The Irish Smoking Ban – One Year On. Published 29th March 2005, Social Affairs Unit web log

In 2004 I contributed a piece to the web log of the Social Affairs Unit, a libertarian-leaning think tank affiliated to the Institute of Economic Affairs. I had come across Digby Anderson’s book Losing Friends somewhere along the way, was impressed with the scope of the book and discovered the SAU and its blog.

I was never asked to take a particular political or cultural line with the SAU. No piece I wrote was ever edited for politics, so to speak. The blog’s editor once suggested I write a review of the Dr Who revival, which I never did. Most of my pieces for the blog are fairly straightforward book reviews or pieces with a cultural bent – as can be seen here .

I don’t think any one political system or philosophy is enough to approach the world. I have concluded that I am not a full throated libertarian, after all. It is too inclined to rather simplistic solutions that involve abolishing this or that (the mirror image of statism) However, if there’s a binary choice between being a libertarian and a statist, I’m the former.

But there isn’t such a binary choice. Perhaps my political stance is best defined as anti-binaryism.

This piece is ultimately impressively non committal about its subject. I note the commentators include doctors who are keen to point of the evil of smoking, which I kind of take for granted in the piece. Someone chimed in with a similar comment on this more recent piece on the Manhattan Project.

What is also striking is how, 11 years on, the smoking ban is utterly taken for granted. This pieces was a rare attempt at topicality on my part (aside from occasionally writing about an anniversary, I find I don’t really do topical pieces)

Anyhow, here it is:

Towards the end of 2004 I bought a computer magazine which featured, for some reason, a timeline of the major events of the last half decade or so – not just in computing but in the wider world. Thus beside the launch the iPOD and Windows XP, we had September 11th and the beginning of the Iraq War. In the middle of these indisputable events of global importance, in March 2004 we read that “Ireland introduces a ban on smoking in public”.

March 2004 saw Ireland the focus of global media attention, for once not due to paramilitary activity of some kind. Smoking bans are all the rage internationally, and a live issue in British politics. For a certain mentality, there was something exciting about Ireland, for once, not following the trends of other more ‘progressive’ countries but setting them.

One of the ironies of all this was that the pub is so central to the Irish international image that it was the basis for all the coverage in the world media. Most commentators seemed struck by the piquant irony that the drinkin’, swearin’, fightin’ Irish would be embracing the healthy life in their drinking dens.

The ban, of course, is not by any means confined to pubs. All workplaces are included – with certain exceptions such as prisons and psychiatric hospitals. Pubs, of course, are one of this country’s most successful exports. No town of any size anywhere is complete without a pub called something like Dicey O’Reilly’s or Scruffy Murphy’s, filled with faux-Irish décor, wannabe Irish drinkers and indeed, rather embarrassingly, actual Irish drinkers crying into their Guinness.

A few months after the ban was introduced, the English movie actor Paul Bettany was quoted expressing his amazement that the ban was still in force; “I thought the Irish would have risen up as one to overthrow it”. For the ban, as became apparent within weeks, was – in its own terms – wildly successful. A pub in Galway announced its defiance and a few days later backed down, a bored Fine Gael T.D. (M.P.) lit up in the Oireachtas largely for publicity reasons and to get out of a rather tedious front-bench job. That was, roughly speaking, the extent of the mass civil disobedience.

Those whose experience of Ireland was based on more than a few nights on the beer singing rebel songs were perhaps less surprised. The Irish are far less the feckless anti-authoritarian individualists of popular legend than we are world leaders in radio call-in show whingeing.

Healthism with its ubiquitous health promotion messages is as strong in Ireland as anywhere else in the world. When I was in Australia, another country with an ostentatiously laid-back image, it seemed impossible to move very far without some public health message or other being shoved in one’s face. In Melbourne I finally found it going too far with little stickers on traffic meters warning pedestrians not to jaywalk. Ireland is heading that way too. Most ads seem to be related to some health worry or other these days. The papers are filled with apocalyptic warnings of the forthcoming Biblical plague of obesity – ignoring the recent report that we are one of the less obese nations of Europe, according to theInternational Obesity Task Force.

