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The Renewal of Generosity

Posted in books, from the consulting room, from the reading room, health, narrative, philosophy on April 25, 2010| 2 Comments »

I recently stumbled over Arthur Frank’s “The Renewal of Generosity” (ISBN 978-0226260174). Many years ago I read and was hugely impressed by his “The Wounded Storyteller”. It’s a great small book which is an important contribution to the struggle to create a better way of practising medicine in the 21st century. Doctors and patients are increasingly demoralised by the reduction of health care to technical procedures and the delivery of products (what Dan Siegel describes as “diagnose and drug” in his analysis of contemporary psychiatry). The everyday, subjective experiences of both patients and doctors are dismissed as irrelevant in the pursuit of measurement, targets and throughputs. Isn’t it some kind of indictment of our current health care that he can say this on page one –

My conviction is that at the start of the 21st century the foremost task of responding to illness and disability is not devising new treatments, though I’m grateful this work will proceed. Our challenge is to increase the generosity with which we offer the medical skill that has been attained.

That’s the word which really struck me – generosity. I think a lot about compassion and its central place in good health care, but I’ve not really considered the work generosity. It’s such a good word. Somehow it not only encompasses compassion but it contains within it a sense of enlarging life – my own life, and the lives of others to whom I am generous. It’s a welcoming, loving, life growing word. It’s a good word to bear in mind when considering “how to live”, how to find happiness and how to create well-being.

His key theme in this book is to weave together the teachings of ancient Stoicism (a much misrepresented classical philosophy I believe), with the case for dialogue. He primarily draws on the writings of the Stoics, of Levinas and Bakhtin.

The practice of medicine is a relationship between two people. What are we to call these two people? As a doctor, I’m fairly comfortable with the term, “patient”, but it bothers me that it seems to imply something passive, expecting the ill person to just be treated, and that contains the seeds of objectification – treating people not as people, seeing them as instances of disease, instead of persons who suffer. I hate the word “client”. It’s laden with commercialism and contractualism for me. However, Frank pulls a different set of words out of the bag and they hit me between the eyes –

The renewal of generosity will be hastened if participants in medical relationships think of themselves not (at least not only) as patients and professionals, much less as consumers and providers, but as guests and hosts.

Guests and hosts! He elaborates and explains, but I won’t share that here. Just think about this idea for a moment. I’ve never encountered it anywhere else. Wonderful.

I love so much of what he has to say about the importance of dialogue –

Dialogue suggests that the world is co-experienced by two of more people. Each one’s perspective is necessarily partial, and each needs to gain a more adequate sense of the world by sharing perspectives.

I wrote about that from a neuroscience perspective recently here.

The enlarging of perspective, or, in the other words, the attempt to see a more full picture demands dialogue. It prevents us from dismissing others through judgement and classification.

…no final, finalising discourse that defines anything once and forever. No last word can be said about this you, whose horizons of possibility remain open.

“whose horizons of possibility remain open”……how often do we forget that? How often do we squash hope with the illusion of certainty? How often do we practice as if we know exactly what a treatment will bring about for the person undergoing it? Having open horizons of possibility is a characteristic of healthy living.

We have other good reasons for dialogue apart from sharing our perspectives to gain a fuller picture. We use dialogue to value the other.

…the moral demand of dialogue is that each grant equal authority to the other’s voice……it’s being willing to allow their voice to count as much as yours

[doctors] are taught monological medicine: the doctor is the one cognitive subject in the consulting room, and the patient is an object for that cognition.

Identification with others requires giving up monologue.

The other element which we have to consider when we focus on dialogue is the other part of the doctor-patient (or host-guest) relationship – the carer. I think our system of medicine dismisses this almost entirely. The focus on “randomised controlled trials” is a focus on the statistics of groups. Once a drug or treatment is “proven” it seems to be irrelevant who delivers it, or how. Yet that’s not our experience when we are ill. Who the doctors and nurses are is important to us. How they talk, how they listen, how they treat and care for us. The idea that its the treatment which is important and the not the person administering it seems inhuman to me.

