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Archive for the ‘from the consulting room’ Category

I was walking in a forest just outside of Kyoto and I noticed the reflections of these strange stumps of wood in this pond. I raised my camera to capture the scene, expecting to have a photo of a slightly unsettling landscape of chaotic, jagged sticks and stumps standing at all kinds of angles in the pond, their reflections doubling the feeling of their brokenness. I clicked. As I did so I noticed a blur of white flashing past. It was only when I checked the image in the screen at the back of my camera that I saw this white bird. A heron, I think. A moment of its flight captured in the instant of the camera’s action. Its great white wings elegantly beating downwards to propel the creature over the surface of the water.

It’s pretty difficult to get photos of birds in flight. Well, at least, I find it quite hard to do so deliberately. I have lots of photographs of birds standing on the ground, or perched on rooftops, or in branches of trees. But capturing a bird in flight takes a certain amount of luck. It’s almost a zen archery thing where you don’t try to hard but relax into capturing the scene.

Actually I have several photos of flamingos in flight, and swans too, but in both those circumstances I was somewhere where there were dozens, if not hundreds of them, and they were so busy flying here and there it was hard not to get a photo of at least one of them in flight. But this was different. Here I hadn’t even noticed there were birds around before I took this photo.

So what is this? A lucky photo? Serendipity? Or simply an example of the unplanned moment produced an experience of delight, an opportunity to wonder and feel awe?

I once read that a General Practitioner is a “specialist in managing uncertainty”. I know why that was said. As a GP you never knew what the next patient was going to tell you about. You never knew exactly what you’d have to deal with today. More than that, many, many people present to their GP at a stage in their illness where nothing is yet clear. You know the kind of thing. Someone feels “off”, “achey”, or “has a pain”, or some other of a host of possible symptoms, but it’s the early stage of an illness, and the “signs” – changes in the body which can be felt, heard, or measured – are not very clear. Within hours, or maybe over many days or weeks, the disease makes itself more obvious. It always struck me that this was one of the big differences between GP work and hospital work. In the latter case, the vast majority of patients present with something pretty obvious – either because of the severity, or the acuteness of the problem, of because by the time the problem is this troublesome the “signs” have all become clear. Absolutely, that’s not always the case, but having worked in both settings, my experience was that GP work was filled with much more uncertainty. There was another aspect which intensified that – time. In hospital practice the time spent with the patient is pretty limited. There’s an event or an episode, a diagnosis to be made, a treatment to be administered, then the patient, hopefully, is “discharged”. They go away. In General Practice the relationship is, potentially, for life. For those who spend a whole career in Primary Care they will have patients who they met as newborns, accompanied through their school years, their relationships, setting up their own homes, their work pressures, and the creation of their own little families. They will have known some middle aged men and women become elderly and frail. Patients in General Practice, at least traditionally, didn’t exist only in events or episodes, they existed in these long term relationships. So, of course, when someone developed a serious, potentially chronic illness, as a GP you had no way of knowing how the illness would progress. For some, it would become trivial, or even non-existent, for others there would be an unsteady but unrelenting path of decline, for yet others, this disease would be fatal. The uncertainty came in not knowing what might lie ahead……a fact of life, you might say, but, still, a key issue in the daily life of a GP.

Since the beginning of this pandemic, it’s felt that uncertainty has become a more difficult, daily presence for most of us. The twists and turns of the infection rates, the government responses, the attempts to find ways to treat and prevent it…….

How many times have you heard the word “unprecedented” in the last couple of year? I bet it’s an unprecedented number of times!

What have so many people done to try to cope with this? Because, let’s face it, to be filling your thoughts and imaginings with future possibilities, many of them, frankly, scary, doesn’t feel good! I think what many of us have done is to either deliberately, or serendipitously, focus on the present moment. There was a time in mass confinement when our world’s shrunk to the walls of our dwellings, or the fences of our gardens. In those times it felt better to be aware of daily little wonders, to focus on the real delights. That’s my “émerveillement du quotidien” thing that you can read about on this site. And even since the restrictions have eased somewhat, there’s been a sense of increased value and importance in relationships, with more communication…..perhaps not more in person, but certainly more in WhatsApp groups, video calls, phone calls and messages.

I think that’s how we cope best with the unexpected – delight in it when it offers us delight, feel the calmness which can accompany focusing on the present, and filling our days with what we value most.

