The Return of the Mum

Love

Shrink Grows Kids is 2 years old! And more exciting things are happening: I have been offered two book deals and am about to sign up with the lovely people at Pan Macmillan for my first ever book. So thank you to everyone who has read and supported my little site. Your reads gave me the confidence to continue and it has led me to things beyond my imagination.

Those who followed my journey from the start may have realised by the tone of some of my blog posts that I started this blog as a child psychiatrist that had been somewhat cast aside by her profession for her decision to work a maximum of 3-days a week such that she could be there for her children. Working so little is highly frowned upon in a profession where apparently working till 10pm and on Saturdays is deemed a standard working week (thanks Mr Hunt). In the battle of children vs career, for me children had to win out.

It’s a tough decision faced by many driven parents and I respect the individual choices made by others even if they differ from mine. For me, I am lucky enough to be married to a banker who pays the mortgage and financially as my post-tax income would have been equivalent to quality childcare, money was negligible in the decision making. Unluckily, being married to a banker means that for much of the time parenting responsibility falls to me as Banker is often out of the house before 06:30am and not back again until 8pm, if he is even in the country. Thus I squarely felt the responsibility of how our children turned out was down to me. As a child psychiatrist who spends days and years hearing and helping children and families that have struggled, it seemed implausible not to at least attempt to practice what I believe and preach: spend time with children.

For quite some years I took positions that allowed me to work a 3-day week by virtue of my being over-qualified and under-paid and saw friends and colleagues speed by in the race to the top. It was not without its frustrations, anger, tears, self-hatred and despair. What was the least anticipated, yet most destructive was the loss of identity. I would never have seen myself as one for airs and graces and felt that I took people on face-value, but it was amazing how naked I felt when stripped of a prestigious job title. Signing on reluctantly for gym membership post-baby fat one time I felt wounded to see that the lady had listened to my description of my work circumstances and had written: Occupation: House-wife/ Doctor.

I had never identified myself as a house-wife. A mother yes, but not a house-wife. I don’t and doubt I ever will darn my husband’s socks (although once my mother-in-law did offer to teach me).

It was with this inkling that I wanted something more that I tentatively set up my blog. Slowly by slowly, with your help, a sense of confidence and purpose grew that even if the system would not support me, I could use my skills to support myself. I started speaking to friends  about work outside of the NHS which although I loved, had rejected me for my lack of ambition/ work-ethic/ dedication because of my insistence on limited hours. We set up a little private practice which has been doing great. This led to more confidence in my ability, to connections and friendships which have led to more and more opportunities, which have eventually culminated into a return to a prestigious NHS position on MY TERMS – 3 days a week. Alongside, the material from my blog has continued to grow, albeit slowly of late, and I am still pinching myself that a publisher is willing to support me in growing it into a book. Never in my wildest dreams did I think that I could or would become a writer.

My horoscope predicted that 2016 could be one of the best years of my life (so be happy all Pisceans) and I am really looking forward to the year. My message to other parents that chose children over career is to say “Believe in yourself”, give it time, you never know where it might lead you and soon you’ll be back on top.

THANKS FOR SUPPORTING MY BLOG.

WATCH THIS SPACE FOR NEWS OF MY BOOK!

Here are some posts from rock bottom that might help:

Dear Me

Advice to My Former Self – Desperate Working Mother of Two Young Children

Did You Get Maternal Adjustment Disorder?
 

 

This Boy Can

This boy can

I love Sport England’s “This Girl Can” campaign to get girls into sport with glossy ads showing ordinary girls and women of all shapes, sizes and colours enjoying sport. Set to high octane music it oozes adrenaline, power, energy and confidence. It’s about sport, but also ultimately about self-esteem. Its underlying message is that women should be confident about themselves and their bodies, which is a great message which is why the campaign has been so acclaimed. There have been a number of other positive Ad Campaigns empowering women to achieve, study maths and science, aim high, aspire and be ambitious. GREAT! Despite all that women have achieved in the last 100 years, I can attest that women still underestimate their ability in the workplace and this media encouragement is totally welcome.

However, it doesn’t work on its own.

How do I know this? Because I, and all girls that were fed through an ambitious, high expectation girls’ school in the nineties already heard this message and were already ambitious and aiming high. We flew the flag, but like the generations before us were cut down to size when we reached the higher echelons of our organisations, or the minute we fell pregnant. Many of us even felt bitter towards the encouragement that we received as young women because we were fed a dream that society could not yet deliver.

The bottom-line is that there is only so much women can change and society’s current solution of “encouraging women to change” (codified in encouraging women to become “more” confident/ ambitious/ this-that-and-the-other) in order to fit into pre-existing male oriented organisations and structures has not worked. Not only has it not worked, but it continues to perpetuate the myth that the reason that inequality has not yet been achieved is because women have not put in enough effort into changing “they do not put themselves forward”, “they shy away from leadership positions”, “they choose to opt out”. The implication is still “Women are not good enough”.

This perspective turns a blind eye to the fact that it is also institutions and their cultures that need changing. Women are being put off by bullying and macho cultures exemplified but not limited to the goings-on in British politics (men are driven to suicide by it, so why would women want to engage?).

And, if society wishes there to be a next generation, SOMEONE needs to look after the children. For many of us, we believe this strongly and fundamentally should be parents. If we continue to one-sidedly empower girls and women to take on rewarding and powerful careers, what is society’s solution to “parenting” and “family-life”?

What is the solution?

It may not seem attractive at first (but isn’t it the job of slick Madmen to make it so?), but I believe that for every “This Girl Can” ad that goes out; there should also be a “This Boy Can” ad. Footage of boys crying, talking about their emotions, helping another child, reading, drawing, dancing, dressing up as a Princess. Footage of men sticking on plasters, listening to the ideas of their female colleagues, talking to their daughters, nursing their elderly parents, helping children with their homework, picking up children from school, doing the laundry, cleaning the house, cooking the family dinner. These latter activities are the really important things that keep Britain going. The Engine of Britain is not just the boardroom, but the living room, dining room and kitchens across the country. Without the domestic engines, no one could get to work. As long as these activities, pivotal to family life, are undervalued and represented as “female” or lower order tasks, there can be no escape for women from the home and no “respect” for women overall.

Many boys and men already do these things and they need to know that their efforts are appreciated and the ones that are not doing these things need to be empowered and enabled to do so, else any women’s empowerment program will be futile. As long as we continue to view ambition, aspiration, hard-work, determination and ruthlessness as the only virtues worth rewarding and publicising, we are devaluing and undermining the equally valuable virtues of compassion, loyalty, understanding and sensitivity. As such we marginalise the fantastic people who possess these traits and create future generations with warped and unbalanced ideals. Much as I applaud campaigns to improve body confidence, body image problems in women will continue to be problematic as long as there are men who objectify women. While empowering girls is good, we must also focus on educating boys, and I feel that this part is lacking.

