Who Stole the Orgasm?

My day job is a Physician, but outside of this, when I'm not practicing medicine I enjoy something entirely different, curing people of disease, which as I've learnt throughout my working life is almost entirely  psychological.
Dr. Ignatius J. Reilly

Twenty years ago when I was an illegal alien in the US, my girlfriend's father advised me to enroll in a college in order to obtain a J1 visa and protect myself from deportation, and his daughter from the unlikely trauma of my being carted off in an immigration wagon.

Having failed my leaving cert three years earlier, college was not on my wish list, at least not before  the 'rich and famous contract'.  Fortunately her father was a lecturer at a small university in Orange County and the requisite forms were procured and stamped.  Whether by necessity or design, the father insisted that I should enroll in at least one class to validate my visa.  Looking back now I suspect he may have wished to address my lack of education, and the willful ignorance that was the undoubted source of my inflated self confidence.  The unfortunate thing about ignorance is that it is almost invariably oblivious to itself, and at the time I perceived no shortfall in my philosophy or my world view.  On the contrary I believed myself capable of almost anything, I could, as a point of fact; sing, play the guitar read, crack some whoppers and generate a bit of  a laugh, what more does a young Irish immigrant need? 

Some years previously my own father had wisely counselled me that I should leave home and travel the world whilst I knew everything, because, he said, "by the time you get to my age you'll realize you don't know shite!"

Indeed I could do almost anything, bar school and college, and really the only thing that was out for me (or so i thought) was to become  President as you have to born in the US to be eligible for that job.  America has a funny way of convincing you of all of that (see http://youtu.be/mKkdFSqAxV8 ). Regardless of my confidence in other things, the Irish education system had put me in my place in terms of learning or academics, and my dirty little secret was, that I was a bit stupid and no good at school.

There I was taking a class or two each semester, for no other purpose than to keep my visa alive, so why shouldn't I take classes in subjects that appealed to me?  It didn't  matter a rats arse if I failed them or didn't show up,  I experienced that inverted form of discipline that is a consequence of the total lack of discipline, and as such I rarely missed a class or an assignment.  This was helped by the fact that I took classes in subjects that I found interesting, like English, (I could at least speak the language) and Human Sexuality, I had, and as yet retain one of those as well.

I have no doubt whatsoever the American education system is the best on the planet, and despite being; anti-democratic, anti-capitalist, anti-consumer and anti-American foreign policy, my medical degree and much of what I am today (if I am anything more than Sam I am) I owe tot he wisdom of my x's father, and to the vistas that were opened and the encouragement I was afforded by  the American education system. 

In that system anyone attending University spends their first two years completing a course of General Education, where units are chosen from the disciplines of; Arts, Science, History Geography Maths, Culture and language.   Once one has enough units one progresses on to to upper division units which are derived from classes in ones chosen field.  As with most aspects of American society (outside of the prison system) the individual is the priority, not the institution, an inversion of the traditional Irish approach where institutions always come before people( See: Ruin of the Irish economy, any author).  One chooses what classes one wishes to take, when, and in what order.  In America, University is more about educating people, dispelling their ignorance, opening up vistas and new horizons, whilst our relatively primitive Victorian model is almost entirely about 'training', about teaching people to put pegs into holes, about manufacturing performing monkeys. The products of this distinction  can be observed in the generality that innovation comes from America, whilst productivity and discipline comes from the self imposed slavery of the Bavarians or the Europeans.

Around that time I had discovered A Brief  Introduction to the Writings of Sigmund Freud, and had fallen in love with the tweed suited old man with the cigar, who emerged from the pages of my secondhand copy, as the father I had never dreamed of.  The path I wanted to put my newly found learning-feet upon, pointed towards an understanding of human understanding.

Personally I believe that Freud was more of a philosopher than a clinician, although an army of experts would undoubtedly disagree. Nonetheless were I to attempt some of the clinical practices he employed; to lie my patients on my examination couch and ask them to free associate, or tell me about their dreams or their sex lives, I would probably spend the morning tearing up solicitors letters.  However, the ideas that Freud employed, if not discovered, are alive and well, and I regularly bring a chronic back pain sufferer to the realization that she may have lost touch with herself  and her sexuality, and that within the context of muscle or psychological tension, the female orgasm is therapeutic and not an example of self harm or a criminal act.