Because, although it’s almost a cliche, life is best lived in this present moment. And sometimes, the unexpected can actually feel like a gift.

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There are certain numbers which are described as magic numbers in particular cultures. Whether they are magic or not, there are clearly some numbers which are powerfully significant and which appear widely a huge variety of forms.

I could probably make the case for most single numbers to be thought of as significant numbers. But the one I want to highlight today is “3” because I just stumbled across this little group of photos I took during a trip to Japan some years back.

This symbol, of three “comas”, or “tomoe”, is one I kept coming across everywhere. The first photo shows it at the end of a roof, and this is really, really common in traditional Japanese architecture. The second one shows it on the lid of a pump at a fountain. I really like that something everyday, something otherwise quite functional or mundane, is made more beautiful this way. The third one is at the other end of the scale – it’s gold and magnificent. But perhaps the one I like the best is the biggest image in this collection. It’s embedded into one of those wonderful, standing rocks you find at temples and shrines. The white background looks like a light source, but it isn’t. I love the “wabi sabi” appearance of the rusty, reddish metal which forms the shapes of the three commas, and I especially like how the sun casts the shadow of the same symbol onto the white background.

Maybe I find this symbol of three commas especially attractive because it reminds me of the dual, yin yang, symbol, a version of which I wear around my neck. But more because the Celtic form, known as a “triskele” is a symbol which was around me as I grew up and lived in Scotland.

But to come back to the number 3……why do I, and I suspect, so many others, find that such an attractive, even magical number?

Well, for me, I relate it to “body, mind and spirit”, which is one of the key ways to think about an holistic approach to human wellbeing and health. Throughout my entire career, both as a GP in the first couple of decades, and as a Specialist in Integrative Medicine, in the second couple up to retirement, taking a holistic approach was the keystone of my everyday work.

As a medical student back in the 1970s I was hugely impressed with a “Biopsychosocial” understanding of Medicine. There’s another “3” – the biology, the psyche, and the social – all of which, my teachers impressed into me, were important in health care. In fact, it’s been the dominance of the “materialist” approach which has been my main source of discomfort in our form of health care which reduces human beings to data sets and Medicine to pharmacology. That never impressed me, and it still doesn’t.

It’s always struck me that whether I come from a “body, mind, spirit” position, or a “biology, psyche, social” one, that only one of the elements of those triples, is visible. Only the body, or the “biology”, can be observed, palpated, measured. The other two, the mind/spirit or psyche/social, are invisible, and, frankly, I’d say irreducible to measurements. Materialism can’t capture them. Maybe that’s why I’ve always given such emphasis to the individual story, to emotions, thoughts, values and beliefs.

As I understand it, it’s not completely clear exactly what the triple commas represent in Japan, but it’s sometimes related to something like three kingdoms – of Earth, of Heaven, and the Mundane World, or to the Gods who rule each of those kingdoms. In Western thought, perhaps the triad would be Heaven, Earth and the Underworld.

It does strike me as interesting that Freud came up with Ego, Id, and Superego, as his tripartite model of the human psyche. And Lacan, I believe, wrote about the Imaginary, the Real, and the Symbolic in his model of the psyche. I’m also struck by the more modern psychoneurological triad based on the structure of the central nervous system – the “triune” model of the “reptilian”, “limbic” and “neocortex” structure, something which I used a lot with patients after I learned Dan Siegel’s “hand model of the brain“. By the way, he also describes the “map making” capacity of the frontal cortex as an ability to create maps of “me”, “you” and “we” (another interesting triad)

Hey, I could go on, but I’m sure you could add your own favourite triads and triples to this understanding.

Powerful as the number 3 is, I often think in terms of other numbers. I’m quite a visual thinker and as I explore ideas I’ll often find I’ve created little maps of 4 zones, or 5, 6, or 8 pointed stars. How about you? Are you aware of these numbers and their symbols in your thinking and your culture?

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I’m of an age where I can say that one of the first “singles” I bought in a record shop was “I want to hold your hand” by the Beatles. Feels a long, long time ago (“though she was born a long, long time ago, your mother should know“)

I took this photo at a festival in Provence many years ago. As we were all leaving the venue (it was a piano recital in a forest), the sun was sinking a bit lower and the shafts of light streaming through the trees caught my attention. It’s one of those photos which only revealed a whole other dimension once I looked at it on my computer. See how the brightest sunbeam is illuminating a couple who are holding hands. Actually, it is illuminating their hands, drawing our attention to exactly this – holding hands.