Whilst many may feel that traits are gender specific (typically masculine: ambition, determination etc.; and feminine: compassion, empathy etc.). I don’t believe this to be the case but that from a young age children are taught to emphasize these traits within themselves and suppress other traits to conform to gender expectations. While great Ad Campaigns like “This Girl Can” try to address this imbalance for girls, what we desperately need in concert is a “This Boy Can” campaign to empower boys to truly be themselves.

I really hope that someone steps up to the mantel and does it.

What makes a child anti-social?

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The media is full of the rise of anti-social behaviour (e.g. violence, aggression, bullying, fighting, lying, stealing, vandalism, fire-setting, drug and alcohol abuse, cruelty to animals) in children and youth offending, but what is the cause of childhood antisocial behaviour and are all anti-social children the same? What is the role of parenting?

Are all anti-social children the same?

There is evidence that not all children with anti-social behaviour are the same. Some children may show a phase of anti-social behaviour in adolescence but this passes and they settle down in adulthood. Far more concerning are children with a life-long tendency to anti-social behaviour. These children tend to be anti-social from a younger age and behaviour is more extreme (e.g. cruelty to animals at age 5 years), but even amongst these children there is evidence of different subgroups. Much research is focused on differentiating groups of anti-social children to see if we can better understand them.

One differentiating factor found is lack of empathy. Empathy is the ability to share someone else’s feelings and experiences by imagining what it would be like to be in that person’s situation. Psychologically speaking, this requires two different types of processes: a “thinking” part: the ability to see things from another person’s point of view; and secondly a “feeling” part: the ability to recognise emotion in others and to feel it in oneself. People without empathy are described as being callous and unemotional. To be anti-social, violent or aggressive is easy if you do not empathise with the victim, so it is no surprise that >90% of children with callous-unemotional traits are involved in some form of anti-social behaviour.

How does empathy affect anti-social behaviour?

Researchers have been interested in children that lack empathy for a while now because of its links to extreme anti-social behaviour, and the definition of “psychopathy/ sociopathy” (this is a criminal justice not mental health term) includes having this lack of empathy. The childhood precursor to this psychopathy label is “callous-unemotional traits” (as it is pretty harsh and pessimistic to label kids as psychopaths), and even this terminology has recently been rebranded as “limited prosocial intent” so that it sounds less pejorative; but this is just semantics, we are essentially talking about the same thing: people that have shallow feelings with lack of empathy and guilt.

My colleague, Essi Viding does research into these traits and wrote a great summary paper (2012), the findings of which I wanted to share as I thought it was fascinating. It turns out that if you study ASBO kids (kids with anti-social behaviour), you will find that 50% of them have these callous-unemotional traits. These children don’t really care about others’ feelings and tend to show no remorse for wrong-doing. It is this group of kids that have the most serious and long lasting problems.

What is the difference then psychologically and biologically between children that commit antisocial behaviour with and without empathy?

In experiments where anti-social kids are hooked up to show responses (for instance heart, skin and eye-tracking monitors or brain scans) to photos/ voice recordings of other people in pain or grief, the children with callous-unemotional traits showed no or reduced physical or brain response. Most people will wince in shared pain if shown pictures or exposed to sounds of others in pain, but these children don’t. When these children were asked to play a game where not following the rules led to punishment, they continued to flaunt the rules and did not seem to learn from punishment. There is biological support for these findings with differences in brain scans in areas of the brain linked to emotion processing and reinforcement learning pathways in callous anti-social children.

In contrast, the anti-social children with empathy showed the same aversive responses as children not involved in anti-social behaviour to pictures and sounds of pain and grief, and learnt quickly from punishment. However when they are shown threatening faces, they over-respond with emotion and when they are shown neutral and ambiguous facial expressions, they identified them as being threatening. Brain scans back up these differences. The anti-social children with empathy tended to have abnormal amygdala development. This is the area of the brain involved in fear and anxiety processing. These anti-social children have normal empathy but have a heightened awareness of threat, which explains why they perceive neutral faces as threatening. In a world where everyone is viewed as threatening, hostile or an enemy, it can make sense to be combative, aggressive and violent. This is that bully in the playground that says “Are you looking at me?” – when you weren’t even looking at them.

Genetic studies have also supported this divide, finding that there is strong inheritance of callous nature, whereas anti-social behaviour without callousness was not inherited but generated by environmental factors such as harsh or inadequate parenting, or an interplay between these environmental factors and genes associated with anxiety or heightened emotion.

Finally, it has also been found that the children in the different groups respond differently to parenting strategies. Punishment and traditional sanction-based strategies (time-out, withdrawal of privileges) works well for empathic anti-social children, but has no effect on callous children. Callous children only respond to positive reinforcement (praise) and rewards.

What causes anti-social behaviour?

This type of evidence has led to different theoretical models for two groups of children involved in anti-social behaviour.

Group 1: Genetic predisposition. Antisocial and callous kids: these children are thought to lack empathy as they do not find other people’s distress aversive and because they fail to be able to learn from punishment. It is easy to be aggressive and cruel if you are unable to feel guilt and if the suffering of others doesn’t bother you. It is easy to continue to behave in this way life-long if you are unable to learn from punishment. These difficulties are often inherited in brain structure.

Group 2: Environmental Causation: Anti-social but not callous kids: these children have abnormal socialisation because they have a heightened sense of threat, and view the world as hostile towards them. They exhibit aggression and cruelty as a result of living in unstable and threatening environments which has shaped their brains and psychology to respond in this way as a means of coping and survival. Their anti-social behaviour is often in the context of a peer group within which there is support and empathy.

What has this got to do with parenting?

Whether we like it or not, parents are the first line defence against anti-social behaviour in society. By better understanding the causes of anti-social behaviour and by understanding our children, we can best adapt our parenting to prevent our children becoming anti-social. Although children in group 1 with genetic predisposition are the more difficult to help, they can be supported by fostering self-esteem. They will respond better to motivation to act in a pro-social way, rather than harsh punishment which will not deter them. Anti-social behaviour in children with empathy can be prevented by strong loving families that place appropriate boundaries and sanctions. For these children, wider society has a great role to play in generating or preventing anti-social behaviour, as tolerant, peaceful and accepting societies can offer protection whilst violent, unstable and alienating societies can fuel them.

