“Functional disorder”: one of medicine’s biggest failures

About a third of patients attending neurological and gastrointestinal—or almost any outpatient clinic—have functional or psychosomatic disorders, meaning that they do not have a physical cause that can be detected  with a microscope, scanners, or blood or genetic tests.  These are patients whom medicine has helped to create and fail more than almost any other group.

I’ve been reading Suzanne O’Sullivan’s The Sleeping Beauties: And Other Stories of Mystery Illness, a book that was recommended by a doctor colleague because it had had a big impact on him. It’s now had a big impact on me and probably will on you if you read it. O’Sullivan is a Queen Square neurologist who specialises in functional disorders and a gifted writer is acutely aware of the limitations of her medical craft. Her book tells the stories of outbreaks of mass psychogenic illness, including the young asylum seekers in Sweden who have been “asleep” for years, the American diplomats in Havana and Beijing suffering symptoms attributed to a sonic bomb weapon, and several others. The stories make excellent reading, but the value of the book to doctors is that it can benefit their practice and deepen their understanding of medicine.

Language, as always, is part of the problem. Functional disorder is perhaps the best term for these conditions, but psychosomatic, psychogenic, conversion disorder, and in the past hysteria have all been used. Hysteria, with its association with women, is clearly unacceptable, and the prefix “psycho” is unhelpful. As O’Sullivan writes “Every medical problem is a combination of the biological, the psychological and the social. It is only the weighting of each that changes.” Medicine was cursed when René Descartes divided the mind from the body.

Almost any symptom, perhaps every symptom, can result from functional disorder. O’Sullivan lists paralysis, blindness, headache, dizziness, coma, tremor, skin rashes, breathlessness, chest pain, palpitations, bladder problems, diarrhoea, stomach cramps, and on and on. I might add fatigue, abdominal pain, diarrhoea, cough, backache, pain any part of the body, and a gamut of symptoms that have no known physical cause.

We are all aware that mental activity, emotion, can cause bodily symptoms like tears and blushing, but most of us find it hard to accept that mental activity could cause something as extreme as a coma, fits, or blindness. If no physical cause can be found then people are tempted to think that the symptoms are “not real,” “all in the mind,” or that the patient is faking them. These are serious mistakes to make: the symptoms are as “real” as with any physical cause and just as severe; they are not “all in the mind” because the body is clearly affected and the division between mind and body is not helpful; and there is no fakery. It’s also, a mistake, writes O’Sullivan to attribute them to “stress.”

Our understanding of how people develop these symptoms is poor, but the starting point is distress of some kind. “Embodied cognition” is the theory that sensory and motor systems are integrated with cognitive processing. As O’Sullivan writes: “The body is awash with white noise, so symptoms can always be found if a person looks hard enough.” “Looking hard,” implies a conscious action, which is probably not what she intended. Those symptoms are then linked with illnesses, even diseases, we know about. “Illness is a socially patterned behaviour, far more than people realise,” writes O’Sullivan, “How a person interprets and reacts to bodily changes depends on trends within society, their knowledge, their education, their access to information and their past experience of disease.” Modern medicine offers an increasing range of diseases for people to unconsciously connect with.

The philosopher Ian Hacking has described a phenomenon he calls “Making up people.” New classifications “bring into being a new kind of person” who have the classification attached to them or attach it to themselves. Their symptoms may then be added to the new classification, changing, and expanding it. “The classification changes the person, who in turn changes the features of the classification,” which has been called “the looping effect.” (Inevitably I thought about long covid, as I read this.)

Prior experiences can be important in developing functional disorders. O’Sullivan uses the example of patients who have lost their voices after a severe bout of laryngitis. The next time the patients develop sore throats, perhaps milder ones, the prior experience may lead to the brain to cause the patients to lose their voices. “The top-down priors overwhelm the sensory input.”

Our understanding is, it seems to me, limited, and the theories and mechanisms that O’Sullivan discusses are unfamiliar to most doctors.

Just as culture dictates how we try to make sense of symptoms it also dictates how we respond. Our usual response is to see a doctor, and the doctors feel obliged to exclude physical disease even if their strong sense is that the symptoms may be the result of a functional disorder. The patient undergoes a barrage of tests, and some of those tests may suggest something wrong both because of false positives and because “normal” is often defined as being with two standard deviations of the mean, which means 5% of results with be abnormal by mathematical definition. Patients are understandably made anxious by tests that suggest that something may be wrong, and more tests are needed to exclude disease, giving further opportunities for misleading results. Many patients will conclude that “Something must be seriously wrong if the doctors are doing all these tests.”

The patients may then begin the merry-go-round of specialists. Once the cardiologists have found no physical cause for chest pain the patient may be referred to gastroenterologists or some other “ologists” and so on. Only the crass will say “there is nothing wrong with you” because the patient clearly has something wrong. Indeed, after all the tests and anxiety he or she may be feeling worse. But the first ologist may say “I cannot find a physical cause for your problem, but I am referring you to….” When no physical cause is found the patients may be referred to psychiatrists, with at least the implication that the patients have a psychological problem. Because of the stigma unjustly attached to psychological problems this can cause distress and offence and is anyway to fall into the trap of thinking the physical and psychological separate.

