jamescalumcampbell

History, once more, is getting up to its rhyming tricks.  Last week, when President Trump announced he was thinking about bombing Iran’s uranium enrichment plants, I was reminded of the run-up to the invasion of Iraq in 2003.  Tony Blair told the House of Commons that Saddam Hussein held weapons of mass destruction which could be deployed against us in the space of 45 minutes.  Did this mean that these WMDs were a threat to British interests abroad, or could they, in fact, be directed against the UK?  This was never made quite clear.  Either way, the announcement was met with widespread scepticism from the British public.  Hans Blix, head of the United Nations Monitoring, Verification and Inspection Commission between 2000 and 2003, had been visiting Iraq on multiple occasions, looking for evidence of WMDs, and he never found any.  When the BBC reported Tony Blair’s assertions, the reports were usually accompanied by pictures of ancient ordnance rusting in the desert sands.  They didn’t look like an imminent threat.  The British public took to the streets in one of the biggest anti-war demonstrations ever seen in this country.  Most members of the government took little notice, with one or two noble exceptions, for example, two notable Scotsmen, the late Charles Kennedy and the late Robin Cook.  After the invasion, people carried on looking for the WMDs.  Tony Blair urged us all to be patient, to wait and see.  They were never found.  Then Iraq fell apart.

This time, we have been told that Iran is within weeks, perhaps days, of developing a nuclear bomb.  Is that true?  I don’t know.  I’m not party to the intelligence.  Perhaps Blaise Metreweli knows.  She has just been promoted from the position of Q, to the position of C, thus being the first woman to head MI6, not counting Judi Dench.  I didn’t know there was such a person as “Q”.  I thought it was a confabulation, not of the Bond books, but of the Bond films.  There was a Q Branch – Q perhaps for Quartermaster – which put together Bond’s attaché case, full of dirty tricks, in From Russia with Love.  You may say I digress, but these days the demarcation line between fact and fiction has become increasingly blurred. 

Unlike Tony Blair, who had to take the House of Commons with him, President Trump had no need to “reach across the aisle” in Congress.  He did fly a kite for a few days, no doubt gauging public opinion, conscious of the fact he was reneging on a promise not to take America into any more foreign conflicts.  He said, “Nobody knows what I’m going to do.”  Least of all, perhaps, himself.  At any rate the operation went ahead, apparently by Executive Order, and then President Trump, in the White House, flanked by J. D. Vance, Marco Rubio, and Pete Hegseth (what a grim picture they make), announced a fait accompli.  He said the operation was a spectacular success.  Is that true?  

Was this sortie, (one could call it a “special military operation”) justified?  The British Government sat spectacularly on the fence.  They were informed it was about to take place, but not directly involved.  They were pleased with the result, although they would have preferred that it had been brought it about through diplomacy. 

I’m not sure that I see the logic in refusing to allow Iran to develop a nuclear bomb.  After all, the UK has about 160 of them.  Most of them are stockpiled in a silo 25 nautical miles from where I now sit.  The continuous at sea deterrent is apparently keeping me safe in my bed at night.  If they guarantee our security, shouldn’t we be encouraging every other country to stockpile them, as a mutual guarantee of world peace? 

Alas, we are addicted to violence.  Periodically we become possessed by it.  There was disorder in Northern Island last week.  Two Romanian youths were charged with an alleged sexual assault on a teenage girl.  Violence flared in Ballymena.  People from minority ethnic groups, businesses, and homes, were attacked.  Racist violence was fuelled by misinformation emanating from social media.  I was reminded of Kristallnacht.  And of Quatermass and the Pit.  When I saw Nigel Kneale’s remarkable BBC series as a child I was frightened out of my wits.  But I didn’t realise at the time that Kneale was really utilising a science fiction genre to depict what happens when people in a society fall under a demonic spell and gang up to hunt down “the other”.

This morning, President Trump is flying another kite.  He is thinking about “régime change”.  History is rhyming again.  In 2003, perhaps Saddam’s putative MNDs were always known to be a figment.  They were posited as a justification for war, when all the time, régime change was the real motivator.  Could Iran’s nuclear threat be another figment, and has régime change always been the goal?  

What’s to be done about all the violence in the world?  What a question.  It’s like stopping an Irishman in the street to ask for directions.  He says, “If I were you, I wouldn’t start from here.”    

A Different Kind of Power

Jacinda Ardern

Macmillan, 2025

As I write, highly civilised human beings are flying overhead, trying to kill me.

George Orwell wrote that during the Second World War.  Hold that thought.

I was very moved to read the memoir of the Right Honourable Dame Jacinda Ardern, fortieth prime minister of New Zealand.  I’ve read many political memoirs, and biographies, mostly British, in my time.  Many I admire; others, less so.  John Wilson’s CB, A Life of Sir Henry Campbell-Bannerman, (Constable London, 1973) is a favourite.  CB was liberal PM between 1905 and 1908, and died in office, in No. 10.  His tenure was, by and large, a time of tranquillity on the international stage, such that, every September, he would take himself off to Marienbad for six weeks and read German literature.  Imagine a PM doing that now!  (I wish they would.)  R. J. Q. Adams Bonar Law (John Murray 1999) is another.  Both CB and Bonar Law were modest men, despite the fact that they both attended Glasgow High School.  Another modest man, frequently underestimated both in his own time and subsequently, was Clement Attlee.  His autobiography, As It Happened (William Heinemann, 1954) is a fascinating read.  Churchill called him a modest man, who had much to be modest about, and on another occasion, “a sheep in sheep’s clothing”.  We tend to think that the rough and tumble of parliamentary discourse has today become devoid of kindliness, and much coarser.  Yet it was ever thus.  Lloyd George said of Churchill that he would make a drum out of his mother’s skin, in order to sound his own praises.  Cabinets chaired by Churchill were said to be great historic occasions, but Cabinets chaired by Attlee got so much more done.  He just got on with it.  He ended his career as a Companion of Honour, with an Order of Merit.  You may say he got his own back on his critics, when he composed a limerick:

There were few who thought him a starter,

Many who thought themselves smarter.

But he ended PM,

CH and OM,

An Earl and a Knight of the Garter.      

Churchill himself of course dominates the whole realm of political memoir, and remains the subject of a seemingly inexhaustible supply of fresh biographies.   There seems no end to the fascination he exerts.  I’m currently reading Robert Schmul’s Mr Churchill in the White House, the untold story of a prime minister and two presidents (Liveright Publishing Corporation, 2024).  Earlier, a remarkable insight came from his doctor, in Churchill, the Struggle for Survival, 1940/65 by Lord Moran (Constable London 1966).  Many doubted whether, as Churchill’s personal physician, Sir Charles Wilson, Lord Moran, ought to have published these extracts from his diaries until perhaps 50 or 100 years had passed.  But Lord Moran’s excuse was that Churchill was such a monumental figure, that the observations at first hand of somebody as close as an attending doctor must be invaluable.  Perhaps.   

