You can slow water down by freezing it, but the ice will eventually melt. You can place obstacles in its path but it will flow around them as it gradually wears them down. You can heat it up and it’ll evaporate, disappearing for a while until it forms clouds, rain, rivers and oceans again.
Stagnant pools look and smell bad. The water doesn’t want to stay there.
It wants to flow.
Life has the same desire. It wants to flow. Your blood flows through your arteries and veins, the air flows in and out of your lungs, electrochemical signals flow through your nervous system, hormones send constant messages as they flow from your endocrine glands.
Your thoughts flow, your memories flow, your emotions and sensations flow, your imaginings flow.
I’m in Palermo, on the island of Sicily, as I write this. One of the things I enjoy so much about being here is the glorious presence of such a diversity of cultures….even this street sign provokes me to be aware of that.
The architecture, the art, the symbols and the multilayered history that different peoples have left on this island are obvious everywhere.
I was born in Scotland and my ancestors over the last three hundred years or so lived in Scotland but I long held a notion to spend part of my life in a different country, a different language and a different culture, so when I retired after four decades of work as a doctor I emigrated to France. That’s almost ten years ago and I nowadays I love stepping out of my garden gate in the little French village where I live and chatting with my neighbours who might be happening by. I thoroughly enjoy the magazines and books I buy in my local newsagents and “librairies” (bookshops). I love getting in harmony with French cultures of eating and drinking and everyday manners of behaviour and speech.
I’ve also discovered I can drive to Spain, leaving home after breakfast, and arriving in time for lunch. And right now I’m on a rail adventure to Italy where I’ve sampled the very different cultures of Milan and Palermo and delighted in them both.
I wrote the other day about my life of “E”s, and days like this allow me to fulfill them all – I’m Exploring, Enjoying and Expressing – going places I’ve never been before, enjoying and savouring new sights, sounds and flavours, and taking hundreds of photographs, only a few of which I’ve shared so far, but which I’ll draw upon for posts in the days, weeks and months ahead.
Life is richer when we encounter diversity and difference, when we meet strangers and make new connections, when we open ourselves up to “the other”.
I noticed this doorpost the other day while strolling along by the canals in Milan. I find this kind of image beautiful. Because you can see the remains of at least four layers of different coloured paint, you realise you are looking at the past made manifest in the present.
I think I’ve been guilty of oversimplifying at times, splitting reality into three parts….past, present and future. The truth is there are no hard and fast boundaries between these apparent time zones. The past informs the present, the present emerges from the past, and the future unfolds within each present moment.
The past doesn’t go away and the future isn’t lying in wait for us around a hidden corner.
We have to use memory, attention and imagination if we want to understand this life, our life, and that of others.
If we don’t slow down we’re liable to experience life as superficial, thin and unsatisfying but if we do pause and reflect we can see a depth, a richness, in every moment and in every person.
A. You create the conditions favourable to the growth of the flower.
The modern orthodoxy of Medicine isn’t about cure, it’s about management. The majority of drugs prescribed and surgical procedures employed aren’t curative. We don’t generally talk about curing asthma, diabetes, multiple sclerosis or dementia. At best, our treatments attempt to manage disease – to control or reduce symptoms and/or disease progression. These are laudable goals, but they aren’t enough. The global burden of chronic disease continues to grow relentlessly.
We could do better.
We could do better if we consciously attempted to support the body’s natural systems of health maintenance and of repair. We can do that by mobilising the individual’s resources in body, mind and spirit, and by creating the living conditions conducive to health and flourishing.
Really, this is about learning more from Nature than we do from Industry. It involves understanding the importance of care, loving attention, diversity and the creation of mutually beneficial bonds. It involves clean air, clean water and toxin free soil. It involves whatever nurtures and nourishes growth and resilience – in body, mind and spirit.
In short, it requires a shift in emphasis away from management and control of individuals towards the creation of life enhancing societies and environments.
