MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

knighthood

A new condition, the Knighthood Starvation Syndrome (KSS), might soon be included in our systems of disease classification. Sporadic cases have been noted as far back as the 1950s, but recent decades have seen an alarming proliferation of incidents. The epidemiology of the KSS is most peculiar: it is endemic in the British Isles, particularly in large centres and seems to affect almost exclusively alpha males in their 60ies who have climbed up to dizzy heights on the career ladder and who think of themselves very highly.

The KSS tends to remain unrecognised for many years; early signs of dormant KSS include name dropping, pomposity, and a general alignment with the views of the establishment. Later stages are characterised by a sudden and often surprising change of opinion on several professional matters, an abnormal need for political correctness, an insatiable hunger for favourable mentions in the national press, a phobia related to rocking boats or blowing whistles, an urge to get involved in charitable work and/or high-profile committees of any type, and an increasing ruthlessness in pursuing ones personal goals under the guise of a professional purpose. Some of the features of the KSS are reminiscent of a classical degenerative disease, say experts who have studied the syndrome in much detail.

Opinions are divided as to the root causes of the KSS. Some psychiatrists claim it is due to early childhood mal-adaptation or bad potty-training, while sexologist are convinced that it caused by a chronically unfulfilled sex-life, and psychologists tend to believe it is a delayed mid-life crisis that was not allowed to blossom in a timely fashion. Endocrinologists have identifies various abnormalities regarding the levels of stress and sex hormones, nutritionists are discussing a lack of vitamin D in combination with an excess of red meat and fast food, and ENT surgeons speculate that it is caused by the absence of tonsillectomy during adolescence.

Unsurprisingly, alternative practitioners have developed their own theories most of which are, however, frowned upon by mainstream medics. Chiropractors view the KSS as the result of subluxation at the atlas level and advocate spinal adjustments followed by life-long maintenance therapy. TCM-practitioners are suggesting that a blocked kidney-chi has led to a pathological dominance of yin-energy, a minor aberration which could easily be corrected by acupuncture along the appropriate meridian. Bach Flower enthusiasts speak of vibrations being out of tune and recommend an intensive cure with Rescue Remedy. And finally, homeopaths see the KSS as the final poof of their theory of miasma where the bad air of the executive floor and caused serious damage which can only be neutralised by an in-depth homeopathic history and prolonged, individualised treatment.

Despite these and other attempts of altering the natural history of the syndrome, it tends to progress gradually in predisposed individuals, and symptoms are likely to worsen significantly over time, often to the point that the poor victim becomes a public menace. So far, the only known, evidence-based remedy is rather heroic and sadly not often available: the award of a knighthood. This intervention usually leads to a swift and uneventful recovery. In some tragic cases, however, the KSS subsequently degenerates into the HoLS-Syndrome, the even more vicious House of Lords Starvation Syndrome.

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