Anorexia Nervosa: a cult?

I have long recognised that Anorexia Nervosa is really only a symptom, like a headache, for which there is no “one-size-fits-all” cure.

In my book The Cockroach Catcher, I wrote:

“……It is probably too late as so many doctors and psychiatrists are brought up on empirical diagnosis that sheds little light on the sufferings of the individual. The more powerful the diagnosis is, the easier it is to ignore the person as an individual and not to take into account his life history that may have a strong bearing on his treatment…….In psychiatry, attempted suicide is not in itself a diagnosis and that is simple enough.

When we come to Anorexia Nervosa, psychiatrists are suddenly blinded. It is what I call a powerful diagnosis because it overshadows everything else…….”

In that Chapter, I went on to describe two girls, both severely anorectic. One suffered severe sexual abuse, and the other experienced the traumatic witnessing of her father’s death.

That is not to say that there is always underlying trauma.

Minuchin’s concept of the psychosomatic family (enmeshment, rigidity, over-protectiveness, and lack of conflict resolution) was both insightful and ground breaking at the time. However, it seems to be no longer fashionable or politically correct in the modern day no-blame culture. I do not have any argument with the no-blame approach, but it would not hurt psychiatrists to understand cases from Minuchin’s point of view without making a song and dance about it.

Sometimes modern parents give their children too much right and freedom for self determination.

In the chapter “SARS and Knowledge” of my book, I compared the freedom to starve oneself to that of not wearing a mask during the SARS outbreak in the endemic zones:

“…… If a child can be made to wear an uncomfortable mask, why can parents not make a child eat?...”

In matters concerning life or death, shouldn’t zero tolerance really be a no-brainer?

No doubt the promotion of zero size models by the fashion industry has managed to exert undue influence on some gullible teenagers and created a “cult” following. Have you not noticed how frightened some of the anorectics are of even the slightest touch of fat? How they panic when banned from exercising! There always seems to be a little voice in their head asking them to disobey their parents, nurses, psychiatrists and anyone who tells them that their belief is wrong. Like any cult rescue, someone needs to take over and the one taking over will take over the wrath of the new Anorexia god.

“It is not me who wants to eat, it is them.”

All those trying to help are on the “other side”

Yet, given time, there will be recovery for cult victims, at least for some.

Other Posts:
Anorexia Nervosa: Olanzapine (Zyprexa)-Veganism
Anorexia Nervosa: Bach
Anorexia Nervosa: What If!
A Brief History of Time: Anorexia Nervosa

The Book: The Cockroach Catcher, 

 A Chapter on Anorexia Nervosa,  

Reader’s views.

Quinoa: the super grain

I first came across Quinoa in Peru and was amazed by the beauty of the crop.

©2008 Am Ang Zhang

“… Quinoa (KEEN-wah) is a powerful supergrain that's been used in South America for 5,000 years. A good source of protein, it's a great choice for vegetarian main dishes….” said the Houston Chronicle. (A recipe for stuffed red peppers with quinoa, provolone and walnuts was also included.)

The Incas must have known as they had strong warriors.

NASA also considered Quinoa as a candidate crop for their controlled ecological life support systems:

“……Quinoa (Chenopodium quinoa Willd.) is being considered as a potential "new" crop for NASA's Controlled Ecological Life Support System (CELSS). The CELSS concept will utilize plants to remove carbon dioxide from the atmosphere and generate food, oxygen, and water for the crew of long-term human space missions. Criteria for selection of potential crops include nutritional composition, harvest index, canopy stature, and life cycle duration……”

Quinoa is said to be almost perfect as a grain. It has all the essential minerals and amino acids (including lysine, which is deficient in most grain crops) that are required for a balanced human diet.

WOW!

Be sure to include it in your diet or get the shares of the companies that market it. Quinoa can be used to replace rice or couscous and there are loads of recipes around, e.g. quinoa, tomato and broccoli salad, quinoa and lentils salad, quinoa pilaf, quinoa salad with raspberry vinaigrette.

