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No actors, only mechanisms

March 1, 2026 by bobleckridge

In Jenny Odell’s “Saving Time” she criticises the term “Anthropocene” and writes – 

“A history with no actors, only mechanisms”

That phrase stopped me in my tracks. Isn’t this also a perspective we could take on contemporary Health Care – a system “with no actors, only mechanisms.”?

“Agenda for Change”, a management led sweeping reform of job descriptions and contracts was applied to all but medical staff in the Scottish NHS. It involved breaking the daily work of employees (mainly nurses and admin staff) into tasks with the defined knowledge and skills required to carry them out. Once written into the job descriptions and contracts the human beings actually performing the tasks became invisible. Only the knowledge and skills to do the tasks are important. The tasks take first place, who carries them out becomes irrelevant. The process resulted in many staff finding their posts had been downgraded, and, later, that less highly trained, less well paid staff, trained to do specific tasks, were employed to take over much of the work. The concept of the nursing professional, trained and experienced to conduct her or himself with much day to day autonomy in clinical decision making, was eroded. The posts became interchangeable, more minutely monitored, measured and controlled. The “mechanism” became more important than the “actors”. 

“Lean Management” techniques, developed in factories and offices, where daily work is broken down into processes and events each of which can be measured and controlled in the interest of “efficiency” were rolled out, with no interest whatsoever in either individual patients or the doctor-patient relationships. It didn’t matter who cared for a particular patient, as long as they carried out the necessary tasks with the prerequisite knowledge and skills. The efficiency of the Service is now measured in terms of numbers – numbers of patients treated each year, numbers of “clinical events” carried out by each member of staff, daily, numbers of various tasks “completed”. In the ward where I worked, where there had never been a case of “hospital acquired infection” or a patient who developed “bed sores”, the nurses had to report the zero number of cases of each of these problems every month to their managers, and to create and display a graph showing the zero number, a straight line, running through a number of months. Concepts like “continuity of care” have been eroded. When my dad was admitted to hospital in the terminal phase of his cancer, I found myself thinking, “Why is it that every single doctor, and every single nurse, I ask about his condition, replies that he is not their patient but they will consult his records and get back to me?” And while visiting another relative in a different hospital I overheard one member of staff ask another if they’d “taken the blood from bed 14, yet?” Good luck getting blood out of a bed, I thought. To be fair, this substitution of patients’ names by their bed numbers was a practice which I’d encountered way back in the 1970s as a medical student where we’d be sent to “listen to the heart murmur” or “feel the enlarged liver” in Ward 3…..”no actors, only mechanisms”.

It’s also a long established fact that a disease centred approach is used both in medical education and in clinical practice. Hospitals and clinics are organised along disease centred lines, with departments of specialisms from Cardiology to Dermatology, Renal Medicine, Endocrinology etc. The disease and the systems of treatment structure the entire institution, irrespective of individuals with multiple comorbidities. As the numbers of people living with three or more chronic diseases rises, more and more people experience their care divided between several different hospital departments, each with their own appointment systems, processes and ever changing staff. General Practice used to be the counter to all this, with both training and practice founded on patient centred, holistic principles, but the same principles applied in hospitals have infiltrated General Practice, with the development of disease-centred clinics within each Practice, and an increasing number of doctors working on limited term salaried contracts, or as locums. None of my relatives can tell me the name of “their GP” any more. Instead, they are encouraged to seek telephone assistance from NHS call centres staffed by people they will never know, and directed to see certain doctors, “specialist nurses” or “assistants” depending on their disease and circumstances. People who they don’t know, and may never encounter every again…..”no actors, only mechanisms”.

An additional systems first approach has become the dominant philosophy in health care – “Evidence Based Medicine” (EBM), based on the statistical analyses of experimental trials. Randomised Control Trials, the “gold standard” of EBM are designed to make the human participants irrelevant. The actual humans involved – the experimental subjects and the prescribers – are “controlled for” – they aren’t named. They don’t exist as anything other than collections of data points. This is the foundation of EBM where treatments “just work or don’t work” irrespective of the nuances and differences between human beings, whether patients or prescribers. It’s a system without actors where individual experiences are disregarded as “anecdotes” of “no scientific value”. Students are taught “patients lie all the time, you can only trust data”, and “if a patient tells you they aren’t any better after taking and evidence based treatment they either haven’t taken it or they are lying” and “if a patient says they are better after taking a medicine which is not evidence based they are either lying or deluded”, or their experience is dismissed as “the placebo effect”. (I’ve heard all these exact statements from young doctors in training). I once heard, on BBC Radio 4, a Public Health doctor dismissing the request for continuing treatment at Royal London Homeopathic Hospital, from a patient with psoriasis who said he’d tried everything dermatologists offered but the only treatment which had really helped his psoriasis was homeopathy. The Public Health doctor said that was impossible because he’d read all the clinical trials and homeopathy did not work. Somehow, his literature review was better able to assess the daily experience of this man’s skin, that the man himself.

Health care with no actors, only mechanisms. 