What do you think? Is this possible? Can we work towards such a future?
Mostly doctors see sick people. Generally, we don’t go to visit doctors when we are well. However, we think of doctors as “health care professionals”, who work for the “health service”.
Whilst the goal of a doctor is to help a sick person back to health, their knowledge and skills are focused on treating disease.
Health and illness are not two entirely separate states. There’s a spectrum of health, with excellent health at one end and poor health (or illness) is at the other.
I’ve often wondered what lies behind this spectrum and how do we move back and forward along it?
One of the key concepts in modern biology is “homeostasis” – a complex set of regulatory systems which act to try and keep the “inner environment” of the body in a condition of balance. When imbalance occurs illness appears. Or, another perspective is, illness disturbs the inner balance.
We all understand that concept – if our diet is inadequate we are likely to get ill, and if our diet contains an excess of anything, especially too much salt or sugar, we get sick.
So, one way we stay well by having enough but not too much of whatever we need.
A second key concept is that of inflammation. The human inflammatory system exists to recognise what is us, and what isn’t….in particular to recognise potentially harmful “intruders”. (The immune system and the inflammatory one are intimately linked). We recognise inflammation when part of the body becomes hot, red, swollen and painful – as we do when we have an abscess, a sore throat, or an arthritic joint. Inflammation can occur anywhere in the body, but it especially occurs at our borders – the skin, the lining of the gut, the lungs, the genitourinary system. It’s our first line of defence.
However, the inflammatory system can become too active, as it is with almost all chronic ailments. And it can be very harmful when the immune system turns against healthy tissue (as it does in all autoimmune diseases).
The third concept I find useful has only come to the fore in more recent years. It’s “integration”. Integration can be understood as the creation of mutually beneficial bonds between very different parts. Our body contains very different tissues and organs. Our organs don’t compete with each other. They collaborate. They work in harmony with each other. When this goes awry chaos ensues!
All three of these – balance, inflammation and integration work together, each influencing the others. Almost all disease is “multifactorial” – there are a number of influences and factors combining to produce the dysfunction that leads to illness.
On the other side of the coin, it’s these same three we need to attend to if we want to be healthy. We need balance, healthy boundaries and defences and we need integration in our lives – in our physical needs for nutrients and water, in our psyche and in our multiple environments, social, cultural, and natural.
The same principles apply throughout the natural world. Healthy environments are the prerequisite for healthy lives.
So, these are what I have in mind whether I’m focused on helping a sick person, or helping a healthy one – balance, inflammation and integration.
One day a patient came to see me and I asked how things were. She replied, “not so good, my husband has been diagnosed with cancer and he’s been told he’s got six months to live.”
“Oh dear, how do you feel about that?” I asked.
“I’m angry”
Not a response I expected but I was interested to understand. “Why are you angry?”
“Well, how come he gets to know how long he’s got and I don’t get to know how long I’ve got?!”
This led to a discussion about certainty. I’ve never been a fan of doctors telling patients they have x months or years to live. Many people take it as a death sentence and either go downhill turning it into a self fulfilling prophecy or they reject it and soldier on.
The point is we can’t be that certain. The further ahead we look the less certain we can be. You see that every day with the weather forecast. But even over a short period of time we can’t be 100% certain. Thanks to diversity, chance and constant change, we cannot be certain.
But we crave certainty. We want to know for sure that we’re making a good choice. We would like to be sure we have at least another x years to live. (We would like to know the value of x!)
We want the pilot to be certain he’s pressed the right buttons, made the necessary pre flight checks. We want the surgeon to be certain they are about to make an incision exactly where it should be made. And so on…..
But, on the other hand, those who are utterly convinced of the rightness of their own views can be scary and dangerous people. From religious fundamentalists to despots like Hitler, Stalin, Mao or Pol Pot. To narcissistic politicians who refuse to tolerate any opinion different from their own (don’t we have way more of those than are good for us in the world just now?)