More recently, I read Tony Blair’s A Journey, which seemed by and large to be a prolonged apologia for the Iraq War.  I dodged Boris Unleashed.  A step too far. 

But Jacinda Ardern’s memoir is something totally different.  What can I say?  It describes a culture, a background, and a way of life that is recognisable, and recognisably “normal”.  It is intensely familiar to me because I lived in New Zealand for thirteen years, in the North Island, and Dame Jacinda’s upbringing was in central North Island, in places such as Murupara, Te Aroha (Mount Te Aroha is the Mountain of Love, short for Te Muri-aroha-o-Kuhu, te aroha-tai, te aroha-uta), Morrinsville, Rotorua; and her subsequent political career predominantly unfolded between Wellington, and Auckland.  So I can visualise her account, with sharp clarity.  Her background is humble.  Her father was a policeman, as was mine.  And even although she attained the highest office in the land, at a very young age, she never lost her straightforwardness.  She carried on shopping in Kmart.  She once sent out to a local pizza place for a takeaway, to be delivered to Jacinda Ardern, Government House.  She had to phone back when it wasn’t delivered.  They thought it was a hoax.  Her premiership happened to begin during early pregnancy, and her main preoccupation during the inauguration ceremony was not to throw up.

In New Zealand, the gap between the rich and poor, and between the powerful and the weak, is much less than it is here.  The powerful are much more accessible.  I knew a Minister of Internal Affairs, the NZ Home Secretary if you will, and I met Dame Jacinda’s predecessor, Bill English.  I once pushed, apologetically, the hospital trolley of a very distinguished finance minister out into the corridor of our Emergency Department, because we had run out of room.  He wasn’t in the least fazed. 

Politicians in the UK are almost unanimously enthusiastic about the concept of “social mobility”.  It is a manifestation of the idea that people deserve a chance to fulfil their potential no matter how humble their origin.  The trouble with social mobility is that you offer people a chance to “move up”, or to move out, without questioning the whole structure of social class.  But is it really better to be a hedge fund manager than a home help?  I have a notion that Dame Jacinda would not think so.  You can sum up the entire ethos of her book in one word: kindliness.

Not that she lacks an inner core of strength.  But she learned how to channel her own perception of her weaknesses – impostor syndrome, anxiety, sensitivity, to turn them into strengths, and hence, a different kind of power.  She needed that, to face the challenges of “events”, be they the Christchurch shooting, the White Island volcanic eruption, or Covid.

From the perspective of the Northern Hemisphere, kindliness is surely what contemporary political life lacks. The world remains in a terrible state, does it not.  Ukraine, Gaza, the West Bank, Sudan, Lebanon, and now, Israel and Iran.  Even as I write, so many people in the world might echo the words of George Orwell at the top of this piece.  Plus ça change…

I think the leaders of the G7, currently congregated in Banff, should all read A Different Kind of Power. 

Yesterday was Whit Sunday, and it also happened to be the Day of Pentecost.  Broadcasting House (BBC Radio 4, 9 am) ended with an extract from The Whitsun Weddings, read most mellifluously by its author, Philip Larkin.  Thence, as is my wont, to Dunblane Cathedral, where the lessons offered an intriguing comparison.  Old Testament Lesson – Genesis chapter 11, verses 1 – 9.  The Tower of Babel.  In one sense it is a story offering an explanation for the phenomenon of the vast diversity, and disparity, of languages spoken across the world, just as the story of Adam and Eve offers an explanation for – well – pretty well everything. 

And the whole earth was of one language, and of one speech.   

It occurs to me that that might actually be quite accurate.  Life, human life, and with it the language enabling communication, had to start somewhere.  Then, as peoples migrated, moved about the world, their language mutated in different directions, such that people who once lived together could no longer understand one another.  A week ago I heard Michael Rosen in Word of Mouth (BBC Radio 4) talking about Proto-Indo-European, an ancient language which would develop into many languages in the world today, including English.  So it would appear that languages naturally diverge.  However the Genesis story does not depict this as a natural evolution, but rather as a divine intervention, one of retribution.  God was displeased because the people inhabiting the plain of Sinar decided to construct a Ziggurat, a skyscraper.  They wanted to do this in order to “make us a name, less we be scattered abroad upon the face of the whole earth.”   

For some reason, God took exception to this.  He did not wish that a tower reach to heaven. So he decided to frustrate the operation by rendering all the movers and shakers unintelligible to one another.  I suppose that is a version of “divide and conquer”.  Babel descended into babble.  Is it purely coincidental that Babel and babble can refer to the same thing?  We would need to ask the linguistic archaeologists who reconstruct Proto-Indo-European.  But people cannot progress, if they cannot cooperate.  As a result, the tower never got built, and the people were indeed scattered upon the face of the earth.

Then came the New Testament Lesson:  Acts 2: 1 – 21. 

And when the day of Pentecost was fully come, they were all with one accord in one place. 

Here is another story, in some ways diametrically opposed to the Babel story of the Old Testament.  Here, there is a divine intervention to allow communication among a large and disparate group of peoples visiting Jerusalem.  They seem to represent most of the known civilised world of the time: Parthians, and Medes, and Elamites, and the dwellers in Mesopotamia, and in Judaea, and Cappadocia, in Pontus, and Asia.  Phrygia, and Pamphylia, in Egypt, and in the parts of Libya about Cyrene, and strangers of Rome, Jews and proselytes.  Cretes and Arabians…

I take my hat off to ministers of the church who dare to interpret such extraordinary tales.  On this occasion the minister characterised the builders of the ziggurat as a totalitarian state which demanded of its people uniformity, and feared diversity.  But the apostles – “the eleven” – were empowered by divine grace to move among strangers, to listen, to communicate, to understand, and be understood. 

But sometimes I think such tales, much like the parables, defy interpretation.  Perhaps if I’d been there, I’d have been one of the crowd who accused the apostles of being drunk.  “What?” said Peter.  “At 9 o’clock in the morning?”

Communication can be deeply deceptive.  ScotRail are minded to replace the voice of their announcer with Artificial Intelligence (AI).  That reassuring Scottish accent will have been adopted by a robot, one “Iona”.  Last Tuesday, one of the journalists in the Herald took exception to this; and by coincidence, in the same issue there was a contribution from an external source, championing the use of AI in small to medium business enterprises in Scotland.  The contrast provided a Babel – Pentecostal moment for me.  I could understand the language of the AI critic, but not the AI champion.  I wrote to the Herald, who kindly published me on Thursday:          

Dear Sir,

There is a stark contrast between two articles in today’s Herald discussing Artificial Intelligence.  On page 15, there is Neil Mackay’s “When AI kills off the ScotRail lady, you know we’re all in trouble… is this what we want?”  And on page 17, there is the Agenda article, “How to make AI work for SMEs in Scotland” (Herald, June 3).  Neil Mackay’s piece is concrete rather than abstract; it lays out an argument that is coherent, intelligible, and intelligent.  The meaning is clear; the language is of the real world, humane, and passionate.

