The Horsepower Oath · 7:14pm Oct 25th, 2022
Blog Number 202: š· Medical Mask Edition
Did you know that Hippocrates, the Ancient Greek "father of medicine" and origin of the Hippocratic Oath, had a name that meant "horse power"?
Ponies: healing people before it was cool. 
Medicine is always a subject I go back to, even though I'd never be any good at it. I'm not squeamish at the sight of blood or anything, but between my memory problems and my complete dislike of high-stress, high-stakes situations, it's a subject I can only appreciate from a distance.
At its best, it's a collaborative, up-to-date, cautious yet determined practice, and principles such as "First, do no harm" and "Prevention is the best medicine" seem to me great in all contexts, as a model for those outside the field to aspire to generally.
Of course, the Hippocratic Oath is actually more a guideline than an actual rule, and modern updates do exist. Here's one quoted directly from Wikipedia's article:
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
"I will have friends like these who'd get me over here in a jiffy: I'm getting tired of carpooling."
(Admittedly, I had to follow that link to find out what "therapeutic nihilism" was, and I'm still not clear if the term applies to any case about the pessimism of cures or if it's exclusive to the historical movements listed there.)
I especially liked this part: "that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug." Whether you interpret it as a psychosomatic effect (the body responds at least partly to the state of the mind) or the safety net idea (other people encourage you to take care of yourself or can spot unusual symptoms early), in medical and psychological literature, it's a limited but notable effect on people's physical and mental health.
Here, I'll link some examples of what I'm talking about:
Social Relationships and Health: A Flashpoint for Health Policy
Many types of scientific evidence show that involvement in social relationships benefits health. The most striking evidence comes from prospective studies of mortality across industrialized nations. These studies consistently show that individuals with the lowest level of involvement in social relationships are more likely to die than those with greater involvement (House, Landis, and Umberson 1988). For example, Berkman and Syme (1979) showed that the risk of death among men and women with the fewest social ties was more than twice as high as the risk for adults with the most social ties. Moreover, this finding held even when socioeconomic status, health behaviors, and other variables that might influence mortality, were taken into account. Social ties also reduce mortality risk among adults with documented medical conditions. For instance, Brummett and colleagues (2001) found that, among adults with coronary artery disease, the socially isolated had a risk of subsequent cardiac death 2.4 times greater than their more socially connected peers.
In addition to mortality, involvement in social relationships has been associated with specific health conditions as well as biological markers indicating risk of preclinical conditions. Several recent review articles provide consistent and compelling evidence linking a low quantity or quality of social ties with a host of conditions, including development and progression of cardiovascular disease, recurrent myocardial infarction, atherosclerosis, autonomic dysregulation, high blood pressure, cancer and delayed cancer recovery, and slower wound healing (Ertel, Glymour, and Berkman 2009; Everson-Rose and Lewis 2005; Robles and Kiecolt-Glaser 2003; Uchino 2006). Poor quality and low quantity of social ties have also been associated with inflammatory biomarkers and impaired immune function, factors associated with adverse health outcomes and mortality (Kiecolt-Glaser et al. 2002; Robles and Kiecolt-Glaser 2003). Marriage is perhaps the most studied social tie. Recent work shows that marital history over the life course shapes a range of health outcomes, including cardiovascular disease, chronic conditions, mobility limitations, self-rated health, and depressive symptoms (Hughes and Waite 2009; Zhang and Hayward 2006).
(Do note, though, that the article makes clear social ties can backfire too: later on, for instance, it describes how marital status can also be a predictor for the opposite, causing extreme stress. I think the lesson here is that social ties can be a great good or a great evil, but that the effect will be great regardless).
"For depression, I recommend having a spouse-ectomy!"
