- Email: [email protected]
The meaning of detox
DISSECTING ROOM
Doctoring the risk society The meaning of detox
Talking aids
With the festive season over, it must be time for a detox. Regimes of abstinence, purgatives, and enemas are available at “detox camps” in overseas locations and at health farms. But more gentle detox courses, involving dietary supplements and herbal infusions, can now be purchased at every high street chemist. For those who prefer self-help guides, Amazon.co.uk offers more than a hundred detox titles. But what does detox mean? Like many terms that have made their way from medicine into popular parlance, the meaning of the concept of detoxification has changed dramatically in the transition. Once used to refer to the process of extracting poisons from the blood stream, it has now expanded to include diverse forms of therapy purporting to cleanse both mind and body of the polluting effects of life in modern society. Perhaps the most familiar form of detox is in the treatment of alcohol and drug misuse. Here it means replacing one drug with another, such as chlordiazepoxide for alcoholics or methadone for heroin addicts. Of course, both these drugs may be toxic in overdose—and neither alcohol nor heroin are poisonous in themselves. The major appeal of detox lies in its promise to cleanse the body of the residues of pesticides, atmospheric pollutants, and other hazardous chemicals, which are believed by many to be accumulating in the body. The vogue for detox reflects a paradoxical insecurity: though our environment has never been cleaner or safer, many people believe that they are in constant danger of external contamination. Indeed, the quest for enemas and colonic irrigation reveals that, for some, the threat has been internalised: they need to protect themselves against the enemy within their own bowels. For the vulnerable person in our intensely individuated society, the greatest threat comes from other people. So it is no surprise to find that the idea of detox has been extended to “toxic relationships”. Here, self-help writers, counsellors, and therapeutic entrepreneurs find a flourishing market. It is easy to dismiss detox as just another harmless fad. Yet the popularity of the post-Christmas detox reflects a fearful and misanthropic outlook to the year ahead.
Mike Fitzpatrick e-mail: [email protected]
94
arrived at Grand Rounds the other week in the traditional manner— late, and without any idea of the programme. I navigated my way through the rows of medical students sitting on the stairs and brazenly took a seat at the front among the consultants. For an Englishman this is daringly non-hierarchical (I have always been jealous of the friendly Australians who are able to address professors and knights of the realm immediately by their first names.) The speaker was giving a talk he had clearly given a hundred times before, and that he had prepared carefully. It had obviously been thought about, planned, rehearsed, and practised. He spoke from a text that he had clearly spent a lot of time and effort over. He used advanced visual aids: not merely slides and the ubiquitous dark blue and yellow of Powerpoint, but also clips of film. The whole presentation, despite the tradition of superb unpredictability proudly maintained by Grand Round audio-visual technology, passed off smoothly. In short, it should have been unremittingly dull. I remember once arriving early for a lecture and witnessing through glass doors the spectacle of the speaker rehearsing. It made me wince at the prospect of what was going to be a monotonous talk. Just as we will fail to interest the belles and beaus of our amorous dreams if we speak to them from a preprepared text, so we will guarantee a bored audience if we try the same in public. Neither courting nor orating benefit from being deprived of spontaneity. Samuel Taylor Coleridge, whose public talks in London proved so popular they resulted in the invention of the one-way system to cope with the traffic of attendees, spoke so wonderfully because he was absolutely spontaneous. He would think about his subject beforehand but not about his words. He relied on his passion to inspire him. As a result his lectures were
I
riveting to his audiences and completely terrifying to himself. (His latest biographer, Richard Holmes, tells wonderfully the story of how Coleridge would shed more and more layers of clothing, and darken his glass with ever more drops of laudanum, as his talks progressed.) As the Grand Round the other week progressed, the film clips grew ever more painful. One of the greatest stories of modern medicine was being re-told as a fifth-rate piece of melodrama, stuffed so full of cliches and superficialities that the life was squeezed out of it. Somehow the speaker, who had actually lived through it all and was one of the few people in the world placed to give a first hand account of it, felt that the film was good enough to replace him telling us about his experiences. Desdemona fell in love with Othello because she was so moved by the stories he told her about his life; one can’t imagine her responding the same way if he had played her a few clips from Gladiator and said it was “a bit like that only the things they showed didn’t really happen that way”. At the very end, to an audience made sleepy by being postprandial (a word Coleridge coined, incidentally) and pestered by the intermittent bleeping of pagers, the speaker played a final clip. Suddenly he had captured the attention of his audience. It was a montage of memorials to many of those killed by the disease under discussion. The lecture theatre was filled with the rapt silence of a gripped audience. Doctors often use medical meetings to show off their wits or their achievements, but seldom to show off their feelings. For the first time in a hospital since I had listened to a music therapist’s tapes of his last sessions with dying patients, I found myself with tears in my eyes. Some stories mean enough to survive their telling. Druin Burch