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Love, love, love

February 14, 2026 by bobleckridge

“Love is what and who we dedicate our time to”

Katy Hessel. How to Live an Artful Life

“Attention without feeling, I began to learn, is only a report. An openness — an empathy — was necessary if the attention was to matter.”

Mary Oliver

Another February, another moment to think about the importance of love. I don’t just mean romantic love, although that’s what we celebrate on the 14th, Valentine’s Day, named after Saint Valentine. I mean love as a way of life. The motherly love, almost all of us experience, which is characterised by unconditional care and attention. The brotherly love, which is the basis of any good society, loving not only your family, but also your neighbours, other people’s neighbours, human beings wherever they live, treating them with respect, care and attention. The love of Life, which underpins our attitude to the world, to all of Nature, ourselves included, to all forms of Life, without which none of this would exist, open to wonder, to the desire to know, to understand, to form strong caring bonds with all that is “not me”. Self love, based on self belief, taking time and making an effort to look after ourselves, to care for this astonishing, complex phenomenon of a body, of an embodied being. 

I can’t define love. I can’t even fully describe it. I can’t lay out its form, its nature or its character. But I know it. And you know it. Because love is an experience. It’s something we do, something we feel, something we live. It’s an attitude towards the world. It’s a way of paying attention. It requires, as Mary Oliver says, openness and empathy. 

We experience love with our hearts. Think of phrases like “heart to heart”, “heart felt”, “heart broken”. I remember Saint Exupery’s “It is only with the heart that one can see rightly; what is essential is invisible to the eye.” and “The most beautiful things in the world cannot be seen or touched, they are felt with the heart.”

What we pay attention to grows. What we pay loving attention to grows love. The way we live spreads the way we live. I guess that’s where the idea of karma comes from. Those ripples and waves we cause change the ocean in which we swim. If we live loving, then love spreads. If we live hating, then hatred spreads.

Nobody can make you love. You have to choose to love, pay attention to love, put your energy into love. 

I like this affirmation – “I choose to live a life of love, so that I, so that others, so that Life on this planet, can thrive.”

The old songs remains true, “What the world needs now is love, sweet love”, and “All we need is love” (well, maybe not “all” but it sure helps!) 

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Life after death

February 4, 2026 by bobleckridge

“There are such things as ghosts. People everywhere have always known that. And we believe in them every bit as much as Homer did. Only now, we call them by different names. Memory. The unconscious.” The Secret History. Donna Tartt. 

Throughout my career in Medicine my everyday was spent in one to one consultations with individual patients. My focus was always the person present before me. So you might think I’d be a firm believer in the physical world, and, indeed, I am. 

I found that patients who were suffering were often separated from the here and now, and that, one way to help them find relief was to bring their attention back to the present, teach them to notice and wonder about the everyday. 

I described myself as a wholistic practitioner because I understood each person as a whole being, not divisible into separate realms of mind and body, and certainly not reducible to the body alone. 

But is there more than this? 

When a person dies, is that it? Last chapter written. Book finished. Gone. 

That’s not my experience. Here’s why. 

A human being, a person, is not contained fully within the skin and bones of a body. We exist in relationship. We come to be within relationship. Relationship to others, certainly, but also relationship to the world in which we live. Our senses are activated by the signals they receive from the environment (and, yes, they are also activated by our own minds and bodies). Our world view is created by our experiences and events. We are beings constantly changing, constantly becoming. We are creative beings, always in the process of receiving, giving, expressing, making the everyday unique. 

I read someone recently saying that when they lost their parent, they suffered two losses….the loss of their loved one, and the loss of that part of themselves which only existed in relationship with that loved one. I think that’s an incredibly important insight. 

We are multi-faceted creatures, with a Self which is best understood as a “community of selves”. We experience, and others experience, a different self at work, from at home, a different self with a close friend, with a lover, with a competitor. 

It’s helpful to understand that we are the totality of the multiple relationships in our lives….past, present and future. Yet, where are these selves? Despite advances in neuroscience and imaging techniques we still cannot pinpoint these different aspects of the Self. We know some of the key brain areas involved. But we’ve also discovered that complexes of nerve networks, and chemical messaging pathways in the gut, around the gut, around the heart, and, indeed, throughout our physical body, are also involved. 

Within psychology, neuroscience, and the developing disciplines of psychoneuroimmunology and psychoneuroendocrinology, we have learned that our emotions and our cognition is “embodied”. In other words, they are not confined to our brains. Others have shown that we are good at outsourcing some of our cognition to the extent that we should think of our psyches as not simply “embodied”, but also, “extended”…..extended into the environment and into others. I suppose that’s become all the more obvious with our new technologies. Our phones have taken over vital parts of our memory functions, vital parts of our cognition. We use technology to create what is popularly called a “second brain”. 

But, even though we now understand that no human being lives in complete isolation, even though we now understand that we are not fixed beings captured within physical bodies, isn’t there even more to be understood? 

I think there is. And there’s a clue in that quote from “The Secret History”. We humans have always believed in ghosts, but, nowadays we call them by different names – memory, the unconscious. 

