suited).

Miliband rightly drew attention to the fact that the physical health and the mortality of those with long-standing mental-health conditions are far worse, and, although doctors may ask for better training, there has to be a massive shift in attitude, if the chest-pains of someone with a mental-health diagnosis are not, until it proves to be a heart condition, to be ascribed to panic-attacks or anxiety, whereas any other patient is looked at with open eyes.

It is a complete disgrace how, on mental-health units, even patients with diagnosed, pre-existing physical conditions receive - or do not receive - care, and the opposite case, of such a person being in a physical-health ward and needing their mental-health needs understood and not patronized, can be just as bad.

But, whatever the poor starting-point, Miliband is right to identify these issues, and I have tried to draw the half-dozen or so key messages out of his speech in my blog at [URL for this page censored by
The Guardian]:

Next, I shall make another version of this posting, and interpolate comments between the Tweets of Miliband's speech...

Tuesday, 11 September 2012

Wellington boot beef

More views of - or before - Cambridge Film Festival 2012
(Click here to go directly to the Festival web-site)

11 September

An army marches on its Napoleon. Any Napoleon worth the part takes the cat's whiskers, and she, instead, wears pyjamas.

Meanwhile, in Beijing, the duck still haven't got used to the enforced change of name, and, knowing no better, decide to petition Mao. John Adams, content with Nixon in China, dances with the Chairman of the Bank of England, soon to retire. Adams, however, has no intention of retiring, but, just to be on the same side, goes for a check-up with Dr Atomic.

Past Eve and Adam's, down at the Atomic Energy Authority's annual ceilidh and cake, there's plenty of craic, assuredly no crack, and, to Jennifer Saunders' infantile dismay, barely an arse-crack, let alone a builder's. She takes her tea rough, shaken not stirred on board a somehow sea-borne HMS Belfast, which was a damn-fool choice to sail up the Liffey.

Gub-boat duplomacy being what it is, they have discplined the Guardian's staff, who charter-partied the vessel for their own bash. Insurers rub their hands, having heard that it was for a bash, because their command of idiom is pedestrian, and a crossing such as this is, to be blunt, beyond even Mary's conception.

The army straggles on, into the territory that once was occupied by The Banana People. They had no objection to being named after a green fruit, and still live there, but International Law, International Relations, the UN, and International Rescue deemed them The Papaya People:

For all the sense that it made, it might as well have been The Pipistrelle People, or Pirelli People

Pan's People, anyone?

Friday, 7 September 2012

This is a farce that makes you think (according to The Guardian)

This is what the theatre says was written about Hysteria by Terry Johnson

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7 September

This is what the theatre says was written about Hysteria by Terry Johnson

Johnson is best known to me as having written the play on which the film Insignificance (1985), directed by Nicolas Roeg, was based, but may also have directed the performance that I saw of One Flew Over the Cuckoo's Nest (taken from the novel), and almost certainly did that of Shelagh Stephenson's The Memory of Water.

I do not know Johnson's earlier play, but what do we have here ? : the fictionalization of a real meeting between the inventor of psychoanalysis and one of the world's most eccentric artists of the twentieth century. In Insignificance, Marilyn Monroe famously meets Albert Einstein (though I don't think that they ever did).

But this is not Michael Frayn with Copenhagen, Nils Bohr, Werner Heisenberg and Bohr's wife Margrethe circling like sub-atomic particles on the stage. Frayn's play is not exactly in the vein of scientific speculation (e.g. The Cambridge Quintet, and nor could Johnson's be imagined to be.

If you could see the last five to ten minutes before the first five to ten minutes you might simply not bother to watch what follows, it is as simple than that - any creative work that does not at least do what Through the Looking-Glass and What Alice Found There to maintain the magic may not be worth the watching.

For does the play actually give rise to the thinking that is attributed to The Guardian? Not beyond thinking that three characters depicted might represent Freud's id, ego and super-ego in a dream, and that just is not that interesting. It is also not interesting that, at the end of his life, Freud might have contemplated again, and regretted having rejected the idea of sexual abuse in the infantile period as the basis of his patients' psychiatric problems - as I reflected on this conceit, I realized that I already knew of this rejection, and that the notion did not add very much.

A great advance on the play filmed as Insignificance? Not really.

Friday, 8 June 2012

NHS Choices : content reviewed

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8 June

Who's mad here*?:

Thank you for contributing to the NHS Choices website. We have removed your
contribution because we feel it is unsuitable for publication on this page. We
do not allow comments which actively seek to dissuade other site users from
following the evidence-based health advice provided.

Judge for yourself:

Commenting on ('Exercise 'still valid depression treatment')

“Exercise doesn't help depression,” according to The Guardian. The paper said that patients advised to exercise fare no better than those who receive only standard care.

Exercise is among the treatments for depression currently recommended by the NHS, with many patients 'prescribed' a course of physical activity as an alternative to antidepressant medication or therapy. Despite what several headlines have suggested, new research has not re-examined the effect of exercise on depression, but instead looked at whether giving depressed patients additional support to encourage exercise proved beneficial.