O’Sullivan worries about this: “Like many Western doctors, I medicalise feelings and behaviour. People come to me so that I will do that for them – give them a medical explanation for their suffering – but, in truth, I worry all the time that what I’m doing, faithful as it is to my training and welcome as it may be to my patients, is wrong and potentially harmful.”

Fascinatingly, O’Sullivan finds herself attracted to some of the conditions that western medicine calls mass psychogenic illness (MPI). Grisi siknis (which sounds like crazy sickness) occurs only among the Miskito, an indigenous people from the coast of Nicaragua and Honduras. The sickness begins with mild symptoms like but progresses to irrational behaviour, convulsions, and hallucinations. Sufferers, who are mostly young people and mostly female, see a dark figure that they know to be the devil.

The condition does not attract blame but rather support from the community, and it usually passes. O’Sullivan writes: “I found a great deal in grisi siknis that I could admire. It can be a very effective culturally agreed means of expressing distress. It is an acceptable way to exteriorize and deal with personal and social conflict. It is also a useful one, because it comes without blame. The demon infiltrator presents an external cause that removes the focus from the individual. It also provides something at which to aim treatment.”

She draws a contrast with people with functional disorders exposed to modern medicine. Not only must they undergo many tests and pick up “diagnoses” along the way but they may also become permanent patients. Worse still, the patients may find themselves in battles with the medical establishment. “It is in the gap between the diagnosis of conversion disorder (functional neurological disorder) and the understanding of what that diagnosis means,” writes O’Sullivan. “that there is space for harmful things to grow.” She doesn’t venture into the highly charged subjects of myalgic encephalomyelitis (ME), chronic fatigue syndrome, or long covid, but a reader will wonder how much these are functional disorders.

People recover from functional disorders, but treatment is difficult. Doctors and patients going to war, as has happened with ME, is the worst outcome for everybody. O’Sullivan concludes her book emphasising the role of community: “I also learned that the best chance of recovery comes when you surround yourself with a community that allows patients and their doctors to find that common ground. A community that can listen without judgement. A community that provides support. A community that can tolerate imperfection and failure, and which has the humility to put aside its vested interests. A community that is able to take a holistic view of health.”

A marvellous description of Berlin from “Less” by Andrew Sean Greer

Berlin is all around them, the Fernsehturm rising high in the east like the Times Square New Year’s ball, the lights of Charlottenburg Palace glowing faintly in the west, and all around the glorious junkyard of the city: abandoned warehouses and chic new lofts and boats all done in fairy lights, concrete Honecker residential blocks imitating the old nineteenth-century buildings, the black parks hiding Soviet war memorials, the little candles somebody lights each night before the doors where Jews were dragged from their houses. The old dance halls where elderly couples, still wearing the beige of their Communist lives, still telling secrets in the learned whisper of a lifetime of wiretapping, dance polkas to live bands in rooms decorated in silver Mylar curtains. The basements where American drag queens sell tickets for British expats to listen to French DJs, in rooms where water flows freely down the walls and old gasoline jugs hang from the ceiling, lit from within. The Currywurst stands where Turks sift sneezing powder onto fried hot dogs, the subterranean bakeries where the same hot dogs are baked into croissants, the raclette stands where Tyroleans scrape melting cheese onto the bread and ham, decorating it with pickles. The markets already setting up in local squares to sell cheap socks, stolen bicycles, and plastic lamps. The sex dens with stoplights signaling which clothing to remove, the dungeons of men in superhero costumes of black vinyl with their names embroidered on them, the dark rooms and back alleys where everything possible is happening. And the clubs everywhere, only just getting started, where even middle-aged married folk are sniffing lines of ketamine off black bathroom tile, and teenagers are dosing each other’s drinks.

What was it like to live with genius?

This is part of my move into commonplacing. https://richardswsmith.wordpress.com/2022/11/18/my-move-into-commonplacing/ It’s an account of what it was like to live with a genius from Andrew Sean Greer’s Pulitzer-prize winning novel Less. https://richardswsmith.wordpress.com/2022/11/19/an-enjoyable-romp-of-a-novel-that-won-the-pulitzer-prize-but-probably-shouldnt-have-done/  I thought the piece both funny and insightful—not that I have any idea what it’s like to live with a genius (apologies to my wife). If asked what it might be like to live with a genius, all I could guess would be “tough.”

Like living alone.

Like living alone with a tiger.

Everything had to be sacrificed for the work. Plans had to be canceled, meals had to be delayed; liquor had to be bought, as soon as possible, or else all poured into the sink. Money had to be rationed or spent lavishly, changing daily. The sleep schedule was the poet’s to make, and it was as often late nights as it was early mornings. The habit was the demon pet in the house; the habit, the habit, the habit; the morning coffee and books and poetry, the silence until noon. Could he be tempted by a morning stroll? He could, he always could; it was the only addiction where the sufferer longed for anything but the desired; but a morning walk meant work undone, and suffering, suffering, suffering. Keep the habit, help the habit; lay out the coffee and poetry; keep the silence; smile when he walked sulkily out of his office to the bathroom. Taking nothing personally. And did you sometimes leave an art book around with a thought that it would be the key to his mind? And did you sometimes put on music that might unlock the doubt and fear? Did you love it, the rain dance every day? Only when it rained.

Where did the genius come from? Where did it go?

Like allowing another lover into the house to live with you, someone you’d never met but whom you knew he loved more than you.