I think we see this best when we consider great artists and musicians. We can recognise a Van Gogh, even if we haven’t seen a particular painting before. We can identify Frank Sinatra even if he’s singing a song we’ve never heard before. We can spot a Mary Oliver poem, a Shakespeare play, a Hemingway novel. Can’t we? Because that’s the thing about the great creators. They were great at expressing their uniqueness. And when that uniqueness resonates with so many people, it can ripple down through not just years, but centuries. 

Even within a single family, there are characters whose uniqueness made such an impact that their “presence” is still felt, and known, generations later. 

There is something about the person which exists and persists outside of, and beyond the body, beyond the mind-body, beyond the brief period of history marked by two dates, a date of birth, and a date of death. 

It’s partly memories, but it’s also partly unconscious patterns of behaviour, patterns of speech or thought, sayings, expressions, the undercurrents of our everyday. It’s the lingering traces of uniqueness. 

You see, we can’t help but change this world, just by being alive. We consume, we metabolise, we send out into the environment molecules, energies, waves, thoughts, ideas and feelings. The world is never the same tomorrow as it is today, and that active, constant process of movement, of adaptation, of growth, of actions and reactions, ripples outwards over much greater distances and timescales than we can be aware of. 

We don’t just stand on the shoulders of giants, we live with them. Don’t you think it might be worthwhile getting to know some of them? We can still reach so many of those unique and amazing people. We can still develop healthy, creative relationships with Bach, with the Beatles, with Van Gogh, Turner, Picasso, with Jane Austen, Keats, T S Eliot, Rodin, Michelangelo and Leonardo, even if they are “long since gone”, because their uniqueness lives on. 

We don’t have to focus solely on the past either, because there is no doubt we are influenced by others every day. We can choose who we want to pay attention to (even if certain massive egos make it hard to ignore them!). We can choose which songs to listen to, which poems to read, which people we want to spend time with. Or we can just be blown along like zombies, driven this way and that, unconsciously, unthinkingly, our days determined by those who seek to influence and control us for their own purposes. 

There are such things as ghosts, and some of them, aren’t even dead yet…..

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Small boats

February 3, 2026 by bobleckridge

The British obsession with “small boats” has always struck me as odd. Not least because the numbers of migrants arriving that way is a tiny fraction of total net immigration. There is no way the people arriving in the UK in these small boats can be responsible for unacceptable NHS waiting lists, inadequate social housing, or poverty and inequality in the country. However, let’s set that aside, because the “Small boats” issue is part of a greater narrative being spread by Right Wing populists in many countries. 

The thing is – we humans migrate. We always have done. We always will. Sometimes it’s just a trickle, other times, it occurs en masse, as it did when early humans moved out of Africa. In fact, we reckon that around 70,000 or 60,000 years ago, modern humans began leaving Africa in large numbers. And they didn’t just stick to the land masses. They set off in small boats. 

A recent article in New Scientist explores the evidence for human migration across seas occuring tens of thousands of years ago. 

https://www.newscientist.com/article/2511681-ancient-humans-were-seafaring-far-earlier-than-we-realised/

Indeed, even the ancestors of we homo sapiens headed off to new lands in small boats. “There is probably growing acceptance that early humans, and perhaps hominins like Neanderthals, were making sea crossings to the Greek islands earlier than 200,000 years ago,”

The New Scientist article arrives at some important conclusions. 

“But seafaring also points to something intangible – prehistoric peoples were cooperative. Building boats takes a long time, so “you would have reduced that labour cost by having multiple people”, he adds. Seafaring is also evidence for something even harder to see across deep time: courage….simpler craft don’t feel so secure. “If you start thinking about getting into a hide-skin boat and travelling long distances… there’s absolutely no way that most people would do that.” Yet many prehistoric people, like those who made their way to Malta at least 8500 years ago, must have jumped into boats and taken that chance, voyaging to new lands that they couldn’t be sure were there, because they lay far beyond the horizon. These were incredible, inspiring leaps of faith – and they took our ancestors all around the globe.”

You know what? We’ve inherited all that. We are still a co-operative species, working together to achieve what we couldn’t do separately. And we still have the courage, the “leaps of faith”, to set out, to explore, to discover, to find better lives…..even in small boats. 

Migration can’t be stopped. You can’t stop Nature. What we can do is develop our abilities to work together….to integrate, to cooperate, to build healthy communities, no matter where the inhabitants set off from. 

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And not or

February 2, 2026 by bobleckridge

Some time ago I wrote a book called “And not or” – the idea of “and not or” came to me as a good way to approach life, and it’s since become something of a family feature. One of my grand-daughters, mentioning to a friend who queried it, said “What is “and not or” not a thing in your family?”

Essentially, I believe that “or” is divisive. It’s about “this OR that”. It divides the world into pieces, looking through binary lens. “And” on the other hand, builds bridges, forges connections. It is the link between apparently polar opposites. “And” reminds us that no particular experience or view is complete. We never know all that could be known. “Or” is more judgemental. “And” is more humble, more open to learning more.