No doubt most readers will have their own opinion on the advisability or otherwise of smoking bans. As for myself, the freedom to smoke cigarettes in enclosed public spaces does not strike me as one of those immemorial freedoms you could give up your life for. The purpose of this article however is not to get stuck in that debate, but simply to report how life has changed – or rather how little it has changed – in the year since.

From a purely selfish point of view as a non-smoker, the ban has made things more pleasant on a night out. Indeed, many people I know are now much more prepared to go into a pub during the day for a meal as opposed to only on a night out. No longer do I come home from a night out with clothes smelling like a sweaty ashtray. No longer the coughing or streaming eyes as another diner or patron lights up at the next table. So, from pure self-interest, I am all in favour of the smoking ban.

The apocalyptic consequences the Vintner’s Federation had warned of – the Republic’s social life decamping en masse to the North, and the streets filling with starving publicans begging for their daily bread – did not come to pass. Soon billboards showing smiling, satisfied drinkers extolled “the breath of fresh air” that had swept the “greatest pubs in the world” – a certain megalomania is one of the unfortunate side effects of the economic boom in Ireland. One Dublin radio station proudly promotes itself as serving “the greatest city in the world”. Does anyone, even the most patriotic citizen, really believe that?

One wonders if, in the long term, there will be any fewer smokers as a result of the ban. The little knots of smokers outside each pub soon became a familiar sight, and in these little groups they often seemed to be having quite a bit of fun. Indeed, in its status as a social lubricant, the cigarette has been enhanced rather than diminished. In due course there will surely be smoking-huddle marriages, and no doubt smoking-huddle babies are already filling out their Pampers. The outlaw image of smoking is surely enhanced by bans. It has become a mysterious Other, the little world of the smoking huddle, and we all know the attraction of the mysterious Other.

The ban was originally meant to come in on January 1st 2004 – for a variety of bureaucratic reasons, it was delayed until March 29th, which was fortunate for its proponents. One wonders if this innovation had come during a freezing midwinter as opposed to a reasonable spring if there would have been the increase in general hooliganism that was widely touted pre-ban. Having said that, an orthopaedic surgeon did note a couple of weeks into the ban that there had been a sharp increase in fractured jaws as a result of smoking huddle melees. Little further has been reported on this phenomenon.

Many of my friends claim that in a nightclub, the odour of cigarette smoke acted as a sort of deodorant, and what formerly would have been a seductive, erotic haze is now replaced by an unappealing blend of sweat, flatulence and alcohol. Fortunately, perhaps, I have yet to notice this, or perhaps I was less than seduced by the odour of the average Dublin nightclub even before the ban.

If there has been a definite effect of the ban so far, it is that tolerance of smoking – in the most basic sense of being able to put up with it – has been greatly reduced. Any exposure to any smoke at all is now a big deal. In Birmingham last year for a course, wandering Broad Street on a Saturday evening looking for something to eat, I found myself at first irritated and then slightly baffled by the pub smokers. Thus, something which probably wouldn’t have bothered me a few months before became a source of (albeit minor) distress. Whatever the rights and wrongs of smoking bans, my stock of toleration has become ever so slightly diminished. Readers will have their own view as to whether this is a good or bad thin

Review submitted in Feb 2007 of “Mastering the Techniques of Glaucoma Diagnosis and Management.” for Eurotimes

OK, undoubtedly the writing I have been paid the most for over the years – the writing that has been the closest I have been to earning some kind of living via the pen – were the book reviews I wrote for Eurotimes, the publication of the European Society of Cataract and Refractive Surgeons, from 2004 until 2010. With a payment by the word, and a brief essentially to write a piece about a book that would include a physical description of the size, cover design and proportions of the book, this was an assignment that ultimately became too much “for the  money” rather than any great emotional investment on my part. Perhaps that was all to the good. Generally I would hold forth for some paragraphs about some wider issue inspired by the book, and this is fairly typical of my efforts.

I was upfront with the magazine about my lack of specialist knowledge of ophthalmology (although it has always been an interest and even quite far into psychiatric training I thought of changing specialties…. occasionally I think of it still) but that didn’t matter – the ability to write serviceable prose on a reliable schedule was the important thing. I tried to make these pieces interesting. I am not sure I always succeeded. Payment by the word may have engendered a certain long windedness.

