Tag Archives: Health & wellbeing

The shorter your sleep, the shorter your life: the new sleep science

Leading neuroscientist Matthew Walker on why sleep deprivation is increasing our risk of cancer, heart attack and Alzheimers and what you can do about it

Matthew Walker has learned to dread the question What do you do? At parties, it signals the end of his evening; thereafter, his new acquaintance will inevitably cling to him like ivy. On an aeroplane, it usually means that while everyone else watches movies or reads a thriller, he will find himself running an hours-long salon for the benefit of passengers and crew alike. Ive begun to lie, he says. Seriously. I just tell people Im a dolphin trainer. Its better for everyone.

Walker is a sleep scientist. To be specific, he is the director of the Center for Human Sleep Science at the University of California, Berkeley, a research institute whose goal possibly unachievable is to understand everything about sleeps impact on us, from birth to death, in sickness and health. No wonder, then, that people long for his counsel. As the line between work and leisure grows ever more blurred, rare is the person who doesnt worry about their sleep. But even as we contemplate the shadows beneath our eyes, most of us dont know the half of it and perhaps this is the real reason he has stopped telling strangers how he makes his living. When Walker talks about sleep he cant, in all conscience, limit himself to whispering comforting nothings about camomile tea and warm baths. Its his conviction that we are in the midst of a catastrophic sleep-loss epidemic, the consequences of which are far graver than any of us could imagine. This situation, he believes, is only likely to change if government gets involved.

Walker has spent the last four and a half years writing Why We Sleep, a complex but urgent book that examines the effects of this epidemic close up, the idea being that once people know of the powerful links between sleep loss and, among other things, Alzheimers disease, cancer, diabetes, obesity and poor mental health, they will try harder to get the recommended eight hours a night (sleep deprivation, amazing as this may sound to Donald Trump types, constitutes anything less than seven hours). But, in the end, the individual can achieve only so much. Walker wants major institutions and law-makers to take up his ideas, too. No aspect of our biology is left unscathed by sleep deprivation, he says. It sinks down into every possible nook and cranny. And yet no one is doing anything about it. Things have to change: in the workplace and our communities, our homes and families. But when did you ever see an NHS poster urging sleep on people? When did a doctor prescribe, not sleeping pills, but sleep itself? It needs to be prioritised, even incentivised. Sleep loss costs the UK economy over 30bn a year in lost revenue, or 2% of GDP. I could double the NHS budget if only they would institute policies to mandate or powerfully encourage sleep.

Why, exactly, are we so sleep-deprived? What has happened over the course of the last 75 years? In 1942, less than 8% of the population was trying to survive on six hours or less sleep a night; in 2017, almost one in two people is. The reasons are seemingly obvious. First, we electrified the night, Walker says. Light is a profound degrader of our sleep. Second, there is the issue of work: not only the porous borders between when you start and finish, but longer commuter times, too. No one wants to give up time with their family or entertainment, so they give up sleep instead. And anxiety plays a part. Were a lonelier, more depressed society. Alcohol and caffeine are more widely available. All these are the enemies of sleep.

But Walker believes, too, that in the developed world sleep is strongly associated with weakness, even shame. We have stigmatised sleep with the label of laziness. We want to seem busy, and one way we express that is by proclaiming how little sleep were getting. Its a badge of honour. When I give lectures, people will wait behind until there is no one around and then tell me quietly: I seem to be one of those people who need eight or nine hours sleep. Its embarrassing to say it in public. They would rather wait 45 minutes for the confessional. Theyre convinced that theyre abnormal, and why wouldnt they be? We chastise people for sleeping what are, after all, only sufficient amounts. We think of them as slothful. No one would look at an infant baby asleep, and say What a lazy baby! We know sleeping is non-negotiable for a baby. But that notion is quickly abandoned [as we grow up]. Humans are the only species that deliberately deprive themselves of sleep for no apparent reason. In case youre wondering, the number of people who can survive on five hours of sleep or less without any impairment, expressed as a percent of the population and rounded to a whole number, is zero.

The world of sleep science is still relatively small. But it is growing exponentially, thanks both to demand (the multifarious and growing pressures caused by the epidemic) and to new technology (such as electrical and magnetic brain stimulators), which enables researchers to have what Walker describes as VIP access to the sleeping brain. Walker, who is 44 and was born in Liverpool, has been in the field for more than 20 years, having published his first research paper at the age of just 21. I would love to tell you that I was fascinated by conscious states from childhood, he says. But in truth, it was accidental. He started out studying for a medical degree in Nottingham. But having discovered that doctoring wasnt for him he was more enthralled by questions than by answers he switched to neuroscience, and after graduation, began a PhD in neurophysiology supported by the Medical Research Council. It was while working on this that he stumbled into the realm of sleep.

Matthew
Matthew Walker photographed in his sleep lab. Photograph: Saroyan Humphrey for the Observer

I was looking at the brainwave patterns of people with different forms of dementia, but I was failing miserably at finding any difference between them, he recalls now. One night, however, he read a scientific paper that changed everything. It described which parts of the brain were being attacked by these different types of dementia: Some were attacking parts of the brain that had to do with controlled sleep, while other types left those sleep centres unaffected. I realised my mistake. I had been measuring the brainwave activity of my patients while they were awake, when I should have been doing so while they were asleep. Over the next six months, Walker taught himself how to set up a sleep laboratory and, sure enough, the recordings he made in it subsequently spoke loudly of a clear difference between patients. Sleep, it seemed, could be a new early diagnostic litmus test for different subtypes of dementia.

After this, sleep became his obsession. Only then did I ask: what is this thing called sleep, and what does it do? I was always curious, annoyingly so, but when I started to read about sleep, I would look up and hours would have gone by. No one could answer the simple question: why do we sleep? That seemed to me to be the greatest scientific mystery. I was going to attack it, and I was going to do that in two years. But I was naive. I didnt realise that some of the greatest scientific minds had been trying to do the same thing for their entire careers. That was two decades ago, and Im still cracking away. After gaining his doctorate, he moved to the US. Formerly a professor of psychiatry at Harvard Medical School, he is now professor of neuroscience and psychology at the University of California.

Does his obsession extend to the bedroom? Does he take his own advice when it comes to sleep? Yes. I give myself a non-negotiable eight-hour sleep opportunity every night, and I keep very regular hours: if there is one thing I tell people, its to go to bed and to wake up at the same time every day, no matter what. I take my sleep incredibly seriously because I have seen the evidence. Once you know that after just one night of only four or five hours sleep, your natural killer cells the ones that attack the cancer cells that appear in your body every day drop by 70%, or that a lack of sleep is linked to cancer of the bowel, prostate and breast, or even just that the World Health Organisation has classed any form of night-time shift work as a probable carcinogen, how could you do anything else?

There is, however, a sting in the tale. Should his eyelids fail to close, Walker admits that he can be a touch Woody Allen-neurotic. When, for instance, he came to London over the summer, he found himself jet-lagged and wide awake in his hotel room at two oclock in the morning. His problem then, as always in these situations, was that he knew too much. His brain began to race. I thought: my orexin isnt being turned off, the sensory gate of my thalamus is wedged open, my dorsolateral prefrontal cortex wont shut down, and my melatonin surge wont happen for another seven hours. What did he do? In the end, it seems, even world experts in sleep act just like the rest of us when struck by the curse of insomnia. He turned on a light and read for a while.

Will Why We Sleep have the impact its author hopes? Im not sure: the science bits, it must be said, require some concentration. But what I can tell you is that it had a powerful effect on me. After reading it, I was absolutely determined to go to bed earlier a regime to which I am sticking determinedly. In a way, I was prepared for this. I first encountered Walker some months ago, when he spoke at an event at Somerset House in London, and he struck me then as both passionate and convincing (our later interview takes place via Skype from the basement of his sleep centre, a spot which, with its bedrooms off a long corridor, apparently resembles the ward of a private hospital). But in another way, it was unexpected. I am mostly immune to health advice. Inside my head, there is always a voice that says just enjoy life while it lasts.

The evidence Walker presents, however, is enough to send anyone early to bed. Its no kind of choice at all. Without sleep, there is low energy and disease. With sleep, there is vitality and health. More than 20 large scale epidemiological studies all report the same clear relationship: the shorter your sleep, the shorter your life. To take just one example, adults aged 45 years or older who sleep less than six hours a night are 200% more likely to have a heart attack or stroke in their lifetime, as compared with those sleeping seven or eight hours a night (part of the reason for this has to do with blood pressure: even just one night of modest sleep reduction will speed the rate of a persons heart, hour upon hour, and significantly increase their blood pressure).

A lack of sleep also appears to hijack the bodys effective control of blood sugar, the cells of the sleep-deprived appearing, in experiments, to become less responsive to insulin, and thus to cause a prediabetic state of hyperglycaemia. When your sleep becomes short, moreover, you are susceptible to weight gain. Among the reasons for this are the fact that inadequate sleep decreases levels of the satiety-signalling hormone, leptin, and increases levels of the hunger-signalling hormone, ghrelin. Im not going to say that the obesity crisis is caused by the sleep-loss epidemic alone, says Walker. Its not. However, processed food and sedentary lifestyles do not adequately explain its rise. Something is missing. Its now clear that sleep is that third ingredient. Tiredness, of course, also affects motivation.

