Philip Roth foresaw in his 1973 book “The Great American Novel” how the Russians would help Trump destroy America

“And if he is elected [with the help of the Russians], he will ring down the curtain on the American tragedy – a tragedy because it will have been made into a farce! And when that terrible day comes…when a President Mazuma [an immoral showman just like Trump]  is installed in the White House, they [the Russian communists in the novel but now the Russian ex-communists] won’t need a Red Army marching down Trust Street to blow up the Industrial and Maritime Exchange; the poor bewildered American people will do it themselves.”

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“Why We Sleep: The New Science of Sleep and Dreams”: one of those rare books that changes your world view and should change society and medicine

One of the professors at Edinburgh Medical School, where I was taught from 1970-76, was a world expert on sleep, but I remember hearing little about sleep at medical school. We were taught about sleeping pills, and I remember routinely prescribing them for patients undergoing surgery the next day–with no understanding of the damage I was doing. In my 25 years at the BMJ I remember publishing little on sleep, although we did publish  an ABC of Sleep Disorders, with the emphasis on the disorders. Generally, like most doctors, I thought little about sleep. Now I read in Mathew Walker’s book Why We Sleep: The New Science of Sleep and Dreams that: “ [The] silent sleep loss epidemic is the greatest public health challenge we face in the twenty-first century in developed nations.” He perhaps forgot climate change, but he makes a strong–if not wholly convincing–case to support his dramatic claim.

His core argument about the public health challenge is that we all need at least seven and preferably eight hours sleep a night because sleep is vital for many functions of the brain and body, including memory, problem solving, attention, immune function, growth, and the effective and efficient functioning of most of our organs. Lack of sleep leads to dementia, raised blood pressure, heart disease, stroke, cancer, road traffic and other injuries, and proneness to infection–in other words to all the commonest causes of morbidity and mortality. Yet many people in the developed world are not getting seven to eight hours sleep a night, and crucially he shows that you cannot catch up on lost sleep–sleeping late at the weekend will not indo the damage done during the week. Worse, we have a culture that almost sees sleep as for wimps, and we admire people like Margaret Thatcher and Ronald Reagan (both of whom succumbed to dementia, points out Walker) who supposedly slept only four or five hours. Walker shows that people who can sleep so little and not suffer long-term damage are vanishingly rare.

All of biology is ultimately about evolution, and humans have evolved over two million years to sleep eight hours a night. Walker presents evidence from hunter-gatherers of how they sleep eight hours a night, although often in two parts. Sleep is clearly important, and it is also extraordinary: Walker mimics a paediatrician talking to parents of a new born baby:  “From this moment forth, and for the rest of your child’s entire life, he will repeatedly and routinely lapse into a state of apparent coma. It might even resemble death at times. And while his body lies still his mind will often be filled with stunning, bizarre hallucinations. This state will consume one-third of his life and I have absolutely no idea why he’ll do it, or what it is for. Good luck!” Walker makes us think that this bizarre state must have some vital function and teases the medical profession for paying  little attention to the importance of sleep.

Medicine, with its emphasis on disease and malfunction, has also neglected to a lesser degree diet and physical activity, and I suspect that few doctors would describe sleep as a pillar of good health, but Walker goes further:  “I was once fond of saying, ‘Sleep is the third pillar of good health, alongside diet and exercise.’ I have changed my tune. Sleep is more than a pillar; it is the foundation on which the other two health bastions sit. Take away the bedrock of sleep, or weaken it just a little, and careful eating or physical exercise become less than effective.”

Walker, a scientist rather than a clinician, is at his best explaining the functions of sleep, although we still have a long way to go with understanding all the effects of sleep. His book reminded me of Daniel Kahneman’s world-changing book Thinking Fast and Slow in that much of the evidence comes from psychological experiments performed in sleep laboratories.  To be fair to my teachers at medical school most of the research has been conducted since I left medical school. I particularly liked Walker’s sculpture metaphor for explaining how REM (rapid eye movement)  sleep and NREM (non-REM) sleep are essential for memory: NREM, which predominates at the beginning of sleep, moves the great clumps of clay (the day’s learnings) into memory and then REM sleep, which predominates later, refines and shapes  the clay to make the memories.