Mastering the Techniques of Glaucoma Diagnosis and Management. Editors: Ashok

Garg et al. Jaypee Brothers, New Delhi, 2006. richly illustrated with colour

photographs, diagrams and tables. 556 pp.

Over the last number of months, this column has increasingly been dominated by the

publications of Jaypee Brothers of New Delhi. This production, from the cover in, is

their most lavish production yet. “Mastering the Techniques of Glaucoma Diagnosis

& Management” – which boasts a tiny picture of an eye in the “o” of “Glaucoma” on

the cover – is a production resulting from the efforts of 97 international contributors

from 15 countries. It required ten editors, with as nearly a spread of nationalities

involved. Perhaps unsurprisingly, the text on the back cover about this platoon of

editors requires quite a small typeface cover to accommodate all their life stories and


India is often used a case study in the effects of globalisation, and while from a

European point of view stories about outsourcing are often used as a stick to beat

globalisation, this books global range and scope illustrate the positive side of the

process. The internet has made the idea of a book published in India with contributors

from 15 different countries and editors from 7 countries all collaborating not merely

feasible, but a commonplace, and the globalisation of computer technology has made

the technical quality of the book achievable in a wide range of settings.

As glaucoma is now catching up with cataract as a worldwide cause of blindness, this

book is timely. Our awareness of the pathophysiology and natural history of glaucoma

has greatly increased. With an ageing population worldwide, chronic progressive

conditions like glaucoma will affect both patients themselves and practitioners more

and more as time goes by. New therapies offer the promise of a more efficient, more

cost-effective and therefore more available approach to glaucoma therapy.

The book is divided into four sections. First one on preliminary considerations and

diagnostic procedures in glaucoma. Secondly the management of glaucoma itself –

medical, surgical and laser – is discussed. This section, unsurprisingly, takes up the

largest section of the book, at over three hundred pages. There follows a short section

on complications of therapy, and finally a section on minimally invasive glaucoma

surgery, which focuses on recent technological and technical advances and possible

future developments.

The book is extremely practical. The final section in particular on innovative

techniques is, by its very nature perhaps, quite didactic and instructive. Experienced

surgeons will find this section of particular interest and will be able to compare their

technique with that of the authors due to the high quality of the instructions given.

In the early section on diagnostic and pre-operative assessment too, we see this

eminently practical approach. Checklists and instructions for very practical tasks are

given, while the more discursive text describes the evidence base and technical and

theoretical reasons for the actions recommended. We find the same approach

throughout the longest section on the technical issues around management of

glaucoma itself.

I have commented before on the high quality of books coming out of India in general,

and in particular on the high quality of books being published by Jaypee Brothers.

This book is not only of as high quality, it is aesthetically more pleasing. The typeface

and general design seem cleaner and more pleasing to the eye – and the various

sections are colour-coded for ease of access. The book is pleasant to handle. It is a

large, reference book, rather than one one could easily carry around the wards or into

theatre. It has a very attractive, soothing even, blue colour scheme on the cover.

The quality of the illustrations – and in particular the reproductions of colour

photographs – is also much to be commended. It is pleasant to come across a book

about ophthalmology so, in its way, attractive to look at. And again, this enhances the

practicality of the book.

As is the fashion nowadays, and as is the tradition with these large Jaypee Brothers

books, there is a DVD provided with the book. It is important to actually see

procedures being performed rather than just written about, and the selection of video

clips from the practices of some of the contributors is a valuable addition to the book.

Sometimes DVDs and CD-ROMs that come packaged with textbooks have a rather

gimmicky feel to them, replicating elements of the book rather than being used for

their own unique qualities, but this DVD is focused on providing visual backup for

the text rather than this pointless duplication.

This book is boggingly comprehensive and will satisfy both the trainee and the

specialist. There is perhaps overmuch detail for all but the most enthusiastic medical

student or non ophthalmologic doctor. With the rise of glaucoma noted above, it is

important that books for these groups are also produced, to raise awareness of the

condition and to give a simpler overview of treatment modalities. However, this

certainly is a useful overview of the state of the art with glaucoma management, with

a strong practical bent.