So, when I came across this again this morning, yet again, it inspired a train of thought about holding hands. I know that since this pandemic began we’ve been forced into way more social isolation and distancing than most of us are happy with, and a lot of the focus has been about holding loved ones again…..about having a hug. Well, I share that, and look forward to hugging some loved ones soon. But in addition to the desire for hugs, I think there is this important part of human, physical contact which is about holding hands.

Maybe holding hands isn’t as passionate as hugging, but it is such an important part of the way we connect. It’s an important part of our personal lives and physical hand holding is something which almost casually, almost unconsciously connects us with others to whom we feel close. It’s a longer term connection than a hug too. You can go for a walk and hold hands all the way. You can stroll along a beach, through a forest, along a city street, or sit quietly on a park bench, or in a cafe, holding hands.

Most hand-holding occurs side by side. It’s that connection which embodies and symbolises having “someone by my side” and “someone who stands with me”, or someone who is sharing a part of life’s journey with me. We all need people, not just to “have my back”, but to “be by my side”.

But we can hold hands across a table too. You can look into someone’s eyes, raise a glass, tell them you love them, whilst holding hands across a table.

There are other situations too where hand holding is important and powerful……I’m thinking of the shared times between patients and carers. Holding someone’s hand as an act of compassionate connection is a terrifically powerful thing to do. We can connect, you and I, through words, through talking and listening, but touch magnifies the connection enormously. I don’t know if you know about the work of the Heartmath Institute, but they have shown that our heart beat rhythm radiates an electromagnetic field which can interact with that of another who is metre or so away from us. If my heart rhythm is in a state of “coherence” I can induce a similarly coherent state in the heart of someone standing next to me. If we hold hands, that harmony increases several fold, producing coherence in both of us, more quickly and more powerfully, than when we are standing apart.

So, this is my salute to hand holding. Maybe it doesn’t get much publicity or promotion but I honestly feel that the more we hold hands, the better our relationships are going to be…..and vice versa.

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I took this photo in Ueno Gardens in Tokyo. It’s the centrepiece of a peace memorial and I think it’s utterly beautiful. I love the design of the dove whose curves suggest the flowing shapes of the yin yang symbol and the little flame flickering in its heart, or soul, is very moving. Isn’t it wonderful?

When I look at it, it stirs feelings of peace in me, but there’s more than that, which I think comes down to the nature of the little flame. It looks vulnerable. It’s not a raging fire. It’s a flickering light. It looks as if it could be blown out by not too strong a gust of wind. That moves me too.

That small, flickering flame, contains two polar opposites for me…….the energy which is at the heart of all Life, in other words the power of Life, and, on the other hand, the vulnerability and transient nature of every individual life.

When my daughter was small and had an illness which seemed to flatten her I told her to imagine a small candle flame inside her which would grow in brightness and strength as she paid it attention. That helped her to recover and it’s a practice we’ve used at other times as we’ve needed it.

There used to be a belief in an entity called “the Vital Force” which was an invisible spirit-like force which kept us healthy and restored us when we were ill. “Vitalism” fell out of favour a long time ago, even if it is kept alive in certain healing traditions. As far as I know there is no such entity, but the concept remains a good one. As I understand it now, human beings are “complex adaptive systems” which have the capacity to be “autopoietic” – what all that means is that biologically our systems and responses enable us to protect ourselves on a daily basis…..our immune systems are a part of this natural defence. And we have systems which enable us to repair any damage which occurs….our inflammatory systems are part of that. We also have the abilities to learn, change and adapt. Putting all that together, we have something which isn’t a “thing”, something which we can’t see, can’t measure and can’t pin down which is like an inner flame – it’s the flow of Life energy which pulses through our whole being from conception to death.

In short, we have the capacity to self-heal, and all “treatments”, in every stream of healing tradition, work, only if they support and/or stimulate that capacity. There is no artificial healing. There is only the ability of the living organism to heal itself. We can learn to nurture that, to support that and to stimulate that. That, for me, is what Medicine should be about.