By contrast, the Agenda article, as a piece of prose, is almost entirely devoid of meaning.  It could well have been written by a robot.  Every sentence exhibits abstraction, and lack of precision.  An example: “The application layer is not a black box, it’s an enabler, a multiplier of human potential.”  I’ve read the piece several times, and still have no idea what the application in question is supposed to do.

George Orwell saw it all coming, this eradication of meaning in abstraction.  In “Politics and the English Language” (1946), he translated a verse from Ecclesiastes into modern prose:

”I returned, and saw under the sun, that the race is not to the swift, nor the battle to the strong, neither yet bread to the wise, nor yet riches to men of understanding, nor yet favour to men of skill; but time and chance happeneth to them all.”

Here is Orwell’s version in modern English:

“Objective consideration of contemporary phenomena compels the conclusion that success or failure in competitive activities exhibits no tendency to be commensurate with innate capacity, but that a considerable element of the unpredictable must invariably be taken into account.”

Well done to Neil Mackay for dumping AI from his phone.   

Yours sincerely… 

And on Saturday, the RSNO closed the season with an all Shostakovich programme: the Festive Overture, the Second Cello Concerto with soloist Daniel Müller-Schott, and the 11^th Symphony – The Year 1905.  I suppose Dmitri Shostakovich found himself trapped in the Babel of a totalitarian state.  He had to lead a double life, simultaneously critical of the Soviet authorities, while being their darling.  No wonder he kept a packed suitcase just inside the door to his flat, forever expecting the fateful nocturnal knock on the door.  So his music, often sardonic and sarcastic, is babble to some ears, and deeply significant to others.  And brutal.  The RSNO is currently on top form.  The culmination of the hour long symphony, with the sonorous ringing of the Muscovite bells, and the abrupt cessation of an enormous, tutti fortissimo, to leave the toll of a single bell, was absolutely shattering.

Maestro Sondergard thanked a full house for attending, and invited us all to reconvene on October 7^th.  He also invited us all to dump our devices.  He said, “They are making us ill.”

I applauded.               

Yesterday I failed to win the Sunday Times crossword clue competition, from a couple of weeks ago.  The light was ACETYLENE.  C2H2.  While sipping my coffee in NEXT I idly mulled it over, but I misremembered the chemical formula as C2O2, which was remarkably dumb of me as the gas is a hydrocarbon, not an oxide.  COCO, I thought.  So I came up with:

It’s Coco Chanel, yet ’e drops H for Barney Rubble (9) 

When I subsequently remembered it wasn’t COCO, but rather H – C = C – H (that should be a triple bond between the carbons, beyond the scope of my QWERTY keyboard) and that I was wasting my time in pursuit of a mirage, I tried again:

Bonding between the goal posts, couple of Charlies gas (9)  

Didn’t win.

If J. Alfred Prufrock measured out his life in coffee spoons, I’m in danger of frittering mine away doing crosswords.  I suppose it is one way of diverting one’s mind from the appalling international situation.  The defence spending review is due out today, and we are to be gloomed up for the prospect of war.  Not only must we pour money into munitions, we must all develop a warlike attitude.  Mr Healey will sound like Henry V on the eve of Agincourt.

In peace there’s nothing so becomes a man

As modest stillness and humility,

But when the blast of war blows in our ears,

Then imitate the action of the tiger.

Stiffen the sinews, conjure up the blood,

Disguise fair nature with hard-favoured rage.

Then lend the eye a terrible aspect…

Presumably the gentler sex must emulate Lady Macbeth.

Come, you spirits,

That tend on mortal thoughts, unsex me here,

And fill me from the crown to the toe top-full

Of direst cruelty. 

Meanwhile I am like M. Manette, Lucy’s father, in A Tale of Two Cities, driven by the revolution, and PTSD, back to his cobbler’s last.  And continuing on the anodyne theme of preoccupation with trivia, I burst in on a conversation this morning as I popped into the village store for my morning paper. 

“What’s the point in tipping for a buffet?”  My opinion was sought.  “Would you give a tip at a buffet?”

I shrugged.  “I suppose if the food was good.”

“Yes but you’re serving yourself!”  Then my local shopkeeper had a recollection.  “You’re at a function attended my 100 people.  50% of the adults eat 3 sausage rolls each, 75% of the children eat 2 sausage tolls each.  How many sausage rolls are eaten?”

“Sounds like a non sequitur.  A bit like Question 7.”

“Question 7?”

“A memoir by Richard Flanagan.  Chatto and Windus 2024.  Won the Baillie Gifford Prize for non-fiction.”

“What’s the question?”

“Posed by Anton Chekhov.  I paraphrase.  Or rather, embellish.  A train leaves Aberdeen at 3 a.m. in order to reach Penzance at 11 p.m.  As the train is about to depart Aberdeen, an order comes through that the train has to reach Penzance by 7 p.m.  Who loves longer, a man or a woman?”

“That’s absurd.”

“Precisely.  Back to the sausage rolls.  I suppose it’s a piece of algebra.  Leave it with me.”

“No.  You’re on a game show.  You’ve only got 30 seconds.”

“Give in.”

“150.”

“Pourquoi?”

“Suppose the hundred guests are all adult.  50 of them eat 3 sausage rolls, ergo, 150.  Suppose they are all children.  75 of them eat 2 sausage rolls, ergo, 150.  Say there are 60 adults and 40 children.  That’s (30 x 3) + (30 x 2) = 150.  See?  It always works.”

“I’m not convinced.  Suppose there are 90 adults and 10 children.”

“Well, that’s 135 + 15.”

“No, no.  That means seven and a half children eat 2 sausage rolls each, which really is absurd.  A half child isn’t capable of eating anything.”   

“I think you’re taking the scenario too literally.”

And I was reminded of the arithmetical problems we were posed in primary school, when we were introduced to algebra by stealth.  I suppose Chekhov’s Question 7 was a spoof, much like a subsequent piece by the Canadian humourist Stephen Leacock.   You know the sort of thing.  If it takes 3 men 4 days to dig a hole 20 feet deep, how long would it take 2 men to dig a hole 10 feet deep?  The trick was to realise that you were merely manipulating numbers.  It had nothing to do with men, or holes.  If you started thinking about men and holes, you realised that the problem was much more complicated than it appeared.  The third man, who has been made redundant; was he a toiler or a slacker?  Are the soil substrata of the holes the same?  Do the men take tea breaks?  Have they organised?  What does the union think?  It was always assumed that the people adept at solving these problems were cleverer than those who sweated endlessly over them.  But I don’t know.  Weren’t the people who appreciated all the potential complications actually more insightful?  And the people with the facility for simplicity were, in reality, simpletons. 