Sleep has a powerful effect on the immune system, which is why, when we have flu, our first instinct is to go to bed: our body is trying to sleep itself well. Reduce sleep even for a single night, and your resilience is drastically reduced. If you are tired, you are more likely to catch a cold. The well-rested also respond better to the flu vaccine. As Walker has already said, more gravely, studies show that short sleep can affect our cancer-fighting immune cells. A number of epidemiological studies have reported that night-time shift work and the disruption to circadian sleep and rhythms that it causes increase the odds of developing cancers including breast, prostate, endometrium and colon.

Getting too little sleep across the adult lifespan will significantly raise your risk of developing Alzheimers disease. The reasons for this are difficult to summarise, but in essence it has to do with the amyloid deposits (a toxin protein) that accumulate in the brains of those suffering from the disease, killing the surrounding cells. During deep sleep, such deposits are effectively cleaned from the brain. What occurs in an Alzheimers patient is a kind of vicious circle. Without sufficient sleep, these plaques build up, especially in the brains deep-sleep-generating regions, attacking and degrading them. The loss of deep sleep caused by this assault therefore lessens our ability to remove them from the brain at night. More amyloid, less deep sleep; less deep sleep, more amyloid, and so on. (In his book, Walker notes unscientifically that he has always found it curious that Margaret Thatcher and Ronald Reagan, both of whom were vocal about how little sleep they needed, both went on to develop the disease; it is, moreover, a myth that older adults need less sleep.) Away from dementia, sleep aids our ability to make new memories, and restores our capacity for learning.

And then there is sleeps effect on mental health. When your mother told you that everything would look better in the morning, she was wise. Walkers book includes a long section on dreams (which, says Walker, contrary to Dr Freud, cannot be analysed). Here he details the various ways in which the dream state connects to creativity. He also suggests that dreaming is a soothing balm. If we sleep to remember (see above), then we also sleep to forget. Deep sleep the part when we begin to dream is a therapeutic state during which we cast off the emotional charge of our experiences, making them easier to bear. Sleep, or a lack of it, also affects our mood more generally. Brain scans carried out by Walker revealed a 60% amplification in the reactivity of the amygdala a key spot for triggering anger and rage in those who were sleep-deprived. In children, sleeplessness has been linked to aggression and bullying; in adolescents, to suicidal thoughts. Insufficient sleep is also associated with relapse in addiction disorders. A prevailing view in psychiatry is that mental disorders cause sleep disruption. But Walker believes it is, in fact, a two-way street. Regulated sleep can improve the health of, for instance, those with bipolar disorder.

Ive mentioned deep sleep in this (too brief) summary several times. What is it, exactly? We sleep in 90-minute cycles, and its only towards the end of each one of these that we go into deep sleep. Each cycle comprises two kinds of sleep. First, there is NREM sleep (non-rapid eye movement sleep); this is then followed by REM (rapid eye movement) sleep. When Walker talks about these cycles, which still have their mysteries, his voice changes. He sounds bewitched, almost dazed.

During NREM sleep, your brain goes into this incredible synchronised pattern of rhythmic chanting, he says. Theres a remarkable unity across the surface of the brain, like a deep, slow mantra. Researchers were once fooled that this state was similar to a coma. But nothing could be further from the truth. Vast amounts of memory processing is going on. To produce these brainwaves, hundreds of thousands of cells all sing together, and then go silent, and on and on. Meanwhile, your body settles into this lovely low state of energy, the best blood-pressure medicine you could ever hope for. REM sleep, on the other hand, is sometimes known as paradoxical sleep, because the brain patterns are identical to when youre awake. Its an incredibly active brain state. Your heart and nervous system go through spurts of activity: were still not exactly sure why.

Does the 90-minute cycle mean that so-called power naps are worthless? They can take the edge off basic sleepiness. But you need 90 minutes to get to deep sleep, and one cycle isnt enough to do all the work. You need four or five cycles to get all the benefit. Is it possible to have too much sleep? This is unclear. There is no good evidence at the moment. But I do think 14 hours is too much. Too much water can kill you, and too much food, and I think ultimately the same will prove to be true for sleep. How is it possible to tell if a person is sleep-deprived? Walker thinks we should trust our instincts. Those who would sleep on if their alarm clock was turned off are simply not getting enough. Ditto those who need caffeine in the afternoon to stay awake. I see it all the time, he says. I get on a flight at 10am when people should be at peak alert, and I look around, and half of the plane has immediately fallen asleep.

So what can the individual do? First, they should avoid pulling all-nighters, at their desks or on the dancefloor. After being awake for 19 hours, youre as cognitively impaired as someone who is drunk. Second, they should start thinking about sleep as a kind of work, like going to the gym (with the key difference that it is both free and, if youre me, enjoyable). People use alarms to wake up, Walker says. So why dont we have a bedtime alarm to tell us weve got half an hour, that we should start cycling down? We should start thinking of midnight more in terms of its original meaning: as the middle of the night. Schools should consider later starts for students; such delays correlate with improved IQs. Companies should think about rewarding sleep. Productivity will rise, and motivation, creativity and even levels of honesty will be improved. Sleep can be measured using tracking devices, and some far-sighted companies in the US already give employees time off if they clock enough of it. Sleeping pills, by the way, are to be avoided. Among other things, they can have a deleterious effect on memory.

Those who are focused on so-called clean sleep are determined to outlaw mobiles and computers from the bedroom and quite right, too, given the effect of LED-emitting devices on melatonin, the sleep-inducing hormone. Ultimately, though, Walker believes that technology will be sleeps saviour. There is going to be a revolution in the quantified self in industrial nations, he says. We will know everything about our bodies from one day to the next in high fidelity. That will be a seismic shift, and we will then start to develop methods by which we can amplify different components of human sleep, and do that from the bedside. Sleep will come to be seen as a preventive medicine.

What questions does Walker still most want to answer? For a while, he is quiet. Its so difficult, he says, with a sigh. There are so many. I would still like to know where we go, psychologically and physiologically, when we dream. Dreaming is the second state of human consciousness, and we have only scratched the surface so far. But I would also like to find out when sleep emerged. I like to posit a ridiculous theory, which is: perhaps sleep did not evolve. Perhaps it was the thing from which wakefulness emerged. He laughs. If I could have some kind of medical Tardis and go back in time to look at that, well, I would sleep better at night.

Why We Sleep: The New Science of Sleep and Dreamsby Matthew Walker is published by Allen Lane (20). To order a copy for 17 go toguardianbookshop.com or call 0330 333 6846. Free UK p&p over 10, online orders only. Phone orders min p&p of 1.99

Sleep in numbers

Two-thirds of adults in developed nations fail to obtain the nightly eight hours of sleep recommended by the World Health Organisation.

An adult sleeping only 6.75 hours a night would be predicted to live only to their early 60s without medical intervention.

A 2013 study reported that men who slept too little had a sperm count 29% lower than those who regularly get a full and restful nights sleep.

If you drive a car when you have had less than five hours sleep, you are 4.3 times more likely to be involved in a crash. If you drive having had four hours, you are 11.5 times more likely to be involved in an accident.

A hot bath aids sleep not because it makes you warm, but because your dilated blood vessels radiate inner heat, and your core body temperature drops. To successfully initiate sleep, your core temperature needs to drop about 1C.

The time taken to reach physical exhaustion by athletes who obtain anything less than eight hours of sleep, and especially less than six hours, drops by 10-30%.

There are now more than 100 diagnosed sleep disorders, of which insomnia is the mostcommon.

Morning types, who prefer to awake at or around dawn, make up about 40% of the population. Evening types, who prefer to go to bed late and wake up late, account for about 30%. The remaining 30% lie somewhere in between.

Read more: https://www.theguardian.com/lifeandstyle/2017/sep/24/why-lack-of-sleep-health-worst-enemy-matthew-walker-why-we-sleep

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Hollywoods grim century of fat-shaming: from Greta Garbo to Chle Grace Moretz

The film industry has a long and unhealthy obsession with the weight of its female stars. The more who speak up like Moretz did this week the more chance there is of change

This week, 20-year-old actor Chle Grace Moretz said she had been body-shamed by a male actor on set when she was 15. He was her co-star at the time, in his 20s, cast in the role of her love interest, and he said he would never date her in real life, because she was too big. It was a comment that drove her to tears. Moretz is the latest in a string of Hollywood stars who are prepared to be more open about their experiences of sexism in the industry, from Jennifer Lawrence to Emma Watson. Like the late Carrie Fisher, who revealed she was asked to lose weight before appearing in the new Star Wars series, Moretz touches on something particularly troubling: the pressure on women on screen to maintain a body size that may be unrealistic or unhealthy.