In many respects there is an enormity of therapy in healthy sexual function, and although Irish women and Irish doctors generally don't go in for that sort of 'dirty' talk, I owe it to Freud that I can make the connection between chronic back pain, irritable bowel, fibromyalgia and the absence, or perhaps more correctly the 'social theft' of the female organism. In recent decades male masturbation has undergone something of a liberation, as a phenomenon it occupies a kind of subliminal social space, one where it has been almost entirely divested of it' immorality and is neither moral nor immoral. Female masturbation on the other hand has perhaps not been so fortunate and it remains within the realm of the immoral particularly for married women, where an orgasiim is something she may (if she is fortunate) be 'given' by her partner.  There is a fundamental inequality here, and aside from the etiquette of masturbation in general, we must ask why this should be so and upon what basis does this inequality continue to be substantiated.

Some time into my own academic journey one class that has  an indelible mark upon my medical brain and emotional soul was: Human Sexuality, at American River College in Sacramento California.  The course was given by a tall thin wiry grey professor of psychology, I can't remember his name but I can see him clearly in my mind.  I was immediately impressed on the first day because he came to class wearing shorts and sandals (an educated hippy who's brain cells had survived the sixties).  He stood silently behind the podium until a self imposed quiet filled the air. His opening remarks were simple and serious; "If you have come here to be titillated, and to giggle like children when the words penis or vagina are mentioned, I strongly advise you to leave before I have the displeasure of throwing you out."  He said, or words to that effect.  "This class involves the science and psychology of sexual function, if you are looking for something different, you are in the wrong place. The lecture theatre was packed to capacity and no body stirred.  The sombre introduction did not get in the way of a few laughs along the way and the class left a deep impression on me and gave me a strong hang-up about hang-ups about sex.  I have been liberated from my fear of penises and vagina's and in my practise I can use these words on a daily basis as though they were a normal part of our language.

One of the reasons that class made such an impression was not simply because of the scientific manner in which human sexuality was explored, or the infinity of myths that were dispelled. The Penis the vagina, the Orgasm (male and female), ejaculation, etc etc were each and all discussed and considered in a practical and scientific way. Drawing heavily upon the seminal works of Kinsey Masters and Johnson, undoubtedly the founding fathers of our modern schools of sexual function. Interestingly, late into the course when the topic of orgasm was begun, the professor introduced the subject by citing a study conducted in Ireland in the 1970's which found that some 60% of  Irish women did not know what an Orgasm is and some 70% of Irish women had never had one!  After reassuring myself that my mother was in the appropriate group I proceeded to be thoroughly shocked.

An article in the Irish Examiner in 2012

The more you relax, the better chance you will have an orgasm

Sunday, September 16, 2012

might lead one to assume that we have come a long way since the frigid-fifties, however my own practise tells me that we have moved one step forward and two steps back.  Never before has there been a greater need for a body of work and objective research into sexual function and dysfunction in Irish males and females.  There are perhaps few societies where sexual dysfunction has been so grossly manifest, as it has been here in Ireland in recent years, and still we counter this dysfunction with our usual  'head in the sand', 'medicalisation of sexual dysfunction' total denial and our fear of words penis vagina and orgasm, as being 'dirty' and bad.

It is a sincere pity that the vogue at present is to apply a medical name to psychological pathology.  In many cases we Irish in particular have a particular repugnance for psychology dis-ease or malaise. In many respects an Irish patient would rather have a diagnosis of HIV or Hepatitis than to be told they suffer from 'depression'.   Its almost as though there is some kind of subterranean belief out there that if you suffer from mental illness, its somehow your fault, you are imagining your disease or it's all in ones head.  We persistently drive psychological and sexual dysfunction underground, by either denying it or medicalising it and yet we are in horror and despair when that dysfunction inevitably manifests itself as deviance.  The deviance is (in part at least)  caused by our denial and our medicalisation. 

As a consequence of this fear of psychology and fear of sexual dysfunction, we doctors  have conjured up a complicated medley of medical musings that patients are much more willing to part with their cash for, instead of a diet of worms and the cold unpalatable or unprofitable truth.  These fictitious illness include; chronic back pain, infertility, fibromyalgia, chronic sinusitis, tension headache, insomnia, migraine, and many more. 

