Friday, February 10, 2012

What is different about Mickel Therapy? Part 1

I was recently on a TV programme – Trusadh – about ME/CFS [links to Part 1 and Part 2 on YouTube]. The relevance of my contribution lay in the fact I was doing a course of Mickel Therapy – a controversial treatment with many people claiming improvement and even cure, although it is not recognised by the NHS nor the ME Association.

However, while the programme was very good at highlighting both what it is like to live with ME/CFS, and the difficulty and diversity of opinion in identifying and tackling this debilitating condition, it didn’t give any real sense of what Mickel Therapy (MT) is. I’ve since seen plenty of comments left on different discussion sites where its clear many have been left with the impression it is just another version of CBT (Cognitive Behavioural Therapy) or psychotherapy, which it is not.

So I thought, having been through and benefited from MT I would give my interpretation of why it has had an impact on me, and what separates it from these other treatments.

At this point, I need to offer a disclaimer – I am not a medical doctor/researcher, and I am not a trained Mickel Therapist. These writings are entirely my own opinion and are not endorsed by anyone with a stake in what I say.

What I do have is a degree in philosophy – which could be said to be a 4 year training course on Bullshit Detection - and I have spent well over 5 years of my life crippled by fatigue and related symptoms, which no one in the medical profession was able to adequately explain or do anything about. Since going through a course of Mickel Therapy, my energy levels are much improved and I can see a path towards further recovery.

Much of the controversy of MT stems from it being a “talking therapy”, as opposed to a physical or drug based therapy, and the idea that words alone might be able to affect a physical condition can seem nonsensical. Indeed, it seems to imply the illness is “all in the mind” or, at worst, even a false illness belief.

So was I not really ill, responding to some kind of placebo effect, being conned or outright lying about my condition? Well, obviously I don’t subscribe to any of those theories, so what has been going on then?

In order for it to make any sense, we first have to break down some commonly held assumptions – the biggest being the mind is a separate entity from the body, and is in charge of what’s going on.

If you have this belief, then there are other assumptions that follow. You might think, for example, that you could compare the mind and body with software (the programming) and hardware (the physical components) of a computer. So if your computer stops working, you first have to figure out whether it is a hardware or software problem. Is it that the Windows Vista has corrupt files or a virus so can no longer boot up, or has the keyboard broken or the motherboard fried – in which case no amount of software changes are going to make any difference – the hardware needs to be physically fixed or replaced.

Bring this analogy back to humans, and if there is something wrong with the body, it needs to be physically fixed – you can’t talk a broken leg into healing itself.

But, how accurate is this model of human beings?

At this point, rather than doubling the length of this post, I would ask you to read a previous post of mine – Who’s In Charge, which outlines the mistaken idea that the conscious mind is somehow the primary authority that needs to be obeyed.

The point being, that once we start really thinking about it, the separation between mind and body is fuzzy at best. Most of what we think of as independent conscious thought has been driven by subconscious desires, habituated thought patterns and bodily functions. If you doubt this, see how long you avoid going to the toilet before it occupies your conscious thoughts so completely, you are utterly unable to think of anything else.

Our conscious thoughts are not the start of any action, they are the result of a whole mass of stuff going on in the body and brain before we become aware of them. Our thoughts can, of course, affect our emotions and vice versa, and even create feedback loops, which intensifies both, but they are rarely the starting point.

Can physical traumas affect the mind? Can mental states affect the body? Absolutely yes in both cases. To draw a hard line between the 2 is simplistic and naïve. However, if we think about them as different aspects of the same thing, different members of the same team, different faces of the same whole, then we open ourselves up to other approaches.

For example, each time we are in a stressful situation and our body goes into fight-or-flight mode, the brain activates a whole pile of chemicals and hormones to enable us to deal more effectively with the threat. Our heart rate increases, pumping more energy to our muscles, our senses heighten, and even our digestive system slows down as resources are diverted elsewhere. We have a very physical response. And once we perceive the danger to have passed, we start to calm down and the alarms are switched off.

Several theories are now pointing at the idea of mid-brain activity being at the heart of ME, CFS, Fibromyalgia and other fatigue and auto-immune conditions. The notion being put forward is that instead of switching off once the danger has passed, the flood of instructions keep coming. But the fight-or-flight response was designed to be temporary, not permanent, and consequently the person can end up with an array of symptoms, from fatigue to muscle pain to IBS as the body and immune system steadily wears itself out.

