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Archive for November, 2007

A three year study into ADHD treatments has shown that while drugs like Ritalin reduce ADHD childrens’ “difficult” behaviour in the short term (in fact even up to a year), looking at them over three years shows that not only are the children still on these drugs not showing sustained improvements in their behaviour but some are showing significantly adverse effects such as stunted growth.

There’s a real emphasis in the dominant medical model on quick fixes. Arthur Frank, in his excellent The Wounded Healer, calls this approach the “restitution” one – the patient’s narrative is one of “I’m broken, please fix me and I’ll be on my way”. He says this is like the Fast Oil Change approach to medicine, but it’s very, very common, and it’s nurtured by both the medical profession (as fixers) and by the health industries (not least Big Pharma with its pill-for-every-ill approach to suffering). It is supported by a short-termist managerialism which insists on measurable targets or “outcomes” in clearly defined groups of patients. So we end up with people being classified according to diagnoses and then given treatments intended to produce changes in a set of variables defined by experts.

In ADHD (Attention Defecit Hyperactivity Disorder) the thrust has been to classify it, turn it into a defined entity and then “treat” the symptoms. The pharmacological approach is not curative but in the short term it takes the edge of the more extreme behaviours and so makes the child’s behaviour more acceptable. To be fair, this can also produce real benefits for the child who can then progress socially and educationally. What this study shows, however, is that in the longer term these benefits are often not sustained. And worse than that, in the longer term, the disadvantages of a drug approach become more apparent – stunted growth being one of the main findings.

What’s a better way? Well we don’t know yet but a complex approach involving the parents, the child, and the school seems to bring sustained benefits. And what about the roles of diet and the lived environment?

The trouble is those kinds of approaches are not as easy to deliver as a drug and the outcomes are not necessarily so measurable. But we have to bite that bullet if we want to move away from drug-focussed containment, to genuine improvement in terms of coping, resilience and growth.

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Take a look at this

pre-history

Then have a look at this

stand out

What do you see?

If you see what I see, you see puddles of water in the impressions in the rock in the first photo, then in the second photo it looks like the water is standing up out of the rock, almost like those scattered drops of mercury that would fly across the floor if you dropped an old thermometer.

This is the same photo. First time shown to you the way I took it, and the second time with it rotated through 180 degrees. Isn’t that stunning?

By the way, these are the markings carved into rocks of the Kilmartin valley, in Scotland, in Neolithic times.

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oldglass, originally uploaded by bobsee.

The glass in this window is very, very old. These days, a pane of glass like this would be tossed into the reject bin quick as a flash. And what would we have lost?
Look at the textures, the shapes, the whorls and lines almost like a fingerprint, and that’s what this is – a unique, one-off, handcrafted work.
“But you can’t see through it very clearly!”
That’s true. But does that bother you? Is all glass for seeing through? This pane of glass lets in the light and it sits in its frame with its marks, its folds, its what you might prefer to call flaws, beautifully displayed.
I stood and gazed at this glass for ages. Can’t say many modern panes of glass have caught me that way!
There is a beauty in uniqueness, and that beauty is never found in homogenised, mass-produced, “perfection”.
Japanese culture has a word for this – wabi-sabi – it’s funny how there’s no direct translation into English.

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I read this book some time ago but it came back to my mind when I stumbled across the dancer who claims to reveal whether your are dominantly left-brained or right-brained. The book in question is “A Whole New Mind”, by Daniel H. Pink (ISBN 1-904879-57-8). Let me say at the outset that I really liked this book. I found it stimulating, thought-provoking an useful. The basic thesis is that there has been a time of great progress in societies from left-brained dominance and, rather than argue that what we need is a time of right-brained dominance, Pink, I reckon, gets it right by arguing for a whole-brained approach. I like that. I find the left-right debate rather stale and unhelpful.

What he does is argue for the development of six, what he calls “senses”, which are, in effect attributes, or characteristics, which he says will give people who use their whole brains success over those who stick with old sided dominances. I really like all six of them. They are –

  1. DESIGN – products, services and experiences that aren’t just functional, but which are also “beautiful, whimsical, or emotionally engaging”
  2. STORY – it’s not enough to fashion effective arguments from information and data, “The essence of persuasion, communication, and self-understanding has become the ability also to fashion a compelling narrative”
  3. SYMPHONY – not analysis but synthesis “being able to combine disparate pieces into an arresting new whole”
  4. EMPATHY – “logic alone won’t do. What will distinguish those who thrive will be their ability to understand what makes their fellow woman or man tick, to forge relationships, and to care for others.”
  5. PLAY – there is a need for seriousness but there is also a need for play
  6. MEANING – many of us live in material abundance, and this has freed us up to “pursue more significant desires: purpose, transcendence, and spiritual fulfillment.”