Unfortunately, this is nothing new. Silent-film expert Pamela Hutchinson cites the example of Greta Garbo. Louis B Mayer hired her for MGM in 1925, when she was already a success in Europe, with the caveat that In America, we dont like fat women. Garbo ate nothing but spinach for three weeks and then dieted, rigorously, for the rest of her Hollywood career. There were even more extreme measures. An actor called Molly ODay had her excess weight cut away by a surgeon. In 1929, Photoplay magazine explicitly blamed the death of comic actor Katherine Grant on the Hal Roach studios demands for her to lose weight.

Carrie
Carrie Fisher, who said she was told to lose weight before appearing in the new Star Wars films. Photograph: Chris Pizzello/AP

The issue has persisted ever since. Emma Thompson recently said she threatened to quit the 2008 film Brideshead Revisited after a female co-star was asked to lose weight. I said to them, If you speak to her about this again, on any level, I will leave this picture. You are never to do that. Troublingly, Thompson feels the problem is increasing. Its evil whats happening, she continued, and whats going on there, and its getting worse.

While male actors may be asked to lose weight for extreme roles such as Matthew McConaughey playing an Aids patient in Dallas Buyers Club women are routinely asked to slim down simply to play female leads. Ive heard of women on set being openly poked and prodded by male studio executives who discuss their unsuitable size and these actors are tiny in the first place. Jennifer Lawrence has spoken of being considered plus size or fat in Hollywood, while on Twitter, Amanda Seyfried said she had been considered overweight. X-Men: Apocalypse actor Sophie Turner also chimed in recently. There are often times when I have done jobs and theyve told me that I have to lose weight, even when it has nothing to do with the character, she told Porter magazine. It is so fucked up.

This infuriating pressure prompts the question: why? If this is about idealism and adulation, are audiences really asking for this? Actors such as Christina Hendricks and Sofia Vergara, who are curvier than the Hollywood average, have no shortage of admirers.

The feminist campaigner Laura Bates, who started her career as an actor, says this pressure is absolutely rife, both in and outside Hollywood. The pressures on Hollywood women lead to a screen ideal which then heaps more pressure on ordinary women and girls. That Moretz was just 15 when this happened, says Bates, also highlights how body-shaming can impact girls from an incredibly young age. We know that girls are just five when they first start to worry about their size and shape, and that a devastating one-quarter of seven-year-old girls has dieted to lose weight. They are also bombarded with airbrushed, unrealistic media and advertising images that repeatedly send them the message that their bodies are not good enough, that they will be judged by their looks, and that they must conform to a narrow, media-mandated notion of beauty.

Joan Smith, human rights campaigner and author of Misogynies, agrees. Making girls and women feel uncomfortable about their bodies is a way of attacking their confidence. It makes women defensive and inward-looking, and when you feel like that, you lose your sense of having a place in the world. It happens in Hollywood because the stakes money, fame are so high, but it goes far beyond that. At a time when we have a legal right to equality, its a way of restoring the old inequality women are permanently open to scrutiny. Its not always conscious but its nasty and effective.

Bates also points out the massive double standards in Hollywood, saying women are often more pressurised than men. Women who arent Hollywood thin are very rarely cast in mainstream thrillers, sci-fi or fantasy films, and in dramas they usually appear in character roles, often played by older actors. When bigger female characters are the lead in a film, their weight is never incidental, but rather a defining characteristic, such as the role played by Gabourey Sidibe in the 2009 film Precious. Meanwhile, male leads come in all shapes and sizes Jack Black, Seth Rogen and Jonah Hill (now slimmed down) have all appeared frequently in a variety of leading roles, including drama as well as comedy, and stars such as John Travolta, Russell Crowe and Vince Vaughn have been allowed to change physically over the course of their careers.

Gabourey
Gabourey Sidibe, star of 2009 film Precious. Photograph: Robyn Beck/AFP/Getty Images

Comedy seems more welcoming of female actors such as Melissa McCarthy, though many of her lead roles have been in films made by her own production company, and others such as Rebel Wilson are usually relegated to the funny best friend role. Amy Schumer has something resembling an average body shape watching 2015s Trainwreck, I remember being startled to see someone who looked more like me and my friends on the big screen. I thought, perhaps, this signalled a cultural shift, but since then Ive mostly been reviewing romcoms with stick-thin heroines perhaps the kind that Moretzs cruel co-star was comparing her with. And sadly, his kind of body shaming isnt confined to Hollywood far from it.

Actor, comedian and writer Arabella Weir thinks Moretz should name and shame the man in question. The problems, as expressed by this particular guy, she says, are all his, not hers and her BMI. To allow comments about ones size to cause one pain is to validate them. Name, shame and circulate as widely as possible all comments of this nature and let their authors attempt to justify them theyre in the wrong, the subject never is. Until women refuse to be categorised by their size, and that includes naming the person, then well always be seen as participating somehow in the myth that thin equals good.

There is hope on the Hollywood horizon: the Sundance hit Patti Cake$ (out on 1 September) is a joyous celebration of a female rapper (Danielle Macdonald) that shows her character suffering from body shaming while she challenges expectations of what a performer should look like. While the story tackles the subject of her weight, its as much about her character and her career aspirations. Moretz herself is in an upcoming body-positive take on Snow White, although she spoke out after its poster seemed to body-shame her character. Also in animation, last years Disney teen Moana had a more realistic shape and this is in a genre previously well known for its preposterous female figures.

But animation is one thing, living, breathing actors another. Hollywood has the power to change things by showcasing a far greater diversity of womens body types, shapes and skin colours, rather than reinforcing suffocating stereotypes and impossible standards, says Bates. It has an opportunity to be part of the solution rather than part of the problem.

Shes right. We need more female actors to speak out and for Hollywood to listen.

Read more: https://www.theguardian.com/film/2017/aug/11/hollywoods-grim-century-of-fat-shaming-from-greta-garbo-to-chloe-grace-moretz

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Why do stars like Adele keep losing their voice?

The long read: More and more singers are cancelling big shows and turning to surgery to fix their damaged vocal cords. But is the problem actually down to the way they sing?

I dont even know how to start this, Adele wrote in an online letter to fans on 30 June. The previous night, she had played the second show of a sold-out, four-night residency at Wembley Stadium. These dates, in front of audiences of 98,000, were supposed to be the triumphant conclusion of her record-setting, 123-date world tour. But on stage, something had just felt wrong.

Ive struggled vocally both nights, she wrote. I had to push a lot harder than I normally do. I felt like I constantly had to clear my throat. After the second show, Adele went to see her doctor, who told her she had damaged her vocal cords and had no option but to cancel her remaining shows. The most powerful young voice in the music business had fallen silent. To say Im heart broken would be a complete understatement, she wrote.

Though only 29, Adele had been here before. Six years earlier, she had suffered a haemorrhage to her vocal cords after singing live on a French radio program. In order to repair the injury, she underwent an incredibly delicate, high-risk medical intervention: vocal cord microsurgery. In this operation, the surgeon wields miniature scalpels and forceps attached to foot-long poles that are guided down the throat to excise whatever damaged tissue is robbing the vocal cords of their elasticity, and depriving the voice of its natural timbre, range and clarity.

Adeles surgeon, Dr Steven Zeitels, was after a nasty polyp that had formed under her epithelium, the thin outer layer of the vocal cord. Zeitels carefully snipped the layer with a scalpel, and then, with a forcep, pulled back the tissue like a flap, exposing the polyp below. With a second forcep he pulled out the gooey, infected mass, and zapped the remaining haemorrhaged surface with a laser to stop the bleeding and prevent scarring.

The margin for error in such surgeries is measured in fractions of a millimetre. You cant let the instruments touch any healthy tissue. Dig too deep, Zeitels knew, and he would risk damaging the superficial lamina propria, the soft, pliable underlayer of Adeles vocal cords. If he pierced that, he told me, there would be no way to preserve the power and suppleness of her voice.

On 12 February 2012, three months after her surgery, Adele swept up six awards at the Grammys, including album of the year and song of the year. In her acceptance speech for best pop solo performance, she thanked Zeitels for restoring her voice. To most observers, it was a cheering comeback story, but for a handful of medical specialists it was a watershed moment. For years, vocal cord microsurgery had been considered risky. (In 1997, an unsuccessful surgical procedure left Julie Andrews already damaged voice beyond repair.) More than the physical risk, though, singers feared the damage to their careers that could follow if word got out. In the world of showbusiness, it was safer to be seen as a singer with a healthy young voice than as a one-time great with surgically repaired cords.

Now, Adele had suddenly swept away the stigma. In the years since, Zeitels business has boomed, along with those of many of his peers. They have no shortage of patients: there is an epidemic of serious vocal cord injuries in the performing arts. In addition to his work on Adele, Zeitels, who directs the Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, has repaired the cords of more than 700 performing artists, including Sam Smith, Lionel Richie, Bono and Cher. Michael Bubl, Keith Urban, Meghan Trainor and Celine Dion have also had to quit touring to get their cords surgically repaired. In a mark of how attitudes to surgery have changed, both Smith and Bubl broke the news of their surgeries to their fans via Instagram.