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Groundhog Day and Prozac

This morning an email from one of my former juniors alerted me to the latest Times headline on antidepressants:

“Depression drugs don’t work, finds data review.

…. Millions of people taking commonly prescribed antidepressants such as Prozac and Seroxat might as well be taking a placebo, according to the first study to include unpublished evidence….”

She remembered hearing the same from me quite a few times a number of years ago.

The paper that attracted the latest media attention is ”Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration”. It was published in PloS (Received: January 23, 2007; Accepted: January 4, 2008; Published: February 26, 2008). The authors were listed as: Irving Kirsch, Brett J. Deacon, Tania B. Huedo-Medina, Alan Scoboria, Thomas J. Moore, Blair T. Johnson.

This is how the authors described the methods and findings:

“… We obtained data on all clinical trials submitted to the US Food and Drug Administration (FDA) for the licensing of the four new-generation antidepressants for which full datasets were available. We then used meta-analytic techniques to assess linear and quadratic effects of initial severity on improvement scores for drug and placebo groups and on drug–placebo difference scores. Drug–placebo differences increased as a function of initial severity, rising from virtually no difference at moderate levels of initial depression to a relatively small difference for patients with very severe depression, reaching conventional criteria for clinical significance only for patients at the upper end of the very severely depressed category…. ”

This looks exceedingly similar to the report in USA Today on 7th July 2002:

“Study: Antidepressant barely better than placebo.

… Through a Freedom of Information Act request, two psychologists obtained 47 studies used by the FDA for approval of the six antidepressants prescribed most widely between 1987-99.

… More than half of the 47 studies found that patients on antidepressants improved no more than those on placebos… “

The drugs included in his evaluation were: Celexa, Prozac, Paxil, Zoloft, Effexor and Serzone. The findings were released in a paper titled “The emperor's new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration” published in Prevention and Treatment, an e-journal of the American Psychological Association on 15th July 2002. The authors were listed as: Kirsch, Irving (a University of Connecticut psychologist); Moore, Thomas J.; Scoboria, Alan; Nicholls, Sarah S. (Notice that some of these names are the same as those in the new “ground breaking” paper.)

A paper titled “Another view: Talking back to Prozac” in Psychology Today, Jul/Aug 94 (Article ID: 1471) also came to mind. It was written by Peter Breggin who has been the most vocal against SSRIs and drug treatment for ADHD.

As early as on 19th March 1999, CNN reported: “Study: Prozac no better than older depression drugs”

Yet today the Guardian reported:

“Prozac, used by 40m people, does not work say scientists.

.…The review breaks new ground because Kirsch and his colleagues have obtained for the first time what they believe is a full set of trial data for four antidepressants.

… They requested the full data under freedom of information rules from the Food and Drug Administration, which licenses medicines in the US and requires all data when it makes a decision….”

Then I checked my Web Bookmarks:

14 September, 2004: Prozac raises child suicide risk

8 August, 2004: Prozac found in drinking water

8 February 2008: Britain 'is true Prozac Nation'

Groundhog Day or otherwise, raising public awareness is no bad thing. No matter, some big Pharmas must be holding emergency meetings.

What we have to consider is not only whether anti-depressants have the desired effect, but also what undesirable effect they may have.

Only a few days ago, CNN reported:

“Girlfriend: Shooter was taking cocktail of 3 drugs.

.… Steven Kazmierczak had been taking three drugs prescribed for him by his psychiatrist, the Northern Illinois University gunman's girlfriend told CNN.

…. Jessica Baty said Steven Kazmierczak was irritable but not erratic before his shooting rampage.

…. Jessica Baty said Tuesday that her boyfriend of two years had been taking Xanax, used to treat anxiety, and Ambien, a sleep agent, as well as the antidepressant Prozac…”

Just who can we trust now? An article in the Independent (27^th February) read:

“Drug giants warned: Tell the truth on medicines.

