Archive for March, 2011

Female/Male, yin/yang, moon/sun, there are these two aspects, types or tendencies described in many cultures throughout history. It’s too simplistic to say men are one way and women are the other. However, it’s also too simplistic to say men and women are the same. This way of thinking can be helpful if we consider male or female qualities are tendencies, rather than fixed types, if we see their interaction as being present and dynamic in all human beings, and if we aspire to an integrated, mature state, where each of us access both ways of being.

One helpful discussion about this is in Carol Gilligan’s “Different Voices”, where she highlights masculine and feminine ways or types of being in terms of “voices”.

A man’s voice tends to be focused on autonomy, justice and rights, whereas a woman’s voice tends to be focused on relationships, care and responsibility. In other words, men tend towards agency, and women towards communion (see the qualities of holons).
Men follow rules, women follow connections. Men look, women touch. Men tend towards individualism, women to relationships.

Neither of these are better than the other. For example, if the masculine way goes too far, or goes wrong, we see

not just autonomy, but alienation, not just strength but domination, not just independence, but fear of commitment. And if the feminine way goes too far, instead of being in relationship, she becomes lost in relationship, instead of healthy communion, she becomes dominated by others, and instead of flow, panic, or meltdown.

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In Ken Wilber’s integral map of development, he describes an evolution from egocentric, to ethnocentric, to worldcentric. By this he means an initial focus on “me”, to an identification with others like us (“we”), to an identification with all living things.

He demonstrates how this relates to stages of moral development, from preconventional, where a child is self-absorbed, to conventional, where they learn the rules and norms of culture, and identify with their tribe or group, then onto postconventional, where their sense of identity expands out to include all humanity.

Interestingly he suggests there may be another map which lays nicely onto these – body (a focus on my physical body), mind (expanding to shared relationships and values) and spirit (all sentient beings).

Or even, from a neurological basis, from the reptilian brain stem (centred on me), to the mammalian limbic system (centred on we – the seat of attachment), to the neocortex (able to perceive and identify with the world).

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I’m always interested to hear about non-pharmacological treatments for depression (especially as antidepressants are no more effective than placebo for all but the most severely depressed). Here’s a study on depression in the elderly. The researchers compared those who were prescribed antidepressants plus a Tai chi class, to those who received the drugs plus weekly health education classes.

Researchers at UCLA turned to a gentle, Westernized version of tai chi chih, a 2,000-year-old Chinese martial art. When they combined a weekly tai chi exercise class with a standard depression treatment for a group of depressed elderly adults, they found greater improvement in the level of depression — along with improved quality of life, better memory and cognition, and more overall energy — than among a different group in which the standard treatment was paired with a weekly health education class.

It would be interesting to compare the Tai chi class to the antidepressants……

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My place of work is “The Centre for Integrative Care. Glasgow Homeopathic Hospital”. It’s an NHS hospital with a small inpatient unit, a new day service, and a very busy outpatient department. Here’s an interesting fact about our budget – over 90% of our total costs are spent on salaries. That means less than 10% is spent on drugs, equipment, maintenance etc. Over 90% is spent on people. I think that’s amazing and something to be very proud of.

Health care is about people. It’s about people who are seeking help and those who are seeking to help. It’s about care, about compassion, relationships, communication and understanding.

Our particular approaches, our integrative approaches, prioritise the human aspect of health care. I’d be worried if the greatest part of the budget was spent on technology or drugs. (I understand that this is not the same in all departments – some acute medicine and surgery has to be very high tech, and that tech is very expensive – but even where non-people costs are great, I still think it’s important to prioritise the human beings – the patients and the carers)

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What is “integrative care”?

This is a term which is being used more widely in recent months and many times it seems to be used interchangeably with “integrated care” (or “integrated medicine”), so what is it? And are they both the same thing?

From what I can see different people use these phrases different ways, so let me just explain what it means where I work. I work in the “Centre for Integrative Care. Glasgow Homeopathic Hospital”. Those are the titles fixed to the front wall of our building, and they’ve been there since this hospital was built just over a decade ago.

What we mean by “integrative care” is an intention to support and develop greater integration in a patient. If we think of health as being a state of wellbeing and good function of the whole person, we can think of such a state having certain qualities. These include all the bits working well together! We call that “coherence”, but sometimes, I think the metaphor of “flow” is a better one – it’s where not only does everything flow well, but the person has an experience of “flow” (Csikszentmihalyi).