There is no precise data on the number of performers who have gone under the knife over the years. But several surgeons told me they estimate that vocal cord surgery has been performed on thousands of pop, rock and classical singers, as well as on theatre and stage musical stars. Cancelled shows reverberate across social media and hit a struggling music industry hard. When Adele pulled out of her remaining two Wembley shows this summer, nearly 200,000 tickets had to be refunded. Its unclear if she will ever tour again.

After Adeles 2011 surgery, Zeitels became something of a celebrity. Occasionally, a reporter asked him if Adele was cured for good. He made no assurances, but told Channel 4s Jon Snow that her surgically repaired voice sounds smoother now than before.

While the media was celebrating this miracle surgery, one woman in the music industry raised a dissenting voice. According to Lisa Paglin, a former opera singer turned voice coach, Zeitels had simply found a temporary fix; in the not too distant future, Adele would once again be forced off the stage and back into the operating theatre. It was a prediction that Paglin and Marianna Brilla, her coaching partner, were willing to stake their reputations on. The rash of vocal injuries silencing our most promising young talents, they argued, is too big a problem to be solved by microsurgery.

How many surgeries would Dr Zeitels consider performing on Adele? Or on anyone? After surgery, unless a singer makes major changes, return to performing means a return to the vocal abuse that put her/him on the operating table in the first place, Paglin wrote, in the small trade publication Intermezzo. Concerts injury surgery rest concerts injury surgery. Is this the life of a professional singer?

When Adele cancelled the final nights of her recent tour, Brilla and Paglin felt saddened but vindicated. For more than a decade, they have been pushing for a revolution in the way that almost every modern performer has been taught to use their voice. After years of painstaking research in musical archives, early scientific journals and the classroom, Brilla and Paglin say they can deliver what medical science has failed to: a permanent fix for vocal burnout.

Their solution requires the revival of an all-but-vanished singing method that is not just beautiful to the ear, but also easy on the throat. Some of their ageing and beleaguered clients described it to me as a kind of fountain of youth. But their cure is not without controversy. It is based on a provocative theory that has been gaining ground among a small cadre of international talents: that we have all been singing completely wrong even Adele.


Singing is a rough business. Every vocal performance involves hundreds of thousands of micro-collisions in the throat. The vocal cords also known as vocal folds are a pair of thin, reed-like, muscular strips located inside the larynx, or voice box, in the throat. They are shaped like a wishbone, and contain the densest concentration of nerve tissue in the body.

When we are silent, the cords remain apart to facilitate breathing. When we sing or speak, air is pushed up from the lungs, and the edges of the cords come together in a rapid chopping motion. The air causes the cords to vibrate, creating sound. The greater the vibration, the higher the pitch. By the time a soprano hits those lush high notes, her vocal cords are thwacking together 1,000 times per second, transforming a burst of air from her lungs into music powerful enough to shatter glass.

Beautiful singing requires lithe cords, but all that slapping together can wear down their fine, spongy surface and lead to tiny contusions. Over years of heavy use, nodules, polyps or cysts form on the vocal folds, distorting the sound they create. For a singer, the first sign of trouble is often the wobble. His pitch fluctuates on and off key because his ragged cords have lost their natural vibrato their ability to resonate properly. Then theres the hole, a point on the scale where a singers vibrating vocal cords fail to produce the proper tone. Try as he might, those notes will exit his mouth flat or, worse, as a barely audible gasp.

An
A vintage engraving of a view inside the throat. Photograph: Alamy Stock Vector

It was once unheard-of for a singer to perform with a faulty voice, but the opera world has recently been shaken by a trio of incidents in which the stars Rolando Villazn, Aleksandrs Antonenko and Robert Alagno walked off stage mid-performance, unable to go on. Some opera singers complain of year-round cold symptoms, and legal steroid injections and other drugs are often used to get a struggling singer through a performance. But singing through the wear and tear can cause the lesions to burst and bleed, creating voice-ruining scars, which is what happened to Adele in 2011.

Voice specialists liken the physical toll on singers and stage performers to what athletes endure. Surgery to the professional singers vocal cords is what ligament reconstruction has become to the football players knee. Dusty theatres, stuffy airplane cabins, erratic eating and sleeping patterns, the stress of living off stingy contracts all affect the vocal cords. Add to it the occupational hazard, at least in opera and classical music, of taking on roles that require you to sing above your natural range, and the cords become extremely susceptible to injury.

In 1986, the conductor, vocal coach and New York Times music critic Will Crutchfield lamented that vocal burnout was cutting short careers and diminishing the power of opera, as audiences, by necessity, accustom themselves to hearing voices in poor condition. Back then, Crutchfield saw that singers peaked in their 30s and then began to decline. But Adele, Trainor and Smith all underwent career-saving surgery in their 20s. Vocal burnout is afflicting amateurs, too. One veteran teacher in Italy told me that female students in their early 20s who want to sing like Adele or a young Whitney Houston are the ones who come down with vocal nodules. Another music teacher told me she recently had to instruct one of her 10-year-old students to stop singing and get his damaged cords checked by a specialist.

The rise in vocal injuries is linked to a change in what we consider good singing. Across all genres, it has become normal to believe that louder is better. (One reason that Adele is such a big star is because her voice is so big.) As a result, singers are pushing their cords like never before, which leads to vocal breakdown.

New waves of medical research into the causes of dysphonia, or the inability to properly produce voice, bear this out. In the west, vocal abuse is surprisingly common in all professions that rely on the voice , from schoolteachers to opera singers. Awareness of the problem is growing, but as Adeles case demonstrated, and separate studies conclude, surgery is not necessarily a lasting fix.

Brilla and Paglin have been saying this for years. You cannot solve the problem by simply relieving the symptom, Brilla said. Its a motor problem. The singer has to understand its the way youre running your engine the techniques theyre using to sing. If you dont fix the engine, its going to happen again.


Teatro La Nuova Fenice, a 19th-century opera house built in the neoclassical style, sits at the top of the small hill town of Osimo in central Italy, just inland of the Adriatic Sea. In the grand lobby of the building is a marble plaque commemorating the night in 1927 when the Italian tenor Beniamino Gigli, one of the greatest talents of his era, performed here. Gigli packed concert halls across Europe and the Americas in a career that spanned five decades.

Gigli is an icon of the purer, more natural singing style that characterised a period when vocal injuries were almost unheard of, say Brilla and Paglin. They have a small teaching studio in a cul-de-sac below La Nuova Fenice. Brilla, a dramatic soprano with a fearless air, first became obsessed with the fragility of the human voice more than 50 years ago, as a teenage opera singer growing up in Pennsylvania coal country. A doctor there diagnosed her with a problem common among young singers with big voices: her vocal cords werent coming together properly. She had a hole. Over the next few decades, she cycled through nearly 30 teachers, including legends such as Antonio Tonini and Ellen Faull, trying to learn to sing in a style like Giglis at once powerful, clear and sustainable over the course of many years.

Brilla met Paglin, a lyric soprano who appears small next to Brilla, while studying voice at Indiana Universitys school of music. The two bonded over their love for Italian opera and their frustration with the way singing was taught, even by their legendary teacher Margaret Harshaw. Feeling that the giants of music instruction didnt have the key to vocal longevity, Brilla and Paglin determined that they would be the ones to unlock the secret.

In 1977, Brilla won a prestigious Fulbright scholarship to travel to Italy to search for a way to sing beautifully without risking injury. There, she heard glimpses of perfect arias from older, mostly Italian opera singers who learned their craft in the early 20th century. These singers seemed to effortlessly produce clear, powerful musical tones, and so many of them were still performing with vigour well into their 60s, 70s and 80s. To Brilla, they held a clue to the vocal longevity lost to singers today.

Paglin soon joined her in Rome, where they started spending hours each day at the national sound archive, La Discoteca di Stato, listening to early recordings. They also scoured libraries for texts that discussed how operatic and classical singing techniques had changed over the centuries. When they werent researching, they were performing; big talents in their own right, they performed in many of the major opera houses and music halls of Italy and Austria. This put them in the presence of more masters, whom they peppered with questions. They also tracked down other ageing opera stars, teachers and conductors.

Their research pointed Brilla and Paglin to a surprising conclusion: that responsibility for the modern decline of the voice lay at the feet of Verdi, Wagner and Puccini. These three composers were the pop music sensations of their day. Music scholars credit them with being the first to challenge their singers to push their voices to new limits, in order to capture the emotional ups and downs their characters were feeling. Think of the teenage Japanese bride in Puccinis Madama Butterfly, her heart breaking, desperately watching the seas for a sign her love will return, or the thunderous battle cries of the Valkyries in Wagners Ring cycle. If youre going to kill off the main character of your show, you need genuine rage and pathos on stage.

But Brilla and Paglin heard something different that the emotionally charged, full-throated, operatic singing style Verdi and Wagner made popular in the late 19th century and that Puccini amped up even further in the early 20th century had subsequently infiltrated all singing genres and public performances. With each passing decade, the style grew more extreme. To illustrate the point, when I visited the duo earlier this summer, Paglin pulled from their sprawling research library a file containing a series of images. The first was a photograph, taken in 1920, of the legendary Italian tenor Enrico Caruso mid-aria. Caruso seems to be enjoying himself, even as the camera flashes; its as if hes talking to a friend, not baying at the audience. This is natural singing, Paglin said.

