Feeds:
Posts
Comments

Archive for June, 2015

heart in the keystone

It strikes me that the practice of Medicine (I’m specifically referring to the world of Medicine for humans here), begins and ends with a relationship between human beings.

I’ll just focus on the doctor-patient relationship here, because that’s how I spent my working life. But I suspect that much of what is relevant to this relationship is also true for other health care workers, and perhaps even in other areas of human life.

When I say the practice of Medicine begins and ends with a relationship between human beings, I mean that the whole, unique person who is the patient has to be understood, cared about and attended to, by the whole unique person who is the doctor. Both individuals are important. I think this is partly why there are no doctors who are the best doctors for everyone, and I think it explains how in a group General Practice, each of the doctors in the partnership will have a specific loyal cohort of patients who always seek a consultation with that one particular doctor.

I also think this means that the whole person must always be considered. Anything less is reduced, and anything reduced is less than human.

In this context, I recently read “A General Theory of Love”, by Drs Thomas Lewis, Fari Amini and Richard Lannon. [ISBN 978-0-375-70922-7]. This book describes the model of the triune brain, which you might have come across elsewhere. (My introduction to that model was Dan Seigel, and later, Rick Hanson). It’s the observation that we have three brain regions – the brain stem, which is responsible for survival, and is found even in reptiles (henceforth to be known as the “reptilian brain”), the limbic system, which is responsible for memory processing and emotions (called the “mammalian brain”, because all mammals have this part), and the neocortex, which is massively developed in humans and seems to give us the capacities for abstract thought, conscious decision making and rational analysis.

In “A General Theory of Love”, Thomas Lewis and his colleagues focus on the limbic system – they describe in detail how this part of the brain helps us to “feel” other people’s feelings. It’s the kind of phenomenon that others call “heart feelings”. Without this part we’d have the reptilian survival strategies or the cold, analytic distancing of the neocortex. Let me be really clear here – this is a simplification and human beings are a lot more complicated than that. But this is a useful simplification which clarifies certain truths about what it is to be a human being.

In this post, I want to just bring to your attention some of the points the authors make when taking this perspective on the practice of Medicine, because I think health care is in a dire and degenerating situation in the world.

The last century saw a two-part transformation in the practice of medicine. First, an illness beset the relationship between doctor and patient, then radical restructuring attached the residual integrity of that attenuated tie.

I think the illness and the radical restructuring they refer to developed from a general reductive de-humanising of health care. Iain McGilchrist has shown how a “left hemisphere approach” has come to dominate society and I find that explanation helpful. Lewis says

American medicine has come to rely on intellect as the agency of cure. The neocortical brain has enjoyed a meteoric ascendancy within medicine even as the limbic star has fallen into disfavour.

Whilst this focus is a little different, the basic point is actually the same. By coming to rely on data, figures, statistics and techniques, we have reduced the human-ness of medicine. We’ve increasingly denigrated the patient’s narrative, the individual’s subjective experience, and the place of heart felt caring.

The limbic brain has a crucial role to play in attachment, and Lewis describes attachment theory along with the physical and social consequences of disordered attachment incredibly clearly. And here’s one of the most important points in this book – the physical reality and hence importance of relationships, emotions and attachment –

Medicine has lost sight of this truth: attachment is physiology

The radical restructuring they refer to is seen throughout Western Medicine – its the rise of bureaucracy. We see it in the proliferation of protocols and guidelines, of the prioritisation of measurement – what others have referred to as “Taylorism 2.0” (the modern equivalent of Taylor’s “scientific management”) – at the expense of what cannot be measured – the lived experiences of the patients and the health care workers.

Good physicians have always known that the relationship heals. Indeed good doctors existed before any modern therapeutic instruments did…

For many years, the medical community hasn’t believed that anything substantive travels between doctor and patient unless it goes down a tube or through a syringe.

They neatly sum up their thesis with

medicine was once mammalian and is now reptilian

Corporations and organisations have taken the high ground imposing their limits, their rules and regulations on those who try to care.

A corporation has customers, not patients; it has fiscal relationships not limbic ones.

The use of terms “customers”, “clients” and “consumers” in the area of health care has always disturbed me. Now I think I understand more clearly why!

I concur with this conclusion –

Before it is safe to go back to the doctor, a mammal will have to be in charge. And before that can happen, our physicians will have to recapture their belief in the substantive nature of emotional life and the determination to fight for it.

I’m not sure I’ve heard any politician, manager or profession leader say this so clearly – the problems facing health care are not ones of efficiency, targets and “better” guidelines. The problem is we need to make health care more human.

We need Medicine based on love, care and attention….where the heart is the keystone.

