Did you catch these?

So far in Cockroach Catcher: Phew! I am still catching my breath! I learn that most blogs have a weekly or monthly summary. There was no summary from me at the end of January as I had only just started, but below is a summary of the postings to date.

Nature

Anhinga in Costa Rica - Faking Is Not All Bad

Bauhinia blakeana and other health warnings

Elephant and teenage pregnancy

Lunar Eclipse

Mother Nature should be ecstatic

The Cockroach Catcher in Costa Rica

Turtles in Barbados

Yunnan

Food

Antioxidants and cooking

Chinese New Year and the Goose

Papaya and Nobel Prize

Quinoa: the super grain

The secret is out: recipe for Teochiu Braised Goose

The sliced Goose and a natural dose of Glucosamine

Child & Adolescent Psychiatry

A Brief History of Time: Anorexia Nervosa

Adoption

Anna Freud and Common Sense

Anorexia Nervosa: a cult?

Autism and Money

Child Psychiatry, Ping Pong, Paper Planes and Toys

Hiccup Boy

Please don't poison our children with stimulants

Religious Fanaticism and the Ice Maiden of Peru

The doctor is the drug

The William Tell Mom and Peas

This Child Psychiatrist also uses the Stethoscope

Trust Me

Unwillingly to School

Medicine & Medication

Autism, the Brain and Tiger Woods

Che Kung Temple (che gong miao) and the Power of Prayers

Flight into Health - Why Do People Get Better?

Groundhog Day and Prozac

Monkeys and NHS

Multiple Sclerosis, Iguanas and Wrong Foot

Orthodoxy and Knowledge

Rashomon and Prozac

Sadness medicated to extinction

SARS and Quorum Sensing

The Knowledge' and the Brain

Traditional Chinese Doctor

Leisure Pursuits & Health

Barbados

First Encounter with Mondrian

Golf and Health

Medicine and Snorkelling

Pleasure Principle and Wine

Tiger Woods and Breathing

Buy the book: The Cockroach Catcher

Papaya and Nobel Prize

Papaya Plantation - Costa Rica

In my book, the Cockroach Catcher reminisced about going home after the final medical school examinations:

“……The guavas were not quite ready but our own giant papaya tree seemed capable of fruiting through the year. These were yellow fleshed and delicious though without the special fragrance associated with the red variety……”

As fashion in food recommendation changes with time, I prefer to eat what I like and I happen to like papaya. Right now, non-green fruits and vegetables seem to be the flavour of the month, and in this respect papaya certainly fits the bill.

View recommendations with some caution, and if it fits in with how you feel then go for it.

Papaya – red variety from Costa Rica

Papaya contains the enzyme Papain, which has a special ability to break down peptide bonds. This makes papaya ideal for marinating. Go easy though. If left too long the meat may be over tenderised. I definitely prefer the fresh fruit to the commercial preparation.

As early as in 1978, the Time Magazine reported on the controversial use of Papain for treating slipped discs. Chymopapain, the enzyme derived from Papain was legal in Canada then but not in the U.S. Some individuals may be allergic to Chymopapain. I often wonder if there might have been other reasons. The Time Magazine article pointed out that 170,000 Americans underwent disc surgery every year. The best recommendation was perhaps by the Chicago Orthopaedic Surgeon Dr. Noble, who not only referred his patients but also himself to a Canadian Hospital for the treatment. He sort of “put his back where his mouth was”.

Papaya and its extract has other uses. Papain is used in some preparations of soft contact lens cleaning solution.

Small Jelly Fish - Barbados

In the unfortunate event of a swimmer or snorkeller getting stung by a jelly fish, papaya is by far the best treatment as a local application. It is also wonderful as a facial mask. Next time when you buy a whole or half papaya, keep the skin after cutting off the flesh. Rub your face with the flesh side of the skin and leave for ten minutes before washing off – this beats most other facials. Just make sure you do not have cuts or scratches on your skin. The last time I checked the prices of some facials containing Papaya extract, they were upwards of £16.

Now you have a secret recommendation from the Cockroach Catcher.

However, you may be too late to get the Nobel Prize. Rodney Porter in 1972 was awarded the Nobel Prize in Medicine for his ground breaking work on the chemical structure of antibodies, jointly with Gerald Edelman:

“ … Porter aimed at separation of those parts of the molecule that are responsible for the capacity of the antibody to react specifically and combine with that foreign substance, that antigen to which it is specifically fitted. He found that this indeed could be done with the aid of the protein splitting enzyme papain.

The Nobel press release concluded:

“Their discoveries represent clearly a break-through that immediately incited a fervent research activity the whole world over, in all fields of immunological science, yielding results of practical value for clinical diagnostics and therapy.”

Buy the book: The Cockroach Catcher

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Rashomon and Prozac

Rashomon (1950) was made by one of Japan’s top directors Akira Kurosawa when Japan was just recovering from the Second World War. The director even had difficulty finding a horse for a crucial part of the film. I am sure many working in the field of mental health have heard of the Rashomon Effect, although many may not have had the chance to see the film. I used to keep a copy to loan to my staff. The Film, in black and white, was extremely well made and has been hailed by other film directors as near perfect. It just shows how lack of funding does not necessarily mean lack of quality.

