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Archive for January, 2015

The cognac cellars

Becoming not being

You’ll see that phrase up at the top of the home page here, just underneath the heroes not zombies title.

Such a phrase can lead me off in many directions. For example, it brings a focus on verbs instead of nouns. Nouns are words we use to name things. We categorise with nouns. We put things into defined boxes and then argue about the purity of the box’s contents. Verbs on the other hand are action words. It’s harder to pin a verb down. It’s always changing. Every Sunday you’ll find a post here about a verb (put the phrase “A to Z of becoming” in the search box and you’ll find lots of them).

Becoming not being is about change, about transience and about process.

Eric Cassell says in his “Nature of Clinical Medicine

I say that “thinking about processes differs from thinking about a thing in at least four aspects. Process implies change, a direction of change, a rate of change, and a purpose, result, or outcome of change”

Who I am today is different from who I was yesterday, last week, last year. I am still me and the nature of change in a human being is of constant adaptation and evolution. It’s developmental. The cells in my body are constantly changing, some dying off, some being born. The connections in my brain are constantly changing – with every thought, every image, ever memory, every sensation.

I AM change.

There are many directions of change in the Universe, but the one which fascinates me most, is the one which underpins “The Universe Story“. If we start about the time when there were only Hydrogen atoms, and follow the change through to the emergence of Life, and on to the births of you and I, we see a direction of change – towards every greater complexity, from fairly simple atoms to complex adaptive organisms – and up into the emergence of consciousness. With this direction of change we see more and more diversity in the Universe.

The direction of change is towards ever greater connectedness and ever more uniqueness.

The rate of change is not constant. We see that with evolution. There are no smooth transitions from one life form to another. The changes occur in leaps. We see that in the development of a child. One day they can’t stand up, then from another day they can. One day they can’t walk. Then they can.

Change occurs in quantum leaps.

Cassell mentions “a purpose, result of outcome of change”. The thing with outcomes, is that they are only what you describe at the time you describe them. Outcomes lead to new changes. There isn’t a stopping point. You could say the same about results. So what about purpose? I think purpose is discovered, and/or created through narrative.

The narrative of change creates and reveals meaning in our lives.

The photograph at the start of this post, is of a cognac cellar. The barrels sit there in the dark for years as the cognac constantly changes, every year producing a unique new flavour.

Becoming not being.

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Around one and a half million people took to the streets of Paris yesterday. Throughout France in towns and even villages the people came out with their “Je suis Charlie” signs (about 4 million people all across France), their pens and pencils held aloft, as they demonstrated their commitment to the principles of the French Republic.

Amongst the many creative signs and symbols in the crowds, one of my favourites was, 

Osons vivre ensemble

which translated into English is something like

Let’s dare to live together

It takes courage and determination to accept difference, to respect the choices and beliefs of others, and to manage to do that while living together. 

Another banner which struck me was this one –

Love is stronger than hate

Sign me up. I believe that and I choose to live according to that belief.

(by the way, these photos are not mine. I found them on web)

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When I started the A to Z of Becoming, the first verb beginning with an A was Attend. (Click through on that link to read the original post)

This week I want to explore the difference between passive and active attention. What I really mean can most easily be understood from that common expression – “that caught my attention”. We experience our attention being “caught” all the time. Whether it’s caught by a loud bang, a bright light, a word or a phrase we hear or read, what we experience is suddenly noticing.

What caught my attention and led me to take the above photograph was the colour of sky at sunset. I noticed the red sky, picked up my camera and went out into the garden to take the photograph.

What caught my attention next was the bright spot of light you can see shining up there in the top left of the image. 

What is that?

So, then I took out my iphone, opened up the Star Walk app, and held the screen towards that part of the sky I had photographed.

Venus. That bright light is Venus. I then noticed (on the app) that several other planets were in the same vicinity, some of them having already disappeared below the horizon with the setting sun, and some of them not shining brightly enough yet to be visible in the red light.

What happened there was that my attention was caught, first by the red sky, then by the shining “star” (which turned out to be a planet). The whole experience was extended by following the curiosity which my attention had provoked. And I extend the experience further again now, as I write this.

We’re often not that aware of what is catching our attention because we don’t linger with it. We become aware of something, then we quickly start to think about something else. So, how can you become an more active player and influence what your mind is paying attention to?

Here’s an exercise you can do to find out what keeps catching your attention.