As she flipped from image to image, we travelled towards the present, a decade at a time. The photographs of the more contemporary singers including the tenor Rolando Villazn, who has suffered multiple vocal injuries looked like horror-movie stills: their mouths were wide open, eyes bulging, neck veins popping, as if they were screaming. There was none of Carusos easy calm.

Caruso and Gigli produced legendarily big sounds, but with an effort that todays performers might deride as somewhat wimpy. Compare Carusos 1916 recording of O Sole Mio with Villazns 2010 rendition. Carusos is powerful, but not so powerful that the lyrics crash into one another and become indecipherable; and even at the height of the aria, he doesnt drown out the strings. That Brilla and Paglin had identified this contrast wasnt enough. They wanted to reverse-engineer exactly how Caruso and his contemporaries sang.

Rolando
Rolando Villazn on German TV in 2015. Photograph: Hannes Magerstaedt/Getty Images

In 1983, Brilla convinced Maria Carbone, a retired Italian operatic soprano, to work with them. Carbone was nearing 80, but still had a powerful voice. While Carbone sang, Brilla would clasp Carbones abdomen to feel what was happening inside her body. Carbone started with an aria from Tosca. As her voice rose, hitting higher and higher notes, Brillas eyes widened. I could feel this tick, tick. Tick, tick, she recalled. It was the natural up-down release of her diaphragm. Nothing else was happening. Carbones ribcage wasnt ballooning out as she sang, and there were no deep gulps of air, as is common with todays big-voiced singers. More amazing still, the movement of Carbones abdomen while singing was just as quiet and rhythmic as when she spoke. It was a discovery of what the perfect singers posture should be, Paglin said.

Brilla added: Whereas all the teachers in my life had been telling me to open, open, open to exaggerate her breathing and lunge into every high note to produce the biggest sound Carbone was demonstrating the opposite.The root of the problem, they realised, is in classrooms. Too many students graduate from conservatories who dont know how to sing, and its leading to injury, Brilla said. Weve got to stop this. Its ass-backwards!


It is not just singers whose careers are threatened by deteriorating vocal cords. In 1989, the Italian actor Maddalena Crippa momentarily lost her voice during a live performance of Shakespeares bloodiest work, Titus Andronicus. Crippa was playing Tamora, the vanquished queen of the Goths. After Tamoras son is murdered before her eyes, Crippa said she unleashed these uncontrollable cries. But, for a moment, her next line wouldnt come out. It was the first time in her acting career that Crippas vocal cords had failed her. The suffering I felt was indescribable, she told me.

That suffering continued for more than a decade. Crippas voice was no longer reliably crisp and sonorous, and a burning pain lingered in her throat. After visiting vocal coaches and throat specialists, she got the prognosis that all performers dread: nodules on her cords. Cortisone injections and voice exercises worked well enough to get her back on stage, but her confidence was shaken. You mean you still dont know how to use your voice? she remembered thinking. Its demoralising. Then, in 2002, at the suggestion of a fellow actor, Crippa visited Brilla and Paglins Osimo studio.

Unlike medical doctors, Brilla and Paglin dont own a laryngoscope that allows them to peer into the throat. If someone comes to them with injuries, they treat the problem by ear. They sing a soft note and ask the student to match it precisely. They can hear in the response where the pitch is off-key, and where the damage is located on the cord. (When I spoke with Adeles surgeon, Steven Zeitels, he demonstrated something similar, singing a scale to isolate where his own cord is damaged a perturbation, as its called, the result of years of long hours in the classroom.)

The moment Crippa said hello, Brilla and Paglin knew there was something very wrong with her voice. She exuded tension, as if bracing for confrontation, and took big, gulping breaths before speaking. Brilla and Paglin often see this problem with singers; their vocal cords are so used to having great quantities of air shoved at them that the cords wont respond without that force. Once you start pushing, youre condemned to push for the rest of your life, Paglin told me. Unless you learn a new way of doing it.

In their studio, Brilla and Paglin instructed Crippa to lie on her back and produce a series of high notes, which Paglin demonstrated for me. It sounded like a faint squeaking, as if she was gently releasing air from the neck of a balloon. When Crippa was told to reproduce what Paglin called a floating high C, she protested, saying she couldnt get that far up the scale. Finally, she gave it a try, producing a barely audible piff, followed by a more sustained tone. Hearing herself, Crippa broke down and cried. They were tears of joy, Crippa told me. They touched a nerve deep inside me. I mean, this is my voice. My voice.

Brilla and Paglin say they can restore most vocal cord problems naturally, via exercises that massage out the defect over time. They aim to stimulate the cords precisely where they arent coming together properly, and to break students out of the bad habits that cause problems in the first place: taking big gulps of air, tensing the throat and jaw muscles, forcing the mouth to open to exaggerated proportions, and the urge to scream out the high notes.

There are limits to what Brilla and Paglin claim to be able to do for an ailing artist. Paglin told me of a time when she was watching a singer perform on stage, and could tell there was something very wrong. She got a message to the singer that he urgently needed to see a doctor. He did, and was diagnosed with a form of throat cancer.

But their track record with other difficult cases has earned them a small international following. The veteran Italian stage actor Moni Ovadia was one of their earliest big-name success stories. Throughout his mid-40s, he performed up to 250 shows a year, in Europe and the US, but by 48 he was ready to quit showbusiness. His voice had become flat and raspy, and he found it physically painful to perform. He credits Paglin and Brilla with restoring his voice and his career. They saved my life, he told me. Today, at 71, he is a bull on stage, and can perform non-stop for up to three hours.

In May, at Brilla and Paglins studio in Osimo, I watched an aspiring dramatic soprano named Emanuela Albanesi rehearse the high-energy duet Mi Volete Fiera?, from Gaetano Donizettis comic opera Don Pasquale. There are few, if any, widely accepted standards for teaching singing, and many teachers complain that too many of their peers get jobs because of how they sound, not what they know. Paglin and Brilla mine the internet for teaching videos that concern them, such as one in which a soprano chides a student to open her mouth wider and wider as she sings an aria, in order to achieve more volume; not until the student plugs her fist into her mouth is the teacher satisfied.

Albanesi, however, sang with an ease that belied the strength of her highest notes. As she came to the final grazie!, I was expecting a thunderous, take-the-roof-off moment, but she never lost the disarming grin with which she performed. I thought of that photo of Enrico Caruso singing with such relaxed ease. I whispered to Brilla that it was the first time I had ever been able to make out each and every lyric in a such an intense operatic number. Im telling you, she said. Weve cracked it.


The question remains: could Brilla and Paglins approach permanently cure an artist like Adele by teaching her to sing in a more natural way? Steven Zeitels is dismissive of such an approach, and quick to defend Adele and his other clients against the contention that bad technique is causing their vocal problems. People used to think if you needed an operation it meant you dont know how to sing. The people I see they know how to sing!

Zeitels believes that medical specialists such as himself are becoming increasingly important to the arts, which he compared to other demanding physical pursuits. Any athletic endeavour will eventually take a toll if done for long enough, he said. Whats terrific is were getting better and better at bringing people back.

Specially trained vocal therapists have also restored performers to health through voice training, but medical experts advise taking this route only for minor vocal injuries, such as small nodules. Otherwise, they strongly suggest surgery. This attitude rankles Brilla and Paglin, who have cured artists such as the internationally renowned jazz singer Maria Pia De Vito, who suffered from vocal edema, a painful swelling of the cords, for which surgery is the generally recommended course of action. What irony, Paglin said. There is an industry built around singers who harm themselves while singing, and there is another one built around fixing them up.

Another renowned throat surgeon, Dr Robert T Sataloff, who has performed voice-corrective surgery on several Grammy Award winners, including Neil Diamond and Patti LuPone, bristles at the notion that surgery is not a sensible way to keep singers healthy. Combined with proper education on the dangers of improper singing technique, he believes it can keep people on stage for longer. Is it perfect? No. And it probably never will be, he told me. Like Zeitels, Sataloff drew a sporting analogy. Injury is inevitable and thats when they end up in my office.

Swedish
Swedish opera singer Sigrid Onegin (18891943) having her vocal cords examined. Photograph: Bettmann/Bettmann Archive

Some conservatory teachers in Italy dismiss Brilla and Paglins natural-singing approach as heretical, and their disciples as a sect. Over time, the duo have made a number of enemies. An invitation in 2011 to teach a series of master classes at Romes Conservatorio di Musica Santa Cecilia, one of Italys top conservatories, met with near universal opposition among the faculty. The classes were popular with the students, but many teachers didnt want them on campus. Edda Silvestri, the former director of Santa Cecilia, told me she didnt recall any overt hostility towards the duo, but she did remember the rift Brilla and Paglin created between faculty and students. Unfortunately, this is common when you try to introduce any new approach to a conservatory. They are conservative places, Silvestri said. Elizabeth Aubry, the vice president of Italys most influential organisation of singing teachers, the Associazione Insegnanti di Canto Italiana, finds Brilla and Paglins critiques terrible. She said the main objective of her organisation and its counterparts in the UK and US is to teach teachers precisely not to do damage.

