In England, you do not start long-distance walking to escape from civilisation, but to meet people. England has no wildernesses, but many field paths and country pubs, market towns and comfy bed and breakfasts. I began my life as a long-distance walker at a lonely time of my life in the 1970s, after divorce from my first wife. I chose the Offa’s Dyke Path because it was easy to reach from my then home near Birmingham, because it led in a reasonably straight line from one shore to another, and because it crossed land I had never been to before.
I had no experience of long-distance walking and no-one to ask for advice. I bought a strange backpack from Milletts, which included a plastic fabric bag with several containers held onto a frame of thick plastic rods by aluminium pins and split rings. Over the following years, the pins broke one-by-one, and were replaced by an assortment of bolts, depending on what was available at the time. I wore a good pair of walking boots, although these were heavy by modern standards. I decided to brew my own tea and coffee en route, and took a small gas stove, plastic water bottle, and containers for tea, coffee and powdered milk. It did not occur to me to take a spare pair of trousers.
I took the train to Chepstow one Saturday morning in Spring and arrived before lunch. The first part of the Path involves crossing the Wye and then doubling back to the River Severn through some suburbs. There seemed no point to this, so instead I crossed the Wye and headed North up the Path. The first part of the walk was a steep climb and I discovered, like many before me, that a pack is much heavier to carry when going uphill. After crossing a few fields, I found that I had lost my map. I decided to retrace my steps to find it. I began crossing a large field when, coming the other way, was the entire Manchester Rambling Club. At its head was a man carrying my lost map. They were due to stop at Tintern Abbey on the other side of the Wye, which had also been my planned destination. But by then I was lost to the joys of walking through sweet-smelling Spring woods, finding footpaths alongside the ancient military dyke, and making progress across an unfolding land. So I headed onwards to complete 16 miles to Monmouth.
For late lunch, I stopped by a bend in the River, sitting on a large log, ate my sandwiches and brewed my coffee. I then continued along the Dyke and by dusk came to the Kymin Hill overlooking the town of Monmouth. Finding a path downhill is a lot harder than finding it uphill, and I got lost, tripped and rolled with my pack over and over through a mass of ferns. I remember laughing at the ludicrous sight I must have been, and then walked down across the Wye once more, and into Monmouth town.
I found a place to stay in the Queen’s Hotel in the centre of town. After a bath and a big steak meal, I went to bed early. It was then I discovered that old timber-frame buildings carry sound efficiently. Below my room, there was a party in the bar. After closing hours, all fell quiet for five minutes, when a couple entered the bedroom next door to mine. There followed an hour of the most noisy copulation, like a kind of audio pornography. After this ended, I became aware of the town steeple next to the hotel, which rang out the hours every hour.
I was still young enough then to be able to recover well from a disrupted night’s sleep. I woke before the rest of the Hotel, had an excellent breakfast, gathered my possessions into my backpack and headed off down Monmouth High Street. I found that my legs hurt from yesterday’s efforts, but this eased by the time I left the town. I then headed through an enchanted land of fields and ruined castles, and came at lunchtime to a pub by the side of the Path. This was full of fellow walkers chatting to each other, while other walkers passed the pub and greeted us. I realised I had joined the company of long-distance walkers, and began a life as a walker that took me all over Britain, to France, Italy and Switzerland, and only ended 20 years later when I lay on the side of the Mendip Hills crying with arthritic pain.
Sunday 29 March 2009
Thursday 26 March 2009
Compliments not complements
I live in a rural area amply provided with therapists. The listings page in our village magazine advertises two counsellors, an acupuncturist, and a firm selling ‘health and nutrition products’. Also listed within a few miles are providers of osteopathy, cranial osteopathy, shiatsu massage, reflexology, neurostructural integration technique, and magnetic therapy. Complementary and alternative therapists do not yet outnumber our electricians, plumbers and plasterers, but they are a large enough army to challenge our doctors, nurses and professions allied to medicine.