The sausage rolls reminded me of Gauss, the mathematical prodigy.  At school, his class was asked to sum all the integers between 1 and 100.  Perhaps the teacher wanted a break, to read the newspaper.  The class settled down to the laborious task.  But, so the story goes, Gauss realised instantly that 1 + 100 = 101, 2 + 99 = 101, 3 + 98 = 101… 50 pairs = 50 x 101 = 5050.  Just like that.  I wonder if the teacher gave him a pat on the back, or two swipes of the Lochgelly, or its Teutonic equivalent, for the unpardonable breach of discipline that is precocity.  It was such a minefield, education.  Sometimes I would deliberately aim for mediocrity, just to keep my head under the parapet.  I once wrote an essay on Keats’ Ode to a Nightingale which I think – I still have the C2 ink exercise jotter – was quite good.  Mr George handed it back to me with a cool demeanour and dubious, pursed lips.  “It’s very good, Campbell.  Where did you get it?”

“I made it up, sir.”

“Hmm.”                  

The Tony Blair Institute has developed a New Grand Enthusiasm.  Last month’s Enthusiasm was for Artificial Intelligence (AI) in the NHS.  This month’s Enthusiasm is for the population-wide general roll-out of Anti-Obesity Medication.  The argument seems to be based on economics rather than pathophysiology.  Because obesity is linked to so many pathological conditions – cancer, ischaemic heart disease, cerebrovascular disease, diabetes etc. – the removal of one major risk factor will help sustain a healthy population and workforce, and hence, the prosperity of the country. 

Other Enthusiasms have come to light his past week.  There is an Enthusiasm for chemically castrating sex offenders.  First it would be voluntary, but its champions are not ruling out making it compulsory.  Nothing is off the table.  When politicians are “minded” to go one step further like this, it usually means they are flying a kite; or sticking a wet finger in the air to see which way the wind of public opinion is blowing.  I seem to recall that Alan Turing, now a great hero of the proponents of AI, once himself deemed to be a sex offender, was chemically castrated.  Was it voluntary or compulsory?  Or was it offered as an alternative to imprisonment?  In other words, was he coerced?  He took his own life. 

Another Enthusiasm is to create separate acute assessment units for patients with issues of mental health.  The “chaos” of “A & E” is not helpful to them. 

These, and other similar initiatives share two common features.  First, they are public health initiatives, based on perceived crises, pandemics of morbid obesity, sexual abuse, and poor mental health.  Public health initiatives are usually preventative measures, designed to protect whole populations by lowering a relative risk.  They are not, by and large, “patient focused”.  Secondly, they tend not to be initiated by health care professionals, but rather by groups, factions, and vested interests which seek to organise and shape the societal Gestalt, politicians, Think Tanks, QANGOS, and various allied “Medinfluencers”.  Doctors and nurses are often the last to know what the latest societal manipulation is going to be, because they are too busy seeing patients.  Patients consult them; but the medinfluencers don’t.

I certainly don’t mean to knock public health initiatives across the board.  Vaccination, after all, has been the most successful public health initiative of all.  We have known of its overriding beneficence for hundreds of years, ever since medieval villagers got their children to climb into bed with a child who had cowpox, because it protected them – nobody knew why – against smallpox. 

But it seems to me that, over the course of the new millennium, the focus in health is shifting from the individual, to the populace at large.  Everybody is at risk of something; everybody is on a spectrum of disease.  I first started noticing this when patients were referred to hospital, either acutely or via outpatients, with symptoms suggestive of cardiovascular disease – chest pain, shortness of breath, exercise intolerance.  The tests – CXR, ECG, treadmill test, echo, bloods – would all be normal.  But the patient would still come home on a swag of preventative medication – statins, antihypertensives, aspirin…  The next development was the polypill.  Just put everybody on that swag of preventative medication even if they are entirely well.  Why not?  These drugs are well tolerated (mostly; so, for that matter, are anti-obesity drugs, apparently).  The notion of normality, of “normal values”, became eroded.  Traditionally, a blood pressure of 140/90 was regarded as “the upper limit of normal”.  No longer.  130/80?  Too high.  Drive it down as low as you can (without keeling over).  Same with cholesterol.  Don’t even bother measuring it.  Just take the statin.  “Fire and forget.”  New diagnoses crept into the medical lexicon – “pre-hypertension”, “pre-diabetes”.  Something similar has happened in mental health.  Everybody is on the spectrum of something

It’s hard to overestimate the extent to which this prevailing trend is completely alien to the way I was taught as a medical student in the 1970s.  Then, the whole structure of medical practice was based on the concept of diagnosis.  The medical consultation was designed, and systematically conducted, in order to reach a clear, and accurate, diagnosis.  It was based fundamentally on the elucidation of a very careful history, taken from the patient.  That was paramount.  The patient was not thought of as a cog in a huge, national industrial wheel, that had to be kept turning, but rather as a unique individual. 

The history was followed by the physical examination.  We were taught to elicit physical “signs”, evidence of pathological processes.  We were encouraged to be decisive about the presence, or absence, of signs.  A cardiac murmur, a palpable abdominal mass, a neurological deficit – either it was present, or it was absent. 

The history and the examination predicated, perhaps, some highly specific and targeted radiological and laboratory investigations, designed to confirm, or repudiate, the formulation of a pathophysiological process.  The confirmation of a diagnosis was the solid bedrock of therapeutics: treatment, and patient management. 

All this has been eroded.  Why bother talking to the patient when you can simply run them through an algorithm?  Why bother examining them, when you can order up a swag of tests?  (I remember hearing a GP give a presentation in which he said, somewhat boastfully and without a trace of irony, that he didn’t own a stethoscope.  It was the worst medical talk I ever heard in my life.) But the trouble with practising Blunderbuss Medicine is that soon you are inundated with an entire population which has been persuaded that it is unwell.  No wonder “A & E” is described as “chaotic”.  We need to ask ourselves: why are so many people overweight?  Why are so many people miserable?  My theory, on both counts, is that it is because they have been encouraged by the masters of the universe to spend their entire lives, both professionally and at leisure, in front of computer screens.  I have no doubt that for some patients, some weight reduction drugs have a place.  But for the most part, and for most of us, millions of people in the population, we don’t need them.  So Log off, and go and climb a hill.  It’s cheaper, healthier, and much better fun.         

Meandering round the Milngavie Reservoir the other day I beheld the awesome sight of an Emirates Airbus A380, newly airborne out of Glasgow, and passing overhead at about 3,000 feet.  The enormous airframe seemed almost stationary in the cloudless sky, defying the laws of physics, the engine note remarkably quiet.  In a few moments it had disappeared into the deep blue.  I think on the same day news had come out that Qatar was to gift President Trump a brand new, extremely luxurious, and extremely expensive Airforce One.  It’s not really for me, said the President, but for America.  Timeo Danaos, et dona ferentes.  (As a child studying my Virgil I used to think of Donna Ferentes as a Latin American pop star.  The name has a certain euphony; all Latin verse lines end in the same rhythm: strawberry jam-pots.) 