We can keep the question before us: what do they think about how I am imagining them? and we can believe that what they think matters.

We should honour patients’ stories, not dismiss them as “subjective” or “anecdotes”. They matter.

Finally,

…the person who we see ourselves revealed to be is seen most fully in others’ responses to us

Isn’t that so true? What have you seen of yourself in others responses to you today?

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The Angel’s Game

Posted in books, from the reading room on December 14, 2009| Leave a Comment »

Just read Carlos Luis Zafon’s “The Angel’s Game” [ISBN 978-0753826447]. I quite enjoyed “The Shadow of the Wind” but I actually enjoyed this more. Maybe I’ll go back and re-read “The Shadow of the Wind” now. Both books are set in Barcelona (which I’ve never visited but is definitely on my wish list….) and both have a strong flavour of mystery about them.

At times I found “The Angel’s Game” a bit confusing, but it’s that slipping into magical realism, and interweaving of imaginary and “real” even within the context of fiction that brings both the confusion and the dream-like quality. There’s plenty of evidence that this is exactly what the book’s “about”…

All interpretation or observation of reality is necessarily fiction.

and

Everything is a tale, Martin. What we believe, what we know, what we remember, even what we dream. Everything is a story, a narrative, a sequence of events with characters communicating an emotional content. We only accept as true what can be narrated.

That first quote is provocative of course, but it does remind us that all of our experience of “reality” is a creative act. Michael Frayn’s “The Human Touch” describes this beautifully. How do we experience reality without our subjectivity? We don’t. Our senses, our imagination and our memory and perpetually active in creating what we observe, what we know.

The second quote reminds me of Richard Kearney’s “On Stories“. This point often pops into my mind when I encounter someone who thinks rationalism is about “data” or “facts” and fails to acknowledge the narrative they tell to convey their interpretation of reality.

One more…..

It is impossible to survive in a prolonged state of reality, at least for a human being. We spend a good part of our lives dreaming, especially when we’re awake.

Hear T S Eliot there? “Human kind cannot bear very much reality”

To sum up, I like a book which makes me think. I like one which is well written and really stimulates my imagination so that I “see” the places and events. And I also enjoy a page turner. “The Angel’s Game” hits all three buttons for me!

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The Selected Works of T S Spivet

Posted in books, from the reading room on November 26, 2009| 4 Comments »

The Selected Works of T S Spivet is quite unique (ISBN 978-1-846-55277-9). It’s a novel by Reif Larsen and tells the story of 12 year old T S Spivet who maps everything he comes across. He draws the most illuminating, enlightening and thought provoking diagrams and maps and the novel is liberally illustrated with them down the margins of virtually every page. I can’t remember the last time I was so delighted by a book. Utterly engaging, charming, thought provoking, funny, and, in places, intensely moving.

The novel uses the device of the innocence of the child observer to great effect. You begin to look at the world anew after reading a book like this. The ordinary seems less ordinary. The world seems more full of wonder.

Here’s two or three short passages to illustrate something of the novel. As T S looks out over the landscape he spots a bird –

A red-tailed hawk swooped down into the rippling rapids of the river. It was gone for a full two seconds, completely submerged in the cold mountain water. I wondered how it felt beneath the surface, a creature trained for the air but now surrounded by liquid. Did he feel like a clumsy visitor as I did when I was underwater, staring at the minnows that lurked like flecks of light on our pond’s bottom? And then the hawk was already tearing back up into the air, droplets exploding off its pumping wings. There was a tiny silver fish in its beak. A perfect slip of a thing. The bird circled once and I strained to watch it move against the cliffs of the canyon, but it was already gone.

What I love about this observation is not just the detail which conjures up such a vivid image in your mind, but this kind of observation is special. It’s empathic observation. T S doesn’t just see, he uses his imagination and his memory to connect with the bird far more deeply than a simple description would do.

As the Montana born and bred T S reaches Chicago he is amazed by the cityscape. The passage is far too long to quote here but within the description is this –

As I watched I fell under the city’s spell of multiplicity and transience.

