The Sickening Mind: Brain, Behaviour, Immunity and Disease. Paul Martin

of smokers have, however, confirmed the truth of several common assumptions.

      It is indeed true that people who are depressed or stressed are more likely to smoke (and, consequently, more likely to die from lung cancer). Smokers really do experience a stronger desire to smoke at times of heightened anxiety. To add to their problems, psychological stress is associated with a higher failure rate among smokers trying to kick the habit. One long-term study of smokers found that individuals who had been depressed as much as nine years earlier were 40 per cent less likely to be successful in their attempts to give up smoking.

      It gets worse. The psychological and emotional factors that make people inclined to smoke induce them to do other unhealthy things as well. Research has shown that moderate-to-heavy smokers are, on average, significantly less conscious of health-related issues, hold less favourable attitudes towards healthy behaviour and have a generally less healthy lifestyle in comparison with non-smokers or light smokers. (Conversely, wholesome behaviour patterns also come in clusters; researchers at Harvard University Medical School found that individuals who drank only decaffeinated coffee also tended to eat lots of vegetables, take regular exercise and wear their seatbelts.)

      As well as prompting people to smoke, stress is also linked to increased alcohol consumption – at least, in certain types of individual. The health implications of excessive drinking can be profound. Approximately 20 per cent of all male in-patients in British hospitals have alcohol-related problems. Alcohol can rot people’s livers and kill them in drunken accidents (though alcohol is not the only recreational drug capable of damaging health: there is reasonably good evidence, for example, that marijuana impairs the immune system, with potentially adverse consequences for the health of long-term users.)

      The perils of the grape are amusingly described in Othello. The scheming Iago lures the unwitting Cassio into getting steamingly drunk, as a result of which Cassio lands himself in serious trouble and loses his job. On sobering up, Cassio bemoans the loss of his reputation and curses the demon drink:

      ‘Drunk! And speak parrot! And squabble! Swagger! Swear! And discourse fustian with one’s own shadow! O thou invisible spirit of wine, if thou hast no name to be known by, let us call thee devil! … O God, that men should put an enemy in their mouths to steal away their brains! That we should with joy, pleasance, revel and applause, transform ourselves into beasts!’

      Literature is amply stocked with characters who drink themselves into an early grave in reaction to emotional crisis or unhappiness. There are roistering drunks who drink to escape boredom or poverty, like J. P. Donleavy’s Ginger Man, Sebastian Dangerfield. There are determined drunks who drink to escape from grief. In Wuthering Heights, the unfortunate Hindley Earnshaw becomes a hopeless alcoholic after the death of his wife (from consumption, naturally) and drinks himself into the grave by the age of twenty-seven. And there are aimless drunks who drink to forget their own pointlessness. In F. Scott Fitzgerald’s The Beautiful and Damned, for example, we have Anthony Patch, an independently wealthy and well-educated young man blighted by indolence, boredom and melancholy. A turbulent marriage and self-imposed idleness push him into self-destructive alcoholism and he degenerates into ‘Anthony the poor in spirit, the weak and broken man with bloodshot eyes’.

      Incidentally, when it comes to self-destruction by alcohol the track record of doctors is almost unrivalled. As a profession, they rank second only to pub-owners and bar staff in the league table of deaths from alcohol-related liver disease. Doctors are 3.4 times more likely than the average worker to die from cirrhosis of the liver. According to one 1995 estimate, as many as one in twelve British doctors is addicted to alcohol, drugs or both, thanks mainly to the enormous stress the majority of them are constantly under. (But I should not be too smug about this statistic because ‘literary and artistic workers’ also fare badly, with twice the average death rate from cirrhosis.)

      On the other hand, moderate alcohol consumption can be an effective buffer against stress – and here again science has only of late managed to verify thousands of years’ worth of everyday experience. Psychological studies have confirmed what countless millions of people have discovered for themselves, namely that when we are under stress we often feel less anxious if we drink alcohol. (A moderate intake of alcohol also appears to reduce the risk of coronary heart disease, but that is another story.) Sir Winston Churchill’s opinion was clear: ‘I have taken more out of alcohol than alcohol has taken out of me.’

      There is nothing surprising about the fact that alcohol has its good side. It has, after all, been an intimate part of human life since the dawn of civilization. Alcohol was in use for medicinal purposes (in the literal rather than euphemistic sense) over four thousand years ago and was probably quaffed for recreational purposes long before that.

      Opinions differ as to when exactly humans first discovered the joys of booze, but there is evidence that wine was being drunk in Transcaucasia eight thousand years ago – long before the wheel was invented. Some authorities have argued that Stone Age man was cultivating vines as early as ten thousand years ago. Wine growing was well established in the Middle East by 4000 BC and was an integral part of daily life in ancient Egypt and Mesopotamia. It says something that wine is mentioned 150 times in the Old Testament.

      Then there are the social benefits of communal drinking to add to the purely pharmacological pleasures of alcohol. Samuel Johnson spoke for many when he declared that: ‘There is nothing which has yet been contrived by man, by which so much happiness is produced as by a good tavern or inn.’

      Yet the things that give us pleasure carry risks, and we are very poor at assessing those risks. While we consistently overestimate the dangers posed by rare or exotic threats like plane crashes, murders, nuclear accidents or shark attacks, we tend to disregard the risks of common killers like heart disease and vehicle accidents. We are especially prone to underestimating the risks arising from our own behaviour, such as smoking, travelling in cars, abusing alcohol or having unprotected sex.

      Smokers now acknowledge the unappetizing fact that their behaviour significantly increases their risk of dying prematurely from heart disease or cancer. Nevertheless, psychological research has established that they seriously underestimate the magnitude of that risk. There is a consistent ‘optimistic distortion’ of perceived health risks among smokers; they know smoking is bad for them but they do not recognize just how bad. No matter how often the statistics are quoted they do not seem to sink in. One reason why the health consequences of smoking have such a muted impact on people’s perceptions is the large delay, often measured in decades, between starting to smoke and falling ill.

      If you should happen to be an overweight, tobacco-addicted, boozing, couch potato who loves fried food, you can take a few crumbs of comfort from the fact that others’ attempts at healthy living can backfire. Dieting, for example, almost invariably fails to bring about the desired result of sustained weight loss. The sense of personal failure that comes as the scales lurch upwards again can produce a damaging drop in self-esteem and a sense of losing control; the frustrated dieter’s response may be to abandon the diet and thus swing back to even greater porkiness. Mother Nature also conspires against the earnest dieter. People whose body weight oscillates because of dieting have a greater risk of premature death from coronary heart disease or other causes. Unsuccessful dieting can be bad for your health – and most dieting is ultimately unsuccessful.

      What of behavioural self-destruction in literature? Fiction is littered with protagonists who recklessly expose themselves to danger, neglect their health or run themselves into an early grave because of great unhappiness or emotional turmoil.

      An early case history of self-destruction appears in Le Morte d’Arthur, Sir Thomas Malory’s fifteenth-century version of the legends of King Arthur and the knights of the Round Table. It is the sad tale of the Fair Maiden of Astolat and her doomed love for Sir Launcelot.

      The brave, noble, irresistibly attractive Sir Launcelot rides to Astolat en route to a joust, and stays the night there at the home of the elderly baron, Sir Bernard of Astolat. Sir Bernard has a beautiful and virginal young daughter, the Fair Maiden of Astolat, who is at once smitten by Sir Launcelot. She is, as Malory so engagingly puts it, ‘hot’ in her love for the noble knight: ‘for he is the man