During the research, 361 adults with depression were randomly allocated to receive either standard treatment or standard treatment with additional encouragement and advice on exercise. Standard treatment can include medication, therapy and physical activity. This means that all participants could take up prescribed exercise, but some had greater encouragement to do so.

The research found that encouraging activity increased physical activity levels but did not reduce depressive symptoms more than standard care alone. This is a useful finding for NHS staff wishing to know the best way to help patients with depression. However, given that the study did not test the general effect of exercise, the results do not support the view that exercise is 'useless' for treating depression, as some news sources have suggested.

Exercise has a host of benefits for physical and mental health, which may help patients with depression in ways other than reducing their immediate depressive symptoms. These include reducing the risks of other diseases such as obesity, cardiovascular disease and diabetes.

Where did the story come from?

The study was carried out by researchers from the Universities of Bristol and Exeter, and the Peninsula Medical School. It was funded by the Department of Health as part of the National Institute for Health Research’s Health Technology Assessment programme.

The study was published in the peer-reviewed British Medical Journal.

Media reports of this story were slightly misleading, and may have given the impression that the researchers specifically tested the effect of exercise. This was not the case, as the research compared two groups of people who were offered the same range of treatments, but with one group receiving additional support and advice designed to encourage exercise. This meant that all participants had access to exercise-based treatments, but some received some additional encouragement.

The Metro newspaper went too far in saying that the study showed exercise “had no positive benefits on mental health”. The study in question looked at the effect of one particular exercise intervention programme on depression symptoms, so did not directly address other mental health problems or other exercise programmes.

What kind of research was this?

This UK-based multi-centre randomised controlled trial (RCT) looked at whether a specific exercise support programme helped reduce symptoms of depression in adults more than standard care alone. The study was 'pragmatic' in nature, which means it tested interventions in a real-world setting rather than in the highly artificial environment of many trials. For example, patients were prescribed the most appropriate form of treatment from a range currently used in clinical practice, rather than a set treatment that might not have been ideal for them. As such, the study was well designed to assess how the exercise programme would work in reality.

The authors say previous evidence suggests that exercise is beneficial for people with depression, but that this evidence has come from small, less well-designed studies using interventions that may not be practical for use by the NHS. Therefore, this latest research aimed to investigate whether depression symptoms could be reduced by an activity programme that could be practically implemented by the NHS if deemed effective.

This type of study is one of the most effective at demonstrating whether a particular health programme, or 'intervention', has a measurable benefit in patients.

What did the research involve?

The researchers recruited 361 patients, aged 18 to 69 years old, who had recently been diagnosed with depression by their GP. Participants were randomly divided into two groups, who received either usual care methods from their GP or usual care plus a physical activity intervention.

Participants were recruited if they were not taking antidepressant medication at the time of initial diagnosis or if they had been prescribed antidepressants but had not taken these for at least four weeks before their diagnosis. Patients with depression who had failed to respond previously to antidepressants were excluded from the study, as were people aged 70 or over.

Participants in both groups were asked to continue to follow the healthcare advice of their GP for their depression. This was classed as 'usual care' by the researchers. Both groups were, therefore, free to access any treatment usually available in primary care, including antidepressants, counselling, referral to 'exercise on prescription' schemes or secondary care mental health services. However, those in the physical activity group were also offered up to three face-to-face sessions and 10 telephone calls with a trained physical activity facilitator over eight months. The intervention aimed to provide individually tailored support and encouragement to help participants engage in physical activity.

Depression was measured before enrolment and then at four, eight and 12 months after the intervention to measure any changes. Depression was initially diagnosed using standard, recognised assessments, including the 'clinical interview schedule-revised' and the 'Beck depression inventory'. Subsequent changes in depression symptoms were based on self-reported symptoms of depression, as assessed by the Beck inventory score.

During a trial, researchers should aim to conceal, if possible, which treatments participants receive. This is known as 'blinding' and avoids the risk of bias from participants knowing which treatment they are getting. This study was a 'single blinded' RCT as treatment allocation was concealed from the study researchers. It was not feasible to blind the participants to which group they’d been allocated to.

The analysis of this study was appropriate and based on an 'intention to treat principle'. This means that everyone who was allocated to a group was included in the final analysis, irrespective of whether they followed the intervention or dropped out. This is good way of analysing the 'real world' effects of an intervention.

What were the basic results?

At month four, there were no statistically significant improvements in mood among participants encouraged to exercise compared to those in the usual care group. Similarly, there was no evidence that the intervention group had significantly improved mood at the 12-month follow-up compared to those receiving usual care only.

There was no evidence that the exercise intervention led to a statistically significant reduction in the use of antidepressants compared to usual care.

Using data from all three follow-up points combined (four months, eight months and 12 months), the participants in the intervention group reported significantly more physical activity during the follow-up period than those in the usual care group, which was maintained at 12 months. This suggested the activity-support intervention was successful at increasing activity levels. Importantly, the participants stuck with the intervention well and completed on average 7.2 sessions with their exercise advisor. By four months, 102 (56%) participants had at least five contacts with the advisors.