Take a notebook and write continuously without stopping to think what to write for either a period of time, or until you’ve filled a number of pages. I’ve seen several variations of this exercise and suggest you choose the one that best fits for you. Either fill three, or more, pages of A4 size, or write continuously for 30 minutes, or a period time you can fit into your schedule (I’d suggest it needs to be at least 15 minutes)

The rules are, do it every day, don’t stop for a second as you write, and don’t read what you’ve written. Do this for 30 days, then read the whole lot. You’ll be surprised when you find some of the things that keep coming up. Some will be obvious to you, but I bet there will be others which really surprise you. These repeated phrases, topics or whatever, are what has been catching your attention this last month. (If 30 days is too much for you, try it for 7, or for 10 days. Set your target in advance and don’t read anything until that target has been reached)

As you reflect on what you’ve written, you can make some choices. You can choose to stop paying attention to something, or you can choose to actively look out for something else. In other words you can engage actively with your attention, setting yourself up to have your attention caught more frequently by whatever it is you’d like it to be caught by.

We are never fully aware or completely present for long, but the act of choosing to attend to something in particular, again and again, begins to influence our passive, less conscious reactions too.

We can gradually begin to experience more of what we choose to experience.

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air and water

water and fire

air water and fire

air water fire earth and Life

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I used to support this idea that you ‘write what you know.’ You hear that advice given to young writers all the time and even to kids in school. It’s one of the greatest disservices – even in elementary school, teachers ask students just back from holidays to write about what you did, what happened to you, what you know. What about what you imagine? The imagination is the richest tool you will ever have as a novelist and, really, as a person. Anybody can do research. To use your imagination is to use a gift of the gods. The imagination is really disrespected when you’re telling people over and over to write what you know. This idea that what you experienced in your backyard when you were 15 is more significant or more real is just not true. Lawrence Hill

I’m increasingly convinced that imagination is indeed a “gift of the gods” and that it is the “richest tool” any creative person can use, not just writers. 

In fact, I’m increasingly convinced that more imagination is needed to solve the problems and crises we face, to feel genuine empathy with others, to develop tolerance, and to re-enchant our dis-enchanted lives.

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Look at this!

I saw it on a French Nature programme, but it’s originally from the BBC.

If you look carefully you’ll see the little puffer fish at the centre of his creation. Isn’t it totally amazing?

How can such a wee fish make such a perfectly accurate circular pattern like this? And isn’t it just beautiful?

Apparently this is what the male puffer fish creates to attract a female. If the female fish is satisfied with the creation she lays her eggs right in the middle of it, he fertilises them, then she lays more, which he fertilises. Then she swims off.

The way he makes the pattern, it creates a perfect consistency of sand in the middle for the protection of the eggs. In other words, from an engineering perspective, it’s brilliant. 

But what amazed me most was how he makes it so beautiful, and how the beauty of the pattern attracts the female.

Are you aware of any other creatures, apart from human beings, which produce creative works of beauty? I know certain birds, and some other creatures, can create incredible nests, but ones which seem to be created to be beautiful? I didn’t know other creatures did that.

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In Eric Cassell’s “The Nature of Clinical Medicine”, he postulates that a key problem with Western Medicine is the focus on disease, at the expense of seeing, hearing and understanding the person who may, or may not, have the disease. At Medical School I was taught it was very bad practice to refer to “the gall bladder in bed 3” or to say “I admitted a case of pancreatitis last night”. Despite that we continue to think of disease as paramount in patient care, and we even create our health care services around the diagnosis and “management” of disease. Whole protocols of procedures are created, distributed and enforced around the concept of diseaes. Doctors and nurses are told what to do with a patient with disease X on the basis of “the best evidence”, where “the best evidence” refers to group studies which seek to “control for” individual factors – a process which prioritises the disease over the individual experience of it.

Eric Cassell enumerates “8 problems with using disease language”.

Disease names, for example, coronary heart disease or carcinoma of the breast, wrongly imply that a disease is a concrete thing (as opposed to an abstract concept) that can be found separate from the patient in whom it is found.

I read the phrase about disease being a concept, not a concrete thing, many years ago, and it had a big effect on me. Disease is exactly that – a concept. It’s a pattern of change which we name. Yet how many people, patients or health care professionals, think of a disease as being a thing? If you look at recent slogans used in health care, and in charity campaigns you’ll see the kind of thing. They are full of war metaphors about fighting this, beating that, kicking cancer’s butt, and so on. 

Disease names, for example, renal cell carcinoma or ulcerative colitis, incorrectly imply that the disease and its behavior are independent of the persons in whom they are found.

There are NO diseases which exist outside of people (or other living organisms). A disease is ALWAYS found in the context and the environment of the person who is suffering. 

Disease names, for example, lupus erythematosis or chronic obstructive pulmonary disease, mislead the unwary into believing that the name refers to one thing whose manifestations in individual patients are more alike than dissimilar. Just as the word tree refers to a class of things whose members are more alike than not, when, unless one wants to use trees or their wood, their variations are more important than their similarities.

