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Archive for November, 2008

I woke up this morning and looked outside. Thick fog. I couldn’t see more than a couple of hundred yards. Everything I could see was covered in white, icy frost. Brrr…… How horrid! At least it’s Sunday, and I can stay warm and cosy, tucked up inside my house!

Then I thought, hang on a minute, bet there are some amazing photos I could take out there. So I got wrapped up nice and warm, picked up my D70, and headed out along the country lane. Here’s some of the things I saw..

a frozen web……

frosty web

ice frozen onto the wire of a fence turning it into razor wire……

razor ice

how ice doesn’t form symmetrically on a leaf….

bearded leaf!

and how it doesn’t form symmetrically on a berry….

frozen particles on the berries

the amazing patterns it makes when puddles freeze…..

patterns on the puddles

the trees at the foot of the castle turning into a Christmas card….

Back Walk Stirling

frosted oak leaves……

oak leaves

frozen roses with thorns of ice growing out of their petals……

frozen roses

and, on this St Andrew’s Day, Robert Burns, covered in frozen webs….

Robert Burns statue

I’m glad I went out and took a walk.

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Here’s one way to think about the hurts and wounds in your life, and how to address them.

Gravity is a force we don’t understand. How can two objects exert an influence on each other at a great distance? There doesn’t appear to be any kind of invisible string connecting them! Einstein came up with an interesting theory, however. He proposed that space and time were warped – that rather than being spread evenly in all directions, there were dips and undulations. The best way to think about this is to imagine a cloth. If you place, say, two oranges on a table cloth they will just stay where you placed them. However if you stretch the cloth out and allow the first orange placed to make a dip in the middle, then the next orange will inevitably fall towards the first one. Here’s a drawing from wikipedia, to explain Einstein’s theory, which shows what I mean –

spacetime_curvature

I think life is a bit like this too.

Events and experiences make an impression on us. Hurtful or painful ones leave dents in our psyche (or our bodies!) Death of a loved one is like this. It hits us, dents us, leaves a wound, changes our life forever. But, more than just a dent, this wound, or lesion, seems to have the power to draw life towards it. We find our minds constantly returning to it. The landscape of our life has changed. Things don’t look the same any more.

If we were like cars, we’d pop along to the body shop and have a panel beater knock the ding out making the surface nice and smooth again. He’d remove the dent for us. But we’re not like cars and there aren’t any panel beaters to take away a death.

One approach to deal with this is to try to remove the effects of the impact – drugs try to do this – antidepressants, sedatives to reduce anxiety or agitation, or to induce sleep for example. However, this approach doesn’t change the landscape. It doesn’t remove either the dent or its impact.

Another approach is the talking one. People are encouraged in counselling or psychotherapy to talk about the event or the experience and to in the process to try and change its impact on their present life. The difficulty inherent in this approach is that it can reinforce the strength of the dent. By focusing attention and energy on it, it can become all-consuming, increasing it’s pull and therefore its effect.

I think there’s another way.

Make more dents!

It’s not only negative experiences which make an impact. Positive ones can do it too. This is the approach used in positive psychology for example. By actively engaging in positive experiences we take an active role in fashioning the landscape of our lives. This is very different from the passive approach which can be utterly disempowering.

I know that when the impact of a negative event is large it’s effects are strong and long lasting, and the dent can be so deep it can be very difficult to climb out of it’s powerful influence. It acts like a black hole and draws everything to it. In such circumstances a combination of approaches might be needed covering all three of the main strategies I’ve written about above. There aren’t any right or wrong approaches here, but having a model to work with can help you understand what’s happening and find a way to change life when you feel totally trapped.

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evening clouds

  • The Celtic mind adored the light……….We need a light that has retained its kinship with the darkness. For we are sons and daughters of the darkness and of the light.
  • Every thought that you have is a flint moment, a spark of light from your inner darkness.
  • All creativity awakens at this primal threshold where light and darkness test and bless each other.
  • Light is the secret presence of the divine. It keeps life awake.
  • Light is a nurturing presence, which calls forth warmth and color in nature.

All quotes from “Anam Cara”, by John O’Donohue. (ISBN 0-06-092943-X)

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Complexity science

I wish someone could come up with a better name for this branch of knowledge and enquiry – calling it “complexity science” makes it seem so, well, COMPLEX! But actually it isn’t! It’s only the science of understanding reality in the raw. By that I mean understanding how natural and living systems function in the real world – in their connectedness and embeddedness. It’s the opposite of reductionism which takes the approach of breaking something down into small pieces (which actually don’t ever exist by themselves) and understanding the pieces as a way of understanding the whole.

I was interested to find this little article on Science Daily recently which mentioned the University of Vermont’s “Complex Systems Center”. It’s good to hear of universities bringing resources to bear on this area and I wasn’t surprised to hear it was part of their engineering and math Faculties. I do hope more universities expand their work on complexity and I wish more were multidisciplinary bringing together both physical and biological sciences with humanities.