Social connection is the strongest protective factor for depression
This two-stage approach allowed the MGH researchers to narrow the field to a smaller set of promising and potentially causal targets for depression. "Far and away the most prominent of these factors was frequency of confiding in others, but also visits with family and friends, all of which highlighted the important protective effect of social connection and social cohesion," points out Jordan Smoller, MD, ScD associate chief for research in the MGH Department of Psychiatry, and senior author of the study. "These factors are more relevant now than ever at a time of social distancing and separation from friends and family." The protective effects of social connection were present even for individuals who were at higher risk for depression as a result of genetic vulnerability or early life trauma.
On the other hand, factors associated with depression risk included time spent watching TV, though the authors note that additional research is needed to determine if that risk was due to media exposure per se or whether time in front of the TV was a proxy for being sedentary. Perhaps more surprising, the tendency for daytime napping and regular use of multivitamins appeared to be associated with depression risk, though more research is needed to determine how these might contribute.
"Spike! Get up and stop putting on Michael Jackson music video reruns! No more 'Smooth Criminal'!"
And lastly, though this is more for general well-being than medical benefit, it does at least indicate just how widespread the trend is, and what factors may account for it:
Social Connection and Well-Being during COVID-19
As the pandemic persists and surges in COVID-19 cases recur, it is critical to continue to closely and regularly examine the causes, antecedents, and consequences of shifts in well-being and social connection in 2021 and beyond. Accumulating research has shown that the pandemic has led to increases in negative psychological outcomes, such as depression and anxiety, for a large portion of the population. However, many people are arguably faring better than expected, with some reporting increases in life satisfaction and felt social connection. Researchers have identified multiple factors that may account for individual differences in well-being and social connection across the globe, such as seeking out COVID-19-related information, experiencing flow during the pandemic, using social media, being from a vulnerable population, living with a partner, and having positive psychological characteristics like gratitude or resilience. However, before effective interventions to improve well-being and social connection globally can be recommended, much more research is needed. With the wealth of information already published and more on the horizon, researchers, policymakers, and health officials must continue to rely on empirical data to inform interventions and policies that aim to balance physical health with a focus on maintaining or boosting the well-being and social connection of people around the globe.
If you can prevent it, excellent! If you can cure it, good. If you can alleviate the symptoms, OK? And if you can admit that sometimes there's nothing we can do...
Hmm.
"Hmm?"
What can we do, really? Not being doctors, nurses, surgeons, specialists - medical practitioners, I mean.
It's kind of disappointing (for me, at times) to look at this fandom and often see people just talk about ephemeral stuff or modern memes or momentary blips on the "heh I'm amused" radar - trivial matters, to put it bluntly* - because I still vaguely remember the moments when fans explicitly aspired to something more ambitious, something like this, something almost medical. Not always, probably not all that often, and likely not with that specific thought in mind (as opposed to a more generic niceness).
* To be fair, I don't exclude myself from this category. My point isn't that it's bad; it just doesn't seem to be enough.
I mean capturing the positive aspects of the show and channelling them into what I suppose I should call the pro-social drive. Not bandying around "love and tolerance" like some sort of passive-aggressive license, but actually making an effort to care about and for other people. Viewing redemption not as some cheap "Get Out Of Jail Free" Card, but as a committed process to help someone who needed guidance and a do-over*.
* To be blunt: we can blame the show for this, up to a point. Personally, I think it was too episodic for its own good, at times, or failed to take redemption seriously. But on the rare occasions when it didn't just end an ep with "they're good now, friendship hugs!", but committed to showing someone's personal long-term progress - say, Sunset Shimmer's, however abruptly it started - I think it was actually on to something.
Apart from the obvious fandom parallels here, the social aspect of healing reminded me of what I'd heard about Patch Adams online (the real deal, not the misguided film) and his belief that patient care involves the larger social and community context, not just the standard healthcare tools. So I looked up his article too (much to my surprise, this is the first time I've learned about the Ithaca Health Alliance in New York).
Whether or not that particular approach or incarnation of that approach holds up over time, it's the sort of thing I think about. Because I have the twin problems of seeing medicine as the ultimate if not one of the greatest callings, and being completely unqualified for it.