In my own clinical experience for many women, a simple honest orgasm is the cure for much pathology. The  longevity of this 'cure' is almost entirely dependent upon the underlying stress, fear, anxiety, frustration, self doubt, lack of self esteem  that lies behind the symptom that is "safely " presented to the doctor.  

Interestingly the first dildo was a medical device, invented to treat hysterical or anancastic women. The device was in wide use amongst general physicians, up until someone realised what it was that the device was eliciting. Undoubtedly some bright spark within the profession declared in a Eureka moment that,  if it looks like an orgasm, shakes  and wobbles like an orgasm,  then it probably is an orgasm. After which the device was quietly dropped from clinical use, and quietly passed on to the eternal custody of the sex-shop.

Whilst I am certainly delight that the device is no longer part of the accoutrement of my profession, it is a sincere pity that the concept of the orgasm and its therapeutic value are shrouded in this silliness that usually surrounds the pragmatics of  normal sexual function, and perhaps nowhere is this more apparent than in Ireland.

There is not a week that goes past in my own practise that I do not encounter the somatic consequence of  sexual depravity and emotional isolation. Not infrequently I advise my patients that 'if you cannot connect with your own body in a healthy manner', you are certain to experience tension and stress as a consequence.  In many respects this 'connection with self' is a merely euphemism for the orgasm.

It is of course the same tension and stress that causes muscles and bowels to spasm and cramp, sleep to be broken and diet to fall to pieces, pain to worsen, unhappiness to deepen etc.  To my mind our generation must free sex from the vulgar, and the immoral and re-instate it as an essential  barometer for a healthy psychology.  To the horror and despite the perhaps justified warnings of many of my colleagues, a question I very often ask my patients is firstly are you happy? and secondly; 'When was the last time you had an orgasm?  The answer very often is returned with a flood of tears, as the curtain is parted for a moment and one glimpses the unhappiness that lies behind most if not all chronic conditions.

If could have one wish for the women of Ireland it would be to give them back their orgasms. However to do this to even contemplate this vulgar horror, this immoral obscenity, we must first ask who stole it in the first place?

The Last Days of Finn Mac Cumhal. (Chapter 1)

This Novel has been moved to its own Blog : http://www.dyingireland.blogspot.com

From Pasture to Plate: Child Abuse in Ireland

"I see so many little boys I want to marry."

Devandra Barnhart 

In the same newspaper that recently gave voice to the  universal anger at the abuse of children in certain crèches in Dublin,  I came across the following advertisement for an upmarket city restaurant. The advertisement featured a juicy fillet steak, sizzling away on a flaming grill, above which the caption declares:

“Our organic beef isn't so much supplied. Its caressed and loved from pasture to plate.”

 The ad makes perfect sense as long as we entirely exclude the sentiments of the animal who is to enjoy these fond caresses, at the abattoir and ultimately upon the grill of this most loving establishment. This advertisement is interesting on several levels firstly in how the concept of love is treated. This is the type of love that does not extend further than the lover, for the animal, if aware of its motive and objective would be unlikely to appreciate or reciprocate it. 

Perhaps our contemporary ideal of love is undergoing a type of evolution, one that reaches its climax when consummated at the slaughter house?  In respect of this evolution, one hears an echo of Slavov Zizek's famous assertion that "Love is evil."  http://youtu.be/hg7qdowoemo .

 In real terms the materialization of love, it's utilitarian conversion into a self-serving commodity, is nothing new and nothing short of it's destruction.  Love (at least in this instance) is being used to promote its inverse. What does it say of our society, that we should transform love into its opposite, without the bat of an eye?  In the context of suicide and self or social destruction, it makes it easier perhaps, to loathe this world, to wish to destroy it, or depart from it, when love is so frequently and so grotesquely transformed. 

It is not so much that the advertisement bastardises the truth of what a genuine 'love' for the animal might entail. It is rather the  fact the advertisers should (rightly or wrongly) assume that most of us would not find this assertion to be offensive if not entirely questionable.