How did the researchers interpret the results?

The researchers concluded that adding an intervention to usual care that encouraged physical activity did not reduce symptoms of depression or the use of antidepressants compared to usual care alone, despite the exercise intervention significantly increasing physical activity levels.


This well-designed randomised control study provides strong evidence that adding an exercise-promoting support programme to standard care did not significantly reduce symptoms of depression compared to standard care alone.

While this study has many strengths, including its large size and randomised design, it is important to bear in mind its limitations.

This study assessed just one type of exercise intervention that involved facilitating greater activity levels. Therefore, this study does not tell us whether other types of support or exercise programme may have a positive effect on depression. Consequently, the study’s findings do not mean that no exercise interventions can reduce symptoms of depression, especially as there is some evidence from systematic reviews that certain types of exercise intervention may be therapeutic.

Also, there are other benefits of exercise beyond those related to mental health. The Daily Mail quoted an expert as saying: “It is important to note that increased physical activity is beneficial for people with other medical conditions such as obesity, diabetes and cardiovascular disease and, of course, these conditions can affect people with depression.” The trial did not assess whether exercise prevents depression.

Exercise has a host of benefits for physical and mental health that may help patients with depression in ways other than reducing their immediate symptoms. However, the finding that this exercise support intervention doesn’t seem to reduce depressive symptoms is very useful to NHS staff wishing to know what interventions may help patients with this condition.

So far so good?

The Agent Apsley said on 07 June 2012

OK, so what we seem to learn is that those experiencing depression, if encouraged, will tend to exercise and go on exercising, as against those with just access to information and a lower level of advice from their GP.

Well, any good habit needs to be fostered, and the best of us needs encouragement - I write something, show it to you, and, although you have suggestions for improvement, you say that it is good, and that I should write more. If I trust my judgement or yours, thinking you sincere, I might do some more writing.

Depression is marked by benefiting from prompting or encouragement for many who experience it, though the reality is that they may all too often be alone, having no partner, and can only look to friends and maybe understanding neighbours to offer words of encouragement or reminders. This quite apart from the disabling and debilitating effect of losing or not being in employment (or in employment under pressure), with the resultant likelihood of the additional stress of low income.

Obviously, then, the always rather dubious-sounding claim that, by exercising and releasing endorphins, one may imrove one's prognosis for recovery should not be the only reason for all to be encouraged to exercise. This study seems to show that the specific intervention of encouragement used did tend to give rise, if the participants are truthfully reporting their 'exercise levels' (and not just to second guess that they are supposed to say so), to the establishment of regular exercise in daily life.

Depression's not unique amongst mental-health disorders in that another's insight - 'You might feel better, if you have a shower and change your clothes' - can be a useful intervention, clearly a programme, based on GPs' surgeries and the long-overdue task of properly assessing the physical-health profile and needs of such patients, is needed to give them the kind of prompting to look to the needs of the body that those able to afford personal trainers get.

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* Postscript (as at 9 June)

I rather wonder whether I am: I took what had been written to me at face value, and believed that my comment had been removed, but, when I go there to see anyone else's comments, mine is still there...

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Saturday, 5 May 2012

Pasta made from durum wheat

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5 May

Perhaps we have become accustomed to this assertion

I don't doubt its truth, but - except through familiarity with the fact that pasta-packets usually make it - I have no notion what it means (and so wonder whether that might be true of most of us), any more than if it stated, with just as much specificity*, made from wheat grown in Co. Durham (or in Dumbartonshire).

Unrelatedly, a woman from The Czech Republic** gave my parents what my mother called 'a peck on the cheek' - not spotting that it could have been descrbed as a Czech on the peak, if they had been on an eminence.

And what about the word surreal (or even surrealist)? I do have to agree with what was mentioned in passing yesterday in that day's issue of The Guardian***:

'I feel the word "surreal" has been totally overused as a fancy word for weird'

For, having read a fellow writer's piece about surrealism in films, which was pegged almost entirely (for factual basis) on the well-known collaboration that was Hitchcock / Dalí (and with scant, if any, mention of the other collaboration, Buñuel / Dalí****, or of the former's significant career as a director), I despaired at what the author went on to identify as evidence of surrealism in more modern (but mainstream) cinematic works.

That said, there seems to be as little chance of stopping misuse of this word***** - so carefully employed to be in opposition to the boring or bourgeois - as of its beleaguered friends random, manic, psychotic, and (surely not for want of anything better to say) like.


* A word that - I am led to believe that - T. S. Eliot, if he did not revel in it, used more than others did.

** My mother and father both resolutely, because instinctively, used the name Czechoslovakia in telling more about this woman.

*** g2, p. 8.

**** If Dalí is to be believed, that should be Dalí / Buñuel, but, it any case, they gave us, of course, A Dog and a Toilet (amongst other things).

***** Except, of course, by seeking to impose a totalitarian regime (one with a competent secret police!).