Here’s the text of the opening chapter of my book, “And not Or” ………..

No man is an island entire of itself; every man

Is a piece of the continent, a part of the main;

If a clod be washed away by the sea, Europe

Is the less, as well as if a promontory were, as

Well as any manner of thy friends or of thine

Own were; any man’s death diminishes me,

Because I am involved in mankind.

And therefore never send to know for whom

The bell tolls: it tolls for thee.

John Donne

Ubuntu – « I am because we are » 

None of us are entirely separate, neither from other people, nor from the rest of the natural world in which we live. On the other hand each of us is unique. It seems as if one of the most fundamental paradoxes in human life is a tension between belonging and uniqueness, between connections and separateness. Do we have to choose between these two options? Or is there some way to reconcile them? Many years ago I was wondering how to share my photos with other people. I looked at one option on the internet – a web service called Flickr, dedicated to storing and sharing photos. I also looked at the fairly new idea, at the time, of personal websites, or “blogs”, where I could post photos and write some descriptions of them. I could combine some creative writing with my photos by sharing some of the thoughts inspired by each image as I reflected on them. It didn’t stop there. There was also Facebook, and Twitter, and a kind of mini-blog site called Tumblr. How could I choose? Each of these options offered some features which the others didn’t, and each service seemed to have its own group of users. I knew that if I shared photos on Flickr, certain people would see them, but if I shared them on a blog, on Facebook, Twitter or Tumblr, then different people would see them. As I researched the different options and read reviews, I realised I wasn’t the only one finding it difficult to choose. 

Then I came across a phrase taken from the language of logic and computer programming – « and not or » – and a light bulb went on in my head. I could share my photos on more than one of these services. I didn’t have to choose only one. In fact, I discovered that there were many ways to create connections between the different services. I could write a blog post, linking it to a photo hosted on Flickr, whilst automatically sharing it one or more of the other services just by clicking a button named « publish ». 

None of us can be reduced to only one part of our character or nature. We are all multiple within ourselves. Have you ever done the thought experiment where you plan a party for everybody you know, and everybody you’ve ever known? You’d hire a large hall and invite absolutely every relative, friend, colleague, client, well, just anybody who has, or has ever had, a personal connection to you. Pretty quickly as you think about all the people who would be there, you realise that almost the only thing they would all have in common is their connection to you. Chances are you quickly realise this isn’t enough to create a cohesive group. The people you know from different contexts in your life may well not share that much in common with each other. The people you’ve known from different times in your life might not share much in common with each other either. Yes, of course, there will be common threads, common interests, values, shared histories, but their individual and even group differences will amount to more than their similarities. You can imagine that several of your guests won’t really click with each other. It turns out that whilst each of us has many different aspects to our character, which particular aspect comes to the fore is highly context sensitive. I could slip easily between my roles of husband, father, son, doctor, colleague, teacher or friend, just to name a few of the more prominent ones. I am not stuck in any single role. I should be able to behave appropriately according to the social context. 

And not or. 

This is how we live. We constantly change. We flow back and forwards between different aspects of our selves. We don’t choose one role and then attempt to live a whole life within it. 

But wait, I hear you say, we have to make choices all the time, don’t we? There are many circumstances where have to make a decision, to commit to one direction rather than another. We can’t have our cake and eat it. 

You are right. We often have to choose. In fact, we have created an entire economic system on having to choose. We have even turned choosing into one of our highest virtues. Freedom equals the freedom to choose. Choosing is based on the word « or ». You can choose this political party in the election, or that one. You can apply for this job, or different one. You can spend your money on this, or that. It is the basis of competition and a free market economy. Competition is the basis of both capitalism and our modern interpretation of Darwin’s principle of selection. Different options are set against each other. One wins, the other loses. This is just how things are. 

When I say « and not or », I’m not advocating the famous « have your cake and eat it ». Nor am I advocating indecision or indifference. The way of « or » is inextricably bound to the way of « and », just as our need to be unique and separate is bound to our need to belong and to connect. Choosing « and » neither restricts us, nor does it stop us from making decisions.

I’ve come to believe that « or » has become too dominant in our culture and in our everyday lives. I’m anxious that it is separating us from each other, setting us in opposition to each other. We seem to be living through a time when polarities and mutually exclusive identities are proliferating, and on the back of that we are witnessing more strife, more anger, and more division. We hear the rhetoric of « us not them », which stokes prejudice, hatred and suspicion. We have created a civilisation of oppositional camps, each creating their own little worlds, each speaking only to like-minded others in shared echo chambers. We talk of « winners and losers » where the winners take all and the losers are advised to « suck it up » and « move on ». There are more walls going up, more doors being closed, less bridges being built, and less agreements made. Competition and winning are seen as strong and desirable, whilst co-operation and consensus are portrayed as weak. 

I want to contribute towards a redressing of the balance. I know we have to make decisions. I know we often have to choose. But when we invest too much in « or » then things start to fall apart. « Or » divides, separates, alienates and creates dis-ease. 