Political leaders have been in receipt of gifts since time immemorial.  Think of Lloyd George and cash for honours.  More recently, Tony Blair’s New Labour were in receipt of £1,000,000 from Bernie Ecclestone, and, by a curious coincidence, the ban on cigarette advertising in sport was found not to extend to Formula 1.  Sir Tony had a kind of Teflon defence – it was perhaps its first manifestation – that clearly everything had been done in good faith because, “Most people know I’m a pretty straight sort of guy.”  When more recently I heard of the Prime Minister et ux receiving gifts of fine apparel and free tickets to Taylor Swift’s Eras tour, I remember I shook my head and muttered, “Don’t they know there is no such thing as a free lunch?”  These transactions carry with them a vaguely noxious subliminal aroma.  People who donate are not merely philanthropic; they expect something in return.  A friend of mine once attempted to shout another friend a coffee in a place in Sicily.  The barista shook his head and said, “Everybody pays for himself here.”  That was how the Mafia got you, with a gift.  Once you take the gift, they own you.  You may not think they own you, but your opinion no longer matters.  They’ve got you.  A big guy with a quiet hoarse voice, his gums stuffed with cotton wool says, “That’s a lovely wife and family you have.  It would be a pity if something unfortunate were to happen to them.” 

I found myself smugly reflecting that I would never succumb to a bribe.  After all, I’ve never even received a professional bonus (apart from when as a boy I delivered newspapers for £1.00 a week.  I got £2.00 at Christmas).  But then I remembered. 

When I was in medical practice I would see representatives of pharmaceutical companies – drug reps.  Not all my colleagues did.  They refused to be influenced to prescribe one drug over another, other than on the basis of evidence-based medicine.  Many of them prescribed generically, without recourse to brand names.  I saw reps largely as a courtesy.  If they had the patience to sit in the waiting room until I had finished consulting, it was only polite to give them five minutes of my time.  I had a running joke with the practice receptionists – politically utterly incorrect – that I would see them if they were attractive enough. The receptionist would pass me the rep’s business card and say, “You’ll definitely want to see her!”  I told myself that whatever the rep’s pitch, I would not be influenced; water off a duck’s back.

Twenty odd years ago I had a fling with a rep, and when she eventually dumped me I buried my sorrows my going on a spree of posh pharmaceutical meetings.  Perhaps I wanted to wreak some generic revenge upon the industry – who knows?  This was at a time when going on such junkets was deemed perfectly acceptable.  Indeed they were almost a requirement of continuing medical education, the need to demonstrate that you had attended so many hours of lectures, seminars, etc.  I went for the top end, and I remember in particular three weekends at five star hotels, first at Gleneagles, where I occupied a suite, with exquisite underfloor heating, the size of a badminton court; then a golf hotel in St Andrews round the corner from the Old Course; and finally, of all places, Trump Turnberry, though the President-to-be had yet to acquire it.  I remember little of the academic content of these meetings.  I do remember at Turnberry a lawyer giving a talk on medical misadventure, litigation, and the perils of going to law.  “Remember,” he said, “When you go to law, you may think you are inviting us to enter your world.  But we are not entering your world; you are entering ours.”  That is remarkably similar to what the barista told my friend in Sicily.

Of course, I ended up prescribing the drugs of the pharmaceutical companies hosting the events.  They didn’t even have to advertise them, plug them, push them, or give me a scintilla of evidence that they were more potent, or efficacious, than those of their competitors.  The names, the branding, the ambience; these were enough.   

Shortly afterwards, meetings of this kind came to an abrupt end, when, as I recall, a pharmaceutical company hosted a group of GPs to a dinner of spectacularly conspicuous consumption.  A dozen people in a restaurant racked up a bill of about £50,000.  Scandalous.  This happened around the time of Shipman, and the whole creaking edifice of drug-sponsored continuing medical education was replaced by “Appraisal”, a system by which every GP would be assessed annually by an appraiser, ostensibly to ensure they were keeping abreast of the contemporary customs and mores of practice.  I actually trained as an appraiser, and appraised 25 of my colleagues over the course of a year, before packing it in.  I never believed in the efficacy of appraisal.  It was just another hurdle to be negotiated.  I colluded with my appraisees: this is the easiest way to tick this particular box.    

GPs generally adopted an attitude of resigned cynicism towards appraisal.  “Shipman would have been an exemplary appraisee!”  It was said that he was rather a good GP, and a popular one. There was indeed something vastly incongruent about appraisal as a logical response to Shipman.  Shipman after all was a serial killer.  It was as if an airline pilot had been discovered to be poisoning his passengers when they visited the loo.  In order to ensure this would never happen again, the pilots’ ability to fly the aircraft would be more rigorously assessed.  It was as if General Practice as a whole was being collectively punished because the most prolific serial killer in the history of the UK happened to have been a GP.  When Shipman committed suicide in jail, I happened to be at another medical meeting, in London, not sponsored by Big Pharma, but by the British Medical Association.  On news of Shipman’s death, David Blunkett, Home Secretary at the time said, “De-cork the champagne bottles!”  Or words to that effect.  I voiced disapproval.  The Home Secretary should not rejoice over the death of a prison in-mate, no matter how heinous his crimes.  My observation did not go down well.   

Now that I’ve hung up the stethoscope, I’m not aware that I am the recipient of any bribes, bungs, or sweeteners.  But you never know.  That is the subtlety of a bung; it is invisible.  One of the delights of retirement is that you can shout your friends a meal without any expectation of reciprocation.  When they demur, I say, “Give me this small pleasure!”  It’s as if I want to demonstrate that there is, after all, such a thing as a free lunch.          

The other day I plugged my all electric Skoda Enyaq into a local charge point, and I got an “Access denied” message.  So I phoned the provider.

“Hoy o thru Adammyatakyrnemandpozzquot?”

“Sorry?”

“Yanampozzkyott.”

“I don’t understand you.  Could you possibly speak a little more slowly?”

“Hello, you are through to Adam, may I take your name and postcode?”

He had a Scottish accent.  It wasn’t as if he was at a remote overseas location.  He explained that access was denied me because I hadn’t paid for half a dozen charges over the previous three months.

“But how can that be when you automatically charge my credit card, and I have settled my latest account?”

Pause.

“We’ve been having software glitches.”

Ah.  But billing apart, as it turned out, the charge point was kaputt. 

I suppose I was a bit tetchy.  It has been a difficult week for me, as the orchestra rehearsed, and performed, Mozart, Grieg, and Brahms.  Maestro iterated, and reiterated the mantra, “Play nearer the bridge, James!”  But I’m not sure I want to.  It sounds so strident.  I said to him, “Old dog, new tricks.”  He wants us all to download an app on to our smart phones, and tune to A441.  Why bother listening to the oboe when hi tech can do it for you?

