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Archive for August, 2007

Engleby

Engleby is Sebastian Faulks’ latest novel. It’s written in a very different style from his previous novels but touches on some of the same themes. I read Human Traces recently and really loved it. Both novels are concerned with ideas of consciousness and the creation of the sense of self, but they deal with this in very, very different ways.

The first thing which strikes you about Engleby is that it is written in the first person. It’s difficult to do this successfully for the course of a whole novel, but Sebastian Faulks is a great writer and handles it beautifully. It really works. You have the sense that you are inside the head of the narrator, seeing and experiencing the world the way he does, and, more importantly, getting some sense of his subjective, inner mental processes. The narrator, it quickly becomes clear, is not “normal”. At best he’s a misfit, and, at worst, may even be mentally ill. This reminded me of the excellent “The Curious Incident of the Dog in the Night-time” by Mark Haddon (excuse me while I digress, but I also recently read Stumbling on Happiness by Daniel Gilbert, and one of his chapters starts with a quote from one of the Sherlock Holmes novels where Holmes solves the crime by noticing “the curious incident of the dog in the night-time” – so THAT’S where the title came from!). In Mark Haddon’s novel the narrator is a boy with autism and the fact it’s told in the first person gives you an understanding of what it’s like to experience the world from the viewpoint of an autistic mind. I think “The Curious Incident…” is a much funnier book than “Engleby” (to be fair, Engleby isn’t supposed to be a funny book!) but it also packed a bigger emotional punch for me than Engleby did (“Human Traces” packs a more powerful emotional punch too). The narrator of Engleby has a mental disorder which means he has difficulty making healthy relationships so the whole experience of the novel is from the standpoint of someone who is a bit cut off from others, who finds social interaction difficult and who is seen by others as strange.

It’s a bit of a whodunnit too because one of the students Engleby knows disappears and for much of the novel it’s not clear what’s happened to her. I’m not going to reveal any of the endpoints of this novel because I do think the suspense adds to the enjoyment of reading it.

Consciousness, memory and the self are core themes of this novel and that really appeals to me. Consciousness, for example, is still not clearly understood and I do think our understanding of it increases by considering it using ALL the tools of philosophy, neuroscience, cognitive psychology AND literature. Drop any of these approaches and it’s harder to understand.

Taken together, “Human Traces” and “Engleby” really contribute to our understanding of the workings of the human mind. I highly recommend both of them but the reader should be prepared for two VERY different books.

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Shelter

Shelter, originally uploaded by bobsee.

You never know where you might see the light!
As I passed this empty bus shelter the other morning I was suddenly struck by how it wasn’t empty at all – it was filled with LIGHT.
Lovely effect I think

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I was heading home on the train from Glasgow to Stirling the other day. I enjoy having my daily commute of about an hour in a train or a bus either way because it gives me quiet, undisturbed time to sit and think, or read, or write, or listen to my ipod. This particular day there was a young, blonde woman opposite me. At one of the stations she moved and sat in another seat (I think to have a table to herself!). The train arrived at Stirling station and I gathered up my belongings and headed for the door. As I passed her table she said, in an American accent, “Excuse me sir. I feel I’m supposed to give you this” and handed me this –

thebox.jpg

I was a bit taken aback and without thinking stepped off the train with the gift in my hand. It was a metal box. I unclipped its magnetic catch and opened the lid to reveal this –

insidethebox.jpg

So now I’m thinking……what??!! A bible!!?? Why me? What did she see in me to make her think she should give this to me! Worse, it was a well worn box which was obviously her frequently used personal copy of the bible. She wasn’t even a bible distributer handing bibles out to strangers like some kind of Scotrail Gideon! What had she seen in me? Did I look depraved and in need of saving? Was I looking weary and worn and needing my spirits lifted? It was all deeply disturbing! What did she think was wrong with me? What need did she think she saw in me?

Then I remembered what I had been reading as she had sat opposite me. Here’s what she would’ve seen –

reading.jpg

OK, so now I understand! She thought I was searching for happiness and I guess she thought I’d be more likely to find it in the pages of her bible than in Daniel Gilbert’s book. Well, it was a kind thought. It involved some sacrifice for her to give away something that was important and personal to her. But! She judged me! She saw what book I was reading and figured not only what kinds of problems I might be facing but how I might best find the answers! Thank you for your kindness, anonymous American girl, but I wasn’t searching for how to be happy. I am happy. And you can rest assured your gift will not get any more worn out than it was the day you gave me it.

An interesting variation on the old saying, huh? Not only can you not judge a book by its cover, but you shouldn’t judge a person by the cover of the book they’re reading!

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The Wellcome Library specialises in the history of medicine. It’s based in London but has recently put online a collection of images which you are able to use freely under the Creative Commons License. The Head of Wellcome Images says,

Wellcome Images is an invaluable tool for teachers and researchers of medical history, health, clinical and biomedical sciences. Through visuals users are able to develop a more profound understanding of human and animal biology, and can use them in their research and teaching. What is unusual for a picture library of this nature, is that the online service is completely free.