Or how about the “new atheists” who are so certain of their own position that they mock and dismiss anyone who has any faith? Or the so called “sceptics” who are so sure of their own “evidence” that they campaign to prevent others making different health choices?
When I was taught how to make a good diagnosis, I was taught to draw up a short list of possibilities….a “differential diagnosis” then to act according to the most likely one whilst remaining constantly alert, observing, examining, testing as time past, ready to drop the chosen diagnosis if the facts no longer fitted.
Maybe what we need is enough certainty to make choices and to live the life we want to live, but to hold those certainties loosely….ready to change and adapt as we encounter the ever evolving reality of daily life?
Many years ago I used to listen to a pirate radio station called Radio Caroline. It was broadcast from a boat in international waters which got around the broadcast licensing issues of the time. At one point they went through a phase of promoting something they called “the LA habit”, encouraging the listeners to “get the LA habit”. LA, in this phrase, was short for “Loving Awareness”.
I remembered this when reading Iris Murdoch’s “The Sovereignty of Good” recently. She wrote about the benefit of paying a particular kind of attention to – loving attention. When we pay loving attention to the world we see more beauty, develop more compassion and experience the Good.
“Loving Awareness” is probably a good idea, but, actually, I’m even more persuaded of the benefits of “Loving Attention”. Our dominant way of attending to the world comes from the left cerebral hemisphere, and it’s what we employ to grasp and manipulate the world by dividing reality up into manageable pieces. The right hemisphere, on the other, pays a broad attention to the world, which we need to see and create connections. We need a holistic attention to better understand others. We need it to engage and understand.
This is what we need today to counter the alienation, division and despair which is so prevalent in our societies.
We need it to build bridges, form mutually beneficial bonds and to deepen our engagement with nature and with each other.
We need to pay more loving attention – the evolution of the LA habit!
Yes, you read that right – a 3 E Life – not a 3 D one!
I’ve been doing a lot of reflecting these last few months, not least because a diagnosis I received last summer has made me more acutely aware of both mortality and the vulnerability of Life.
What I’ve come up with feels very important to me and I don’t know if it would be good for you as well, but I decided I’d share it and then you can decide for yourself.
I started with the age old questions – what am I here for? and what makes a “good life”?
I reckon every one of us will come up with our own answers to those questions but here’s mine – they are both answered by paying attention to three actions every day – Exploring, Enjoying and Expressing.
Exploring. I have always been curious, I love to learn, to discover, to deepen my understanding of others and myself. I love to travel to see other places, see how other people live. I read A LOT, both non fiction and fiction. When I was at work my greatest delight was learning more and more about each of my patients. People fascinate me. I’m astonished by Nature pretty much every day. The plant world and birds especially fascinate me. I love art – music, painting, sculpture, photography, literature, poetry, cinema.
Enjoying. I think every experience should be engaged with, paid attention to. I love to slow down and really see, really hear, really smell, taste, touch. “Savour the Day” works better for me than “Seize the Day”. Every day is full of experiences and events to be relished, to be amazed by, to be enjoyed. I love the French saying “l’émerveillement du quotidien”, I love “forest bathing”, I love to immerse myself in the here and now.
Expressing. I think we create change all the time. Just by living we change the environment, the planet. What we do, say, write, affects others. Everything we do ripples out across the world, and I think every one of us is unique. Only I can share with the world what it’s like to be me. Only I can radiate out the emotions and thoughts I have. And only you can share yours. I think we are all here to share our experiences and creativity with each other. For me this mostly takes the form of the photos I take and the words I write as I reflect on them. You’ll have your own ways.
But there’s something else I want to add beyond the 3 Es and that’s LOVE. It’s loving attention which creates both a better world and a good life. It’s the love given and received that makes every day so good.
So, I hope to practise my 3 Es every day – explore, enjoy, express – always from my heart, always in love.
