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Archive for September, 2007

Some books you can gobble down quickly like fast food, but some just need to be sipped and savoured. I’ve been carrying around and reading The Joy of Philosophy by Robert C Solomon (ISBN-13 978-0-19-516540-1) for the last two or three weeks. Got some strange looks from people on the train who could only see the first part of the title…….”The Joy Of” (bet they never worked out the next word was “Philosophy”!).

I really enjoyed this book. You know how sometimes you read a book and it seems to open doors for you? Suddenly you see or hear something differently and the world and the way you experience it has changed forever. I played with an idea for a story once. I called it “Quantum Days” because I wanted to explore the phenomenon, that we all experience, of those days when something changes and its so dramatic, or so significant, that the world is changed for us so completely that we feel now we’ve moved to a new level (like electrons jumping from one level to another in the atom – quantum jumps). Well I will get round to writing the rest of that story one day. Quantum Days can come about from reading something though. Occasionally there’ll be an “aha!” moment and your world will be changed. This is one of those books for me.

The central thesis of the book is contained in it’s subtitle on the front page – “Thinking Thin versus the Passionate Life”. Throughout the book Professor Solomon uses a very interesting language device – the juxtaposition of “thin” and “thick”. For him, “thin-ness” of thinking is limited, reduced, somewhat sterile thinking. In particular it’s that form of rational thinking which deliberately attempts to be dispassionate.

my revolt against logical “thinness” is very much a celebration of the passions in philosophy and the richness they provide.

It’s amazing how in medicine as well as in philosophy (and I suspect in science too) the passions, or emotions, are frowned upon. There’s a belief around that “the truth” can only be discovered by the dispassionate, the disengaged, the distant, but Robert Solomon argues strongly against that. In fact he argues for the central importance of a passionate life. He doesn’t use the language of “subjective” versus “objective” but that debate fits well with his. I’ve always been amazed that anyone can think the subjective can be left out of health care (or even “controlled for”). The subjective self (an at least partially socially constructed self) can never be taken out of our experience. It’s just impossible to have an experience which isn’t coloured by, framed by, and reacted to by, the self. That’s why who the doctor is, is important in a consultation. Yet I’ve never seen a single research study in medicine which identifies and/or describes the therapists who are actually entering into the encounters with the patients. Sorry, I digress……..but that’s just one of the many trains of thought this book set off and running for me.

He questions the traditional notion in philosophy that a dispassionate thinking about life can lead to a “good” life

A virtuous life might be something more than becoming the congenial neighbour, respected citizen, responsible colleague, and affective zombie that many philosophers and contemporary moral pundits urge us to be.

Oh yes! I love that phrase “affective zombie”! Here’s more….

I do want to raise the question of whether mere proper living, obedience to the law, utilitarian ‘rational choice’ calculations, respect for others’ rights and for contracts, and a bit of self-righteousness is all there is to a good life.

What he is arguing for is a life of passion, an emotional life. What does he mean by emotions though? How does he understand emotion? Well, he definitely does not think we can fully understand emotions by studying brain chemistry, nor by psychoanalysis, or, I suspect, the research conducted into Cognitive Behavioural Therapy. Why not? Because he proposes (and this is one of his radical ideas for me) that we best understand emotions by not focussing on individuals but on relationships, behaviours, actions and society.

….an emotion is not a disposition: it is, first of all, an experience and a way of being-in-the-world

and, later,

it is the context and the social environment that make most emotions intelligible

and

an emotion is not so much an element or item “in” experience as it is the ordering of experience

I could go on……I’ve written down many quotes from this book. What is exciting for me about this thought is that it embeds the experience of emotions so firmly, so inextricably into the contexts of the world in which we live and it gives them a central role in our attempt to make sense of our lives and to act rationally and deliberately in life.

He writes a lot about love but I’ll explore that in a separate post. Let me finish this one with two more quotes from this stimulating book.

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Emotions are strategies

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I’m giving that space so you don’t miss it. Think about this. Are emotions the ways in which we effect change and make an impact on the world? Are emotions actually actions? What does happiness do? What does love do? Anger? Grief? This is a potentially liberating but also empowering perspective.

We too often opt for victimisation or cynicism, the products of our overactive faculty for blame and our extravagant sense of entitlement, or we take refuse in pessimism. But there are better ways to think about life…..