Wow! The “city’s spell of multiplicity and transience”! Goodness, that hits the nail on the head!

Finally, here’s what one of the characters says about maps –

A map does not just chart, it unlocks and formulates meaning; it forms bridges between here and there, between disparate ideas that we did not know were previously connected.

Absolutely. T S believes we all have a complete map of the world engraved into our brains when we are born and we spend our lives creating maps of what we see and experience and trying to figure out how to access that map.

Read this. It’s lovely. Really, it’s a sheer delight. It’s also unique. You’ll never have read a book quite like this one.

Reif Larson has an accompanying website – http://www.tsspivet.com/

 

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Pharmakon

Posted in books, from the reading room on September 9, 2009| 1 Comment »

Pharmakon, by Dirk Wittenborn, ( ISBN 978-0747598107), is a good read. It’s a novel which tells the story of one American family, starting with a focus on the father, a psychologist, then following the story of his youngest son. The territory of the book is the treatment of mental health, and in some ways, that reminded me of Sebastian Faulk’s “Human Traces“. However, despite the fact that both novels make you think about psychiatry as a therapy, it’s a more modern novel than Human Traces, taking a focus on drugs. You could tell that from the title I’m sure! In fact, by focusing on drugs taken to alter mental states, Wittenborn explores and entwines both “therapeutic” and “recreational” use of drugs.

Dr. William T. Friedrich wonders if it is possible to find a drug which will produce human happiness. The idea that this might be possible is prompted by two things. Firstly, he is horrified by the contemporary 1950s psychiatric treatments, finding psycho-surgery barbaric and psycho-analysis ineffective. Secondly, he comes across the use of a plant by tribes in New Guinea to alter mental states. He persuades a colleague to set up a clinical trial of this plant extract and see if they can prescribe happiness. Things, of course, don’t go according to plan, and one of the volunteers, a deeply disturbed young man called Caspar, after an initial apparently astonishingly good response to the drug, turns homicidal and sets out to kill the two researchers.

For the rest of the novel, Caspar haunts the Friedrich family. His crimes result in him being committed to secure psychiatric care for the rest of his life, and to Dr Friedrich and his wife having another child, Zach. Zach’s story leads into recreational drug use and its sorry consequences. Friedrich himself goes on to become a successful consultant to major drug companies helping them to create and market a number of anti-depressants and other psycho-active products.

As you might imagine, this is not a happy story, but it’s engaging and it also makes you think not only about psychiatry and drug companies, but also about human happiness – what is it and can it ever be achieved by using chemicals?

The drug company thread of the narrative echoed some of the themes of Popco but this is not a novel about drug companies. It’s a novel about life, mental health care, the place which drugs (prescribed and illegal) play in our society, and, ultimately, it’s a novel about families and happiness.

I found the last paragraph of the book immensely satisfying. I won’t spoil the story for you, but suffice it to say that at the beginning of the story, Friedrich wonders if its possible for a drug to produce happiness, and at the end, he’s wondering if it’s possible to find a drug which will produce tears.

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Popco

Posted in books, from the reading room on September 7, 2009| 1 Comment »

I enjoy books for different reasons. Popco, by Scarlett Thomas, (ISBN 978-1847673350) is one of several novels I’ve read this summer and which I’ve thoroughly enjoyed. It strikes me the novels I’ve read are all very different and I wondered if maybe I enjoyed such diversity in the same way I enjoy the company of diversely different people.

When it comes to a novel my main prerequisite is that it’s a good story. I love a good story, and this one drew me in right from the start. Popco, is an imaginary multinational toy company, supposed to be the third largest in the world, and the narrative takes place in a country retreat out in the wilds in southern England, where a select group of Popco employees are receiving classes in the mindsets of teenage girls to try and come up with some new products to crack this notoriously difficult sector of the market.

