Archive for September, 2009

indra's net

I spotted this be-dew-elled spider’s web this morning and immediately thought of Indra’s Net.
Interestingly, the entry about Indra’s Net on wikipedia illustrates the following quote by Alan Watts with a very similar image.

Imagine a multidimensional spider’s web in the early morning covered with dew drops. And every dew drop contains the reflection of all the other dew drops. And, in each reflected dew drop, the reflections of all the other dew drops in that reflection. And so ad infinitum. That is the Buddhist conception of the universe in an image

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There really are many definitions of health, and that’s not a bad thing. Such a complex phenomenon cannot be wholly understood by the use of a sound bite, a mission statement, or a simple formula. However, a simple statement or formula can provoke thought, change a perspective, or shine a light on a poorly understood issue.
Here’s one simple statement about health

Vitality + Resilience = Health

When someone is sick they seek a restoration of health. They, preferably, want a cure. Something which will completely remove all traces of the disease and leave them back where they were before they became ill (or, maybe even in a better place than they were to start with!). In acute disease that can be a reasonable aim. Infectious disease is a good example. If you suffer from some infection this winter, say a chest infection, a cold or a flu, then you’ll find that the illness will last a few days after which time, the symptoms will all fade away. You might need the assistance of some anti-infective drug to kill the offending bug but the bottom line is your body will repair itself and the disease will be over. (I’m talking best case scenarios here!) However, chronic diseases are not like that. Chronic diseases involve changes which don’t go away. Despite that two people with the same chronic disease will experience very different levels of health. Two people with the same pathological lesions (similar locations, similar severity) may report completely different levels of well-being, and whilst one may state that the illness is making life unbearable, another may state that life is good, or even that they are flourishing. Eric Cassell, the American physician explores this in his writings by taking a focus his patients’ assessment of their “suffering” and shows that whilst there is a relationship between disease and illness, or, shall we say, between lesions and experience, that it’s not a simple one-to-one relationship.
If we return to the scenario of acute disease for a moment, two people who suffer from the same infection don’t have the same experience. One may get severe or long-lasting symptoms whilst the other experiences only mild, short lived ones. Beyond the period of infection, one person may bounce back fully restored, whilst another finds themselves with lingering symptoms or feeling just under par for several days, or even weeks. What makes the difference?
I think one explanation lies in this simple statement
Vitality + Resilience = Health.
Vitality is not an easy thing to pin down. Some people understand it best as “well-being”, “wellness” or “energy”, but I prefer the word “vitality” because I like it’s positive connotations and I think it captures a sense of vigour or brightness. The opposite of vitality would be debility. It would be reasonable to expect that someone whose vitality is very low will be both more susceptible to catching an infection, and more likely to experience a more severe or prolonged illness. Without good vitality, resilience is impaired.
Resilience is the capacity of a person to cope, to deal with what has happened by repairing damaged tissue or systems, and/or by adapting to the changes in their bodies and their lives. Resilience also involves some kind of growth. When we cope with something, or when we adapt to a major change, then we grow. We grow by having learned something, by having become stronger in some way, more able to deal with challenges perhaps. This kind of growth is a part of resilience. When we grow as a result of our coping and adapting then we become more resilient.
I think both vitality and resilience are important parts of health and I think they’re relevant to the treatment of both acute and chronic diseases. But most treatments used by doctors are not designed to influence either of these phenomena. Why is that? Sure, it’s good to have treatments which directly kill bugs, or which assist the body to address a pathology by having a direct effect on lesions, but if we don’t pay attention to vitality and resilience are we really going to become healthy?
We need to understand vitality and resilience better. We need to better understand how they work, and we need to understand what therapeutic interventions will stimulate vitality and enhance resilience. Then we need to develop that whole aspect of health care because so far, we focus almost exclusively on lesions and disease, not on health.

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Pharmakon, by Dirk Wittenborn, ( ISBN 978-0747598107), is a good read. It’s a novel which tells the story of one American family, starting with a focus on the father, a psychologist, then following the story of his youngest son. The territory of the book is the treatment of mental health, and in some ways, that reminded me of Sebastian Faulk’s “Human Traces“. However, despite the fact that both novels make you think about psychiatry as a therapy, it’s a more modern novel than Human Traces, taking a focus on drugs. You could tell that from the title I’m sure! In fact, by focusing on drugs taken to alter mental states, Wittenborn explores and entwines both “therapeutic” and “recreational” use of drugs.

Dr. William T. Friedrich wonders if it is possible to find a drug which will produce human happiness. The idea that this might be possible is prompted by two things. Firstly, he is horrified by the contemporary 1950s psychiatric treatments, finding psycho-surgery barbaric and psycho-analysis ineffective. Secondly, he comes across the use of a plant by tribes in New Guinea to alter mental states. He persuades a colleague to set up a clinical trial of this plant extract and see if they can prescribe happiness. Things, of course, don’t go according to plan, and one of the volunteers, a deeply disturbed young man called Caspar, after an initial apparently astonishingly good response to the drug, turns homicidal and sets out to kill the two researchers.