For his part, Zeitels is working on a futuristic fix to dysphonia. Anyone who relies particularly heavily on their voice schoolteachers, talkshow hosts, sales reps, preachers, lawyers, frazzled parents is vulnerable to chronic raspiness, or to going hoarse. One of Zeitels patented innovations is to apply a biomaterial a gel implant in the tissue of damaged vocal cords to restore pliability. He sees it as a potentially huge breakthrough. It will be just as important what you put into a vocal cord as what you remove, he told a journalist in 2015.

But some of Brilla and Paglins students are thriving without such intervention, including Maddalena Crippa, who at 59 years old is in the midst of a remarkable second act. Her voice has been injury-free since she started working with Brilla and Paglin 15 years ago, and last May she wrapped up a critically acclaimed tour of LAllegra Vedova, a one-woman-show based on a 1905 operetta. For 75 minutes each night, she sang and acted two roles, the husky-voiced Danilo and the high-pitched Anna, who at one point sing a virtuosic duet. Critics were impressed, with one raving that Crippa is still a brilliant singer.

Adele, however, is one of those rare figures in the arts. Her unique voice, and her story, are so big that many people believe that what she does (or doesnt do) to correct her latest injury will determine future approaches to protecting the voice.

On 1 July, when news broke of Adeles cancellations, Paglin sent me a Whatsapp message. She was frustrated by the press coverage. Recalling that Adeles original surgery in 2011 had proved to be a huge PR victory for vocal-cord microsurgery, she worried that the message from Adeles latest setback would be that, not to worry, a second or third surgery will get the star back on stage. What makes matters worse is that the mechanics are still convinced that all there is to it is to keep operating, while the singers themselves still talk about air travel, drafts, allergies and stress. #elephantintheroom could be a good hashtag, she wrote, referring to what is wrong, as she sees it, with how people are taught to sing in the first place.

A few hours later, she sent me another note. She felt bad for Adele, and wanted to help. We know how to fix Adeles problems (sans surgery), and for good. If only we could talk with her.

Main photograph: Sascha Steinbach/Getty

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Read more: https://www.theguardian.com/news/2017/aug/10/adele-vocal-cord-surgery-why-stars-keep-losing-their-voices

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How thoughts and speech shape our wellbeing | Gary John Bishop

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Your internal chatter has a huge impact on the way you feel about yourself. Listen in, says Gary John Bishop

You stumble through the door into your morning coffee ritual. As you make your way through a maze of chairs, tables and outstretched legs you finally arrive at your space at the end of the queue, and the deliberation begins

Maybe Ill have something different this time, hmm, let me see Iced cranberry lemon tea? Nah, I need the jolt, Ill get my usual. Good, now what else What about one of those muffins? Nah, Im piling it on, theres about 6,000 calories in one of those Bagel? Ugh no, Ill stick to the coffee.

Your turn comes, the server asks: How can I help you? and you confidently declare: Vanilla latte with a shot of espresso please.

It all happens in seconds, this mass of deliberation, reasoning and decision making, and its never ending. While the coffee shop scenario might not be quite your thing, youll have your own version. This is how your mind works. Its how all of our minds work, going constantly back and forth, every moment of every day of our lives.

Sometimes its quiet, sometimes its loud, but its always there, that little voice in our head. We all know the one, the internal dialogue that filters life, categorises people and hears what it hears to give life that ever-so-familiar ring to it.

Studies show that we have more than 50,000 thoughts per day. While we have little or no say in those automatic and reactionary thoughts, we have a massive say in which of those thoughts we attach significance to.

Your emotional state, your moods, your ways of being and acting are in a dance with your internal dialogue. Your experience of yourself, of being you, is intricately woven into existence in the way that you speak to yourself and others. Its not only what you talk about but, more importantly, how you talk about it.

Most people believe that they have certain feelings first, followed by a thought to themselves about how they feel. Not quite. The language you use has a direct and powerful in-the-moment impact on your feelings. The German philosopher, Martin Heidegger, said: Language is the house of being, while his compatriot, Hans-Georg Gadamer, insisted: Without language nothing exists.

Look at your own life where you use terms like This is impossible, I cant, Im confused, This is too much or Im trying. Each of these (and a litany of others), gives rise to certain emotional states (anger, frustration, resentment, hopelessness, etc), all of which work against you in your endeavour. How does feeling hopeless help in that job search, or being frustrated help in healing your relationship, or feeling incompetent get you that promotion? It doesnt. It weighs you down and dampens your enthusiasm.

As a simple example, changing Its impossible to I havent worked it out yet has a remarkable impact on the way in which you deal with certain problems. Your emotional state shifts.

In very real terms, how you talk about what you are dealing with either works for or against you.

Next time youre feeling suppressed, frustrated or worn down, check yourself. Go over that internal chatter a few times and see if you can connect how youre describing it to yourself to how you feel. Ask yourself: Am I using the kind of language that is building something or destroying something? Is this in my favour or working against me?

Language really is that important. After all, you are what you speak.

Unf*ck Yourselfby Gary John Bishop is published by Yellow Kite at 12.99. Order a copy for 11.04 from bookshop.theguardian.com

Read more: https://www.theguardian.com/lifeandstyle/2017/aug/06/we-are-what-we-say-how-thoughts-and-speech-shape-our-wellbeing

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To the Bone confirms there are (almost) no good movies about anorexia

The Netflix drama, which stars Lily Collins, leans on some outdated tropes. But only a handful of novels and films have evoked the reality of the illness, or explained why so many women turn their unhappiness on themselves

No talk about food. Its boring and its unhelpful, announces Keanu Reeves playing (hold on to your hat) a doctor specialising in eating disorders in To the Bone, the much-discussed upcoming film about anorexia, starring Lily Collins and distributed by Netflix. And this is excellent advice, but it can be hard to see beyond the surface issues when you are dealing with someone who is literally starving themselves to death: the shoulder blades jutting out like birds wings, the food hidden under place mats, the limbs so wasted you can circle them with your fingers. It is even harder if a part of you is turned on by skinny, self-destructive women, as the movies invariably are, and this one definitely is.

Its not easy to make a good movie about anorexia, which is why almost almost none exist. How to depict a mental illness that unlike, say, schizophrenia or bipolar disorder has such a well-known and hard-to-fake physical manifestation? To the Bones writer-director, Marti Noxon who based the movie on her own experiences with the illness got around this by getting Collins, who has spoken about her own struggles with eating disorders, to lose an astonishing amount of weight so that she looks credibly anorexic on screen. Given how thin female actors now have to be just to look slim, your heart breaks at the thought of how much weight she must have lost to look so painfully ill.

To the Bone has been wildly praised since it debuted at Sundance in January, and I can only assume this is because critics get weirdly overexcited when actors undergo physical transformations. The truth is To the Bone is not a good movie about anorexia. In fact, it is a bad one. We could talk all day about the ethics of hiring a young woman who is known to be vulnerable to eating disorders, and then telling her to lose weight to look anorexic, but lets give Collins the benefit of the doubt and say she is an adult woman who is free to make her own career choices. Instead, lets talk about To the Bones real problem, which is that it is shallow, sexist and sick.

The only justification for making a movie like this is that it is going to provide some insight into a much-discussed if little understood problem, a requirement Netflixs earlier and similarly exploitative foray into self-destructive young women, 13 Reasons Why, notably failed to meet. But from the very first scene it is obvious that To the Bone leans on some wearily outdated tropes. We first see Ellen (Collins) in an in-patient unit, in which she and her fellow anorexia patients are beautifully styled in the universally recognised signifiers of crazy-but-sexy young women: heavy kohl eyeliner and mascara, Tank Girl-esque distressed clothing and biker boots. We have gone from 1999s Girl, Interrupted to 2017s Meal, Interrupted.

Click here to watch the trailer for To the Bone.

From there on, the anorexia stereotypes are ticked off with the regularity of hospital mealtimes. The movie disregards its own advice almost immediately about not focusing on the food and does so with voyeuristic intensity, without ever asking why so many women feel so unhappy, and why they then turn this unhappiness on themselves. All the anorexia patients, with one male exception, are young, attractive, middle-class white women, when the illness affects a far broader demographic. Reeves, as Ellens psychiatrist, Dr Beckham, is a self-described unconventional doctor, who proves his unconventionality by swearing occasionally and insisting his methods are totally different from anyone elses (theyre not: they rely on therapy and healthy eating, as almost all eating-disorder treatments do). He also clearly enjoys his power over his mainly female patients and a braver, less conventional film would have explored this more. Instead, To the Bone merely accepts the doctors version of himself as the brilliant, patriarchal medical professional who can fix women.

I am going to show my cards here and say that I am undoubtedly biased on this issue, because I had a doctor similar in some regards to Beckham during my first three hospitalisations: Dr Peter Rowan, then based at the Priory in Roehampton. I was only 14 when I first met him but even then it seemed to me that he revelled too much in his authority over a ward of vulnerable women, who in turn viewed him as god-like. In 2011, 18 years after we parted ways, he was struck off when it emerged he had what was described as a blurred and secretive relationship with a female patient, who left him more than 1m in her will.