What makes this type of love interesting in the context of abuse, is that a similar psychological process is invariably applied when our children are abused by their teacher, their parent or by society at large. When a child  is objectified, or like the cow materialized into a form that is of benefit solely to the observer the lover, the parent, the school,  step into the shoes of the abuser.

There is a very powerful scene in the 1998 Film Festen. Christian's Speech (http://youtu.be/_7N-x9TGCuw).  The family of Helge a successful Danish businessman, return home for a reunion on the occasion of their father's 60th birthday. After dinner, the eldest son Christian, gives his father the option of two prepared speeches; '...a green one, or a yellow one'. The scene is immediately reminiscent of that pivotal moment in The Matrix when the protagonist must choose between the 'blue pill' of blissful ignorance or the 'red pill' of conflict, and reality. 

When Christian reads out the contents of his yellow speech, he begins with what sounds like a humorous childhood anecdote pertaining to; 'Fathers bath-time'.  However the story ends with a vivid and disturbing description of how their father would sexually abuse Christian and his sister as part of his regular bathing ritual.

The reaction of the well dressed gathering amid the formal setting of a silver-service dinner party is perhaps one of the most classic moments in the history of contemporary film. It  calls to mind the initial response to abuse scandals that emerged when the swamp of Irish politics was partially drained in the early nineties.

 Later in the film when Helge must ultimately confront the truth of his abusing past, when he is compelled to answer the question that his son puts to him, (the question that many victims of abuse struggle with for an eternity), namely: why a father would defile his children in the most brutal and horrific manner imaginable? Helge shares with the gathering what are probably the sentiments of most abusers of children; "I did it because it was all that you were good for.”

The cow in our advertisement can be loved, as long as it is only good for eating, and in the same respect our Children are abused when they are materialized, objectified, and  good for nothing else.

Capitalism as a modern cultural ideal is integral to the progressive materialization of our world view. Our horizon becomes ever narrowed, and we see the world in an increasingly utilitarian light; one where all things are good, relative to their material value.  The distinction between the piece of carbon we wear upon our finger, and that which we toss into the fire, is made entirely upon this horizon.  

Within the capitalist social model we must remain intellectually poor. We no longer see the inherent beauty of a thing but rather consider firstly if it is of any material value. Shopping Malls have become the new cathedrals, literature art and philosophy have a paltry material value and have been annexed from the currency of our daily lives.  Philosophy, the highest form of intellectual function has the lowest social value.  As a course of study it is in least demand, requiring the lowest points, and is disappearing from the curriculum of many universities.  Indeed, when Harry Potter and the Philosophers Stone was released in the United States, the Producers changed the name to: Harry Potter and the Sorcerer's Stone, as it was felt that the word Philosophy would be a turn-off for American audiences.  Emerson and Thoreau would surely turn in their graves.   

So too with literature and the arts, indeed the very act of independent thought is under siege. This is the tragedy of capitalism. It is a tragedy that is acute among post colonial cultures, who have themselves been comodified for centuries, and are most familiar with tipping their caps to the master of the day. It is for this reason that Mr Kenny should have a panic-attack in the Dail when Clare Daly recently had the audacity to speak ill of the visiting American President. 

The transition is near complete, we have turned ourselves into our own Punch Magazine, we are the Quiet Man and Darby O'Gill's little people. The self styled playthings of our cultural and capital masters.  We have turned ourselves into slaves and it should come as no surprise that we should insist that our children learn to be good slaves also.

Last September a friend of mine started work as a teacher at  Secondary school in North Dublin. As he walked down the corridor, one of his older more senior colleagues asked him, how he was getting on; “Fine” he replied, “we don’t really have too many discipline problems at the school” he added. The older teacher corrected him and said; “that might be true for the younger boys, but so far I have had to send two of the sixth years home in order to shave themselves.”

My family returned from New Zealand in 2009 . There my children enjoyed an education system where they called their teacher by his first name, Where they sat about him in a circle, and were encouraged to speak out, and to think independently.  

Each morning my daughter struggles down the road with ten tonnes of paper blocks strapped to her back like an Egyptian pyramid builder. We laughed together when she brought home strict instructions that she was to have a 'fountain-pen' as part of her accouterments. I recall having to have one myself some thirty years ago.  In 2013 in Ireland we are insisting that children must bring fountain-pens to school, whilst learning to type upon the near ubiquitous keyboard is about as common as learning to speak Yiddish?

