Archive for July, 2007

Julia Hasselberg

I found myself captivated by this portrait of Julia Hasselberg painted by Eva Bonnier. Eva Bonnier was a Swedish artist and this painting is of her lover’s illegitimate daughter who Eva adopted after Julia’s father’s death.

This girl has a look which is very familiar to me. It’s a combination of pain and resilience. There’s reserve, distance, independence and spirit here. The kind of spirit that emerges from suffering to strengthen and protect. I find it both moving and powerful.

You can find this portrait and others by Eva Bonnier along with a really interesting short biography of her on the Giornale Nuovo blog. Thank you for posting this Mr h.

All Eva Bonnier’s portraits which you’ll see in that post share these characteristics for me. These are powerful people, fiercely independent, with that special kind of strength which emerges from suffering. One thing that fascinates me is this description of Eva Bonnier

She is reputed to have been an intelligent, strong-willed and sharp-tongued woman who ‘could neither in private nor as an artist charm or flatter her contemporaries.’

How much does the character of the artist influence their portraits of others? How much do they see a bit of themselves in their subjects and, unconsciously, highlight those qualities in them? What do you think Ester?

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french family, originally uploaded by bobsee.

Here’s a variation on my Five Days, Five Colours idea.
I was in France on the weekend of Bastille Day so I thought I’d go out and photograph red, white and blue.
Here’s the set of photos I took

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It is that loving you as much as I have been able to manage has defined the person that I am. That is who I have become.

Sebastian Faulks. Human Traces.

How do we gain a sense of self? How do we answer the question “Who am I?” It seems to me that we gain a sense of self through the stories we tell ourselves and others. It’s a narrative process and it’s an always unfinished, creative process. We are all unique. Every time I conduct a clinic I meet new patients. Never once have I heard a patient tell me the exact story I’ve heard before. Everyone has a new, unique narrative. But this implies that the creation of a sense of self is all internal. It isn’t. We create a sense of self through our boundaries, our connections, our interfaces and interactions. We create a sense of self through our experience of love – its presence, its absence, its possibility, its loss.

Loving you, I become me.

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Evolution is a passage from the most automatic to the most voluntary.

Sebastian Faulks. Human Traces.

The zombie life is the automatic life. Becoming the hero of your own personal story involves developing awareness and making more and more conscious choices.

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ripples in the sand, originally uploaded by bobsee.

Then the long trail of her footprints, stretching back towards the sea, became slowly indistinct as each one filled with water and edged in upon itself; and in a matter of minutes, as darkness began to fall, the shape of the foot was lost at every place until the last vestiges of her presence were washed away, the earth closing over as though no one had passed by.

Sebastian Faulks. Human Traces

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Human Traces by Sebastian Faulks (ISBN 978-0-099-45826-5) is a novel of ideas. Set in the late 19th, early 20th century it tells the story of two young men who become idealistic doctors, determined to work together to understand mental illnesses so that they can cure them. In addition, they hope that in understanding the interface between the body and the mind they will understand what it is to be human.

I found it really absorbing. Much of the discussion was around subjects which are very familiar to me – consciousness, the relationship between the body and the mind, the debate about whether mental illnesses have neurological bases or not, and the still young area of evolutionary biology. However, as a doctor, the book has additional relevance. After all, my experience is also one of idealism and hope; the belief that doctoring will be about curing, and the gradual erosion of that to aim at managing diseases instead of curing them (that last is a painful loss – for sure, doctors have cures for many acute diseases now, but the burden of illness is chronic disease and, sadly, we seem a long way off from finding genuine cures for those)

Sebastian Faulks floats an incredibly interesting hypothesis about the hearing of voices, having one of the characters, Thomas, propose that this was a facility that all human beings possessed but which has since been lost by most of us. He cites the literary evidence of Man’s relationship to God/gods where the earlier stories show people hearing voices which they obeyed – they experienced the daily reality of their gods; and later stories showing that people no longer reliably heard those voices and had to throw lots, examine entrails, find unusual characters (prophets) who could still hear the voices, in order to know what the gods wanted. He links this idea to the emerging concept of evolution and natural selection by proposing that the hearing of voices was linked to the development of consciousness and the loss of the voices was related to the development of self-awareness through the acquistion of language. If you are not familiar with any of these ideas this novel is a great place to introduce yourself to this area of thought.

However, this 609 page novel did not engage me emotionally……..until page 595. From page 595 to the very last word of the novel, it hit me like a sledgehammer. I didn’t just cry. I sobbed. I was totally unprepared for it. This is quite honestly one of the most powerful pieces of writing I’ve read. Maybe it hit me so hard because it touched so many issues which lie in the core of my being – what is it to be a doctor? what use am I to others? how do we get a sense of self and how does it feel to lose that to an illness like dementia? what does it mean to become invisible? and, ultimately, what trace do I leave on this Earth?

There are a number of phrases and passages which have stimulated a whole lot of things for me, and I’ll return to post about some of them separately.

