Archive for March, 2009

To love and be loved

Do I need a randomised controlled trial to prove that love is an important part of a good life?

Can science show me the Truth about the value and importance of love?

I don’t think so.

I think a poem will be more convincing.

Late Fragment. (by Raymond Carver)

And did you get what

you wanted from this life, even so?

I did.

And what did you want?

To call myself beloved, to feel myself

beloved on the earth.

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What makes life a “good” life?

This seems such an easy question to answer…….until you start to try and answer it! In fact, it’s puzzled philosophers and other thinkers for centuries. You can read the views of Confucius, Seneca, Aristotle…..and on down the line of Eastern and Western philosophers, and then there is the whole body of religious and spiritual teaching through the ages.

One clear thread that runs through most of the literature on the subject includes some consideration of “eudaimonia” – what is often translated as “happiness”, but which is, I think, more usefully translated as “flourishing”.

My daily work as a doctor is about not only trying to help patients to suffer less, but also trying to help them to “flourish”. That, naturally, leads me to read a lot about this subject, and to think a lot about it too.

I’m not claiming I’ve got new insights, or even to have nailed this issue down, but I have reached the point of achieving some clarity about it which I’d like to share.

Here’s what I think. A good life doesn’t just happen. It’s an active process. It involves individual choices and what constitutes a good life for one person would not necessarily be a good one for someone else. It’s a dynamic, constantly changing phenomenon. Like life itself.

And it’s a creative process. We create the flourishing in our own lives. That’s not to say that others have no part to play, or that events outside of our control don’t have an impact. Of course they do. But as Viktor Frankl and William Glasser, amongst others, have said, what’s important is how you respond to the situations you find yourself in. You can’t always choose the situations but you do have some choice about your responses and your next actions.

Here’s one way to think about it. If it’s a creative process then what do you need on your palette? What paints do you need to create your good life?

The GOOD Life – the palette

  • Love
  • Understanding
  • Passion
  • Imagination
  • In the amazing here and now.

The GOOD life – a summary

To love and be loved

To understand, to make sense of our lives

To engage wholeheartedly, to be passionate about, absorbed in, immersed in activities

To imagine actively, creating, expressing, dreaming and playing

All within the context of the daily reality, finding much to marvel at, to be amazed by, to be in awe of, in the present, in the here and the now

I’ll post about each of these in turn, but this is my key, these are my elements, my building blocks, the colours on my palette from which to create my experience of a good life.

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I used to think honey was honey. Well, what I mean is that I knew there was runny honey and there was a thick, almost solid kind, but it all tasted pretty much honey-like. Well…….! How wrong was I! Take a look a this photo –


Here are three jars of honey on my window shelf in Aix. The one of the left was bought in a shop. It’s a mix of honey’s – see the label says “3 sources”? In whisky terms, that’s a blend. I never drink blended whisky – it’s just a taste thing. The other two honeys are bought in the local market. The one in the middle is honey made from bees which have collected pollen from chestnut trees. Goodness! I wish my vocabulary was better! The scent which hits you when you unscrew the cap! It’s like nothing I’ve ever smelled before. I can’t say I’ve ever noticed that either chestnuts or chestnut trees have much of a scent but this honey has the most powerful aroma! Then the taste! I swear I’ve never tasted honey like this. It is a really strong taste. I’m sure this is one of those honeys you’d either love or hate. I bet there aren’t many people who’d say they could take it or leave it. The third honey, the one on the far right, is from lavender. You might have tasted a lavender honey I guess. This one, maybe again because it’s from a market, has a very strong taste, but totally different from the chestnut one. It’s consistency is also totally different. Looks solid but the spoon slips easily through it and it drips thick and creamy onto your brioche (or your bread).

What makes them so different? Is it the plants the bees gather the honey from? Is there something involved in the production method of the different bee-keepers? I don’t know. It’s a huge area of ignorance for me. But let me tell you something interesting. Starting the day, carefully savouring such different flavours, smelling such different aromas, it sets you up to taste everything you eat or drink that day with more care and attention. I recommend it.

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My daily working life is that of a doctor. That only tells you a little because Medicine is a very broad subject and doctoring can require extremely different sets of skills. Sometimes I muse about just what is the job of a doctor? Or what makes for a good doctor? I’m pretty sure it involves trying to understand people better. I’m also pretty sure it involves helping people. It involves never thinking you know everything or that you are definitely right! (I know that’s a surprising conclusion but there’s a difference between being decisive and being certain…..read the linked post for more on this). I think it’s also a common experience that a good doctor is one who gives a damn ie one who cares. However, the specifics of the working life of a doctor depend a lot on the context of the doctor’s work. I made myself a “human spectrometer” to clarify this point.