The narrator is a quirky, bright, highly intelligent young woman. She heads up one of Popco’s sections related to producing kits for children who want adventure – spy kits, code kits, survival kits and so on. She’s not someone who really fits in very easily with others, and I imagined her to be a bit like Chloe O’Brian from “24” – geeky, socially clunky, very bright, and interesting! The novel interweaves the story of her early life brought up by her grandparents, one a maths genius, and the other a professional code-breaker, with her present day experience on the idea-generating retreat for Popco.

I think it was the rich and varied subject matter which really hooked me in this novel. I loved all the explanations about code-making and code-breaking (took me right back to my early teenage years), and I enjoyed the discussions about prime numbers and mathematical patterns. Also, almost as an aside, I loved the way she used homeopathy for self-care and explained the homeopathic method so clearly but modestly. What disturbed me most about the novel was the way the company worked. I don’t mean the structure. I mean the way it operated in the world, dividing children into demographic segments, codifying them according to their interests, desires, and maturity, then producing marketing campaigns to sell loads of branded merchandise and toys to them. I found that all scarily believable. It was all so manipulative, and slick. I think it’s the fact that it was a toy company targeting children that made it especially uncomfortable. I’m pretty cynical about marketing anyway, but this book just made me wake up again a bit, and see behind the TV schedules, comic and magazine tie-ups and marketing campaigns.

There are a couple of interwoven plots which drive the book along. One about a treasure map (yes, really!), and one about a  fightback against globalisation and consumption. I enjoyed both of those plots, and I’m not going to reveal any detail about either of them (in case you decide to read the book)

I like novels which make me think, and ones where I learn something too, but I mostly like novels where the author tells a good story.

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Muriel Rukeyser’s how to be a hero

Posted in books, from the reading room, personal growth on July 15, 2009| 3 Comments »

I’ve just read Muriel Rukeyser’s The Life of Poetry (ISBN 0-96381-833-3). An extraordinary book.

Here is the paragraph which hit me right between the eyes. Here’s where she hits the nail, squarely, on the head….

If our imaginative response to life were complete, if we were fully conscious of emotion, if we apprehended surely the relations that make us know the truth and the relations that make us know the beautiful,we would be….what? The heroes of our myths, acting perfectly among these faculties, loving appropriately and living with appropriate risk, spring up at the question. We invented them to let us approach that life. But they remind us of our own lives. They offer us a hope and a perspective, not of the past in which they were made – not that alone – but of the future. For if we lived in full response to the earth, to each other, and to ourselves, we would not breathe a supernatural climate; we would be more human.

It’s hard to put this in other words, but her insight into the value of imagination, of being aware of our emotional responses, and of how our relations to ourselves, others and to the rest of nature is the key to becoming fully human is fabulous.

What do we become if we develop such a FULL response to LIFE? Heroes. The heroes of our own myths. And THIS is how we gain both perspective on life and hope for the future.

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Passions and Tempers

Posted in books, from the reading room, health, tagged on July 5, 2009| 1 Comment »

I’ve just read Passions and Tempers, by Noga Arikha (ISBN 978-0-06-073116-8)

