Archive for June, 2020

The tendency to think that whatever we see is made up of small parts goes back a long, long way. You can trace it at least back to the Greek concept of the “atom” – that basic unit, or building block, from which everything else is made.

Well, maybe it took the 20th century splitting of the atom to discover that there are no basic units after all…..that when you look inside the “smallest” component part, there are even smaller ones inside, then when you look inside of those, there is……well, it all fades into invisibility somehow. Turns out there are no fixed, fundamental building blocks after all.

The Italian Physicist, Carlo Rovelli, who wrote “Seven Brief Lessons in Physics”, and “Reality is not what it Seems”, describes this well. Here are a few passages from him…..

The world of quantum mechanics is not a world of objects: it is a world of events.

The world is not a collection of things, it is a collection of events. The difference between things and events is that things persist in time, events have a limited duration. A stone is a prototypical “thing”: we can ask ourselves where it will be tomorrow. The world is made up of networks of kisses, not stones.

A handful of elementary particles, which vibrate and fluctuate constantly between existence and non-existence and swarm in space even when it seems that there is nothing there, combine together to infinity like the letters of a cosmic alphabet to tell the immense history of galaxies, of the innumerable stars, of sunlight, of mountains, woods and fields of grain, of the smiling faces of the young at parties, and of the night sky studded with stars.”

“Elementary particles which vibrate and fluctuate constantly between existence and non-existence” feels like a totally different universe from the one built from indivisible, fixed, discrete atoms.

The deluded idea that the universe is made of bits was compounded during the Industrial Revolution where the machine became the dominant model for interpreting the world. It still is.

Human beings are not like this.

But we still interpret experience using this lens of the machine. We want what was described by Arthur Frank as the “Restitution Model” in Medicine – just fix the broken bit and I’ll be on my way – Diagnosis is finding the wonky part and sorting it or removing it. A patient with multiple disorders is compartmentalised with each disease treated by a different team of specialists….some to deal with the heart, another one to deal with the stomach, yet another to deal with the bones and joints. We even turn symptoms into parts, treating “pain”, for example, with “pain specialists”, as if pain was an entity in its own right.

We take the same machine model and apply it to society as well, reducing human beings to mere cogs in the great machine.

The English philosopher, Mary Midgley, in her “Beast and Man”, said

I had better say once, that my project of taking animal comparisons seriously does not involve a slick mechanistic or deterministic view of freedom. Animals are not machines; one of my main concerns is to combat this notion. Actually only machines are machines.

Animals are not machines, human beings are not machines, and society is not a machine. Using machine models to understand and create institutions, policies, methods of health care, education…….I’d like to see all that disappear.

Life is not machine-like.

You think you can understand, and explain the existence of, a creature like this by seeing it as a machine?

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What’s this young woman doing? She looks relaxed, leaning both her forearms on the low wall as she gazes, or looks, (there is a difference) towards….who knows what? You can’t help but turn your head to see if you can see what she is seeing.

Deleuze and Guattari, in “What is Philosophy?” talk about three ways of thinking – concepts, functions and affects+percepts. Philosophy, they say, is our way of thinking concepts. Science describes functions. Art deals with sensations, affects and percepts.

In the city of Angouleme, about an hour from where I live, there are many, many examples of wall art. Angouleme is a major, maybe THE major centre, for graphic arts in France. Several of them are absolutely stunning. Many of them make you stop and think.

If art is a “bloc of sensations, that is to say, a compound of affects and percepts”, then what does that really mean in everyday life? I’m no philosopher and I wouldn’t be surprised if I misunderstand philosophical writings, but I am a “wonderer”. So, the two photos I’m sharing with you today, in this post, are just two examples of murals I’ve come across in Angouleme…….two murals which really stimulate my powers of perception and evoke emotions. They both make me wonder.

In this first one, everything in blue is the painting, but it’s been so cleverly painted that, at least at first, you have the impression you are looking at a real woman, leaning on a real wall, in front of a real hotel. Well, actually, it is painted on the gable end of real hotel, and the painted wall is an extension of one you can actually lean on. Maybe this graphic woman is looking into the window on the left? If so, she’s looking into a real window, not an imaginary one. Here’s the full picture…..