For the rest of the novel, Caspar haunts the Friedrich family. His crimes result in him being committed to secure psychiatric care for the rest of his life, and to Dr Friedrich and his wife having another child, Zach. Zach’s story leads into recreational drug use and its sorry consequences. Friedrich himself goes on to become a successful consultant to major drug companies helping them to create and market a number of anti-depressants and other psycho-active products.

As you might imagine, this is not a happy story, but it’s engaging and it also makes you think not only about psychiatry and drug companies, but also about human happiness – what is it and can it ever be achieved by using chemicals?

The drug company thread of the narrative echoed some of the themes of Popco but this is not a novel about drug companies. It’s a novel about life, mental health care, the place which drugs (prescribed and illegal) play in our society, and, ultimately, it’s a novel about families and happiness.

I found the last paragraph of the book immensely satisfying. I won’t spoil the story for you, but suffice it to say that at the beginning of the story, Friedrich wonders if its possible for a drug to produce happiness, and at the end, he’s wondering if it’s possible to find a drug which will produce tears.

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I enjoy books for different reasons. Popco, by Scarlett Thomas, (ISBN 978-1847673350) is one of several novels I’ve read this summer and which I’ve thoroughly enjoyed. It strikes me the novels I’ve read are all very different and I wondered if maybe I enjoyed such diversity in the same way I enjoy the company of diversely different people.

When it comes to a novel my main prerequisite is that it’s a good story. I love a good story, and this one drew me in right from the start. Popco, is an imaginary multinational toy company, supposed to be the third largest in the world, and the narrative takes place in a country retreat out in the wilds in southern England, where a select group of Popco employees are receiving classes in the mindsets of teenage girls to try and come up with some new products to crack this notoriously difficult sector of the market.

The narrator is a quirky, bright, highly intelligent young woman. She heads up one of Popco’s sections related to producing kits for children who want adventure – spy kits, code kits, survival kits and so on. She’s not someone who really fits in very easily with others, and I imagined her to be a bit like Chloe O’Brian from “24” – geeky, socially clunky, very bright, and interesting! The novel interweaves the story of her early life brought up by her grandparents, one a maths genius, and the other a professional code-breaker, with her present day experience on the idea-generating retreat for Popco.

I think it was the rich and varied subject matter which really hooked me in this novel. I loved all the explanations about code-making and code-breaking (took me right back to my early teenage years), and I enjoyed the discussions about prime numbers and mathematical patterns. Also, almost as an aside, I loved the way she used homeopathy for self-care and explained the homeopathic method so clearly but modestly. What disturbed me most about the novel was the way the company worked. I don’t mean the structure. I mean the way it operated in the world, dividing children into demographic segments, codifying them according to their interests, desires, and maturity, then producing marketing campaigns to sell loads of branded merchandise and toys to them. I found that all scarily believable. It was all so manipulative, and slick. I think it’s the fact that it was a toy company targeting children that made it especially uncomfortable. I’m pretty cynical about marketing anyway, but this book just made me wake up again a bit, and see behind the TV schedules, comic and magazine tie-ups and marketing campaigns.

There are a couple of interwoven plots which drive the book along. One about a treasure map (yes, really!), and one about a  fightback against globalisation and consumption. I enjoyed both of those plots, and I’m not going to reveal any detail about either of them (in case you decide to read the book)

I like novels which make me think, and ones where I learn something too, but I mostly like novels where the author tells a good story.

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The other day Ian sent me an email with a link in it (he does this quite a lot!). It was to a book which he thought would interest me. I followed the link and, yes, it sounded really up my street. The book was called “Friends in Low Places”, by James Willis and it seemed to be a plea for a human approach to medicine, instead of a protocol-imprisoned one. I clicked “buy’ from one of the amazon marketplace resellers (I do that quite a lot!). I then picked up a book from my bookshelf as I walked out of my front door. I wanted something to read on the train and I’d just finished reading “Popco” by Scarlett Thomas (VERY enjoyable). The book I picked up was “Pharmakon“, by Dirk Wittenborn, and I’d read a review of it in the BMJ about a month before, thought it sounded like just the kind of novel I’d like to read, and clicked “buy” from one of the amazon marketplace resellers (I told you I do that quite a lot!)

I settled down on the train and started to read it. I got to page 21 and this little piece of dialogue hit me between the eyes

“But how did you get it here?” “Friends in low places.”

The identical phrase. Twice in the same morning. No, twice in the same hour! What are the chances of that? Have you ever even come across that phrase before?


This story isn’t finished yet. Pharmakon is a great novel. I thoroughly enjoyed it. The following day, before leaving for work I was browsing through my rss feeds in googlereader and came across this astonishing video –

Go on, watch it. It’s amazing. It’s about how the Hubble telescope was pointed by scientists at a part of the sky where they could see nothing. Nothing at all. Just darkness. Watch the video to see what they saw when they looked where there seemed to be nothing……! Then I left for work, got on the train and continued reading Pharmakon. Page 95. Here’s what I read…..

Caspar tried to distract himself by looking out of the window in the direction of galaxy clusters not visible to his human eye

Well, I don’t know about you but it sent shivers down my spine. How does that work?

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