What causes the gate to be jammed open is unknown, but viruses and stress are the top runners. But whatever the initial trigger, according to MT, our relationship with our thoughts, emotions and more primal areas of our brain, are the key to rebalancing the system.

But this is not about using the conscious mind to instruct the body what to do, which is the approach of CBT and various psychotherapies. Indeed, trying to “will” yourself better can actually make your condition worse.

In part 2 I will go into more detail about this

27 comments:

Theanne said...

Whether I understand completely what you're explaining is immaterial...if the Mickel Therapy works for you, if you have relief, if it enable to you to continue to be a photographer and live your life, then I'm for it!

Pat said...

'Can physical traumas affect the mind? Can mental states affect the body? Absolutely yes in both cases. To draw a hard line between the 2 is simplistic and naïve.'

I totally agree with you. I wish I had your skill to actually put it into words. I await part 2 avidly.

Carole said...

I am so enjoying the videos online to see how this is working.

I should think that people who actually experience ME/CFS should know more about Mickel Therapy than those in the medical field who have no personal experience.

Pat said...

In Part 2 the Irish doctor who actually said 'Nonsense!' is so typical of a certain type of medic. I didn't know they still existed.

Mimi and Tilly said...

I am fascinated by this. I completely agree that the body/mind cannot be separated with regard to healing illness, and that that doesn't mean a physical illness is not physical. I would love to know more about this with a view to possibly trying it myself. Thanks for posting this Kim. :)

katierobertsart said...

fantastic to hear Kim, ca t wait to know more Xx

Eric said...

Hey Kim, did all this by the way start after or during the period of major weight loss?

Kim Ayres said...

Theanne - I take it from that response, I wasn't clear enough in my explanations. If you have any questions, please feel free to ask. Part 2 will be going up in a few miniutes - I don't know whether that will make things clearer, or more complicated...

Pat - you're a highly skilled writer. Part 2 in a few minutes :)

Carole - are you learning any Scots Gaelic in the process?

I think when you have an unknown illness, those who experience it tend to have far more knowledge than the medical profession who are mostly concentrating on what they do know.

Pat - I think it said he's retired now.

Em - at least 2 more posts to come :)

Katie - more in a few minutes :)

Eric - to be honest, it's difficult to know exactly when it started - it wasn't an overnight thing - it kinda crept up on me. I kept attributing my tiredness to other things. It was Maggie who finally pushed me to go to see a doctor. By that time it was well over a year since I'd sold my business and we'd started a new life, including eating more healthily. At the point I went to the doctor, I'd probably lost about 75lbs over 15 months. Why do you ask? I take it you see some kind of connection?

nmj said...

With respect, Pat, the Irish doctor Professor Behan, is a (retired)consulant neurologist, he diagnosed my ME in 1983, after over a year of worsening health which led to my being bedridden and having to abandon my Honours degree. I was extremely grateful to him and remain so. He (and his late wife) have done groundbreaking research on ME and Coxsackie virus. I wish there were more doctors like him - then we may not now have the very harmful misinformation about my illness which is out there.

nmj said...

Hello again
Re. Mickel I do know of two women with neuro ME – I know one well - who improved after MT, but they were also on the road to recovery – after typical relapsing /remitting cycle of ME - and both had had pregnancies which sometimes ‘re-sets’ the immune system, so it is hard to know objectively how effective MT actually was – but the main thing for them is they are actually feeling more well. However, I would need scientific validation before I would try it, anecdotal is not enough for me. (At this point I have tried so many things.)

And graded exercise is not the leading recommendation for severe ME, it is highlighted by both NICE and Scottish Good Practice Statement that graded exercise has made many people with ME worse! Graded exercise is absolutely contraindicated in severe ME (they have no studies to back it up!).

You just can’t compare apples and oranges when it comes to therapies.

I am sorry to bang on the drum here, but I do understand that the ME/CFS divide must seem massively confusing to those outside the illness.

I am not a 'militant' ME commenter, anyone who saw me on Alba will see I am simply assertive about an illness I have had for almost 30 years - and I just find it soul destroying when someone can make such a flippant, glib comment (above) about the neurologist who has done so much for us. I accept this comment was not made with ill will, but it is still tremendously upsetting, I wish you could have seen the state I was in when I was admitted to his clinic for a plasma exchange not yet 21-years-old.


