Testing, John Ruskin and Alexis Brook

There's plenty of discussion going on at Kent about how and how much we ought to assess our students. Wouldn't they be better off being assessed less and having more of our time to teach them? Interesting then to see Ruskin taking up this question:

How many actual deaths are now annually caused by the strain and anxiety of competitive examination, it would startle us all if we could know: but the mischief done to the best faculties of the brain in all cases, and the miserable confusion and absurdity involved in the system itself, which offers every place, not to the man who is indeed fitted for it, but to the one who, on a given day, chances to have bodily strength enough to stand the cruellest strain, are evils infinite in their consequences, and more lamentable than many deaths. (Fors Clavigera, September 1871)

He reports there on a young man so eager to emulate Dürer or Turner that he "spent his strength in agony of effort; - caught cold, fell into decline, and died." Now we know 'scientifically' that exams take their toll. Back here I told you about wound-healing studies which showed that this process is delayed when students are in the midst of exams.

Someone else who understood psyche-soma connections was the psychotherapist Alexis Brook, whose obituary appeared in The Guardian yesterday.

[His] choice of career sprang from an experience he had with the Royal Army Medical Corps during the second world war. When the numbers of soldiers falling ill with malaria, dysentery and venereal diseases rose, he was afraid he would be castigated for not providing adequate medical care.

"To my surprise and relief, no one took any notice of me," he said later. The person who was on the mat was the battalion commander, who was asked to explain to his superiors what was wrong with his leadership that had caused such low morale." Viscount Slim, then commander-in-chief in Burma, was one of the few who recognised that these figures were indices of morale. If morale was high, fewer soldiers fell ill.

He was also interested in gut disorders, something I discussed back here:

After his retirement from the NHS in 1985, he became an honorary consultant psychotherapist at St Mark's hospital, Harrow. There, he highlighted the contribution a psychotherapist could make to the work of a hospital in dealing with disorders of the gut. His work was so successful that when he left, a post for a permanent consultant psychotherapist was established.

And he later turned to eye disorders. Ophthamology is an extraordinarily rich field for the psychosomatic approach to study. On pages 39-40 of our book, we say

Ophthalmology is a similarly isolated branch of medicine. Again, analysts and psychiatrists once received many referrals from ophthalmologists, yet today this would be bizarre. Despite the many hundreds of papers written and the detailed case reports which show the rationale and efficacity of such treatments, their usefulness has been forgotten. In 1960, it was reckoned that between 40 and 100% of recorded eye disorders were influenced by psychological factors. Intraocular pressure, for example, can be clearly associated with states of anxiety and emotional conflict, and so may affect conditions like glaucoma. This has never been disproved, but advances in medical technology have drawn attention away from it. Where talking therapies have been successfully used in conjunction with medication to reduce intraocular pressure, today drug treatments are applied almost automatically. Textbooks like Schlaegel and Hoyt’s once popular ‘Psychosomatic Ophthalmology’ have become historical curiosities. The amazing and detailed knowledge now available about the eye and its structure must seem much more appealing than psychological theories about unconscious factors in eye problems. And who can blame ophthalmologists for this?

How can Brook's legacy, in this field and others, be kept alive?

A Library at Last

Starting a new job entails complete immersion into the local ways of doing things. To convince myself I'm coming up for a gasp of air, let me jot something down. With a new academic post comes the thrill of exploring a new library and the chance of serendipitous discoveries of books from their different arrangement.

Yesterday I found myself by Ruskin's works, so took home for the evening the first volume of Fors Clavigera, his letters to the workmen of Britain. There I met up again with a passage I'd written down elsewhere.

I also took out Dr. Golem, the third book in the series by sociologists of science Harry Collins and Trevor Pinch. This continues their quest to get the reading public to realise what science is really like. Their history of resuscitation techniques is eye-opening. The changes in recommended practice from one decade to the next are frequent and dramatic, and there's little evidence that applied to heart attack victims that very much is achieved. Where ER, Chicago Hope and Rescue 911 show a long term survival rate of 67 percent after cardiopulmonary resuscitation, 1 to 2 percent might be more accurate in the real world.

The Usual Suspects

Two interesting posts at Science and Reason:

1) This one reports on research linking hostility, anger, and depression to inflammation. Remember that inflamation is implicated in all sorts of chronic diseases: heart disease, cancer, rheumatism, etc.

2) This one reports on the link between stress and weight gain.

While researching for the book we read endless studies of the sort discussed in these posts. There really is a very impressive body of research now which links psychological traits and experiences with health-related physiological changes.

However, what we come back to time and again is our sense of disappointment with what we consider to be the overly simplistic psychology of this kind of research. When you come to look at them closely, constructs like 'stress' and 'hostility' just can't be made to do the work required of them. Let's return 'stress' to its natural home - helping us think about whether bridges and the like are liable to collapse.