Reference:
Anti-social behaviour in children with and without callous-unemotional traits. Viding et al. (2012) Journal of the Royal Society of Medicine. 195-200.

Patchwork Childcare

patchwork_fabric_patchwork_quilt_235498

Whoa! Where did September go?

Apologies for going quiet for a month but things have been hectic, what with school start, new job and September being conference season for child psychiatrists. The last month has been about patch working childcare and prioritising, which sadly meant no time to blog. I’m hoping that it will calm down a bit now that October is here. Phew!

Unfortunately the new and hard won London NHS Consultant job has meant that I can no longer drop off the children at school on the 3 days a week that I work. I am not quite sure who worked out the logistics that school should start at 8:50 am, and work should start at 9am, because who in London can get to work in 10 minutes….? And which childminder would want to come for just an hour of work in the morning to take children to school?

Then there was the afterschool care. I am lucky that my mother has always taken the children 2 days a week after school. I say, “lucky” – but of course, luck has little to do with it. I purposefully moved home to the other side of London from my job expressly for this purpose so I have to endure a 75 minute commute each way. I just had one afternoon to fill, so a Nanny or Au Pair was not needed, and I had fought hard to get a part-time job to stave off this need for full-time childcare. After meeting a few young ladies over the summer that might have potentially been able to take the kids after school a day a week, I settled on one and sat on my laurels thinking the problem was solved. One week before school start and I text to confirm arrangements, only she has disappeared off the face of the earth. I suddenly felt immensely sick that just as I was about to return to “a career” where I had left off, I was struck down again by the nagging problem “who will look after my kids?”

I thought about starting a breakfast club at the school with a rota of parents or paying a parent of another child in Big Sis or Lil Bro’s class to take them. I looked into which other parents might be interested. And as each cock-a-mamy plan fell through, the same sinking feeling. It was then that I had my revelation. The solution was so simple that looking back I cannot believe that I didn’t think of it immediately.

Before I tell you the solution, I want to share with you an old brain teaser:

A teenage boy who grew up having never met his father has a terrible road traffic accident. He is rushed to hospital and straight into emergency theatre, the surgeons gather around ready to operate, but just then the lead surgeon looks at the boy’s face and gasps saying “I can’t operate, this is my son”. What has happened?

Before you make some sort of long winded reply about how the surgeon recognised the boy to be his son because they looked so similar, I will tell you that the answer is that the surgeon is the boy’s mother. Yes, a FEMALE lead surgeon.

And so, you can see how many of us can be blinded by gender stereotypes. Hopefully, you might fathom that my solution to my childcare problems was to make Banker involved. Yes – men can do childcare! He was made to drop the children at school, at least one of the days I was at work, and also told to make arrangements for the children to go to after school club once a week. Why should I be the only one suffering an ulcer over this?

Just as I was taken aback by my realisation that fathers could actually contribute to regular weekly childcare duties, rather than just at the weekend, he too was surprised to be asked! I am amazed that he had sat through my endless rantings of “maybe we could pay so-and-so to take the children”, without once suggesting that part of this responsibility was his, and he could offer a solution. There ensued of course the typical grumblings… “important job”… “impossible” … “money” … “promotion”… “blah” … “blah” …”blah”.

However, I was lucky enough to know that one of his colleagues was able to wrangle a late start to drop his children off at school a few days a week. You see this colleague had just spent a tonne of money fighting for shared custody of his children following a divorce such that he could have the privilege of taking them to school half of the week. So I pointed out to my darling banker that I was offering him exactly this privilege without the expense of divorce and custody battle. Bargain!

Humour aside though, surely childcare arrangements are a shared responsibility, why does it so often fall to mothers? Even when fathers are doing childcare, it is because the mothers have told them to do so and given them explicit instructions of where things are and what to do. I for one would like some time off from the thinking and planning as well as the doing. And how come good divorced fathers are so great at arranging time off “important” work to be with their kids?

Contentious, but I will put it out there just for contention: Maybe if they had always done so they mightn’t be divorced?

 

A Room of One’s Own

Room

I’m writing from the eaves of the in-laws’ farmhouse in the middle of nowhere in rural France. Sunlight is pouring in from the mosquito netted windows where the shutters, traditional of the region, have been flung open against the two foot thick walls.

Outside, set against the gently undulating silver of wheat fields that form patchworks with the bright-yellow of the sunflower fields, a blue oasis nestles like a magnet to small brown children. I can hear their high pitched squeals and splashes of water as they cannon-ball/ dive/ slide/ leap into their granny’s pool. The sun is forever shining; the ipad-hardened eyes of gritty-city children have opened to the simple delights of warm weather and water. This is not the chlorine infused, electrically heated sanatorium-like institutions where they are used to being drilled to swim strokes, but a splashing/ shouting/ dive-bombing free-for-all under the semi-watchful eye of Banker relaxing on a sun lounger.

And the best part?

I don’t have to be there.

I can hole up in a room of my own with my laptop. I feel I can only now truly understand Virginia’s sentiments.

September is upon us and I wonder if there are other parents out there like me who are finally feeling free? Feeling that for the most part the intensive back-breaking part of our job as a parent has been broken. The start-up we started has flourished and is headed for break-even. That we can finally breathe.

This time last year, I was still weighted with nervous anticipation about how Lil Bro would fair at school and mourning the loss of small kissable feet and their replacement with sweaty ones laden with verrucas. This year, having seen Lil Bro gain in confidence and social skill over the last year and Big Sis continue to thrive, I feel differently; almost as if a weight has been lifted; a strange mixture of relief, freedom and entitlement. As the kids approach 8 and 6 years, not even the most chauvinist can dare say that their needs now require the “maternal” instinct. Having given up sleep, life and career for the best part of a decade, I feel excitement that these next years might be my time to reclaim my life. That “me-time” that had been consigned to history might actually make a re-appearance and that I might actually be able to take time to feed my soul with books, art, writing rather than my children broccoli, cucumber and disliked super-foods. Requisite selflessness can now secede into my more natural selfish position.

That yoga class, that recipe, that job opportunity, those designer clothes, that hair-cut, that book I meant to write. That woman I meant to be. It now seems so much more possible. I would have shouted it to the roof tops “THERE IS LIGHT AT THE END OF THE TUNNEL!”, had I not known it to be inhabited by a family of loirs.

Then in strops Big Sis, wet and dripping, fresh from the pool; a vision in pink which is now “so babyish” but whose body had failed to grow as quickly as her attitudes meaning that she is still forced by me to wear the pink goggles, swimming costume and flip flops. She is closely followed by a trail of wet footprints.