So here are the revised Canadian Clinical Criteria (CCC), which PWME want adopted by NICE. I’ve been in this from the beginning so I have the advantage of having been diagnosed with neuro ME (I have Ramsay-defined ME) and then seeing the illness criteria diluted and broadened a decade later in UK when psychiatrists adopted the name CFS and tried to banish the name ME. The confusion of criteria has led to utter chaos and conflation of neuroimmune and biopsychosocial.
http://niceguidelines.files.wordpress.com/2011/07/revised-canadian-myalgic-encephalomyelitis-chronic-fatigue-syndrome-case-definition.pdf

To make matters more confusing the term CFS is also used in the USA to denote actual ME (though not veryone there with CFS has ME because of the criteria). It is a mess.

The International Consensus Criteria (based on Canadian)call for the name CFS to be dropped for neuroimmune illness. The hallmark symptom is post-exertional neuroimmune exhaustion (PENE). Fukuda (USA) and Oxford (UK psychiatrists’ criteria) do not require this hallmark symptom, hence people get diagnosed with ME when their chief symptom is being tired all the time, which has little bearing on PENE. ie. they have chronic fatigue, disabling as it is, it is not ME.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/abstract

Kim Ayres said...

Nasim - thank you for taking the time to write detailed and referenced points about the confusion surrounding the definitions and diagnoses.

I don't know what tests you've been given - I get the impression you've had considerably more than me. Certainly here in rural SW Scotland, I've never been offered anything that would be able to make a distinction between whether I had CFS or ME (by whatever definition anyone would choose).

I was given no tests beyond the standard blood tests and general physical examination. I had to push to even get a sleep study done. I was told about GET and CBT, although I had to push for the CBT too.

All I've ever been able to say is I was struck down by a mystery illness with debilitating symptoms that never went away. The doctors gave me a label for it which changed nothing as I was told there was no cure, because no one knew what it was.

At least I never had to fight to be believed.

Only in the past 6 months have I come to realise there are at least 4 different camps of strong opinions - those who think there is nothing wrong with either of us; those who think there is only something wrong with one of us; those who think we are both suffering from the same thing; and those who think we are both suffering from something different.

I have no vested interest in prefering one label over another. These blog posts are purely about trying to give an insight into why MT has made a difference to my unknown condition where other things I was offered by the medical profession have not.

I do, however, completely understand and sympathise with your desire to make a clear distinction, and appreciate the links you've placed in this and other posts for those who wish to pursue it further :)

Pat said...

NMJ: I respect what you say and am glad that Professor Behan has been so helpful to you.
It just seemed to me to be an old-fashioned response to write things off as 'nonsense'.
I didn't mean to be flippant or glib.
Please accept my sincere apologies

Aziza Jansen said...

As Nasim pointed out there is much confusion about what ME really is and what criteria are used. For the sake of clarity I would be very much interested whether you think you would fit the CCC or ICC (http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/pdf).

nmj said...

Hey Kim, After it was established I had Coxsackie, I had muscle biopsies, EMG, and much blood taken for his diagnosis. I had already had every test under the sun before being referred, chest xrays, kidney xrays, barium enemas, I had so many symptoms etc; I think what has upset me about this thread is there is no real sense of the utter catastrophe of the illness ME. You say, Kim, you went to your GP because your wife suggested it, I know men are reluctant to visit medics, but with ME it is not sth you would put off, or that you *could* put it off, your life stops, the symptoms are so overwhelming.

Thank you, Pat, for your comment. Appreciated.

word ver: defying

That made me smile.

Kim Ayres said...

Aziza - I took a quick look at your link, but I quickly realised my eyes were about to start glazing over and the brain fog was about to descend, so I'll take a proper look through it another time.

Nasim - the severity of your condition has been appalling, and even on my worst days I did not have to cope with some of the things you did. I've never had the muscle and joint pains, and I've never had an entire day where I was completely unable to get out of bed (I might have been pretty useless and spent most of the day on the couch after I crawled out, but I'm aware that's not the same thing).

My mystery illness has been severe enough to hugely impact on my life, and that of my loved ones. And no effective treatments have been offered by the medical profession.

