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Archive for the ‘from the consulting room’ Category

There was a craze hundreds of years ago for “chimera” – originally an idea from Greek mythology, medieval peoples took it a whole stage further and created all kinds of bizarre animals.

The chimera is an invented animal made up of the parts from other animals…so maybe a human head, a lion’s body, wings, a serpent tail etc. You can see lots of them carved onto the sides of old churches, and they illustrated old texts as well.

What do you think of them? Are they horrifying? (I think they were often intended to be so) or are they fun? Fascinating?

They just aren’t “natural” are they? You would never imagine that a creature like this existed anywhere. Maybe, once upon a time, some people did. Maybe they believed that they lived in unexplored regions…..remember the old maps with the unmapped areas labelled “Here Be Monsters”?

Probably the commonest reaction to them is a sort of disgust. We find them a bit repulsive….even the more beautiful ones!

I wonder if both chimera and genetically modified plants and animals touch that same core discomfort in us. There’s something a bit unsettling about cutting some DNA out of one creature and splicing it into another, don’t you think?

I think it’s no surprise that many people want GM foods labelled so they can choose not to buy them if they don’t want to. I think it’s not a surprise either that many people think there are complex ethical challenges to be addressed, and a need for intense oversight and control of the whole business of mixing DNA from creature into another……

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There’s something which really bothers me about modern management theory and practice – “efficiency”.

“Why should that bother you?” you ask.

Well, because it seems to me that it usually means getting the greatest return from the least input or effort. And I’m not sure that’s always a good idea. I’m coming from the perspective of health care. I despaired of the annual cuts after cuts after cuts in the NHS. Every year I saw colleagues who retired or moved away, not replaced. Every single time someone left the remaining staff were asked to “absorb” the missing colleague’s workload. Every year there were more budget restrictions, more closures of beds and services, all in the name of “efficiency”.

So what has happened now that a pandemic has hit? Not enough beds, not enough equipment, not enough staff. Even now, weeks into the crisis, frontline staff lack adequate amounts of PPE (Personal Protective Equipment). All the pressure to “protect the NHS” was due to the fact it had been pared down to the bone over at least a decade. There was, and there is, no, or little, resiliency in the system. Yes, they redirected staff and reallocated beds to deal with the COVID-19 patients, but did so at the expense of the care and services which those staff and beds were normally employed for.

Is it really a good idea to have “just in time” ordering and delivery systems for something like the NHS? It doesn’t look like it. Is it really a good idea to have as few beds as possible, as few hospitals as possible and as few staff as possible? It doesn’t look like it.

Nature doesn’t do it this way.

Nature goes for abundance. Look at the seedhead in the photo at the start of this post. How many seeds are there from that single plant? Way more than you’d “need” for reproduction and spread you might think. Would it not be more “efficient” for the plant to produce, say, half that number of seeds? Or maybe only ten percent? It doesn’t look like it.

Complex adaptive systems are Nature’s way of enabling adaptability and resilience. All such systems have what scientists call “redundancy” – by which they mean there are “belt and braces” approaches, there are several pathways to achieve the same thing. It’s by drawing on those “extra” resources and methods that Natural living organisms survive and thrive.

I think we need to learn that from Nature. There’s been way too much paring back, stripping down, and minimising going on. If we want resilient services, and resilient societies we aren’t going to get there by “efficiently” going for the least, the cheapest, the quickest and the meanest.

Here’s what Nature does –

It goes for more……

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Here is my secret. It is very simple: It is only with the heart that one can see rightly; what is essential is invisible to the eye.

Le Petit Prince. Antoine de Saint-Exupéry

I often notice, and photograph heart shapes, but in this particular photo what I like best is that the heart is in a path.

I like that because I think this is the most fundamental value for me. It’s not a simple value….this heart-focused one….but its complexity adds to it, rather than diluting it.

The heart is a symbol of love for us. If I want to live the best life I can live, I believe it has to be a life of love. Love in all its forms. Love in the form of care and compassion. Love in the form of passion and desire. Love in the form of bonds and relationships. Maybe we don’t speak much about these forms of love these days, but it’s always something I think we can do with more of.

The heart is also a symbol of the soul. “Heart felt”, “heart warming”, “good hearted”, “heart to heart” are all phrases which suggest authenticity and depth. It is the antithesis of the superficial and careless. It nurtures. It supports. It nourishes.