I love how the painted image blends with the physical world around it. It transforms reality. As I gaze at this in wonder, I slow down, feel calm and contemplative, and take my time to explore the whole painting. Isn’t it amazing that the woman, who is the artist’s creation, somehow induces in me, the viewer, these feelings of slow, calm contemplation?

What would this building look like unpainted? I’m not sure I’d even have noticed it. I certainly wouldn’t have stopped to gaze at it. And, here’s the other thing….I might not have followed the gaze of the woman beyond this low wall out over the valley below, towards the winding river, the boats, the houses and buildings at the edge of the city, and the farms and forests further out. I haven’t the slightest doubt that this work of art transformed my experience of Angouleme.

But, then, so did this one….

This is one of the most imaginative, evocative, narrative murals I’ve ever seen. It also stops you in your tracks. You can’t help but get drawn in, first to the woman and the man, who are kind of embracing, but there’s a mystery in this embrace. It doesn’t look entirely comfortable. What’s going on with these two? Then, above them, the glass in the window is broken. How did that happen? And above that, this enormous moon, which doesn’t really look like our Moon, but maybe some other planet? It always makes me think of the movie, “Another Earth“….But look at the biplane flying over the face of that planet? What era is this? Which makes us look at the couple again, and wonder what era they lived in as well…..they sure aren’t dressed the way we’d expect to see someone dressed in this day and age.

Then as I look again at this photo, I see the pink bike, parked against the railing, and I can’t help but think it’s her bike! So reality and fantasy blend and blur and lose their hard edges (do reality and fantasy really ever have hard edges?)

Finally, I look up and see what looks like the shadow of an angel with a trailing umbilical cord…..at least, that’s what it looks like to me, and I can’t help but turn around to see if I can see the actual angel behind me.

Oh, there’s the angel, over there, on the building opposite….

Isn’t that quite something? A drawing of a shadow which makes you turn around to see what’s casting the shadow? What a wonderful blending of perception and imagination!

Somewhere in the depths of my memory I seem to have a story of an ancient debate about whether or angels would have tummy buttons – because angels, allegedly, aren’t born, so don’t have umbilical cords. I remember thinking what an odd thing to have a debate about! But as I stand looking at this drawing, that old story comes rushing back to me, and in so doing, makes the artwork all the more interesting and engaging.

With both of these murals my experience of the day was transformed. They both challenged my perception of reality. They both stirred my feelings, stimulated my imagination and provoked memories. They both made me wonder.

As far as I know only human beings make art.

What kind of humanity would we be without it?

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This photo of water flowing over rocks in a Highland stream transfixed me the first time I saw it, and it’s lost none of it power.

When you watch water pouring down over, around, and between rocks in a stream or a river, you can see how the water itself is shaped by the rocks and the earth which create its edges (the banks of the river). If you look carefully you can often see that there is an ongoing lengthy relationship between the water and the rocks. It’s not just that the rocks make obstacles which the water has to flow around. You can see that as the water flows over the rocks, it shapes them.

However, what you see in this photograph is an additional dimension. You don’t just see that the rocks are making the follow a particular path. You can see that the surface of the water itself is shaped. Those bands, or ridges, look waves spreading over the surface of the water, except you wouldn’t expect to see waves in a stream or river as it pours down a rocky hillside. Where do they come? Maybe it’s something to do with the rocks on the river bed, or the rocks within the river itself, but it looks like something different. It looks like this pattern, this shape, emerges from within the water itself. As if it looks this way because of some influence within the water.

So, this photo always makes me think of that. It makes me think of how each of us is shaped by external structures, and the environments in which we live – by which I mean the physical, social, and cultural environments at least. But how we are also shaped by our constantly evolving inner structures and environments……our memories, imaginings, thoughts and ideas, as well as our physical bodies and all the cells, tissues and organs which lie hidden inside.

Who we are, what we are like, what we look like to others, what our characteristics are, are all shaped, are all constantly being shaped, by an alchemical mix of the external and the internal, of the visible and the invisible.

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This is one of my all time favourite photos. I took it while having breakfast at a little cabin at the top of the hill on the edge of Biarritz. I realise that the concrete fence is not bonny! But that doesn’t take anything away from the picture for me. The rich, deep hues of blue in the sea, sky and even distant mountain are just gorgeous and I like the fluffy summer style of clouds floating by.