Poetry every day. A novel every few years. Something happened in that room, despite everything; something beautiful happened. It was the only place in the world where time made things better.

Life with doubt. Doubt in the morning, with the oil beading on a cup of coffee. Doubt in the pee break, not catching his eye. Doubt in the sound of the front door opening and closing—a restless walk, no good-bye—and in the return. Doubt in the slow sound of typewriter keys. Doubt at lunchtime, taken in his room. Doubt vanishing in the afternoon like the fog. Doubt driven away. Doubt forgotten. Four in the morning, feeling him stirring awake, knowing he is staring at the darkness, at Doubt. Life with Doubt: A Memoir.

What made it happen? What made it not happen?

Thinking of a cure, a week away from the city, a dinner party with other geniuses, a new rug, a new shirt, a new way to hold him in bed, and failing and failing and somehow, at random, succeeding.

Was it worth it?

Luck in days of endless golden words. Luck in checks in the mail. Luck in prize ceremonies and trips to Rome and London. Luck in tuxedos and hands secretly held beside the mayor or the governor or, one time, the president.

Peeking in the room while he was out. Rooting through the trash bin. Looking at the blanket heaped on the napping couch, the books beside it. And, with dread, what sat half-written in the typewriter’s gap-toothed mouth. For at the beginning, one never knew what he was writing about. Was it you?

Before a mirror, behind him, tying his tie for a reading while he smiles, for he knows perfectly well how to tie it.

Use your vote for maximum benefit for the planet

It’s easy to be cynical about democracy—famously “the least bad system of government.” We’ve recently seen two prime ministers elected by a handful of people wildly unrepresentative of the population. “What use,” you might think, “is a vote once every five years?” I have lived all my life in safe parliamentary seats, meaning that my vote seems to matter not at all. Many young people report that they would prefer to live in a country with a strong leader than in a democracy. Yet your vote can count for a great deal, and I have recently seen how.

For me and many others there is one issue that overrides all others because it represents a threat to the survival of humanity: the planetary crisis. I want to use my vote to do everything I can to keep the planet livable for my children and grandchildren. I was thus happy without hesitation to sign up to the commitment “to vote only for politicians who work for urgent action on the climate and nature.” https://www.thecommitment.uk/ I posted my commitment with words explaining why I made the commitment and a picture of my two-year-old granddaughter and me cooking together. https://www.thecommitment.uk/makeyourcommitment (scroll down and you can see my granddaughter and me)

What I didn’t understand was what a sophisticated operation lies behind the campaign. Now I do because I’ve met the leaders of the campaign, and the UK Health Alliance on Climate Change, http://www.ukhealthalliance.org/  which I chair, is supporting the campaign.

Crucially the Commitment is not associated with any political party and doesn’t tell anybody how to vote. UKHACC is now a charity, and we couldn’t support any programme that was politically partial—but can support political action that furthers our charitable purpose, countering that world’s major threat to health.

The campaign is not just about elections. It is about influencing MPs (and other politicians), and what the organisers know that I didn’t know is that MPs understand how hard it is to gather specific commitments from named people on how they will use their vote. MPs will multiply these specific commitments by “eight to 12 times,” meaning that assembling as few as 50 commitments from a constituency can have considerable impact on an MP.

MPs are graded by the campaign on a five-point scale with climate deniers at one end and those who are unequivocally committed to urgent action on the planetary crisis at the other end. The campaign concentrates on those in the middle and sends them a report showing the number of people in their constituency who have made a commitment and a map of where they live (people committing have to give their postcode). The report says that “climate change and the environment consistently rank in the top three policy concerns in surveys of the UK public” and includes a quote from a councillor that “each commitment speaks for maybe 100 people who don’t have the time or aren’t good with words.” The report also says that its research shows that over 95% of people honour their commitment.

The words used in some of the commitments are picked out with pictures and first names, but all commitments from the constituency are included without names and postcodes. The report then highlights issues that particularly concern voters in that constituency and gives the MP specific actions he or she might take. The report is well presented and transmits its information quickly, easily, and convincingly.

The reason that relatively few commitments can have such an influence is that it’s hard to get people to make a commitment. They may completely agree with the idea, but the challenge of writing words, adding a picture, and giving their postcode means that many people put off the task until tomorrow—and then never do it. People are also understandably nervous of who exactly is asking for the information. (It is, of course, because of this reluctance that MPs recognise that a few people making a specific commitment represent many more people who agree with the commitment.)

The campaign team gets round this reluctance by working with people at meetings to make commitments there and then. We will do the same at UKHACC meetings, but I urge you to make a commitment now using the link here: https://www.thecommitment.uk/ We have only one planet, and it’s already in bad shape.

Mea culpa: “correcting” my 2012 BMJ article on the Abolitionists

In the Christmas issue of the BMJ in 2012 I published an article on the British Abolitionists, arguing that they were the first social movement. https://www.bmj.com/content/345/bmj.e8301.full  I was primarily interested in understanding social movements, and I thought that analysing how the Abolitionists had been so effective would both lead to a readable article and be a way to pull out useful points on how a social movement might be achieve its aims. There is validity in my thinking, but if I were to write the article today I would write it differently. This piece is my “correction” of that article. I’ve put “correction” in inverted commas because nothing in the article is, as far as I know, factually wrong, but the story has been told in a biased way.