I expect you’re familiar with the four terms, melancholic, choleric, phlegmatic and sanguine. They might not be everyday words any more but they’re certainly still common enough currency for most people to have at least some idea what they mean. They are, of course, the four temperaments, each of which is expressive of one of the four humours. Noga Arikha is a historian and this book is astonishing in its range. She begins way back in the sixth century BC and traces the idea of these humours from then right up into present time. I found the book totally absorbing and convincing, not just because of the fascinating story of both the persistence and the development of this ancient idea, but because of the meta-narratives……what this particular history tells us about what it is to be human, what it is to be a physician, and how strong ideas can evolve with the expansion of human knowledge rather than be destroyed by that process.
The book is divided into seven main sections (and given Noga’s deep familiarity with cultural rhythms and divisions, I wouldn’t be surprised if this very structure wasn’t a nod towards the seven ages of Man!). Each section describes the humours in a period of history from antiquity right up to the end of twentieth century. Before I read this book I thought the humours were an interesting extinct idea, and it was the invention of the thermometer in the 17th century which did for them. I understood that when the body temperature of a choleric was compared to that of a phlegmatic type and found to be the same, that the theory was discredited. I now know that analysis was not only simplistic, it was wrong! I also thought that the autopsies performed in the great 16th and 17th century Parisian Public hospitals made the morbid anatomist the great medical authorities and turned illness from being a holistic imbalance, to being a physical disease which could be seen, touched and measured in the body (see The Anatomy Lesson of Dr Tulp) That too turns out to be way too simplistic an understanding.
Humoural theory was indeed a holistic one where the proportions and flows of the humours within a person were thought to be connected to, or influenced by, the environment in which that person lived, which was, in turn, intimately connected with the movements of the Cosmos. The humours themselves were invisible but there were plenty of theories created to explain their behaviour and significance. Dissections and, horrifically, vivisections performed back in third century BC not only developed our understanding of anatomy, but by both failing to show any humours, and by providing alternative, observable explanations for illness, began a train of thought which was indeed to take off in the 17th century with Descartes’ separation of the body from the mind, and in the 18th century with Julien-Offray de la Metrie’s description of Man as a Machine (L’homme-machine) becoming the dominant mode of thought in scientific medicine right up to the present day.
However, as Noga Arikha shows so clearly, the humours as a concept, (as opposed to humours as material entities), still help us to understand the body and the mind as one, not two, and to seek to explain the links between the various parts of the body and the mind. The fact that such modern ideas, as described by researchers in “psychoneuroimmunology”, and philosophers and neuroscientists who discuss the embodied nature of the mind, has such ancient roots is quite breath-taking.
As she says in the introduction…..

….there was a continuum between passions and cognition, physiology and psychology, individual and environment.

Even in Hippocratic writings we read…

every part of the body, on becoming ill, immediately produces disease in some other part.

and

Men do not understand how to observe the invisible through the visible.

Let me just share with you two features of ancient practice which I found highly thought provoking and relevant to current medical practice.
From the sixth to the second centuries BC Asklepieia were the temples of the healer who became a god, Asklepios. One particulary famous one was in his birthplace, Epidaurus. A sick person would have a stay in one of these Asklepieia (which were healing centres, or spas). On admission they would have a ritual bath, then settle to sleep in an area known as the “abaton”. Every morning they would discuss their dreams with the priests, and they would receive water treatments, herbs and even, if necessary, surgery. The lucky ones would be visited in their dreams by the “drakon”, a healing snake which would cure their wounds with its tongue. The patients were encouraged to write down their experiences and their case records became the basis of medical learning which the priest/healers used to develop their treatments.
I find many aspects of this quite fascinating. Don’t we still need such places of healing, where patients can be cared for (maybe we don’t use water treatments and bathing enough these days!), and where, not only can they share their dreams, but are encouraged to record their experiences of care so that health care professionals, and other patients, can learn from them? What strikes me about this story is how the focus was on health, not disease, and how the individual’s subjective experience was central to the care.
The second story which similarly provoked my thinking was captured in these two passages –

A learned doctor was one who had primarily read many books, rather than treated many patients.

Doctors could treat only symptoms that corresponded to cases which records or histories existed already.

The dominant current model is medicine is called “Evidence Based Medicine” and “evidence” is primarily published research. It stuck me as I read the first of those two sentences, that nowadays, those who claim authority in medicine are typically those who have read many articles, rather than treated many patients! Indeed I am often amazed at the pronouncements of professors who claim to know the best way to treat patients but who are not clinically active with real patients.
The second sentence stimulated two thoughts in my mind. The first was recalling what Dr Harry Burns, Chief Medical Officer of Scotland once said about his concern with the way “Evidence Based Medicine” was being used, and that was where was all the innovation to come from, if we only allowed the practice of what we already knew? The second was how difficult it is for many doctors to accept the reality of illnesses which don’t fit the models already described – chronic fatigue syndrome, and, fibromyalgia, being just two of the obvious ones.
So, I found this book stimulating and enlightening. It is a GOOD read and I think it has the potential to deepen any health care professional’s understanding of health and healing.

