Wednesday, 12 December 2012

Loneliness is bad for you

Since I started writing this blog, I have been struck by how the Church really is the expert par exellence in humanity. The Church knows that we are made for communion, for relation, and that this is essential for our happiness. Everyone else is only just catching up: the Daily Express reports that there is a link between loneliness and dementia.

I don't agree with their headline, that an active social life is the key, and later in the article they identify that it is feeling alone rather than being or living alone which is the important factor. In university we were taught that "people with fewer social contacts are more likely to commit suicide". That seems to suggest that it is being alone rather than experiencing loneliness which leads to ideation of suicide. But I would imagine that it is experiencing loneliness rather than being alone which contributes to depression. The correlation between depression and suicide is not well defined, but now appears to be less than 10% among all depressed people (although only 2% for the majority of people with depression) compared with 1% in the general population. Given that ideation of suicide is a symptom of depression, as well as the fact that depression interferes with normal rational thought processes, 2% seems fairly low.

There is also a strong link between depression and other illnesses. People with chronic illness are more likely to become depressed, and people with depression are at greater risk from other illnesses. Demonstrating direct causality here is probably nigh on impossible, given the number of interconnected factors, medication, employment, relationship... Obviously there is going to be some overlap between being alone and feeling lonely and single households are now the most common type in the UK.

If this is a step up from last week's reduction to the biological it is still a reduction of the human person, only this time to the bio-psychological. Two out of three ain't bad, but there is a hierarchy and the spiritual always gets top billing. The first communion to which we are invited is communion with God. Faith and communion with God can transform and elevate all the other experiences of our lives, even illness and suffering. With God's presence, even loneliness is transformed and dispelled. But people are not going to realise this when five million only have their television for company (especially if they watch Eastenders). It's Advent, God is coming, so go and see one of the five million and tell them about it!

Sunday, 9 December 2012

Something this simple shouldn't take two decades

For H: Keep up the good work!

Recently (with my Catholic Link hat on) I have been trying to find short videos or animations which explain the Church’s teaching on contraception. There is a huge want of apostolic resources on this topic and it has been something of a struggle. I was telling my brother (or unsuspecting apostolic guinea pig, as I like to call him) about this lack of videos on the topic and his response was, “Of course not, no-one wants to think about that stuff!” Eventually, I found something and then I sat down and tried to write a post. I ended up with a reflection on my own experience which was completely wrong for that site, but I decided to post it here instead.

In every parish I attended as a child there was always one family with more than four children who were regarded by the rest of the parish as more Catholic than everyone else at mass. Nobody ever explained why this was, but they were generally viewed with a mixture of superiority and guilt-fuelled admiration. Apparently being more Catholic meant that you were usually late for mass and were unable to get your children to sit still for 45 minutes.

At (my non-Catholic) secondary school that I learned that “Catholics believe that contraception is wrong”. There I also learned that contraception was the answer to pretty much all the world’s problems (and this was before the AIDS epidemic!). I had one conversation at home on the subject in which I was informed that “NFP probably works for clever people” and the clever couple cited had about five university degrees between them (and three children). I had a friend at school who was one of nine children. I used to hear people saying that they must be Catholic, which always mystified me as I knew they weren't.

In short, by the time I was 15, what I had learned about family planning was this:
  • The Church is against contraception (apparently for no reason).
  • Catholics themselves know better (and mostly ignore the Church).
  • NFP is very complicated and difficult (and ineffective).
  • Having children turns your life into chaos.
  • Contraception will allow me, an intelligent woman, to have the life and career I deserve (and should want). Without contraception, this will not be possible. I am capable of making the world a better place and if I have children this will be impossible.
What a devastating combination! The world tells me all the disadvantages of children. The Catholics I know tell me nothing, in word or deed. (This sounds like poor me, I am a sad victim of the big, black formation hole, and that is not the point I am trying to make.) The world has got louder since then. It now assumes I want to have casual sex and assures me that there is no problem with that, in fact I should probably be encouraged in that line.

Now we have to fast forward almost ten years to the time of my personal conversion. Through prayer, formation and endless patience on the part of those who did apostolate to me I discovered that I believed in the Faith and that I wanted to live by the teachings of the Church. But I was still really stuck on the subject of contraception. I ended up feeling that I would have to go along with the Church even though there was no reason for what she said. I would have to suspend my own intelligence out of some sort of blind obedience to the Church and for this I would suffer: I would be unlikely to be able to find a sane man who would marry me under these conditions, and if I did I was going to have fifteen children (and probably die young, worn out from childbirth and never being able to afford a holiday). It took a lot more years of prayer and formation for me to understand and love the wisdom of the Church, a loving Mother who cares for her children and knows what is best for them.