Human spectrometer

Most health care is created around systems. There are whole departments defined on the basis of their focus on a system – Neurology, Urology, Gastroenterology etc. The focus of a doctor in that department is a particular system of the body. He or she becomes expert in the diseases and disorders of that system and acquires the knowledge, tools and experience to intervene, to either resolve, or to manage those disorders. Some doctors specialise more than this. Move left a little from the system on the spectrometer. We have both medical and surgical specialists who focus on one particular organ, or part of a system, like liver specialists, hand surgeons, and so on, and following that path further left we have biochemists and geneticists who concentrate on the functions right down at cellular, or intracellular levels. Jumping to the other end of the scale, there are the epidemiologists and the Public Health doctors who consider disease at a population level. I’m a great admirer of the work of Prof Richard Wilkinson who makes clearer than anyone else I know just what an impact inequality has on population health. The knowledge, skills and experience he needs to do his job are quite different from those of the hand surgeon. Move left again along the spectrum from the right hand side. There are doctors who focus on families, whose everyday lives involves working with whole families, or parts of families. Then there’s me. Right there in the middle. There are lots and lots of doctors like me. Our days are spent largely in consulting rooms with individual patients. Our approach is a generalist one, not a specialist one. We focus on the person. The skills, knowledge and experience needed to do this kind of daily work is holistic, narrative-based and focused on the ability to listen, to communicate and to understand at an individual level.

So each doctor needs the skills and the knowledge appropriate to their practice but there’s something else all doctors share. We are all trying to relieve suffering.

Suffering isn’t a word you’ll find in medical textbooks (just like you won’t find the words “health” or “healing” in textbooks of clinical medicine either!) but it’s our raison d’etre. You can judge me by it. I judge myself by it. When I go to work any day, I want to relieve suffering. If I interact with a patient and don’t feel that I’ve contributed to a relief of their suffering by my involvement and my actions then I don’t feel I’ve done my job. Dr Eric Cassell’s book, “The Nature of Suffering”, deals with this issue beautifully. He says in this book, and in his others, that he changed his clinical practice by deciding to focus on the issue of the patient’s suffering. In fact he explicitly asks his patients to tell him about their suffering as a powerful way of allowing them to set and declare their agenda and for him to focus his care where it matters. In that book he shows how suffering might lie in an individual patient, but it might lie in their relationships, their family, their workplace or community. You could, in fact, ask that question at any point on the “human spectrometer” above. Just where on the spectrum does the suffering lie?

However, human beings have a complex relationship with suffering. It might even be extolled as something good – “No pain. No gain” “I have to suffer for my art” I’ve read more than one book which considers the place of a serious illness in an artist’s life and puts forward the hypothesis that it was their suffering which enabled them to produce their distinctive, great art. I recently read David Lynch’s book, “Catching the Big Fish; Meditation, Consciousness and Creativity” (which I highly recommend actually!) where he powerfully refutes that argument, claiming that Van Gogh might have had the chance to produce even more and even greater art if he hadn’t had all that suffering to cope with in his life. Suffering gets a good press in many religious teachings as well as in a certain kind of New Age thinking. There are many spiritual practices based on inflicting suffering on the body and there’s even a belief in destiny, or Fate, or karma, which states that if you are suffering it’s because that’s what your soul requires. Even the “quest story” of Arthur Franks, as exemplified in Lance Armstrong’s “It’s not about the Bike” shows how suffering can be a path to growth and development.

I’m not denying any truths which lie in those beliefs. Nor am I claiming to know better. But let me be very clear, as far as I know, nobody, given the choice between a path of suffering and one of bliss, chooses suffering. We only choose suffering if we can see no other way to get to where we want to be. If we can find another way that doesn’t involve suffering we’ll choose it. So, yes, maybe my job involves helping people to make the most of their suffering, or to even get something good out of it, but, my first priority, my prime motivation is to do my best to relieve it.

Whether I can help relieve someone’s suffering or not, the inextricably related goal I have is to help that person to have a good life. The point of relieving suffering is to enable a person to experience a good life. But as suffering is an inevitable thread that winds its way through all lives, a doctor’s job is to help people to have a good life, whether they are suffering or not.

Doctors are not the only people to help others to lead good lives of course, but I do think a doctor who loses sight of this goal, loses sight of what it is to be a doctor.

PS Now you’ll be thinking “ah, but what is a GOOD LIFE?” Me too! (I’m working on a post about this but here’s an earlier one to be going on with)

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Towards the end of last year I went unicorn hunting. It opened up whole unknown areas for me, not least that of medieval art. I’m still exploring this and learning all the time and, frankly, its awe-inspiring. Well, here’s another part of that adventure. When I read about the unicorn hunt tapestries which are in Cloisters of the Metropolitan Museum in New York (which are being re-created in Stirling Castle), I also read about the Lady and the Unicorn series which are in the Musee Cluny in Paris. I determined to go and see them, and, last week, I did.

