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Archive for May, 2015

sky writing

Last night I saw these clouds up in the sky just before sunset.

Never seen clouds quite like these before and they didn’t hang around for long.

Don’t they look like symbols? A number two perhaps, followed by some question marks?

Or, what do you see?

We do that, we humans, don’t we? We look for patterns. We try to interpret patterns, to name them, recognise them, make sense of them.

And the other interesting thing is….all of that is personal. Yes, maybe you agree that these clouds look like something, some writing, or numbers or whatever, but maybe you don’t. And even if you do, you’ll maybe “recognise” something in them that I don’t.

When that happens, it’s good to share. To just say, “This is what I see”, “This is what I experience”, “This is what sense I make of it”.

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ava charlie

I was recently sent a copy of an article published in Norway back in 2011. The article’s title is “The human biology – saturated with experience“. Here’s the summary –

SUMMARY

BackgroundHuman beings are reflective, meaning-seeking, relational and purposeful organisms. Although experiences associated with such traits are of paramount importance for the development of health and disease, medical science has so far failed to integrate these phenomena into a coherent theoretical framework.

Material and methodWe present a theory-driven synthesis of new scientific knowledge from a number of disciplines, including epigenetics, psycho-neuro-endocrino-immunology, stress research and systems biology, based on articles in recognised scientific journals and other academic works. The scientific sources have been deliberately chosen to provide insight into the interaction between existential conditions in the widest sense (biography) and biomolecular processes in the body (biology).

Results. The human organism literally incorporates biographical information which includes experienced meaning and relations. Knowledge from epigenetics illustrates the fundamental biological potential for contextual adaptation. Intriguingly, different types of existential stresses can enhance disease susceptibility through disturbances to human physiological adaptation systems, mediated in part through structural influences on the brain. Experiences of support, recognition and belonging, on the other hand, can help to strengthen or restore a state of health.

It’s a fascinating review of research literature on the links between “biography” – an individual’s unique story, and “biology” – the biomolecular processes of the body. It seems clearer to me than ever that talk of “mind and body” as if these are two separate entities is both unhelpful and misguided.

We are certainly “reflective, meaning-seeking, relational and purposeful organisms” and it’s long seemed to me that to practice medicine without that understanding demeans both patients and practitioners. Human beings are not objects which can be reduced to genes, molecules or cells. We are complex adaptive organisms with consciousness. As these authors say, we have  –

a capacity for self-reflection, for designing sophisticated symbolic structures, for attaching metaphorical concepts to experiences and for building models and categories with the aid of the imagination.

We create art, music, poetry and stories. We play. We make sense of our daily lives. (See my recent series of posts on re-enchanting life for more about these very human activities) We connect. We live embedded in a mesh of relationships. We use language, myths and symbols to interpret and experience the world.

Unfortunately, such experience does not lend itself easily to standardised interpretation; it is always an experience of something for someone, in a unique context

All of our experiences are personal and unique. To be fully human, to really understand another person, we must consider the personal and unique. My contention is that we must not only consider it, but must hold that focus as central come what may.

Yet, as these authors point out, contemporary “evidence based” approaches to medicine have failed to include the subjective –

Human subjectivity is not only absent from contemporary evidence-based medicine, it is in fact explicitly eliminated by the mathematical analyses performed during assembly of evidence.

Should we allow statistics and “controlled” de-humanised research (with the experiences of the human beings who are the subjects of the research removed) be our “gold standard”? We need the research which incorporates the subjective and the personal if we want the findings to be relevant to the real, everyday lives of human beings.

Right up in the “Results” section of this paper the authors say “Experiences of support, recognition and belonging, on the other hand, can help to strengthen or restore a state of health”. That is completely congruent with the clinical experience of my lifetime’s work as a doctor. The essential elements of healing are based on the relationship – as a doctor it is my role to recognise each patient – to see each one as a unique individual with a particular issue or problem to discuss – and to be able to say “I see you”, “I hear you” and “I understand what you are experiencing” (and that includes making a diagnosis and being aware of the natural history of diseases). It is also my role to support, not judge. To provide what help and care I can. And finally, at the base of it all, it is my role to create a relationship with each patient, a meaningful connection which reduces the feelings of isolation or alienation a person who is suffering can experience.