Review for TLS of Rose Shapiro’s “Suckers: How Alternative Medicine is Making Fools of Us All” , 2008

Original text of review for TLS of Rose Shapiro’s “Suckers: How Alternative Medicine is Making Fools of Us All”

The TLS published this with slight tweaks, I will try and use Lexis/Nexis to get the final text.  I suppose my view on “alternative medicine” comes across here. Wellness and health are ultimately subjective, and experienced at an irreducibly individual level. This doesn’t mean every wild claim should be taken at face value.  Books like Suckers are exercises in shooting fish in a barrel. What is really interesting about alternative medicine is why so many people are drawn to it. This may be because of failings of mainstream medicine, but ultimately I believe says more about society in general. Increasingly life expectancies and an increasing  expectancy of an active older age do not necessarily mean that our expectations of what it means to be healthy are realistic, or even achievable. The WHO’s grandiose definition of health doesn’t help. Ultimately the popularity of alternative medicine is an attempt to sate a need that mainstream medicine doesn’t even begin to address – nor should it.

Suckers: How Alternative Medicine Makes Fools Of Us All by Rose Shapiro – Harvill Secker 2008

In the UK, £4.5 billion is spent each year on Complementary and Alternative Medicine (often usefully abbreviated to CAM). CAM is a broad term. As Rose Shapiro observes towards the end of this astringent book, these treatments are on a continuum, with some herbal remedies and relaxation techniques being incorporated into the mainstream. Somewhere beyond these therapies are the likes of acupuncture – with some possible efficacy for pain and nausea – and further along we get to the bulk of CAM “therapies”, of which Shapiro gives many lengthy and non-exhaustive lists – from ear candling to Bach flower remedies and from homeopathy to cranial osteopathy – all of which are unproven and with a theoretical basis positively antithetical to physiological, biochemical, chemical and anatomical knowledge.

CAM therapies and have recurrent features, and their pioneers and proponents have recurrent tendencies. Emblematic is the life of Daniel David Palmer, inventor-prophet of chiropractic. Canadian-born, in the 1890s Palmer had established a magnetic healing practice in Iowa and styled himself “Doctor” (despite their disdain for the medical establishment, CAM practitioners seem keen to claim the title and trappings of the profession) and decided that there must a single cure for all diseases, another familiar theme.

In the world of CAM, anecdotal experience trumps repeatable scientific study. Palmer claimed to have restored a local janitor’s hearing by manipulating his spine (a claim disputed by the janitor’s family) thereby discovering “subluxations”- a borrowing from orthodox medicine which in chiropractic refers to any spinal deviation, the supposed cause of 95% of disease. Palmer lost control of chiropractic, the idea for which had been revealed to him during a séance, to his less mystical and savvier son B J Palmer, who realised that the real money was in training further chiropractors. Much entertaining brouhaha ensued, with the elder Palmer dying after being hit by a car whilst protesting at the annual jamboree held by his son’s school of chiropractic (internecine feuding, no surprise with so many “discovering” the cure to all disease , seems another feature of the CAM landscape).

Shapiro wittily illustrates other CAM traits, the misuse of scientific-sounding words like “quantum” and “paradigm”, the paranoid stance towards conventional medicine which is in conspiratorial cahoots to suppress the hugely profitable CAM, the paradox that CAM practitioners stress the timeless, ancient qualities of their remedies while often trying to cloak it in the terminology of state-of-the-art technology. She has read widely, yet there is little evidence of original research or observation. There is not much here that not covered in more depth in other popular books, or even more pertinently websites such as Stephen Barrett’s Shapiro takes Barrett’s impatient, take-no-prisoners approach, which plays well with fellow sceptics but does little to convert the undecided. There is more of a UK focus than in other books on the subject, with issues such as availability on the NHS and should B.Sc. degrees in CAM practices (Bachelor of Science without the science, as one critic points out) be offered discussed.

