For an instant it was exactly as it would happen in a film. The traffic that was thundering in my ears a few seconds ago was suddenly muffled as if it were miles away. My body felt cool and detached and everything appeared in ultra slow motion. The fraction of a second it took between jumping and hitting the deep water seemed stretched out like a long lazy summer afternoon. Looking back it was a stupid thing for a supposedly responsible doctor to be doing. I feel a bit guilty about admitting to it in a respected medical journal. I really should have known better. I'd just got carried away by the holiday atmosphere and joined a few other tourists copying some of the locals we'd just seen throwing themselves off a road bridge crossing a deep lake in the sunny south of France. It was risky but exhilarating and the experience has burned powerfully into my memory. It did make me wonder about how we seem to be good at criticising risky habits and behaviours without taking into account the more complex human impulses and experiences that trigger them.
I recently read a report from a meeting of the American Association for the Advancement of Science suggesting that playing video games regularly can improve the eyesight of patients with cataracts.1 It was refreshing to find something fundamentally enjoyable in itself being encouraged for being beneficial as well. Reading something positive like this, it struck me how often the medical profession tends to criticise the enjoyment of things such as violent video games. At times I think we are in danger of coming across as nagging new puritans. Be careful what you drink, what you eat, that you don't get too much sun, be careful about the dangers of sex …
We're regularly criticised for not giving patients enough cautionary information, but I think that people are aware of the dangers of their behaviour more often than we think. They still choose to do them because they are more driven by enjoyment, excitement, and immediate pleasure. Too much information can be counterproductive and cause common-sense fatigue that weakens its own case.
And, as for the example with the video games, enjoyment in itself can be good for you. The dangers of too much sun have been well publicised. After my leap in to the cool lake, basking in the warm afternoon sun gave me a profound sense of wellbeing that I'm sure was beneficial. Concerns about the dangers of too much sun have also been tempered by more recent reports of generalised low vitamin D levels in many communities. Not so long ago I remember GPs being regularly criticised for not doing enough to prevent teenage pregnancies. We weren't accessible enough and didn't give teenage girls enough information about contraception. But a recent radio programme, ‘The Teenage Pregnancy Myth’, suggested that social scientists now view the situation as more complex.2 There is evidence that teenage pregnancy can be a positive choice that can lead to a sense of purpose and fulfilment for many of the mothers which leads to happy, healthy lives. It turns out that it's much more than a simple lack of factual knowledge.
Before I get reported to the GMC, I'm not suggesting an ‘anything goes’ approach. But I think we should be more willing to accept that enjoyment is important. If we spend too much time tut-tutting at certain behaviours and forgetting the deeper forces that drive them, important messages will be lost and people are less likely to listen to us in the future. The balance between risks and immediate enjoyment and pleasure is complex, but if we ignore it, people will ignore our advice.
- © British Journal of General Practice 2012