Thought provoking, educational, well-written, and, ultimately, powerfully emotional.

Highly recommended.

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web water 1, originally uploaded by bobsee.

As i walked to my front door this evening something sparkly caught my eye.
Look at this!
It’s raindrops lying on a spider’s web! I’ve never seen a range of water droplets of such varying shapes and sizes before. This is SO different from how dew or frost looks on a web.
Isn’t it beautiful?

There were a number of other webs with raindrops caught in them today. You can see them on my flickr page

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I read a great post on the SlowDownNow.org blog. In it Christopher Richards describes his experience of being looked after by a doctor who took his time, then his experience of trying to find a new doctor after this first one had retired.

I’m pretty sure we’re losing something really important with our current round of NHS reform. And its something related to speed. Sure you need fast, effective treatment when you are acutely unwell, but the surgeon or physician who is tending you still needs to take his or her time and not rush things or the job just won’t get done properly. However, the big demand in health care these days is chronic disease and here we really have been looking for quick fixes at the expense of taking our time to listen, to understand and to enable patients to adapt, to grow and to enlarge their lives in the presence of their diseases.

An American sociology professor, Arthur Frank, wrote “The Wounded Storyteller” (ISBN 0-226-25993-5) to describe his study of how patients talk about their illnesses. He identified three major “genre” of narrative – the “restitution” one – which is the quick fix approach to health care (“A bit of me’s broken. If you could just fix it or replace then I’ll be on my way”). This is appropriate in much urgent and acute medicine but is really of no use in chronic illness or in enabling patients to become genuinely healthy. He proposes that doctors should help their patients to create new narratives – “quest narratives” based on the principles of Joseph Campbell’s work on the structure of myths and legends (otherwise known as Hero stories).

That very process entails a shift from the quick, the immediate, the partial to the slow, the lasting and the whole.

I wrote here about countering Getting Things Done with Dolce Far Niente, and here about finding the spaces where you can relax, and here about becoming aware of the gaps in our experience.

What ways do you slow down?

Does slowing down improve your quality of life? Give you time to reflect, re-charge, and to grow?

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“It is a truth universally acknowledged, that a single man in possession of a good fortune must be in want of a wife.”

Hands up if you recognise that opening line……

David Lassman, the director of the Jane Austen Festival in Bath decided to copy out opening chapters of Jane Austen novels, changing only character names and send them to publishers as his own work to see what would happen. He sent Northanger Abbey, Persuasion and, yes, even Pride and Prejudice (that’s the opening line up there….!) to a number of big publishers and agents.

Two interesting things happened. Firstly, they all got rejected – the publishers didn’t want to publis them. Secondly, nobody seemed to spot the plagiarism – well, apparent from one person at Jonathon Cape. But here’s the bit that really struck me – Penguin said this about his Pride and Prejudice look-a-like

It seems like a really original and interesting read

When challenged about this later they said

A spokeswoman for Penguin pointed out that its letter had said only that it “seemed” original and interesting. “It would not have been read,” she insisted.

What??! They said it “seemed” interesting but they didn’t read it? Oh dear, is publishing totally random? Is it just luck? I suppose it would have been worse if some publisher had offered him a contract and published it without realising the book was actually a Jane Austen novel, but that probably was never going to happen. The saddest part of this tale is the way the rejections either suggested the book was not good enough to be published (poor Jane Austen!), or gave false hope. Wouldn’t it be better for a manuscript to either be sent back with a note saying the company did not want to look at it, or for it to be taken seriously and a clear, honest communication about it to be given to the author?

Why does this interest me? Well, one of the key themes of this blog is a call for individuals to matter more than institutions and systems. The more impersonal and systems based our society becomes the more we are all poorer.

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The Guardian today has an article about a research paper published back in May in the British Journal of Psychiatry. There are more and more attempts to control the future in our society. Predictive statistical models are increasingly being used by everyone from supermarkets (to “target” their marketing to you on the basis of what they think you might like to buy), to social work (to give special help to young mothers who they think might give birth to children who will become criminals), to the criminal justice system (to try and predict re-offender probability), to (my main area of interest) health care (where the experience of groups is used to determine what interventions an individual should or should not recieve – so called “Evidence Based Medicine”).

The paper discussed in today’s Guardian shows that the margin for error between the group studies and individual outcomes is so great that –

When applied to individuals the margins of error are so high as to render any results meaningless.

Almost every day I have a discussion with patients about risks and choices. I always emphasise that the statistical predictions are based on groups and averages and that there is absolutely no way of knowing to what extent they are relevant to this individual.

We are all different. Nobody, but nobody, can tell an individual what their future holds and to pretend they can on the basis of statistical modelling which isn’t up to the job is potentially very harmful.

This heroes not zombies site is about encouraging people to become aware, to think, and to develop their uniqueness. We need to celebrate individuality and difference more and we need to understand that people matter more than statistics – especially in social work, justice systems and health!

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