Hey, you might be saying, you’re going on about the fence, the sea, the sky, the mountain, even the clouds, but isn’t this a photo of a coffee cup?

Well, yes. You could say that. But, then you know my tendency to explore the contexts, the connections and the environment….how I am drawn to the “whole”. But, yes, it is a photo of an expresso, and that’s what I want to talk about today.

Even though these short coffees in Europe are called “expressos” they don’t necessarily imply a brief, speedy period of time. I noticed that when I first stopped for a coffee in Italy that the cafe had tall tables and no chairs. That was a surprise. Maybe that’s when I thought that an “expresso” wasn’t just fast to make, it was fast to drink. But that was a misunderstanding. When I went for breakfast with a group of Italian friends, they stood around the tables chatting, drinking their coffees, eating pastries or biscuits, and there was absolutely no sense of urgency or hurry.

Coffee time is a pause.

It’s often an in-between time….between waking up and engaging with the tasks of the day, for example. When I worked in Glasgow, I lived in Stirling, and traveled in the train for about an hour each way each day. I’d stop and enjoy a coffee once I arrived in Glasgow and before I caught my second train to the hospital, and, often, I’d stop and enjoy another one on the return journey. Those were times of pausing. Of stepping off the busy flow and slowing down to reflect, to read, to ponder. Coffee times were also times of sharing, of enjoying the company and chat. Not all coffee times are social times, but many of them are, and that’s important.

There’s a term in buddhism – “bardo” – it means a space. For example, there is a bardo between each in breath and each out breath, and another between each out breath and each in breath. There is even a bardo between each thought, but good luck catching any of those! I think a pause is a kind of bardo. A life bardo, breaking up a busy day, and helping us to re-centre, to re-focus, to re-connect and to re-store.

I was reading in an article in “Philosophie” magazine this morning. It was about rituals and one philosopher described his coffee ritual. He said he wakes up, drags his heavy feet and thick head through to the kitchen, pops a “dosette” into the coffee machine, presses the on button, and listens to the familiar sounds of the machine. That first coffee begins to re-connect his disconnected brain cells, but it also makes him cough. He has a second coffee, which settles his cough, then, the third coffee, he says, is “for pleasure”. Then he is ready to get on with the rest of the day. Wow! I think if I started every day with THREE expressos I’d FLY through the day!!

We all have our own rituals, our own habits, our own routines. This little coffee cup resting on the fence reminds me of that. It’s good to pause now and again, and in that bardo to take stock, to reflect, and to become aware of rituals, habits and routines. What are they, and what part do they play in my life?

How about you?

What comes to mind when you think of a pause, a bardo or a ritual?

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In most countries the response to the Coronavirus pandemic has been to enact a lockdown. In France, it’s called “Confinement”. The same word used in English generally refers to imprisonment, but in Obstetrics it has another meaning related to the time between labour commencing and the baby arriving. Both of those situations come with quite a degree of stress!

Many people have found the restrictions tough but as long as they were in place then a kind of predictability began to emerge. In fact, each day could seem so similar to the previous day that sometimes it could be hard to work out exactly which day of the week it was. I’ve no doubt these lockdowns have produced their own particular stresses.

However, pretty much everywhere, the lockdown is ending (in France we have moved into “De-confinement”). The restrictions are being lifted in varied ways at different speeds. Because I live in France and would like to visit family in Scotland, I have to keep up with three sets of rules – those in France, those in the UK, and those specific to Scotland. Week by week that’s getting harder and more confusing. This period of lockdown easing has, in turn, its own, particular stresses. Not least because the rules keep changing now.

In addition to the stresses induced by trying to factor in different regulations in order to make future plans, I’m hearing an increasing number of people say that although they are now allowed to leave their home, they are too afraid to do so. On top of that, when you do venture out, what with all the perspex panels, instruction signs, brightly taped lines on the ground to stand behind or to follow, wearing masks, standing in long spaced-out queues (I don’t mean spaced-out in a drugged way!), and trying to maintain distance from everyone else…..well, it sure doesn’t feel like it used to do. It all takes some of the pleasure away. It all produces a sense of un-ease.

So, I thought today might be a good day to share a calming image. I’ve seen people sharing calming images on social media but I must say I don’t often find them very calming. I guess we all find different scenes calming. However, here’s one that works for me.