The collection is grouped into six sets (each starting with the letter “W”!) –

  • Wellcome
  • War
  • Wonderful
  • Witchcraft
  • Wellness
  • World

Some of the images are startlingly beautiful. Go have a browse. This is an especially useful resource if you teach biological or health sciences.

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Arthur C Clarke proposed three “laws” or principles about prediction –

  1. When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong.
  2. The only way of discovering the limits of the possible is to venture a little way past them into the impossible.
  3. Any sufficiently advanced technology is indistinguishable from magic.

There’s a lot of noise these days about “anti-science” – I find this a strange term actually. It’s about as useful as “anti-art” or “anti-philosophy”. “Science” is not a discreet entity. It’s a way of thinking. Deleuze really clarified this for us. He said science was a way of thinking about function. That’s a good summary in my opinion. I enjoy science because it helps me to understand how things work (sometimes!). Deleuze went on to point out that philosophy was a way of thinking about concepts and art about percepts and affects. These great human endeavours – of science, philosophy and art – give us very different ways to think about our lives and the world we live in. Each way of thinking can potentially be illuminating. But it isn’t a competition. The one way of thinking takes nothing away from either of the others.

So when distinguished but elderly scientists claim that “science” is under attack, I fear they’re misguided. What they probably mean is that their world-view is being challenged. Scientists should challenge each other. They should continuously enter into rational debate with each other. But science (thinking about function) is only one way of understanding experience. What’s the science of love? What’s the science of poetry? What’s the science of Shakespeare? Yes, you can take a scientific approach to any of those subjects but there are better ways to understand love and literature.

Health is an interesting case. It’s actually hard to understand. We know when we’ve got it and when we haven’t, but what is it actually? Science can help us to understand a lot about health by helping us to find out how organisms function. But philosophy and art can also help us to understand health, because health is an idea, a concept and an experience too.

So when “scientists” dismiss experiences which they can’t make sense of, it is worth while considering what they have to say, but it’s important not to make the mistake of thinking they are telling the Truth, the Whole Truth and Nothing but the Truth. There’s more to life than understanding function and there’s more to life than we currently regard as possible. We, the human race, progress by not accepting that something is impossible. Progress involves discovering that much more is possible than you previously thought. Daniel Gilbert writes about this very nicely in his Stumbling on Happiness. He says when imagining the future we are always limited by what we know now. Futurologists tend to imagine versions of the present rather than the radically different futures which actually transpire.

I love life at the edge of discovery. It’s like magic.

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I’ve been reading some of the happiness literature recently. Not because I’m not happy – I am! But mainly because the area of medicine in which I work is based on two things – taking a holistic view, which really just means engaging with a person instead of just a person’s disease! And, secondly, it’s based on trying to aid recovery and increase resilience, as opposed to just trying to rescue a situation, or repair some damaged tissues. There’s a lot involved in helping someone to get better including enabling self-understanding, instilling hope, encouraging a positive attitude, as well as tackling disease processes. I’m especially interested in an approach to medical care which seeks to understand the uniqueness of each and every patient I see and enabling them to develop in the face of their illnesses – by develop I mean to adapt, to become more creative and to be more fully engaged with their lives (see here)
I read The Happiness Hypothesis and thoroughly enjoyed it. Thought provoking and enlightening. I then moved on to Stumbling on Happiness, by Daniel Gilbert (ISBN 978-0-00-718313-5). These two authors have completely different styles but both are tackling the question of what makes people happy. Gilbert’s book is much more a psychologists approach – in fact, I’d go as far as to say an experimental psychologist’s approach. In the opening chapters he lays out his strong belief that the way to understand how the human mind works is to study phenomena of large numbers of people. He says we can’t rely on the experiences of individuals but we can rely on phenomena which can be demonstrated time and again in group studies. That made me a bit uncomfortable because as a clinician I find that often the statistical “evidence” from group trials turns out not to be appropriate for an individual. Drugs are a great example of this. There isn’t a single painkiller on the market which you can guarantee will take away the pain of a particular patient. It doesn’t matter how many hundreds of thousands of people have benefited from a particular treatment, this particular patient today may well turn out to be the one who gets no response at all. We see the same phenomenon with blood pressure pills, sleeping pills, anything really. Obviously a doctor should recommend the safest treatment which seems to have helped a significant number of patients but he or she must remain open to understanding that for this patient this pill just might not work. We are all actually different. I’ll return to this issue shortly.

I really didn’t want to like Gilbert’s book because of the cover. It looks cheap and puerile. However, you can’t judge a book by its cover! Once I started to read it, I loved it. I’ve read criticisms of his familiar, humorous writing style but it really works for me. It’s a treat to read and it often made me laugh. His cultural references, especially to Beatles songs hit the spot for me. The content was fascinating too. OK, many of these studies published by psychologists have been written about in other books, but Daniel Gilbert presented a fair number of interesting studies which I’ve never read anywhere else.