After antidepressant treatments are discredited, fears grow tht other products may be ineffective ..."

I can hear Peter, Paul and Mary sing:

“Oh, when will they ever learn? Oh, when will they ever learn?”

(From: Where have all the flowers gone - 1962 Debut Album.)

Peter, Paul and Mary saw us through medical school!

Religious Fanaticism and the Ice Maiden of Peru

In 2004, I had the great opportunity to visit Peru to have a glimpse of this country full of relics of ancient Inca culture.

We were fortunate enough to be able to get to Machu Picchu, as the train had only just resumed running two days after their worst flash flood.

©2004 Am Ang Zhang

The other highlight was Lake Titicaca (elevation 3812 m), where we visited the floating reed huts of the Uros people.

©2004 Am Ang Zhang

To our amazement, we found these huts were buoyed up by empty two-liter plastic bottles – a sort of adaptation to modern culture, I suppose. Electricity for their TVs and even computers was supplied by solar panels, another modern invention.

We combated altitude sickness, some with the local coca tea and coca candies. Some of us chewed coca leaves.

Those with high blood pressure had to suffer the humiliation of having oxygen administered from tanks now and again, and so did highly trained athletes because of their low heart rate. The only ones in our group who seemed to take it in their stride were the heavy smokers. There is no justice!

In the chapter “Religious Fanaticism” of my book, there is a story about a 12-year old girl who attempted to hang herself, after seeing shadows and hearing voices:

“……Mother assured me later that she did not think there was any sex abuse but it did cross her mind that all the dramatic teaching of Revelation might have something to do with her daughter’s hearing voices and especially those of her father.

At that time I had just come back from Peru, with images of Juanita still fresh in my mind. The tribal rituals of virgin sacrifice in the Andes, visions and religious fanaticism suddenly took on a new meaning.

She respected her father and what he said had to be done, even if it was hallucination. Sacrifice would be nothing and if she was to go to heaven anyway, she would have avoided the torture of hell……”

We saw Juanita in Museum of the Universidad Católica de Santa María of Arequipa, Peru. Juanita is also known as “The Ice Maiden” and was believed to have been sacrificed in ancient times by the Inca to appease the gods, especially the gods of the mountain.

Following the volcanic eruption of 1990, it was discovered in 1995, and Time Magazine hailed it as one of the top ten discoveries of the year. Juanita’s age at the time of the sacrifice was estimated to be between 12 and 14, similar in age to the patient in my story.

Was it the ignorance of these very advanced Inca people that made them believe that the unfavourable weather was an act of the gods whom they had to appease? Were they fooled by the rulers and priests of this ancient culture whose interest was to ensure ignorance of their people so that they could maintain control? Is there something we could learn from such a discovery?

©2004 Am Ang Zhang

This girl in Peru could have been another Juanita if she had lived in Inca times.

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Autism, the Brain and Tiger Woods

If London “Cabbies” can train themselves to remember 25,000 London Streets and navigate them and make their brains develop, we too must be able to do much in enhance ours.

If this can happen with adult brain in this very specific visual spatial area we must be able to do the same with other areas of brain functioning.

In the chapter “Miracles” of my book "The Cockroach Catcher”, I highlighted the case of how a boy who was considered beyond the then accepted critical age for language acquisition managed to acquire not one but two languages after intensive input. This was after half his brain was removed to treat a specific neurological condition.

In another chapter, I told the story of how one mother managed to get her autistic boy to speak by giving him her intensive input, against all predictions that he would have great difficulties in that area.

Be warned: there are no short cuts. Great commitment and dedication is required. But believe you me – often the results surprised even The Cockroach Catcher.

“ Many new parents tend to parent by responding to cues given to them. There is nothing wrong with that. We talk to our kids when they talk to us and we leave them alone if they want to play on their own. Sometimes parents insist that quiet play is actually good for their children when they themselves want some peace and quiet…..

