Saturday, 21 October 2017

My thoughts on UNREST (2017) ★ ★ ★ ★

UNREST is a new film from USA about ME directed by thirty-five year old Jennifer Brea. The film has garnered much praise and documents Brea's own descent into ME (or CFS as it's interchangeably referred to in the film - this is not without problem as the toxic reframing of ME as CFS remains unexplored). Still, ME sufferers have been starved of representation (though we've also had VOICES FROM THE SHADOWS (2011) and FORGOTTEN PLAGUE (2015)) and it's unsurprising there's been such a buzz about the film. I'm passionate about education and I tried hard to watch UNREST as someone who knows nothing about ME, to see what it taught me. This was almost impossible to do (to put my own experience and knowledge to the side). UNREST is not just about illness, it's about how technology connected Brea to other 'shut in' people, invisible - housebound and bedbound with ME.  We are all networked, now, globally, if we choose to be. In a way, the theme is the obsolescence of the written word for communicating lived experience.

I found UNREST to be powerful in its illumination of ME - particularly through the inclusion of three very severely ill younger patients - and I found myself in tears frequently. But I also found the film lacked clarity in places. The politicisation of the illness is glossed over, as is previous advocacy, but it would be impossible to investigate the politics of ME in a 90 minute documentary - and this is very much Brea's own story (not a UK story where the horrors of PACE still abound). I think those more recently diagnosed, still grappling with the hell of it all, will find the film resonates hugely for them.

The film looks beautiful and, at times, has a dream-like quality: this reflects the sense of unreality that comes in the early stages of this illness, the sense that it can't actually be possible to be so alarmingly ill without any recognised treatment path. I loved the lighting, the shadows, the focusing on objects, like blue jars on a window sill with snow falling behind, to mark the passing of time. When writing about chronic illness there is little sense of plot, nothing changes, so you have to amplify small moments. A ceiling fan, a ladybird, a pair of high heels - unworn shoes are an important #millionsmissing campaign symbol - objects that take on immense meaning when you may be staring at them for hours on end, too ill to do anything else.

Having been ill since 1982 - and gone through my own hell as an eighteen year old -  I'm naturally a little jaded, but it was impossible not to cry at the extreme circumstances of Jessica Taylor-Bearman (UK), Karina Hansen (Denmark) and Whitney Dafoe (USA). I already knew a little about all of them. The image of poor twenty-seven year old Karina sitting on her bed, back home with her parents after being forcibly institutionalised for three years, will haunt me for a long time. The expression on her face is something that is hard to see (or unsee). Danish psychiatrist Per Fink is the villain in this piece and I couldn't help but have the very personal memory of my dear late Danish stepfather who supported me unfailingly throughout my illness. Twenty-six year old Jessica has been ill since she was fourteen and was in hospital for four years. She has severe osteoporosis as a result of being bedridden for so long. She has champagne held to her lips by her dad and counts back to the birthdays she has spent in bed (I thought of my own twenty-first in bed in 1984, which I fictionalised almost twenty-five years later, Helen Fleet, bedbound, feels like ‘a clown, a grotesque invalid wearing bright red lipstick and titanium earrings’). And Whitney, the son of Stanford professor Ron Davis, is unremittingly and severely ill, inhabiting a dark and hellish place - he  cannot even speak.

Brea decided to film herself to document what was happening, as doctors were not taking her symptoms seriously. She goes through what is familiar to many of us, trailing from specialist to specialist until we find someone with the expertise and knowledge to identify what is actually wrong (those more recently diagnosed or new to the illness may find Brea's own story more immersive than someone like myself, ill for decades). Seven years ago, she had a high fever, she  appeared to recover, but still never felt quite well. She would drag herself to classes. She  got infection after infection and would experience suddenly not being able to pick up a glass of water or sign her name on a cheque. On bike rides, instead of being able to do twelve miles, as before, she could only do six (this is not in the film but I've seen mentioned in a recent Times interview). After no joy with other doctors, she is eventually diagnosed with conversion disorder by a neurologist and walks home from the appointment to see if it is all in her head, as she has been told. She narrates that she collapses when she gets home and is in bed for most of the next two years.