It has taken nearly 20 years to undo the brainwashing I underwent at school. And it still isn’t completely done. (Interestingly, the undoing hasn’t come from having endless conversations about the merits of NFP over contraception but from understanding Catholic anthropology and the dignity of the human person.) I have a fairly constant mental battle with myself every time I read about sexually transmitted diseases, teenage pregnancy etc. I know that trying to address these problems with contraceptives is like sticking a plaster on a gaping, infected wound and expecting it to heal all by itself. But the world's roots go deep.

I am not surprised that “no-one wants to talk about that stuff”. There is a wall of silence surrounding the subject that probably stems from a fatal combination of “no sex please: we’re British” and abject ignorance on the part of the majority. I finally begin to understand the weirdos people (see what I mean about brainwashing) I knew at university who wouldn’t shut up about NFP: if people, and especially young people, don’t hear about the Church’s teaching from those faithful to the Church they are going to hear about it from somewhere else. And those other people who tell them about it are not going to have the integral wellbeing of the human person as their motivation and the inate dignity of that same human person has the foundation for all their reasoning. Because of this they will, however well-intentioned they may be, get it completely wrong.

Wednesday, 5 December 2012

Join the Advent Avalanche

Catholic Link is launching an avalanche for Advent. The idea is to flood social networks with an apostolic avalanche in order to help people prepare for Christmas (too much weather in that sentence!). All this in addition to their usual fare of creative apostolic resources.

Join the Avalanche!
The first four videos are a lovely Nativity play, a reminder of what Advent is about from XT3, some Christmas Carols in a shopping centre (with a nice touch at the end) and the well-known Hallelujah Chorus Flash Mob. I should really add a declaration of interest, as I also write for them, but I think the interest I really need to declare is  apostolate and not blog partisanship!

It's not my fault!

I was somewhat bemused to read yesterday morning that there is a gene for binge drinking. Further inspection suggests that this gene predisposes some people to experience a stronger physiological response than others when drinking alcohol.

Personally, I would say that binge drinking has more to do with sin, freedom and the perennial search for happiness than genetics. Obviously binge drinking can't make us happy, any more than sleeping around can (and there does seem to be a strong correlation between the two). But whether they know God or not, everyone has a hunger for him, a longing for the infinite, and without knowledge of God this leads us to look for happiness in many places where it isn't to be found. Furthermore, I would say that not finding this happiness, not being able to satiate this desire we have (because for so many people they haven't chosen to reject God, it's just that faith has never been suggested to them as an option) we end up trying to fill up our lives with <i>anything</i> that might make us feel something, be it sex, drugs or rock n roll. Of course this self-destructive behaviour leads us into a downward spiral of increasing unhappiness: only in God and his loving Plan can we find happiness. He has made us for Himself and our hearts are restless until they rest in Him, to paraphrase St Augustine.

I am not some sort of neo-luddite who wishes to exclude science and technology from every facet of life. If people have genetic tendencies towards certain behaviours or illnesses then of course identifying that and seeking solutions can be a good thing. But the increasing tendency to identify genes is part of both the "loss of the sense of sin" bemoaned by Pope Pius XII (once we blamed "the system", now we blame our genes) and also constant reduction of the human person to the merely biological. Yes, I have a body, but I am not my body. Neither am I my DNA. And while we continue to place all our hopes on genetics we will never find the answer to those situations which many would agree are a problem.

Monday, 3 December 2012

Weighing risk and benefit: audacious or reckless?

Prescribing is all about weighing up risks and benefits. The weighing up may be explicit (helpfully already carried out by the licensing authorities and NICE guidelines etc.) or implicit (carried out by the doctor at the bedside) and everyone makes some sort of judgement when self-medicating. It is half a millenia since Paracelsus said that the only difference between a medicine and a poison is the dose.

However, it does seem that lately this process of weighing up risk and benefit seems to be going a bit squiffy. I see two contributing factors to this. On the part of the presciber we have the loss of the personal, an absence of a holistic view of the patient leading to, or due to, the emphasis of explicit over implicit. On the side of the patient there is a tendency to subjectivism, giving an additional weight to the inconvenience of the illness rather than the reality of the treatment. Reduced inconvenience in the here and now weigh more on the scale of risk and benefit that the long term effects of a medicine. And it is not just the healthcare professionals who have lost their holistic view: patients too are inclined to reduce everything to the biological. I'll take a tablet and it will all be better.