Now, clearly, there are plenty of excellent male psychiatrists who work with eating disorders, and my experience was an outlier. But given that anorexia is often a form of rebellion against gender norms, with female and male sufferers rejecting, respectively, sexualised femininity and macho masculinity by starving themselves, it is ironic that a movie should re-enact such gender cliches. The doctor is a man, the nurse is a woman, the women in Ellens life (her mother, stepmother and her mothers girlfriend) are all self-obsessed and bitchy, her father is absent but hard-working. The one male anorexia patient is wise and selfless in a way none of the female patients are, and spoiler alert he, along with the male doctor, helps to save Ellen. Many brilliant women are now the leading lights in eating-disorder treatment, not least the woman who treated me through my last three hospital admissions, Professor Janet Treasure, now the director of the Eating Disorder Unit at the Institute of Psychiatry at Kings College, London. So the idea that all that these hysterical female anorexia patients need is a couple of calm men to save them from themselves is, to put it mildly, grating. The film even tacks on a frankly ludicrous romantic subplot, and anyone who thinks patients with eating disorders are making out with one another on hospital wards has clearly never bothered to Google what starvation does to a persons libido.

There is currently a petition online demanding that Netflix pulls the show for two reasons. The first, that it might trigger sufferers, is a point I feel sympathy for but cannot agree with. Legislating against anything that might trigger the mentally ill or vulnerable is an impossible game of Whack-a-Mole. But the petitions other complaint, that it glamorises anorexia, will be less easy for the film-makers to dismiss. Contrary to what the character of Ellen might suggest, anorexia is not all thigh gaps and eyeliner. By the time I was admitted to hospital for the first time when I was 14, most of my hair had fallen out, I could barely walk because I was so cold and my knuckles bled constantly due to extremely dry and cracked skin. Instagram-ready, I was not. There is a line between rendering a complex subject filmable and sexing-up a serious illness, and To the Bone crosses it from the first scene. And when all a movie about anorexia tells you is that people with anorexia have issues with food, and that this makes them thin and unhappy, you have to wonder what the point of the movie is.

Anorexias physical manifestations distract even those of us who have suffered from it from grasping the internal issues. Indeed, that is the point of the starving: we dont have to think about the unhappiness that led us to this point. In one interview, Noxon said that being around Collins and the other actors who were losing weight was difficult for her. I started to need to turn to the other female producers quite frequently and say: Im going to need you to tell me that I dont need to lose weight, she said. When there is a part of you that still gets turned on by not eating, you will not be able to discuss anorexia properly, because you are still preoccupied by the surface symptoms.

Lily
Lily Collins in Netflix drama To the Bone. Photograph: Gilles Mingasson/Netflix/Netflix

Even beyond the directors own issues, it feels almost inevitable that anorexia should be glamorised in a movie made today. We have come a long way from 1983, when Karen Carpenter died of anorexia and people were shocked that someone could actually starve themselves to death, but despite the increased awareness, conversations about the illness still too often descend into voyeuristic fascination. Since the 90s, when skinny became the female beauty standard (a sharp diminution from the more Amazonian supermodels of the 80s), representations of anorexia in mass culture have come wrapped in a weird mix of prurience, spectacle and aspiration. The Daily Mail has a regular, long-running and wildly irresponsible column by a woman writing about her anorexia. The glamorisation of anorexia online is notorious by now, with the rise of pro ana (pro anorexia) websites, which pass on tips about how to avoid eating, and thinspo (thin inspiration) images on Instagram; anorexia has been reduced to an aesthetic expression and To the Bone reflects that.

In terms of art, there is remarkably little that is much better. Poor Richey Edwards, the late guitarist from the Manic Street Preachers, wrote probably the most brutally evocative song about it, 4st 7lbs (I eat too much to die / And not enough to stay alive / Im sitting in the middle waiting). But he himself was so caught up in the illness he could only depict the immediate experience, not the larger overview. In books, there are plenty of anorexia memoirs now both celebrity and non most of which, to be honest, are little more than a mix of food diaries, pop-psychology and self-help.

By far, the best book on the subject is Jenefer Shutes astonishing novel Life-Size, which captures the confusing early descent into the illness, the loneliness of it at its most extreme and the weirdness of hospitalisation better than anything I have ever seen or read. Noxon has responded to criticism of her movie by emphasising it is based on her indidvidual experience, but Life-Size reveals the laziness of this popular get-out clause. Everything is an individual experience, but if your re-telling of it strikes no general chord, the fault is in your telling. Life-Size is a deeply personal story, about a twentysomething with anorexia called Josie. But in its wholly original, quasi-poetic prose style that shifts between memory, the hospitalised present and Josies hallucinations, this is a book that eschews the cliches and, in doing so, touches a wider truth. No one thing can cure someone with anorexia and this book definitely didnt cure me. But it did help me get a fix on my own experience as I was finally starting to recover and, in that regard, changed my life.

There have been only two good movies about anorexia: both treat the subject almost metaphorically and both were directed by Todd Haynes. Most obviously, there is Superstar: The Karen Carpenter Story, Hayness film about the most famous anorexia sufferer of all, retold with modified Barbie dolls, which perfectly captures the artificially perfect world that many with anorexia feel they need to embody. Then there is his 1995 film Safe, about a woman who seals herself off away into an antiseptic world. While not explicitly about anorexia, Safe evokes the real experience of the illness: the self-imprisonment, the illogicality, the sense you are being eaten up from within by forces you cannot control.

When I think back on my years of being ill, which went on long after I left hospital, I barely think about the food and the weight at all. Instead, I remember the cold, the isolation, the institutionalisation, the time lost and all the things Hayness movies and Shutes book depict so well. Keanu was right: its not about the food. Thats just the boring stuff that distracts even those who should know better.

To the Bone streams on Netflix from Friday.

Read more: https://www.theguardian.com/film/2017/jul/12/to-the-bone-confirms-there-are-almost-no-good-movies-about-anorexia

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From Viagra to Valium, the drugs that were discovered by accident

From Alexander Fleming onwards, the lives of millions have been transformed and saved by treatments that scientists were not even looking for

When scientists in New Zealand discovered that a meningitis vaccine fortuitously protects against gonorrhoea, they were benefiting from an unpredictable force responsible for some of historys most striking medical breakthroughs: serendipity.

So many things have been discovered by chance. The German writer, scientist and all-round polymath Johann Wolfgang Goethe, a discoverer himself, wrote: Discovery needs luck, invention, intellect none can do without the other.

Viagra

In pharmaceutical giant Pfizers laboratories in Kent, a failed treatment for angina accidentally became a billion-dollar erectile dysfunction blockbuster, and the worlds most famous blue pill.

During early clinical trials of sildenafil, now better known by its trade name Viagra, male volunteers taking the pills consistently reported unprovoked, long-lasting erections. After further investigation, it turned out that Viagra, designed to relax blood vessels around the heart to improve blood flow, was having the same effect on arteries within the penis. Since its commercial release in 1998, it has been used to improve the sex lives of millions of men worldwide.

Incidentally, the 2007 Ig Nobel Prize, awarded annually for that years most useless research, was awarded to three Argentinian scientists who discovered that Viagra helped hamsters recover faster from jet-lag.

Penicillin

Returning to work after a month-long Scottish vacation in 1928, pathologist Alexander Fleming made a discovery in a discarded culture dish, which he had unintentionally left open to the elements on a window sill in his laboratory at St Marys Hospital in London.

In Flemings absence, the dish, growing the dangerous bacteria staphylococcus aureus, had become contaminated with an air-borne mould a type of fungus. Fleming noticed that, near the blue-green strands of fungus, growth of the bacteria had been stopped in its tracks.

Fleming had inadvertently stumbled across the first antibiotic, which he called penicillin.

For his accidental discovery, he shared the Nobel prize for medicine in 1945 with Florey and Chain, Oxford chemists who perfected the process of penicillin mass production in time to treat infected battlefield injuries sustained in the second world war.

When I woke up just after dawn on 28 September, 1928, I certainly didnt plan to revolutionise all medicine by discovering the worlds first antibiotic, or bacteria killer, Fleming later recalled. But I suppose that was exactly what I did.

Heart pacemaker

New York engineer Wilson Greatbatch invented the worlds first implantable heart pacemaker but he didnt mean to.

While trying to build a device to record heartbeats in 1956, he accidentally installed the wrong type of resistor into his prototype which promptly began to emit regular electrical pulses.

Realising these pulses were recapitulating the electrical activity of a normal heartbeat, Greatbatch immediately saw the potential of his device. After two years of refinements, his design for a pacemaker that could be implanted into the heart was patented in 1960 and soon went into production. Life-saving descendants of this first device now improve the lives of over half a million patients with slow heartbeats every year.