Take a wee while to yourself and gaze at this scene. Look at the wide and extensive calm water, stretching to every edge of the scene and beyond. See the red guide markers on the left, subtly guiding any boats to or from the shore. Look into the distance and see the long flat bridge, connecting the mainland on the left, to an island on the right (take that from me, you can’t see that you are standing on an island looking out at the sea from here) . Then notice the colours, the deep blue of the sky at the top of the scene fading into the pink from the last light of the sun which has just this moment set below the horizon. See the light blues in the sky just above the band of pink, and the similar light blues in the sea just in front of the bridge, and notice how the blues become darker and richer as the water reaches the shore just in front of you.

I find this scene wonderfully calming and peaceful. I hope you do too.

Do you have any photos on your phone, your pad, or your computer, which you can turn to, to absorb your attention in the beauty of this world we live in?

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I am very attracted to liminal spaces…..the zones of change, the places where the boundaries dissolve, the areas where the elements mingle at their far edges creating new, different and unique phenomena.

One of my most favourite such space is the shore line. That magical rhythm of the sea dissolving on the sand as the big waves turn to foam and flatten themselves out as they land on the beach, followed by a rush of water, sand and pebbles as the closest waves to dry land retreat speedily back into the sea again.

On this one particular evening an extra layer of “liminal” came into play, as the light turned pink and tinted both the sea and the sand with the colours of a setting sun.

So, simultaneously, in both the dimensions of space and time, that liminal zone emerged….that place of wet sand, not quite beach any more, but not yet wholly ocean yet. And that time of the day, not quite daytime any more, but not wholly night yet.

It makes me tingle just to remember it.

These phenomena of borders, of liminal spaces, of junctions and transitions….they all appear in the “between-ness”. That means they all share that characteristic of revealing connections, influences, bonds and relationships. Whilst the left hemisphere of the brain is so brilliant at selectively focusing on parts, analysing them, classifying them and categorising them, it’s the right hemisphere which sees the “between-ness” and in so doing reveals the singular, the unique, relationships and connections, and, so, the “whole”.

I think it’s good to stimulate your right hemisphere with these experiences. If we are to re-balance the influences of the two hemispheres and move towards more human, more humane, more holistic values, the more we can develop our right hemisphere powers the better!

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One of the cognac distilleries in the town of Cognac is in the old chateau. When you take a tour of the place you walk into this incredible room. What do you think this room would be used for?

Bet you didn’t say “for keeping prisoners in”. But that’s exactly what it was used for. Centuries ago it was very common practice to capture opposing army soldiers….especially knights, princes or kings….and hold them while you negotiated a ransom.

I’ve just finished reading a history of the “Black Prince”, Edward, who fought many campaigns for the English in Aquitaine, which in those days was controlled by England, not France. In many of the stories you read about knights or princes getting captured and the ransom money being used to fund more battles.

The proof that this grand room was used to hold some such prisoners is on the walls.

They are covered with carvings and scratchings such as these. And, yes, as you’d expect some are simple rows of lines, where someone has been marking off the days.

But look at this one….this is my favourite

This one has always got me wondering, what would I scratch on the wall of a prison like this, while I was awaiting my freedom?

So, how about you? What do you think you’d scratch onto the wall for people to see three hundred years later?

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Lighthouses are fascinating aren’t they? It really felt as if we had lost something when they all went automatic and the lighthouse keepers disappeared. Well, maybe there are still lighthouse keepers who look after the lighthouses but they don’t live in them any more. Putting aside the questions about what kind of life that was lighthouses make me think about the significance of light.

I mean, lighthouses were never intended to be giant torches lighting up the night sea so a sailor could see where he was going! They are warnings. They say “Beware! There are dangerous waters around here!” They also acted as navigation points. My maternal grandfather was born on the island of South Ronaldsay, in a little croft. From his house he could see nine lighthouses at night. I remember trying to count them when I visited there as a young boy.

In a very real sense the purpose of the light from the lighthouse was to convey information. This is something very human. I think of us as vibrant, living creatures embedded in constant flows of materials, energy and information. The materials bit is perhaps the most obvious. We ingest and inspire molecules from the environment, process them inside our bodies then expel them back into the environment. What we can’t see are the energy flows, but we are aware of some of them because we have sensory cells to pick them up. We see light, we hear sound, we feel heat and cold…and so on.

