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Archive for May, 2007

According to the French philosopher, Gilles Deleuze, wrote that there are three ways to think. I know, you’re already wondering how you can think three ways with one brain! Well, you probably use the three ways all the time. In fact, Deleuze claimed it was important to know about the three ways so you could both see things more clearly and communicate more effectively. You’ve probably come across arguments where one person is saying “But what are the facts? Just give me the facts!” while another says “But what is your heart telling you here?” and a third wants to know “But what does this all mean?”. These three questions arise from three different ways of thinking and whilst they are all trying to get at THE TRUTH, they are all actually dealing with entirely different aspects of reality.

So here they are –

  1. Science – thinking about function. A scientific way of thinking takes a focus on how something works. Understanding how something works is very useful. It gives us the chance to try and make it work better, or at least to improve our experience by figuring out how the world works.
  2. Philosophy – thinking about concepts. Science uses concepts to design experiments and observational studies which will throw light on how the world works. Without the concepts though we wouldn’t know where to start. Many scientists unfortunately confuse concepts with facts, thinking that both are THE TRUTH which leads to closed minds and arrogance. This causes a kind of blindness – “my view is THE correct view, yours is WRONG”. We have to be able to think conceptually if we want to better understand our world.
  3. Art – thinking about percepts and affects. What do we perceive? And what feelings are associated with our perceptions? This is not about the how of perception or the how of feelings, it is about using conscious engagement with our perceptions and feelings to understand an aspect of reality which science and philosophy cannot achieve.

I really like this idea. When I meet a patient it’s important that I am aware of my perceptions and of the feelings that arise in me during a consultation. It’s important that I have a developing conception of illness and of health and it’s important for me to understand what isn’t functioning well in this person’s body-mind.

I also like this idea when it comes to teaching. We learn better when our learning experience engages our three different ways of thinking. We need education which shows us how things work, which teaches us to to conceptualise and which engages our feelings. Remember “Gradgrind” in Dickens’ Hard Times? His view of education was that children were empty vessels waiting to be filled with facts. Ring a bell? Oh, for more enlightened educators!

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You should never believe a scientist who claims to be certain about what is possible and what is not possible. For most of the 20th Century physicists believed that crystals could only have certain structures (based on their “rotational symmetry”). In fact, until 1982 they claimed that is would be impossible for a crystal to have a structure based on a five-fold pattern (like a pentagon). Then in 1982 somebody discovered the “impossible” – a crystal which had exactly that structure. As is often the case in science, once one had been discovered several others then turned up (you only see what you can see!). These structures were given a new name “quasicrystals”. Now, mathematicians are beginning to understand these strange materials –

“Mathematically speaking, quasicrystals fall into a middle ground between order and disorder,” Damanik said. “Over the past decade, it’s become increasingly clear that the mathematical tools that people have used for decades to predict the electronic properties of materials will not work in this middle ground.”

This is such an interesting comment – the “middle ground between order and disorder”. Finding patterns in apparent chaos is always somehow exciting. But for me, this story has another interesting element. There’s a kind of arrogance in many scientists which is the arrogance of certainty. Any scientists who stands up and declares that either all that can be known about a subject is already known, or that anything which does not fit our current understanding is just impossible, will, time and again, be proven wrong!

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Janssen LP have created goggles and a headset that give the wearer the experience of having hallucinations. There are two scenarios to choose from – riding on a bus where people appear and disappear randomly and birds of prey claw at the windows, and going to pharmacy where the pharmacist gives you poison instead of pills and other customers stare at you in disgust.

They’ve used these goggles to train social workers, policemen and others who might have to deal with mentally ill people and have apparently shown that after the training the workers understand mental illness better – learning through virtual empathy!

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I was taught at medical school that the way to make a diagnosis (that is to understand what’s wrong with a patient) was to listen carefully to them (take a history) and examine them thoroughly. Only if the diagnosis remained obscure at this point would we subject the patient to any investigations. Sadly, there has been an increasing reliance on technology to the point where many doctors seem to be losing the ability to diagnose on the basis of listening and looking. A study from the University of Winsconin has shown another problem with this.

The researchers studied patients with acute appendicitis. They compared what happened to those who went straight to surgery after the diagnosis had been made clinically, and those who first went via a scanner room to have a CT investigation to make the diagnosis. Those who went via the scanner (two thirds of all the patients!) took longer to have their operation done than those who went direct to theatre (only a third of them). The scanner group had twice the rate of burst appendix (perforation) and twice the number of post-op complications.

