Saturday, June 23, 2012

The Politics Of Parkinsonism

This is  my very last post on the subject of dopamine illness. As I noted last week, all of the reading I have done on it is flushing slowly out of my system, but the thinking and theorising about it will take longer to disappear; such as whether the dopaminergic qualities of the coffee bean - at home I drink the contents of a 100g jar of coffee each week and need at least 10g to get me going in the morning, notwithstanding what I also consume at work -  can be aerosolised, possibly enabling Parkinsonians to carry around wee sprays that would enable them to titrate their medication themselves, as and when they require it and not when somebody else directs that they should take it. Or whether or not the role of the vowel sounds of the swearwords used by coprolalic Tourettists in their utterances has been investigated as thoroughly as it might have been. Or whether or not dopamine illness has a recognisable anatomy, represented by a tendency to spindling limbs in some cases (I've got some completely cracking and totally off the wall examples of that; they will never in a million years guess who I've got lined up to put in front of them, and it's likely that nobody would have found that funnier than the gentleman himself).  Or perhaps expanding on the range of activities to which the operation of 'kinetic melody' can apply, or of the range of emotions which can be invoked by 'somatic compliance', or discussion of the types of relationships to which sufferers of dopamine illness might best be suited. It is highly unlikely that I will ever get a chance to discuss any of these ideas with a neurologist on equal terms, which seems something of a pity.

Not that I am in the least bitter about this, you understand, not at all. You live with it for decades, try to find out about it, get diverted from your original purpose (securing your son's financial future for the day you won't be able to work any more), then become more affected by it until you have to stop. This particular no-win scenario is still sticking in the gullet somewhat. At the very least, I can put my hand over my heart and truthfully say, as every former pupil of the Jesuits should be able to say of all their endeavours, 'I did my best'. Perhaps this is The Lord's will; that my theory of dopamine illness should be investigated and will be investigated, but not by me. If that is the case then one must accept, it, regardless of how much joyous trauma it inflicts upon one's vanity and avarice. Your prayers that God grant me the grace to overcome this extreme irritation would be most welcome.

However, like all bad lovers I cannot say goodbye without having the last word; and my last word on this subject is 'shock'. 

Writing in 1964, Gilbert Onuaguluchi, to my mind the greatest of all students of Parkinsonism, noted how he was aware of one sufferer who had been propelled into the condition by the prospect of having to give evidence in the High Court (he did not elaborate on whether the High Court he was referring to was the English or Scottish version, two very separate beasts; as he conducted his work in Glasgow, I have assumed that he was referring to the High Court of Justiciary).

Of course, Onuaguluchi was writing in the days of capital punishment, when proceedings in that forum often carried very much more of an all-or-nothing flavour than they do nowadays; however even the most experienced lawyers find the prospect of having to give evidence very stressful, particularly in their own home courts - one solicitor who was on the other side of a case I was once involved in nearly had a nervous breakdown down the phone at me when he was advised that he might have to get into the box and take the oath. Whether or not stress induced by the prospect of having to give evidence in the High Court was a factor in the recent and very untimely passing of Paul McBride QC will never be known. If it was, it would be evidence that even the most accomplished examiners can be affected by the prospect of becoming the examined, even when their actions have been beyond reproach and they are classed by the law as complainers, victims of crime. 

Onuaguluchi's case studies refer to a woman whose first two children were born live and her latter two born dead, who became Parkinsonian in the same year as the first stillbirth. He did not make the connection between the two events, but one has a nagging query whether or not the two events were connected. As she became Parkinsonian in 1926 and Professor Onuaguluchi died in 2005, we will never know for sure. 

In 'Awakenings', Oliver Sacks writes at some length about the impact of shocks to the system in inducing Parkinsonism; indeed he saw it himself on his own ward, en masse. Having started his L-DOPA trials in New York in the spring of 1969, he returned home to London for the month of August that year. While he was away his hospital underwent a change of administration, going very quickly from a relaxed regime to a very much more rigourous one. Upon his return he found that much of his good work from prior to his departure had been undone, with many of his patients just as Parkinsonian, if not more so, than they had been before he had started them on L-DOPA.