Information is something of yet a third quality. It wouldn’t exist without our bodies and brains to process the other two flows. So when we see the light of the lighthouse we don’t just see light, we interpret it. It tells us something.

In the case of the light from the lighthouse this is still quite a utilitarian phenomenon. We USE the it to guide us, or to orientate ourselves. But we interpret everything, and we surely don’t reduce all information to the level of utility.

This is moonlight on water.

On this particular night (a 14th of July) there was a full moon so the intensity of the light was great. You could actually see objects illuminated by it. But that wasn’t its attraction.

Moonlight on water is beautiful to us. It’s romantic, perhaps. It’s inspiring, even. Maybe it makes us think of Venus, the Goddess of love and beauty. Maybe it stirs our memories and our imagination to inspire certain emotions. Looking at the moonlight can induce feeling.

Moonlight, it seems to me, isn’t primarily a practical light. It’s purpose, if I could call it that, is more to inspire reflection. And that’s especially interesting, isn’t it? Because moonlight IS reflected light.

Do you see what happened here? I started with a light which I claimed was primarily practical, then went on to consider a light which was primarily inspirational. But if you go back and read the beginning of this piece again, you’ll see that much of what I wrote about the lighthouses came from my memory and my imagination. It inspired wonder. It generated feelings.

Nothing is really so binary in real life, is it?

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When I noticed this stone on the beach I was entranced. It looks like a whole small world. Look at the layers of minerals, their colours, their extent and shape. Look at the top of the stone with several species of lichen and/or seaweeds living there.

It makes me think of illustrations I saw when I was a child. Colour drawings of the Earth with a segment removed to show you the multiple layers all the way down to the core.

It also makes me think of the concept of the ecosystem, or even a biosphere….a complex of elements, some living, some non-living (which reminds me….I came across a quotation yesterday which said the opposite of “life” is not “death”, it’s “non-living”……must look that up!)

The idea of networks of connections and relationships between minerals, uni-cellular and multi-cellular organisms, air, water and sunlight co-creating the reality we live in…..I just love that.

It makes me think of the idea of viewing whatever we are looking at from different scales, because everything which exists, exists in nested layers of everything else……remember the old funny story about the teaching that the world floats on the back of a turtle? How the enquirer asked “And what does the turtle sit on?” The answer “Another turtle”. To which the enquirer asks “What does THAT turtle sit on?” The answer “Another turtle”. After a few minutes of this exchange continuing along the exact same question and response, the teacher finally responds to one of the “What does THAT turtle sit on?” with “It’s turtles all the way down, son. It’s turtles all the way down.”

On a more serious note, I found Lynn Margulis’s theory of “endo-symbiosis” hugely convincing. Briefly, she claimed that all multi-cellular organisms (that includes you and me) are made up an incredibly complex co-operating network of single cells, and that inside each of our cells are individual elements, like mitochondria, for example, which, way back in history were single celled creatures in their own right. She hypothesised that the evolutionary path of development was driven by collaboration and co-operation, with single celled organisms combining to live together at new levels. In other words all the different elements of a single cell came from smaller single “celled” creatures merging. Maybe that idea was a bit too challenging for some people, but it’s pretty undeniable that multi-cellular organisms like humans can actually be understood as whole worlds of vastly networked individual cells. It’s reckoned that only a tenth of the cells of your body are genetically “you”, the other ninety percent being bacteria and other unicellular organisms. Pretty mind boggling isn’t it? But it seems to be true all the same.

This idea of scale…..a long time ago I created a “human spectrometer” to help me discuss a patient’s issues with them at different levels of scale. Here it is

I’d start in the middle with the “person” because that’s where we met, person to person. Then I could move left zooming in on smaller and smaller parts of the person to consider the problems and their effects….perhaps in the “nervous system”, or the “digestive system”, then further “in” to disturbances in particular organs, “the heart”, or the “liver”, then further in yet to consider the role of cells, like white blood cells, or the cells of a specific organ, or, at an even smaller level the circulating levels of individual molecules, like hormones, antibodies, chemical messengers and so on.

I’d then return to the “person” and start moving right to consider the person within their significant relationships, within their family, within society, considering cultural, economic and work issues, or, finally within the “world”, by which I meant the environment.