This is a small local example of a national pattern. Complementary and alternative therapies are now a very big business indeed, with ‘health food’ shops on every high street, television programmes promoting ‘nutrition therapy’, and with more complementary and alternative therapists than medical practitioners in the UK. Businesses need customers prepared to part with their money, and this particular business succeeds in getting them to do so on a large scale, even though access to medical care in this country is free. Complementary and alternative therapy can therefore be compared with bottled water, except that bottled water is exactly the same product as the stuff that comes out the taps. Complementary and alternative therapy, by contrast, is offering something different. What could that be?
‘Alternative medicine’ sounds like a pretty clear concept: it means attempting to attain better health without using the services of a trained medical practitioner and being enthusiastic about receiving treatments which have not been shown by research to be therapeutic and safe. There are no end of alternatives too, a bit like a therapy supermarket. And there are plenty of people who report that they feel better as a result.
Of course, many illnesses get better whether treated or neglected, while the very experience of meeting a therapist and being given any sort of treatment can itself make people feel better. This is the ‘placebo effect’, and it works for conventional medicine as well as for complementary and alternative therapies. This is why medical research has developed elaborate research techniques using randomised controlled trials to detect whether a specified treatment results in an improvement beyond the placebo effect. Unfortunately, medical research techniques are difficult for many people to understand, and fall before the power of the personal anecdote which guides so much human behaviour.
Alternative medicine is always going to use therapies which have not been rigorously tested because, once shown to be effective, they cease to be alternative. Soaking the bark of willow trees to produce an infusion did succeed in reducing pain, and the key ingredient was eventually refined and sold as aspirin. There is also reliable evidence that some forms of counselling reduce the symptoms of depression, distress, and various other mental disorders. They too have now become mainstream treatments in mental health and primary care services.
The concept of ‘complementary therapy’ is a bit less clear than alternative medicine. In what way does it complement conventional medical treatments? Taking alternative therapies in addition to the treatments prescribed by their doctor is probably quite common. But ‘complementary’ could also mean therapies for people who do not have an illness, or have an illness for which there is no known effective treatment. The second group can easily be exploited. Complementary and alternative therapists can offer short-term hope to the suffering, and even if what they prescribe does not in the end produce relief, then it can still generate a tidy profit in the meantime.
My proposal, however, addresses the large group of unhappy and distressed people who do not have an illness recognised by a medical practitioner, but who still wish for some kind of relief. Most people, when they are unhappy, seeks the company of friends and family for comfort and praise, but this avenue is not open to all and some alternative is required. This is the key task of complementary therapy in such cases - to produce good placebos. We should therefore assess complementary therapy not by whether it makes an improvement over placebo effect, but by the quality of the placebo it provides. This will vary from person to person. Most people respond enthusiastically to the invitation to talk about themselves at length, and, speaking personally, the experience of being rubbed in warm sweet-smelling oils by an attractive young woman would certainly brighten my day.
Are there any opportunities for developing new complementary therapies that will deliver an even better placebo? The therapy supermarket is already well-stocked, but I believe there is one gap in the market: complimentary therapy with an ‘i’. This essentially consists of praising the client fulsomely. To be a really good placebo, this should take account of the kind of compliments that work best for each particular client. People who are miserable because they believe they have not made a success of their lives are told that they are highly-talented and that their achievements will be recognised. People who are unhappy because they are rude, offensive and unpopular will be assured that they have a quiet sensitive side that is under-appreciated by others.
There are objections to complimentary therapy. Critics complain that it amounts to little more than sustained flattery. But flattery is therapeutic. Why else do so many rich and powerful people surround themselves by flatterers? A second objection is that there are some people with a more masochistic streak who respond not to compliments but to enemas and other forms of humiliation and pain. Fortunately, there is a counterpart of complimentary therapy designed to meet their special needs. This is ‘insulting therapy’. I do not have the right sort of personality to engage in this, although come to think of it, there are one or two people in powerful positions that I would really enjoy insulting - particularly if they paid me money to do so.