……With autistic children one may have to wait a very long time for those cues and they may never come……

…… there is something you can start if you are not doing already. Do not stop talking to Anthony. Give him running commentaries on what you are doing even if it is about tidying the place, getting his dinner or doing his laundry…...’Don’t wait for his response,’ I emphasized……”

Then,

“……At three years and four months Anthony spoke. He did not just speak. He was in full sentences.

I said to mother, you have delivered……”


Tiger Woods:

As I wrote, Tiger Woods just won the Accenture Match Play World Championship, his fourth tour win this year alone. It is a tribute to the commitment of Tiger’s parents and especially to his father Earl Wood’s induction of Tiger into golf from an early age. The same goes for parents of many successful sportsmen and musicians. There is no doubt all these pursuits also require manual dexterity, accuracy and concentration from the individual. They all have regular and long practices – regular feed-back to the brain.

Even when we cannot drive long drives like Tiger, the Cockroach Catcher contends that if a golfer wants to improve his brain, he should concentrate on the short game, especially putting. The visual spatial computation required is what will keep the brain cells “wriggling”.

Congratulations to Tiger on his success. I must book my next week’s Tee time now.

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'The Knowledge' and the Brain

Early on in my neurological training at one of the world’s top centres, we were told in no uncertain terms that we were born with a fixed number of brain cells which would not be replenished whatever we might do.  At the time and for a long time afterwards I believed them.  So did most doctors and neurologists and the public in general.  Now I realise that in life what you and a lot of people have always believed in may turn out to be not true.

‘The Knowledge’ unique to London is what blew that belief into pieces. All London taxi-driver have to go through two to five years of training to learn and memorise all the London streets (about 25,000 in total within a six-mile radius of Charing Cross) and one-way systems.   In the licence examination they have to answer questions on how to drive from A to B along the shortest possible route.  The scientists in London did MRI studies of these London taxi-drivers and confirmed that the specific part of their brains that is responsible for this visual-spatial memory had indeed become bigger and more complex than average. What we previously knew about the brain had to be deleted and a new chapter was re-written.   Brain injured people began to have new hope.

In my travels I have come across minority ethnic groups that give their children very specific motor skill training in the form of traditional dances and games, and on the small island of Taquile in Peru, even knitting for boys – perhaps they know a thing or two.

Island of Tequile, Peru

Peruvian boys in Tequile

One can argue that computer games are the modern equivalent.

Playing musical instruments requires both manual dexterity and memory work, and musicians are often good mathematicians, possibly because of the proximity of the areas in the brain for these functions, although it may not be that clear cut. Making children recite poems is not a bad idea either, nor indeed the study of Latin, as these activities all help to exercise their brain. 


The Jewish have probably known for a long time the benefit of studying the Torah for Bar Mitzvah:

“……It is most common for the celebrant to learn the entire haftarah portion, including its traditional chant, and recite that.”

Now lessons in music instruments are no longer offered in most state schools in the U.K., nor is Latin. Medical schools are moving away from rote learning. Good intentions may indeed have major drawbacks that could affect generations to come.

By the way, if you have been trained to have a good memory, that ability will transfer easily to the remembering of the taste of wine! Think about it, the brain is very economical in its application, and is still the best computer around.

Mmmm….perhaps that is why two of my friends started learning the piano when they retired. They too might know a thing or two.

If we want our children to have a future, bring back music, rote learning and poetry, and let medical students toil through anatomy. Our world will be better.

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Anna Freud and Common Sense

I wrote in my book:

“……But Miss Horowitz you cannot fault. Her father was a famous child psychiatrist and she was really an Anna Freudian. Not so much of the penis envy or bad breast good breast stuff that Gail kept talking about……”

Miss Horowitz was my psychotherapy supervisor. We spent an hour and a half every week talking about my patients. It was years later when I realised the essence of her approach and therefore that of Anna Freud’s is the naturalness.