My daughter tells me each week of the classmate who is disciplined for wearing nail polish, or the wrong coloured trainers to PE.

Abuse in Ireland is often an accumulation of these little twists of the knife into the spine of common sense. We don't see children, we see 'pupils' or little advertisements for the success of our petty regimes.  Its all about control. In America or New Zealand teachers generally do not exercise autonomy over the bodies of children in the same way that they do here. Perhaps it is for this reason that there is little innovation here, that we remain incapable of thinking about new politics, a new social order or a new type of washing machine.  

Independence of thought is an anathema, to be stamped out as soon as it appears. It is for this reason that Pearse referred to our largely unchanged education system as The Murder Machine.  It is this same system that has brought us RTE, and the same paralysis that caused Joyce and Beckett to flee.  

When did we assume the right to tell our teenagers what they must wear, how they must dress, when they must shave? What do these modalities of personal expression and freedom have to do with education?  

For his Junior cert my son took honours maths, his parents have been to University and yet we struggled to help him comprehend this mathematical mess of social irrelevance. What of a kid from the ghettos of Ballymun or Balbriggan? Who will help them with their maths and their physics?

Irish education is where we begin to abuse our children.  It is where we begin to crush their spirits and their capacity for self expression and independent thought. It is where we teach them to accumulate points so they might purchase a career. It is where we turn them into commodities of greater or lesser value, where we love them and caress them from pasture to plate.

Health Insurance is dangerous!

Health Insurance. Your most dangerous possession?

The best thing you could do for your health (physical and financial) would be to bin your health insurance. In an Irish context health insurance is not only unnecessary but is dangerous. If you have health insurance you are far more likely to have an operation, and as is the case for many who are left incontinent and impotent following prostate surgery, many of those operations are of no benefit to the patient.

During a recession,most if not all private enterprises feel a degree of pressure to improve or at least maintain their profits. Within the private sector these pressures exist even in the absence of recession. Only a fool would assume that hospitals and private health practitioners are entirely immune to these pressures. In fact, given that much private medicine is conducted in supposedly public hospitals, the public system also experiences these pressures, albeit in more subtle and perhaps more sinister ways. Take for example the new consultant contract on offer to newly appointed consultants at public hospitals. These contracts forbid newly appointed consultants from working at private hospitals outside the public hospital. As such, the only private income a new consultant can enjoy is when he or she treats a private patient within the public hospital. There exists therefore, a certain financial pressure or incentive to treat or operate on as many private patients as possible or as permitted within the public hospital.

In short if you sit on the other side of the desk from a newly appointed hospital consultant with your health insurance, you represent a significantly greater income to the consultant and the public hospital, should you be inclined to agree with the doctors recommendation for the particular procedure that is in your best interests.

We would be fooling ourselves if we were to assume that these pressures do not ultimately translate into unnecessary surgeries and interventions for those with health insurance. Add to this pressure the reality that 'older' consultants with older contracts, who are free to work in private hospitals and clinics, undoubtedly enjoy significantly higher incomes than the newer consultants. The dice are even further weighted against the impartial consideration of the patient with private health insurance.

On a deeper analysis all serious medical or surgical cases are given priority within the public system, and in this respect Health Insurance is little more than a manifestation of our health anxiety’. An entire industry has been constructed upon this anxiety, an industry that is finding it difficult in the face of a recession, where many of its patrons are being forced to recognise insurance as “luxury” that can be done without. Rarely if ever do we consider whether the possession of insurance might have an influence upon the type of treatment we might be recommended. It is often naively assumed that the more money spent on our health the more more healthy we will become or the better the outcome if we are unwell. This is not entirely true, and in many cases the best health outcome results from being left alone. The extreme version of this little truth is echoed in the old adage that medicine is 'how to occupy the patient whilst nature effects a cure'

Unfortunately our health system has not evolved beyond the Victorian model and our consultants retain what the bishops have lost. Most of us are familiar with the traditional model of the suited consultant on ward round with a train of juniors and other inferiors waddling behind like a gaggle of goslings. Rarely are we even capable of asking could things, indeed should things be different? As the priesthood of yesteryear enjoyed an absolute power that corrupted absolutely, so too do many consultants enjoy an autonomy, that is as devoid of governance and will undoubtedly form the next entirely predictable health scandal.

