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Archive for April, 2007

Now here‘s and interesting piece of research. Meyers-Levy and Rui Zhu from the University of British Colombia have shown that ceiling height affects the way we think. When the ceiling is higher, people think more abstractly and when it is lower they think more specifically.

Now that’s interesting! Because they are not saying that one particular ceiling height is good and another bad but that the physical environment in which you sit or move will be conducive to a particular way of thinking.

So, next time you want to be creative, think freely, brainstorm, or whatever, maybe you should get yourself into a room with a high ceiling! What about outside I wonder? Is that better? But, next time you want to focus in on the specifics, the details of a piece of work you might be best to find a more tightly enclosed space. Reminds me of something I read about writers who use a garden shed to write in! I wonder if the different kinds of rooms writers write in suit different kinds of writers?

What do you think? Are you aware of the effects that a room’s dimensions can have on your thought processes?

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Ben Ledi

From the window of my apartment I can see across to the hills. One hill in particular stands above the others – Ben Ledi. I got to thinking the other day about how things change, how everything constantly changes, but how if something changes slowly we think its staying the same. You know what I mean. A plant changes quickly, growing from a seed to a seedling and blossoming under the sun’s rays to show its petals to the world, then developing its fruit or its seeds and withering away again, in endlessly repeating cycles. But mountains, now, they change so slowly they look the same for hundreds or even thousands of years. Don’t they? But then, as I gazed out of my window across the fields at the light and the shadow on the hillside, I thought to myself, actually, Ben Ledi looks different every day. OK, the rocks probably don’t change very much, but Ben Ledi is more than its rocks. The Ben Ledi I see from my window is not just the rocks, the slope, the shape of the peak. It’s foliage, the colours, the light and shadow. When I look at Ben Ledi I see something different every day. Here are four (of many!) photos of Ben Ledi all taken from my window.

Ben Ledi just after a storm.

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Ben Ledi with morning mist.

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Ben Ledi covered in snow.

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Ben Ledi in a winter setting sun.

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If you like these Ben Ledi photos you can find more on my Flickr page here.

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Patients’ stories are often dismissed by doctors as being too subjective to be of value. Objective information is rated more highly. In fact the dominant paradigm of the biomedical model is “evidence-based medicine” where a hierarchy of value has been created which emphasises the findings from research trials conducted on groups of patients over the individual stories of doctors and patients. Let’s understand and maybe challenge this hierarchy.
By subjective we usually mean a person’s unique experience. No two people can have identical experiences because no two people are identical. The dismissal of a patient’s story is the dismissal of personal experience.
We tend to think of objectivity as being outside ourselves, as being a phenomenon which is free from individual prejudice, as if it is unfiltered or pure. However, objectivity is actually just a consensus of personal, subjective views.
Take a look around your room now. What do you see? A computer probably! Maybe you can see a chair. Let’s just focus on the chair for a moment. This experience you are having right now of seeing that chair is subjective. It is YOU who is seeing the chair. But if everyone who comes into your room can also see that chair then seeing that chair becomes objective. The observation becomes more reliable in the sense that you could say to a perfect stranger “Come into my room and tell me what you can see” and, amongst other things, the stranger will report seeing that chair.
But subjectivity and objectivity are not mutually exclusive, either/or, categories. There’s a range or degrees of objectivity. For example, what colour is that chair in your room? The answer to that question will vary. Not everyone will agree about the colour of an object because colour sensation is a highly subjective phenomenon. Let’s push this one step further. Is it a comfortable chair? Well, now the consensus will become seriously shaky. You cannot be sure that a stranger coming into your room will describe that chair as comfortable.
The greater the consensus of experience, the more we are likely to call it objective, because we know that there will be a high probability that almost everyone will concur.
However, what matters to me if I have a pain is my experience of the pain. Nobody else can experience my pain. The concept of objectivity becomes irrelevant. If I take a painkiller, only I can tell you if it is working for me. No doctor or scientist knows better than you do about your pain. So claims that only treatments which are “evidence based” ie which work for many other people should be offered to patients are not supportable. Clinical trials (group experiments) reveal useful information about possibilities and even probabilities but they should never be treated as the last word on something. “Evidence” is never complete. However, although a majority of people may claim relief of their symptoms from a particular treatment, we can never guarantee that that treatment will work for this particular patient. Some people will only respond to a totally different treatment, possibly one which has never been shown to help the majority of patients. We should never prevent patients from having the treatment that works for them just because that treatment hasn’t helped most other patients.
How many patients should get relief from a drug before we can claim this drug is “evidence based”? Well,
However, as Dr Roses of Glaxo SmithKline, specialist in pharmacogenomics at Glaxo SmithKline famously said,

“The vast majority of drugs – more than 90 per cent – only work in 30 or 50 per cent of the people,” Dr Roses said. “I wouldn’t say that most drugs don’t work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don’t work in everybody.”