Much has been written about Sigmund Freud as a person with what looked like unresolved personal problems. He had without doubt influenced our thinking for at least thirty years as the Nobel Laureate Kandel conceded. He provided a framework for our further understanding of the working of the human psyche. Much as physical medicine is being continually updated by newer findings based on new scientific discoveries, later psychiatrists have been able to modify and improve upon Freud’s original ideas. I always view with suspicion the rigid adherence to classical ways in matters of the mind.

At the time when I was working at the Tavistock, Anna Freud (December 3, 1895 - October 9, 1982, sixth and last child of Sigmund and Martha Freud) continued to give seminars on Wednesdays at lunch time at her home opposite the Hampstead Clinic. This is now the Freud Museum. Anna Freud herself would already have been seated even if you made special effort to arrive early in order to have a seat. She would invariably be knitting and the few times I was there she seemed to be knitting this enormous scarf or even blanket. It spread over her knees and the floor in front of her as if to say “This is my space.”

Arthur Couch, who had 6 ½ years of psychoanalysis with Anna Freud, wrote a paper to try to give a picture of Anna Freud's views about adult psychoanalytic technique. The following excerpts gave particular insight:

“……She seemed not to know the orthodox 'Freudian' rules of technique about such restrictions. At times she even expressed her own opinions on certain realistic issues I was talking about. I recall telling her I was surprised that she should say such things; she answered : ‘Why are you surprised?’ …… I came to realize that I had previously assumed something too rigidly limited about Freudian clinical principles…….”

“……As I recounted these various failed attempts each day, Anna Freud seemed to increase the intensity of her knitting, which she did most of the time so silently that I hardly noticed it. Finally, in one session, she began to speak about the issue of my soft-spoken patient. I expected her to give a very important interpretation about my difficult situation. But what Anna Freud simply said was: ‘Tell her to speak up.’ This I did, and it solved that particular problem for the rest of a long analysis……”

“………Erikson's wife was pregnant, and he was spending many sessions talking about his worries about her pregnancy and what having a baby meant to him. Being very involved with this topic and wanting his analyst's full attention and concern, Erikson expressed his irritation to her that she was not speaking about it, but Anna Freud just kept knitting with increasing intensity while remaining silent……. when Erikson came into his session and announced that his new baby son had been born, Anna Freud gave him a blanket she had been knitting all along for his baby……”

Anna Freud once said: “The trouble with common sense is that it is so uncommon.”

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Lunar Eclipse

I played golf this morning with a keen amateur astronomer who recently acquired an 11” reflector telescope. Alas, the modern telescope makes life so easy. Those equipped with a "Go To Controller" can search out stars for you. He told me he had a most marvelous time watching the Lunar Eclipse last night. It will be nearly three years before the next full eclipse but there will be a partial one in August this year. NASA provides detail of future eclipses and of the past.

Photo courtesy of Associated Press - Images taken about every 20 minutes show the moon passing through the shadow of the earth as photographed Wednesday, Feb. 20, 2008, in Toronto. A lunar eclipse, which only can occur during a full moon, happens when the moon passes through the shadow of the earth.

Then I thought to myself, as far as I can remember from early childhood, there is an old Chinese Tung Sing (Almanac) that has been used by generations of Chinese for deciding on important events. Farmers refer to it for most of the important ploughing, sowing, planting and harvesting schedules. In the almanac are also dates and times of eclipses.

In my book, I wrote:

“……the Jesuits were generally regarded as the greatest scholars. They brought Western culture and religion to the East. They must have had a glimpse of the Chinese understanding of the universe and the world. Yet for so long the religious view of Flat Earth held true. Did the Jesuit scholars know the truth or did they pretend not to in order to avoid persecution and possible death?....”