It’s my contention that we need more « and » because «and» connects, creates healthy bonds, encourages sharing, and a sense of belonging. We need «and» in order to heal. 

« Or » stops thought. We choose, we separate, we finish. Why would I be interested in anything else when I’ve already made my choice? 

« And », on the other hand, pushes us towards novelty and connections. It stokes our curiosity, demands our humility, sustains our open-ness to others and to change. It can teach us how to handle uncertainty and unpredictability. It can develop our capacities for awareness, reflection, flexibility and adaptation. 

Every living organism survives and grows by making connections, by being open the flows of materials, energies and information in which we all exist. Every living organism survives and grows by responding to, and adapting to, the ever changing environments and contexts in which we all exist. 

Maybe the best way for me to explore and share this idea is to tell something of the story of my life. Maybe the best thing I can do is to share some of my experiences and to reflect on how those experiences shaped me, and shaped my life. 

This is my story. These are some of my stories. I’m writing this to help me make sense of my life. Maybe reading my story will help you make more sense of yours, too, and I’d be delighted if that were the case, but, ultimately, you will have your own stories to tell. We all do. 

You can find a Kindle version of the book here – https://amzn.eu/d/akoOnrz (or search Amazon in your own country)

A paperback version, with colour photos, is available on Blurb – https://www.blurb.co.uk/b/10155078

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Two stories of immigration

February 1, 2026 by bobleckridge

Two stories about immigration caught my eye this week. 

Firstly, here in France, applications for full citizenship are down in 2025 following a tightening of the guidelines issued to the Prefectures. Not only have they increased the required level of French language skill from B1 to B2, but the evidence required to demonstrate “integration” has been increased from verbal claims to written attestations about volunteering, membership of associations and attendance at memorial events. Perhaps, most significantly, for retirees, there is now a requirement that the majority of a person’s income must be sourced in France, so if you are retiring from another country with a pension, that no longer counts as “economic integration”. Well, that’s the end of the road for me! In addition, Justice Minister, Gerard Darmanin. has proposed a two or three year “pause” on ALL legal migration. The overall message here is that the current French authorities see immigration as a bad thing, and despite the fact that almost 10% of the population is of foreign origin, they have no plans to facilitate integration of those 6 million people into society. 

The second article which caught my attention is really the polar opposite of the first. Spain has proposed that the 500,000 “undocumented” people living in Spain can apply for a one year residency permit which is extendable, legalising the position of half a million foreigners, as part of an over all strategy of integration based on human rights and fairness, which, they believe, will improve both Spanish society and the economy. The Far Right don’t like this, of course, arguing amongst other things, that this will make Spain more attractive to immigrants, and that as their numbers increase, then the pay and conditions of Spanish workers will be put at risk. 

I was never a fan of Theresa May’s ‘Hostile Environment” policy. It strikes me as bizarre to think the best way to stop people wanting to come and live in your country is to make living in your country more miserable for them. If the aim of a government is to make their country safer and better for the whole population, it’s counterintuitive to try and make life more precarious and worse for SOME of them. 

The economic argument is not as simple as the Right Wing populists argue either. The Spanish government argues that active integration of immigrants into the agriculture and care sectors, amongst others, for example, will plug the existing employment gaps in those areas. But, in addition to that, what about the immigrants who set up businesses and employ those currently unemployed? And what about those with skills who can then teach and train others, enabling many more people in Spain to get better jobs with better skills?

Perhaps the worst stories about immigration currently are those flowing from the USA which seems to have determined that getting rid of as many black or brown immigrants as possible will be an over all benefit. Deploying masked, armed men to workplaces, schools, courts and homes, snatching people without recourse to lawyers or courts and putting them in detention centres then sending them abroad, is surely one of the harshest regimes of treatment of immigrants in the world. 

Meanwhile Right Wing populist parties across the planet spread an increasingly nasty, prejudiced narrative about immigration, as if it is the greatest, even only, cause of hardship in any country. These narratives are sheer xenophobia, labelling foreigners as criminals or scroungers.

I say, good on the Spanish! Let’s hope their strategy pays off and that other countries begin to follow. Human beings migrate. Always have done, always will. All human beings should have equal rights. They are all of equal value. 

Diversity is Nature’s super-power. 

I believe everyone who lives in the same country should have the same rights, and, be valued the same. I totally oppose discriminatory treatment based on the country of origin of a person, or their family. 

We need to work harder at integration – not just of immigrants into countries, but of whole populations. Inequality has reached record levels, resulting in many more people living lives of exclusion and hardship. Let’s tackle that. Let’s make our countries more equal, more just, and more fair. Not less so. 

“Integration for everyone!” 