The point I wanted to make above was I've not had anything beyond cursory tests, so I have no idea whether what I have is a milder version of what you have, something related, or something entirely different. No effective tests means I have no idea and cannot claim with authority one way or the other.

But these posts were never intended to be about the impact of living with a debilitating condition - if you like, that side of it is a given. Instead they are my interpretations about some of the principles behind MT, which I felt were worth writing because I don't think many people know where to begin with it. You saw the programme on BBC Alba and weren't any the wiser, and I think that's probably true for nearly everyone who watched it. As I've been through the treatment and benefitted from it, I felt it was a good idea to try and shed a bit of light on the process :)

And I love your word verification :)

nmj said...

Hey Kim, Yes, Alba was disappointing, very little of Mickel Therapy was actually revealed, when it purported to be following two patients through sessions...I wanted to see more of the mechanisms.

And, yes, that is the crux, we cannot truly know if you have a milder version of what I have, or sth completely different and therein lies the absurdity: GPs are handing out diagnoses of 'CFS/ME' because they are not adhering to the same criteria, hell, they don't even know what criteria they are adhering to! (NICE tells them what to do, NICE follows the psychiatrists' 'CFS/ME'). With the result, ME is overdiagnosed and misdiagnosed because it has been lumped together with chronic fatigue disorders.

I will link to one more thing, sorry, I hate tons of links, they glaze my eyes, and I am now guilty, but it tells the story of how UK psychiatrists turned ME into CFS then to 'CFS/ME' when they realised they could not banish ME as they hoped...

http://www.meactionuk.org.uk/ME_CFS_TERMINOLOGY.htm

And not at all diminishing the impact of your own illness, I did pick up on your being 'preoccupied' by the emotions of your illness though, with the paper cut analogy, I think you said it gets you down the sheer relentlessness, and when asked about MT you said you were almost afraid of trying it for fear of it not working, and you spoke of having to cope with the disappointment, and also your fear of previous depression returning - and I just cannot relate those to my experience of ME. When I was at my worst I would have - and did - try anything and everything, disappointment didn't come into it.

I see Aziz has also linked to the CCC and ICC, which I had referred to above, but they are *ultra-important* as they describe ME, the illness I know. I think the conflation has been so harmful, it has simply been absurd. Okay, I will stop now!

I swear the word ver. is 'Slainte', which I'm sure everyone knows is Gaelic for cheers/good health ;)

Kim Ayres said...

Nasim - my preoccupation with the emotional side of things is because it fundamentally effects the experience of pretty much anything, especially illness.

We can endure all sorts of horrors, discomforts and pains, but when the emotions collapse, our ability to cope disappears.

There are people who lose both legs who eventually go on to climb mountains or achieve sporting accolades. There are others who never mentally or emotionally recover from it.

Mental health makes all the difference in the world between surviving and thriving, and being consumed or even taking your own life.

When the deep void of despair overwhelms and will not go away - relentlessly eating your soul with no sense of hope that it will ever end (mistakenly believed or not) - that is hell: true living hell.

People can, and do, endure amazing amounts of shit, but whether we survive or not is down to the state of mind and emotional health.

Depression - the illness, not the temporary state of mind - is a life destroyer. And it is another invisible illness often rarely understood by those without direct experience of it.

So in truth, while the physical condition was always a huge thing to deal with, the emotional consequences of the condition were a greater concern to me. Because it was the emotional state which would make the difference as to whether I survived or not.

Much like I said in the previous comment, the fact ME and CFS are debilitating conditions were taken as a given. The question that then arises, is how do we cope with it?

If mental health issues are something you have never had to deal with, then I am genuinely relieved for you - please believe I mean that from my heart and it is in no way glib or patronising. If you want, I can point you to a couple of posts which give a flavour of what it is like, which might help you understand why the emotions were the bigger concern.

But it's not compulsory :)

Cusp said...

(I've had to break this up into two comments)

I'm so glad that Nasim has been able to clarify matters and provide some useful links to more information about M.E. I wanted to do the same but have been unable to do so because I am so exhausted at the moment, with brain fog and no end of joint and muscle pain.