The book has two sections. The first makes the case for a whole brain approach and the second devotes a chapter to each of these six “senses”. In fact, one of the things that takes this book out of the theoretical and into the practical is that he treats every “sense” to two chapters – the first clarifies what that sense is and the second is entitled “portfolio” which is a collection of exercises you can do to develop that “sense” in your own life.

You know what? I’m going to read it again!

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pebble

pebble, originally uploaded by bobsee.

How do these patterns form? How does this circle (OK a pretty wonky circle but a perfectly joined up circle all the same) form on a pebble on the beach? Isn’t Nature a wonderful and serendipitous artist?

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morning sky stirling station, originally uploaded by bobsee.

There’s no end to the variation of light in the sky.
When I looked up and saw this sunrise it looked as if someone had dipped a paintbrush in the emerging sun and streaked the colour up through the clouds

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A recent article in the Journal of Nutrition Reviews raises the issue of how focusing on single ingredients or nutrients within food in relation to health both misleads us and at times even results in harm.

The authors propose the concept of “food synergy” by which they mean “a perspective that more information can be obtained by looking at foods than at single food components”. They point out for example that measuring the amounts of a single nutrient – for example a vitamin, or a mineral, or an energy supply like fat or carbohydrate – frequently (I think they may even mean usually) significantly underestimates the levels that have biological effects on human beings which are available from actual food, due to synergistic effects of a variety of components within a foodstuff.

They take an example of the dietary connections with heart disease and cite several pieces of research which show that considering only the fat content in a diet to lower cholesterol levels in blood and so reduce the chances of heart disease is actually pretty inadequate. In fact, they even cite studies which show that certain other food factors in the diet may be even more important than lipids. For example, diets rich in unrefined plant foods such as whole grains, dark green and yellow or orange fleshed fruits and vegetables, legumes, nuts and seeds etc can lower blood cholesterol “comparably to statins”. Wow! What does that mean?

Well, before I draw any conclusions let me say one further thing from this paper – they show that what is most important is not the levels of single nutrients or components of food, but that the way components interact within a food is more significant. But more than that, they show that food patterns within a diet are also very important.

So here’s the conclusion. You can’t consider the impact of diet on food by measuring components and classifying some as good, some as bad, and defining optimal levels of them. No. What you have to do is consider the diet as a whole. And that’s much harder for scientists – because scientists have become dependant on “randomised controlled trials” and they can do those with single components of single foods but its much much more difficult to do that with the complexity of whole diets.

But, just cos its difficult for scientists to use their traditional componential methods, doesn’t mean we can’t develop emergent ones instead!

Look at the example of the relation between diet and heart disease again. There are two standout features there. Unrefined foods. And colourful foods. The more your diet contains refined foods, the worse it is. The more your diet contains brown or beige foods, the worse it is. (And, hey, no cheating – no artificial colourants allowed!!)

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It’s Amy‘s birthday today. Happy Birthday Amy

I’m gonna watch you shine
Gonna watch you grow
Gonna paint a sign
So you’ll always know
As long as one and one is two
There could never be a father
Who loved his daughter more than I love you

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I understand the value of focusing on only the part of something to try and understand it better. It’s an essential part of the way we make sense of our world. BUT we must never lose sight of the fact that we CANNOT understand the whole by understanding the parts when we deal with complex adaptive systems.

My own area of medical practice is holistic and that’s not a New Age concept – it’s a focus on the person, rather than just a part of the person which is damaged (the pathological lesion).

A couple of authors I’ve read recently have used other vocabularies to address this issue. Robert Solomon describes a focus on parts as “thin” – it lacks “richness” and “depth”. That strikes me as very true. There’s too much left out of explanatory models which are reductionist. So much left out in fact that they fail to help us understand real life complexity. And Andy Clark uses the term “componential explanation”. Somehow this immediately makes sense to me. He shows how this only works when “the parts display the relevant behaviour even in isolation from each other.” Otherwise, we try a “connectionist explanation” similar to that described so beautifully by Barabasi in Linked. But, he points out, even a focus on the connections is not enough and he describes another model – “emergent explanation” (as explored in Dynamical Systems Theory). This is a good explanatory model for real life complexity and includes a study of “collective variables, control parameters, attractors, bifurcation points and phase portraits”.