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Creative environments

December 23, 2025 by bobleckridge

My area of work was health. I worked as a doctor over four decades and I learned a lot about what made for a healthy environment and what was a more toxic or harmful one. I reckon the characteristics of healthy environments are pretty universal. We all need to breathe clean air, drink clear water, eat nutritious food, have nourishing and caring relationships. There’s a lot of evidence about the positive healing effects of natural environments. I say “natural” but what I mean is, as opposed to built environments. Trees and forests stimulate healthy changes in body and mind, but busy six lane motorways, not so much. But even within these universalities we are all different, so, for some, it’s healing to walk by the shore, or to gaze out at the ocean, breathing in the salt air. For others, the most healing environments are in the mountains and lakes, breathing the clear, fresh air of a little altitude, surrounded by birdsong and wildflowers (“and not or” remember…..both these environments can be good for the same person) 

I read a section of Rick Rubin’s “The Creative Act” recently (I’m working my way through, reading and meditating on, one section a day just now. It’s such a rich resource)….this morning’s section was “Setting” where he discusses what environments are creative, illustrating how very different ones allow us access to different flows from the universe, each of which can stimulate our intuition. He points out how tranquil natural environments allow us to appreciate the direct information from the universe, whereas, busy peopled places, like cafes, town centres etc, can allow us to tune in to the universe as filtered through human beings. In all situations it’s a question of detached awareness, so that we can notice patterns, but not allow ourselves to be overwhelmed by them. That made me think of the phenomenon we call doomscrolling, where we get caught up in social media feeds. They too can be sources of creative stimulation if we allow ourselves to notice the patterns and themes, and not get caught up in them. 

In fact, Rick also suggests cultural environments where we focus on reading, music, visual art, etc to pick up the information from the universe filtered through culture. 

The most important point he makes is that we are all different. His conclusion is that we need to “hear the chimes of the cosmic clock ring, reminding [us] it’s time. Your time to participate.”

It is.

It’s your time to participate, to become aware, to trust your intuition and to engage. Which environments do you find most conducive to creativity? What factors make a positive contribution to your creativity?

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Tackling the obesity crisis

December 21, 2025 by bobleckridge

In New Scientist, 8 November 2025, Graham Lawton wrote an article entitled “Older Faster”. He describes the difference between biological age and chronological age. Biological age is an estimate of your fitness, your wellbeing, based on how well your cells and systems are functioning. It’s closely related to inflammation. The more inflammation in your body, the faster it ages, and the more likely you are to suffer from pretty much any chronic illness. The phenomenon he describes is that, globally, we humans are ageing faster than we used to. 

There seems to be a strong correlation between obesity and biological ageing, and as we are seeing an obesity pandemic it’s no surprise that people are ageing faster too. But does the one cause the other? Are people ageing faster because they are more obese? Or are they becoming obese because they are ageing faster? 

These two statement shocked me – “Cancers are increasing in younger age populations, people under 40 years of age have more heart attacks, more diabetes” (social epidemiologist, Paulina Correa-Burrows) and “Cancer used to just be considered a disease of ageing. Now people are being diagnosed with colon cancer in their 30s, breast cancer in their 30s. Why is that? Perhaps some of the processes of ageing are acting earlier and causing ageing to accelerate, which then causes early onset cancer” (Jennifer Guida)

A study of 150,000 people whose blood samples were stored in the UK Biobank, revealed that those who were born after 1965 were “17 percent more likely to show signs of accelerated ageing than the older ones, born between 1950 and 1954” They also found this accelerated ageing caused an increased risk of early onset cancers of the lungs, gastrointestinal tract and uterus. 

The author argues we seem to have created an “obesogenic environment” in the world, and proposes that because this is correlated with accelerated ageing, we use the term “senesogenic environment” – an environment which is causing us all to age faster. 

Obesity rates in 5 to 19 year olds increased 1000 percent between 1975 and 2022, and it continues to rise. Something has changed. It’s still not clear exactly what, but one theory is excess calories, which seems to cause both obesity and accelerated ageing. In fact, calorie restriction activates body repair processes and slows ageing. 

However, we do know that it isn’t all down to calories. Stress hormones play a significant role. And, although, Graham Lawton doesn’t cover this aspect, poverty, job insecurity, social insecurity, poor housing, as well as environmental pollution from microplastics to cocktails of “forever chemicals”, and poor air quality, all increase the levels of stress hormones in our bodies. 

Rather, he concludes with the typical medical individualist approach and asks what we can do as individuals to slow down this biological ageing – exercise, calorie restriction, good sleep hygeine and the avoidance of alcohol and smoking, are the usual suspects. He mentions the benefits of GLP-1 agonist injections (like Ozempic) but concludes “time to lose weight and get active again”. 

That’s kind of a disappointing end to the article, because what interested me more was this concept of a “senesogenic environment”. Shouldn’t that be at the heart of government policies, not just on health, but on economics and the political choices we are making? If we want to tackle obesity the answer won’t lie in the next “miracle drug” (why do miracle drugs always turn out to be not quite so miraculous as time goes on?), but in a shift of focus towards the senesogenic environment, and that’s going to involve Public, collective, political and economic policies to reduce poverty and insecurity, to provide decent housing for all, accessible health care and education for all, and by cleaning up the air, water and soil by clamping down on chemical and plastic pollution.

This senesogenic environment isn’t natural. It’s created by political choice, putting the wishes of corporations and the rich over our common, shared needs. And by “our” I mean, not just we humans, but we living creatures of all kinds on this little spinning planet.