It is heartening to see the beginnings of a scientific method which will help us all in the future to create the conditions for health. And if the start of that is to create “Experiences of support, recognition and belonging”, then we will be starting from a good place.

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Thistle in the vines

A thistle in the vineyard.

I stumbled across this thistle in the vineyard up behind the house in the Charente where I’m living now. I thought the symbolism captured something about this phase of my life.

When I retired from clinical practice last year, I sold my house and Scotland and moved to France.

I had the idea to move to France, having never lived anywhere other than Scotland throughout my whole life, because I thought if I put myself into a different culture, and worked to become fluent in the language of that culture, then I might stimulate my imagination and my creativity. I thought that it would also be good for my brain – a lot of people suggest that learning a second language is good for the brain at any age. I thought that moving to a more rural community in France would also allow me to enjoy food which was grown locally and available fresh in the markets. (Adopting the Michael Pollan Food Rules – Eat food. Not too much. Mostly plants) I thought it would enlarge and deepen my experience of the world.

It’s doing all that, and more.

Then today, I read a review of David Graeber’s “The Utopia of the Rules“, which really inspired me, so I set off to read more reviews, interviews and articles by this author. In one of the first pieces I read he quoted the following –

Putting yourself in new situations constantly is the only way to ensure that you make your decisions unencumbered by the nature of habit, law, custom or prejudice – and it’s up to you to create the situations

(It’s from “Crimethinc.” – an anarchist collective which says it is “in pursuit of a freer and more joyous world”.)

Well, wherever it’s form, it’s spot on!

Putting yourself in new situations constantly is certainly a way to move from zombie mode to hero mode.

David Graeber, by the way, is the man responsible for the slogan “We are the 99%”, and his book, “Debt: the first 5000 years” called for debt to be written off around the world.

What new situations do you plan to put yourself in, in the year ahead?

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Twins dandelions

What might health care look like if we base it on the values which emerge out of a prioritisation of difference?

Uniqueness.

Whilst a knowledge of pathology and the natural history of diseases aid a good diagnosis, a focus on disease is not a focus on a person, or on health. Even when running a specialist clinic, such as an Asthma Clinic, every single patient who attends is unique. Their asthma symptoms will be specific to them – the circumstances where their asthma is most troublesome will be specific to them – the strategies they have found bring greatest ease will be specific to them – and, crucially, their narrative will be unique. Where asthma appeared in their lives, and when, will be part of that narrative. What impact it has made and how they have responded to that impact will be part of that narrative. How the asthma will progress will also be part of that narrative. This latter part is unknowable, as the future is always an emergent phenomenon in a complex living organism. It cannot be accurately predicted. Last, but not least, each individual has a personal world view created by their genes, their nurturing, their life experience, their connections to others and so on – everything which influences values, beliefs and attitudes. Understanding that world view will help the patient to make sense of the asthma in their life, and understanding that world view is essential in helping them to choose therapeutic interventions as well as adaptive strategies. Whatever the general, the shared, or the common, all the findings, test results and so on, need to be re-integrated into the context of this unique human being’s life.

Diversity

Because every patient is unique, the interventions which a particular patient finds beneficial will be specific to them. One-size-fits-all is a terrible approach to health care. Every single treatment protocol has an end point, and none of those end points can encompass benefit and a good outcome for each individual patient who goes through that protocol. So, what happens to the patients who make it all the way to the end of the protocol and are still suffering just as much? What does the doctor do with them? If we make only certain treatments available then there will always be patients who get no relief from their suffering. We need a diversity of treatment options, approaches and techniques available if we are to find the best, most effective treatment for every single patient.

Are protocols compatible with uniqueness and diversity? Can truly individualised health care be delivered by protocol? Can health care which actually relieves the suffering of every single patient be delivered by protocol? This might be extreme, but I’ve a feeling we should trash the protocols. Let’s get back to sound, clinical judgement which is flexible and focused ultimately on the needs of the individual who is in the consulting room here and now.