Stomach ulcers

In the 1980s, two Australian doctors were ridiculed for suggesting that stomach ulcers were caused not by business lunches and stress, but by infection with a common bacteria. Barry Marshall, a gastroenterologist and his pathologist colleague in Perth, Robin Warren, noticed that stomach biopsies taken from their ulcer patients all contained the same spiral-shaped bacteria, called helicobacter pylori.

To prove their hunch, Marshall deliberately downed a pint of foaming helicobacter broth that hed grown in his lab after isolating it from the stomach of one of his patients. Within a week, he had rampant stomach inflammation which was then completely reversed by taking antibiotics.

Their discovery has also meant the virtual eradication of a type of stomach cancer caused by helicobacter infection.

For their work (and presumably Marshalls bravery), Marshall and Warren were awarded the 2005 Nobel prize for medicine.

Antidepressants

Several classes of antidepressants owe their discovery to chance, from iproniazid, which was initially used to treat tuberculosis in the 1950s, to the tricyclics of the 1960s, which stemmed from an experimental treatment for schizophrenia and the more recent breakthrough involving the use of ketamine.

Valium

The entry-level benzodiazapine was developed in the 1950s by a Polish immigrant in the US, Leo Sternbach, from discarded chemical compounds he had synthesised 20 years earlier in Poland when he was working on experiments to create new dyes.

The dyes were a failure. The benzodiazapines quickly became the most popular prescription drugs in the US.

Read more: https://www.theguardian.com/lifeandstyle/2017/jul/11/from-viagra-to-valium-the-drugs-that-were-discovered-by-accident

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Sense of purpose aids sleep, US scientists find

People who felt they had a strong purpose in life suffer from less insomnia and sleep disturbance, says neurologist

The secret to a good nights sleep later in life is having a good reason to get up in the morning, according to US researchers who surveyed people on their sleeping habits and sense of purpose.

People who felt they had a strong purpose in life suffered from less insomnia and sleep disturbances than others and claimed to rest better at night as a result, the study found.

Jason Ong, a neurologist who led the research at Northwestern University in Chicago, said that encouraging people to develop a sense of purpose could help them to keep insomnia at bay without the need for sleeping pills.

More than 800 people aged 60 to 100 took part in the study and answered questions on their sleep quality and motivations in life. To assess their sense of purpose, the participants were asked to rate statements such as: I feel good when I think of what Ive done in the past and what I hope to do in the future.

According to Ong, people who felt their lives had most meaning were less likely to have sleep apnea, a disorder that makes the breathing shallow or occasionally stop, or restless leg syndrome, a condition that compels people to move their legs and which is often worse at night. Those who reported the most purposeful lives had slightly better sleep quality overall, according to the study in the journal Sleep Science and Practice.

Insomnia and some other sleep disorders become more common in old age, but Ong said that the findings were likely to apply to the public more broadly. Helping people cultivate a purpose in life could be an effective drug-free strategy to improve sleep quality, particularly for a population that is facing more insomnia, he said.

Age UK, a charity, advises people who sleep badly to go to bed and rise at the same time every day; establish a bedtime routine; and cut out caffeine, alcohol and nicotine in the evening. Not eating a heavy meal late at night; avoiding exercise before bed; cutting out daytime naps and banning TVs and computers from the bedroom helps too, they add.

Read more: https://www.theguardian.com/science/2017/jul/10/sense-of-purpose-aids-sleep-us-scientists-find

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Ultra sound: why music means so much to us | Adam Ockelford

Music is one of lifes great pleasures. But why, asks Adam Ockelford, does it affect us so profoundly?

Its a question that has intrigued thinkers across the ages from Socrates to Schopenhauer: why is it that abstract patterns of sound mean so very much to human beings?

We are more exposed to music than ever before, thanks to streaming from Spotify and YouTube to Mixcloud and downloading, and were bombarded with music via advertising, too. It is there to influence the way we think, feel and behave. As every filmmaker knows, music is unique in its power to stir the emotions. As music therapists work with dementia patients and autistic children has shown, music has the capacity to touch us and tap into memories that words alone are not able to reach. But how?

Defining what isnt music can help us to understand its powerful effect on us. There are those who believe that certain everyday sounds particularly the sounds of nature should be classed as music, such as Tennysons babbling brook. This may be regarded as music to a poets ear, but it doesnt communicate to us in the way music does. Music conveys meaning since all its constituent sounds notes elicit tiny emotional responses, and these are locked together in a coherent narrative through imitation. In this sense, rushing water or pattering rain fail the musical test.

How does music compare with the other uniquely human form of communication in sound: language? Unlike words, sequences of notes are free to convey pure emotion, unfettered by the need for semantic understanding. Hence music requires less mental processing power than language, and music in its simplest form the early vocal interactions between baby and caregiver precede language in human development. The miracle is that the structure and meaning of both music and language are grasped quite intuitively in the early years, merely through exposure. This is because the young brain is primed to search for patterns in sound explicit tuition isnt necessary.

Music is central to the notion of what it is to be human, and spans cultures, continents and centuries.

Many of the core cognitive traits required for musical understanding stem from an evolutionary need one being the ability to detect difference and similarity around us: what looks the same, smells and tastes the same, also sounds the same, and therefore is the same. It may be, as the human brain evolved, other purely musical abilities built on these cognitive survival skills above all, the ability to express oneself emotionally, and to understand others through abstract narratives in sounds. And these skills also became important to our survival.

Current thinking stresses the importance of music in early bonding between parents and infants, and the sense of cohesion within wider social groups it can provide. There is increasing recognition, too, of the potential role of music in the development of empathy, ie If I can copy the sounds you make, then I must in some respects be like you; the emotions that I experience as I make sounds like yours may be the same as the emotions that you experience. And the process is reciprocal, as in: If you imitate me, then to a degree you must understand me, must know how I feel.

My music, your music, our music can bind us together as families, as tribes and as societies in a way that nothing else can.

Comparing Notes: How We Make Sense of Music by Adam Ockelford is published by Profile Books at 20. Order a copy for 17 from bookshop.theguardian.com

Read more: https://www.theguardian.com/music/2017/jul/02/ultra-sound-why-music-means-so-much-to-us

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Cheap, widely available drug could stop thousands of mothers bleeding to death

Tranexamic acid could save the lives of a third of women who die in childbirth from excessive bleeding, which kills 100,000 a year

A cheap and widely available drug could save the lives of thousands of women who die in childbirth from excessive bleeding, one of the main killers of women worldwide.

The drug, tranexamic acid, is available over the counter in the UK to women suffering from heavy periods. In Japan and the far east, it is used as a skin whitener. But now a very large study of 20,000 women in 21 countries has shown it can stop a third of cases of bleeding to death after giving birth.

Haemorrhage after childbirth kills 100,000 women a year, mostly in low and middle-income countries. It is not only the women dying it is the impact on the child that has to grow up without a mother, children who might already be in the family and the husband, said associate professor Haleema Shakur from the London School of Hygiene & Tropical Medicine who led the trial.

This is of absolutely huge importance. While a single mother is dying, we need to keep fighting for them.

The drug has already been proven to cut the death toll from bleeding after accidents in a trial of similar size. The latest trial, published in the Lancet medical journal, recruited more than 20,000 women who either gave birth in one of 193 hospitals involved or managed to get there after starting to bleed. They were randomly assigned either tranexamic acid or a placebo.

The researchers found that tranexamic acid was most effective when it was given soon after the bleeding began. The trial was originally intended also to find out whether the drug saved women from having to undergo a hysterectomy the removal of the womb. But the scientists discovered that in many countries, where anaemia is common and blood supplies are limited, surgeons operated immediately as the surest way to save the womans life.

If all women who haemorrhage after childbirth were given the drug, the trial suggests that 30,000 lives could be saved a year. In practice, that will be more difficult. Tranexamic acid was given in an intravenous injection in the hospitals, as the quickest way to have an effect. Many women give birth at home and may not get to a hospital in time.

It is available in the form of a tablet for heavy periods, but absorption may take too long, said Shakur. They are now working on new ways to get it rapidly into womens systems perhaps as an injection in the arm muscle or as a capsule under the tongue. It is also possible that women deemed to be at high risk of haemorrhage could be given a tablet before they give birth. The trials have shown no side-effects, making the drug very safe.

Of the two-thirds of women who died in spite of being given the drug, Shakur said some arrived at hospital too late, while others had underlying illness including severe malaria and anaemia which may have been the cause of death.

It has taken a long time to show that the drug does work in the context it was designed for. Professor Ian Roberts from the London School, who co-led the study, said: The researchers who invented tranexamic acid more than 50 years ago hoped it would reduce deaths from postpartum haemorrhage, but they couldnt persuade obstetricians at the time to conduct a trial. Now we finally have these results that we hope can help save womens lives around the world.

There are many next steps, said Shakur. We have to make sure tranexamic acid is available wherever a woman gives birth and is at risk, she said. We must make sure doctors and midwives are aware of the results of the study. And we need health ministers to make sure that the drug is available in their country and is on their shopping list of essential medicines.

Read more: https://www.theguardian.com/science/2017/apr/26/cheap-widely-available-drug-could-stop-thousands-of-mothers-bleeding-to-death-tranexamic-acid

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