Some philosophers have described human beings as “symbolic beings” – because we are only the creatures which seem to create and handle symbols. Symbols are a powerful tool for us. They help us to connect with each other, to communicate and to learn. They can help us to thrive. In fact, I believe, they can help us to survive.

So this work of art, in Ueno Gardens, works for me as a powerful combination of symbols – ones which activate the forces of both Peace and Life.

I hope this works for you too.

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In my photo library I’ve named this “waterfalls”. Yep, plural. And when I looked at it again this morning I thought it seemed a great image to stimulate thought about working together…..in fact, “flowing together” was the phrase which popped into my mind. I slowed down the shutter speed for this photo so the water would blur like this. I think the whole sense of movement and flow is captured better that way. There’s a power in this scene, and that power lies in the water itself. Or, at least, that’s how it seems at first.

So I look at this and think, this is what we are like together…..when we flow together…..when our energies, our focus and our direction all align. Isn’t that beautiful?

I’d almost be happy to leave it at that. Just to put this image in front of you and hope that you’ll think of the power and the beauty of harmony, resonance and alignment.

But, then I wondered why I’d called the photo “waterfalls”, plural. Isn’t it just one waterfall? After all most waterfalls don’t have a single stream of water falling over a specific rock. Rather, most waterfalls are made up of multiple paths where different amounts of water channel through particular spaces, and tumble over specific rocks. We don’t look at a waterfall which has six streams of water falling and think, oh look at those six waterfalls, do we? Or maybe we do.

So that’s where my mind went next. It went off to reflect on our very human capacity to separate out whatever we are looking at. To break the whole down into parts. There are a number of words for that – abstraction is one. Abstraction is where we abstract, or remove, something from its context. Our left hemisphere is brilliant at doing that. Indeed it seems that’s the normal process……the whole flows into the right hemisphere which hands off some of that flow to the left so it can abstract the components, the parts, the pieces……abstract them, label them, categorise them. And, yes, what’s supposed to happen next is that the left passes the results of that analysis back to the right for it to re-contextualise it. It’s just, if Iain McGilchrist is right, that this process has broken down and we have developed the habit of giving priority to the work of the left hemisphere…….too often we see only the parts, and forget to re-contextualise them.

If we don’t allow ourselves to use our whole brain, then we see two waterfalls here, where, seeing the whole would mean we see just one.

I don’t know what works best for you, but I’ve had a lifetime of work refusing to rest with reductionist abstractions, and always striving to see and hear the unique whole person every time. Yes, I’ve had to focus down onto parts, perhaps listening to someone’s lungs or heart, perhaps measuring the level of a component in their blood, but, I’ve always preferred to re-contextualise whatever those abstractions reveal.

I think we need to do more of that.

I think we need to see the whole, to see the contexts, to seek the connections and relationships, and to realise that every experience we have changes us…..just as this beautiful waterfall constantly changes, moment by moment, month by month, year by year.

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Why don’t I just keep my photos in albums which I flip through from time to time?

Why don’t I just write my thoughts and ideas in a personal journal which nobody can read but me?

Because I’m driven to share.

We humans have developed as intensely social creatures. We haven’t evolved to survive as independent, isolated creatures. We have one of the longest dependent infancies on the planet. The little birds I see hatching in nests in the mulberry tree go from looking like small bald dinosaurs with open beaks, to feathered individuals which fly from the nest, successful on first flight, within days. It takes babies many months to walk, to speak and to be able to feed themselves with the food which they have no ability to find by themselves.

You know what I mean. We are created with the social means, the relationship-forming means, to survive and thrive.

Look at these wee girls. I don’t know what they are sharing but you can tell just from their body language how enthusiastically they are sharing. This is a basic, fundamental, necessary drive in all humans.

OK, I know, some people prefer to be more private, to limit their sharing to one or two, or a small handful of, people. But if we have no-one to share with, then, over time, that becomes a problem. We feel alienated, separated, lonely or abandoned. Depression sets in as a kind of implosion obscuring our view of others and of the rest of the world. When I worked at the Centre for Integrative Care in Glasgow, we would sometimes take a patient into the garden and sit with them noticing…..seeing the flowers, the bushes and trees, hearing the birds, spotting the squirrels and the fox. Those times enabled people to safely take the first steps out of the dark hole of depression. Their attention was captured by the natural world and their energy and focus began to flow back into a positive form of connection.