After a while, psychology experiment after psychology experiment begins to feel like a magic show. So often the result is a surprise. I could almost hear “abracadabra!” in the background! This is fun and interesting but its novelty begins to wane. (Actually his section on magic tricks themselves is particularly interesting – check this post) Throughout the book he held my interest, and he made a good, clear case for the claim that memory, perception and imagination are all imperfect representations of reality –

Foresight is just as fallible as eyesight and hindsight.

I have no doubts about that. However, for me, I’m more comfortable with the understanding that memory, perception and imagination are all creative processes – individual, subjective, creative processes.

Having demonstrated that we are not reliable judges of either what did make us happy, or what will make us happy, he ends up with a recommendation that totally baffled me. In his final chapter (the one before the “Afterword”) he seeks to answer the question “how should we decide what to do?” Somewhat astonishingly he says that as we can’t rely on our memories or our imagination, we should rely on the experiences of others. He claims this will work because we have an over-inflated sense of our individuality and uniqueness. He says “What makes us think we’re so damned special?” and argues “Our mythical belief in the variability and uniqueness of individuals is the main reason why we refuse to use others as surrogates……..surrogation is a cheap and effective way to predict one’s future emotions, but because we don’t realise just how similar we all are, we reject this reliable method…”

Pardon?

The best way to predict how I’m going to feel in a situation is to ask others who have already been in that situation? Yes, I understand the importance of empathy and of sharing stories and learning from others, but, you know something? There’s only ONE Daniel Gilbert! And there’s only ONE me! I liked some of the same Beatles songs as you, Daniel, but I don’t rate statistics and experimental psychology as highly as you do because we’ve lead different lives, in different cultures with a myriad of different experiences.

Just stop for a moment and think about taking his recommendation to rely on the reports of others to predict how you’re going to feel in a certain situation. When was the last time you read a movie review, went to see the movie and had such a different experience from the reviewer that you thought “did we see the same movie?!” In “Who Wants to Be a Millionaire?” you can go 50/50, phone a friend or ask the audience – you might get some clues from what they say but they don’t always give you the right answer – why not? Well Daniel Gilbert answers that himself – they too are humans with fallible memories, fallible perception and fallible imagination. Why should the report of someone else be more reliable than what I know about myself?

I think there are two crucial elements missing from this exploration of happiness – narrative and the importance of meaning. We experience life through the creation of stories – the stories we tell others and the stories we tell ourselves. Storytelling involves using memory, perception and imagination. Through the creation of stories we gain a sense of self AND we make sense of our experiences. Human beings are meaning-seeking, meaning-creating creatures. And two people in the same circumstance will have vastly different experiences because the circumstance is interpreted differently, made sense of differently, means something different to each of them.

Yes, yes, yes, we share more than we often realise. With a bit of empathy we can realise just how much we do share with other people, but I insist, we are all different, all unique and, you know what?

YOU ARE SPECIAL!

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Daniel Gilbert says in his book, Stumbling on Happiness, that research shows us that people regret the things they DON’T do much more than they regret the things that they do.

Do you agree? Do you think you’re more likely to regret what you DON’T do…..maybe not today, maybe not tomorrow, but soon and for the rest of your life?

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If you like nature programmes, or enjoy bird-watching, this site – birdcinema.com will be a treat for you.

It’s kind of a Youtube for videos of and about birds!

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The BMJ published a study today which has been reported across at ScienceDaily. This is an incredibly thoughtful article which questions the prescribing of lipid-lowering drugs (statins) to the elderly. Whilst there is good evidence that lowering lipid levels in younger patients reduces their risk of suffering from cardiovascular diseases, there is not good evidence that the same benefits can be achieved with the elderly. However, doctors are being encouraged to treat the elderly with the same assumptions as they make when treating younger patients. Worryingly, one of the studies conducted in the over-70s who take statins shows that while there did seem to be a reduction in death from cardiovascular diseases, the overall mortality remained the same. In other words they died from something else. In this particular study there was an increase in deaths from cancer. The authors of this paper ask a question which I’m astonished has not been asked before.

Is it possible, they ask, that by introducing preventive treatments in the elderly aimed at reducing the risk of a particular cause of death, we are simply changing the cause of death without the patient’s informed consent?

Too often drugs are presented to the public and the medical profession in terms of “saving lives”. Drugs don’t save lives. However, they do alter the experience of dying, and, of course, therefore, the experience of living. But when coerced into taking medication to “prevent” future diseases, patients are not being told exactly what not dying from this particular disease might mean for them. What are they more likely to die from if they don’t die from heart disease for example? This is not a question that should only be asked when treating the elderly. It’s time we had some decent research on how medication changes the experience of living and dying, not just research which only focusses on single diseases. Only then can doctors and their patients make truly informed decisions.

However, the issue of treating the elderly as if you can expect they will receive the same benefit from a treatment as a younger person is also something we need to think about. It doesn’t make sense. People are different and “evidence” from drug trials conducted on younger people may well not be at all useful “evidence” when making a prescribing decision for an elderly person. To be useful, evidence has to be relevant to the individual patient who is being persuaded to take medication.

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green, originally uploaded by bobsee.

If you enjoyed doing the previous “What is this?”, here’s another one.
You’ll have to look very carefully

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