The “therapies” are so many fish in a barrel, and Shapiro does her debunking work with glee. And yet there is a sameness to it all, a sense of missing the wider point. The post-industrial West is a world with unprecedently high life expectancy and freedom from serious life-shortening disease. This is also s world where “Dr” Gillian McKeith markets a snack bar listing “Unconditional Love” as an ingredient. Why are the legions of educated, high-disposable-income middle-aged, middle-class women– identified by Shapiro as the key consumers of complementary/alternative medicine – so keen to abandon critical thinking when it comes to their health? Shapiro makes some unexceptional observations about CAM offering these women some control and power over their lives, but does not explore these issues in depth.

Why do the majority of the headaches, back aches, fatigue and non-specific pain that comes the way of general practitioners have no physically identifiable cause? Why has having an illness become somehow desirable; why for instance are the “ME lobby” so vehement in their insistence that the condition has a purely physical cause? The World Health Organisation has defined health as “a stage of complete physical, social and mental well being and not merely the absence of disease or infirmity”, a statement of awesome fatuity which renders health unattainable in this world. And if health is considered a right, and not a blessing or or what the Stoics would have called a “preferred indifferent” (to be desired, but out of one’s control and therefore not should try and view with indifference) – its unattainability becomes unbearable.

We are often told that CAM is a reaction to authoritarian, impersonal mainstream medicine. The irony is that there are few graduates from medical schools nowadays who fit the paternalistic stereotype. Medical students are taught to beware personal authority and experience and to follow the impersonal calculus of evidence-based medicine. As Shapiro writes, it is mainstream medicine that suggests a holistic, biopsychosocial approach to ME, and it is the alternative medical world that promotes a unitary physical cause. The cult of personality of the trust-me-I’m-a-doctor archetype is more likely to be found in the world of CAM

Shapiro quotes Richard Dawkins’ observation “either it is true that a medicine works or it isn’t – it cannot be false in the ordinary sense but true in some ‘alternative’ sense.” The contemporary sense of what health is renders this commonsensical statement – which perhaps could be the epigraph of Shapiro’s book – unworkable. What does it mean anymore for a medicine to “work”? CAM promises panaceas where mainstream medicine is humble and promises palliation. If health is promoted as complete well-being, we should not be surprised if the public falls for the deceptive and unlimited promises of completely unproven therapies

Ancient Medicine by Vivian Nutton – review from, between July and November 2004

Unfortunately the link to the original review is broken (at time of writing)

I wrote somewhere else (I thought it was here, but revisiting it I don’t see this point) that while we don’t look to the Ancient Greeks or Romans for medical advice, we do for philosophical advice. Re-reading this piece, I wonder if the ideal of the four humours being “in balance” continues to have a strong lay influence, and indeed an influence on us all. Certainly I aspire to be “in balance” and tend to feel bad about it if I don’t.

I heard Nutton speak at a symposium on Vesalius last year in Cork – a fascinating talk, and I was lucky enough to have a chat with him afterwards.

Re-reading this review, I feel awkward about the passages which are pretty obvious paraphrases of Nutton himself, ie the third, fourth and fifth paragraphs. I am not sure how equipped I really was (or am) to properly judge this as a scholarly work. That doesn’t scupper the review, but perhaps I should have avoided throwing around terms such as “magisterial.” The reference to “The Simpsons” also dates this piece  a little – even in 2004 I doubt I kept up with “The Simpsons” that much anymore.

Ancient medicine – Vivian Nutton

Think “ancient medicine”, and for most, Hippocrates comes to mind. The famous oath, which Hippocrates himself almost certainly had nothing to do with, has preserved the name into the age of mass pop culture; one recalls Homer Simpson begging Dr Hibbert to “remember your hippopotamus oath.” Perhaps some have dimly heard of Galen or other medical figures of classical antiquity, but Hippocrates is undoubtedly number one. Many would have also some awareness of the theory of the four humours, the four fluids which ancient doctors felt went “out of balance” in illness.

Professor Vivian Nutton, in his magisterial study that is, apparently, “the first large-scale history of ancient medicine in a single volume for almost 100 years”, looks beyond the Hippocratic method and tradition to the other medical practices of the Ancient Greeks and Romans. He acknowledges that much, and in particular much of the folk tradition and the role of female healers and midwives, is out of our reach because of the nature of the sources that have survived, and avoids making the book a dry account of the famous names and competing theories.