She discovers others with similar symptoms online and wonders if she too might have ME (this, of course, is the Wesselyian fantasy, ME sufferers diagnosing themselves on the Internet. In Professor Wessely's world, patients are discouraged from educating themselves in case they discover that they are actually physically ill). Brea learns much about the illness through social media. This would have been the stuff of science fiction in the eighties. I'd never heard of ME. I remember looking up Coxsackie in the university library and the heavy book burning my arms. It is hard now to convey the paucity of information thirty years ago.  Brea consults New York's ME specialist Dr Enlander  - though he is not named in the film - and is prescribed Valcyte - an antiviral drug - which leads to her improving in two days and being able to walk again. This seems almost miraculous and it frustrated me that there was no discussion about Valcyte - what it is, what it does - some viewers may have wondered why we are not all taking Valcyte. It is an off-label treatment, which has not helped everyone who has tried it - and indeed can make some feel worse. And is not easily available to most (NICE guidelines in UK do not recommend antivirals,  unsurprisingly, as 'CFS' clinics prefer to treat ME sufferers with wholly inappropriate graded exercise and CBT. These guidelines are now, thankfully, under review, not before time).

Brea acknowledges that she was lucky to have access to a specialist. I felt, though, I wanted to know more about her actual diagnosis. We see her having lots of blood taken, I wanted to know what the tests were for. Being diagnosed is such a significant moment for those of us who have struggled to be believed: I went through the hell of Coxsackie B4 virus, undiagnosed for nine months, which then 'evolved' monstrously into ME. The Coxsackie diagnosis was a key moment - crucial to my getting a referral to neurologist Prof Behan, who worked closely with Dr Melvin Ramsay - all those years ago. My GP could no longer say I was imagining tremors in my muscles.

The film did make me think about how different a diagnosis is now than in the eighties. I was horrified in 1984 that I might stay ill for another five years (that was the advice back then - that it might 'burn itself out' in five years). I did not know how I would be able to stand the physical hell of ME for that long. I'm glad I had no idea of the true prognosis. Now, of course, those with an ME diagnosis know that that they might stay ill for decades. Brea speaks tearfully in the film of the grief and loss that the illness brings, she reflects candidly that she is doing 'a good job' by not killing herself.  I was struck by the scene where via Skype,  Jennifer asks Jessica, who is lying down flat in bed, almost ethereal, being filmed from  above: How did  you stay sane?

I remember too crying a lot at the beginning of my illness. I felt so ill, completely poisoned. It was terrifying ('How can you feel so ill and not be dying?' as my character Helen Fleet says). I'm sure I articulated my grief too back then but I can't now remember. I think it took me a decade to truly adjust to the illness. I missed my academic self. I wanted to know more about how Brea felt having to give up her PhD. She never refers to it after her diagnosis. Decades on, I still feel a kind of grief that I had to abandon my year studying in France in 1982/3 - and that I was unable to complete my French and English Honours degree.

I was conscious, though, while watching the film that it is a constructed piece of art, an artifice, like any narrative, and a couple of Brea's own scenes felt slightly 'theatrical', at least, to me. I don't mean acted, rather enacted. For me, this detracted from authenticity. It felt, at times, that she was re-enacting what she had experienced rather than experiencing it in that moment. I imagined numerous 'takes' to capture the reality of the illness. I compared it in my head to writing a scene, which you polish and polish until it's perfect (I could be totally wrong, of course, these are only my thoughts). Also, I was interested that much remains unsaid in the film. For example, Brea is not seen having to cope with the very damaging disbelief from family or friends, as many of us have done at some point in our illness (of course, she may well have done, we don't know, we only know what she reports). We see her interacting only with her husband, Omar, who is noble and loving and patient. He only loses his cool - understandably - when Brea attempts extreme mould avoidance as a treatment for her illness. Earlier in the film, when Brea has had an acute episode after over-exertion at a Princeton reunion, Omar - in tears himself - makes an observation that resonated for me: other people's pity is hard to bear.

Brea makes a crucial point when she says that one of the reasons the illness is not always believed is because we are hidden so much of the time. We spend so much time indoors recovering from small exertions. No one sees us at our worst. Some sufferers, tragically, cannot move from bed at all and are totally dependent on others for care. And there are a minority of ME sufferers whose illness is actually progressive. There is a brief but good description from Dr Nancy Klimas on mitochondrial dysfunction and the problems with aerobic exercise that ME sufferers have.

As I understand it, these days, Brea uses a power wheelchair when she is outdoors, but has now improved sufficiently to be able to promote her film in the USA and other countries (Brea also says she has POTS, though this is not referenced in the film. I think she should have mentioned this, as POTS and ME often 'overlap'). Improvement is always to be celebrated in ME, it's wonderful when it happens, though her current schedule seems impossible to sustain for someone with ME, certainly, the illness I know as ME.