"Just hiding behind a book... don't mind me..."
So what then? Talk? Spread the word? Push for some kind of viral movement? I'm not enough of an ideologue to naively suggest I could pull that off in the dot of a dot-com, nor to insist at the top of my lungs that the world would improve if this kind of medical "help people" ethos dominated. Besides, it's one thing to occasionally chat about the particular illness on your mind (as I did when COVID-19 was a fresh new horror I could keep at bay with intellectualization, and not something that hit me out of nowhere and ruined a week). It's quite another to gather up the myriad diseases into some kind of symbolic casus belli.
Politics was the first field I thought of that could do with fewer sheltered rich groupthinkers squabbling over seats and more frontline caretakers pulling citizens out of unhealthy pits, or at least of appreciating the scale of the challenge. But quite apart from the logistics (of new management, and not least of getting from here to there), I'm too cynical to see it working: politics is power, power tends to lose interest in anything that isn't power games, and power games attract and bring out the worst - and clingiest - in human beings.
It doesn't even stay in politics. Economics, the media, education, law and justice, throughout history and across continents: maybe I'm just dreary and misanthropic, but everywhere I look, I suspect I'm seeing past-their-sell-by-date pyramids, topped by grim people playing me-first games in the map room while riotous wars of all kinds break out in the real world.
A fondness for pony isn't going to stop it. So, barring some future revolution wherein patient-first healing outcompetes social manipulating as the way to sway people, we're down to looking for oases.
Really, I'm not sure what I want, or if whatever it is would even be possible.
Moreover, it's a daunting prospect. Just restrict ourselves to the medical profession's scope, and look at the range of enemies it has to contend with. I've got a book about the human body open in front of me, and it has multiple pages and subsections about various body systems and their diseases, so let me reference those, and the combined ills will give you some idea of the army's strength.
"Tackiness. Tackiness is a disease, right?"
Deep breath, now. There's:
WARNING: THIS LIST INCLUDES EXTREME AND UNPLEASANT DISORDERS. PLEASE SKIP TO THE END IF YOU DO NOT WISH TO READ THEM
SKELETAL (BONE AND JOINT) DISORDERS
- Bone fractures
- Spinal fractures
- Sciatica
- Whiplash
- Disc/Disk prolapse
- Osteomyelitis
- Osteoporosis
- Osteomalacia
- Paget's Disease
- Bone Cancer
- Torn Cartilage
- Adhesive Capsulitis
- Bunion
- Dislocated Joints
- Bursitis
- Congenital Hip Dysplasia
- Perthes' Disease
- Slipped Epiphysis
- Osteoarthritis
- Rheumatoid Arthritis
- Gout
MUSCLE AND TENDON DISORDERS
- Muscle Tears
- Soft-Tissue Inflammation
- Tendinitis
- Tenosynovitis
- Tennis Elbow/Golfer's Elbow
- Ruptured Tendon
- Myasthenia Gravis
- Muscular Dystrophy
- Carpal Tunnel Syndrome
NEURAL AND SENSORY DISORDERS
- Stroke
- Subarachnoid Haemorrhage
- Transient Ischaemic Attack