The Center Director said –

“In its most simple form, a complex system is many distributed parts interacting in some distributed way,” Dodds says, “giving rise to some interesting, often unexpected, macrophenomena.”

and this reminded me of Linked by Albert-Laszlo Barabasi – I swear this is one of the most exciting books I’ve read this year and that if you want to begin to explore this whole area I couldn’t recommend any other better starting point than this. Read my review here first – but then go get the book!

The Science Daily article led me to explore the University of Vermont site. Here’s the link to their Complex Systems Center. And here’s a link to a video about “emergence” on the “PBS” site – and you’ll find links to John Holland of the Santa Fe Institute there (one of THE major thinkers and researchers in this area).

I hope you enjoy some of these resources – this really is a fascinating area of study. As best I can see, this is a MAJOR way forward to help us better understand our world and our lives.

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One of the things that frustrates me about clinical epidemiology (which goes by the name “evidence based medicine”) is how often it seems detached from the real world. Whilst researchers and statisticians pore over reviews of randomised clinical trials, real people with real problems turn up each day in the doctors’ consulting rooms. In the British Medical Journal there’s a regular column entitled “From the Frontline” and it’s written by a Glasgow GP called Des Spence. I always read his column because so often it reflects the daily reality I used to experience as a GP and which I still experience as a Glasgow hospital doctor. This week his column was particulary good – a healthy, realistic alternative view of the government’s “Quality Outcomes Framework” within which all UK GPs now practice.

It is not just the huge financial opportunity cost, nor the well made unwell, but the wanton consumption of our medical energies that I take issue with. Our energy has been spent bean counting the measurable while dismissing the most valuable aspect of medical care, the immeasurable. Perhaps I am wrong. But I will stand my ground of absolute scepticism until some redcoat finds real evidence to run through my Jacobean heart.

Well said, Des!

I especially appreciate your succinct “Our energy has been spent bean counting the measurable while dismissing the most valuable aspect of medical care, the immeasurable.” It’s a daily sadness to me that we increasingly pay attention to the measurable while dismissing the immeasurable in health care.

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Researchers at Ohio State University have just published a randomised clinical trial of pyschological interventions in women with breast cancer. Here’s the summary conclusion –

breast cancer patients who participate in intervention sessions focusing on improving mood, coping effectively, and altering health behaviors live longer than patients who do not receive such psychological support. The study indicates that reducing the stress that can accompany cancer diagnosis and treatment can have a significant impact on patients’ survival.

This was a study of 227 women who had been treated for breast cancer for an average of 11 years. Half of them were given an intervention designed to address stress and help them cope better psychologically (I can’t find the actual detail of the intervention yet!). The intervention group experienced about half the recurrence rate of the others and that group also had about half the risk of death from breast cancer.

Two things interest me about this trial. Firstly, it shows that non-drug, non-surgical interventions in serious conditions like cancer can both positively influence the course of the disease and even reduce the chance of dying from the cancer. Secondly, by reporting improved mood, and healthy behavioural changes, the researchers highlight the value of interventions which make living better. I recently wrote about death avoidance and made a plea for health care which is focused on living. This little trial is a piece of that jigsaw. It not only shows the potential for such interventions but it begins to make the case for such approaches to become routine.

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A few years ago I stumbled across the works of the “General Semanticists“. I won’t go into detail about this school of thought here, but it originated with a man called Alfred Korzybski in the early years of the 20th century. He wrote and taught about the way in which human beings reacted as whole organisms to their environment. One of the most interesting features of this way of thinking is the emphasis it gives to not only environment, but to what Korzybski called the “meaning environment” – in other words both symbols and the symbolic power of the environment itself. This focus raises all kinds of issues including change, transience, and context. The book which made this whole way of thinking clear to me was Samuel Bois’ Art of Awareness (ISBN 978-0965103701).

One of the ways of thinking they highlighted for me was “two value thinking” – we do this a lot. It’s the process by which we classify experience into one of two categories – us and them; black or white; and so on. Although generalisation and categorisation can be useful tools they are dangerous and frequently stop us seeing reality. You’ll come across this a lot in medicine. I’m sure you’ll have heard people talk about treatments as either “proven” or “unproven”; “evidence-based” or “not evidence-based”; “drugs which work” and “drugs which don’t”. But this is a silly and unhelpful way to think about treatments because all treatments need to be considered within the inescapable context of the individual. And you can’t even say a treatment “works” or “doesn’t work” for an individual – the same treatment can work at some point for a person, but then not work at another.

Think about painkillers as a simple example. Is there a “proven” painkiller which will kill pain for all individuals on all occasions? No. And, actually, it’s the same with all medical treatments. The only person who can tell you whether or not a treatment is beneficial for them, is that person – doctors have to listen to their patients and hear what their experience is. It’s very frustrating for patients to be told by a doctor that their lack of benefit they’ve received from a particular treatment is their own failure – because the treatment is “proven”. Similarly, it’s very frustrating for a patient to be denied a treatment which brought them benefit because somebody has ruled, on the basis of clinical epidemiology, that that particular treatment is “not evidence-based” or “does not work”.

The world is more complex than that. See if you can spot any two-value thinking today, and consider different contexts to see the weakness of this type of thought.

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