Tolerance

This goes with diversity. If there are a plurality of needs, and a plurality of solutions, with both being deeply affected by the world view of the individual, then we need to genuinely tolerate, in a non-judgemental way, those differences. There is no place in health care for rubbishing a patient’s experience and world view. Whose life is it anyway? Who is a professional to say that they know what the best life choices are for a patient? A professional should be caring, empathic, compassionate and supportive. Not judgemental, superior or authoritarian.

Integration

There is no such thing as a cure. Other than the cures which the body achieves. Human beings have the most incredible bodies. One way to think of a human body is to see it as a complex adaptive system. Complex adaptive systems have a number of characteristics but one of them is a self-healing capacity. The only healing which occurs in the natural repair, defence and growth of the living organism. It does this not least through integration – through the creation of mutually beneficial relationships between highly differentiated parts. All health care should be directed towards an increase in integration. Any treatment which impedes integration, impedes healing.

Flourishing

A lot of health care seems limited and disappointing to me. Sure, nobody wants to suffer, and a doctor’s duty is to relieve suffering. If we can do that by enabling a patient to get a handle on what’s happening, supporting them in the creation of a more meaningful narrative, whilst easing suffering and reducing difficult and limiting symptoms, then we are doing a good job. But is it enough? Is it enough to reduce the symptoms and stop there? Is it enough to support a patient through an acute illness but then stop when it comes to an end? Or if we really want HEALTH care, don’t we need to think beyond disease? Don’t we need to think about flourishing? About assisting an individual to grow, and, yes, to flourish – to feel well, to feel able to become whatever it is they have the potential to become?

If we begin to think about health in its fullest sense and in its greatest diversity, then we need to think beyond institutionalised health care systems. We need to think about what we can do to maximise the chances of people experiencing the best health they can – and that will take us into thinking about society, the environment, the economy, and indeed everything which is involved in creating the conditions for the health of human beings.

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strawberry

With the current dominant world view, there is an enormous tendency to focus on “mass” – mass production, mass consumption – and to focus on quantities – GDP, profit, numbers “in work” etc. This all seems to drive core values of conformity and uniformity. We have ever more protocols and algorithms which are supposed to deliver “evidence based outcomes”. We find one-size-fits-all policies in health care, education, economics and politics. Difference is described as “variation” to be eliminated and “integration” is about forcing people with different values and beliefs to conform.

What values and what kind of world view might develop from a positive prioritisation of difference?

A shift from the general to the particular. 

Human beings are brilliant at spotting patterns, classifying them and naming them. We categorise by moving quickly from specific instances to general characteristics. We do that by stripping away the context and homing in on one or a few characteristics. By doing so we quickly lose sight of the individual, of the reality of the uniqueness of every person, every experience, every organism. And we quickly lose sight of the whole.

If we keep our eyes and ears open for the differences, then we take these generalised patterns which we spot and then consider how this particular instance fits, or doesn’t fit into those generalities. In other words we do what Iain McGilchrist describes in his “Divided Brain” – we perceive with the right cerebral hemisphere, analyse and classify a part of that with the left, then hand that analysis back to the right for further integration.

A shift from quantities to qualities.

“Lies, damned lies, and statistics”? Does the total number of people with jobs mean very much? Or is the nature and content of those jobs important? Does it matter if the jobs are zero-hour contracts, or full-time, more than minimum wage contracts? Does it matter if the jobs are to manufacture chemical weapons, or chemotherapy?

In health care, in education, in politics or society, because these are human institutions, its the quality which matters, not just the numbers.

A shift from seeing the world as composed of fixed objects, to seeing the world as a complex system which is continuously growing and evolving.

A shift from conformity to diversity.

Should we all have the same beliefs, the same values and make the same choices? If I choose one modality of health care when I am ill, and you choose another, is that a good thing? Or is it better that we both receive the authorised treatment which the protocol demands? Nature thrives on diversity. Monocultures are not natural.

A shift from a focus on parts to a focus on connections.

When we focus on parts, we tend to reduce what we are considering to objects. But no object exists in isolation. Everybody, every creature and every “thing” on our planet has a history. We all emerge out of what already exists. In the here and now we are inextricably linked to who and what is around us. Our left cerebral hemisphere is great at focusing on the parts. Our right is fabulous at focusing on the connections – the “between-ness” (to use Iain McGilchrist’s term)

A shift to integration.

Integration is the creation of mutually beneficial relationships between well-differentiated parts.