Whilst other countries apply strict criteria and protocols to the decision for surgical interventions, in Ireland similar criteria rarely exist and for better or for worse the ultimate decision is left with the doctor and the patient. Within the NHS Cardiologists must adhere to strict criteria before inserting stents into the arteries that supply the heart. No comparable criteria exist here in Ireland, yet insurance companies pay significantly more to both the hospital and cardiologist alike for inserting such stents. Criteria apply for stenting, for angiograms and for many invasive procedures. In a similar respect strict criteria apply to the the removal of prostates (radical prostatectomies). In the united states, insurance companies will not pay for the removal of a cancerous prostate unless it is at a more advanced stage. Here in Ireland Prostate surgery is a lucrative business for both the surgeon and the hospital alike. So much so that a private Dublin Hospital offers the surgery 'robotically' , the cost is near 20,000 to the insurance companies.

Despite the fact that radical prostatectomy has been proven to be of no benefit for localised prostate cancer, the rate of prostate removal in Ireland has increased in recent years rather than decrease.

Recently the New England Journal of Medicine, published a study that was unequivocal in its findings:

“In conclusion, our study showed that, as compared with observation, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality through at least 12 years among men with clinically localised prostate cancer that had been diagnosed in the era of PSA testing.”(N Engl J Med 2012; 367:203-213July 19, 2012DOI: 10.1056/NEJMoa1113162 )

Regardless of this well published research some 20-30 of these largely unnecessary procedures are carried out in Ireland every week. In my opinion it is highly likely that the majority of these patients have health insurance. The real tragedy here is that a significant portion (20% in some cases) of those undergoing prostactectomy are left, either incontinent of urine, impotent, or both.

As a consequence of both the lack of investigative journalism in Ireland and our collective fear of established medicine, no one is asking the pertinent question of; how the need to turn a profit, and the need for financial survival have intensified the 'pressure' on doctors and private hospitals alike, to consciously and perhaps subconsciously encourage patients towards more expensive, more invasive and more dangerous procedures?

Undoubtedly the present situation is set to worsen with this government's plans for 'money follows the patient', after which hospitals will be paid per procedure, and all presenting at their public hospital night be deemed in need of some form of an intervention.

In my own experience as a General Practitioner I have come to the conclusion that the possession of Health insurance is a significant risk factor for; prostate surgery, Cesarean Sections, Invasive Cardiology and more. It is for this reason that when I advise my patients to give up smoking I also advise giving up their health insurance. At present I am unsure as to which of the two is the lesser evil?  Personally if given the choice between smoking and Health Insurance,  I would take my chances with Marlborough man any day of the week!

The Goose and the Golden Eggs.

"I want a goose that lays golden eggs!"

So said Veruca Sulk before she went the way of a bad egg at Willie Wonka’s chocolate factory.

Without wishing to sound facile. Irish medicine is a bad egg, and it stinks! Most commentators begin by saying as much, in perhaps more erudite terms. Usually analysis of our broken system begins with a litany of ongoing horrors with which we are all familiar; the inhuman conditions in A&E the length of time granny is waiting for her hip, the absence of a functional psychological service, for a nation that is recovering from the mental illness that was the Celtic Tiger, and so on.

Consultants and GP’s love to join in the fray and each medical discipline passionately points to the ‘reality’ that the cardinal problem with health care in Ireland is that we don’t have enough money or enough manpower to deliver services. And there you have it! Turn the pages of most contemporary medical analysis and that’s the nuts and shells of it!

As Joyce’s brutally practical medical student Buck Mulligan often shouts; ‘Scutter!’ We have heard it all before, and will hear of it for another millennium, at least until we evolve the capacity to look a little deeper at our problems and accept that we doctors are as much a part of the problem, as we are the purveyors of the usual solutions.