The book even manages to cast light on the particular importance of dreams not just the REM sleep during which they occur. Ingenious experiments have shown that dreams have therapeutic, problem solving, and creative functions.

There is epidemiological evidence in the book, but I’d have liked more of that to be wholly convinced of Walker’s assertion that lack of sleep is our leading public health problem.  I think that anybody who reads his book will be convinced of the importance of sleep and will make sure that they do all they can to get eight hours’ sleep a night, but there are many forces–including work habits and requirements, electric light, noise, electronic gadgets (particularly those, the majority, powered by blue LED lights), alcohol, caffeine, mass entertainment, and a culture that doesn’t grasp the importance of sleep–that work against getting eight hours sleep every night. ( I reflect on how little that harmful effects of sleep disruption as opposed to pollution have featured in the arguments over a third runway at Heathrow–I wake most mornings to the sound of planes heading towards Hathrow.)

An individual, particularly  a retired one like me,  can do something to try and ensure eight hours sleep a night, but many social forces work against it. Walker chastises school systems that oblige adolescents to attend school at 7.30 am for failing to understand that adolescents’ diurnal rhythm runs some three hours behind those of adults, meaning that getting up at 6am to each school by 7.30 feels like getting up at 3am for an adult. He also criticises medicine for its long-hours culture, meaning that doctors make many more errors.

This book, a bset-seller, has changed my thinking greatly. I wonder if it will manage to have a broader effect on society. I hope so.

PS. A fun quote from the book:

“Last night, you became flagrantly psychotic. It will happen again tonight. Before you reject this diagnosis, allow me to offer five justifying reasons. First, when you were dreaming last night, you started to see things that were not there— you were hallucinating. Second, you believed things that could not possibly be true— you were delusional. Third, you became confused about time, place, and person— you were disoriented. Fourth, you had extreme swings in your emotions— something psychiatrists call being affectively labile. Fifth (and how delightful!), you woke up this morning and forgot most, if not all, of this bizarre dream experience— you were suffering from amnesia. If you were to experience any of these symptoms while awake, you’d be seeking immediate psychological treatment.”

 

 

 

 

Thoughts ( and a Haiku) on walking down Shaftesbury Avenue at 10.30 pm on a Saturday

Thoughts on walking down Shaftesbury Avenue at 10.30 pm on a Saturday

All these people

So much work for death to do

But death never tires.

 

 Haiku on walking down Shaftesbury Avenue at 10.30 pm on a Saturday

All these people

Much work for death

But death never tires

 

The love letters of Anton Chekhov and Olga Knipper

It’s taken me a year or so to read through the love letters exchanged by Anton Chekhov and Olga Knipper, his lover, wife, and window. They are clearly not letters to be published, in contrast to many other “private” letters, and much of the time they seem trivial, containing little but accounts of the weather and expressions of love and exasperation; but they provide an oblique view into one of the great theatrical love affairs.

Chekhov was 38 when he came to admire and take up with the 30-year-old Nipper. She was an actress, and he saw her perform in several plays and thought her under appreciated. Subsequently he wrote for her the parts of Masha in Three Sisters and Ranevskeya in The Cherry Orchard. She was Masha sometimes in her life and letters, and she was Masha for the Russians of her generation. At the age of 80, nearly 50 years after Chekhov’s death, she could not stop herself while in the audience from speaking some of Masha’s great lines before the actress on stage.

Their letters stem from them mostly being apart during the five years of their relationship before Chekhov died of tuberculosis in 1904. She was mostly in Moscow acting every night; he was in Yalta, his “hot Siberia,” on the orders of his doctor. Their letters reach a passionate crescendo as they approach being together and then become silent when they are together.