Big Sis: Where’s my towel?

Me: I don’t know. Where did you leave it when you last used it?

Big Sis: I dunno

Me: Well, where did your father say it was?

Big Sis: I didn’t ask him. I came to ask you.

Me [incredulous]: You walked 50 metres from the pool where your father was and where your towel is most likely to be, to ask me hiding up a flight of stairs on my laptop having been nowhere near the pool today where your towel is because you think I might know?!!

AAARGGGH!

Did I say a light at the end of the tunnel? I meant a firefly…

Pool

Where the Tiger Mothers are

tigger

Since Amy Chua’s book on tiger parenting exposed the prevalent Chinese ethos in parenting, life has been hard. It’s impossible for a Chinese parent to have a child play well at a music concert without arched eyebrows from other parents thinking “Well, she must make them practice till all hours” and a good class report cannot go by without mutterings of “Well, her children must be tutored beyond belief”. Indeed, parents have come up to me in the school playground specifically to ask my advice about tutors, when anyone who reads my blog knows, I am anti professional tuition and am resisting the pressure to get a tutor and certainly know no tutors (although I reserve the right to crumble to the tutor fad closer to 11+!). Come parents evening, I generally nod obediently and keep my mouth shut, cowering behind Banker and poke him into action to ask the questions that we want answered lest the teacher labels me as “That typical Chinese tiger mother”. Banker, being Caucasian is allowed to ask questions about the children’s education without prejudice.

It was a surprise then that I recently encountered where the Caucasian Tiger Mothers are.

Ballet.

Big Sis recently sat a ballet exam. I am ambivalent on the issue of ballet. I have to confess that I did arrange for Big Sis to start ballet at age 3 years as who can resist the cuteness of little dumpling girls toddling about in pink tutus? I presumed that by age 7 years, she would have grown out of it as the discipline, the classical music and the strictness, didn’t seem to me to be overtly appealing to children. I thought she may have asked to change to drama or street dance, which are probably my preferences and were alternative options that I have muted each year. But no, Madam loves ballet. So I dutifully send her each week and give her due encouragement, and I attend the ballet shows and clap enthusiastically, but all the while thinking to myself: when will she get fed up of this as I don’t want her pursuing ballet seriously and developing an eating disorder in adolescence. It’s a prejudice I know, but for me ballet and eating disorders are just linked in my brain, and given a preference I’d like to think that Big Sis would’ve said “yes” to rocking out with the Skater Boy rather than ruefully going to his concert in years to come.

Big Sis and I ran like a pair of insane loons to this ballet exam, as typically we were LATE. Big Sis had her hair in a pony-tail, only by now, it was all tumbling out and her face was sweating like a pig from having been told to run like a madman or face a telling off by a stern Russian for tardiness. Big Sis was wearing white school socks instead of tights as it was a baking hot day and who wants to wear tights in the heat? Big Sis and I had just stuffed our faces with chocolate digestives because we were a bit peckish and crumbs tumbled from pink taffeta as we barreled in through the doors huffing and puffing.

When we arrived, we were met by the other girls and parents. 90% of the girls were tall, blond and with thigh girth smaller than my arms. Every girl without exception had their hair neatly pulled back into a perfect bun. Gel, wax and constellations of Kirby grips took a vice like hold on hair lest a strand fall out of place. Most of the girls had a full face of make-up on; they all wore tights not crumbs. Oops, was there a memo I missed about a dress code or were we to have intuited this? Parents fussed about and guided the girls as they dutifully underwent elaborate warm up stretches in the corridor. Meanwhile Big Sis stood in the corner fanning her sweaty nose.

“Phew” I said. “They’re running late so we haven’t missed it. We were running, now we are sweating like pigs.” I attempted to explain to another parent.

Arched eyebrows at my disorganization and pitying smiles from other parents, and I got the sense that I had not correctly judged the seriousness of this ballet exam. Then, what I hadn’t anticipated. The Spanish inquisition:

“So when did Big Sis move into this ballet class?”

“Are you sure she is at the correct exam? Some of her class mates were being examined in the earlier exam.”

“My daughter is doing ballet 3 times a week. How many times a week is Big Sis doing ballet?”

And so on.

As I muttered “I dunno. We came at the time we were told”, I started to feel perplexed about this excessive interest into what I felt to be an irrelevant extra-curricular activity that I was forced to enthuse about because my kid found it fun. Then I began to feel a strange sense of familiarity at the questions I was being asked. These questions were recognizable and I and others I know have asked these questions before. They were just like the questions Chinese parents ask each other about maths and English exams!

“So how long has your child been at Kumon?”

“Which grade piano is your child taking this year?”

“How many times a week do you set them extra maths homework?”

If and when my kids are required to sit for academic exams, you can bet that we would be early, sitting outside the exam hall probably swotting up on home-made exam cards of some description.

I smiled.

So this is where the white Tiger Mothers hang out.

It’s sort of cool to feel vindication and that it is not just the Chinese that are a tad pushy after all. It’s just that for the Chinese the focus of achievement is on academics and music, whilst for Westerners it’s sport. Banker recalls similar parents at swim meets when he swam in junior national swim teams in South Africa. Many of his team mates rebelled against their ambitious parents and refused to continue swimming in adolescence because of it. It’s funny that I am sure that Judy Murray (and any parent of a top athlete) did her fair share of threatening, cajoling and bribing her sons to get out of bed and get to training for long hours when they didn’t want to, yet she is a national treasure, whilst a parent that used similar parenting practices to target academic achievement would be vilified.

Having initially felt intimidated and antagonized, I felt serenely at one with these other parents. Still, as a Chinese parent I can’t for the life of me understand why ballet should be the target of such efforts. At least with academics, half-hearted success at maths will still land your child a decent job, whilst even the top students in a ballet (or any sports) class are unlikely to make a career of it…

Each to their own I guess.

We need to talk about weight

Eating rocky road

I recently read an article from the British Medical Association which advised that obesity in children needed to be tackled by all doctors, teachers and social workers, much in the same way as child protection matters; that the crisis in childhood obesity was such that it was beyond something that only health professionals should help manage.

The facts on childhood obesity and its negative impact on health outcomes are overwhelming. In 2012 almost 30% of children aged 2-15 years were estimated to be obese (Solmi 2015); and childhood obesity is associated with adult obesity and negative outcomes including diabetes, heart disease, stroke, asthma, polycystic ovaries, joint problems, poor mental health and cancer (Solmi 2015). Worryingly, with the increase in children’s waistlines, some of these conditions, only associated with adult poor health when I was at medical school (e.g. type 2 diabetes), are now regularly seen in childhood and adolescence (Solmi 2015).