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The Spirit Level. Alternative paths out of this mess we’re in

Posted in books, from the reading room, life, tagged , , , , on April 15, 2009| 2 Comments »

I don’t know about you but in the middle of this “world economic crisis” I’m just not hearing what seems like a decent plan. The main so-called solutions seem to be about how to get people borrowing and spending again. But weren’t borrowing and spending actually at the heart of the problem? Wasn’t it the system which encouraged the unregulated pursuit of self-interest which produced exactly the current crisis? But tired old slanging matches between free market capitalists and state control advocates just seem like debates about who should hold the reigns of power. It feels like something more radical and new is needed. I found myself saying, don’t we need a society more based on love, than on power? (and does that mean I’ve never quite left Woodstock, flower power, and the “LA habit” behind?)
I’ve long since been impressed with the work of Richard Wilkinson and been convinced about his findings on inequality so when he commented on one of my posts recommending his latest book, The Spirit Level (ISBN 978-1-846-14039-6), I knew a trip to Amazon was imminent.
Most of The Spirit Level, which he has written with Kate Pickett, re-presents the findings and the arguments I’ve read before. If you’ve never read any of his work, then is, for sure, the best starting place. However, where it got exciting for me was at chapter 14. In fact, the last three chapters of the book were the three which gripped me most strongly.
The authors quote Thomas Hobbes who believed that there was always a danger of conflict in human societies as people competed over scarce resources, so the purpose of strong government was to keep the peace. You’ll be familiar with the Hobbes’ phrase that without such government life would be “solitary, poor, nasty, brutish, and short”. Against this view they propose

“As well as the potential for conflict, human beings have a unique potential to be each other’s best source of co-operation, learning, love and assistance of every kind. While there’s not much that ostriches or otters can do far an injured member of their own species, among humans there is.”

They describe the ‘ultimate game’ where volunteers are paired randomly, one is given a sum of money and told to propose to the other a share of the money. If the ‘responder’ accepts the proposal both keep the money. If they reject it, neither keeps the money. Interestingly, what happens is that the commonest offer is 50%. This is despite the fact it’s made clear that there will be only one ‘round’ of this game and the volunteers will never meet again. ‘Responders’ reject offers less than 20% on average, so punishing greedy proposers. This shows two interesting human characteristics – co-operation and “altruistic punishment” which reinforces co-operative behaviour.
Somewhat startlingly, but undeniably, they claim that human beings have lived for 90% of our history in egalitarian societies based on co-operative, hunter-gatherer groups, and only with the invention of agriculture did dominance hierarchies develop.
Their conclusion is to call for more “affiliative strategies”

At one extreme, dominance hierarchies are about self-advancement and status competition. Individuals have to be self-reliant and other people are encountered mainly as rivals for food and mates. At the other extreme is mutual interdependence and co-operation, in which each person’s security depends on the quality of their relationships with others, and a sense of self-worth comes less from status than from the contribution made to the well-being of others. Rather than the overt pursuit of material self-interest, affiliative strategies depend on mutuality, reciprocity and the capacity for empathy and emotional bonding.

I think this hits the nail on the head. I think we need some bright minds to come up with the  detailed methods, but I do believe what we need now is a radical realignment of our energies and our structures away from the mistaken belief that competitive self-interest producing dominance hierarchies are the best model for society, back to our roots, to the 90% of our history, to

“mutuality, reciprocity and the capacity for empathy and emotional bonding”

Wilkinson and Pickett make it clear that their research has compared existing developed nations, not current models against a hypothetical utopian one. If we can reduce our enormous economic inequalities, we can look forward to less violent, more healthy societies. If you’re not convinced about that, read this book.