Rashomon is fundamentally about truth and subjective truth. At the end of the film you are still not too sure but you have some idea. The story was simple enough:

“This landmark film is a brilliant exploration of truth and human weakness. It opens with a priest, a woodcutter, and a peasant taking refuge from a downpour beneath a ruined gate in 12th-century Japan. The priest and the woodcutter, each looking stricken, discuss the trial of a notorious bandit for rape and murder. As the retelling of the trial unfolds, the participants in the crime -- the bandit (Toshiro Mifune), the rape victim (Machiko Kyo), and the murdered man (Masayuki Mori) -- tell their plausible though completely incompatible versions of the story.”

(from the: New York Times Review: March 1, 2008)

The murdered man was in fact a Samurai who had the task to maintain the honour of the Samurai tradition, even as a ghost. This was to some the most shocking part. We know people lie: but GHOSTS?

In today’s news, the Oliver star Mark Lester now divorcing his wife has his story to tell so has his wife.

Not many days ago, Prozac and other SSRIs hit the big news worldwide. The big Pharmas have their stories so have these and other researchers from around the world. The millions of patients on one of these drugs have their stories too. If NICE were to make a pronouncement, would that not be just like the words of the Samurai’s ghost? Are we to believe it would not be driven by political or economical considerations? Not too many years ago Ernest Saunders was let out of prison early because of Alzheimer’s disease though he later denied it. What about Pinochet? O. J. Simpson?

Rashomon has remained one of the top hundred films ever made. The ending at least gave the poor monk, who probably would have committed suicide or would nowadays be reaching for Prozac or other SSRIs, some hope.

A baby was heard crying. It was an abandoned baby. The woodcutter, who was poverty stricken, decided to adopt and look after this poor baby. He had six children – one more mouth would hardly make much difference.

There is hope in the world still.

Buy the book: The Cockroach Catcher

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A Brief History of Time: Anorexia Nervosa

Il faut manger pour vivre et non pas vivre pour manger.
(One should eat to live and not live to eat.)
- Moliere (1622 – 1673): L'Avare (The Miser)

Some hae(have) meat and cannot eat,
Some cannot eat that want it:
But we hae meat and we can eat,
Sae let the Lord be thankit.
- Robert Burns (1759 – 1796): The Kirkcudbright Grace

This is not about Stephen Hawking’s famous book that sold over 9m copies world-wide, but a collection of material that relates to Anorexia Nervosa in a chronological order. You see, I believe in free sharing of knowledge.

First introduction of the term Anorexia

Sir William Withey Gull (1816 – 1890) first used the term:

“In… 1868, I referred to a peculiar form of disease occurring mostly in young women, and characterized by extreme emaciation…. At present our diagnosis of this affection is negative, so far as determining any positive cause from which it springs…. The subjects…are…chiefly between the ages of sixteen and twenty-three…. My experience supplies at least one instance of a fatal termination…. Death apparently followed from the starvation alone…. The want of appetite is, I believe, due to a morbid mental state…. We might call the state hysterical.”

Source: Anorexia Nervosa (apepsia hysterica, anorexia hysterica).
Transactions of the Clinical Society of London, 1874, 7: 22-28.
Classic description of Anorexia Nervosa.

Earliest published accounts

Richard Morton (1637-98), a London physician: The Treaty in his book Phthisiologia, or a Treatise of Consumptions, first published in Latin in 1694.

Ernest-Charles Lasègue (1816 - 1883), a professor of clinical medicine in Paris: “De l’Anorexie Hysterique” containing descriptions of eight patients.

More recent views

Girl in a Chemise circa 1905 Pablo Picasso (1881-1973)
Tate Collection

Anna Freud’s psychoanalytic view (1958):

• Adolescent emotional upheavals are inevitable
• Anorexia Nervosa is the outward manifestation of the battle between the ego and eating, with the former struggling for it’s very survival

Bruch (1966): relentless pursuit of thinness

Crisp (1967): weight phobia

Russell (1970 ): a morbid fear of becoming

Crisp (1967 - 1980):

• Anorexia nervosa serves to protect the individual from adolescent turmoil.
• Anorexia nervosa reflects a phobic avoidance of sexual maturation.
• Unsettling effects of sexual maturation at puberty may drive the female adolescent to a pursuit of thinness leading to greater acceptance, self-control and self-esteem.
• Anorexia nervosa tends to appear in families with buried, but unresolved, parental conflicts.
  

Palazzoli (1978) on women’s role (not just Anorexia Nervosa)

• Women are expected to be beautiful, smart and well-groomed.
• They are expected to have a career and yet be romantic, tender and sweet.
• They are expected to devote a great deal of time to their personal appearance even while competing in business and professions.
• In marriage, they are expected to play the part of the ideal wife cum mistress cum mother.
• They are expected to put away her hard-earned diplomas to wash nappies and perform other menial chores.
• The modern woman is therefore exposed to a terrible social ordeal, and the conflicting demands and dual image of the female body as sex symbol and as commodity.
• An adolescent girl may develop feelings of insecurity and alienation toward her changing body.

Finally, it is appropriate to close with two quotes:

L'appetit vient en mangeant.
(The appetite grows by eating.)
- Rabelais (1494 - 1553): Gargantua

One hath no better thing under the sun than to eat, and to drink, and to be merry ...
- Ecclesiastes 8.15

Other Posts:
Anorexia Nervosa: Olanzapine (Zyprexa)-Veganism
Anorexia Nervosa: Bach
Anorexia Nervosa: What If!
Anorexia Nervosa: a cult?

The Book: The Cockroach Catcher

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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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