Sacks seems to equate the increase in Parkinson's cases that occurred at the time of the Industrial Revolution with increased exposure to toxins. There may certainly be some truth in this, and I actually fear that the advent of toxic Parkinsonism on a large scale in Scotland might just be an unintended, very unwelcome and very destructive consequence of the recent Scottish law regulating the minimum price at which alcohol may be sold to the public. If anyone wishes suggestions on why that law should be reconsidered, that's one right there.

I quote from memory, and my memory may fail me; however I do not recall Sacks suggesting that shock might have been a factor in the increase in the number of Parkinson's cases seen in the early 19th Century. Another factor I do not recall him exploring was whether James Parkinson's publication of the 'Essay On The Shaking Palsy' might have caused his peers to look more closely for its symptoms; in 'The Man Who Mistook His Wife For A Hat', Sacks records his own shock at seeing a Tourettes sufferer for the first time in 1971 (he was nearly 40 at the time, and had been qualified for many years), then seeing three others on the streets of New York the next day, then two more the day after that. I do not know whether the increase in Parkinson's cases 200 years ago described by Sacks could have been the consequence of the type of vogue for diagnoses which Arthur Shapiro roundly criticised in the context of Tourettes. It might have been, it might not. 

However, in my respectful view the possibility that the shock which their systems suffered as a consequence of their involvement with the Industrial Revolution was the cause of, or contributed towards, some of those extra 19th Century Parkinson's sufferers described by Sacks becoming Parkinsonian cannot be discounted (and my apologies for the unwieldy nature of that sentence; you only have to read it, I had to write it). The Industrial Revolution was a horrible environment in which to live, with 18 hour days being routine, slum living conditions, very few employment protections and with the spectre of the workhouse sometimes (often?)  being the only thing keeping you going back to work the next day. I have even come across one example, from Leeds in 1815, of corporal punishment being used in the workplace. For the majority of those who had to live through it, the Industrial Revolution was a thoroughly horrible experience, one of constant struggle and stress. If, however, those conditions and that stress resulted in an increase in the number of cases of either Parkinson's Disease or Parkinsonism, then that presents a high and severe moral for us in our time.

For many years now the imposition of shocks by the state, the use of shock as an instrument of  policy apparently in all aspects of policy, has been so widespread that a few years ago a very clever and thorough Canadian lady named Naomi Klein wrote a book about it called 'The Shock Doctrine'. 

I am not trying to be apocalyptic. I am not suggesting that we run to the hills. I am a Christian, and accordingly the forecasting of catastrophes is above my pay grade. However, we would perhaps do well to consider why our governments set such store in avoiding manifestations of pandemic flu; influenza is famously and exceptionally efficient at insulting the substantia nigra to such a degree that Parkinsonism can develop as a result. By the same token, we live in a society which seems to require anti-depressant drugs in order to function. The effects of some of these drugs can be controversial. There are undoubtedly many people out there whose lives are enhanced by them. However, given that anti-depressants are often used in the treatment of Parkinsonism, it is only fair to note that what I am truly and absolutely sure is an unintended consequence of their prescription could be the arrest of Parkinsonian symptoms in some users.

If what is known as shock therapy continues to be used by governments in the face of what would seem to be the overwhelming burden of evidence that its effects can be wholly detrimental to the governed, in my view even creating a risk that the governed might develop even Parkinson's Disease and Parkinsonism, this does not merely indicate massive bad faith on the part of government, it also makes the avoidance of mass Parkinsonism a political issue. I await the advent of any British politician with the necessary combination of guts and brains to pick up that standard. I feel I might still be waiting some years from now.
As I say, I don't do secular eschatology. My Lord has given me my own burden, and I've spread it around quite enough. Encephalitis lethargica was so shocking to the general public, the presence amongst them of so many people with symptoms that could be mistaken for Tourettes so unsettling, that it was forgotten, as actually were most other expressions of dopamine illness, until Arthur Shapiro, Oliver Sacks and all their most dedicated and humane colleagues helped discover them again.  My own experience of researching dopamine illness has been such that I wish to forget it. Let us hope that those in power who adhere to the application of shock therapy do not forget it. If they do forget it, or have known nothing of it, or have chosen to ignore it, they might not be too pleased at having to deal with the consequences. Realising that you might have seen the future staring back at you from the shaving mirror is a most unattractive thought. 

The neoliberal doctrine which underpins shock therapy might be of the utmost purity; but the neurological trumps the neoliberal every time.



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