Two quotes are buzzing around in my brain as I begin my piece, the first is the assertion by the historian E H Carr that history tells you more about the time it is written that the time that it is written about. Next, Eric Williams, politician and historian, wrote in 1964: “The British historians wrote almost as if Britain had introduced Negro slavery solely for the satisfaction of abolishing it.” I wrote my article before the appearance of Black Lives Matter, and I concentrated more on the success of the Abolitionists than on the vastness of the crime of slavery as an industry.

My mea culpa has been brewing some time, but I’ve finally been inspired, or obliged, to sit down and write it by a visit to the exhibition on slavery at the Museum of London Docklands, which concentrates much more than my article on the suffering of slavery and its long-term benefit and harm to Britain, particularly London.

I failed in my article to make clear the scale of slavery and that Britain’s wealth depends on slavery. I did write: “The British economy depended on slavery, and sugar, coffee, and rum, which people loved, were produced by slaves. Many rich men and institutions, including the Church of England, owned plantations worked by slaves, and most members of parliament had close links to slavery.” But I didn’t make clear that over three centuries the British enslaved more than 2.3 million people. London was the fourth biggest slave trading port in the world after Rio de Janeiro, Bahia, and Liverpool, and over 3100 ships from London carried nearly a million Africans into slavery.

Exactly how much of Britain and London’s wealth depends on slavery is disputed, but it was a substantial amount. Britain’s manufacturing, banks, and insurance companies grew in part through slavery. When we remember that, as the economist Thomas Pickety has shown, https://richardswsmith.wordpress.com/2020/05/16/the-ideas-of-thomas-pickety-for-overcoming-inequality-in-a-nutshell/ wealth is the surest ways to more wealth, we realise that much of Britain’s present wealth depends on slavery. That is why many want Britain not to talk about aid or charity to poorer countries but rather “reparation.” That debate has just been prominent at COP27 with the argument for rich countries, which have produced most of the greenhouse gases, paying “loss and damage” to poorer countries.

Another major “correction” to my article is that the British may have been motivated to abolish slavery not through moral outrage but because it was no longer profitable. The ships which carried the enslaved people [the museum uses “enslaved people” rather than “slaves”] from Africa to the Caribbean could be used more profitably, and economists argued that free labour was more productive than slave labour. As with everything in history—and particularly the politically charged history of Empire—this conclusion is disputed, and it seems likely that the Abolitionists played an important role even if changing economic conditions and arguments may have been more important.

In my 2012 article I did make clear that former slaves and people of colour played a role in the Abolition movement, but I didn’t give them sufficient prominence. I didn’t mention at all the role of women, but the Museum of London describes how “the abolition campaign was the first in which women played a leading role, and they radicalised the movement…In 1830 it was pressure from the women’s organisation that forced the male-dominated Anti-Slavery Society to declare itself in support of an immediate end to slavery.”

As I concentrated in my article on the campaign to stop trading in enslaved people in the British Empire and mentioned only briefly “the aftermath,” I failed to mention that the slave owners in the Caribbean were paid £20 million (about 40% of the Treasury’s annual income) in compensation for their loss of property, whereas the enslaved people were paid nothing. Indeed, many of the “freed” continued to work as “apprentices” in conditions no better than when they were enslaved. The British government also replaced the enslaved people with cheap labour from India, moving around 1.5 million people to the Caribbean and other colonies.

Profits from the slave trade allowed Britain’s imperial expansion, and migrant labour from the colonies helped in Britain’s reconstruction after the second world war, not least in the NHS. Yet, as the Museum of London explains colonistion was accompanied by the “designing of a ‘racialised’ world and the adoption of racism.” Migrants who arrived in Britain were greeted with discrimination and hostility, which persists to this day. Kamran Abbasi, the editor of the BMJ, describes vividly the racism he experienced as a child in Rotherham in his book Englistan. https://www.amazon.co.uk/Englistan-immigrants-journey-turbulent-Pakistan/dp/B08GVD7GFL

The exhibition in the Museum of London asks “How are we as Londoners to come to terms with these legacies?” It doesn’t give an answer, but one answer I can give confidently is that we need to be aware of the past, educate our children about it, and be as accurate as we can in what we write about the past. Mea culpa.

An enjoyable romp of a novel that won the Pulitzer prize but probably shouldn’t have done

Less by Andrew Sean Greer won the Pulitzer prize for fiction in 2018, which surprises me because it’s a comic novel and ultimately, I fear, one that I will have forgotten in months not years.

(Why bother reading books if you’re simply going to forget them? That could be said about almost anything in life. Most things are forgotten. But some thinks stick, some things shape the whole way you feel about life, and many of those things are books, both fiction and non-fiction.)

Less is quickly, easily, and enjoyably, read within a few hours. It tells the story of an American gay writer who shocked by his young lover marrying somebody else embarks on a world tour to avoid the wedding. He simply accepts every invitation that a writer receives, and his journey takes him to Germany, Italy, Paris, Morocco, India, and Japan, a circumnavigation of the globe. Greer does an excellent job of evoking the countries, and I’ve selected a description of Berlin for my Commonplace book/website.

I’ve also selected a section on what it’s like to live with a genius, an experience few of us have but most of us have wondered about. Arthur Less, the hero of the book, is of interest to the world not because of himself or his books but because for many years he was the lover of a Pulitzer-prize winning poet, a man much older than him.