The heart is an important part of the body for processing emotions. We now know there is a neural network, of the kind of cells we used to thought you found only in the brain, around the heart. What does that network do? It seems to be involved in the generation and management of emotions.

The heart also focuses us on qualities rather than quantities. What we see, what we feel, what we know, with the heart can’t be examined under a microscope, weighed, measured or have a monetary value attached to it.

A path of the heart is a path of love, emotion and quality.

What is essential is invisible – and can only be seen with the heart.

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Just below the long bridge from the mainland to Ile d’Oleron, at low tide, you can see lots of people out gathering seafood, digging up the shells from the mud. I like this photo I took of them one day. I like the blue colour of the scene and the way people are scattered across the beach. I imagine they almost look like notes on a musical stave.

There’s a growing understanding of human beings, human behaviour and character which comes from taking an evolutionary approach. I think that sometimes it’s a bit overdone, but there are significant insights to be gained by taking this perspective.

For example, one way to understand the brain is to use the “triune” model – the idea that you can see three, distinct, regions or parts – the brain stem, the limbic system and the cerebral cortex. Taking an evolutionary perspective we can see that the vital life-sustaining functions of the brain stem are shared with many creatures much further back along the evolutionary tree than human beings. Then we can see the functions of social connection and the emotions which seem to be the domain of the limbic system….functions shared with other mammals. Finally, the cognitive functions of the cerebral cortex, and the development of the frontal regions in particular, are shared with higher primates. This model can help you to get a handle on brain function but it falls down when you take a too reductionist approach to it…..a common problem with a lot of neuroscience which, at worst, degenerates into a kind of phrenology. The brain is a much more complex, massively interconnected, distributed network. It can’t be so easily divided into three separate parts.

Psychologists often explain to people about the alarm function of the amygdala and how it developed to keep us safe as hunters and gatherers but that now that we live in urban environments, pretty free of daily predators, those ancient circuits have a tendency to alert us to imaginary existential threats, rather than real ones.

Last year I read “The Emotional Mind. The Affective Roots of Culture and Cognition” by Stephen Asma and Rami Gabriel which brilliantly places emotions in a central role in human behaviour by tracing the evolutionary path of affect. It wasn’t an easy read, and I was glad I’d read so much about neuroscience and evolutionary psychology before I came across it, but it really has helped me understand the emotions as “adaptive strategies”…..something I’ve explored in my book, “And not or”

As I was looking through my photo library I found this photo quite close to the one I’ve shared at the beginning of this post –

See any similarities?

Ha! Sometimes I think it helps to remind ourselves that we humans are part of Nature, not apart from Nature. We have a lot in common with all other forms of Life as we mutually strive to survive and thrive.

If remembering our hunter gatherer origins helps us to remember that, then it’s a good thing!

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I saw this a few years back in the town of Saintes, about a half hour drive from where I live. You have to agree this is a pretty impressive attempt to bar the door! There was nobody going to go through there easily!

The trouble is, as we can now see, that the rest of the building fell down. And there’s not much value in a locked door when the other three walls have disappeared! There’s definitely a story here, but I don’t know it. I mean, who went to such great lengths to bar this door? And why? And what happened to the whole building? Setting all that aside though, I think this image inspires a couple of streams of thought.

You know the phrase about barring the barn door after the horse has bolted? Well, that’s the first thing that came to mind when I looked at this photo today. Throughout this pandemic authorities have been playing catch up. Some countries have been slower than others, (and, goodness me, some countries still haven’t got a grip!), but everyone has been trying to learn as we all live this thing. Still, it’s often felt that lockdowns have come too late, or have been too sloppy, that there hasn’t been enough Personal Protective Equipment for those who need it, that testing and tracing have been slow to get off the ground, and so on, and so on.

What does that tell us?

Well, partly that our societies have been way more vulnerable than anyone has admitted, and partly, that this is life…..that life emerges, continuously evolving and developing into the unknown. We can’t live life backwards, and we are never going to be able to accurately predict the future, so maybe we need to learn how to make the present the best we can make it instead?

The other thought stream which this image set off for me, is that one about dealing with life, and, in particular, health, holistically. It’s just never going to be a successful long term strategy to focus on short term, narrow solutions. We don’t just need well defended front doors. We need strong walls, healthy buildings, safe, clean and secure places to live and work. We need them in the present…..not just once a crisis is upon us, and it’s too late!