In the footnote I quoted Joseph Needham’s monumental work:

“…… Joseph Needham's multivolume Science and Civilisation in China is recognized as one of the great works of historical scholarship in the twentieth century. The conception of world history that frames and shapes its arguments, however, has gone unnoticed……”

In the west, scientific discovery and progress was hindered by religious dogma and it is not my intention to further labour the point. In China the hindrance came not from religion but often from the rulers. It is well known that the First Emperor burnt books and buried scholars in an attempt to ensure that his people were not and would not become too knowledgeable. The opera, The First Emperor, is based on historical records and reveals an aspect of dictatorial control on culture and in this case, traditional music. It is a powerful opera, a true fusion of East and West.

Fortunately astronomical studies in China were later sponsored by the state and from Needham’s account, our early astronomers were astonishingly observant and accurate. Needham noted that Chinese Astronomers in 170 B.C. “……gives the unexpectedly accurate values of 584.4 days and 377 days for the synodic periods of Venus and Saturn; the modern values are 583.92 days and 378.09 days……” . They were very accurate too with tidal predictions. In contrast, Christopher Cullen of the Needham Research Institute noted how “palpably fallacious” Galileo’s pet theory of the tides were.

Chinese Science is essentially observational science.

Needham noted that the arrival of the Jesuits in China in the 16^th Century marked the end of the independence of Chinese Science and Culture. Christopher Cullen noted that “……The Jesuits were naturally first and foremost Christian missionaries, and their scientific work (much of it astronomical) was intended to aid their religious teaching by adding to the prestige of the culture they represented…..”

……The damage done by the Jesuits was not so much a result of their initial conservatism, but of their continued clouding of the issue until well into the eighteenth century……”

I am enthusiastic about Needham. His work was introduced to me by my first consultant in England, and whenever I am in a good library, I would just pick up any volume with a title that catches my interest that day and read through it. I have often wondered what the point is of limiting such work to a few scholars instead of sharing it with the rest of the world. Let us share knowledge!

The secret is out: recipe for Teochiu Braised Goose

The Cockroach Catcher’s wife’s recipe has just been published on one of the best foodie blogs around – Helen Yuet Ling Pang’s World Foodie Guide. It is all there. After reading my post on Chinese New Year and The Goose, Yuet Ling asked if my wife would share the family recipe with her readers. Full marks to her for initiative!

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Child Psychiatry, Ping Pong, Paper Planes and Toys

When commenting on my Golf and Health blog, a reader mentioned Ping Pong as a hobby. You will be surprised to learn that the child psychiatrist in my book The Cockroach Catcher used the game as a therapeutic tool in several of his cases, e.g. in the chapter “Ping Pong” concerning a boy who allegedly had social phobia:

“…The scene was set for a three game match between the consultant and his patient to decide if his patient could go for a short week-end leave.

Even the headmaster came out to watch, shaking his head in disbelief.

It was spring, still cold but sunny. The sun was streaming in. I lost the first game. I had not played for fifteen years. I took off my jacket. I barely managed the second. That brought some cheers…”

and in the chapter “Wrong Foot” concerning a boy with a limp:

“…One day I was having a game with him after lunch and noticed that he was limping on the wrong foot. So before my next serve, I said to him: Tommy, wrong foot. He saluted me and said thanks and went back to limping on his right foot again….”

In another chapter, paper planes came into play with a mute boy:

a paper plane

“…Paper plane.

I hit on the idea of my faithful friend.

I built one, then two. He had one and I had the other. They flew, made beautiful loops, did aerobatics and he was thoroughly enjoying it.

I sensed that he wanted to take them home to show his dad….”

Of course the child psychiatrists had a wide selection of “proper” toys too, so much so that:

“….One little boy once observed, “Do you live here, Dr Zhang? It must be fun, with so many toys to play with.”….”

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Golf and Health

Yesterday I had to finish on the twelfth hole because one of the foursome twisted and hurt his back so much that we had to get him to the hospital. Being known as the doctor on the golf course has one major side effect: strangers tell you their medical stories.