What does every patient who attends an asthma clinic have in common? Asthma? How similar does that make them? Is this the most important fact to know about this person who is attending today? It’s individual differences, not the similarities, which are the most important.

Disease names, for example, multiple sclerosis or pneumococcal pneumonia, fool the unsuspecting into believing that what is referred to is a static entity, like the Bible, the Statue of Liberty, or the map of the New York City subways, rather than a constantly unfolding process that is never the same from moment to moment. The history of disease concepts depended on and furthered the classic separation of structure and function in which abnormal function was believed to follow from abnormalities in structure. This distinction seems to have been derived from the idea of form (which goes back to the Greeks) and its consequences that loomed large in 17th- and 18th-century medicine (King, 1978). The hard and fast distinction between structure and function itself is invalid. Structure is merely slower function, in that it changes at a lesser pace than the process called function—put in mind how bony structure changes in response to trauma or age so that it continues to perform its original function. Even the Statue of Liberty and the Parthenon are constantly changing.

As best I can understand, change is the nature of reality. There are no static entities. Even the ones which look static, are just changing more slowly, or less perceptibly. As Cassell says, “structure is merely slower function”.

Having named a disease within the patient, for example, diabetes mellitus or metastatic adenocarcinoma of the lung, physicians may be fooled into believing that they know what the matter is at this particular time and why. The disease may be the sole underlying reason why the patient is sick, but more often other factors—physical, social, or psychological (or all three)—have been crucial in the generation of the details of the illness and its losses of function (Cassell, 1979).

This is a common error. Just because an abnormal reading is found, that does not necessarily mean the explanation for the patient’s suffering has been found. For example, it has been clearly shown that there is no direct linear relationship between a lesion and the pain a patient is experiencing. Pain can change irrespective of the findings in the MRI scanner.

Disease names, for example, amyotrophic lateral sclerosis and psoriasis, inadvertently cause physicians to fall back on definitions of disease that are now accepted as outmoded because they fail to provide an adequate basis for treating the sick.

Disease names can, and do, change as we develop our understanding.

Using disease nomenclature to describe human sickness encourages the belief that only research into (molecular) mechanisms of diseases holds promise for understanding and treating human sickness.

You’ve probably encountered one of the ways in which “patient centred” is being used – pharmacogenomics. The idea that as long as we find not just the genetic code associated with a particular disease, but the genetic codes which seem to indicate responsiveness to certain drugs, then all we need is the genetic code. This isn’t to say that molecular or genetic research is not of value. It’s just not enough.

Finally, focusing on naming the disease takes attention away from the sick person.

Ultimately, this is Eric Cassell’s main message, and if only we made this the foundation principle of health care then we might have better medical education, more useful research, more effective treatments, and even health care organisations constructed around people, not diseases and drugs.

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Eric Cassell has a new book out. The Nature of Clinical Medicine. Maybe not a title which grabs your imagination but I was very influenced by two of his earlier works – The Healer’s Art, and The Nature of Suffering. In particular, I appreciated the way he articulated the difference between “disease” and “illness”. It seemed to me that the patient’s illness could only be understood by including their story, their reports of the invisible, subjective experiences we call symptoms. 

When I studied Medicine in Edinburgh, the first three years of the six year degree course had a curriculum of “medical sciences” and so my first degree was a BSc in Medical Sciences. It was only when we entered into Year 4 that we were introduced to patients and to a curriculum of “clinical medicine”. So, the first time I saw “cirrhosis of the liver” it was in a perspex box marked “cirrhosis of the liver”. It was a full two years later before I encountered a person who had “cirrhosis of the liver”. 

I know Medical degree curriculae and teaching methods have changed a lot over the years, but what Eric Cassell does, so eloquently, in this book, is make the case for the practice of “Clinical Medicine” which does NOT focus on the disease. Instead, he argues, it needs to focus on the patient. 

The major problem is, simply stated, that when persons are sick, the sickness has an effect on every part of them, and if attention is paid only or even primarily to the pathophysiology, the disease, or the body, then the other aspects and particulars of sickness will get inadequate attention and the impact of the sickness may go on and on. That probably did not matter so much in the era of acute diseases because the patient was either soon well again or died. Now that the overwhelming majority of medical problems come from chronic diseases, from persons with enduring disability secondary to diseases, birth defects, or trauma, and from an aging population, the inadequacies of disease-centered medicine cause problems for individuals and for populations.

Even if this way of focusing on disease paid off in terms of managing acute illness, he makes the point that the world has changed, and now doctors primarily have to help patients who have chronic illnesses. A continued focus on pathophysiology, is a focus on disease, and it runs the significant risk of failing to understand or help the person who actually has that disease.