I always search in a book for a defining sentence or sentences, and this is what I’ve selected from this book: “You’ve bumbled through every moment and been a fool; you’ve misunderstood and misspoken and tripped over absolutely everything and everyone in your path, and you’ve won. And you don’t even realize it.” That tells the story of Less’s journey and even his life.

The book is about writers and the silly things they do, their readings, jealousies, interviews, prizes, travels, and dreams. That’s perhaps why the book won the Pulitzer prize, which is judged by writers and would-be writers. We all like to read about ourselves, and perhaps that is all we ever read about.

Other quotes I took from the book:

The pleasures of youth—danger, excitement, losing oneself in a dark club with a pill, a shot, a stranger’s mouth—and the pleasures of age–comfort and ease, beauty and taste, old friends and old stories and wine, whiskey, sunsets over the water.

Twenty years of joy and support and friendship, that’s a success. Twenty years of anything with another person is a success. If a band stays together twenty years, it’s a miracle. If a comedy duo stays together twenty years, they’re a triumph.

“She told me she met the love of her life,” Zohra says at last, still staring out the window. “You read poems about it, you hear stories about it, you hear Sicilians talk about being struck by lightning. We know there’s no love of your life. Love isn’t terrifying like that. It’s walking the fucking dog so the other one can sleep in, it’s doing taxes, it’s cleaning the bathroom without hard feelings. It’s having an ally in life. It’s not fire, it’s not lightning.

My move into commonplacing

My blog, I have realised, is in part a commonplace, a place, traditionally a book, to hoard treasures you have unearthed while reading. I’ve read about commonplace books in Katherine Rundell’s brilliant book about John Donne, who was a great commonplacer. https://richardswsmith.wordpress.com/2022/07/25/advice-on-living-from-the-greatest-english-poet-of-love-and-sex/  The Elizabethans went about it methodically, compiling headings and then collecting fragments under each heading. Some headings would stay empty.

Rundell writes: “The commonplace book allowed readers to approach the world as a limitless resource; a kind of ever-ongoing harvesting. It was Erasmus, the Dutch scholar known as ‘the prince of the humanists’, who codified the practice.

‘The compiler,’ he wrote, should ‘make himself as full a list of place-headings as possible’ to put at the top of each page: for instance, beauty, friendship, decorum, faith, hope, the vices and virtues.’

It was both a form of scholarship and, too, a way of reminding yourself of what, as you moved through the world, you were to look out for: a list of priorities, of sparks and spurs and personal obsessions.

Donne’s book must surely have had: angels, women, faith, stars, jealousy, gold, desire, dread, death.

‘Then,’ Erasmus wrote, ‘whatever you come across in any author, particularly if it is especially striking, you will be able to note it down in its appropriate place: be it a story or a fable or an example or a new occurrence or a pithy remark or a witty saying or any other clever form of words … Whenever occasion demands, you will have ready to hand a supply of material for spoken or written composition.’

The ideal commonplacer is half lawyer, building up evidence in the case for and against the world, and half treasure hunter; and that’s what Donne’s mind was in those early days. This is a poet who in one single poem could pass through references to Aristotelian logic and Ptolemaic astronomy, to Augustine’s discussion of beauty, and Pliny’s theory on poisonous snakes being harmless when dead.

T S Eliot, a man who had in common with Donne both poetic iconoclasm and good clothes, loved his writing. He said: ‘When a poet’s mind is perfectly equipped for its work, it is constantly amalgamating disparate experience.’

Commonplacing was a way [for Donne] to assess material for those new connections: bricks made ready for the unruly palaces he would build.”

I’m no Donne, but that seems to me all the more reason to add commonplacing to my blog, as, indeed, I have already done. I can’t build palaces, but I can collect palaces and fragments of palaces from what I read.

Dinner surrounded by dead men

I’m having dinner together with many others in the Royal College of Physicians and Surgeons of Glasgow surrounded by portraits of dead men. They are all men, all white, and all are dead apart from one portrait, the living but aged version of whom is sat at the back.

These men seem very dead. Most of the people having dinner have no idea who any of them are. When we are dead we are dead and usually forgotten, no matter of what our achievements, good works, or reputation might have been.

But our speaker and the president bring some of them momentarily to life. One was the founder of the college, a surgeon who trained in France, returned to Glasgow, and horrified by what he saw founded the college to train surgeons and improve the standard of surgery. This was in 1599, and the King who gave him the charter was King James IV of Scotland, four years before he became James I of England. The King’s picture also hangs on the wall.

Another portrait is of a doctor who promoted vaccination against smallpox in the 17th century. Every day he offered vaccinations to the poor from noon to 4pm at the college. Another man, a fellow of the college, was the first to identify carbon dioxide. He made money (I forget how) and invested in James Watt’s steam engine. He thus, the joke goes, makes the college responsible for climate change, our topic for today.

David Livingstone looks down on me from the right. He is remembered, but, whereas once he was admired as a great explorer, now he is “somewhat disreputable,” a colonialist and stalwart of empire. It’s not fair, I’m told, because he was an abolitionist and is still “much loved in Malawi.”