I can fully appreciate the reasons why you would want to explain MT in greater detail: especially after it has helped you to regain more energy and clarity. However, it would appear that in writing about MT you have highlighted the very problem we were originally debating because the encouraging comments seem to be coming either from people who also would say they have CFS or people who don't have CFS or M.E. and know little about either condition or think that they are one and the same.

By describing the efficacy of the treatment for you as an individual, yet not being able to say for sure what is wrong with you, you may be unwittingly leading other people to think it might help them.

Now,that might be true...if they have an illness which can be overcome through altering thoughts and feelings about everyday situations and/or altering the flight/fight mechanism so that it is only aroused approriately rather than by minor irritations such as toothpaste. However, if those same people do actually have M.E., a neurological condition, then I cannot believe that any amount of rejigging responses to stimuli will affect their health in any major way any more than it would help someone to recover from cancer....and that's the point really: because the whole business of M.E./CFS is such a mess and because there is no definitive test for M.E. as yet, people who have M.E. and those who have a fatigue-disorder are constantly lumped together as if they are one and the same.

Cusp said...

Part two

As you say, Kim, you dont know what you have because you have had no tests. I have only had many, many blood tests and a full and thorough examination and history and diagnosis of M.E. taken by two Specialists (because the opportunity to have diagnosis by someone as distinguished and knowleagable as Behan is so rare) but I do know that my condition over 40 years fits every classic description of M.E. and I am amazed now that you have said '....I've never had the muscle and joint pains, and I've never had an entire day where I was completely unable to get out of bed..' when the likes of Nasim and myself have spents months in bed and in my case unable to see or hear properly, speak more than a few words, literally crawling to a bathroom or commode...or our mutual friend who is still bedridden after more than 15 years. She was more or less forced to follow the Lightning Process (which in many ways is not at all unlike MT) by an NHS Specialist ( a 'research' project)and her condition regressed so badly that she went from being able to walk a few steps each day to being completely incapacitated and remains so, some three years later.

THAT is why it is so important for people to know what they have and for all of us to keep hammering away at the GMC for clarification and a proper use of terms in diagnosis. MT is the sort of treatment which is highly likely to either disappoint or damage someone who has proper M.E.. Neither outcome would be helpful. For someone with another condition, such as a fatigue disorder or depression, MT might be very useful and change their life...and that's brilliant for those people and I wish them (and you) well but there are too many of us who DO have a different illness that will not respond to things like MT or Lightning or Reverse Therapy or Gupta and many of those same people have had years and years of being told they are depressed, anxious, hypochondriac, lazy, can get better if they could only sort THEMSELVES out and they have often spent years trying everything under the sun to get better. So for those people it has not been the case that they didnt get any better because they were just 'getting the same thing because they kept doing the same thing'.

I myself have tried whatever the GP has suggested plus every alternative treatment you can imagine (and pay for) ! Nothing has made any difference.

The only thing that will make a difference to the likes of Nasim and myself is (a) recognition that we have a distinct biomedical, neurological condition (b) proper biomedical research into that specific conditon which would hopefully lead to (c) appropriate and distinct treatment and drugs for our specific condition.

Whilst M.E. and CFS are confused and used interchangably, no one will take PWME seriously and there will be no proper research or relief for a condition which at the least destroys lives in terms of hope, ambition, joy and at its worst destroys lives literally as in the case of Sophia Mirza
http://www.sophiaandme.org.uk/

or Lynn Gilderdale

http://www.guardian.co.uk/society/2010/jan/25/lynn-gilderdale-me-assisted-suicide

Kim Ayres said...

Cusp - whether you have a more severe version of what I have, or something different, one thing I am pretty sure of is MT is not something that will make anyone worse.

We can debate about who it might help; about whether the plasticity of the brain can be reshaped without using drugs; about what the definition of "unknown" and "definitive tests" are.

But part of the process of MT is to find ways to become more aware of your body and emotions and how mistaken concepts of what aspects of who we are can make problems worse.

Even if MT does nothing to alleviate the symptoms of ME, it will not do harm, in the way that learning to meditate, or control your breathing, or learning how to appreciate a buterfly in a meadow will not do you harm. It's a system which deals with greater levels of self understanding. I don't know anything about Lightning Therapy, but it doesn't sound like the same thing.

I understand you believe we have different conditions, and I'm not setting out to convince you otherwise. I'm not even trying to convince you that MT would work for you.

