Archive for July, 2008

spiky defence

Look at this plant. Wow! Has it got SPIKY leaves! I find things like this totally fascinating. These little spikes really were needle sharp. This is one of the ways a plant can protect itself. Not much fun when you brush against it or stand on it with you bare feet! But then, that’s what it’s trying to tell you NOT to do!

spiky defence
People can be like this too. Spiky-ness is a very common human strategy of protection. It’s very uncomfortable to be around but it can be very effective in getting the person the distance they want or feel they need from others. Trouble is because it’s so uncomfortable to everyone else, it’s not a strategy that elicits much empathy or understanding. Mostly people either just get “jaggy” back, or avoid the person like the plague. If it’s temporary and what the person really needs is a bit of personal space then it can really work, but if it becomes a way of life, or a strategy which seems ever present, then the person using it can pretty fundamentally feel alone and unreachable. It’s a sad and difficult loop to be stuck in.

It takes more patience and the desire to understand in order to help to gain the trust of someone like this. And it’s only once that trust begins to kick in that the spikes begin to recede.

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golden seedhead

Has anyone any idea what this plant is? I just stumbled across a few of these on a walk (I’m staying just outside of Aix en Provence in the South of France just now). I’ve never seen anything quite like this and there were quite a lot of them growing in twos or threes straight out of the ground, about a foot high. The seedhead itself is about the size of a clenched fist.

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When in France I enjoy picking up a magazine or two in the local newsagents. You just get a different kind of magazine in France from what is available in Scotland. One I like is “Philosophie”
You’ll see I read it with my huge Francais-Anglais Dictionnaire to hand!
This issue has an interesting lead feature about the passage of time. Referring to philosophers past and present they consider time from three “dimensions” (with the seasonal focus being on how we experience the passage of time while we are on holiday).
They discuss “le temps de la nature”, “le temps de la conscience” and “le temps collectif”.
The first is Nature’s time dimension, which is, of course, immense compared to the short period of time experienced in a single human life. They point out that we “temporalise” Nature’s time by our use of clocks, watches and other “timepieces” to “measure” time, but this, actually, is just a human invention. Time is not measurable. Our particular units of measurement are culturally determined. They are what they are just because we’ve agreed to use them. Nature knows nothing of minutes and hours. Holidays allow us to step out of these culturally determined rhythms – the nine to five of working life for example – and get in touch with a different experience of the passage of time, related to the weather, to the cycles of the moon, the growth, blossoming and seeding of the plants around us, to the presence of certain birdsongs as migrating birds move through the part of the world where we are.
The second is time as we experience it subjectively, with our eyes closed. As we drift on the pool, or under the bright sun, the past, the present and the future all intermingle in our consciousness. It’s in our own heads where we can experience time not as a simple line passing before us in single file. We can hold the past and the future together in our minds in the same instant as the present. Contemplative practice allows us to disengage from the world for a while and step out of the constant flow of time to see things from quite other perspectives.
The third dimension to consider is shared time, social, societal time. In this issue, the authors consider this from the perspective of collective rituals, festivals, celebrations and routines. In France, for example, the first weekend of August is known as “Le Grand Depart” – the great departure – because most people start their holidays that weekend. In Scotland the cities have their own version of that. Today, in fact, is the start of the “Glasgow Fair”, otherwise known as “Fair Fortnight”, when, traditionally, all the industries would close down for two weeks and the workers would have their annual holiday. Despite de-industrialisation, the “Glasgow Fair” continues. Today is a Glasgow Public Holiday. Last monday was “Bastille Day” in France and there was a Public Holiday, dances, parties and fireworks. (here’s the mobile phone video I took of the fireworks at Carcassonne Castle last year!) These societal and communal rituals and celebrations mark the passage of time in a uniquely shared way.

So, there you have it. Three ways to think about the passage of time. Think I’ll go and have a lie down!

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Taking forward the theme of what we find quirky in each other’s cultures…….here is a butcher’s shop window in Aix en Provence. OK, any vegetarian readers, look away NOW!

Seriously though, this is a fabulous butcher shop. It’s always busy, the staff are so friendly and efficient and the meat is really of the best quality you could imagine.

But what the @*!! is that squirrel doing in the window???

butcher's shop

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As I was wandering around Valensole the other day I found myself in the Rue Grande.
rue grande

Doesn’t look that grand, does it?
However, what caught my eye, was the catalogue sticking out of the way too small letterbox in that door there.

old and new

This struck me for so many reasons. First off, the building looks uninhabited…..like for years! However, it’s a small village so the postie is bound to know! Of course, such worn external appearances are actually the norm in village France. Still surprises me that. It’s a quirk of the French (actually, now that I think about it, the Italians have the same quirk)….it’s kind of as if they don’t really care about the external appearance of a dwelling but they have an incredible sense of style and chic so you’ll see beautifully dressed people coming out of such places. La Redoute is a major fashion catalogue shopping company.