It’s the heroes not zombies argument. Instead of thinking that emotions just happen to us and that our experiences just happen to us, this perspective gives us the opportunity for a much more active and creative engagement in life.

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River Forth

As I was in a plane flying into towards Edinburgh Airport I decided to take a photo of the Forth Railway Bridge. Only after I’d taken it did I notice the large ship in the estuary – it’s the QE2 on it’s celebratory 40th anniversary tour.

QE2

QE2 and Forth Bridges

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The Stirling Girl, originally uploaded by bobsee.

Over recent months Stirling Council has erected some information panels around the city. On one side is a map of the area and on the other are some images of that area as it was along with interesting little histories.
On the panel at the foot of the “Back Walk” I found this image. I’ve never seen it before even though its from the 1920’s.
I find it quite captivating. I love how the more you look at it the more you see. Within the picture are many of Stirling’s famous landmarks – the Wallace Monument in the feather on her head, Stirling Castle on her hat, along with the Wolf and Robert the Bruce, then around her neck the Old Stirling Bridge.
Have you seen other examples of this kind of drawing anywhere?

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Good science

I’ve always had a bit of a passion for science. But what does that mean? What is science? There’s a lot of talk these days about anti-science, as if it were some kind of political party or team to be opposed, or about bad science, which, strangely, tends not to be a discussion about either the philosophy of science or about more or less effective methodologies. In fact, people do tend to apply labels to the experiences of life and those labels, unfortunately, more often stop thought than promote understanding.

So, let me say what I mean when I use the word science. My understanding of what science is owes a lot to the philosopher, Gilles Deleuze. He said there were three ways to think about experience – science, philosophy and art. You can read more about that here. He said science was thinking about function. That makes a lot of sense to me. A scientific approach to a phenomenon is one of curiosity, one of wonder; it’s driven by a hunger to understand. Specifically, it’s about a hunger to understand how something works – whether that be the brain, evolution, or the weather. Indeed it’s about a way of trying to make sense of some aspect of the world. There are two important consequences to the Deleuzean definition for me – one is that science is only one way of thinking about the world, and the other is that it is the main way to think about how something works.

But there are other factors to consider when thinking about science. Popper’s famous principle of “falsification” really hit the mark too. The scientific method is not one of proving things; it’s one of attempting to disprove things. In brief, what Popper said was that we form a hypothesis (an explanatory theory of something) and then, as scientists, we conduct experiments to try to disprove that hypothesis. The more we fail to do that, the stronger the hypothesis becomes. In other words, good science is a process of never ceasing to doubt. A good scientist never says he or she has worked everything out and there’s nothing more to be discovered here. A good scientist must be humble, open-minded, curious and never cease to wonder. When you read the writings of a scientist who claims to be the holder of The Truth, or who claims to be absolutely certain of their position, beyond doubt, you know you’ve found a scientist who’s lost the plot. Scientists aren’t gods. They are people. When they get hooked on certainty conversation with them becomes uncomfortable or even downright unpleasant. That’s not a function of science though, because a scientific approach necessitates a perspective of doubt which should humble.

There’s another quality which is often mentioned in relation to science. One definition I read, (and I confess I can’t right at this moment remember where!), was that science is the study of what can be measured. Well, I’m not entirely comfortable with that definition but I can see where it’s coming from. It’s impossible for us to lead a value-free life. Everything we think and experience and do and influenced by our values. In the scientific approach, there is a tendency to value the physical over the non-physical and that’s what tends to lead to a view that science is about what can be measured. For example we can easily measure the physical dimensions of red patch on the skin of a patient with eczema but we can’t measure their itch, and we can’t measure their emotional experience of their eczema. If we dismiss what can’t be measured we dismiss the experience of eczema (as Cassell would call it, the “illness”) and focus only on the physical changes which are measurable (Cassell again – the “disease”)

So, let me say again. I’m passionate about science. Why? Because I am insatiably curious! I love to explore and discover. I love to understand the world, my life and the people I meet. I know that understanding is an eternal process. It has no stopping point. It’s never finished. It has no conclusion. So, for me, science is a way of understanding life better. That said, philosophy and the arts are equally important ways of understanding the world and each will shed a very special light which the other ways of thinking won’t.