Apparently this same lack of money and manpower have been the nuts and balls of it for many decades. Yet strangely, after decades of ‘more money’ and ‘more manpower’, the problems have not gone away; the waiting lists are as long, and A&E remains largely unchanged. Paddy still devotes almost half his PAYE to health-care; plus an additional €50-60 to see the GP and €150-200 to see the consultant,- despite his overpriced insurance premium.

What if we were to do something really bold and suggest (you might want to sit down and have a gulp of espresso) that the problem is not ‘a lack of money’ but too much money, and not a lack of manpower but too much manpower; much of which is quite possibly paralysed by having its finger stuck in the wrong place for most of the day?

What makes a molesting clergyman most repulsive is the fact that the most immoral act is perpetrated by a moralist. What makes our health service so abhorrent is the fact that it is defined by a particular stupidity, one that is perpetrated by those of us who are considered by many to be amongst the least stupid in society.

In the privacy of our silent read, and without choking on ones croissant, lets be honest for a nanosecond. Where does most of the existing budget for health go? That’s right wages! Staff wages, our wages! The truth is not pleasant when we see it in black and white, but there it is. If we took less there would be much more to go around. This is not leftist dogma, or profound philosophy, but the arithmetic of a school child.

Here is the elephant in the bedroom. It is as much an intrusion upon the intercourse of medicine as it would be if it were sitting at the edge of ones bed and observing the intercourse of intimacy.

Money! We don’t like to admit it but we are all addicted to, or at least largely dependent upon it as a primary source of happiness. It is part of the reason we get out of bed, it has purchased the bed, and it might even be the sole reason that we have someone to share the bed with?

The health system is interesting in that it is a microcosm of the state. From the top down our dysfunctional health-system is perfectly reflected in our dysfunctional politics. Just as we pronounce that there is not enough money being spent on health, our government tells us that if we don’t vote yes at the end of next the month, we may be deprived of the pleasure of borrowing additional billions to continue running the country.

When will the addiction and the madness end? Perhaps only when we answer the question that Tolstoy poses in his timeless short story How much land does a man need?

If we were to lead by example and show that the wealth-game has reached its sell by date, there would be far less pathology in the land, and far less strain on the mental health of the state, and even the self.

If we were to prove by algebra that happiness arises not out of wealth, but out of a ‘philosophy of living’, …what then? Not only would there be more money for health, but there would be less ill-health, public and private. The question for the nation is in reality a question for the self. How do we know when we have enough?

Unfortunately we are wealthy relative to the wealth of others; our car becomes old when our neighbour drives a new one, and our clothes become old when they are no longer fashionable. Our children’s needs are not being met when they don’t have what ‘all the other kids have’. This madness of modernity, was recently described in a BBC documentary Status Anxiety, presented by Alain de Botton.

Our present recession is Granny’s time! For she will gladly remind us that a car is for getting from A to B, our clothes are to keep us warm, and that a child will benefit more from a library book than an I-pad. She might also remind us grown-ups that putting more on our plate than we need is called greed, and she might inform the health service that a bowl of chicken soup will treat a cold better than any antibiotic. Oh Granny, why did we ever send you to the nursing home and sell your fine house in the suburbs?

If we could wave a magic wand and take relativity out of the picture we would all be millionaires! Emperors who are ferried about in mechanical chariots, and have our clothes washed by fantastic machines. But relativity is here to stay and we are as rich or as poor as our peers and our 'betters' might directly or indirectly tell us.

Next month for nine weeks Minister Reilly will open his home and castle to the public. The 15 bedroomed, three storied ‘Laughton House’ situated on it's 150 acre 'garden' in Co Offaly, will be open to public visitors at €5 a head, (€3 for Granny). The Minister’s residence is listed as a ‘heritage house’ and as such he avails of an €80k per annum ‘tax-break’ if he opens some rooms to the viewing public during the tourist season. A nice addendum to a GMS and a Ministerial pension to boot.

It is hard to imagine how austerity can be preached from such a vantage point? Yet therein lies the irony of both Irish medicine and Irish politics. If there is anything to this relativity lark Laughton House leaves my humble abode in the hay-penny place.

Yet I am sure my auld Gran would approve of my doubtful penury and definite happiness.

“Umpa lumpa dupety da

If you’re not greedy you will go far

You will live in happiness too

Like the umpa lumpas dupety do!”Roald Dahl