Chekhov’s letters are mostly light, flippant, and teasing. He calls her doggie, baboon, granny, cricket, sperm whale, and little German (her parents were Germans who became Russian citizens). Almost every letter includes a reference to the weather. He complains about the difficulties of writing but shies away from anything serious and emotional. Her letters are much more intense, describing how she can move from exultation to despair in moments. She longs to see him. He is cooler, but that, I think, is his natural reserve and diffidence not lack of love for Knipper.

The editor and translated of the letters, Jen Benedetti, explains how Chekhov effectively lived in a ménage a trois. Most of the time he was with his sister, Masha, who cared for him constantly. Knipper was, Benedetti argues, more like a mistress than a wife: she and Chekhov met rarely, and their time together was intense and passionate; but Masha was there every day for her brother. At one point Masha, who clearly resented Knipper, a feeling that was mutual, wrote to Knipper telling her to back off. Knipper was furious and upset, as her letters show; but Chekhov avoided the discomfort, even to the point of lying.

Chekhov and Knipper write a lot about the theatre, and the letters will be of most interest to devotees of the theatre, particularly those intimate with Chekhov’s plays. It was an actor friend who urged me to read the letters. Chekhov gives little way about his writing, except that it’s hard, but he does ask Knipper about reactions to his plays and news of her performances. He saw few performances of his own plays. She describes to him reactions to his plays, but not away with complete honesty. She describes her theatrical life, much of it with Stanislavski, including both her excitement and exhaustion. She felt permanently guilty that she was putting the theatre before her marriage, but I think that he was happy with the arrangement.

A great many of the letters describe the frustrations of trying to communicate by letters over such a long distance at the beginning of the 20th century. Letters took days to reach their destination and didn’t always arrive in order. Letters crossed, and I was reminded of ringing home from New Zealand in 1978 and struggling to adapt to the long gaps between words. How different now with texting, Whatsapping, and even old-fashioned email.

Knipper was with Chekhov in Germany when he died and describes his death in her memoir. He’d become progressively more breathless, and the doctor who was called injected with camphor and ordered champagne. (Oh for those days to return.) “Anton took a full glass, examined it, smiled at me and said: ‘It’s a long time since I drank champagne.’ He drained it, lay quietly on his left side and I just had time to run to him and lean across the bed, and call to him, but he had stopped breathing and was sleeping peacefully as a child…”

After Chekhov’s death Knipper continued to write letter to him for two months. “At last I’m able to write to you, Anton, my dear, my sweet, so near and yet so far….As I write to you, I feel you are alive, out there somewhere, waiting for a letter. Dearest Darling, my sweet love, let me speak words of tenderness, let me stroke your soft silky hair, and look into your dear, shining, loving eyes.”

Choosing seven pieces of music for a BBC broadcast, “Private Passions”

The BBC has a radio programme called Desert Island Discs, which has been running for a half century in which well known people chose seven pieces of music that they would take to a desert island along with the Bible, the Complete Works of Shakespeare, a book of their choice, and a luxury. In addition, the people talk about their lives. It’s a favourite game in Britain to imagine yourself invited onto the programme and select your music, book, and luxury. Most people never get to appear on the programme, but their relatives can use their choice of music as a guide to their funeral. Well, I have got to appear on the “poor man (or perhaps rich man’s)” version, Private Passions.

Desert Island Discs is on Radio 4, which has many millions of listeners, while Private Passions is on Radio 3, the classical music and high brow channel, which has fewer listeners (although still two million). Indeed, I remember a famous television sketch which has Rowan Atkinson saying into a microphone; “Is there anybody there? Is there anybody there? This is Radio 3 broadcasting on frequency….”

You don’t have to be famous to appear on Private Passions, and if you look at the list you’ll have heard of few of them. Still, I was delighted and flattered to be asked to be on the programme. Private Passions differs from Desert Island Discs in several ways: it’s longer, an hour versus 45 minutes; there’s much more emphasis on the music, which has to be predominantly classical; and you talk less about your life and more about the music what interests you–in my case, death, dementia, medicine being lost, Bangladesh, and the hazards of being a television doctor, which I was decades ago.

