Thursday, 21 September 2017

Who knows about cirrhosis?

I've been an alcoholic all my life.  Long periods of recovery interspersed with shorter relapses of mayhem.  I know I'm an alcoholic, and a few other things too.  I didn't think I was in denial, but secretly and unknowingly I had denial.  I thought I was indestructible and immune to liver damage and could physically get away with the odd bout of drinking.  When people warned me of the physical effects of my drinking I would glaze over and continue to intellectualise about the subject.  I knew the psychological, emotional and material consequences but I never thought I would get cirrhosis.  Yet no alcoholic can ever drink safely.

It took just two relapses last year for the scans to start showing a fatty liver.  This is liver damage.  Although not permanent it should have been a serious warning.  Then I had a fierce bender for 30 days of two bottles a day, minimum.  I was back in hospital and this time the body wasn't coping at all.  It went into shock, needles went into the arm and oxygen applied.  Bleeding started inside me.  There was 'turbulent hepatopetal flow' in my liver with reflux.  Over a litre of blood flows through the liver every minute, so if its not going the right way it's bad news.  In short it was about to pop.  Blood pressure had to be dropped.  All the time I was being very sick and hallucinating.  Nasty but I got through these four days.  Then I got my discharge note.

I had been looking forward to this.  So many alcoholics can't cope with the agony of detox they self-discharge and go out drinking again.  To get the discharge note means you've completed the course and get lots of information on your physical health.  I've had plenty of them and they usually say happy things about how health is restored.  Not this time.  There staring at me were the horrible words: "Early cirrhotic change".  The doctors said I'd done it now.  I wasn't indestructible at all.

I was devastated.  The scales dropped from my eyes. That I could permanently damage myself from one of my very private little 30 day benders.  I was inconsolable as I paced around waiting for my taxi from the hospital.  I had been through so much unimaginable pain, and all I get is this.

I cried a bit.  I went to my GP, he confirmed everything.  All the experts were saying the same thing.  You're screwed.  You will now always have a damaged liver and that means you will always be slightly unwell.

Well, we know about experts don't we?   Few in number.  Theoretical.  Personal agendas.  Peer reviewed journal articles count a lot.  The alternative is a more democratic crowd wisdom, which works when the group is large and diverse, drawing on local information.

I went to an AA meeting, the epitome of a wise crowd.  This organisation has been going for 80 yrs, involves millions of members around the world.  All the good recovery stays in the rooms and the bad ideas exit with those who relapse.  Each meeting distils this experience-based wisdom further.  At my meeting there were 30 people.  They had heard plenty on the subject of cirrhosis.  Maybe five or six had it.  This was a far more optimistic land than the doctors surgery.  There were stories of rejuvenated livers with mild cirrhosis (which may not have been cirrhosis at all).  Like a dying man clinging to a raft, I felt this wonderful feeling it would be alright.

Now let's be totally clear.  The situation is very serious for me, I'm not indestructible anymore and I can never drink again.  That point was made over and over in the meeting.  But I trust this crowd optimism as much as the pessimism of the expert doctors, who will probably suggest an alcoholic tries some "controlled drinking" that may lead them to their death.  Many think there are pharmaceutical solutions for alcoholism.  There aren't.

Now I am public about my alcoholism and also my liver disease.  It's good for me to hold no secrets and be very open and honest.  For me this is a proper surrender.  I'm also seeking no sympathy for the dire consequences of my own actions.  If one alcoholic suddenly twigs the destructive capabilities of alcohol from this piece, then it will all be worth it.  I will be tested again in six months and keep you posted.

Wednesday, 15 March 2017

In homage to the game show

Politicians like Nigel Farage, Boris Johnson and Donald Trump treat politics as a game, little more than a popularity contest. They continually court our sympathies with showmanship. If being popular is 'populism', I'm all for it.  

There's a refreshing honesty in this approach - and believe it or not - humility.  These chaps don't act independently of us, like a remote cabal of experts, working under the cloak of 'parliamentary democracy' like Remain supporting peers; or 'party democracy' in the case of Corbyn.  Elitists look after what they interpret to be electorate interests.  Populists respond directly to our stated interests because they know that's how to win the game.  And interests include both public 'feelings' and 'thoughts'.  Feelings to the populist are just as valid as thoughts, indeed if they are any different at all.  In short, populist politicians don't think they know better than us voters.  In fact the voter (like the customer) is always right.

During the EU Referendum, much of the media and certainly Remain supporting social science seemed to think the public were psychologically handicapped in their decision-making.  They trusted gut feelings rather than conducting more 'economic' evaluations of Brexit, thus invalidating the vote and ruling voters out of the game (see previous post).  The cognitive voter is the ideal according to learned political scientists.  What a load of bollocks.  Wise guys feel their way forward.  Feelings are instincts, essentially cumulative learning.  Very Bayesian.  