I am equally passionate about philosophy and the arts.

I titled this post “Good science” because I want to highlight a positive conception of science – insatiably curious, constantly developing, continuously humble, practised with an intention of building our knowledge and understanding.

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heading south

heading south, originally uploaded by bobsee.

Winter’s coming
Look! The geese are heading south. Such a lovely sight.
I’m sorry I didn’t get a better photograph of them but I’ll keep my eyes peeled and maybe I’ll see some more.
We had a thin frost yesterday morning so I guess the geese saw that coming!

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the white house, originally uploaded by bobsee.

I just love the colours in the sky over Ben Ledi.
But see that white house over to the left? It’s catching the sun so it’s catching your eye.
We are very good at spotting what’s different, noticing what is unique.
I love that
I love that our perception allows us to focus on what’s different, what’s unique

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I work at Glasgow Homeopathic Hospital. I’m a medical doctor, used to be a GP (Family Physician), but I became gradually disenchanted with prescribing only antis (anti-biotics, anti-depressants, anti-inflammatories, anti-histamines, anti-hypertensives……..you get the picture) and only having the time to focus on little bits of people instead of the people themselves (we call those little bits diseases by the way). I had perhaps strangely had a notion that being a doctor would be about being involved in healing (ever tried looking up “health” or “healing” in a medical textbook? Don’t bother. No such index items!) so just suppressing bits of people didn’t feel like what a proper doctor should be doing. On top of that there were situations every day where I just didn’t have anything good to offer (everything from infant colic, to night cramps, restless legs, sports injuries, PMT…….blah, blah, blah – believe me, there are LOTS of problems your doctor doesn’t have answers for!)

I happened upon a course in “Homeopathy” at Glasgow Homeopathic Hospital back in 1983 – didn’t know there was such a hospital and had no idea what “homeopathy” was anyway, but something about the ad caught my attention – wish I could remember what it was! – I think it was something that mentioned “healing”! Well, I signed up. I learned there about homeopathic medicines, how safe they were, and what their indications were and they gave us a wee box of 10 remedies to go and try out in our practices. Well, from the first try I was amazed at how good these treatments were. They could deliver improvements in conditions I hadn’t other answers for and that was VERY useful. Patients would stop me in the street and thank me for the prescription because it had helped so much – that NEVER happened when I prescribed an anti-something!

To cut a long story short, the patient demand for homeopathic treatment drove my learning and after I passed the Membership exam of the Faculty of Homeopathy I started working at the Glasgow Homeopathic Hospital in the Outpatient Dept every wednesday. Well, my wednesdays soon got an awful lot more satisfying than the mondays, tuesdays, thursdays and fridays, so I had a crisis. All my life I’d wanted to be a doctor, no, not just a doctor, but a GP, and here I was thinking I don’t want to be a GP anymore. So I stopped being a GP and for a few months did a weekly radio show on ScotFM, wrote a textbook of homeopathy for GPs, and did my wednesday clinics. After a few months my friend and colleague, David Reilly at the Homeopathic Hospital suggested we make a bid for the creation of full-time position for me at the hospital. I started there full-time in 1995 and I’m still there. I love it! Every single day, every single clinic, every single patient. I look forward to every day of work. How many people can say that?

So what do I do there? What’s this homeopathy?

Everyone I see there has been referred by another doctor or nurse. Everyone I see has a chronic problem – everything from chronic pain, to allergies, skin problems, cancer, multiple sclerosis, psychiatric problems like depression, bipolar disorders, you name it. I see a lot of kids. Almost half my practice is treating children. The thing most of these people have in common is that they’ve already tried the drugs, surgery and so on recommended by other doctors but they’re still not well, still suffering. Amazingly, our in-house audits consistently show that across the board, after receiving homeopathic treatment, around two-thirds of these patients claim a benefit which makes a difference to their daily lives.

So, no wonder it’s such a treat to work there. Most of the patients get benefits from the treatments which they didn’t find elsewhere. That’s hugely satisfying if your goal in life as a doctor is to try and relieve suffering.

Ok, enough, you’re probably thinking, what on earth is this homeopathy thing anyway?