- Subdural Haemorrhage
- Migraine
- Epilepsy
- Parkinson's Disease
- Creutzfeldt-Jakob Disease
- Multiple Sclerosis
- Dementia
- Alzheimer's Disease
- Spina Bifida
- Meningitis
- Cerebral Palsy
- Brain Tumours
- Paralysis
- Head Injuries
- Perforated Eardrum
- Vertigo
- Motion Sickness
- Tinnitus
- Meniere's Disease
- Longsightedness
- Shortsightedness
- Glaucoma
- Cataracts
HORMONAL DISORDERS
- Pituitary Tumours
- Cushing Syndrome
- Hyperthyroidism
- Hypothyroidism
- Diabetes Mellitus (Type 1)
- Diabetes Mellitus (Type 2)
- Obesity
CARDIOVASCULAR DISORDERS
- Atherosclerosis
- Angina
- Heart Attack
- Cardiomyopathy
- Pericarditis
- Heart Failure
- Congenital Heart Defects
- Valve Disorders
- Heart Murmurs
- Embolism
- Thrombosis
- Aneurysm
- Hypertension
- Arrhythmia
RESPIRATORY DISORDERS
- Common Cold
- Influenza
- Sinusitis
- Tonsillitis
- Pharyngitis
- Laryngitis
- Acute Bronchitis
- Pneumonia
- Legionnaires' Disease
- Pleural Effusion
- Tuberculosis
- Pneumothorax
- Asthma
- Chronic Bronchitis
- Emphysema
- Silicosis
- Asbestosis
- Lung Cancer
INTEGUMENTARY (SKIN, HAIR, NAILS) DISORDERS AND INJURIES
- Skin Cancers
- Rashes
- Acne
- Mole
- Cyst
- Boil
- Wart
- Puncture Wound
- Cut
- Abrasion
- Burn
- Bruise
- Blister
- Sunburn
- Alopecia
- Ingrown Nail
ALLERGIES
- Allergic Rhinitis
- Food Allergies
- Anaphylaxis
- Angioedema
AUTOIMMUNE AND LYMPHATIC DISORDERS
- HIV-AIDS
- Lupus
- Scleroderma
- Pulmonary Fibrosis
- Polyarteritis
- Sarcoidosis
- Anaemia
- Leukaemia
- Lymphoma
DIGESTIVE/ALIMENTARY DISORDERS
- Gingivitis
- Gastric Reflux
- Achalasia
- Oesophageal Tumour
- Food Poisoning
- Gastritis
- Stomach Cancer
- Peptic Ulcer
- Hiatus Hernia
- Alcoholic Liver Disease
- Portal Hypertension
- Hepatitis
- Liver Abscess
- Gallstones
- Pancreatic Cancer
- Pancreatitis
- Irritable Bowel Syndrome
- Diverticular Disease
- Appendicitis
- Colorectal Cancer
- Intestinal Polyps
- Femoral Hernia
- Mesenteric Infarction
- Volvulus
- Intussusception
- Haemorrhoids
URINARY DISORDERS
- Urinary Tract Infections
- Incontinence
- Stress Incontinence
- Kidney Stones
- Bladder Tumours
- Kidney/Renal Failure
REPRODUCTIVE DISORDERS (FEMALE AND MALE)
- Breast Cancer
- Endometriosis
- Cervical Cancer
- Ovarian Cysts
- Ovarian Cancer
- Fibroids
- Uterine Cancer
- Prolapsed Uterus
- Testicular Cancer
- Hydrocele
- Prostrate Disorders
- Prostratitis
SEXUALLY TRANSMITTED INFECTIONS
- Gonorrhea
- Pelvic Inflammatory Disease
- Non-Gonococcal Urethritis
- Syphilis
- Chlamydia Infection
INFERTILITY DISORDERS (FEMALE AND MALE)
- Damaged Fallopian Tube
- Abnormalities of the Uterus
- Cervical Problems
- Ovulation Problems
- Abnormal Sperm Production
- Inflamed Vas Deferens
- Erectile Dysfunction
- Ejaculation Problems
PREGNANCY AND LABOUR DISORDERS
- Ectopic Pregnancy
- Pre-Eclampsia
- Placenta Praevia
- Placental Abruption
- Miscarriage
- Polyhydramnios
- Abnormal Presentation
- Preterm Labour
- Problems During Delivery
INHERITED DISORDERS
- Turner's Syndrome
- Down's Syndrome
- Mosaicism
- Huntington's Disease
- Albinism
- Colour Blindness
- Cystic Fibrosis
LIST ENDS
"My... in-tray...?"
"Well, it wasn't... that long."