The history of medicine, Nutton writes, is the history of “men and women striving to come to terms with illness, whether as sufferer or as healer.” Hippocrates and the Hippocratics are dealt with fully, but Nutton is keen to bring us the full range of ancient medical thought. He pays especial attention to Galen of Pergamum, a figure much of his academic work has been concerned with and one whom he evidently feels a special affinity. But Galen tended to present himself as a lone fighter for truth amidst ignorance; Nutton introduces other schools of thought, less of whose works have survived (almost three million of Galen’s words are with us still), such as the Methodists, Pneumatists and the various groups of Hippocratics.

Medical thinking inevitably informs and is informed by the wider culture. The detailed description of wounds and their treatment in the Iliad lead some fanciful commentators to postulate that Homer was a medical officer attached to the Argives during the Trojan War. And Thucydides’ famously dispassionate description of the plague that befell Athens during the Peloponnesian War bears the influence of the Hippocratic method and has also inspired speculation that the author has had medical training.

Nutton discusses the interplay between medicine and religion. It comes as a surprise to discover how pliable the Ancient Greek Pantheon was. The cult of Ascelpius, god of healing, only emerged in the fifth century BC. Nutton suggests that there was not competition between medical and magical models of healing in the Greece of this time. It is easy to write of where ancient doctors got things wrong; certainly the four humours (blood, phlegm, bile and black bile) do not feature much in contemporary biology. However, their major insight, that illness was not necessarily a supernatural judgement from above, but something that could be understood and alleviated, was perhaps the most significant breakthrough in thinking about disease in history.

Most commentators have tended to be rather dismissive of Roman medicine. At least some of this is due to an equation of Roman with Latin and a more limited, insular culture than the Greeks; as Nutton writes, this was certainly true of the Republic but not of the multilingual Empire. Galen was a man of the second century AD. The book is strong on the medicine of the later Empire, with the rise of Christianity occasionally clashing with medical thinking but on the whole complementing it. The new religion, with its emphasis on the New Testament injunction to love one’s neighbour, oversaw the creation of the modern hospital in the early fourth century AD.

Nutton’s main focus is an attempt to reconstruct the individual lives of patients and doctors. He writes that he wants to “give a sense of ancient medicine, what it must have been like to have seen Hippocrates at the bedside of a patient, Erasistratus experimenting, Asclepiades or Thessalus holding forth, or Galen dissecting a pig.” Ancient doctors were independent spirits, and Nutton’s attempt to reconstruction the contention of different ideas of healing and illness is entirely admirable. The traditional, heroic account of ancient medicine as the gradual accumulation of skills and knowledge from early Greece to Galen is not abandoned, but balanced.

For a scholarly work, Ancient Medicine is a readable story of the ordinary lives of history. Nutton is a patient, fair-minded and wise guide to the array of medical practices of the classical past. The book acts as a corrective to misconceptions about the classical past, without indulging in revisionism for the sake of it.

Operation Ouch! Medical Milestones and Crazy Cures, Inis Childrens Magazine/Childrens Books Ireland, November 2014

From Childrens Books Ireland, a capsule review of a childrens book about medicine. The van Tulleken brothers strike me as quite admirable in their enthusiastic multimedia presence. Again, perhaps a wry scepticism about history-from-below is evident. I didn’t have space to note that while the entries on Fleming, Nightingale and most other figures in the book are irreverent, that on Seacole is very sober and straight-laced:

Operation Ouch! Medical Milestones and Crazy Cures
Chris van Tulleken and Xand van Tulleken

History traditionally focused on what were deemed great events – sometimes caricatured as the ‘maps and chaps’ approach. In recent decades, ‘history from below’ has gained in academic prestige, with everyday life and consideration of marginalised, under-documented groups being the focus. The huge popularity of the Horrible Histories series has shown the appeal of history-from-below in a perhaps more literal sense – their focus on bodily functions and gross-out humour may not be to everyone’s taste, but they do provide a gateway into reading about the everyday life of the past.