Then again, I don't know anyone who is taking Valcyte. I guess it allows for a much greater level of functioning in some. While I have slight concerns that Brea is somewhat unrepresentative of many with ME, I, of course, recognise that we all can and do have different staminas and symptoms - and  symptoms do fluctuate. I also know that because of the lack of belief we've faced, we can be fiercely wedded to our own experience of the illness. And the rhetoric of 'oh, how can she do that?' can be extremely harmful (we've all faced it, I'm sure). But all of us - with true ME - share the cardinal symptom of post-exertional malaise (PEM). We are defined by exertion-intolerance: fatigability not fatigue. And in between times we are always invisible, always 'recovering' from an escalation of symptoms. The differences, though, between mild, moderate, severe and very severe ME are night and day.

There are small moments that perhaps only someone with ME will see. In one scene, a young woman Casie - whose mother, the quite fabulous Leeray, also has ME - says her arms are getting tired, when holding up her iPad to show photos. A small moment, but instantly recognisable - and important to portray. The last few minutes of the film focus on the #millionsmissing campaign, a campaign conceived by Stacy Hodges. Those empty shoes are such a potent symbol: most of us put our shoes on to go out into the world every day. Those of us with ME often can't and don't. There are ME sufferers who have not had to buy new shoes for years. There are ME sufferers who have killed themselves because they cannot stand it any more. There are also ME sufferers who have died of the consequences of extremely severe ME.

The film ends with beautifully stirring music - the score is by Bear McCreary - and Brea telling us that while the illness has destroyed her life and she wishes every day that she were well again, that she has embraced a different, new life. She expresses gratitude for the lessons the illness has taught her. To be honest, I found this hard to understand - and  a little saccharine. I could never be grateful for the catastrophe of my illness, but you just can't compare seven years with thirty-five, our landscapes are entirely different. Though, I can also say I have never at any stage of my illness felt 'grateful'. The illness has been much too harsh, physically. And I have lost too much. The enforced 'stillness' of the illness has given me a useful perspective as writer but I would swap that in a second for never having had ME in first place.

Perhaps, though, Brea's optimism is part of the narrative arc, a conscious 'happy' ending to such a bleak tale. And perhaps, importantly, her own ending - and significant improvement (thanks to medication) - also gives hope to younger and/or newer sufferers. The film is an exhausting watch. Before the credits, we see the names rolling of some of those who have died as a result of having ME (I think they had taken their own lives). I sat silent for a few minutes, after the film ended, I couldn't speak (and I imagine seeing this in the cinema would enhance the  emotion I felt, I watched on laptop, was sent a link by UNREST UK team).

I'd like doctors and politicians - and anyone who is cynical about the illness - to see UNREST.  I'm glad it's being shown in medical schools. But I'd also have liked to have seen more of the science that we do know - and I fear that the lack of political context may prevent the film having as much impact as it could. The medical and political scandal of what has happened to ME sufferers is never fully articulated. I wish, for example, footage of Stanford's Professor Montoya apologising to sufferers for the way the medical profession has treated them had been included.

In the UK, ME is synonymous with the hijacking and reframing of the illness as 'chronic fatigue' in the 1990s by  Simon Wessely and colleagues -  the ascent of UK psychiatrists cannot be ignored, nor the toxic influence they have had worldwide on the perception of ME, with their relentless and ruthless promotion of the biopsychosocial model - and wilful conflation of criteria of ME and CFS. While the film packs a huge emotional punch, I'm not sure how much it will punch politically in the UK. The biopsychosocial narrative is so embedded, it will take a juggernaut to shift it. Hannah McGill and Leslie Felperin, both respected film reviewers, still referred ignorantly to the physical v psychological debate as if the robust science of physiological abnormalities simply doesn't exist (though the Guardian has historically been dreadful with ME coverage). Mark Kermode gave a lovely review, though he was already empathetic.

We need journalists and doctors - and everyone else - to come out of UNREST enraged at what ME sufferers have endured, and unequivocal that ME is a physical illness - it is not enough that they feel greatly moved by the plight of very sick people.  Still, the film is giving the illness a much needed, greater visibility - and kudos to the UNREST team for pulling this off. I very much hope this visibility can translate to more research funding, which is what we need above all.  I dislike starring systems - they lack nuance and subtlety - but having given my response in great detail above, I happily give UNREST four out of five stars as an art work about ME.

*Just to add that UNREST was funded through Kickstarter and it's a testament to the generosity and hope of ME sufferers and their families - and their faith in the process - that UNREST has had the media coverage/distribution/success it has.