One thing about Paris is that everything is further away than it appears on the map! So, although we set off to find the Cluny by opening time of 0915, it was only after stopping for a coffee at the Sorbonne, and scrutinising the map again, that we managed to actually track it down – only a couple of minutes away from where we had stopped.

musee cluny

The Cluny is one of those amazing small museums in Paris (there are many more for me still to discover!). It’s a rambling, ancient building which doesn’t have real corridors, just the occasional narrow passageway or set of stairs. I had come to see the Lady and the Unicorn tapestries so made my way through the various rooms following the signs to the tapestries.


This plan shows you the ground floor. You enter at the far right and make your way to the far left.

The rooms on the ground floor are either very dimly lit to protect the tapestries and ivories on display, or very brightly lit displaying statuary and parts of medieval buildings. One of the rooms has stained glass all around and all backlit which creates a beautiful effect. Having found my way to the staircase to the first floor, I climbed the stairs and walked through a doorway into the specially designed circular room where the unicorn tapestries hang.


The first thing you encounter is a wall. You can choose to enter the space either to the right or the left of the wall. I went right, and entered into a dimly lit room around which were hung the Lady and the Unicorn series of tapestries, five of them, each representing one of our senses. As you stand gazing at the incredible red and blue tapestries, working your way from the one to the next, you reach the furthest right hanging, “touch”, and turn right around and see behind you the largest of the six tapestries, the enigmatic “A Mon Seul Desir” hanging on the freestanding wall you walked around to enter the room. The overall experience is amazing. No photos, no words, will do it justice. You just have to go. For me, the last time I experienced art like this was when I went to see Monet’s Lily paintings in the Orangerie. There’s another place to put on your places I must see list. When you walk into those oval rooms of the Orangerie and find yourself in the middle of those incredible paintings, it’s completely amazing. You feel surrounded by them, enveloped by them, as if you are diving deep down into the art itself. The Orangerie does that, and so does the Lady and the Unicorn room in the Cluny. It’s pervasive and almost overwhelming. There are a few small stools fixed in the middle of the room and I sat down on one of them.

The first tapestry I looked at was “Taste”, on the far left. I don’t know if you have these experiences with art, but I find when I walk through galleries I can appreciate and admire many works but just occasionally one whacks me right in the heart. This tapestry did it for me. I felt my breath catch, my heart leap, and the tears well up in my eyes. I could hardly take my eyes off it. As I looked at the others, one after the other, they too impressed me but I have to say none of the others had the powerful emotional impact of the first. I’ve read a lot about these tapestries since then and it seems this is one of their key features. They bring out different reactions in different viewers. It’s as if there are deep archetypal truths in them and whoever you are, whatever place you happen to be in, in your life, they have the power to touch something in you, to reveal something of your soul. (no photos will convey even a smattering of the power and impact of these tapestries but if you’d like a quick look check out my collection here)

There are so many mysteries surrounding these tapestries. They are just over 500 years old and are quite astonishingly accomplished works of art, but unlike paintings of the same age, no-one knows who drew the original designs, who actually wove the tapestries, who commissioned and owned them, or what message they were created to convey. There are many theories, and Tracy Chevalier, the author of Girl with The Pearl Earring, is one of those to explore them.

Are all the tapestries portraying the same woman? Who is she? And what exactly is going on in the sixth tapestry, referred to as “A Mon Seul Desir”. Whose sole desire? And what is that sole desire exactly? Only in this last, and largest of the series, is she without a necklace, but is she taking it off and placing it in the casket, or is she taking it out of the casket to put it on?

Here are some of the theories. The tapestries were designed by the Master of Anne of Bretagne and woven in the North of France or in Belgium, having been commissioned by the wealthy Lyon family of Les Vistes. The medieval concept of the senses were that there were six. Taste, Hearing, Vision, Taste, Touch and Understanding (otherwise known as the heart or the intellect or, as we might now call it, intuition). It was this final, sixth sense, which controlled all the others.

I bought the guide book in the museum. It’s beautifully illustrated and lays out all the known facts, and the controversial guessed-at facts about the tapestries, but, frustratingly, I feel, makes only half hearted attempts to deal with the luxurious and abundant symbolism in the tapestries.

It’s this last feature which I find so appealing and intruiging. Someone looking at these tapestries in medieval times would see so much more than we do because the culture of that time was incredibly highly skilled at dealing with symbol, metaphor and allegory. In fact, no flower, no tree, no creature in these tapestries has only one possible meaning. Like the Hunting of the Unicorn they can be read in multiple ways. There just isn’t one answer, one interpretation which is the correct interpretation and even now with our somewhat impoverished skills in handling symbol and metaphor, they have the power to touch us really in the depths of our souls.

I’m fascinated. I’m intruiged. I’m hooked. I’ll tell you more if and when I uncover it. Don’t you just love a mystery?

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