And yet, as a clinician who is aware of all this, I still find it hard to do what the British Medical Association advises me to do. How exactly do I tell a teenage girl presenting with depression and low self-esteem in my clinic “Err, by the way, on top of everything else, you are over-weight.” You can see why that might not go down so well. Of course, if a child brings it up themselves, we jump at the chance to provide help, and in instances where children are clearly obese, I muster the courage to bring it forward as an issue, but where a child is just “overweight” rather an obese; I struggle to bring it up if it is not brought forward as an issue. Who wants angry parents shouting “We came here for your advice on mental health and you tell us our son is fat?” It’s not necessarily how I’d like to spend a morning, and yet, the best prevention for obesity is to curtail problems at this “over-weight” point before “obesity” has set in and psychological and behavioural patterns are entrenched. A quick consult of my medical colleagues and they say the same, unless the condition being consulted on is related to obesity, it is not brought forward routinely. Not many GPs are saying “Here’s the antibiotic for your chest infection, and by the way, I notice you are overweight so would you like a diet plan too?” I wonder if any teachers are actively calling out students and advising them of their weight issues, I would think that that was also pretty hard. Yet, if people in frontline contact with children getting increasingly poorer in health before their eyes do not stop to notify or intervene, what hope is there for prevention? Further as overweight children become the norm, we start to adjust our markers of normality and children who on measurement are overweight go unnoticed.

The issue of weight is a tricky one because of the links between weight, body image and self-esteem. Can you inform someone of their increasingly dangerous weight without affecting their self-esteem? If my own cowardly inaction is representative of most people, it would seem that most people think that you cannot; and there is a strong public perception that preserving self-esteem is more critical than informing someone that their current lifestyle choices may lead them to an early grave. The fear of precipitating low self-esteem and an eating disorder tends to ride high in people’s minds. Yet the prevalence of eating disorders is minute compared to the overwhelming problem of obesity. Reports indicate that even amongst the most at risk groups (females aged 10-19) the highest reported rates of anorexia only reach 34.6 per 100 000 population and bulimia 35.8 per 100 000. Do the maths, and that’s less than 1% of the population compared to 30% suffering from obesity.

The weight issue came up for me a few years back. My frugal upbringing meant that I grew up with the mantra of “Finish everything on your plate” and wasting food was a cardinal sin. I was denied chocolates and cakes, not because of worries about the waistline but purely because my parents couldn’t afford treats. The two unfortunate consequences of this upbringing on my own parenting were a) I continued my parents’ line of a waste not want not attitude to food; but b) I wanted to indulge my children with the cakes I never had.

So it shouldn’t have been such a surprise when Big Sis came home with the school health visitor card showing that she was 50th percentile for height but 75th percentile on weight; but it was a big surprise to me (it is optimal health-wise to be on the same percentile for weight as height). In my eyes, she did not look in any way over weight, yet, on paper, her percentiles were heading that way. When I told other mums about it, they all without fail thought denial was an appropriate option. “No, she’s fine, you shouldn’t worry.”; “It’s a mistake” or “You mustn’t let her know.” The thing was, I wasn’t worried, but there was no way that I was going to be in denial about it, and I worry that this type of supportive advice from other parents whilst well-intentioned is counter-productive. It may dissuade parents from taking action and lead to a false sense of security.

That night as Banker piled Big Sis’ plate up high with pasta and insisted she finish it as it was a waste to leave it, I made skewed eyes at him and squeaked side-ways out of my mouth “She doesn’t have to. If she’s full, she doesn’t have to finish it.” From then on, I consciously ensured that there were more healthy snacks around the house and *tried* to curtail the grandparents’ habit of allowing children free reign to chocolate and Oreos. The whole family got involved in more sport at the weekends. It wasn’t a big deal, but it needed to be in my consciousness so I could act. I don’t think that Big Sis’s self-esteem is linked to her weight and I hope to prevent it ever becoming so.

I do wish that we could talk more openly about weight without hurting people’s feelings. I hope that one day society can move towards consciously uncoupling self-esteem from weight; and weight can become a purely physical health concern (like a verruca?), and maybe then doctors, teachers and parents could better prevent this major and deadly health problem.

References:

Currin, Schmidt, Treasure & Jick. Time trends in eating disorder incidence. The British Journal of Psychiatry Jan 2005, 186 (2) 132-135.

Solmi & Morris. Association between childhood obesity and use of regular medications in the UK: longitudinal cohort study of children aged 5–11 years. BMJ Open 2015

 

Shrink grows kids at 18 months

Signposts

When I started blogging 18 months ago, it was my escape from becoming a desperate housewife. I never expected still to be writing 18 months down the line, yet here I am. Not only am I still at it, but last week I was signed by a literary agent for my parenting book proposal! How cool is that? OK, it is not a book deal yet, but it is a foot on the first rung of the ladder.

Some of you may have noticed that my posts are now fortnightly rather than weekly, and this is down to the explosion of work that has suddenly appeared from nowhere. It would seem that life works in mysterious ways and after a very low two years of feeling pointless and rejected by my chosen profession I am somehow now back in the game. Don’t ask me how that happened. One minute I am being told that “No London teaching hospital will employ you for less than 4 days a week” and “You have a negative reputation for being forthright and assertive and reputations are hard to shift”, so I have been sat at home in my pyjamas twiddling my thumbs and watching “Loose Women”; and the next minute I’ve got sessions at 3 London teaching hospitals (including Great Ormond Street) that still fit around me being able to pick up the kids from school twice a week, medical students to supervise, private patients backed up a month and now a book to write. Phew!

So I hope you will forgive the erratic postings, and I am ever so grateful for all the regular readers of my blog for helping make the book opportunity happen. Without your support I would never have had the confidence to put a book proposal out there. All comments, follows, likes and shares are greatly appreciated.

THANK YOU!

For those new to this site, here’s what I mainly write about:

Gender issues

porridge

Parenting

Incredible years

My parenting hiccups

bag6

Science

Fire engine

Education

Maths

and feminism

Lego men

Sense about science on children’s allergies

Meat cake

Last week I was pleased to hear about the Sense about Science  report on children’s food allergies which stated the scientific misconceptions regarding food allergies and their prevalence. It would seem from the school playground that every other child has some form of food allergy or intolerance and from the hysterical behaviour of some parents that their darling offspring are at constant threat of anaphylactic death. One study in the Sense about Science report stated that whilst 34% of parents said their child had an allergy, only 5% actually did. Worryingly, the report suggests that many children are suffering from malnutrition due to exclusion diets, often initiated on whims and estimates rather than on hard evidence.

