Archive for June, 2011


sunlit cloud

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As June draws to a close, it seems only fitting that this month of celebrating the light should round off with some spectacular displays from the sun over the hills I see from my room.






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The excellent Daran Leader, who wrote “Why Do People Get Ill?”, has written in the Guardian about the current state of Mental Health Services. Many of his points and conclusions are applicable across the board into the whole of the Health Service, not just “Mental Health”.

Mental health services become like a garage where people are fixed and put back on the road, rather than subjects to be listened to. But once we start listening we might well question our beliefs and prejudices about normality. As old psychiatry recognised, many of the phenomena that are seen to define mental illness are in fact efforts to battle against it. A delusion, for instance, may provide a meaning to one’s world, and to try to remove it may deprive the person of a crucial resource.

Listening is a crucial part of health care, which is sadly, all too frequently absent. The “restitution narrative” of quick fix, sort out the broken or troublesome part, reigns supreme. Yet illness remains an intensively personal, subjective experience, different in every circumstance, and understood only in terms of the patient’s values and beliefs.

Bhugra is right that more therapy must become available, but there must be diversity. At present therapies that mimic drugs in their aims clear the field: promising swift outcomes, localised intervention and precise targets, they use the very language of drugs. Yet they all too often buy into a discourse of normality and rehabilitation that ignores the specificity of the patient – and their ways of making sense of their situation. Mental health services need to learn more from patients, questioning the values of efficiency and autonomy fetishised by contemporary society.

Trying to fit individuals into protocols created around cohorts and averages reduces the subject to an object. We need diversity in health care, because, really, one size does not fit all.

Daran rightly highlights how the drug model is sweeping the field of alternative approaches to therapy and care, no doubt because of the vast marketing resources poured into the promotion of drugs and the manipulation of the “evidence base”. But Medicine should never have been reduced the prescribing of drugs, or to treatments which can demonstrate their drug-like abilities.

We’ve lost our way.

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Johann Hari, writing in the Independent about books, reading and the distractions of the internet, includes the following quote

Reading is an act of resistance in a landscape of distraction…. It requires us to pace ourselves. It returns us to a reckoning with time. In the midst of a book, we have no choice but to be patient, to take each thing in its moment, to let the narrative prevail. We regain the world by withdrawing from it just a little, by stepping back from the noise

Fabulous! We all need this experience. We all need to withdraw a little, step back from the noise, gain what Iain McGilchrist refers to as a “necessary distance”, not just from other people, other activities, or the world, but from our own thoughts, habits and obsessions. Reading books can certainly create some necessary distances, but there are other ways too. Many other ways, actually.

What we need is focused, aware attention.

If we take a little time to focus, and to give our full attention to, a book, a movie, a song, a poem, our breath, this present moment……..then we’ll gain this necessary distance. Without it, we’re on autopilot – zombies not heroes!

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A pretty extensive review of research which has looked at empathy in medical students and young doctors concludes that

empathy declines during medical school and residency compromises striving toward professionalism and may threaten health care quality. Theory-based investigations of the factors that contribute to empathy decline among trainees and improvement of the validity of self-assessment methods are necessary for further research.

(How often do you read a paper by researchers which doesn’t conclude that there should be more research!). This is a sad, but also dangerous finding. Sad because there’s something desperately wrong with medical education and training if empathy declines as a result of it, and dangerous because without empathy “quality”, and I’d argue, “safety” are under threat.

Meanwhile, Vaughn Bell, across on the Mindhacks blog doesn’t only highlight this study under a title of “Is medical school an empathotoxin?”, but he has a useful collection of links to other research which shows the importance of empathy in medical practice.

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Where are the edges?
If its true that becoming, rather than being, is the core phenomenon of life (and I think it is) then the attempt to divvy up reality into pieces is misguided.
I was interested, therefore, to come across a piece of research looking into the issue of water’s boundary between liquid and gas phases. It turns out it’s just about impossible to draw the boundary.

The researchers concluded that the change between air and water happens in the space of a single water molecule.
“You recover the bulk phase of water extremely quickly,” Benderskii said.
While the transition happens in the uppermost layer of water molecules, the molecules involved change constantly. Even when they rise to the top layer, molecules for the most part are wholly submerged, spending only a quarter of their time straddling air and water.
The study raises the question of how exactly to define the air-water boundary.

Where do I end and you begin?

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…sometimes I just look at the sky and gasp….

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passing the light

June is the month of the light. Next week in Scotland, it’s midsummer’s day – the shortest day of the year (you’d never know we’re in the middle of summer, given all the rain and wind we’ve had!). So, I’ve been thinking again about light.

Candle light in particular reminds us how sharing light increases it. Have you ever lit one candle from another? When you do, the first candle doesn’t get any dimmer. By lighting one candle from another, you end up with more light.

I wonder what kind of light I bring into this world? You might like to wonder about what you pass on to others too, because, although we might not physically pass light to each other, we certainly pass our emotions, our attitudes, our way of being onto to those around us and spread them the way that light can spread.

Around the turn of the year, when I was thinking about my Life (with a capital “L”), I played with this idea of light and I thought, actually, what I try to do, as a doctor, can be captured in three verbs about light.

Firstly, I try to lighten others’ loads. I try to ease their suffering. If I didn’t achieve at least that, I’d not be much of a doctor. I hope that everyone I see has their life, or the burdens in their life, lightened a bit as a result of my care.

But that’s not enough for me. I don’t want patients to come back and just say they feel a little lighter. I want their lives to be brighter. By that I mean I hope their days become better days, more fulfilling, more colourful, brighter days. I hope for others, and I hope for me, that life becomes brighter, and by that, I really mean an increase in that “emerveillement du quotidien“.

But even that’s not enough for me. I hope, at best, to enlighten, to show new possibilities, to support and stimulate new growth. I just love when I hear that a patient’s life has become lighter, brighter and, yes, transformed – that they’re experiencing a personal enlightenment.

If you think about light this month, why not think of it as a metaphor, as well as a physical phenomenon? What metaphors of light seem most relevant in your life?

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In a consultation recently, the question of what makes an experience or a relationship meaningful came up. Whether or not something feels meaningful is something we seem to know intuitively. We don’t usually sit down, consider the details, weigh them up, then reach a calculated conclusion. But what makes an experience or a relationship a “meaningful” one?

I think there are at least two dimensions to this.

How does this experience, or relationship, fit in to my story?

A story, or a narrative, has a beginning, a middle and an end (actually, I’m increasingly doubtful about this concept of an “end”!). Let’s say then, that in constructing the story of my life, I consider the present as it emerges from the past and lies in the context of the possible futures. We do create a sense of who we are by telling ourselves and others a story – the story of my life. This is one of the two dimensions of meaning. How does this experience fit into my story? Is it strongly embedded? Is it complexly and multiply connected? How does it relate to all that has gone before, and how might it influence the scope of the possible futures? We tend to feel something is “meaningful” when we can make sense of it within our story, and when it is deeply connected to so much of our story.

Secondly, we tend to feel something is meaningful when it makes a big impact. This feels like a second dimension of meaning. The power, the strength, the depth even, of the impact. You could say this is “significance” or you could simply call it “impact”. Of course, it’s likely that the strength of an impact will have an influence on the extent to which it becomes an important part of our story.

Maybe the less meaningful experiences, are covered by a line, or a few words in our story. A paragraph at most. And maybe the more meaningful ones gain an entire chapter, or even volume, of their own?

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