That’s a minority then. This falls far short of objectivity as consensus. Why is that? Because what matters is not just what most people experience but, when it comes to your health, your illness, it’s your story that matters. A doctor can, and should, tell you that a particular treatment has been shown to help a certain percentage of patients but you will decide which treatment to continue with solely on the basis of your unique personal experience. It’s your story, your feelings, your sensations that matter most when it comes to your health.

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There’s a website called Change This. They publish articles which they call “manifestos”. I just came across this one. Nassim Nicholas Taleb argues that unpredictable events are like “Black swans” – until one is seen we lack the imagination to even think such a creature is possible basing our expectations entirely on our previous experience. Taleb says a Black Swan is rare, its occurrence has a large impact, and it is predictable only retrospectively (we explain it with a narrative we make up after the event).

It’s an interesting idea. There’s a phenomenon described in complexity science which is similar to this. It’s called “emergence” and it means the kinds of events and behaviours that occur which are brand new and have never been seen before. For example, when a particular hurricane suddenly starts to behave differently from all previous hurricanes. I see this all the time in patients. There is a terrible tendency in Medicine to focus on diseases rather than the people who have the diseases. Once a diagnosis has been made (the disease has been named) a prognosis is made on the basis of how other cases progressed. But the thing is that again and again patients just don’t comply with statistics. Take Stephen Hawking as an example. He has a disease called Motor Neurone Disease. Usually people die within two years of a diagnosis of this disease. Stephen Hawking was diagnosed over 40 years ago.

People are different. It is impossible to accurately predict an outcome for any single individual with a particular diagnosis. The future is, and always will be, uncertain. That’s not a bad thing, though we crave certainty. I once had a patient who told me her husband had been diagnosed with cancer and had been told he had six months left to live. I asked her how she felt about this and her answer took me completely by surprise (you could say it was a Black Swan!). She said “I’m angry. Very angry. It’s not fair. How come he gets to know how long he’s got and I don’t get to know how long I’ve got?!” I had to explain that actually he might not die in six months time!

But Taleb’s idea about Black Swans makes another interesting point which is about the human use of narrative to make sense of things. Even though an event might be totally unlike any event we’ve ever seen before we’ll do our best to explain it as if it had been predictable all along. This further feeds our tendency to believe in certainty and predictability.

The contemporary practice of Medicine as strongly based on encouraging decision making on the basis of what’s already known (this is called Evidence Based Medicine), but as I once heard Dr Harry Burns (Chief Medical Officer of Scotland) say “If we base all our treatments on what we already know how can we come up with new, better treatments?”

We need imagination. Without imagination we cannot see what might be. Even with imagination however we’ll still have masses of experiences which we didn’t expect. That’s how life is… I don’t want a wholly predictable life. Do you? Understand me here, I’m not saying I want nothing to be predictable. I do want to know that when I catch the 0735 Glasgow train it’s got a good chance of getting me to Glasgow at 0820 (OK, maybe one day!!). I like routines and rhythms. But I like surprises too and the fact that every single patient I see tells me something I’ve never heard before makes my day. Every day.

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It’s time

Time for what? Well, what I’d like to suggest is that you take the time to find out something new about somebody today. I work at Glasgow Homeopathic Hospital and a few months back we had a temp on reception. Her name was Louise Rutkowski. One day over lunch break I got chatting to her and found out that temping was not Louise’s main thing in life. She was a singer and had previously worked with This Mortal Coil. We had some interesting chats about following your dreams and doing what you love in life while also finding a way not just to make a living but to support your dreams. Anyway, recently Louise emailed me and told me she was in the middle of making an album.

Listen to this. It’s called “It’s time”

I love it. On her myspace page she lists Blue Nile and Kate Bush amongst her inspirations. You can really hear that in this song. There is nothing more wonderful than seeing or hearing somebody realise their dreams. This is Louise’s best song ever (IMHO) What do you think?

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There are a number of qualities in complex systems. Let’s have a look at a couple of them and see how they can help us to understand why sometimes we get stuck and why on other occasions we when we get through a certain difficult experience we feel that not only life, but we ourselves, have changed irrevocably.