When I started with this club at the beginning of the year I played with this man who only comes here in the winter.  For the rest of the year, he works up north maintaining gardens. He negotiated a two-month membership. Golf etiquette dictates that you shake hand with your playing partners, but he said he had this skin condition and was not sure if it would be infectious.              On learning that I am a doctor, he started to tell me that he was rather concerned as not only his hands but his whole body seemed to be covered in what looked to me like eczema. I refrained from commenting. This man is interested in a lot of things and one does not get bored playing with him. He is knowledgeable about gardens and grass in particular. My wife was my caddie that day and she found him interesting too.

Then he disappeared. One week, two and then three.

Imagine my surprise when he reappeared one morning and the first thing he did was to shake hands with me.

I must have hesitated a bit. He said, “It’s all right. It’s not infectious.”

Apparently his skin got so bad he went to see a specialist. They discovered he was allergic to shell fish.

“But I never had shell fish,” he told them.

They then found that he had been taking Glucosamine with Chondritin for his back pain. He has been doing so since his aunt gave him some seven years ago.

There seems to be more allergy nowadays, and I have often wondered why this is happening.

This episode throws up something interesting I have observed since becoming a doctor. We all have different views on who to listen to as far as advice is concerned. It seems doctors still top the list and I have often had friends asking me for a second opinion. I did not think much about it at first as I was getting used to it. Now I realise that a second opinion from a doctor who does not charge a fee is considered most valuable.

Money has spoiled everything. In fact, half way through writing this, I had to deal with an enquiry from Hong Kong about some doctor’s recommendation to remove a kidney. Since a high fee was involved, a friend wanted my opinion, although I was given nothing more than an MRI to work on, and I am only a Child Psychiatrist.

In my book, I commented:

“……Most medical students with any emotional problem do not seek help from their psychiatric department but from the professor who drives the most expensive car……”

Most people traditionally choose to believe in their hairdresser, bartender, spar attendant and nowadays their personal trainers.

My new friend’s aunt was rich and gave him the first batch of Gucosamine with Chondritin. He trusted his aunt, and his back did improve very quickly. His aunt was doing well on it and as Glucosamine is a natural product it must be safe. No, he does not blame his aunt.

(Mmm…., cocaine is natural, so is opium, so are a number of other things.)

He has not been allowed out and has wasted nearly half his golf membership. He is glad though that he now knows what his problem was.

Golf without doubt is very stressful for the back, but it has a range of health benefits, or that was what I was told when my wife encouraged me to start having lessons. Now I realise the health benefit is for her as she now has at least five hours of freedom from me everyday. Here is a warning for those ladies who want to do the same: golf is the only addiction I know for which there is no cure.

Joking apart, here are the benefits I have observed:

Walking – Walking has always been regarded as a good exercise for health maintenance. Yet some courses, especially those in the U.S. do not allow you to walk. Slowing down play does not make economic sense. So what can you do? My advice is make sure you do not get too good at the game. That way you will need to do a lot of walking looking for that little white ball. Perhaps that is why I am still not that good! Another way is to make sure you play with someone else and let him drive the cart. He will feel honoured and you can have the exercise. There is also fresh air and beautiful scenery if you remember to look.

A rare sight at a golf course

(Concorde flying over the Barbados Golf Course in 2003)

Mental – You are aware that you need to get five things right all at once when you try to hit the ball. This is good to prevent early aging or whatever they call that illness, “Alzh...something…mer”, sorry, I forgot. Also if, like me, you meet new faces most days, you exercise your brain in another way. Experts now feel that seeing new places and meeting new people are two important ways one can use to exercise the brain. You can of course supplement golf with Bridge or Mahjong.

Finally, maintain a healthy attitude. In golf, always blame something else but not yourself -- one of the first lessons I learned when I started.

And, remember to do the deep breathing. Who knows? You might putt like Tiger one day.

Tiger Woods Putting ©2007 Am Ang Zhang

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Golf, Cholera and Tiger Woods
Autism, the Brain and Tiger Woods
The Open and The Brain
Ancient Remedy: Modern Outlook
Tiger Woods and Breathing