That's 197 items as of this posting. 197 ways of being afflicted, from the minor irritants and the obscure maladies to outright murderous time bombs and common scourges. This is not a complete list, either.
Still, it should give you some idea as to how omnipresent these physical conditions are. I haven't even listed the psychological and mental disorders such as depression, personality disorders, psychoses, neuroses, anxiety disorders, mania, schizophrenia, obsessive-compulsive disorders*, paranoia, phobias, and eating disorders.
* I don't like it when such terms are coopted and confused. This is one reason why I stubbornly insist Twilight would, at best, have OCPD, not OCD. OCPD - Obsessive-Compulsive Personality Disorder - is when someone enjoys being hyper-conscientious despite its potential or actual disruption to their life and others' lives. Whereas OCD - Obsessive-Compulsive Disorder - is when someone has intrusive and distressing thoughts that they try to keep at bay with sometimes-elaborate repetitive rituals. It's far, far worse, and in any case I don't see the value of trivializing serious illnesses.
That's a lot of visceral pain and misery out there, right now, on all fronts. Eradicating some of it may be possible, but it will almost certainly cost arms and legs. Eradicating all of it? No, we're fighting a Sisyphean war there. Eradicating any chance of it getting worse? COVID-19 is only three years old, and if you believe some medical professionals, it may well be merely the herald for more new diseases and pandemics.
Keeping this in mind, turning outside the strict confines of the medical and healthcare professions - with their oaths of prevention, of collaboration, of gritty knowledge, of vulnerable souls and light tread, all for a spirit like me who sooner or later got hit on the frontlines of existence - to turn around and see other kinds of unhappy, enraging, frightening, depressing, and shockingly repugnant "sicknesses" - some we don't recognize as such, but which are just what we do, or ignored, or laughed at, or trampled over, or dismissed, or normal, or "deserved", or somebody else's problem, or even defensible for whatever status-quo-preserving reason if challenged - really gets me down.
It's like watching "Sleepless in Ponyville" with a smile, and then realizing someone in the real world would call Scootaloo a stupid crybaby.
Because that's a healthy attitude to childcare.
Amidst all this - I'm halfway sure, but - what the hell am I doing here really? I spent a good chunk of today trying to muster up any enthusiasm for a writing project that I just don't. It's fluffy as all get-out, it doesn't feel like me, and for no obvious motive than because I'm at the stage where I can't tell if I'm forcing myself to write or not.
After a few hours of this, I ended up wondering what else I'm supposed to do with my time. And then I considered writing a blog post to be different. And then, for reasons which currently escape me beyond "I thought it would be amusing", I looked up the etymology for Hippocrates of the Hippocratic Oath. And then all this happened.
I've said in at least one previous blog post that I'm envious. It's arguably my biggest failing as a writer: I find it hard not to see someone else's writing success as a personal, depressing indictment on my part, however irrational that is. But in this case, it runs deeper than that.
I'm imagining an Impossible Numbers who didn't sit down and write in an attempt to live out some childish creative dream, but who had more brains, took a nobler path, and somehow got a degree or whatever is required and went into medicine, doing something unquestionably worthwhile. Meanwhile, I'm the product of a past me who wanted to grow up and write novels. Novels, moreover, that would have been here today, gone tomorrow, and would have done hardly anything positive in the meantime. A bestseller doesn't save lives.
Combine that with my near-breakdowns over writing in the past decade plus - look at IN, can't even write fanfic without malfunctioning - and it's hard not to suspect I've done something horribly destructive.
"Don't be dumb. There is no mess. It's always looked like this."
"And that's a second moon!"
All that said, (and now I've got my angsty egomania out of the way), the only logical route - barring "scrap everything, go into medical school, and take my chances" - is some kind of therapeutic creative fiction.