You can take it as read that I am a non-believer in food allergy and intolerance being the harbinger of learning difficulties, inattention, anxiety, bad behaviour and the other ills that some people believe. In fact, aside from coeliac disease which is a bona fide gut condition where gluten should be excluded from the diet, I don’t really buy into intolerance at all. You could say that I have an intolerance for intolerance. I’m sure that it does exist in some people in severe and debilitating form, but I am also sure that for most people who claim to be intolerant of something that a bit of bloating and flatulence do not a disorder make.

Typical then that Lil Bro should have a list of allergies as long as my arm.

It started with a spot of eczema on his forehead when he was 3 months old. Despite plenty of emollient creams, by 4 months it had spread to his cheeks and become wet and weepy eczema. I was concerned about infection and he was treated with antibiotics. It didn’t go away. The GP suggested that I cut out dairy, eggs and nuts from my diet as I was breastfeeding. I duly did this albeit reluctantly as I am an avid consumer of milky teas and cake and get quite grumpy when both are denied.

Nothing much happened even on this exclusion diet. Lil Bro’s eczema got worse. He was prescribed a second course of anti-biotics.  On Valentine’s day evening, Banker and I abandoned our romantic dinner plans to spend the evening in A&E as Lil Bro was covered in raw-red wet and weepy rash from scalp to toe. Was it an allergic reaction to the anti-biotics I had wondered?

His scalp to toe eczema continued despite applications of weak steroid creams. My beautiful baby boy had skin that was painful to look at, the facial eczema being the worst. Despite twice daily emollient applications and infrequent oily baths, it didn’t get better. At night time, despite short nails and gloves on his hands, he would scratch himself till he bled, and I could hear his wriggling and itching movements in his cot constantly. Often I lay awake tearful holding him in my arms to sleep so that I could prevent his scratching. The final straw was when one time I was driving and I could hear him crying in the baby seat behind. By the time I had pulled over, his face was covered in blood as he had scratched himself across the face where the eczema had been red and raw.

I took him to see Dr Atherton at Great Ormond Street Hospital. A friend who worked at GOSH as a Consultant advised me that he was the best dermatologist in the country. Lil Bro was prescribed wet wraps and Protopic cream. The small print on Protopic mentions a risk of cancer, but Dr Atherton assured me that this was small print and quoted the statistical risks. I was happy to go with the medication, I was desperate. It helped stabilise the eczema, but it by no means got rid of it. Lil Bro was wet wrapped for a total of 6 weeks. Dr Atherton had mentioned that most parents gave up by 3 weeks and was surprised when at 6 weeks, Lil Bro was still in full body wet wrap. I confessed though that I was at breaking point, but at least Lil Bro’s eczema was under some control. Skin was red, but no longer wet and weepy. The wet wrapping, as well as soothing the itch also prevented any skin damage from scratching. The twice daily wet wrapping though was getting me down. Lil Bro was basically bandaged like a mummy all day. I refused to let wet wrapping ruin Lil Bro’s life. I looked into his beautiful, brown eyes that poked out from the bandages with all my love, and often, being the sweet darling baby that he was, he beamed back. Despite his troubles, he was the sweetest, happiest child. We went to mother and baby groups, and it didn’t bother me if children asked me why he was wearing a mask (which was like a balaclava made of dressing material), they just seemed curious. Big Sis had no problem with the mask at all, but it sometimes got a bit much when other parents came up to me with their little ones saying that they wanted their child to play with him so that they could be “accepting of children who were different”. Other people asked me if I put the mask on him because it was cold. I really didn’t understand these people – did they think that I thought bandages were a substitute for a hat and scarf…?

Dr Atherton recommended an allergist Professor Gideon Lack. I asked around my medical colleagues and confirmation came that Professor Gideon Lack was the best allergy specialist in the country. His prodigy Dr Adam Fox is now often in the media as the go-to allergy specialist, but why go to the doctor when you can see the Professor? By the time we saw Gideon Lack, I was pretty sure that Lil Bro had food allergies. Having breast fed for 6 months, I tried to wean him onto formula. After several desperate attempts that resulted in wholesale visceral rejection of formula (cow’s milk and soya) our food allergy fears were confirmed in skin prick tests and blood tests. Along with allergies to milk, eggs, all nuts, all seeds and soya, he was also testing allergic to wheat, beans, peas, pulses, lentils, banana and kiwi. Professor Lack was sceptical about the wheat allergy as this is very rare. He advised us to try him on wheat pasta at home. We did, and wheals appeared almost immediately on ingestion confirming a positive allergy to wheat. Lil Bro was prescribed Neocate formula, a disgusting tasting blend of amino acids that only the truly allergic could stand. Once Lil Bro started on this formula, his skin came under control without wet wrapping.

The funny thing about being told that Lil Bro had allergies was that my first concern was not about his health and diet, but about his psychological outcome. Maybe this is not so strange, but a consequence of my profession and prejudice. My first thoughts were: I don’t want him to be the skinny, snivelling, wimpy kid that has to sit out of football games puffing on an inhaler or sit in the corner of birthday parties telling people how he can’t eat things while eating his own carrot sticks from a paper bag brought from home.  I wanted him to be a participater, a life-enjoyer. I want his allergies to have no bearing on his life at all.

Thankfully, as we saw a leading expert in the field, we were given expert advice, which I fear is not given to the majority of parents. Whilst we were given Epipens, we were explicitly told that the likelihood that he would have an anaphylactic reaction was only to peanuts and that this risk amounted to the risk of being run over by a car (i.e. not very likely). We were explicitly told that the majority of children outgrow all their food allergies by adulthood, save for peanut allergy which only resolves in 20%. We were told that the skin prick tests and blood tests are grossly unreliable and are mere rough markers for what may or may not be an allergy and that if a child was able to eat the food without a reaction within 2 hours; then they were probably not allergic to it at all. Lil Bro tested positive on blood and skin prick tests for many other things such as corn, but we knew that he had had no allergic reaction on physically eating this and so could not be allergic to it. We were encouraged to continue to allow him to eat all the things he could eat without a reaction. We were told that the jury was out on exclusion as being the best course of practice and that clinical trials for exposure and desensitization were ongoing. That there was a possibility that exposure could actually help not hinder overcoming allergies.