I didn’t usually work through this whole thing methodically, step by step, but used it as an illustration to consider everything from pathology, to pathogenesis, to the impacts from and on the vast networks of life in which an individual lived.

I created a post about it back in 2007, so patients could explore the idea a bit more in their own homes.

It’s only now, many years later, after reading Iain McGilchrist’s “The Master and His Emissary“, that the left hemisphere zooms in to consider the parts, while the right zooms out to consider the connections, the relationships, the whole! Funny, how the universe works!

This notion of nested scales was also explored by Arthur Koestler who coined the term “holon” to describe the idea of multi-level hierarchies. You can read a bit more about that here.

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Life is tangled.

Every one of us is a multitude. Check out Bob Dylan’s new release “I contain multitudes” for a very recent expression of this idea. In fact, as he sings it, maybe we are multitudes, plural.

The Scottish psychologist, Miller Mair, coined the term “community of selves” back in the 1970s. It remains a powerful metaphor for the complexity of an individual personality. That idea made a lot of sense to me, and helped me to understand not only my patients but also myself. We all have that experience of at very least tapping into different strands of our lives when we act within our different roles – parent, child, friend, neighbour, employee, professional, artist, consumer etc etc. We know all those roles are just a part of who we are but it can be very hard to untangle them, to see how they inter-connect.

The French philosopher, Deleuze, wrote about “multiplicities” as a way of understanding the complex universe, and described any particular instance as a “singularity of multiplicities”. I liked that idea the moment I read it. I happened upon his writings at the same time that I was exploring the new “complexity science”, and in particular the concept of the “complex adaptive system“, which fundamentally changed how I saw our lives and our world.

I once spoke to a “Chef de Service” at a Parisian Homeopathic Hospital and he described to me that he saw each patient as like a diamond, with multiple facets shining, each one different, but together all part of the same individual. He saw his therapeutic strategy as being based on addressing several of the most prominent of a patient’s “facets”. A rather poetic way to think of the same underlying issue.

What is the underlying issue?

Life is messy.

On the “inside” and the “outside”. I put those words in quote marks because I’m pretty sure that frequently there is no clear boundary between the two. I think wherever we look we can find multiple threads to follow. We can identify particular paths, storylines, themes, chains of cause and effect, which run through a lifetime.

And, here’s the important point, brought back to the front of my mind by this photo today, all those paths, storylines, threads or whatever, are entangled. They are connected. They are inextricably interconnected, astonishingly woven together to create a unique, beautiful tapestry of a single life.

I’m not a fan of labelling a patient with several different concurrent diagnoses then sending them off to separate specialists to have each disease treated as if it exists in isolation. In Medicine this is referred to as “silo-ing“, a strange word which means separating out someone’s problems into separate baskets, boxes, or “silos”, then treating each one separately. Most of the evidence used in “Evidence Based Medicine” comes from trials where patients have been selected on the basis that they have only the single disease which is under study, and that they are receiving only the single drug which is being trialled. But the real world isn’t much like that. Much more common is the finding that an individual patient will have several different diagnoses active at the same time and that they will already be on a cocktail of drugs. Medicine is more messy than some people would have you believe.

So what? Is this a counsel of despair? Am I saying life is too complex and entangled to make any sense of it? No. Absolutely not.

What I find is that this complex entangled life is beautiful. That it manifests in the most unique, most varied, most astonishing individual narratives you could imagine.

What I find is that when you look for the connections between the parts, you get insights and understanding which you’d miss if you kept your attention only on single parts.

What I find is that it’s best to use your whole brain, not just half of it, as Iain McGilchrist, author of “The Master and His Emissary“, would say. It’s not enough to separate out the threads and elements and study them. You have to weave them back together to see the contexts, the contingencies and the connections. In other words, you need both your left hemisphere ability to see the threads, and your right hemisphere ability to weave them together into a whole.

What I find is that when you look at life this way, then you encounter the “émerveillement du quotidien” – that you find yourself wondering and marvelling every single day. You find diversity and uniqueness. You find infinite trails of connections. You find that curiosity is constantly stimulated and never ends. You find that you are humbled by how little you actually know. You find that you doubt predictions and develop a distaste for judging people.

You find that Life is astonishingly, endlessly, fascinating.

What a delight!

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