The van Tulleken twins are Oxford medical graduates who have carved a niche for themselves as presenters of the CBBC series Operation Ouch! This book is the second tie-in volume; the first, Your Brilliant Body, won the 9-11 Best Fact Book award at the Booktrust Best Book Awards in 2014. Medical Milestones and Crazy Cures is formatted as a series of dialogues between the brothers on various parts of the body, interspersed with short profiles of medical notables and some quirky activities that will get the target readership’s attention.

The history-from-below emphasis is even apparent in the vignettes on pioneers of healthcare, with the Jamacian-born Mary Seacole, about whom very little is reliably known, given equal prominence with Florence Nightingale, Alexander Fleming and the rest. The brothers’ dialogues don’t entirely work on the printed page, but that aside this is a handsomely produced tie-in that combines medical history with bodily functions in a way that will appeal to the target readership.

The Boy Who Never Saw Pictures – The Dabbler Blog, May 2014

I came across the paper described in this piece in a book on the pictorial world of children. I also emailed one of the authors, with no reply. It was circulating around my mind for a few years and finally The Dabbler seemed like the right place to write it for.  It was literally only when writing the piece I realised what seems obvious; the authors of the paper were the parents of the boy described.

A certain wry scepticism about experimental psychology is evident here.

As this piece deals with child development, I thought it was an interesting place to start.

Originally published at The Dabbler

Here it is:

Imagine if, in infancy, your parents made every effort to ensure that you never saw a picture. This is what happened to the anonymous subject of Julian Hochberg and Virginia Brooks’s 1962 paper “Pictorial Recognition as an Unlearned Ability in a study of one child’s performance”; a title which has the virtue of describing precisely what they set out to do.

It had been claimed that certain tribal groups, for whom pictorial depictions were unknown, found pictures frightening and inexplicable. Various accounts from David Livingstone himself and others from his era had included dramatic accounts of natives running in fright from pictures of lions and so on. Later, perhaps more purely anthropological, studies had suggested the same thing. Therefore a theory that the ability to recognise pictures as pictures and also representations must be a learnt ability. Hochberg and Brooks observed there is a weaker version of this hypothesis; claimed that learning was needed to recognise line-drawings, but “the naïve recognition of photographs, with their higher ‘fidelity’, would be admitted.” Hochberg and Brooks embarked on their study “to determine whether a child who had been taught his vocabulary solely by the use of objects, and who had received no instruction or training whatsoever concerning pictorial meaning or content, could recognised objects portrayed by two-dimensional line-drawings and by photographs.”

The paper recounts the story of S: “since birth, the subject (S), a boy, had been exposed to and taught the names of a wide variety of toys and other solid objects … S never was told (or allowed to overhear) the name or meaning of any picture or depicted objects In fact, pictures were, in general, kept from his immediate vicinity.”

Such a regime in the mid-twentieth century was difficult to sustain: “this is not to say that S never had been exposed to picture. There was a Japanese print on one wall of a room through which he frequently passed; a myriad of billboards fronted the highways on which he travelled frequently; a few times (six in all) he accidentally encountered a picture book (which was gently withdrawn) or caught a glimpse of the label of a jar of baby food (these were normally removed or kept covered). (All these encounters were unaccompanied by instruction or naming play)”

You have to love the precise cataloguing of how often the picture book was accidentally encountered, and the regret that the Japanese print and the myriad of billboards happened to float into S’s ken. Not only that “one toy (a top) had picture of elves on it and, accordingly, it was available for play only under strict supervision to prevent any naming in his presence; a high chair had a decal of babies on it, which could be glimpsed (without parental comment) only when S was being placed in the seat.”