 

 

Read Full Post »

paeony

If you look at the header of this blog page, you’ll see the byline “becoming not being”.

I was inspired by the writings of the French philosopher, Giles Deleuze, when I began this blog. He emphasised the difference between “être” and “devenir”. Here’s why –

Really everything in this universe constantly changes. It’s just that some things change more slowly than others. All living creatures, however, change quickly and unceasingly. Maybe you realise that none of the billions of cells which make up your body live as long as you do? Some of your cells only live a few days, whilst others have a life expectancy of a few years. The biological truth is that your body now contains very few cells which were there ten years ago.

We are more than our physical bodies. Our thoughts, feelings and sensations are in constant motion and we process all that information unceasingly. Hopefully, we mature, develop and grow through our lives. Discovering more talents, learning more skills, developing our behaviour and maturing our personalities.

We are more than single beings in isolation as well. We are incredibly social creatures. We live our days in constant exchange with other humans, with other animals and with the wider natural environment in which we live. It’s difficult, indeed I’d say impossible, to understand a person in isolation. We have to see each individual in the contexts within which they live.

How do we hold all these changes together and have some sense of stability? How do I still recognise myself in the flux of all these changes?

Well, partly, we do that by telling stories. Each of us is a narrative self. When you meet someone, you introduce yourself by telling where you came from, where you are now, and maybe also, where you hope to go. In other words, you tell a simple story with a beginning, a middle, and, if not an end, then at least a potential plot direction!

All living organisms are like this. It’s just that we have evolved to a greater level of complexity than other creatures and we, we humans, are the storytelling species.

So, if we focus on “to be” (on “être”) then we reduce the subject to an object. We pin down just part of a person to a particular place and time and we then try to label and categorise them on the basis of a small set of features or characteristics.

I find it so much more satisfying to focus on “becoming” (on “devenir”). It’s slippier, it’s more complex, but it’s more alive. And, fundamentally, it’s a much better reflection of reality.

Try it for yourself – try focusing on becoming instead of being…..

Read Full Post »

To the sea again

I’ve reached “Y” again in my “A to Z of Becoming”, and the first “becoming” verb I thought of for the letter “y”, was “yearn”.

This is a tricky one, because yearning has a bit of a bad press. It’s often associated with wanting what you don’t have, or, in other words, with dissatisfaction. But I think it emerges from something very positive and creative.

When we yearn for something there is the possibility that we are getting in touch with our heart’s desire. The French philosopher, Deleuze, whose writings were the original spark for this blog, talked of “lines of flight” – and interesting metaphor to change the way we think about things. When we look up at the sky and see a plane flying past the moon
Flying past the moon

, we can see a bit of a trail. We can see something of where it’s come from and what direction it’s heading in. It’s an image like that which came to my mind when I read about the “lines of flight” and for me it’s an encouragement to see something in its context – the context of where it’s come from and where it’s going.

When I think of yearning from this perspective, it seems to me that yearning arises from our heart felt desires, from our deepest longings. So, one of the benefits of yearning is to become aware of what our heart’s true desires are.

As K D Lang sang in “Constant Craving”

Maybe a great magnet pulls
All souls to what’s true

Do these heart desires push us forward from within, or are they magnets pulling us towards something, somebody, some place?

When you stop and reflect and wonder about what stirs your longings, your yearnings, you have at the chance to get in touch with some of your most heart felt desires.

There’s something else about yearning – it pulls us out of balance.

I know people talk a lot about balance as a good thing, but it isn’t everything. All living creatures are “complex adaptive systems” and one of the main ways that such systems grow and develop is by tending towards the “far from equilibrium” points. At those places the system can fall to pieces, tipping into chaos, or it can transform to a whole new level, as we see in “dissipative systems“. The “far from equilibrium” points are where our yearnings take us.

So, there’s something potentially enormously creative about yearning. It can pull us towards the new and the heart-felt.

Remember John Masefield’s poem?

I must go down to the seas again, to the lonely sea and the sky,
And all I ask is a tall ship and a star to steer her by;
And the wheel’s kick and the wind’s song and the white sail’s shaking,
And a grey mist on the sea’s face, and a grey dawn breaking.
I must go down to the seas again, for the call of the running tide
Is a wild call and a clear call that may not be denied;
                                                          And all I ask is a windy day with the white clouds flying,
And the flung spray and the blown spume, and the sea-gulls crying.
I must go down to the seas again, to the vagrant gypsy life,
To the gull’s way and the whale’s way where the wind’s like a whetted knife;
And all I ask is a merry yarn from a laughing fellow-rover,
And quiet sleep and a sweet dream when the long trick’s over.

zen seascape

Read Full Post »

one petal left

Starting from here, this photo above, we can move to either here –
poppy seeds

or here –
meconopsis

What comes first?