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As part of the NHS’s 60th anniversary celebrations, Donald Berwick, President of the US organisation, the Institute for Healthcare Improvement, made a speech at one of the specially organised conferences. I’ve always been impressed by his writing and his speeches. I first encountered them when I read “Crossing the Quality Chasm” – the book which introduced me to the concept of “complex adaptive systems”, and I thoroughly enjoyed his “Escape Fire” ( a collection of ten of his annual addresses ).

His speech, in praise of the NHS, compared it very favourably to the state of health care in the US. In summary, he said this –

You could have had the American plan. You could have been spending 17% of your gross domestic product and making health care unaffordable as a human right instead of spending 9% and guaranteeing it as a human right. You could have kept your system in fragments and encouraged supply driven demand, instead of making tough choices and planning your supply. You could have made hospitals and specialists, not general practice, your mainstay. You could have obscured accountability, or left it to the invisible hand of the market. You could have a giant insurance industry of claims, rules, and paper pushing instead of using your tax base to provide a single route of finance. You could have protected the wealthy and the well instead of recognising that sick people tend to be poorer and that poor people tend to be sicker, and that any healthcare funding plan that is just must redistribute wealth. Britain, you chose well. As troubled as you may believe the NHS to be, as uncertain its future, as controversial its plans, as negative its press, as contentious its politics, please behold the mess that a less ambitious nation could have chosen.

He then went on to make ten suggestions for improvement. The first, I think was the most important and one that most health care systems haven’t even begun to implement on any significant scale –

Put the patient at the absolute centre of your system of care—In its most authentic form, this rule feels very risky to both professionals and managers, especially at first. It means the active presence of patients, families, and communities in the design, management, assessment, and improvement of care. It means total transparency. It means that patients have their own medical records and that restricted visiting hours are eliminated. It means, “Nothing about me without me.”

Apart from that he recommended strenghtening the Primary Care and Community aspects of the service, stopping the habit of more and more “reforms”, a strong plea NOT to pursue a market-led direction (ie I suspect, to do more like the Scottish NHS than the English one), and paying attention to the training and integration of the diverse employees of the NHS. Finally, he recommended aiming at health itself, not just health care.

He is astute enough to know that “great health care, technically delimited, cannot alone produce great health”. Of course it would be nice if the NHS was structured around trying to improve the health of its users, but the real big changes in health as such will be achieved through political means and societal changes, not health care ones.

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I just read Professor Richard Wilkinson’s “The Impact of Inequality” (ISBN-13: 978-1-59558-121-1). I first read Wilkinson’s work on the impact of inequality on health in the BMJ back in the early 1990s. I found his research remarkable and disturbing at the same time. Essentially what he was highlighting was that in developed countries absolute income levels were not a determinant of health. Instead, what seemed to cause the greatest harm was the size of the gap between rich and poor. In other words, income inequality within a society impacts on many parameters of health, from infant mortality to life expectancy and many disease rates in between. This was a bit puzzling. We mostly believe that poverty, of the kind where your basic material needs of food, water and sanitation are not met, is indeed deadly, but that relative poverty ie the extent to which people feel poor compared to others in society could be deadly? How could that be? Was it true?

Well, over a decade has passed and dozens of more studies have shown the link between inequality and health. In “The Impact of Inequality”, Wilkinson sets out the case very clearly and then provides an explanation for the findings. In a nutshell, he shows that psychosocial stress has an enormous impact on health, and that the key element underpinning this stress is how we think others perceive us. Shame is a strong social force. We feel it when we are not respected, when we are judged to be inferior or to have failed, when we told we are just not “good enough” or when we are dismissed as irrelevant. Social status is the root of much of this shame in all societies, but especially in unequal societies which have strong hierarchies based on dominance and competition. The biological mechanism for this stress is the body’s inflammatory response. When experiencing stress, the human organism activates cellular and hormonal systems to increase defences and prepare the subject for “fight or flight” as a fundamental survival mechanism. Years of such inner responses produces an “allostatic load” – a fairly new measure for the accumulated inflammatory activity. A high allostatic load is associated with an enormous range of chronic diseases.

Let me just cite one example. In societies where there is great economic inequality, blood cholesterol levels are higher than those in more equal societies. These high lipid levels are part of the body’s inflammatory response. The reductionist, technological, “fix” for this is to prescribe statins for more and more people for greater and greater proportions of their lives. This isn’t exactly a matter of stable doors and bolted horses but even if the statins do what they say on the tin, the problem just shifts elsewhere. Unequal societies experience lower life expectancy, particularly in those who live in the poorest strata. If they don’t die early from heart disease, they die early from something else. The answer, if we take on board what Wilkinson shows us, is political. It’s about creating more humane, more caring, more “affiliative” societies by tackling the fundamental issue of inequality.

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Isn’t this beautiful?

I remember reading that Paulo Coelho starts writing a new novel when he finds a white feather somewhere. Wonder what this feather might be the start of?

It’s hard to know what size something is from a photo, isn’t it?

Here’s the feather again……..

feather on apple

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floating petals

Look at these beautiful little flowers floating in the water of this fountain! Aren’t they wonderful? I love stumbling across a little moment of beauty like this.

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