I set about choosing seven pieces of music, most of which had to be classical. My rules were that they must be pieces I liked, mustn’t be too familiar (so not the slow movement of Schubert’s quintet, even though I love it), must include something modern and at least one piece of jazz; and might relate to the topics we would discuss. The producer told me some people are paralysed by the choice, while one known comedian could chose only pop music, meaning he had to be excluded. (Desert Island Discs includes many guests who clearly have no interest in music, while Private Passions is more about the music than you.) Don’t get hung up on the choice, said the producer, in another week you might chose something very different.

I began, and I knew that I had to include something from Bach’s Cello Suites, the first movement of Shostakovich’s 15^th and last string quartet, Stan Tracey’s Starless and Bible Black, and something from Messiaen’s Quartet for the End of Time. I would also have liked John Coltrane’s After the Rain, although two jazz pieces would probably be too much, some traditional Irish fiddle playing, and some Glen Gould–but not playing the Goldberg Variations (too familiar). It would have been much harder to choose music for Desert Island Discs because I’d have had to have some rock music and probably some Nina Simone (Wild is the Wind) and surely some Bob Dylan and Leonard Cohen.

I was then more opportunistic, picking pieces that I listened to over the weeks I was making my choices. I heard Deborah Pritchard’s piece for solo saxophone at a concert and loved it–plus I liked the idea of including something that wasn’t recorded on disc. I wanted some opera, and I attended a lecture on Sappho where I heard Gounod’s O Ma Lyre Immortelle–so I included that. For Glen Gould I went for his version of the very simple first movement of Sonata in D Major by Haydn (the only piece that Chicken didn’t like). I listen to lots of choral music and so had to have a piece, and I opted for Salve Regina by Hermannus Contractus sung by the Hilliard Ensemble.

Conscious that my choices might be seen as “gloomy,” I chose a piece of Irish fiddle music by Martin Hayes. I listened to all that I had and realised that most of those were “gloomy” as well. I tried to pick one of the jollier ones. I had in addition to pick a single dance from the Bach Cello Suites, which wasn’t easy as I think of them (and listen to them) as a whole. I also had to pick one of the sex cellists I listen to regularly, and I went initially, and with some surprise, for Rostropovich, the most muscular of them. But later we changed to Tortelier because I had once heard him paying the suites early I the morning in a BBC studio. Similarly I had to choose a movement from the Quartet for the End of Time, but I knew that I would go for the solo clarinet.

I sent my list of ten to the producer, and we haggled. She needed seven pieces that together played for 35 minutes. The opera went as too long, and recognising that the programme was primarily about classical music we rejected Coltrane (heart-breaking) and the Irish fiddle music.

The recording was fun. I was crammed into the most tiny studio with Michael (Lord) Berkeley, a composer himself and son of Lennox Berkeley, who was also a composer. It was a conversation more than an interview, and both of our mothers, it emerged, have been demented. I asked him if anybody ever chose his music, and he said how Rowan Williams, the Archbishop of Canterbury, had because he’d composed the music for his enthronement. One bonus was that it emerged that Deborah Pritchard has synaesthesia, and she produced picture to accompany her piece, which was inspired by Basho’s haiku

How wild the sea is,

And over Sado Island,

The River of Heaven.

We recorded about an hour and a quarter, and you can hear the edited programme at: https://www.bbc.co.uk/programmes/b0b5syfy

The music, I’m told, will be there in full for a month but shortened thereafter.

Below is my first list–and then the final list.

First list

*Bach Cello Suite no 3. Gigue. Played by Mstislav Rostropovich

O ma lyre immortelle. Charles Gounod sung by Elina Garanca

*Starless and Bible Black. Stan Tracey Quartet, the version with Bobby Wellins and no words

Salve Regina. Hermannus Contractus. Hilliard Ensemble

After the Rain. John Coltrane.