Tuesday, 17 October 2017

Comment piece in The Medical Independent referencing my novel

Am delighted that the current issue of The Medical Independent, a fortnightly Irish medical journal, has a comment piece on ME  ('George Winter examines the evolution of recognition for myalgic encephalomyelitis (ME)'), which  references my novel, TS Eliot, Hilary Mantel and Virginia Woolf. PACE is discussed too. It is so very refreshing to read a science writer who has an intellectual curiosity about the illness - and the literary slant is lovely too.

Thursday, 21 September 2017

Good news: NICE review - and a science writer who listens

Finally, some good news from NICE, they dug in their heels for ten years with an absurdly harmful guideline - recommending graded exercise and CBT for mild to moderate ME - which they conflate with fatigue - and simply ignoring severe ME - but now they have agreed to a full  review. We can only hope that all the cosiness and networking behind the scenes will be broken down by actual evidence and science. The Royal College of Psychiatry, who naturally did not want an update - must be disappointed that their big cheeses are losing their cold grip over this illness.

Meanwhile, some great research explored at the recent CMRC 2017 (if we can ignore Esther Crawley's involvement). With names like Avindra Nath, Jose Montoya, Julia Newton etc, we are getting to the truth. 

Slowly, slowly.

I rarely go to writers' events - I'm sociable, but mingling usually means standing and I always have to sit down after five minutes - separate myself off from everyone - but in August I attended an event where I met a freelance science writer with a 30 year career in virology/biochemistry laboratory work. I told him about my illness and novel and he was very interested and we agreed to send copies of our respective books. He has since read The State of Me and has also been reading up on PACE. He has a comment piece on ME in the pipeline for an Irish  medical journal.

I have been struck by how  receptive and respectful he has been of  my illness experience. He may even have looked at my blood for Coxsackie, as samples from patients with 'presumed ME' were being sent from Glasgow to Edinburgh in early/mid eighties when I was being diagnosed.

The stuff of fiction.

I am enjoying dipping into his (accessible for non-medics) text on clinical virology (1999). Have learned that enteroviruses are the same size and shape as rhinoviruses but can survive in acidic conditions. I've been thinking of when I first got ill - thirty-five years ago this month - and Coxsackie unbeknownst to me had taken up residence in my gut.

Saturday, 5 August 2017

The scandal of PACE trial continues to shock

Last week the Journal of Health Psychology published a special edition on the travesty that is the PACE trial. Editor David F Marks knew nothing of the trial until a year ago and when he looked at the evidence he realised - as anyone rational would - that this highly spun - harmful - research is abject nonsense from start to finish. By pitting himself against the UK medical/academic establishment he has learned just what ME patients have been tolerating for decades.

Of course, the Science Media Centre's psych-driven lobby hit back with petulant, sour punches as toys were thrown out of the pram. The PACE researchers have nowhere to go, so this barrel-scraping for experts is entirely unsurprising. (Though they have rarely in the past ever used actual experts to comment on ME research, they prefer to use friends of PACE.) David Tuller has  done a great job of describing these recent dirty punches on virology blog.

Meanwhile, in the important, relevant world of research,  we have new findings from Professor Montoya's team on elevated cytokines and illness severity. And next week scientists meet at a Stanford community symposium: a gathering of great minds, including a Nobel Laureate, who have ME patients' welfare at heart, putting the medical mafia here to shame (although those mafiosi remain, as always, unshameable and impudent).

Sunday, 9 July 2017

'Re-writing the hurt' (Jeanette Winterson)

Podcasts can fill me with dread because *sometimes* they are dull and you (often) can't fast-forward. I listened last night - lying down with my eyes closed - to a Jeanette Winterson podcast from 2012, it is a joy and delight. Her clarity and honesty soar and you could listen to her forever. She talks about 're-writing the hurt' in order to be able to cope with the narrative or the memory of what happened. On the writing of truth versus fiction she says she realised - with sadness - after Oranges are Not the Only Fruit that she had written a story that she 'could live with', the other was too painful, she 'could not survive it'. 

As I write slowly, slowly about my Pakistani father, often weeks, even months, with no writing - always thinking, though, always - I understand this more than ever: the stories we (re)write often make the truth bearable. I often say truth comes more easily through fiction. I think it's one reason I had to fictionalise my illness for The State of Me - the physical hell and wilderness of  this illness  -  being a political football, to hell with actual patients - is just too painful.

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I'm reading (non-fiction) The Upstairs Wife by Rafia Zakaria. It's beautifully written and the Partition elements resonate for me, particularly descriptions of Saddar in Karachi, as that is where my father's family migrated to from north India in late 1940s/early 1950s.