Dr Samuel Hanhemann, was a German doctor who lived from 1755 – 1843 As a young doctor he soon grew disenchanted with the practice of medicine of his day – he thought that blood-letting, cupping, leeching, purging and poisoning patients was pretty brutal and didn’t seem to actually heal anyone. So he stopped being a doctor and to earn some money he translated textbooks into German. One day he was translating Cullen’s Pharmacopoeia from English into German and he read about the treatment of swamp fever with Peruvian Tree Bark. Cullen said this drug worked by being an “astringent” ie it dried the body up. Hahnemann, wondered if that was right, so to test it out, he took some. Much to his surprise, he found that he got all the symptoms of swamp fever. How interesting! The drug which can cure the disease can produce the same disease when given to a healthy patient (that’s not exactly true but it’s how he saw it). He then tested a bunch of other common drugs of the time and found the same phenomenon. He called this “the treatment of like cures like” – “homeopathy”.

Does this make sense? Well, yes it does. There’s a phenomenon we know called “hormesis” – where a drug which has one effect at a high dose, has an opposite effect at a low dose. Think of aspirin. In high doses it makes the body temperature rise, yet in low doses it can lower a fever. Professor Bond, pharmacologist in Houston coined the term “paradoxical pharmacology” to describe this phenomenon and even created a receptor theory model to explain it. Nothing really controversial here. Let’s move on.

Hahnemann thought that doctors shouldn’t be poisoning their patients so he decided to find out what was the smallest possible dose of a medicine which would bring about a healing effect (when prescribed on the basis of this like treats like idea). There weren’t any drug companies in those days so doctors had to prepare their own medicines. Hahnemann used a method of serial dilutions and succussions to make his medicines (that’s a stepwise series of dilution of the original substance with vigorous shaking of the test tube between each dilution). He got another surprise. Not only did the smaller doses cause less harm, they actually seemed to cure quicker! The more dilute preparations had a more powerful effect! OK, I hear you say, enough’s enough. This is crazy thinking! Well, it gets worse. Cos he pushed this dilution theory way up to 1 in 10 to the power 30 and beyond – trust me, I’m a doctor – that means there are NONE of the original molecules left! Now THAT is controversial! In fact, its at this point where some people start to say homeopathy is sheer nonsense and can’t possibly work!

Would it surprise you to know I disagree with that view?

You might want to go check out the scientific research in homeopathy. I recommend you start here. In short, there are many clinical trials of homeopathy and many have shown effects of homeopathic treatments that cannot be dismissed as placebo. Something seems to be happening and its probably not placebo. In fact the clinical trial evidence in homeopathy is not very strong and doesn’t really answer any of the questions about this treatment so we need to look elsewhere. Elsewhere includes what are known as outcome studies. These are studies of what actually happens to patients who have homeopathic treatment (not comparing this to placebo medicines). Consistently such studies show around two out of every three patients get benefits from homeopathic treatments. So, however you explain it, for most people it does exactly what it says on the tin – it helps. What about the idea that such ultra-high dilutions can have a consistent biological effect? Is that nonsense? Well, interestingly, there have been a number of laboratory studies in recent years which show that water does indeed have the capacity to communicate specific effects of substances which have been diluted in it many times. This is early work but it shouldn’t be dismissed.

But what IS homeopathy?

Homeopathic medicines are prepared from natural substances – plants, minerals, substances of animal origin – all of which are serially diluted and succussed many, many times to prepare the actual medicines. Every single medicine has its own unique picture of symptoms as described in homeopathic materia medicae – these are reference books based on clinical trials (called “provings”), clinical experience and toxicological information about the substances. The idea is that the picture of the remedy should match, as closely as possible, the picture of the patient’s illness (actually I prefer the concept of the “narrative” as opposed to the “picture”).

The narrative of the patient’s illness reveals their unique experience (no two people with the same diagnosis have the same narrative) and it reveals their patterns of coping (and failing to cope) – this is what we are looking for in selecting a specific homeopathic medicine – the narrative of the experience and the patterns of coping. When the patient takes the homeopathic medicine the intention is to stimulate their processes of self-repair, self-recovery and self-healing. The intention is NOT to suppress but to heal. The medicines themselves are non-toxic – they have no significant side-effects, a record over 200 years of absolutely NO fatalities, and can be safely taken in conjunction with other prescribed medication.

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