*Shostakovich string quartet No 15 first movement

*Quartet for the End of Time. Third movement. Abyss of the Birds. Fibonacci Quartet

Rakish Paddy played by Martin Hayes

*Haydn Sonata in D Major. Hob XVI.42. First movement

Deborah Pritchard. River Above. Played on Radio 3 24/1/18 as part of the Northern Sinfonia 50th birthday

Final list

Bach Cello Suite no 3. Gigue. Played by Paul Yortelier

Starless and Bible Black. Stan Tracey Quartet, the version with Bobby Wellins and no words

Salve Regina. Hermannus Contractus. Hilliard Ensemble

Shostakovich string quartet No 15 first movement

Quartet for the End of Time. Third movement. Abyss of the Birds. Fibonacci Quartet

Haydn Sonata in D Major. Hob XVI.42. First movement. Played by Glen Gould

Deborah Pritchard. River Above. Played on Radio 3 24/1/18 as part of the Northern Sinfonia 50th birthday

Weeping over Brexit

I’ve had a few glasses of wine, it’s late, and I’m talking to an American friend, when the conversation turns to Brexit.

“The country’s committing slow suicide,” I say.

My friend asks me about universities in Britain.

“Brexit is bad for them. They have less access to talented people, and they will be shut out of bidding for European Union research grants.”

Suddenly I’m aware that I’m becoming tearful. I try to control myself. My words come slowly and hesitantly.

“Brexit is bad for Europe too. Britain punches above its weight in science. We have a lot to offer Europe—and not just in science.”

I’m finding it harder to suppress my tears.

“People forget,” I say, now almost sobbing, “that the EU was created to stop wars. My grandfather was at Gallipoli, my father at El Alamein—and then in Italian and German prisoner of war camps. I haven’t had to fight in a war. I don’t want my children or grandchildren to have to.”

Now I’ve reached the point where I have to acknowledge my tears. “This is making me very emotional.” I don’t apologise, I don’t need to.

I’m surprised and not surprised by my tears. I’m surprised that they’ve welled up in the middle of a convivial conversation. I’m not surprised because I do feel deeply about Britain destroying itself and weakening Europe at the same time.

 

Fearsome alarm clocks

Sleeping seven to eight hours a night improves almost every aspect of our brain and bodily functions. Sleeping less than seven to eight hours increases your chances of developing heart disease, cancer, dementia, infections, and other conditions. Yet modern life means that many people sleep less than seven to eight hours a night, and one of the causes of that is alarm clocks, the successor to the factory whistle. I learnt all this in Mathew Walker’ convincing book Why We Sleep: The New Science Of Sleep And Dreams. As an aside, Walker describes some fearsome alarm clocks.

Being woken by an alarm clock causes a spike in your blood pressure, and if you press the snooze button, go back to sleep, and then wake again you get a second spike. Yet many people are capable of sleeping through an alarm clock and need something fearsome to wake them up. Walker describes three fearsome alarm clocks.

One of the clocks includes geometric blocks that explode and scatter across the floor when the alarm goes off. The clock also shrieks. The woken sleeper must climb out of bed, pick up the scattered blocks, and fit them into the clock to stop the shrieking.

A second clock includes a shredder and a twenty-dollar bill, or the currency of your choice. The woken sleeper must remove the twenty-dollar bill to stop it being shredded. Very rich people would need a much bigger bill, and I can imagine some people who on at least some mornings would be happy to pay twenty dollars for a little more sleep.

The third clock is the most fearsome. It is connected to your bank, and for every minute you sleep after the alarm goes off it sends a sum of money, perhaps ten dollars, to the political party you hate the most. Obviously you could vary the time interval, the amount, and where the money goes, perhaps to your least favourite person.

A better strategy is to do as Walker advises and go to bed at least eight hours before you need to get up and so wake naturally.