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Supersizing the Mind. Andy Clark

Posted in books, from the living room, from the reading room, life, neuroscience, personal growth, philosophy, science on April 10, 2009| 6 Comments »

Where does your mind exist? There’s a longstanding “common sense” view that it’s inside your skull. But, it’s becoming apparent, that is far from the whole story. Yes, of course a lot of what we call the mind is related to brain activity and the brain is indeed inside the skull, but many researchers are discovering that just as the brain does not exist in isolation, neither can cognition, behaviour, a sense of self, for example, be understood solely on the basis of brain processes. If we want to understand the mind we have to consider the body in which the brain is embedded. Phrases such as “embedded mind” and “embodied mind” capture the essence of this view, and the more you think about it, the more your realise the importance of the incredible network of connections between the brain and the rest of the body.
I get frustrated by doctors and scientists who act as if we can divide a human being into two components – a body and a mind. Especially when they then use this arbitrary and false dichotomy to actually recommend treatments for people’s illnesses. The “embodied mind” concept binds the body and the mind inextricably. That makes a lot of sense to me. I’ve never met a mind without a body, and the only bodies I’ve met without minds have been in the mortuary.
However, some thinkers, scientists and researchers have pushed the idea of “embedded minds” a stage further. (the difference being that “embodied” is exactly what it says – “in the body”; whereas “embedded” argues for a broad contextual understanding which situates the mind in it’s multiple environments). Andy Clark, who promotes the concept of the “extended mind” is one of the writers who has taken this furthest.

I have three of Andy Clark’s books. The first one I read was “Being There” (ISBN 0-262-53156-9), which was given as a key reference in “Smart World” by Richard Ogle . That book deals with the concept of the “embodied mind”.

Might it not be more fruitful to think of brains as controllers for embodied activity? That small shift in perspective has large implications for how we construct a science of the mind. It demands, in fact, a sweeping reform in our whole way of thinking about intelligent behaviour. It requires us to abandon the idea (common since Descartes) of the mental as a realm distinct from the realm of the body; to abandon the idea of neat dividing lines between perception, cognition, and action.

Being There describes how this concept evolved and lays out the implications of the model. Six years later he published “Natural-born Cyborgs” (ISBN 0-19-517751-7). Here he challenges us to consider just how we, as human beings, extend ourselves outwith the bounds of our physical biology.

For what is special about human brains, and what best explains the distictinctive features of human intelligence, is precisely their ability to enter into deep and complex relationships with nonbiological constructs, props and aids. This ability, however, does not depend on physical wire-and-implant mergers, so much as on our openness to information-processing mergers.

He tracks the evolution of these interactions

….from speech and counting, morphs first into written text and numerals, then into early printing, and on to the revolutions of moveable typefaces and the printing press, and most recently to the digital encodings that bring text, sound and image into a uniform and widely transmissible format…..they constitute, I want to say, a cascade of “mindware upgrades”
What matters most is our obsessive, endless weaving of biotechnological webs: the constant two-way traffic between biological wetware and tools, media, props, and technologies. The very best of these resources are not so much used as incorporated into the user herself. They have the power to transform our sense of self, of location, of embodiment, and our own mental capacities. They impact who, what and where we are. In embracing our hybrid natures, we give up the idea of the mind and the self as a kind of wafer-thin inner essence, the human person emerges as a shifting matrix of biological and nonbiological parts. The self, the mind, and the person are no more to be extracted from that complex matrix than the smile from the Cheshire Cat.

I particularly like this phrase from his concluding chapter in that book –

Our most significant technologies are those that allow our thoughts to go where no animal thoughts have gone before. It is our shape-shifter minds, not our space-roving bodies, that will most fully express our deep cyborg nature.

In his most recent book, “Supersizing the Mind” (ISBN 978-0-19-533321-3), he reproduces the original article which he wrote with David Chalmers, where they both laid out this concept of an “extended mind”. That article alone is worth reading, and, in fact, he recommends you read it first before reading the rest of the book. He juxtaposes the concept “BRAINBOUND” with “EXTENDED”.

According to BRAINBOUND, the (nonneural) body is just the sensor and effector system of the brain, and the rest of the world is just the arena in which adaptive problems get posed and in which the brain-body system must sense and act.
Maximally opposed to BRAINBOUND is a view according to which thinking and cognizing may (at times) depend directly and noninstrumentally upon the ongoing work of the body and/or the extraorganismic environment. Call this model EXTENDED. According to EXTENDED, the actual local operations that realise certain forms of human cognizing include inextricable tangles of feedback, feed-forward, and feed-around loops; loops that promiscuously criss-cross the boundaries of brain, body and world. The local mechanisms of mind, if this is correct, are not all in the head. Cognition leaks out into body and world.