The seed or the flower?

What comes last?

The seed or the flower?

Looked at one way, the seed comes first, grows into the plant which unfurls its petals and reveals its new seeds, attracts the pollinators, then drops the petals, then disperses the seeds to start new plants. Looked at another way, we can start with the flower…..

So, what’s the plant doing? Seeding? Or flowering?

We know, of course, that the plant would not be the plant at all unless it was seeding AND flowering.

Gandhi was once asked “What’s your message?” and he replied

My life is my message

That’s true of all lives isn’t it? Every plant, every animal, every person…..

Read Full Post »

Butterfly on lavender

I recently read an interview with Anne Dufourmantelle, a psychotherapist and philosopher in Paris, who talks about the concept captured by the French word “douceur” (In fact, she has a book entitled “Puissance de la douceur”)

“Douceur” is one of those words which is difficult to translate into English but it has elements of softness, gentleness, goodness, mildness, and sweetness. “Allez-y en douceur!” means “Gently does it!” or “Easy goes it!”. And in the plural, “les douceurs de la vie” translates as “the pleasures of life”

In the interview (and in the book, which I’ve since purchased and read), she talks of the “absolute necessity of ‘la douceur'” in modern life, and I agree with her wholeheartedly.

She says she was looking for a word which would capture the connection between “the body, the spirit, sensation and intention”, and it was the word “douceur” which seemed to best fit the bill.

Let me try to translate a couple of her phrases for you –

“Douceur au sens de force de vie, de puissance, car notre première expérience sensorielle et émotionnelle est d’avoir été enveloppé dans la chaleur et la douceur d’un autre corps…La douceur donne naissance à la vie, elle est, pour l’humain, une nécessité absolue.”

[my translation – Douceur as a life force, a power, because our first sensory and emotional experience is to be enveloped in the warmth and the softness of another body…..La douceur gives birth to life, it is, for the human being, an absolute necessity.]

To make this concept clearer she says that if douceur was a gesture it would be a caress. Isn’t that lovely?

And somewhere (I can’t find it now) I’m sure she says that a flower could be a symbol of “douceur”.

I think she is right that kindness, gentleness, goodness, softness disarms and has great power – it comes from our own sense of vulnerability and that of others. It’s a humble stance – but powerful in the way, as we saw when it was used by Gandhi and others who advocated non-violent resistance. One image which comes to my mind when I think of this is the anti-vietnam war protesters in the 60s giving flowers to the police and the security forces. (OK, I know, the flower power thing went off from “peace and love” to “sex and drugs” but, well, there was a good hearted idea in there!)

Anne Dufourmantelle’s recommendations for how to increase the “douceur” in your life seem completely consistent with those which I find myself writing about again and again in this blog –

She recommends paying attention to details – gestures, facial expressions, the play of the light, all the little, fleeting, amazing things (“toutes ces minuscules chose fugues, merveilleuses…”) which surround us. And she recommends seeking out and, I’d use the word “relishing”, sensations – smells, tastes, sights, sounds, what touches our skin.

I love how she has taken this single concept and used it to link together bodily experiences, a way of engaging with everyday life, and a power of change which can be used to create more goodness in this world.

Read Full Post »

If you’ve been following this blog for a while you’ll know that the “émerveillment du quotidien” is a key life principle for me.

That French phrase captures the sense of continuous open-ness to wonder. (It means the amazing everyday – more or less!)

But look what I managed to film today!

I’ve seen and heard this little creature buzzing around my garden recently and he never, ever stays still. Not for a second! I think it’s called a “hummingbird moth”.

His wings make a deep buzzing sound so its always obvious when he is around.

Look at the speed of his wings! Look at that long proboscis and how it can curl right up into a spiral! It’s astonishing!

Read Full Post »

angel flower

Doesn’t this flower look a bit like an angel?

Or a butterfly if you can’t imagine what an angel might look like!

I read recently that our retinas only register colour in the central 30 degrees of visual field ….the fact that we see a full panorama in colour (even out the edges of our vision) is due to our ability to make up what we are seeing.

Really?

I know that seems a bit incredible, but when you stop to think about it, our eyes convert light energy into electro-chemical signals which are then processed by the neurones in our brains for us to “see” anything, so maybe it’s not such a surprise that we are responsible for “colouring in” most of what we see!

We are incredibly creative organisms with fabulous bodies and powerful imaginations.

Mark Twain said

a person cannot depend on the eyes when imagination is out of focus

Read Full Post »

Older Posts »