If no disease is believed to be present or cannot be found, generally the patients’ problems are shunted aside, symptoms are treated simply because there are treatments, or the patients are essentially dismissed or placed in a category of lesser interest.

This is one of the worst effects of a focus on disease. When the test results return normal readings, the patient is declared to be disease-free, and either dismissed, categorised as having a mental illness, or is prescribed medication to attempt to dull the symptoms they are experiencing even though the doctor can’t explain the presence of those symptoms. Sadly, this often results in loss of trust, breakdown of the doctor patient relationship, and ultimately a failure of care.

It is this almost single-minded focus on disease entities, especially hunting for their ultimately molecular origin, that marks Western scientific medicine and creates difficulties for physicians in the multiple other things they do, from counseling to treating suffering. 

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It’s often said that every action you take, every word you utter, maybe even every thought you have, ripples out into the Universe like the spreading waves on the surface of the water after you throw a stone into a pond.

Take a look at this photo. I took it the other morning when I saw the grass was covered in frost and the sun was coming up.

You can see the sunlight is coming from the top left of the image and that the bush is casting a shadow towards the bottom right. You might think (rightly) that the land covered by the shadow will not be warming up as quickly as that which is in direct sunlight, so the frost will stay there longer. 

But look more closely. there is a whole circle of ground around the bush where the frost has gone. And that circle is on both sides of the bush – the sunlit side, and the shadow side.

More than the metaphor of the ripples on the water, I think this image reminds us how a living organism impacts on the world of which it is a part. 

It reminds me that all living organisms are “a part” of the Universe, not “apart” from the Universe.

It reminds me that our every day living influences and effects the place where we live, the environment in which we live, and that we interact in complex and surprising ways with the Universe.

It’s true, isn’t it? Every action we take, every word we utter, every thought we have, cascades “out” into the Universe.

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UNESCO has declared 2015 as the “Year of Light” (“and light-based technologies”), so I thought I’d share a couple of thoughts about light.

For the last 52 Sundays I’ve published a post about an action to consider in the week ahead. To focus on actions, I’ve been writing about verbs. Verbs are tools for us. We use them to create the lives we experience. Verbs are doing words. They can’t quite be pinned down into one place or time. When we are doing something, we are experiencing continual change. Some even say that the best way to think of the “self” is not to think of self as a noun, but as a verb.

The practice of meditation invites us to investigate the flux of arising and passing events. When we get the hang of it, we can begin to see how each artifact of the mind is raised and lowered to view, like so many flashcards. But we can also glimpse, once in a while, the sleight-of-hand shuffling the cards and pulling them off the deck. Behind the objects lies a process. Self is a process. Self is a verb.

Verbs are our tools of becoming. Because we can choose our verbs and practice them, we can become active creators of our own experience.

I’m thinking of doing two things with the A to Z of Becoming series – develop them into a book which I hope to publish this year, and continue the Sunday series of posts about verbs.

This Sunday, I’m going to pick up on the UNESCO theme and think of verbs related to light. A long time back I figured that being a good doctor included practising three verbs related to light – lighten, brighten and enlighten. But now I think they are good value-grounded verbs which can add to anyone’s life.

So, this week you have three verbs to explore.

What or who lightens up your life? Can you find time to spend doing what it is that lightens up your life this week?

And what light do you shine in the lives of others? In your day to day interactions with others do you make their lives lighter, or darker (lighter or heavier maybe)?

What about brightening? To me, if you lighten someone’s life, you do something which eases any suffering they are experiencing. You help them to relax, feel less anxious, or down. To brighten someone’s life is to turn the light up in their lives. Think of sunshine, or of sparkling. Sparkling eyes brighten a day. Smiles brighten an exchange. Sharing a passion or an enthusiasm makes an experience more vivid. I’m thinking of brightening in those ways.

What can you do to brighten someone else’s life up this week?

And, how do you brighten your life? How do you add colour to it, richness or, variety? How can you increase the intensity of your experiences…..turn up the brightness…..hear, see, smell, taste, feel more vividly?

Finally, what about the idea of enlightening?

To enlighten is to understand better, to see something more clearly, to know what something means. How can you increase your understanding of another this week? How can you see something more clearly? We humans crave a sense of meaning and purpose. How do you make sense of what you experience this week?

There are lots of questions in this post, and I don’t expect you’ll explore them all in just a week, but maybe that’s why I’ve been thinking about them today. If this is to be a year of light, I can explore light in many ways over the coming days and weeks. I’ll do that with my camera, and I’ll do it with my journal. But mainly I’ll do it by coming back again and again to these three verbs – lighten, brighten and enlighten.

Here’s some amazing sunlight

sun

Some moonlight…..

moon

And some sparkles….

sparkles

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