Moral of the story? Don’t rely on machines as a routine way to make a diagnosis.

We need to make sure medical students and doctors know how to look and listen and make good diagnoses without relying on technology.

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We have a real tendency to divide up our experience of the world, put the pieces into separate boxes and label them. Brian Broom talks about this in his excellent book, “Meaning-full Disease“. He says we discriminate, categorise and judge. It’s kind of how we make sense of the world. The human body is remarkable and is endowed with an incredible amount of sensory equipment to detect the world we live it – we sense light and colour, sounds, smells, textures and so on. In fact, our sensory systems are under constant bombardment. If we didn’t discriminate we wouldn’t be able to make sense of it all. We can only deal with so much at a time. We are pattern-seeking creatures, constantly trying to recognise and make sense of the sights, smells and sounds that surround us. Of course, we lose something in this process of discriminating. We ignore most of the signals coming our way and only pay attention to the ones that most interest us. As I said in an earlier post, “we are what we pay attention to“. If we want to grow, if we want to develop and change and not be stuck in deep ruts, then we need to shift our attention, to deliberately try to break our attention-habits and notice what else is in the world. I am a doctor specialising in homeopathic medicine. This is a method which is based on noticing difference. When a patient tells me their story, I don’t want to know just what symptoms they have in common with other patients I’ve known (so I can make a diagnosis), but I want to notice what is different, what makes this person unique. Picking out patterns is a good skill, but we just have to be wary that we don’t always only see the same old patterns. We also categorise everything. We love labels. Often a so-called diagnosis is nothing more than a label. I saw a little boy recently who had an itchy bottom. His mum said the paediatrician had diagnosed the problem as “pruritis ani”. That’s a latin label. You know what it means in English? Yep, “itchy bottom”. So how helpful is that label? Labels, categorising sadly tend to limit our vision. Once we place something in a box we tend to stop being aware of it, stop noticing how different it is from anything else in the same box. Finally, to judge those boxes, calling some “good” and some “bad”? I can’t remember who said it, but I remember once reading “Judgement stops thought”. How true. When we judge something and especially when we judge a person, we stop thinking, stop noticing and stop actually seeing.

Nothing stays the same. We are always constantly changing. We grow, we develop, we change. The processes of discriminating, categorising and judging create a false impression that the world is made up of fixed, separate things. It’s not true. Nothing exists except embedded in a web of connections, and nothing exists without changing. The world is not really so easy to pin down, and thank goodness for that. Life is dynamic. It flows, it moves and constantly changes. Too much pinning down, labelling and judging creates a false impression of a fixed, stagnant world. So, beware. Shift your attention, break your habits and try to see the connections between things, try to see how nothing just is anything, but instead how everything is in the process of developing and changing. Everything is becoming not being…….

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I think it’s good to know where you feel most relaxed, to know what helps you to feel good about life. We all need some time for ourselves. I often tell my patients that they should schedule into their busy diaries some time for themselves – not time to catch up on chores (well, you need that too probably!), not time to spend with your loved ones (yes, you DO need that too!), but time spent alone. It can be simply an hour one day a week (that’s better than no time at all) and it shouldn’t involve anything elaborate. A walk in the park, sitting watching the world go by for a wee while, listening to music, or reading, or just noticing your environment, really whatever works for you is good.

For each of us particular environments are most relaxing. Some of us prefer the seaside. For others, its a park.

This photo is taken in Princes Street Gardens, Edinburgh – plenty of seats there!

Go on, try it. Schedule some YOU time!

 

seats in park, originally uploaded by bobsee.

 

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We are all different and we all find different ways to relax or wind down. One of my colleagues always asks her patients to tell her what’s their idea of a great holiday. The answer can reveal a lot about a person’s coping strategies. I think it’s important to know what makes you feel good, where you feel good, when you feel good. We often get fixated on our problems and one way to not get stuck with problems is to focus on possible solutions. The solutions come from what works for us, the places, times and situations that help us to feel good.

This boat (for many people a boat is a symbol of freedom) and the blue, blue sky, at the seaside represents a way of relaxing for many people.

Where do you go to relax?

What’s your favourite holiday?

 

boat and the sky, originally uploaded by bobsee.

 

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