Now doesn’t that sound much richer than the reductionist approach?

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Being There, by Andy Clark (ISBN 0-262-53156-9) is one of the most interestingly challenging books I’ve read for a long time. Let me say first that it’s taken me longer to read than I’d have expected it to. There are whole swathes of it which just didn’t engage me easily. In fact, a few times I thought I’d pack it in, then I’d come across a few sentences or a paragraph that not only would grab me and turn my thinking upside down, but it’d be exciting, visionary and, yes, down right thrilling.

I really enjoyed Robert Solomon’s, The Joy of Philosophy, not least because I feel he gave me a new vocabulary. His one word/concept of “thin” really expanded my thought. You can read more about it here, but what really excited me about this word was the way it captured the inadequacy of logical/analytical/reductionist thought.

I then read Barabasi’s Linked, which homed in on the key concepts of connections and nodes. I especially liked the way he demonstrated that the world, though a complex and at times chaotic system, is not random. Randomness turns out not to be the explanation for the phenomena we experience daily. That changed the way I thought about the world – there are patterns to be discovered, and phenomena to be understood. Sure, there is such a thing as chance, and life is often extremely unpredictable, but we can begin to unravel the connections between things and events, and in the process we can improve our understanding of the world.

Now I’ve just read Andy Clark’s Being There and he puts forward concepts that similarly change the way I understand the world and uses language in some novel ways which open the doors to other ways to explore life.  His main thesis is that to understand the mind we have to step outside of the study of the brain – not that the brain is not important of course – but we need to understand the environments in which brains exist. He draws the connections between the brain and the physical, social and symbolic environments in which we live and shows that to fully understand how the mind works we need to explore the interactions between brains and the world. He calls this concept of the mind, the “extended mind” and in the process he nicely shows how we use our brains primarily for pattern recognition and for creating change in the world. In particular how we create the structures in the world that we can then use to extend the functions of our minds.

Let me highlight one simple example – doing a jigsaw. To do a jigsaw we don’t work it all out in our heads but we use our hands to literally manipulate the pieces, turning them around to view each piece from different angles, so stimulating our pattern-recognising brains, and moving the pieces towards and away from different sections of the puzzle. In other words we manipulate the physical environment to help our pattern-spotting brains do what they do best, and to do that more quickly. Andy Clark nicely shows how we do exactly the same thing with our social environment and, crucially, with our ability to handle symbols and signs, which has reached its highest point in our development of language.

What does public language do for us? There is a common, easy answer, which, though not incorrect, is subtly misleading. The easy answer is that language helps us to communicate ideas. It lets other human beings profit from what we know, and it enables us to profit from what they know. This is surely true, and it locates one major wellspring of our rather unique kind of cognitive success. However, the emphasis on language as a medium of communication tends to blind us to a subtler but equally potent role: the role of language as a tool that alters the nature of the computational tasks involved in various kinds of problem solving.

I’ve never read this idea anywhere else – it highlights language as not only being a tool of communication but also being a tool we use to reshape the world to enable our brains to more effectively use their capacities.

This whole thrust can feel a little vertiginous. Look at this for example –

Every thought is had by a brain. But the flow of thoughts and the adaptive successes of reason are now seen to depend on repeated and crucial interactions with external resources. The role of such interactions, in the cases I have highlighted, is clearly computational and informational: it is to transform inputs, to simplify search, to aid recognition, to prompt associative recall, to offload memory, and so on…

and this –

Our brains are the cogs in larger social and cultural machines – machines that bear the mark of vast bodies of previous search and effort, both individual and collective. This machinery is, quite literally, the persisting embodiment of the wealth of achieved knowledge. It is this leviathan of diffused reason that presses maximal benefits from our own simple efforts….

Well, I don’t know about you but this embedding of the brain in the web of relationships, stretching backwards, sideways and forwards in time, makes my head spin! It turns the mind into an even more dynamic phenomenon than I had previously realised and at the same time it turns it into a much less isolated phenomenon too.

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