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Like yesterday, I’ve found two images that I want to use together. Unlike yesterday, they don’t represent a single phrase. Instead, I think they demonstrate a single concept.

We try to make sense of the world by focusing on bits of it. A bit like looking through a keyhole, or catching sight of what lies through a gateway.

Our left cerebral hemisphere seems to have evolved to develop this skill to the great heights we now experience. It drills down. It focuses. It abstracts elements from the whole to analyse them, categorise them and label them. In both physical and mental senses of the word, it helps us to “grasp” things.

“Things”. That’s an important word to use here, because this is what this type of narrow focus does. It turns whatever it grasps into objects. It separates “objects” out from each other, and from their contexts. This can work pretty well when we are dealing with material forms, but it starts to go wildly astray when we are dealing with living creatures, with non-material reality such as feelings, thoughts, beliefs and relationships, or, even, I would claim, when dealing with illness.

We often hear illnesses described as if they are objects or entities – “stand up to cancer!”, “conquer heart disease!”, “defeat dementia!” etc. But illnesses are not objects, and neither are they entities. They are more like processes, dysfunctions and disorders of complex networks of relationships.

There is no doubt that zero-ing in on some phenomena helps us to recognise them, classify them, and, yes, grasp them. But the job is only partially done at that point. The normal function of the brain involves the left hemisphere handing back to the right hemisphere the results of its analysis, where the contexts, environments, connections and relationships are re-created. This is how we better understand what we are dealing with….by seeing the whole, by seeing the flows of materials, energy and information, by spotting the dynamic movements, the constantly changing web of connections and relationships. And, in so doing, “objects” often turn out not to be “things” after all.

These two photos remind me of that.

They remind me of the value of peeking through the keyhole, but also the need to step through and into whatever we are observing, in order to know better, to understand more deeply, to more fully grasp….

Looking through the keyhole, turning the key, unlocking the door, approaching the gate…..these are all just a beginning. They invite us to enter, to experience, to explore.

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This is a photo I took many years ago, just using my phone. It’s taken in Edinburgh at night. The purple light of the underside of the bridge caught my attention. It was only once I’d uploaded the shot to my computer that I noticed the person walking along the pavement. At that moment I realised the scene was greatly enhanced by the human presence. It became a much, much more interesting image.

I believe this is a fundamental principle and value which I have. I don’t share the views of some people who think the human species is bad. I believe that we humans are not separate from Nature, we are a part of Nature. We are, in fact, an inextricable part of Nature. I can’t understand a human being without knowing them within their webs of connections, without exploring the flows of materials, energy and information through those networks, without considering them within their contexts and multiple environments, physical, social and cultural.

Yes, we humans have done, are doing, and will do, a wide range of harms to each other, to other creatures, and the one, small, blue marble, planet which we share with all other forms of life, and we need to learn how to live in greater harmony with each other and within this Nature that we are part of. But in four decades of face to face, person by person, patient by individual patient, work as a doctor, I never met a single human being I didn’t value.

I’ve found that as I get older, and in particular, since I retired and moved to live in the French countryside, that I value the rest of Nature, more and more. As I opened the shutters the other morning I looked out and saw two birds…..a Hoopoe drilling down into the grass for some breakfast, and Little Owl, sitting up on the highest point of the wall, spinning his head around surveying his territory. And I thought, well, how amazing is this? I’m more aware of the phases of the moon now, and the rhythm of the seasons. I’m more aware of sprouting seeds, the rate of growth of pumpkins, the cycles of leaves, flowers and fruits. As I garden, I feel in touch with a bond of care, attention and nurture, in this phenomenon we call Nature. But I sure wouldn’t want a world without human beings in it.

There’s something else this image does for me. It sparks the creative, story-telling part of me. Here’s something else which is uniquely human. The ability to perceive, interpret and invent. The ability to make sense of, to apply values to, and to create narratives from, our daily experiences. We are a creative species. We have a driving need to make sense of our lives. I can’t help but wonder about this solitary person, making their way through the streets of Edinburgh at night.

Maybe we just need to learn to shift the balance of our actions and efforts, away from harm, consumption and destruction, towards more harmony, more humanity, and more life-enhancing care. Maybe this pandemic has given us an opportunity to hit the reset button, and do just that.

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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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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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