What I am trying to do is write about why I think it's worked for me and others.

Just as you have had to challenge people's misunderstandings about what ME is, so I am trying to challenge misunderstandings about MT

nmj said...

Hey Kim, I was involved for many years with someone who experienced crippling depression so I am aware of how destructive it can be, and his own illness further served to illustrate that ME exhaustion is v different from the fatigue/lethargy found in depression, so in a way that has been useful (not that I would wish him to have gone through it!). I guess I am personally known as a 'coper', someone who is psychologically strong, but I have had - and do have - dark moments (secondary to having longterm ME) and I can be prone to anxiety, pre-ME, my consultant anaesthetist (alcoholic) father took his own life when I was eight, which would make me a wet dream for psychiatrists (esp. Wessely), they would happily ignore that aged 18/19 I had a catastrophic abnormal immune reaction to an enterovirus and make up their own truth about me. Prof Behan was - thank the lord - wise enough to see beyond that sort of Wesselyian jiggery pokery. Science told him otherwise. (There was a cluster of Coxsackie B4 infection in west of Scotland in 80s, people did not recover and went on to develop ME.)

So, yes, I have a sense of how *awful* mental/emotional illness can be but it is NOT the primary challenge faced by an ME sufferer, and that is all we are trying to say! They are not the same thing and the conflation of neuroimmune and biopsychosocial is harmful and misleading. But I am sounding like a stuck record now, so I really will stop. I am truly boring myself :)

Cusp said...

I understand that you are not trying to convince me that we have the same conditon. I also understand that you're not trying to 'sell' MT to me or anyone else. I understand that you simply want to share a positive experience and I'm really not trying to take anything away from the fact that you feel better for trying MT or being happy for you.

I'm not sure that trying MT will do no harm if it is used by people who are physically too unwell to try it because even if it does no harm in terms of energy/ worsening symptoms, it would surely do harm to someone who would genuinely believe and hope it might improve things if it didnt or couldnt: the damning of hope is a dreadful thing.

As I said, the point is MT has helped some people and not others (just as Lightning Process has helped some and not others) but we can't be sure about WHO it has helped until we can know more about the condition suffered by people who had success (or failure) so whilst people go on using M.E./CFS, CFS and M.E. in eth same breath there will be confusion, hurt and sometimes damage.

The other crux of the matter for me is what you have said about mental and emtional well-being:

'..while the physical condition was always a huge thing to deal with, the emotional consequences of the condition were a greater concern to me. Because it was the emotional state which would make the difference as to whether I survived or not...'

For many people with M.E. it is not the emotional side which determines their survival but the physical. There are PWME who have, somehow, managed to maintain some sort of positive emotional and mental well being and yet their physical health has still deteriorated...so it hasnt been about how they have coped emotionally with physical deterioration, it has been about how their body has coped with physical deterioration and sometimes it has not coped and they have died. Moreover, sometimes those same people's descriptions of their physical illness have been so disbelieved that they have been seen as mentally unwell and sectioned, kept in locked psych wards and abused mentally and physically, denied proper treatment and in some cases died. So whilst a fatigue condition and depression and a neurological illness are being lumped together *none* of the people in those groups are being treated with the respect and belief they deserve.

This comment and my other comments are not an attack. They are attemtps and pleas for clarification of what it means to be given a particular diagnosis: CFS or M.E. or M.E./CFS.

This debate about whether people with symptoms of M.E. are physically ill or 'hysterics' (as it was muted at the time)has been raging since 1955 (a year before I was born) with the Royal Free outbreak as mentioned in the Alba prog. It has gone on long enough and, having been misinformed, misdiagnosed and disbelieved, ridiculed and humiliated since 1972 I have had enough. Do you wonder that I am frustrated and annoyed (not with you)?

There needs to be clarity.

As someone on the MEA thread said ' a rose is not a rose by any other name; a rose is a rose is a rose'.

Kim Ayres said...

http://xkcd.com/386/

Cusp said...

;)

nmj said...

I love that cartoon, I saw it recently and it made me guffaw.

Guyana-Gyal said...

I waited until I could read this thoroughly, instead of rushing. It was well worth the wait.

I'm off to read part 2.

nmj said...

This is good news: http://www.meassociation.org.uk/?p=10372