Why is all this important? Well, I think Andy Clark puts it well himself –

This matters because it drives home the degree to which environmental engineering is also self-engineering. In building our physical and social worlds, we build (or rather massively reconfigure) our minds and our capacities of thought and reason.

This is the why this way of thinking so exciting. How does our physical environment shape not just our patterns of thought, but our whole sense of personhood? How does it limit, or potentially expand, what we think we are and what we think we can be? Our social world is a fundamentally narrative one. So what are the stories we are told in our societies? And what stories do we choose to tell each other? How does this narratively-constructed world both shape our sense of personhood, and stimulate our imaginations to become something more than we are now?
If all this seems a little esoteric for you, read David Chalmers foreword to “Supersizing the Mind”. You’ll immediately grasp the everyday-ness of all this as he talks about how getting an iphone has changed his life, and, further, how the use of notebooks, and visual cues, can maintain independent living in patients with Alzheimer’s way beyond what would be possible were they to rely on the minds inside their skulls!

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Liv Ullman. Changing

Posted in books, from the reading room on April 7, 2009| 1 Comment »

In The Discoverer, Jan Kjaerstad mentions Liv Ullman’s “Changing”, and states that many people who read it changed their lives. Well, The Discoverer is a novel, so I wasn’t sure if such a book actually existed. A quick check on abebooks found that it did and I ordered up a copy for a few pounds. (Changing. Liv Ullman. ISBN 0297772856. Published back in 1977 and translated into English by Liv Ullman herself)

What an interesting book!

I really didn’t know anything about Liv Ullman before I read this book. I knew she was an actress and she’d starred in Ingmar Bergman movies but that was about it. This book is a kind of autobiography telling about certain parts of her life. It’s written in a mix of styles and a strange mix of first and third person sections. The third person parts strike me as most odd and feel the least natural but the first person writing (which is by far and away the greatest part of the book) reads very naturally. It’s as if she is chatting to you or sharing her thoughts with you.

What makes the book remarkable is how it shares the process of maturation and development of wisdom. Yes, wisdom. I’d go as far as to call this a wisdom book. It’s enlightening and inspiring and I say that as a man, even though much of what she writes about is sexual inequality and the struggle to be a single mother and a professional at the same time. I love her clear eyed, grounded focus on the real. There’s nothing polemic, and nothing starry eyed about this book. It’s a story of growing self-knowledge and with that self-acceptance, of the struggles with commitment and freedom, with mothering and professional development as an actress, with privilege and simplicity.

Here’s what she says about success –

The best thing that can come with success is the knowledge that it is nothing to long for.

And here’s what she says about the differences between men and women –

I try to put in words why I believe that all divisions of people into groups just increases our difficulties. Makes it harder to understand each other.

The importance of living NOW –

I think it is good to recognise what the moment is about and to accept it as a gift.

and

Why is it so frightening to reach sixty because one was once sixteen an believed that time existed in infinite supply? Why couldn’t one know that Time moves on with ever increasing speed and plays havoc with all the things we once thought we could leave for tomorrow?

But especially I like what she says about self-acceptance and finding what’s important within –

Sometimes the sense of security is within myself.

and

Pointless to seek refuge in someone else from what was my loneliness and insecurity

and

I realise I was brought up to be the person others wanted me to be, so that they would like me and not be bothered by my presence. That person was not me. When I began to be me, I felt that I had more to give. Life was richer.

and

Perhaps maturing is also to let others be. To allow myself to be what I am.

She completely grasps the dynamic of life –

Is this not where life’s possibilities lie? Not necessarily to arrive, but always to be on the way, in movement.

She says that one of the greatest compliments she ever received was a zen saying –

You have allowed the cloth to weave the cloth

I like that very much!

I don’t think reading this book changed my life but it was certainly an inspiring read.

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