By that, I don't mean writing for my own benefit, as if fiction-writing was a pill I should take once a day. I mean... is there a way to write pony while capturing some of that quasi-medical impulse? Making people feel better, on some deeper level than just "lol amoosing byyyeee OK whuts nxt noaw"? Recruiting comedy, tragedy, drama, adventure, horror, romance, and so on for the Horacean purpose - "to delight and instruct" - and in such a way that it gives people some form of defence against the knocks of life? Not just escapism for a brief, unprepared respite before it wears off, but solid, ongoing defences? Moreover, is there a way to do it without being pretentious as hell?
Can it be done, and if so, how?
Part of me really doesn't like talking like this. It feels crude, stupid, compromised, even kind of arrogant. Besides, pretending written fiction is in the same league as medical or therapeutic help is insulting to both: philistine to art, dodgy practice to medicine.
I don't know. All I know is I want a bit of both. Or at least to adopt some of the principles and work ethic of the one in an attempt to put more purpose into the other.
A fusion of their best? I'm still thinking about it. I just had to get this off my chest.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
That's all for now. Impossible Numbers, out.
Thereās nothing wrong with wanting your prose to mean something more than getting a few chuckles, nor to wish for greater purpose elsewhere. I admittedly donāt have any suggestions there, but still. If anything, I admire the higher standards and expectations you have for yourself than, say, I have for me.
That said, itās okay to let yourself off the hook now and again.
5694490
Generally, I don't think I'd manage without a bit of light comedy every now and then. Getting too serious is tempting but suffocating. Besides, the universe is crazy enough to supply plenty of absurd daftness.
I'm reminded of another Terry Pratchett quote (this one from Equal Rites): "Hilta laughed. Esk quite liked the sound. Granny never laughed, she merely let the corners of her mouth turn up, but Hilta laughed like someone who had thought hard about Life and had seen the joke."
5694497
ā This comment has warranted what we Brits call a caution, for skirting close to the criterion in the following on-site rule (General):
"Bothering" being: flippant, dismissive non-engagement, potentially passive-aggressive insult, and general time-wasting. Constructive criticism is not hard, and these blog posts are optional reads.
Please reconsider before posting something like this again.
Like everything else in life, it depends on how you do it.
If nothing else, I've got to admire your seemingly inexhaustible energy!
Well... I wrote a long thing about the difficulties of promoting rational positivity in a virulently irrational and dogmatic world, and then realized that was probably entirely unhelpful.
Re: OF29
Issuing a caution is very charitable of you, but I recommend a look at their profile page and the groups they belong to before giving them any further opportunity to intrude upon your space. Of course, I have wholeheartedly subscribed to therapeutic nihilism in regards to ill-behaved users of limited intellectual capacity on this site, so take that in the light of my own biases.
5694534
This, basically. I think social ties are more extreme in their results simply because that's the price we pay for being social creatures. Putting it crudely: high investment, high risk.
Oh, it's exhaustible all right, on this side of the screen. I'll have to go to sleep soon, and not just because it's midnight on this side of the Pond. Energy comes and goes, so it depends on the day, what's on my mind, and what else is going on.
I'm not sure what you mean here, regarding how it'd be unhelpful. If nothing else, it's at least worth having an idea as to what to expect. But I acknowledge it is a bit of a depressing topic, so I bow to your judgement.
Perhaps it's similar to my difficulties: I suppose part of my gloominess is from having to watch the UK government's scrambling and our economy's rumbling over the last few weeks. Politics especially isn't a happy topic for me.
Speaking naively, the only strategy I can think of is to honestly strive to follow our own principles, allow people room to figure it out for themselves, play fair, and hope they gradually catch on. Speaking naively, that is: I'm no scientist.
Thanks for the advice, but I think I'll err on the side of forgiving and treat it as a momentary lapse, for the time being. I haven't had any issues with them before, and I want to at least try to be fair.
5694510
I was just joking around; my intent was not to offend. My apologies.
5694555
No worries. Given people's different tastes, comedy is a tricky thing to judge at the best of times. Thanks for clarifying.