Attractors

One quality is that of an “attractor”. The one attractor you’ll know something about is the kind that makes “Black Holes” – those whirlpools in space that suck everything, even light, deep into their swirling vortices. There are three kinds of attractor.

  1. Point attractors – these pull everything towards a single point.
  2. Loop attractors – these have two centres close together and anything which comes close gets swept back and forward between the two centres, flip-flopping between two alternating states.
  3. Chaos attractors – a focus of chaos, with everthing that comes near being pulled into a chaotic system.

What can these phenomena teach us about life? Well, a point attractor is the kind of thing that traps us. It might be a wound, a hurt, a bad experience. Or it might be a habit or stuck way of thinking. These are the well-worn paths that always, inevitably, end up at the same destination, producing the same outcome. It’s hard to move on, to grow or to develop when you keep going back or holding on to the same old thing. Point attractors are about stuckness. They produce routines that become ruts.

Loop attractors are those alternating states we often experience – a cycling back and forward between emotional highs and lows, between frantic activity and depression, between fear and anger. There is more variety in a loop than in a point, but they both entrap.

Chaos attractors are the most confusing of all. They hardly seem recognisable. They have no pattern, no rhythm and no predicability. Their only inevitably is chaos. These are the states we often find ourselves in when we are overwhelmed by something – bad news, loss, terror, grief. Like the points and the loops, the chaos attractors trap. At least points and loops have the comfort of the familiar, and, to some extent, the predictable. Chaos states are very hard to experience and can’t be sustained for long.

How can we break free of the pull of an attractor?

  1. Imagination. Developing your powers of imagination generates the potential for change and for movement. Without imagination it can be hard to believe that there is any possibility of breaking free from the entrapment of an attractor.
  2. Will. Determination and motivation. It’s one thing to imagine how life could be different but it takes a strong desire and determination to change to break free of the attractor.
  3. Relationships. Sometimes it takes an external influence to make the difference. This is where other people can make such a difference. It can be the attention, the love and the care of another which helps us to break free from our stuckness, our habits and ruts.
  4. Changes in circumstances. We all exist in constant interaction with our environments. As the environments change so do we. Changes in circumstances like new relationships, the ending of relationships (whether through break-up or death), loss of employment, new employment, moving house, and so on, can all exert huge power to knock us out of the old patterns and stuck places. This is why sometimes painful events can result in significant gains.

Bifurcators

Bifurcators are like crossroads. They are points where things change. With a bifurcator you usually have two possibilities – growing or shrinking. At a bifurcator the system changes and either develops, changes and grows stronger or more resilient, or it declines, shrinking or disintegrating, becoming weaker. The key thing about a bifurcator is that life is not going to be the same again. A good example is pregnancy. Once pregnant, a woman’s life will never be the same. She can never again have never been pregnant. Either the baby will grow and thrive and the woman will become a mother (and how different does THAT make a life!) or the pregnancy will not progress and the woman will experience an abortion, a miscarriage or a stillbirth. In none of these circumstances will she ever be the same again. Often there are no choices possible. Life develops one way, or it develops another. However, in many situations a bifurcator is all about making a choice. The challenges which come our way for example can be accepted or rejected. Accepting a challenge brings the potential for growth. Rejecting a challenge can leave you stuck in the arms of an attractor!

So, here is a key difference between a hero and a zombie – heroes break free of attractors, grasp the bifurcation points and grow; zombies stay stuck at the same points, in the same loops, engulfed in the same chaos, avoiding bifurcators and preventing growth.

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train table, originally uploaded by bobsee.

For over ten years now I have lived over an hour’s commuting time from my place of work. I love it. What I don’t do is drive! Well, sometimes I do, but only if I really have to. I take the train or I take a bus. I should point out that I live in Central Scotland so commuting for me USUALLY means getting a seat. I know in some places commuting by public transport doesn’t include sitting down!
What this gives me is at least two hours a day to myself. I don’t have to do anything. Just sit there and be chauffered by either a train driver or a bus driver. I take my ipod (I’ll blog about that separately!), notebook, book and maybe laptop. I can sit and think, write, listen to podcasts, music, read and reflect, use my laptop. Mostly I have a low-tech commute, drlnking a coffee, reading a newspaper or a book, or using my notebook to jot down ideas, make mindmaps, do a bit of planning.
My commuting time can be for working, for relaxing, for reflecting and for creating.
It’s a gift

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