I've just watched Breaking Bad.  What a feast of game theory!  What is amazing about the endless stream of choices in the plot, is that they are mainly felt not thought.  When Walt Senior's wife calls a meeting to discuss treatment for his lung cancer, the formal question put to each family member by his (dreadful) wife, is 'what do you feel?'  Isn't that the default wording used when addressing key decisions rather than 'what do you think?'  Sure, Walt makes a cognitive decision that the rest of his life will be spent looking after his family by cooking crystal meth. But thereafter he makes brilliant decisions that are not given any consideration.  He survives.  Despite the craziness of the original choice to make class 'A' drugs. 

Before, Marxists used the false consciousness argument in a slightly different way.  They claimed that the masses were falsely conscious of their interests, misled by external forces such as 'the opium' of religion and the capitalist system.  

All that has changed in the social sciences since Freud, the seminal text on voting behaviour: 'The American Voter' and the discrediting of Marxism, is a tweak.  

Rather than external economic forces misleading the public, the deception now takes place inside people's own heads.  They are still as dumb as ever.  Still prols or worse, lumpen prols.

Trump is playing the game in his first 90 days by trusting the voters wishes, made clear by his election.  And just because a large swathe of the American voting public love his outlandish heterodoxy, doesn't mean they are bad people.  Because they feel he is right, perhaps unable to express a form of words that justifies their support for a BBC interview, that always targets the most visceral red-neck, doesn't mean they are wrong.  And just because populists are entertaining doesn't mean we can't disagree with their views, if only there were some equally entertaining conformists to the old system that we could like.  Like'em or loathe'em, the new populists are the champions of engagement because they make politics interesting again. Any Trump story rises to the top of the most-read leaderboard on news websites, and the sneering Radio 4 comics are back in business, just now on the side of the Establishment.

Look at the dull party leaders Britain now endures.  They despise the idea of politics as a game because they see themselves and their jobs are far too important.  They want us to vote for them as righteous leaders of us, not spokesmen for us.  How do we connect with them?  Corbyn is a lofty ideologue when all political ideologies have failed, as is Farron but purveys even less convincing ideologies like European integration; and May is a ghastly school prefect who has no ideals, but simply hates mucking about.  Those oh so characterful shoes she wears are the limit her personality extends upwards, and usually neutralised by the straight black (acrylic) trousers she so often wears.  How long will the ghastly matron last?

Less than 5 years I reckon.  There has never been a Prime Minster who won so much by default and whose tenure is secured through a lack of opposition.  But she is so vulnerable to waves of 'events' that will smash her into the rocks.  Rolling towards her is rising inflation, higher interest rates, higher taxes, more uncontrolled immigration and ever climbing national debt.  Competitive opposition will inevitably return because of the opportunity for power.  Bereft of any charisma yielding a real connection with the British people, May will succumb to being a another unloved manager of failure, like every post-war British Prime Minister bar Attlee and Thatcher.  She is certainly the wrong women to make a success out of Brexit,  That might require some vision, bravery and charm.  She is no Margaret Thatcher.  God, she is boring.

Her problem is deeper than mere situation or personality.  May really does believe that politics is not a game.  She said exactly that when patronising Nicola Sturgeon at the weekend, and today uttered that wearisome phrase that the SNP leader should 'stop playing politics'.  What else is politics if it is not a game to be played - and one that Teresa plays too, if she is honest.

Boiled down, politics is about choices, winners and losers. It's about competitive engagement amongst players.  It also involves some rules to add some stability - so often framed these days as parliamentary democracy, a term that has become debased into untrammelled elitism.  Less than ever have the public faith in these rules, which in any case are mainly tacit and unclear.  Increasingly constitutional norms are broken as distrust of politics reaches new lows, and the chancers (like Sturgeon) step in.  The modern politician has to be showmen and a risk-taker, accepting short-term contracts like the rest of us.  How few MPs are like this.  Most have seats for life with whopping majorities.  Primaries would be a great political reform, but of course MPs will never vote for them.
Politics is a game

Those who don't treat politics as a game are destined to lose it.  These are the sorts who think they have a divine right to exert power because of their privileged status, or have a greater wealth of knowledge than the mass of voters they claim to represent.  They see politics as the preserve of experts, in some ways divorced from the voters who will ultimately decide on their survival.  May is one of them.  She makes no break with the past and stands firmly on the wrong side of the fence over the great political question: Can the people be trusted?   Can they be players in the game of politics?  No she says.  If there is a game to play, it's wheeling and dealing around the Cabinet table, the corridors of Whitehall and the tea rooms of Westminster.  The disparaged public - hooked on visceral feelings rather than rational thoughts - are locked out.  And they will get angry again.