This photo is one of several I’ve taken where I’ve been really astonished by the shape of a tree. Actually it’s not just the shape that catches my eye, but the impression of movement which appears. It’s as if you can see the past, the present, and the future all at once.
For the first half of my medical career I worked as a GP, what we used to call a “family doctor”. My childhood role models for this work were our own family doctor, Dr Haig, and a fictional one, Dr Finlay. Initially I worked in a small rural town in south west Scotland, and then a city Practice, in Edinburgh. The organisation of our partnership privileged the idea of “personal lists”. People selected the particular doctor they wanted to see and would seek consultations with that individual in preference to the others. If their preferred (or “named”) doctor was on holiday, or not available today, they’d come and see one of the others. This system meant continuity of care was at the heart of our work. I’d get to know an individual through several life stages, sometimes from their birth until they became parents and even grandparents.
For the second half of my career I worked at Glasgow Homeopathic Hospital where we specialised in looking after people with long term conditions. Again, continuity of care was our core principle. From the first consultation onwards we would get to know an individual a little bit more at each subsequent consultation, over months, or even years.
So for my whole career I worked in contexts which privileged taking a whole of life perspective.
Yet, that is not how Medicine had developed. Following the dual influences of a reductive, often mechanistic, approach to illness, and a management methodology more suited to factories and shops than to Primary Care or hospitals. Illness is reduced to disease, to disorder or pathology in particular cells or organs.
Whilst the body can heal after physical trauma, and after most infections, most diseases do not go away. Yes, we can “manage” long term illness better….diabetes, asthma, hypertension etc…but only by using drugs for life. There are few genuine “cures” in modern Medicine.
One of my frustrations with medical research is not just that participants are studied for relatively short periods of time, but little, or no, attention is paid to any whole of life perspective.
If a particular treatment reduces the chances of dying from a specific disease, what do those patients die from instead? What experiences do they have of this disease, and others, months and years later?
Don’t we need a better knowledge of whole of life experiences to make good decisions….decisions only an individual can make with the best information and care?
I have a wish and a hope for the future – that we begin to shift our attention from short term to long term, that we seek out the connections, explore the contexts……in other words that we move towards more joined up, more holistic, more lifelong perspectives.
I listened to an interview with Iain McGilchrist recently where he said the difference between imagination and fantasy is that imagination engages us with reality where fantasy takes us away from it.
Iris Murdoch makes the same point about imagination in her “The Sovereignty of Good”…..
We use our imagination not to escape the world but to join it….
Imagination is our super power. We can’t know the inner life of another….whether that be a person, an animal or a plant.
When patients told me their stories I used my imagination to “see” them, to “hear” them and to “feel” what they were feeling. I think, and Iris Murdoch makes this point too, that we have to focus our imagination with a particular kind of attention – loving attention.
I know love has many forms and is different in different contexts and in every relationship but we need a loving attention if we want to get to know another. We need to regard them positively, to listen without judging and we need to care. All of that falls into place when we act with love, when we pay a loving attention.
Imagination, then, is essential to empathy because it connects, it builds bonds between us. I remember after 9/11, the author, Ian McEwan, described the terrorist act as a “failure of imagination”, and the 9/11 Commission picked up on that in its report. It seems to me that all such cruelties, such acts of heartless violence, are failures of imagination…..the perpetrators don’t know their victims, don’t pay loving attention to them.
Fantasy on the other takes us away from the world, from reality. Fantasies about immortality, fantasies about the human race leaving planet Earth to live on Mars, fantasies about consciousness downloaded into computers or robots…..they all take us away from reality.
Fantasy can be fun. It’s good to escape or dream from time to time. But it’s good to remember that fantasies remove us from real life because they involve a direction of attention away from reality.
There’s a lot more I could say about this but I’ll leave it at that and ask, what comes up for you when you reflect on the differences between imagination and fantasy?
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Heroes Not Zombies 