The man sat behind me, a severe looking man with a big moustache was, I’m told , the first neurosurgeon. On purely clinical grounds he diagnosed a meningioma (a slow-growing, treatable brain tumour) in a patient. He urged the patient’s family to let him operate, but they refused. They did, however, consent to a post-mortem, which showed the diagnosis of the man in the portrait with  a big moustache was correct. He went on later to perform the first operation on the brain.

I’m then told that he, not Joseph Lister, was the father of antisepsis in surgery. Lister is associated with Edinburgh, Glasgow’s great rival, and I think that this claim may be Glaswegian swagger. But I’m well aware of how popular history can ger everything wrong, and perhaps the Glaswegian claim is correct.

A story has now been attached to some of the paintings in the room, but what might be the story behind the others? I will never know, and most people who dine in this room will not know any of the stories. Most of the world’s stories are lost, and people lucky or distinguished enough to have their portraits painted transform from people with stories to mediocre decoration on the wall.

“An Orderly Talks” by Sidney Smith[My father’s contribution to a book on Colditz; his name was Sydney]

My father wrote this as a contribution to a book on Colditz edited by Reinhold Eggers, one of the most senior German officers in the prison. Eggers was an urbane, humane, Anglophile with no enthusiasm for Hitler. The other entries in the book are by officers.

(In Colditz there were about a hundred orderlies – English, French, Polish and Belgian. They were prisoners who had volunteered to do the cooking, cleaning, and so on, for their corresponding Allied Officers. Their orderlies become experts in negotiating with German guards, trading with German civil workers and dealing on the Black Market. They were thus of great help in furthering the escaping activities of their officers, to whom they supplied contraband material and extra food. Not infrequently, orderlies would make their own escapes, sometimes with surprising success, as they had a knack of being able to mix and communicate with all manner of people without drawing attention to themselves.)

I was captured by one of Rommel`s tank units during the Battle of El Alamein, on 28th October 1942.  With me were many of my colleagues of the 4th Battalion, The Royal Sussex Regiment. After we had been taken back through the German lines, we were handed over to the Italians for safe keeping.

For a year we were prisoners of the Italians until they surrendered, leaving us free. Most of us broke camp but were eventually recaptured by German patrols and taken to Germany. After going through various transit camps, we came to Stalag VIB, where about a hundred of us were formed into a party and put to work in a copper mine with some of our Russian allies.

After nine months in the mine, I and five of my friends were moved to Konigstein Castle, where we were housed quite comfortably in rooms built into the castle walls. As far as we knew, we were the only prisoners there, but a strict guard was kept on us, which was ominous, as we did no work. We were all concerned about our fate and our anxiety increased with the arrival, about a month later of some sergeants from the Special Air service, who had been captured a year before in Yugoslavia. Since then, they had been subjected to constant interrogations.  They were not classes as soldiers, but as bandits, for they had been captured while wearing civilian clothes. They had been told they were to be shot.

Three or four anxious months passed while we played cards and chess or just slept. Then, in November `44, we were ordered to assemble in a room to hear a special announcement from the German Army GHQ. It was with a certain amount of relief that we learned that we were all to be moved immediately to the notorious Colditz Castle.

At Colditz, after a searching individual interrogation by the British Security Officer to ensure we were bona-fide British soldiers, we were invited to volunteer for various duties as orderlies. I was offered the job of being batman to a group of special prisoners known as the Prominente. They had a higher hostage value than the rest of us, as they were either related to, or connected with, royalty or high state officials. (Some were of exceptional importance in their own right. For example, General Bor-Komorowski, Commander in Chief of the Polish Army and of the Polish Underground Home Army, has at one time been a Colditz Prominente.)  I found them to be particularly interesting people and well remember those for whom I acted as batman.

Their senior officer was Brigadier Davis, a short, rotund, bald-headed man, who had been captured in Yugoslavia after being parachuted straight into enemy hands. The Germans had found out that fires were to be lit by the partisans to guide Allied aircraft which were to drop supplies and personnel, including the Brigadier, which had dropped right in it, as you may say. He had also been badly wounded for his efforts. He seemed to me (I was only twenty-two) to be rather old to have been floating around in a parachute. We used to chat together freely, and he often showed me his wounds of which he was quite proud.

One of the more important Prominente was Lord Lascelles, who sometimes amused me (I am Cockney born and bred) with his efforts to swear. His swearing sounded as if he were speaking normally, with no particular emphasis on the consonants. It was as if a London docker had said nothing but `Bother! ` when a crate dropped on his toe. I believe that his serenity came from his love of music. He constantly listened to classical music played on a gramophone. I listened too, while I swept his room. My work was made pleasant, and I was given a taste for culture.

Captain Lord Haig, son of the Field Marshal, was another of my charges. He seemed to me to be the least soldierly figure of them all; the antithesis of his father – possibly because of him. He was tall and thin with a pronounced stoop. He felt the cold badly and during the everlasting roll-calls he wore a blanket draped over his shoulders and stood on a box to keep his feet warm. He loved painting, which I am sure was of great help to him during the long days of captivity, as he spent hours working on his canvases. He once told me I had a perfect Greek profile and would like to paint my portrait, but he never did.