If we think of any organism as being a “complex adaptive system” then we can conceptualise an idea of health as a state of optimal self-organisation – that’s maximal integration.

So, “integrative care” is an intention. It doesn’t specify a treatment or procedure. The question is, does this consultation, or treatment, increase integration? Does it, in other words, promote healing? You’d be surprised how little health care is directly intended to promote healing (rather, most biomedical health care is focused on “disease management”)

“Integrated care” on the other hand, tends to refer to the bringing together of “orthodox” and “alternative” treatments. The “Royal London Hospital for Integrated Medicine” is an example of that type – they seek to blend “mainstream” and “complementary” medicine. Terms such as “alternative”, “complementary”, “mainstream” and “orthodox” however, are social constructs, determined by whoever happens to be in a place of authority in a society at a particular time. “Complementary” treatments may, or may not, promote greater integration.


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I find something very disturbing about the Brian Cox style of science programme. He usually presents something along the lines of the current “Wonders of the Universe” (his other recent outing being the astronomy week on BBC2 where his irritation factor was doubled by the contributions of his co-presenter Dara O Briain). The subject matter should be right up my street. I’ve had a lifelong passion for the wonders of Nature and the Universe. So, what’s the problem?

Two things – a certain contempt for human knowledge and wisdom prior to the present day which feeds an arrogant implication that everyone in the entire history of mankind was thick as two short planks until our current cohort of scientists who have finally found out the truth about everything. Secondly, an apparent view that only science can reveal truth. (Consider instead Ken Wilber’s Integral model which shows that science is a way of understanding surfaces, but that we need other ways to understand the depths)

Mark Vernon nails the issue perfectly.

At the start of the second programme, Cox is filmed on the banks of a holy river amidst Hindus attending to their dead. He notes that Hinduism, along with other religions, has a story to tell about people’s origins and the meaning of their lives. Only, that story is flawed. He has a deeper story to tell. ‘The path to enlightenment is not to understand our own lives and deaths,’ he intones, ‘but to understand the lives and deaths of the stars.’ He then proceeds to describe how the elements in our bodies are made from the explosive death of stars. Which is true. Only that’s not nearly enough to deliver on the enlightenment promise at the top. That would be like saying the meaning of Michelangelo’s David can be found in the quarry where the marble came from.

Nicely put, Mark! He concludes –

Science of itself does not do the meaning part. Only a human interpretation of the science can achieve that. But to do so, the interpretation must make raids on the language of values and metaphysics. It needs the beauty of colour and the harmonies of music – qualities which, of themselves, again are unknown to physics as physics.

I think it’s a shame to hear scientists trying to present science as a kind of “the truth, the whole truth, and nothing but the truth” activity. Scientific enquiry and exploration is such a wonderful human enterprise, but it goes seriously off course when it turns into scientism.

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Lovely piece on the School of Life site considering active and passive paths to wellness. The yin yang symbol is one of the most potent symbols we have – I wear one around my neck. One aspect of the symbol is the representation of a dynamic balance of active and passive principles. Taking this idea, Jules Evans writes about a session at the School of Life where representatives of each of these models tell their stories.

The active form of well-being lies in the happiness of pursuit, striving after a goal, making things happen. Its great champion is Aristotle, who defined happiness as a vital activity of the soul. The other form of well-being is passive. It finds happiness in the renunciation of the will – not in making things happen, but in accepting things happening as they do. This is the approach of the Stoics and Epicureans, both of whom define happiness as freedom from desire, and also of the Buddhists and Taoists.

I like this idea. My daily practice of medicine is grounded on the belief that all human beings are unique and by active, non-judgmental listening, I can come to understand the particular worldviews, coping strategies and pathological changes within each patient I meet (and, of course, how these are all linked). One consequence of this approach is to realise that different people have very different approaches to wellness. And that, fundamentally, is ok. There really is no one size fits all, and there is always an alternative.

Representing the Yang school of well-being, there is the entrepreneur Robert Kelsey, full of energy, leaping from mission to mission (‘first I was a journalist, then a banker, then a writer, then an entrepreneur’), picking himself up when a mission fails, only to launch himself on another voyage……[and, on the other hand, Ed Halliwell]….tells us that he only found peace from his battle with depression when he stopped “desperately striving to change my situation. When I did, a curious thing happened: my depression lifted”. Meditation is, he says, the opposite of striving: “It’s impossible to strive to do it. The process is about sitting and observing, being in the moment, rather than striving.”


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