Think of the human body. A heart is distinctly different from a liver. To be healthy we need both, and we need both to be working in ways which maximise the health of the other. Our heart and liver are not in competition. They are not fighting it out to see who survives – only the strongest? Instead, they function best by integrating. I think we can see the same principle at work everywhere – or at least in all complex systems, from living organisms, to families, societies, cultures and environments.

A shift to seeing the flow of change

Nothing stays the same. We have cycles of growth and cycles of destruction. We see change which describe as growth and maturation, from (in the case of human beings) single cells, a spermatozoon and an ovum, to a fertilised egg, which grows into a foetus, a child, and then a fully grown adult. to And from the first moments of the Universe until now we see not just change in terms of growth and maturation, but a direction of change which we call evolution – we see an increase in complexity from the first hydrogen based stars to human beings with consciousness.

Whether in terms of maturation, or evolution, what we see is flourishing – the coming to fullness of all a being can be.

So, here’s my starting list of values

  1. Uniqueness
  2. Diversity
  3. Tolerance
  4. Integration
  5. Flourishing

What might the world become if we prioritised these values?

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Quiet

In my A to Z of Becoming, Q stands for Quiet. I’m thinking and writing about difference just now, so, naturally, it occurred to me this morning that where each of us go to be quiet is likely to be different.

Why be quiet?

Don’t get me wrong, I love conversation and music as much as anyone, but we all need times to just be quiet. Quietness can be calming. It can help us to let go of some of the loops which have established themselves in our minds. It can help us to be present. I know “mindfulness” is all the rage, and, for me, being “mindful” is about being aware and being present.

When we quiet our minds, our emotions and our bodies, we create a little distance from the automatic habits which dominate so much of our daily lives.

Quietness also facilitates reflection. It lets us see things differently and consider them more consciously.

But where can we best find quiet?

Some find it out in Nature, as I did in Aubterre sur Dronne (where I took that photo above)

Some find it in the forest…..

Mirror, mirror

Some find it at the coast…..

just sitting

Some find it in a church….

church

Some find it in a temple…..

kodai ji kyoto

Some find it in a garden…..

A seat in the garden

Sometimes we can find it in our own homes, in a favourite seat, or at a particular window…

window view

How about you?

Where are the places where you can experience being quiet?

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face

No two faces are identical.

Ever.

No two sets of fingerprints are identical.

Ever.

No two pairs of eyes are identical.

Ever.

Have you ever wondered about that? Maybe when you are at a Border Control in an airport, or maybe when you are looking for someone you know in a crowd?

Not only is every single one of us in the world unique, but we are unique in the time dimension too. There has never, ever, been someone with an identical face, identical eyes, and identical fingerprints to you. And there never, ever, will be in the future either.

Human beings are not clones. We are not units of production. Not physically, and certainly not narratively (is there such a word? We each have a unique story to tell….the story which says who we are, what we experience and what sense we make of it all)

Difference is one of our essential characteristics.

Might that be important?

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rose

In Saint-Exupéry’s “The Little Prince”, the little prince talks about the rose he has been looking after.

“To be sure, an ordinary passer-by would believe that my very own rose looked just like you, but she is far more important than all of you because she is the one I have watered. And it is she that I have placed under a glass dome. And it is she that I have sheltered behind a screen. And it is for her that I have killed the caterpillars (except for the two or three saved to become butterflies). And it is she I have listened to complaining or boasting or sometimes remaining silent. Because she is my rose.”

Can you ever “park” the personal? Can you ever set aside the “subjective”?

In “The Little Prince”, the rose which the prince looks after means so much more to him than any other rose. Isn’t this an essential truth about one of the ways in which we experience difference in this world? We develop personal relationships. We don’t just form personal relationships with other people, but with other creatures, with certain plants, trees, even with certain inanimate objects. Children often form intense attachments with particular objects – a blanket, a teddy bear, a soft toy. Does this phenomenon disappear? Or do we just move our attachments to other “more grown up” objects – a pen, a car, a favourite cup?

Could you make a list? Could you describe the people, places, creatures or objects which you are particularly attached to? The ones which mean the most to you? You’ll find that your list is very specific – and very different from anyone else’s.

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