Another of my employers was Captain the Earl of Hopetoun, who wore wire spectacles and looked like an intellectual egg-head. As a leader of the Conservative prisoners, he arranged weekly political meetings, which I attended for want of something better to do. Once he spoke to me about his powers of concentration. He said he could make himself go into a trance and told me I could do the same. “What you have to do,” he said, “is to take the figure one and divide it by three. This gives you .33333 and so on, to infinity. Concentrate hard on that, and you can go into infinity with it, but for God`s sake, Smith, if you do try it you must know how to come back.” I noticed he had a half-empty bottle of Hooch by his bed. I never reached infinity, possibly through lack of the right spirit.

Giles Romilly, a nephew of Sir Winston Churchill, was a highly prized prisoner, who had been captured while performing his duties as a war correspondent. He was small, with a boyish face and light blue eyes; an unassuming quiet man, but easy to talk to. As unlike his illustrious uncle, as one could get. Giles Romilly`s politics were different too, for he held secret Communist meetings to which I was allowed to go. I went for the same reason that I went to the Tory meetings. I remember Giles telling us that he considered the United States would be a bigger obstacle than the Russians to peace in the post-war world.

There were other Prominente too. Some before my time; but I shall always remember with pleasure those who I knew personally in Colditz.

Remembering my father while reading Ben MacIntyre’s lively book about Colditz

Syd, my father was in Colditz, which was what prompted me to read Ben MacIntyre’s Colditz: Prisoners of the Castle. I don’t think that my brothers and I knew that Syd was in Colditz until the hugely popular BBC television series began in the 70s, when it became “the thing” to have been there. An article in the Daily Mirror asking, “What became of Syd ‘Hooter’ Smith?” (Syd had a huge nose of which he and all of us were proud) unmasked Syd’s past, and he went to a reception at the BBC for Colditz prisoners and met Reinhold Eggers, one of the most senior German officers and a humane man.

The Colditz link together with having been at the Battle of El Alamein gave Syd minor fame, which he did not enjoy. He contributed a chapter to Eggers’s book—“An orderly speaks” [I’ll post it]—and gave talks to Women’s Institutes when they all fell in love with him. He was easy to love, as his memoirs show. His memoir is wonderfully honest and readable and the most precious possession of my brothers and me. With luck, it will be published soon.

Macintyre’s book might be called revisionist, deflating the myth of mustachioed British heroes constantly escaping and showing that “Colditz was a miniature replica of pre-war society….intensely divided over issues of class, politics, sexuality and race.” It was an upstairs-downstairs world with Syd very much downstairs.

Colditz was a prison for officers, particularly those who had tried to escape from other prisons and the Prominente, aristocrats and people with links to royalty and powerful people in Britain. The Germans kept the Prominente, who included Giles Romilly, Churchill’s nephew, as hostages, and the most dramatic moments in both MacIntyre’s book and Syd’s memoir come at the end of the war when the Prominente were whisked away and likely to be killed. Syd spent his life regretting that he did not volunteer to go with them.

Under the Geneva Convention the officers could not be made to work. The orderlies, as they were called, were ordinary soldiers who were needed to look after the officers. Syd was in effect a servant, but he came to know Romilly, the Earl of Hopetoun, and other grand people. Several times years later we walked past Hopetoun House on the shores of the Firth of Forth and Syd would say “He still owes me 400 cigarettes.” Syd never knocked and asked for them. The officers were bored most of the time, and the orderlies had a much better experience.

As MacIntyre makes clear, the history of Colditz has been written—even invented—by the officers, particularly Pat Reid, who made a career from writing about his time in Colditz. “Less educated than the officers, the orderlies,” observes MacIntyre, “did not write memoirs after the war and their experiences have therefore been almost wholly omitted from the broader Colditz story.” MacIntyre did not know of Syd’s memoir, but he must have had access to something about Syd because, although not named, he is quoted twice in the book “‘After the copper mines, Colditz was a holiday camp,’ observed one orderly.” And “‘If you had the choice between the most beautiful woman in the world and a cheese roll, you’d choose the cheese roll,’ said one orderly.”  (He may have picked up the quotes from the article my brother wrote in the Guardian about a visit to Colditz he made with Syd)

My father’s memoirs, which are so precious to us, are also a small voice from those who are mostly voiceless.

I took many quotes from MacIntyre’s book.

Quotes from Colditz by Ben MacIntyre


Colditz was a miniature replica of pre-war society, only stranger. It was a close-knit community intensely divided over issues of class, politics, sexuality and race. In addition to the resolute warriors, the participants in the Colditz drama included communists, scientists, homosexuals, women, aesthetes and philistines, aristocrats, spies, workers, poets and traitors.

Colditz Castle was a frightening prison but it was also frequently absurd, a place of suffering but also of high comedy, an idiosyncratic and eccentric crucible that evolved its own culture, cookery, sports, theatre and even a distinct internal language. But this heavily guarded cage, surrounded by barbed wire and cut off from the world, changed everyone who entered it, as life inside the castle evolved, and the war ground on.

It was, wrote Reid, ‘an unspeakably grisly place’.

In 1938 it became an asylum again, but this time a lethal one: eighty-four physically and mentally disabled people were deliberately starved to death, a testing ground for Hitler’s full-scale euthanasia programme.

Prisoners who had tried to escape from other camps, or otherwise displayed a markedly negative attitude towards Germany. These were designated deutschfeindlich, or ‘German-unfriendly’, a word that has no parallel in any other language and is virtually untranslatable: in Nazi Germany, insufficient friendliness was a crime.

The dowagers, lunatics, Jews, virgins, tubercular patients, war prisoners and white stags in the park had all been brought to the castle by others, and could not get out.