First up: drug cocktails. I do think that evidence-based medicine is a good thing. We should be using medicines to help people have improved health and quality of life and it is important that everyone has access to the benefits of knowledge regardless of location and how switched on your GP is. From this point of view, guidelines, recommendations and national standards are no bad thing. But sometimes the guidelines seem to come before the patient. If you have a heart attack, for example, you will be prescribed 4 different medicines straight off, no questions asked to reduce your chance of having a second. As someone who was, until recently, taking 6 tablets a day I would say that the mere fact of taking a lot of medicine makes you feel ill. Physically I feel no better since we changed everything round a bit so I could take only 2 tablets a day, but psychologically it makes a world of difference. If this person who had a heart attack had nothing else wrong with them, they've just gone from zero to four, but the chances are that if they're an older person they might have diabetes (at least 1 more medicine), moderate pain of some kind (paracetamol, codeine and two laxatives for the constipating side effects), anxiety (brought on or compounded by the amount of medicines they now have to take)...

If the number of tablets taken is our main concern then 'polypills' could be the answer. Instead of taking 4 different pills after your hypothetical heart attack, you would just get one which contained all 4 medicines. Easier to remember, less psychological impact,  might be a good thing. But there are problems... If you need to increase the dose of one of these medcines (because following your hypothetical heart attack, you have started taking your medicines and your cholesterol is now under control but your blood pressure is still going through the roof) what do you do? If you need to stop taking one of them (becuase the aspirin gives you an ulcer) what happens then? In fact, prescribing has moved away from combination painkillers in recent years. I believe Such polypills, with their one-size-fits-all approach, possibly lead us yet further in reducing the patient to the merely biological

From the patient point of view I would like to cite the example of hormonal contraceptives, a supposed panacaea for women's health problems as well as the terrible disease of fertility. Contrary to popular belief these are medicines. The benefit (I don't need to worry about what I do) comes from such a narrow vision of what a person really is that immediately half of the risks are discounted (STDs, and then all the non-biological ones) as is the fact that this "benefit" can easily spill over into other aspects of life: I can do what I like with respect to behviour which might lead to pregnancy swiftly becomes doing what I like with respect to commitment (and no, I am not saying that the pill causes infidelity). And the short-term benefit of not getting pregnant becomes a long-term risk of not getting pregnant: very few people think about the fact that when they finally do decide that they want a family they might find that they can't. We also shouldn't ignore the reports of extremely serious consequences: death and permanent disability.

Acne is one of those conditions where the risk:benefit calculation seems to be working out a bit strangely. Above is the report of a girl who died after taking the pill for acne, likewise Roaccutane (OK, the report is from newsbeat, but BBC3 recently broadcast a documentary) can cause extremely serious problems (incidently I don't know why Roche say there is no link between the drug and depression as their own SPC for Roaccutane says there is...?!). I realise this is not a black and white situation. If you have severe acne (and if you are seeking such drastic measures presumably your acne is severe) then you might well be depressed (or so fed up that you think you are depressed), believe your life is over, etc and I don't want to belittle that in any way. But I can't help thinking that the choice of acne or death, or acne or permanent untreatable depression, is a no-brainer. So on what basis are we making these decisions?

Saturday, 1 December 2012

Just what exactly can I get out of when I'm ill?

I have, as we used to say, got the lurgy. Doctor's orders are to stay in bed and there are no arguments from this quarter on that score. I'm a bit disappointed because I was looking forward to the East Anglia Diocese Learning Together day on Bioethics this weekend, and also to the confirmation group I help out with once a month (for whom I ask a lot of prayers...a third of them don't know whether Matthew is in the Old or New Testament). However, they are in capable hands.

Spending time in bed is something I have got used to over the last 18 months and I am getting better at it, especially now that I have icons of Our Lady and St Rita of Cascia above my bed and a crucifix in my direct line of sight which I can't help looking at. They (Jesus, Mary and the Saints) help me not to wallow in self-pity.

We were required to study some medical sociology at university (why people take medicines, why others don't, how should we treat drug addiction, why do people go to see their doctor etc) and one thing we learned about was the "Sick Role". Wikipedia, a resource not favoured by healthcare professionals (officially...although in my experience a worrying number can be found browsing their patients' conditions at any one time...), has a short explanation. Basically a person who is ill is not expected to carry out their usual tasks/functions. This is fine socially, but it really doesn't work spiritually. When one is lying in bed without the energy even to read, one tends to spend a lot of time thinking and this is ripe time for the Old Woman (cf. Eph 4:22) and the devil to start having a go. And rather than not being expected to carry out my usual tasks, this is a great opportunity to learn to rely more on God and trust in Him instead of myself, to be more docile to his Plan of Love and  to  become a little bit holier. I often think that difference between someone who is a saint and someone who isn't (yet), is that the former realises the a trial, mortification, illness, difficulty, temptation or bad day, is an opportunity for holiness at the moment when its actually happeneing. All too often I don't even realise until about two days after the event.