Talking of tech, the schools in Edinburgh have been hacked and everybody’s data compromised.  The pupils had to go to school on Saturday and be issued new passwords, in order to continue receiving teaching materials on line.  There is a move afoot across various countries in the world to ban pupils from bringing their smart phones to school.  I think this should certainly be extended to the teachers, who should be banned from using IT as an educational modality, unless they are teaching computing science.  For the most part, all you need is a room, quietude, a blackboard or a whiteboard, books, and a meeting of minds.

Then the supermarkets got hacked and the shelves emptied with extraordinary rapidity.  The hackers’ motive appears to be purely venal and rapacious; they want to hold the supermarkets to ransom.  All viruses will be expunged, for a fee.  And why not?  Isn’t it just another form of trade?  Business is business.  Everything has become so transactional.

Tech malfunctions also seem to have disrupted business at Stansted, and at Newark.  And, in respect of electricidade, there was a huge outage in Iberia.  People got stuck in lifts.  And nothing worked.  It just shows you.  When things fall apart, you must have the facility to move back, with ease, and rapidity, to the analogue world.  When the computers crash in the GP surgery, doctors must remember how to keep a record using pen and ink.  Aviators know this.  When the instrument panel goes blank, they must reaccess and summon the ancient navigational skills of mental dead reckoning, and compass turns. 

I bet the cardinals didn’t use electronic voting last week in the Sistine Chapel.  Some very rare ballot papers have been unearthed in the National Library of Scotland, from the conclave of 1655, which apparently turned down the favourite Giulio Cesare Sacchetti, in favour of the compromise candidate Fabio Chigi, Pope Alexander VII.  Of course used ballot papers are burnt, so these rare documents are thought to be spares, including ballot sheets and a list of cardinals eligible to vote.                       

They say that it’s an ill wind that blows nobody any good.  When Pope Francis passed away on Easter Monday, I wouldn’t have said for a moment that Robert Harris, the author of Conclave, would have rubbed his hands with glee.  But he must have recognised that the reality of a forthcoming conclave would by no means harm the sales of his book, already boosted by its reincarnation as a successful film.  I remember that I started reading Conclave with no high hopes; how could you possibly turn a prolonged committee meeting into a thriller?  But having read many of Robert Harris’ oeuvres, I should have known better.  It was a page turner, full of twists and turns, not least the final twist at the end.

The process of a conclave is shrouded in secrecy.  We know that the Pope-elect requires two thirds of the cardinals’ votes.  But what voting system is deployed?  STV?  Some sort of modified D’Hondt?  Or is it simply a looser process of horse trading and argy-bargy?  Whatever it is, it seems to work.  White smoke has appeared above the Sistine Chapel.  Habemus Papam. 

Pope Leo XIV seems to be going down well with the people congregated on St Peter’s Square.  A prerequisite of the papal role seems to be that the incumbent must be a polyglot.  I believe Leo’s first address as Pope was delivered in Spanish, and he has subsequently spoken, and indeed sung, in Italian, Latin, and of course English.  It would seem that he was chosen as the continuity candidate in the footsteps of Francis.  He undertook a great part of his priestly career in Peru, ministering to the poor.  In terms of his world view, he has called for peace; peace in Ukraine, in Gaza. 

Does a papal call for peace exercise any influence on the world stage?  Remember a notorious remark of Stalin in response to a previous call for peace from the Vatican.  “How many divisions does the pope have?”  In other words, might is right. 

The notion of might being right, after 80 years of relative peace in Europe, by no means unbroken – remember Yugoslavia – has come once more to the fore.  That loathsome harangue of President Zelenskyy in the Oval Office, from Trump and Vance, brought it all back.  “You don’t have the cards!” said Trump.  Nothing about an illegal invasion of sovereign territory.  Quite the contrary.  Zelenskyy started it!  That’s another old trope that has returned.  The Big Lie.  The first casualty in war is the truth.  If you tell a lie often enough, people begin to believe it.  Dr Goebbels understood that.  And America, said Trump, has given away $350,000,000,000 of aid to Ukraine, much more than Europe.  Actually the US has given about $120,000,000,000, somewhat less than Europe.  But why let facts get in the way of a good story?  In the light of all that, it is not merely tasteless that Trump should allegedly retweet (or rather re-X, or rather re-truth social) – he denies it – a mock-up of himself in papal vestments, it is actually rather sinister.  A proponent of might dressed as the champion of the meek.  A wolf in sheep’s clothing. 

We live in a secular world, and you might suppose that people who regard the religious life as being merely superstitious would have a refined sense of the difference between truth and falsehood.  I think it was G. K. Chesterton, a distinguished Catholic, who said that the trouble with ditching a religious belief is not that you end up believing in nothing, but rather you end up believing in everything.  People believe, for example, that the ills of the world can be surmounted through technology.  Artificial Intelligence, says Sir Tony Blair (another prominent Catholic), is the Next Big Thing.  I’m sceptical.  Technology has a place, many places, but the woes of the world are at heart humanitarian.  Leo’s reiterated message of faith, hope and love, lies at the heart of Christianity.  Light is stronger than dark, good is stronger than evil, love is stronger than hate.  These notions are right now under attack, just as democracy is under attack.  Things fall apart, as once more, the strong men “slouch towards Bethlehem”.  The last time Europe was taken over by a dictator, it was not the white smoke above the Sistine Chapel we saw; rather the acrid black smoke issuing from the chimneys of Auschwitz-Birkenau.    

But as the difficulties of the world expand, coalesce and magnify, our politicians continue to trumpet high tech as a kind of deus ex machina that will solve all our difficulties, local and international.  But remember what the Dean of Coventry said in 1940, amid the blitzed ruins of the cathedral.  We shouldn’t seek vengeance, but rather, a kinder, simpler world.

So I continue to tune my viola to the oboe.  I’m not downloading the app.  A plague on your app.      

As the 80^th anniversary of VE day looms this coming Thursday, I cannot help but reflect on my father’s experience of the occasion. He was a pilot in Coastal Command, stationed at the time in Accra in West Africa.  He told me of a general sense of euphoria on the RAF station when the news of the surrender of Nazi Germany came through.  People at the airfield said, “Give us a show, James!”  Whether or not he performed a few victory loops I don’t know.  He fully expected to be posted somewhere in the Far East to continue the war with Japan.  But in due course, the atomic bombs were “cast” – Churchill’s word – and the Second World War came to an abrupt end.  

Sometimes I look over his RAF log books, which I cherish.  They cover the period from 1941 to 1945.  In 1939 he was a constable in the City of Glasgow Police, aged 21.  When the war broke out, two of his brothers, my uncles, were enlisted in the army and navy respectively.  I suppose he might have stayed on in the police, a reserved occupation, but I think he sensed a duty to follow in the footsteps of his brothers.  Then in 1941 the Germans bombed Clydebank.  I think – well, I know – the scale of the destruction had a profound effect on him, and he volunteered for the RAF.