Reid would become the first and most extensive chronicler of Colditz. He hated the place on sight and spent most of the rest of his life thinking and writing about it.


Leutnant Reinhold Eggers was the antithesis of Pat Reid in every possible way, being formal, self-disciplined and humourless, as patriotic as Reid was deutschfeindlich. The two men detested one another on sight: their meeting marked the start of a long and bitter contest.

A schoolteacher by profession, Eggers retained all the attributes of an old-fashioned Prussian headmaster: an orderly, fastidious disciplinarian, as brittle and stiff as a stick of chalk, but evenhanded, unflappable and insistent on good manners. He believed that a career spent educating disobedient children ideally suited him to maintaining control over the rowdiest POWs in Germany, and he applied his rules for teaching to running a prison camp: ‘Never show any emotion; keep smiling whatever happens; punish disobedience with energy.’ A man of principle, he strongly disapproved of using violence against inmates, except in self-defence. His diary and other writings offer a remarkable insight into Colditz from the German perspective.

Eggers was also an ardent anglophile, a risky enthusiasm in Nazi Germany. He made no secret of his admiration for the British countryside, courtesy, language, food and good sportsmanship.

Eggers offered a counterpoint to the dominant British perspective, as sober and precise as Reid’s was jovial and impressionistic.


One class of prisoner never escaped from Colditz, and was not encouraged to try: the lower class. Running through the very heart of Colditz ran a wide and almost unbridgeable social divide. This was a camp for captured officers, but it also contained a fluctuating population of orderlies, ordinary soldier-prisoners from the ‘other ranks’ employed by the Germans to perform menial tasks and work as servants for their senior officers: cooking, tidying, cleaning, boot polishing and other chores.


The nicknames for Colditz guards, collectively referred to as the ‘ferrets’, included Bigbum, Ropey, Dopey, Pieface, Tiger, Cheese, Snuffler, Hiawatha, Eggs, Auntie and Bastard.

Life in Colditz

Mostly, however, the life of a prisoner in Colditz was spectacularly, soul-crushingly and sometimes almost unbearably boring.

‘Indiscipline was the order of the day, often amounting to plain personal insolence, or at least studied off-handedness,’ wrote Eggers,

Glaesche ordered a roll call for the French alone as a punishment, at 1 a.m., and then another half an hour later. The other nations stood at the windows, baying their disrespect: ‘This took the form of loud animal and bird noises, a cockerel here, a cow there, mixed with wailing sirens.’

Sport, wrote one prisoner, ‘acted as a balm to utter boredom’: played hard, watched avidly and then discussed afterwards, endlessly.

Civilians, one prisoner reflected, ‘could never imagine what it is like to get up in the morning to face a long empty day with nothing whatever to do except what you do to yourself’. Crammed into a warren of small rooms, the prisoners were seldom more than a few feet away from each other; the air felt musty, the conversation stale; minor disagreements could flare quickly into angry confrontation; tempers were short, and attention spans shorter.

‘It was a mental battle to keep sane,’ said Jimmy Yule, the jazz band leader.

One veteran observed that prisoners ‘roughly divided themselves into five main categories: escapers, creators, administrators, the students and the sleepers.


The pièce de résistance was a choreographed display by the corps de ballet, led by prima ballerina Pat Reid, ‘consisting of the toughest-looking, heaviest-moustached officers available, who performed miracles of energetic grace and unsophisticated elegance attired in frilly crepe paper ballet skirts and brassieres’.


One doctor in Colditz even prescribed a treatment for heterosexual longings: ‘If one felt the absence of feminine company, there were always two or three among the French who were prepared to give a vivid account of the pleasures of a high-class brothel in Paris.’

‘If you had the choice between the most beautiful woman in the world and a cheese roll, you’d choose the cheese roll,’ said one orderly.

Douglas Bader

Bader was living evidence that it is possible to be courageous, famous, disabled and quite unpleasant, all at the same time.

He clumped into Colditz on 18 August 1942: a man with legs of tin, a heart of oak and feet of clay.


The illicit production of alcohol had come a long way since the crude and fearsome spirit brewed up by the early Polish distillers. Prison moonshine was made by mixing sugar and yeast with ersatz jam, mashed fruit or vegetables. The resulting mixture was left in a warm cupboard to ferment for six weeks, before being distilled with a rustic Liebig condenser constructed from stolen toilet piping, to produce a clear alcohol of 120 degrees proof.

As the former medical student Peter Storie-Pugh observed, alcohol in moderation had ‘an enormously good effect’ on morale.

The Prominente

The clutch of Colditz VIPs now included Polish and French generals, British aristocrats, politicians’ relatives, members of the royal family, and one famous young American.

The orderly officer asked for volunteers, and two New Zealand soldiers, both Maoris, stepped forward [to accompany the Prominente wherever they were going at the nd of the war] . Eggers was astonished that anyone would voluntarily ‘take this trip with their officers into the unknown’.

Giles Romilly never fully escaped from Colditz. ‘My five years of absence were like a deep shaft, I at the bottom, able to see the free people overhead, not able to make them see or hear me.’

Picture taken on the day Syd, my father, arrived home from the war after three years away. He is in the one with the pipe in the middle. (Some unknown persn kindly added the colour and posted the picture on Twitter.)