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LUCA’s descendants

December 16, 2025 by bobleckridge

I read, recently, about “LUCA”, from whom, every single one of us is descended. In fact, not just every single one of we humans, but every single living creature. 

Isn’t that amazing? Yet, at some level, kind of obvious? 

We humans have a tendency to think that we somehow parachuted onto this little planet, just appearing from nowhere, with no history prior to our arrival. This kind of thinking leads us to consider that, on Earth, there is Nature, and there are humans. It’s almost as if Nature is something separate from ourselves, either a place we go and visit on our holidays, or the less important than us part of the world. 

But these two beliefs are delusions. 

We evolved on this planet, along with every other living creature, past and present. The history of our “arrival” isn’t sudden, but it isn’t disconnected from the rest of existence either. 

Advances in molecular genetics have revealed that all living things on Earth are descended from a single organism dubbed the last universal common ancestor, or LUCA, which emerged around 4 billion years ago. We also know that our planet is approximately 4.5 billion years old. During those first half a billion years, simple, then more complicated, organic molecules were spontaneously synthesised and assembled in larger complexes, eventually evolving into the primitive, single-celled LUCA. How did that happen? We really don’t know. But, then, we don’t really know what “life” is either, do we? We can’t even tell if a seed is dead or alive until it starts to change (or doesn’t). 

There are many, many “creation myths” around the world. Every culture seems to have its own. Over the last hundred years or so we’ve been introduced to new ways of thinking about who we are, and where we came from. Yet even with evolutionary thinking we have a tendency to think of ourselves as different and separate. We present Homo Sapiens as the most highly developed form of life on the planet, and we don’t really consider how we might evolve in the future. We tend to think that evolution led to the creation of we humans, and then it stopped. It somehow reached its goal. And we give less consideration to what we share with the rest of the planet. 

But, in fact, we came from somewhere, as did every other life form on our shared planet. Our ability to understand the molecules which exist inside our cells, and the discovery of how so many of the exact same molecules exist in other creatures, has opened the door to a different understanding. 

LUCA is our shared common origin, and as we begin to trace LUCA’s evolution into the abundantly diverse forms of life which we have discovered so far, we come to understand ourselves as embedded, inextricably in a web of Life on this planet we call Earth. This little blue marble where LUCA came into existence, and gave birth to us all. 

We are not disconnected. Neither from all the other living creatures, nor from each other. We share this planet. We share the same air, the same water, the same soil. We depend on each other. Despite the delusion of hyper-individualism, none of us can exist without creating mutually beneficial relationships with others, with our other common descendants. 

What kind of future could there be for us, for our children and grandchildren, if we all took that shared reality on board and put collaboration ahead of competition? If we began to rate mutual benefit over self-centred greed? If we put more energy and attention into the creation, and maintenance, of the healthy environments in which all of LUCA’s descendants can thrive? 

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Handling uncertainty

December 8, 2025 by bobleckridge

I read an article in New Scientist by Florence Gaub and Liya Yu entitled “Nothing’s certain”. The authors explore two different ways that we handle uncertainty. Their specific take is a “political neuroscience” one. Now, let me just say I have a paradoxical relationship with the “neuro” tag. Firstly, it attracts me. I’m interested in the brain, scored my best exam result ever in the neuroanatomy exam at Medical School. I’m interested in pyschology and in the “mind-body connection” (although that, too, is a phrase which can both attract and repel me). Secondly, “neuro-” has become a bit of a fashion, with everything from “neuroscience”, to “neuromarketing” and this “political neuroscience”. I just don’t think neurology can explain everything about human behaviour. Alongside that, the correlations between neurological observations and behaviour are just that….correlations. We still haven’t explained how the physical brain can have subjective experience, and whether or not subjective experience creates the changes in the brain, or vice versa. 

However, what they had to say really interested me. They say “Political neuroscience shows that the brains of people with conservative views favour security and avoid open-ended solutions with no clear closure. They tend to have increased volume in their amygdala, the region responsible for threat signalling” And, “Liberal brains have a higher tolerance for uncertainty and conflict, as they have more grey matter volume in a brain area implicated in the processing of ambiguity called the anterior cingulate cortex.” 

They point out that when uncertainty is high, the former “conservative” people are attracted to whoever offers the idea of certainty (think Hitler and his 1000 year Reich), and are fearful of novelty, whether that be technologies, foreign people or cultures. 

They conclude that we need to learn that “cooperation across identity and interest groups” can be beneficial, and that we can overcome our big global challenges “only by overcoming our brains’ vulnerabilities together”. 

I’m not sure that MRI scans of peoples’ brains reveal their political preferences, and I’m a bit uncomfortable with how this thesis basically implies that “Liberals” need to help “Conservatives” get over their fear and anxiety, but apparently “Liberals” don’t have anything to learn from “Conservatives”.

I say that despite seeing myself as firmly in the “Liberal” camp, not least because I was trained as a General Practitioner, a speciality sometimes described as doctors who specialise in managing uncertainty. Uncertainty was my daily professional experience, one unique, novel, unpredictable patient at a time. 

