Monday, May 28, 2007



I've been thinking about what bothered me about the obese woman who took the tricyclic overdose, and about some stuff I've been reading. I draw your attention to the almost unbearably sad events described in Forensic Science International - do not follow link unless you are up to it.

See, Mrs Werther was brought in by ambulance following a tricyclic overdose, her first in ten years. She has a son at home, a "disturbed child", she also took some of his dexamphetamines. She is estranged from her family, has a husband but "they aren't close", these last two facts from the psych nurse who has collected the collateral history - Mrs Werther remains unconscious.

It doesn't take Einstein to do this maths. She is alone.

But anyway. She is lying there, pale and gelid, with the rubber tube in her lungs*, and will probably remain so for a day or so. And then she'll wake up, still depressed, no family, a difficult child, a husband who so far has not come to visit her.

I think part of what makes me angry about this - before I say this, part of what makes me angry is neurochemical, part of it is the slow seeping away of the tide - part of what makes me angry about this is the whole idea of choice. Behind the disinterest of the nurses and the open contempt of Dr Fang is some idea that this woman doesn't deserve sympathy because she chose to do this, she did it to herself.

Not to be too brusque about it, this idea and this whole way of thinking is bullshit. Excuse me while I have a "Gospel according to me" moment:

Sympathy isn't something you turn on and off like a lightbulb according to how much the other person deserves it. It's a perception thing, like whether you see a bend in the road or not. The other person is a human being, you either see that or you don't. If you don't see it, there is stuff you can do, books you can read and people you can talk to, prayer or doing stuff for the poor or whatever, but everyone knows that anyway. And you don't have to do it, it's your life, and good luck to you either way.

Here endeth the lesson, sorry about that.

Anyway. Mrs Werther. I don't think Mrs Werther "chose" to do what she did, for about seventy different reasons, but one of them is I am less and less convinced of the existence of choice. The idea that we all have free choice, that we weigh up alternatives and choose what to do doesn't seem useful to me. It doesn't explain a hell of a lot.

Take obesity, a subject close to my heart*. I hold these truths to be both widely known and self-evident:

Eating more and exercising less makes you fat.
We (most of my readers) are getting fatter at however many milligrams an hour.
We hate it - God only knows what the diet and fitness industry is worth, but it's up there.

And yet, we "choose" diabetes and shame and the next size up of pants and that much-longed for early heart attack. Who in their right mind would do this? The "choice" theory doesn't explain this.

Here's another set of factoids:
I believe a child's life is worth more than a CD.
I know can save a child's life by sending about a CDs worth of money to Mediciens sans Frontieres.
I got myself the latest Blind Boys of Alabama CD and it's pretty damn fine.

Of course, if I read in the paper that some other guy let a kid die so he could get a CD, I'd presumably be outraged.

I don't know. What I reckon, the way I look at things, is there are programmes running in our heads. These programmes have been put in our heads by evolution plus a bit of how we're raised with maybe a bit of tweaking from us thinking. I don't know a lot about computers, so I'll name these programmes after what they do:

The "eat as much as you find" programme.
The "do as little as you can get away with" programme.
The "trinket collecting" programme.
The "look after your kids" programme, etc.

And, most importantly, the "tell yourself it's all okay" metaprogramme.

The way it works is there's triggers that set these programmes into action. You are surrounded by people who are eating, or you feel anxious, or you're tired, or you're bored, you see the slice of chocolate dalek cake, half a second later it's at the lower oesophageal sphincter. No reasoned weighing up of the factors, no real thought, not a lot you'd normally call "choice", just the evolutionarily sensible outcome of perfectly natural, billion year old desires.

Same thing happens with the CDs. In each case, the programmes ensure that we do what works for us and - and here's the kicker - that however uncomfortable we feel about the bad consequences - the bulging belly, the starving child - we feel not quite bad enough to stop causing it.

Anyway. I will go off and read something uplifting. Work still goes well, I still get that sense of wonder - I put a nasogastric tube in someone the other day, a thin tube about the thickness and colour of an earthworm that is meant to go up the nose and down into the stomach, and it went down into his lungs instead (this happens reasonably often on the first try). I could feel the air moving in and out with every breath he took, and the yellowy-green substance that was meant to ooze out of the tube didn't. So we pulled it out and tried again.

More cheery next time,


* a couple of kilos of pericardial fat.


Blogger Camilla said...

That was brilliant, and rather *ouch*. Definitely food for thought there.

Those programs you mentioned, do you think they're running in some ancient, intractable part of our brains? Because otherwise, I can't understand why with all the agency, capability and capacity in the world we still persist in making the "wrong" decisions.

Don't mind me. This post of yours just struck home rather forcefully.

1:29 AM  

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