Stuart Cumella
This is a small local example of a national pattern. Complementary and alternative therapies are now a very big business indeed, with ‘health food’ shops on every high street, television programmes promoting ‘nutrition therapy’, and with more complementary and alternative therapists than medical practitioners in the UK. Businesses need customers prepared to part with their money, and this particular business succeeds in getting them to do so on a large scale, even though access to medical care in this country is free. Complementary and alternative therapy can therefore be compared with bottled water, except that bottled water is exactly the same product as the stuff that comes out the taps. Complementary and alternative therapy, by contrast, is offering something different. What could that be?
‘Alternative medicine’ sounds like a pretty clear concept: it means attempting to attain better health without using the services of a trained medical practitioner and being enthusiastic about receiving treatments which have not been shown by research to be therapeutic and safe. There are no end of alternatives too, a bit like a therapy supermarket. And there are plenty of people who report that they feel better as a result.
Of course, many illnesses get better whether treated or neglected, while the very experience of meeting a therapist and being given any sort of treatment can itself make people feel better. This is the ‘placebo effect’, and it works for conventional medicine as well as for complementary and alternative therapies. This is why medical research has developed elaborate research techniques using randomised controlled trials to detect whether a specified treatment results in an improvement beyond the placebo effect. Unfortunately, medical research techniques are difficult for many people to understand, and fall before the power of the personal anecdote which guides so much human behaviour.
Alternative medicine is always going to use therapies which have not been rigorously tested because, once shown to be effective, they cease to be alternative. Soaking the bark of willow trees to produce an infusion did succeed in reducing pain, and the key ingredient was eventually refined and sold as aspirin. There is also reliable evidence that some forms of counselling reduce the symptoms of depression, distress, and various other mental disorders. They too have now become mainstream treatments in mental health and primary care services.
The concept of ‘complementary therapy’ is a bit less clear than alternative medicine. In what way does it complement conventional medical treatments? Taking alternative therapies in addition to the treatments prescribed by their doctor is probably quite common. But ‘complementary’ could also mean therapies for people who do not have an illness, or have an illness for which there is no known effective treatment. The second group can easily be exploited. Complementary and alternative therapists can offer short-term hope to the suffering, and even if what they prescribe does not in the end produce relief, then it can still generate a tidy profit in the meantime.
My proposal, however, addresses the large group of unhappy and distressed people who do not have an illness recognised by a medical practitioner, but who still wish for some kind of relief. Most people, when they are unhappy, seeks the company of friends and family for comfort and praise, but this avenue is not open to all and some alternative is required. This is the key task of complementary therapy in such cases - to produce good placebos. We should therefore assess complementary therapy not by whether it makes an improvement over placebo effect, but by the quality of the placebo it provides. This will vary from person to person. Most people respond enthusiastically to the invitation to talk about themselves at length, and, speaking personally, the experience of being rubbed in warm sweet-smelling oils by an attractive young woman would certainly brighten my day.
Are there any opportunities for developing new complementary therapies that will deliver an even better placebo? The therapy supermarket is already well-stocked, but I believe there is one gap in the market: complimentary therapy with an ‘i’. This essentially consists of praising the client fulsomely. To be a really good placebo, this should take account of the kind of compliments that work best for each particular client. People who are miserable because they believe they have not made a success of their lives are told that they are highly-talented and that their achievements will be recognised. People who are unhappy because they are rude, offensive and unpopular will be assured that they have a quiet sensitive side that is under-appreciated by others.
There are objections to complimentary therapy. Critics complain that it amounts to little more than sustained flattery. But flattery is therapeutic. Why else do so many rich and powerful people surround themselves by flatterers? A second objection is that there are some people with a more masochistic streak who respond not to compliments but to enemas and other forms of humiliation and pain. Fortunately, there is a counterpart of complimentary therapy designed to meet their special needs. This is ‘insulting therapy’. I do not have the right sort of personality to engage in this, although come to think of it, there are one or two people in powerful positions that I would really enjoy insulting - particularly if they paid me money to do so.
Stuart Cumella
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