I'm also reading (fiction) Memoirs of a Polar Bear by Yoko Tawada, which is funny and clever and heartbreaking, told from the point of view of three polar bears, an unnamed grandmother/memoirist, her daughter Tosca (though Barbara, her trainer, narrates parts too), and Tosca's son Knut (based on the real Knut in Berlin Zoo). The memoirist polar bear starts off in the circus and when being trained to get up on hind-legs by appliance of heat says: 'I'd always thought it was the floor feeling pain - not me - so it was the floor that had to change - not me - to make the pain go away'.

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I watched Toni Erdmann on DVD a couple of weeks ago, very different, funny and quirky, if a little unsettling. It is three hours long though and I had to watch it in two parts, no big hardship. It doesn't feel long, and that is the main thing. And is a film that leaves you feeling happy.

Wednesday, 10 May 2017

Dr Avindra Nath's research. And lovely books

I'm so very, very heartened by the research that is currently going in USA at the National Institute of Health with Dr Avindra Nath as principle investigator (PI). Dr Nath is a neuroimmunologist and exactly the calibre of scientist we need in ME research. His hypothesis is that ME is 'triggered by a viral illness that results in immune-mediated brain dysfunction'. His work is described as a 'deep-diving' into the disease, he is looking at not just one aspect but every aspect. Long overdue!!! Brian Vastag is a former science reporter for the Washington Post, now disabled by ME - he got ill almost five years ago. He's one of Dr Nath's patients - you have to have had a clear infectious trigger and been ill for less than five years - and has been tweeting some interesting details of the study. This is a lovely photo of doctor and patient (from Brian's timeline) - such mutual respect and warmth on display (can you even begin to imagine that scenario here with our so-called 'CFS experts'?).



More than thirty years ago, Peter Behan, the consultant neurologist who diagnosed me, was  looking into viral damage and mitochondrial dysfunction (I recently came across this article from 1985 in the The Journal of Infection. He describes muscle abnormalities in fifty ME patients, I'm uncertain if I was one of them but I had all the tests he refers to):


His paper states: 'The illness was severe, with a high morbidity, and a disastrous effect on their lives'. Of course, medical technology is way more advanced now and I'm optimistic about what will be uncovered in the years ahead. Just tragic though that a core in the medical profession, specifically UK psychiatrists, have held back biomedical research with their self-serving theories of false illness beliefs, and their wilful and sinister conflation of ME with 'chronic fatigue'. That's thirty-three years of my life I'll never get back - thanks, in no small part, to their biopsychosocial idealogy.

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Been meaning for a while to mention Marion Michell's book Supinely Sublimely (2016).




Marion is a German-born artist, based in London. She is very severely ill and I can imagine what it cost her to produce this slim book of meditations and art. I love the cover, which if you look closely has tiny paper boats as faces. There is a sense too of being shackled, at least, I see chains, and what is ME if it is not a kind of prison, in all its grimly fluctuating, punitive severity. The book is perfect for dipping into and there are gems such as: 'Limbs, jaws, skull, the hair on my head hurt, my hands had been stamped on, and something pounded my ribs and stole my air. Half a week later, I am still returning''.

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Another book I very much enjoyed recently is Zeeba Sadiq's 38 Bahadurabad (1996), a gorgeous mix of fiction and autobiography, it describes a young woman growing up in Karachi in 1960s with a doctor father who has spent time in Britain. I loved it, especially the chapter called 'Lame Auntie', the writing is exquisite. I was truly sad to learn that Zeeba had passed away suddenly in 2010 after suffering a brain aneuryism, we're almost the same age.

Monday, 10 April 2017

A Book of Banished Words

Delighted to have a short piece in Nancy Campbell's just published The Polar Tombola: A Book of Banished Words (photo from @BirdEditions).



More on  Nancy's live literature event  here: What happens when a language begins to disappear?


I first met Nancy on Twitter via a photo of a snowdrop three years ago and we came to 'know' each other through my dear late stepdad. My own banished word is described in 'The Hoot of an Owl', here is a fragment:

Coxsackie – pronounced cook-sah-kee – is the name of a small town on the Hudson River in upstate New York. Derived from Native American language, it’s said to mean the ‘hoot of an owl’. Poetic when whispered, but Coxsackie can also be a bully, swaggering its hard-sounding ‘C’s.
*

Life is truly stranger than fiction. How could I have known in winter 1982 that the hellish illness that had ruined my year in France - yet to be diagnosed as Coxsackie virus, which in turn triggered ME - would, thirty-five years later, be represented in a piece in a beautiful art book whose author had (by then) done a residency in my stepdad's childhood home in Greenland?