However it does seem that the “Right” are on the rise across the world, and this might well be connected to an increase in the amount of uncertainty which people are facing in modern times…..uncertainty about climate change, about technology, about both national and personal security. 

So, if I want to make a positive contribution, perhaps I need to understand and address the anxieties and fears of those people with a larger amygdala…. 

In other words, how can I help people to deal with uncertainty more comfortably? How can I help them to enjoy novelty, to delight in diversity and difference, and how can I help to create a more secure society for us to live in together? 

In addition to that, what do I have to learn from those who may be more sensitive to uncertainty than I am? 

Let me start with the last point first. We humans need sufficient certainty. We couldn’t go on without it. When I buy a train ticket, it doesn’t cross my mind that the train I’m about to step on won’t make it to its destination (despite the fact that between Stirling and Glasgow I’ve had several experiences of trains being delayed, cancelled, or even terminating a few stops before my intended one). The point is that I’ve had enough experiences of reliable trains to actually get on a train and expect it to take me to where it says it’s going to go. 

When I first went to university in Edinburgh, my mum, who clearly had a well developed amygdala, used to send me newspaper cuttings about crimes in different parts of the city, with the accompanying advice to avoid those areas. When she sent a story about a boy who was stabbed in Princes Street, I had to ask her to stop sending these cuttings, because there was no way I was going to be able to spend at least the next six years of my life in Edinburgh without walking along Princes Street! 

When we wake up in the morning, most of us don’t wonder if this will be our last day. But one day, it will be. No, we have to have enough confidence, enough of a sense of certainty, that we will make it through to bedtime. Otherwise, how could we even get up? 

My point is, that we need certainty. Or, do we? Is it more that we need confidence? Confidence that, no matter what the day brings, we will get through it, we’ll handle it? I suspect confidence and certainty aren’t the same thing, but the greater the certainty, probably the more confident we feel. And, probably, vice versa, because the more confidence we develop through our practice and experience, the more we will experience certainty in our day to day lives. 

I think this is the key lesson those with a larger amygdala have to teach us……although certainty, like perfection, is an impossible goal, it is still important to have it as one of our goals if we are to survive and thrive. 

We can do that as a society by attending to the circumstances of life which lead to security…..abolishing poverty, driving down inequality, creating decent houses and work for everyone, creating and protecting clean air, clean water, and nutritious food, as well as providing freely available, good quality education and health care to all. 

We can do it individually by attending to the rhythms, rituals and habits of our lives. We pass a lot of each day on autopilot, finding ourselves trundling along the railway tracks of our own well established habits. I wouldn’t be surprised if you told me you wake up about the same time each day (or, certainly, each Monday to Friday), follow the same sequence of toilet, toothbrushing, showering, maybe shaving (well, I do), and having a “regular” breakfast. If you are employed, you’ll probably make your way to your workplace, without any great awareness of your surroundings (unless something unexpected occurs on the way). You’ll have your work routines, with the well established break times, and finish time, before heading back home, retracing your steps. The French have a phrase for this – “Metro, Boulot, Dodo” (metro for the commute, boulot for work, and dodo for sleep) – which captures this sense of a routine, hamster wheel, existence. 

It’s not a bad thing to have habits and routines. They can provide a certain security, a certain sense of certainty, an unchallenging, comfortable, structure. But you can see that, pushed too far, they can create a mode of living where life itself seems to pass us by. 

That brings me to the first question I posed to myself….how can I help others to deal with uncertainty more comfortably? My lifetime work experience would lead me to suggest doing whatever gets us to focus on the here and now. I saw hundreds of patients with paralyzing anxiety and/or mind numbing fear. What they all had in common was that their inner world, the world of their thoughts and feelings, was trapped in a kind of loop, or whirlpool, with one anxious thought feeding the next one. Whilst they were absorbed, even overwhelmed, with this inner world, they were consequently disconnected from other people and from the rest of the world. So, we’d begin by pulling their attention to what was happening around them, in this moment, in this particular place. We had built a hospital around a beautiful garden and I’d take patients out into it to walk along the winding paths, noticing the different plants, blossoms, flowers, birds and other animals along the way. We’d sit on one of the benches and just notice….notice what we could see, what we could hear, what we could smell, what textures we could touch. 

There’s a French phrase I’ve loved since I first encountered it – “L’émerveillement du quotidien” – which translates, roughly, as the wonder of the every day. The truth is that every day is unique. Every moment is lived for the first and last time. And each day is filled with encounters which we’ve never had before….a particular moment with a Robin, a moment when the light catches the dew on the newly woven, intricate spiders web……

Paying attention to what is around us, paying loving attention to what is around us, opens us up to a world filled with wonder, with diversity and novelty, and gives us a lived experience of change, of surprises, of unexpected delights. 

Well, that’s a beginning. It’s a way to calm down that amygdala and strengthen the anterior cingulate cortex, perhaps. 

What’s your own take on uncertainty? How high is your tolerance to it? And what do you do to balance consistency and novelty?

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