There followed a rapid induction in London, a treacherous voyage across the Atlantic (on deck on Sunday morning service the troops sang “For those in peril on the seas” with great fervour), and a train across Canada to Saskatchewan, there to be trained as a pilot. 

Initially it didn’t go well.  I think his flying instructor was a bully.  Now I know a little about this because, 30 years later, I was a cadet pilot in the University of Glasgow and Strathclyde Air Squadron (UGSAS).  So I know a little about the traditional teaching methods of the RAF which were, basically, that if you fouled up, you received a “bollocking”.  Ab initio, my father received a lot of “bollocking” until he said to his instructor – and I give him great credit for this, I honour him for this – “If you continue to berate me like this, you will not get the best out of me.”  I think the instructor cut him some slack, and my father won his wings.

The ethos of the RAF of that time is well captured in the 1969 film The Battle of Britain.  I was in UGSAS, and the RAF Volunteer Reserve, between 1970 – 72.  One of our instructors in Glasgow flew Spitfires for that film.  Whenever I see the film, I instantly recognise the then RAF’s “sink or swim” attitude.  That poor guy who forgot to drop his undercart when landing, who is given a devastating flying lesson by Robert Shaw, on how to survive a dog-fight, and who eventually is gone for a burton… well, couldn’t they have done better by him? 

The most intriguing part of my father’s RAF log books is the record of his trip back to Europe from Canada, where he had been engaged monitoring submarine manoeuvres in the north Atlantic.  He flew from Montreal to Bluie West One, in Greenland, thence to Keflavik, in Iceland, thence to Prestwick, in Scotland.  He was now ten miles from his family home.  He requested permission to visit my grandmother. This was denied.  But he went anyway, so I suppose in a technical sense he was a deserter.  But he never got into trouble.  From Prestwick, he was posted to England for a time, thence to Africa, where his war eventually ended.   

As a youngster I knew that sooner or later I would learn to fly.  Of course I was intrigued by my father’s wartime activities.  He had a great pal who had been a POW in Stalag Luft III, and having seen the 1963 film The Great Escape, I wanted to ask him all about people like Bushell, Bader, Tuck and so on.  His only comment was, “Frightful fellows.”  My father took me aside and gently suggested I not enquire further.  Some people didn’t like to talk about the war.

When I went to New Zealand in the 1980s I resumed my flying activities and was amazed at the easy-going attitude of my Kiwi instructors.  No more bollocking.  I flew hundreds of hours, the length and breadth of the country, in many aircraft types.  Around 1992 I did a twin engine rating in a Beechcraft Duchess.  Most of the training involves coping with a single engine failure after take-off.  You lose power and directional control, and in the heat of the moment it can be difficult to figure out what is actually happening.  Experienced pilots have shut down the wrong engine in error.  So you train to get the appropriate response into the muscle memory.  I was on the phone one night to my father in Scotland and I told him I was finding it difficult.  Without any hesitation he intoned the pilot’s mantra, “Dead leg – dead engine – identify – verify – feather.”  He hadn’t flown an aircraft since 1945.

On their next visit to NZ, I took my parents flying.  We flew from Auckland down to Tauranga in the Bay of Plenty to visit friends of mine who ran a Kiwi fruit orchard in Omokoroa.  I remember after take-off I handed control over to my father.  I think I may have used the North American expression, “Your aeroplane”.  For me it was a very moving experience.  And I thought, “Gosh!  You can fly!”

To the Glasgow Royal Concert Hall on Saturday, to listen to Mozart’s Requiem, serendipitously, on the day of Pope Francis’ funeral.  Maybe that coincidence added a further layer of solemnity to the occasion, as well as suggesting a possible reason as to why the auditorium was filled virtually to capacity.  The programme, overall, had a funereal theme.  We began with Beethoven’s rarely heard Op 118, Elegischer Gesang, Elegiac Song, composed in 1814 for string quartet and a small group of voices.  We heard a scaled-up version performed by the strings of the Royal Scottish National Orchestra, and the RSNO Chorus.  The piece was composed in memory of one Eleanor, the wife of Beethoven’s friend and benefactor Baron Johann Baptiste Pasqualati.  Eleanor had died in childbirth, in 1811, aged 24.    

Sanft, wie du lebtest,

hast du vollendet,

zu helig für den Schmerz! 

Gently as you lived

Have you ended,

More holy for the pain!      

Extraordinary to hear some undiscovered Beethoven.  With its hushed opening, we immediately entered Beethoven’s world.  It was as if the great man himself were present in the room.

Conductor Patrick Hahn then directed Alban Berg’s Violin Concerto, with soloist Carolin Widmann.  The ensemble had recorded the Berg, along with Benjamin Britten’s Violin Concerto, earlier in the week, and they were now going to make a live recording, presumably for the RSNO archive, so Maestro Hahn politely asked us to unwrap our cough sweets now.  The audience was very attentive, so no retakes were required. 

The Berg is a serial piece, based on a 12-note tone row and heavily influenced of course by Schoenberg.  But I think of it rather as late romantic, and very lyrical.  I don’t think, on the occasion, that this performance entirely came off.  The soloist made a beautiful but not a big sound, which was occasionally drowned out by the orchestral forces, and similar imbalances within the orchestral tutti concealed the melodic line. 

Ha!  Everyone’s a critic.

But Mozart’s Requiem was wonderful.  Some of the music is severe, and austere.  The clarinets and bassoons which introduce the Requiem aeternam are so doleful.  The use of trombones renders an added solemnity, in the Tuba mirum, and in subsequently reiterated and rapidly moving passages for trombone trio, brilliantly played.  It is a well-loved piece, no doubt made famous by the film Amadeus.  It comes with its mythology – the mysterious commission, conveyed by a masked stranger; an ailing Mozart dictating passages of music on his death bed; the contribution of the amanuensis Süssmayr.  Wonderful music, wonderfully performed.

It just shows you; if you put on beautiful music, you can fill the hall.  Of course filling the hall, bums on seats, is a serious preoccupation for impresarios.  It always has been.  Looking at the prospectus for the 2025-26 season, you can tell that the RSNO are trying to reach out to a wider audience.  RSNO at the movies – Star Wars, Ghostbusters, Gladiator etc.  And in the recently published brochure for the forthcoming BBC London Proms, there’s something about The Traitors, and Claudia Winkleman.  I have no idea what that’s about.  But then I haven’t turned my telly on for about six weeks. 