It is amazing how little one can eat, if you have to exclude the list of food that Lil Bro was allergic to. The majority of dairy-free products substitute milk with soya, which was no good for Lil Bro either. Who would have known that meat pastes and pates usually contain soya? At home it was possible to concoct a meat and two veg type meal and we joked about his Chinese and Irish heritage as rice and potatoes were his main starch staple given bread and pasta were out of the window. It was travelling that was tough. But as I mentioned we were not going to let allergies hold him back, and we travelled widely with our suitcases stuffed full of oat cakes, tins of tuna and sweet corn; staples that we knew he could eat, if push came to shove and we couldn’t find anything for him. For his first birthday, as I couldn’t fathom how a cake could be made without flour, eggs, butter or milk, we bought a hefty joint of beef and wrapped it in a cake frill and stuck a candle on top. It was important to me that he was going to enjoy his birthday cake! Later, I found a decent recipe for a wheat, egg and dairy free chocolate cake that involved pureed prunes and his second and third birthday cakes were sorted.

As was foretold, Lil Bro outgrew many of his allergies. On an annual basis, we tested his allergies and if ever we were told there might be a possibility that he had outgrown an allergy, we billed our insurance company for a food challenge. The elation of overcoming the soya allergy at 2 years was only off-set by failing to outgrow his wheat allergy, but, slowly by slowly, the list of contraband food grew slimmer and slimmer. I watched carefully at the conduct of food challenges that took place in hospitals, and for a few items on Lil Bro’s list; I conducted food challenges at home. The sooner Lil Bro could eat a normal diet the better, and the annual NHS appointments that we had were not soon enough for me. If he could eat something, I wanted him to be eating it. Lil Bro still has an allergy to cow’s milk. This shows on skin prick and blood test, but from home food challenges, we know for a fact that he is able to eat milk that has been thoroughly cooked, although he still reacts to a few sips of a glass of milk. Home food challenges were not advised by the hospital, and I am not advising other parents do this (I am after all a doctor). In fact, I am frequently chastised by the hospital nursing staff “Why did I want to take the risk with a home food challenge?”, but the sight of Lil Bro tucking into a crème brulee, which is his favourite food, is enough justification for me. Why should he miss out? Lil Bro’s current allergies are now only peanuts, cashew nuts, pistachios, raw egg and uncooked milk. He enjoys a varied diet including all the nuts that he was previously allergic to: almonds, hazelnuts, pecans, walnuts and brazils. He has not a spot of eczema on him and only rarely uses an inhaler.

What has puzzled me is the attitude of some parents. Coming from a standpoint of having a child who could eat virtually nothing, and the immense strain on family life that this caused, I found it difficult to understand why anyone would want to inflict this on their families without strong evidence that it was indicated by allergic reaction. Yet many parents seem to be rushing to exclude vital food groups from their children’s and entire family’s diet. In the allergy clinic waiting room, there is almost a frenzied competitive element to the number of allergies your child has, whereas for me, I’d give anything to be the loser in that competition and have Lil Bro be able to eat anything he wanted. I can only imagine that some people don’t enjoy food as much as I do. For me food is life. People that enjoy food tend to enjoy life, and I intend for Lil Bro to enjoy his.

I am not an allergy specialist, I am just writing about my experience, but please check out the Sense about Science website for sensible allergy advice.

How genes and environment affect children

Memory cards

OK, I have to fess up. I am moving house this week and have nothing prepared. So here is an essay I wrote a while back to explain my work in gene-environment interaction. I know, it sounds scary, but its really simple and I’m sure that this “story” will help you understand.

***

I’m here at Mr. Almighty’s Cloud Street Headquarters to interview him on his plans for a family friendly casino.

 

“Mr. Almighty, it’s great to meet you! Tell me the concept for your casino.”

 

Mr. Almighty: It’s ingenious really. My casino actively encourages participation of whole families. Although single people are encouraged to come, it’s in the hope that when they have children, they can continue to come here as a family and I’ll have a continued source of customers!

 

“Very clever. What sort of gambling facilities will you have? Slot machines, roulette, ‘Blackjack’?”

 

Mr. Almighty: Ah, well! I’m a ‘Blackjack’ man myself, but my enthusiasm spreads to all card games and so I’ve dedicated my casino to cards. We’ll have ‘Poker’, ‘Snap’, ‘Bridge’, ‘Old Maid’, ‘Rummy’, as well as ‘Blackjack’ off course. In fact, you name a card game and we’ll certainly be playing it. I’ve divided the venue into sections so that a different card game will be played in each, so called ‘gaming environment’.

 

“A very catchy name.”

 

Mr. Almighty: Yes. I think our advertising boys did a good job on that one.

 

“What’s so special about a casino dedicated to card games for families?”

 

Mr. Almighty: Hah! Well, unlike other casinos, there’s a twist. My casino will be exclusive: ‘Members Only’ I mean…

 

“There’s nothing new about that!”

 

Mr. Almighty: Wait, I haven’t finished. On joining, I deal all members 14 playing cards. They must play with the same 14 cards that they were dealt on joining for the duration of their membership. The only exception will be for members’ children. We anticipate there’ll be several billions as the casino expands, so I’d be here all day dealing out cards to kids if there was no exception made! So, I’ve devised a simpler plan for them. They will be blindfolded and asked to randomly pick their cards from the hands of their parents: half from their mother, and half from their father. From then on, the same rules apply: “You play with the cards you’re dealt”! That’s the slogan our advertising department is adopting for our poster campaign!

 

“But there’s a terrible flaw in your plan! What if I joined and received a terrible hand? I’d have to play with that for the duration of my membership and keep losing! I might as well give up!”

 

Mr. Almighty: No, no – that needn’t happen. You, like so many others, see things at face value and don’t see the complexities in the matter. Whether you win or lose depends not only on your cards but a whole host of factors. For starters: how well you play the game. Parenting is potentially important for this, at least in the beginning. Even if a child has a great hand, if his parents haven’t taught him the rules of the game, he’s pretty sure to lose.

 

“Yes, I suppose so.”

 

Mr. Almighty: Later on, he might have more chance to play with friends or have tuition from teachers and be able to learn skills for card playing from them.

 

“So, his chances of success and failure might be influenced by his peer group and school environment?”

 

Mr. Almighty: Indeed.

 

“But, once you’ve learnt the rules of the game, your potential winnings are still dictated by the cards you’re dealt. You’d be stuffed if you had no ‘Aces’ or ‘Picture cards’.”

 

Mr Almighty: Not so! That’s the beauty of my casino. There are many chances to win. As I’ve said, we play all the card games in the world here, not just one! The ‘Aces’ and ‘Picture cards’ might serve you well in a game of ‘Bridge’, where high scoring cards are valued, but in ‘Old Maid’ where they are penalized, they will cause you nothing but grief! And in ‘Snap’, well, a ‘two’ is as good as any ‘Ace’ so long as you find a pair.