THE LANCET • Vol 361 • January 4, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Doctoring the risk society The meaning of detox
Talking aids
With the festive season over, it must be time for a detox. Regimes of abstinence, purgatives, and enemas are available at “detox camps” in overseas locations and at health farms. But more gentle detox courses, involving dietary supplements and herbal infusions, can now be purchased at every high street chemist. For those who prefer self-help guides, Amazon.co.uk offers more than a hundred detox titles. But what does detox mean? Like many terms that have made their way from medicine into popular parlance, the meaning of the concept of detoxification has changed dramatically in the transition. Once used to refer to the process of extracting poisons from the blood stream, it has now expanded to include diverse forms of therapy purporting to cleanse both mind and body of the polluting effects of life in modern society. Perhaps the most familiar form of detox is in the treatment of alcohol and drug misuse. Here it means replacing one drug with another, such as chlordiazepoxide for alcoholics or methadone for heroin addicts. Of course, both these drugs may be toxic in overdose—and neither alcohol nor heroin are poisonous in themselves. The major appeal of detox lies in its promise to cleanse the body of the residues of pesticides, atmospheric pollutants, and other hazardous chemicals, which are believed by many to be accumulating in the body. The vogue for detox reflects a paradoxical insecurity: though our environment has never been cleaner or safer, many people believe that they are in constant danger of external contamination. Indeed, the quest for enemas and colonic irrigation reveals that, for some, the threat has been internalised: they need to protect themselves against the enemy within their own bowels. For the vulnerable person in our intensely individuated society, the greatest threat comes from other people. So it is no surprise to find that the idea of detox has been extended to “toxic relationships”. Here, self-help writers, counsellors, and therapeutic entrepreneurs find a flourishing market. It is easy to dismiss detox as just another harmless fad. Yet the popularity of the post-Christmas detox reflects a fearful and misanthropic outlook to the year ahead.
Mike Fitzpatrick e-mail: [email protected]
94
arrived at Grand Rounds the other week in the traditional manner— late, and without any idea of the programme. I navigated my way through the rows of medical students sitting on the stairs and brazenly took a seat at the front among the consultants. For an Englishman this is daringly non-hierarchical (I have always been jealous of the friendly Australians who are able to address professors and knights of the realm immediately by their first names.) The speaker was giving a talk he had clearly given a hundred times before, and that he had prepared carefully. It had obviously been thought about, planned, rehearsed, and practised. He spoke from a text that he had clearly spent a lot of time and effort over. He used advanced visual aids: not merely slides and the ubiquitous dark blue and yellow of Powerpoint, but also clips of film. The whole presentation, despite the tradition of superb unpredictability proudly maintained by Grand Round audio-visual technology, passed off smoothly. In short, it should have been unremittingly dull. I remember once arriving early for a lecture and witnessing through glass doors the spectacle of the speaker rehearsing. It made me wince at the prospect of what was going to be a monotonous talk. Just as we will fail to interest the belles and beaus of our amorous dreams if we speak to them from a preprepared text, so we will guarantee a bored audience if we try the same in public. Neither courting nor orating benefit from being deprived of spontaneity. Samuel Taylor Coleridge, whose public talks in London proved so popular they resulted in the invention of the one-way system to cope with the traffic of attendees, spoke so wonderfully because he was absolutely spontaneous. He would think about his subject beforehand but not about his words. He relied on his passion to inspire him. As a result his lectures were
I
riveting to his audiences and completely terrifying to himself. (His latest biographer, Richard Holmes, tells wonderfully the story of how Coleridge would shed more and more layers of clothing, and darken his glass with ever more drops of laudanum, as his talks progressed.) As the Grand Round the other week progressed, the film clips grew ever more painful. One of the greatest stories of modern medicine was being re-told as a fifth-rate piece of melodrama, stuffed so full of cliches and superficialities that the life was squeezed out of it. Somehow the speaker, who had actually lived through it all and was one of the few people in the world placed to give a first hand account of it, felt that the film was good enough to replace him telling us about his experiences. Desdemona fell in love with Othello because she was so moved by the stories he told her about his life; one can’t imagine her responding the same way if he had played her a few clips from Gladiator and said it was “a bit like that only the things they showed didn’t really happen that way”. At the very end, to an audience made sleepy by being postprandial (a word Coleridge coined, incidentally) and pestered by the intermittent bleeping of pagers, the speaker played a final clip. Suddenly he had captured the attention of his audience. It was a montage of memorials to many of those killed by the disease under discussion. The lecture theatre was filled with the rapt silence of a gripped audience. Doctors often use medical meetings to show off their wits or their achievements, but seldom to show off their feelings. For the first time in a hospital since I had listened to a music therapist’s tapes of his last sessions with dying patients, I found myself with tears in my eyes. Some stories mean enough to survive their telling. Druin Burch
THE LANCET • Vol 361 • January 4, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.