The debate about “standards” in music has been going for a long time.  The classical repertoire versus “dumbing down”.  Even in Mozart’s time, some people thought The Magic Flute was a pot-boiler, and a bit naff.  Of a lovely spring afternoon on Thursday I sat with some friends in a very beautiful garden under the flightpath out of Glasgow airport, and we discussed whether it is better to keep classical music classical, or to try to attract a wider, and possibly younger, audience, with “gaming” music and so on.  Predictably, I inclined to the purists’ camp.  When I first saw the BBC Proms brochure I felt a bit impatient with it, though with the serenity of retrospection I can see some wonderful music is in there.  Similarly, the RSNO prospectus is very clever – a combination of the familiar and the new. 

But in fact the problem in programme planning is not really a matter of mainstream versus dumbing down.  The problem actually resides within the purists’ camp itself.  The repertoire is in fact quite limited, limited, if you will, by flavours of the month.  Current flavours of the month across the classical world are undoubtedly Mahler, and Shostakovich.  The current RSNO season ends with an all-Shostakovich programme, and the new season opener is Mahler 7.  The Proms are doing Mahler’s 2, 3, 5, and 7, as well as Das klagende Lied, and one of the Rückert Lieder.  Shostakovich is appearing eight times throughout the season.  Now don’t get me wrong; I admire Mahler and Shostakovich; I just don’t want to hear them every day of the week.  Other composers are available.  For example Arnold Bax, a great hero of mine, does not appear at all in either brochure for the Proms or the RSNO.  There is, in fact, a huge repertoire of beautiful music out there that we never hear.    

Why not? 

Do I detect the baleful influence of managerial pseudoscience?  I have a horrible notion that programme planning may have been taken over by focus groups, strategic planners, audience researchers, and a variety of other “influencers”.  People who know what will “sell”.  Life has become so transactional. 

With respect to music on the BBC, I would suggest Auntie might take some advice from what in this context might seem an unlikely source.  Have you heard Amol Rajan’s interview with the footballer and pundit Gary Lineker?  I recommend it.  Two very smart cookies, and nobody on the back foot.  Lineker famously got suspended (I think a kinder expression was used – he temporarily “stepped back”) when he allegedly breached the BBC’s impartiality rules for voicing political opinions.  He advised the BBC not to pay any attention to the furore; just ignore it, and it will go away.  Besides, even-handedness is not always a virtue.  If somebody says it’s raining, and somebody says it’s dry, you don’t need to give them equal air time.  Just look out the f****** window.  I suppose the analogy is a bit of a stretcher, but in music, you don’t need to research what the audience taste is.  Just play music that is beautiful, and beautifully played, inspirational, and deep.  And people will fill the hall.               

“Servus James!” said my local shopkeeper, who occasionally likes to slip into German.  “Wie geht’s?”  (Hello, how are you?)

“Prima!  Ausgezeichnet!  Lebend den Traum!”  (Champion, top notch, living the dream!)

But I sincerely hope I’m not living out my dreams.  That might be more like lebend den Alptraum.  Living the nightmare.  My dreams, at least the ones I can recall, are not to be envied.  I once tried to delve into them by reading Sigmund Freud’s The Interpretation of Dreams, but I abandoned the book when I came up against Freud’s assertion that dreams are basically wish-fulfilments.  Well, if that were so, I must be of a peculiarly masochistic disposition. 

I have recurring dreams, a phenomenon of which Freud said he had no personal experience.  For a lengthy period I had a dream about being back at school.  I find myself in a school corridor (I’m not sure if corridor is the right word, rather loggia, these passages being open to the elements and therefore supposedly protective against tuberculosis), late for class, struggling to interpret a copy of my timetable.  You know the sort of thing – maths, French, double English…  I am in school uniform.  As the dream recurred this became more and more bizarre, and certainly contributed part of the general sense of angst.  A man in his 40s, in school uniform.  This dream visits me less often now (or perhaps it is I who, like a ghost, revisit the old alma mater), but it still occasionally returns, and I wake to wonder, why have I gone back to school?  Surely it must be to carry out some task.  There is something I should have done when I was here, that I did not do.  I have returned to complete unfinished business.  What business?  What can it be?  What challenge did I not face up to?

But this scenario has largely been replaced by something frankly much more disturbing.  Now in my dream, I am back at work, as a doctor.  Always, the dream takes place in hospital, never in general practice in the community.  Again, I am in a corridor, flitting between units, simultaneously grappling in my mind with a particularly difficult and thorny problem of medical diagnosis or management.  I stay in the corridor, shirking the problem, avoiding the encounter, full of a sense of skulking guilt at my malingering, and wondering how long I can get away with this lack of activity, before I am found out.

I wake in a cold sweat.  What can it possibly mean?  Clearly these two recurring scenarios have common themes.  They are anxiety dreams.  Underlying them is a strong sense of Impostor Syndrome.  They don’t seem to serve any useful physiological, psychological or spiritual purpose, nor to exhibit any positive adaptive value.  I wonder if they don’t perhaps evince a mild form of post- traumatic stress disorder.  I say mild, because I can well imagine that army veterans who have experienced at first hand the horrors of war can, and do, suffer intolerably.  I count myself fortunate that when I rise in the morning all the shady apparitions dissolve. 

The real world and the dream world are as different as night and day.  In the morning, I let it all go.  I’m not attracted to researches in the unconscious.  I think I incline to the stiff upper lip ethos of the late Duke of Edinburgh, and just get on with it.  I have a deep distrust of the medical profession.  It isn’t okay to say you’re not okay.  I wouldn’t dream of undergoing psychoanalysis.  What a can of worms that would open up.  A Pandora’s Box.  So I just keep smiling.  With respect to PTSD, in time of war, Winston advised his officers, if you can’t smile, grin.  If you can’t grin, keep away until you can.  He wouldn’t have recognised the term PTSD.  He might have recognised shell shock, which is at least better nomenclature than cowardice.

I’m told I smile a lot.  I’ve even been reprimanded for it.  “Why are you always smiling?” asked Hobsbaum, my Senior Honours English Lang & Lit tutor, a lifetime ago.  I said, “It’s a way of telling people you wish them no harm.”

“Humph.”

I even received a one-on-one tutorial from a consultant orthopaedic surgeon – who else? – on how to be intimidating to colleagues, in order to get your way.  “And don’t smile!”

What a load of tosh.  Didn’t Our Lord tell us to be the light of the world?      

Sometimes I adopt a Calvinistic attitude towards my dreams.  Of Man’s first disobedience, and the fruit/Of that forbidden tree…  They are my version of the grotesque portrait in the attic.  Surely I have wasted my substance in wild and riotous living.  Yet why should I be tormented by memories of my erstwhile efforts to help people?                 

Yet I count myself fortunate that, for the most part, these nocturnal disturbances to not extend into the wakeful day.  By the time I reach the village shop to collect my newspapers, I am entirely euthymic, and ready to indulge in some light-hearted banter. 

“Servus James!  Wie geht’s?”

“Prima!  Ausgezeichnet!  Lebend den Traum!”