Not for nothing do Hochberg and Brooks comment “the constant vigilance and improvisation required of the parents proved to be a considerable chore from the start – further research of this kind should not be undertaken lightly.” This line made me wonder if S may in fact have been the offspring of Hochberg and Brooks themselves, although I can find nothing explicit and no other internal evidence, apart from the absence of any comment as to how S was recruited (there are later papers credited to Julian Hochberg and Virginia Brooks Hochberg)

By 19 months, the boy began to seek out pictures for himself, and testing began. 21 pictures, mixing line-drawings and photographs of the same objects, were presented to S one at a time, “a somewhat unsuccessful attempt being made to convert the test to an interesting game.” After this, the boy was given picture books, but adults did not engage in picture-naming activities with him. This continued for a month, with “free (but monitored) access to still pictures, but motion pictures, TV and picture-naming play still were completely avoided.” Another round of testing along similar lines took place. Both tests were tape-recorded and independent judges assessed if they could identify that picture based on S’s utterances. Hochberg and Brooks were able to conclude that “it seems clear from the results that at least one human child is capable of recognising pictorial representations of solid objects (including bare outline drawings) without specific training or instructions.”

S pics 2

Psychology textbooks and popularisations are replete with certain key case studies and experiments. There’s the case of Phineas Gage, a Vermont railway worker who suffered a catastrophic injury to his frontal lobes and suffered, so the textbook story goes, a spectacular personality change. There’s Little Albert, conditioned to fear furry things including beards and Santa Claus, thereby (supposedly) proving the tenets of behaviourism. There’s the obedience and prison experiments of Zimbardo and Milgram, thereby (supposedly) proving the essential sadism of humankind.

It almost invariably turns out that these stories are more complex than they are presented. Phineas Gage did survive a pole through his frontal lobes; but the most immediate report described him as “in full possession of his reason”, and two years later the Professor of Surgery in Harvard stated he was “quite recovered in faculties of body and mind.” Only later did a narrative of dramatic personality change emerge. The Zimbardo and Milgram experiments have been rigorously criticised on methodological grounds, and certainly do not seem to “prove” all that much about human nature in the end.

Little Albert is perhaps the most infamous experiment from the early years of experimental academic psychology. In 2009, Little Albert was tracked down. Or rather his grave was; for Albert had died of hydrocephalus only a few short years after the experiment. Typically, it turned out the experiments may not have proved all that much after all.

The subject of Hochberg and Brooks’ experiment is, more than likely, still out there (a couple of years ago I found an email for Julian Hochberg and wrote to see if he could update me. I never heard back). Julian, who got his PhD in 1949 from Berkeley, has a web bio on the Columbia University site. A ballet site lists dance films made by a Virginia Brooks and produced by a Julian Hochberg. One wonders did the effort to deprive S of pictures end at 20 months or were there any attempts at extending it.

S’s story is not as striking as Little Albert’s, or Phineas Gage’s, and it doesn’t seem he suffered all that much. It is hard to imagine such a study happening today, not so much due to ethical reasons as that with the endless trumpeting of the importance of the early years of infancy for development, what parent would agree to allow their little treasure to be deprived of any form of sensory stimulation?

About “A Medical Education”

This is a blog in which I am planning to collect and curate various writings of mine from 1996 onwards, which in some way relate to medicine or medical practice. “Some way relate” could be very broad. This arises from my inchoate desire to anthologise my writing, and the suggestion (from Simon Cutts and Erica van Horn) that blogging some of my past pieces may be a way to try and find a common thread.

I am a doctor. I have never let this define, or wanted to let this define me. In ways, my writing has always felt like something separate from medicine. I even practice under a different name. A relatively small percentage of what I have written is directly about medicine.

However, medicine is a thread through much of what I have written, even invisible, and all I have written as an adult has been as a medical student or a practising doctor. Some influence, to say the least, is inevitable both ways.

Furthermore, I am interested academically and personally in medical education, and particularly trying to capture the “hidden curriculum”, the processes of becoming that are not captured in any matrix of learning outcomes or assessment schedules. Systems have a life and existence entirely uncaptured by the organogram or the flow sheet.

My initial working hypothesis is to try and gather pieces that will in some way trace my own development within medicine, even tangentially. I intend to publish pieces from the past – some from a few months ago, some from nearly twenty years ago, some from peer reviewed journals, some from student magazines and various freesheets, some written to express a deeply felt perspective, some written for the money (not that many, really) – and see what happens.
Seamus Sweeney

(Jan 15th 2016 – I have some further thoughts about this blog, although I don’t intend to adjust this text)