 

“O.K. So how well you do depends on the interaction between your cards and your ‘gaming environment’. A hand full of ‘Aces’ in a ‘Bridge’ game spells success, but the same ‘Aces’ when playing ‘Old Maid’ spell disaster. So the handicap I predicted isn’t necessarily so, and it’s a matter of finding the optimal combination of game played and cards possessed.”

 

Mr. Almighty: Exactly!

 

“Even so, how well you do in the long run is still dependent on your cards isn’t it?”

 

Mr. Almighty: In some respects. I can’t say that your cards will not ultimately limit your potential but there are still further factors that could influence prospects.

 

“Besides your cards, acquired knowledge of the game and the game being played, I can’t think of any thing else that would influence progress.”

 

Mr. Almighty: I see you’re not a regular card player! Otherwise you would know that there is a lot more to card playing, not least the abilities of your opponents, or ‘gaming society’ as our advertising boys like to call them.

 

“O.k. I suppose if I were playing with novices, I’d certainly have a better chance of winning.”

 

Mr. Almighty: Now you’re catching on! As you can see, there are lots of ways you can still win with a deficient hand of cards. You choose a game you’ve been taught to play well, a ‘gaming environment’ where your cards are valued and where your fellow card players are suited to allow you to thrive.

 

“So, I could look at my hand and in effect change my prospects by selecting a ‘gaming environment’ dependent on my cards.”

 

Mr. Almighty: Yes, indeed there’s likely to be a great deal of correlation between your cards and your selected environment. But it’s not always easy to tell from the outset which is the best ‘environment’ for your hand. I’m not going to label the environments ‘Professional Poker Player’s table – avoid unless you have a Royal Flush’ or ‘Beginner’s Bridge – you’ll win big here even if you have no Picture Cards’. What usually happens is that there is a fair amount of trial and error before some satisfactory environment is found.

 

“But clever manipulation of the ‘gaming environment’ can make good from a poor hand.”

 

Mr. Almighty: Indeed. And these are just factors I’ve thought of so far. I’m sure if more research was done in this area, more significant environmental and social factors will be found to allow players who receive a poor hand to win.

 

“That’s amazing! But tell me, how can this venture possibly make money? You’ve said players with terrible cards can still succeed by choosing the correct ‘gaming environment’. If players got wise they’d keep winning and you’d go bankrupt!”

 

Mr. Almighty: Well, I have a few tricks up my sleeve. I didn’t wish to impose this restriction, but the reality is that to stay economically viable as a business, I must. I have had to impose a cost attached to changing ‘gaming environments’. You will have to start playing in the same ‘environment’ as your parents. Otherwise, I’d be bankrupt by the babysitting fees alone! If you want to change environments, you or your family will have to pay a fee, and it’s not cheap. It’s sad but true, some poor buggers get stuck in an environment totally at odds with their cards and they just carry on losing.

 

“Let me get this straight. If my parents play ‘Poker’, then I have to start off playing ‘Poker’ even if my hand is better suited to ‘Snap’. In order to play ‘Snap’ and make it big, I need financial backing?”

 

Mr. Almighty: Yes. That’s the gist of it. I have to make money somehow! If only the government would give us casino proprietors more money, I’d love to let my members play in their optimal ‘gaming environments’ and watch them flourish. Unfortunately, I can’t afford to do that.

 

“Isn’t there another way? What if between my parents they have the cards to give me a ‘Royal Flush’ which would make me almost guaranteed to win at ‘Poker’. Couldn’t they pay a fee to engineer it so that they select which cards I inherit, rather than my picking them randomly? Or, could I modify my hand and change certain cards for ones that might suit my circumstances better?”

 

Mr. Almighty: That certainly would allow you to win. It’s a contentious issue though! Some would even call it cheating! But I can see where you’re coming from. If I was constantly playing to lose with no prospect of winning, and with the knowledge that my children would inherit a poor hand and little financial resource to change their lot, I’d quite wish to be able to do the same thing too. I often see players with no ‘pairs’ or ‘Picture cards’ continuously losing their savings at the ‘Poker’ table and I think, what if I could give him a pair of ‘Aces’ or two. Unfortunately, if I sanctioned card changes, all my members would be queuing up to change their cards and I would have no peace! As it turns out, there are many intelligent members who’ve devised ways of ‘card modification’. But there’s no point changing your cards willy nilly. The trick is to research your ‘gaming environment’ and ‘society’ and strategically find the correct card to change. By changing specific cards, some have been able to turn the tides of their fortune. Sometimes, it can rejuvenate whole families who’d lost hope, not to mention the benefits to their future generations. Other times it’s used for the wrong purposes, and I totally disagree with it, but am powerless to stop it. It’s really up to members to decide how much ‘card modification’ they can tolerate. There’s a committee that monitors it. I try to keep out of it, though they often try and bring me in to their debates!

 

“But it could ultimately affect your business. If all this ‘modification’ was allowed to go on, everyone would have ‘Aces’ and ‘Royal Flushes’ in their hand and you’d go bankrupt!”

 

Mr. Almighty: Not necessarily. The members can modify cards behind my back all they like, but they need ultimately to bear in mind that if everyone had ‘Aces’ and ‘Royal Flushes’, the whole ‘gaming society’ would change. There’d be no members with losing hands and you’d have to be an even better card player to succeed. There will always be winners and losers just the same. In any case, don’t you know the first thing about casinos? The house always wins. I have one last trick up my sleeve and that is, I have the right to close down any ‘gaming environment’ I choose, at any time.

 

“How would that insure your success?”

 

Mr. Almighty: Well, if all my members were gaining ‘Aces’ and ‘Royal Flushes’ to win at ‘Poker’, then they would be taking a large gamble. I could close down all my ‘Poker’ tables and turn them into ‘Old Maid’ gaming environments at my whim. That way, I could turn all the winners into losers and losers into winners whenever I choose!

 

“Caution and the importance of environment is the order of the day then?”

 

Mr. Almighty: Indeed.

 

“It certainly sounds like a fascinating venture! One thing I wondered though, your advertising guys seem to have coined great names like ‘gaming environments’ and ‘gaming societies’, but couldn’t they think of a more catchy name for the cards?”

 

Mr Almighty: Yes, they’re working on that, so far, they’ve only come up with ‘genes’.

 

“‘Genes’. That might just take off! Tell me, what are you going to call your new casino?”

 

Mr. God Almighty: Well, actually, the prototype has already been running successfully for several millennia, and I think I’ll launch the real thing with the same name as it’s a good a name as any. I call it ‘LIFE’.