I made a commitment to write a post every day when the first lockdown came in here in France. I suppose, like all of us, I had no idea how long this pandemic would last, and so, it’s something of a surprise to find I’m still creating these daily posts. My thinking was to share one of my photos and also some of the thoughts and feelings which came up within me when I looked at particular images. The main reason to do that was that I find these photos and the reflections they elicit, a source of joy, wonder, delight and positivity.

So, this was my original thought – what if I shared something positive every day? What ripples might that set off? Whose lives might they touch? Might the joys, the wonders and delights become magnified in the sharing? I think they do. Because that’s the really fascinating thing about sharing – it’s not giving away – it’s not losing something that somebody else gains – it magnifies its positive effects on both or us. My life feels better at least in part because of this daily sharing. And I hope yours does too.

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What makes this photo special?

For me, it’s the sort of symmetry you can see here between the rows of vines covering the hillside and the rays of sunlight shining down through the gaps in the cloud.

There’s a resonance there. A sort of harmony which catches my attention. I think “as above, so below”, which is an old esoteric teaching about the way in which this physical world and the spiritual world are connected….or, if you prefer, how the Earth is connected to the Sky or Heavens.

Our brains are brilliant at spotting patterns. In fact, we don’t just spot patterns in the way that a mirror might reflect what stands in front of it, we create patterns. We learn patterns. We remember patterns. Think of the night sky, for example. Once you’ve been taught to see the invisible lines between some of the stars you call them constellations. And then you can find them again much more easily in the millions and millions of stars shining down on a clear night. But someone imagined those lines. They aren’t the same as the threads which make up a spider’s web, or the lines of minerals running through stones you find when you are out for a walk. Our ancestors created those patterns, and told stories so that others would be able to see them and share them.

So we are brilliant at spotting “similars” – we see patterns and attempt to match them to ones we know already, or others we can see, or create in the same moment. When we spot a similar it’s exciting. It’s “remarkable” – it’s attention grabbing and potentially meaning-creating – because that’s something else we are great at – making experiences and perceptions meaning-full. We constant attempt to make sense of the world we are living in, and to connect our experiences to a sense of purpose.

Some of these matches, these “similars” are like resonances – and this is one of those. Resonances are like harmonies. They delight. They spark a little joy, set off some feelings of awe or wonder. They are special.

This is one of the ways in which we can live a more “enchanted” life. A more “meaningful”, “rich”, “deep”, life. A life of soul. A life of spirit. A connected, “integrated” life. A healthy life. A life of flow and movement.

What patterns do you notice today? And what resonances, or similarities, do you see between those patterns, both between them and ones you already know, and between them and the others around you today?

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I saw this woman yesterday standing outside a supermarket in the middle of town. I was struck by the size of the books she was holding, and which she couldn’t resist opening and starting to read. It turns out they are a trilogy of YA fiction by a famous French author, the third volume having just been published, which is maybe what inspired this woman to buy all three.

I understand this compulsion. I’ve always had way too many books on my shelves….well, way too many in the sense that I couldn’t read them all in one lifetime. But that doesn’t stop me buying new ones. Suffice it to say I read a LOT!

I’ve had a fascination for stories all my life. In my earliest years I remember my Grandpa reading to me – he read me all of Walter Scott’s “Tales of a Grandfather” and he read me collections of myths, legends and fairy stories which he bought for me when I was born. My mum used to have a photograph hanging on the wall of her living room. It was a black and white print showing my Grandpa reading in the local library. I guess I got that gene!

I’ve told countless people that when I worked at the NHS Centre for Integrative Care (which I did for the latter two decades of my career), I used to look forward to meeting a new patient every Monday morning because I knew they would tell me a unique story – one I’d never heard before. In fact, story was the very heart of my engagement with these patients who, largely, suffered from long term conditions which had failed to respond to drug treatments.

Did it surprise me that they had failed to respond to drug treatments? Nope. Because there aren’t any drugs for people, there are only drugs for diseases and drugs to suppress symptoms. Drugs don’t heal. At best they create an environment conducive to healing. It turns out it’s people who heal, not drugs. It’s people with self-defending, self-repairing, self-balancing, self-creating and growing interwoven complex systems who heal.

I found that stories were the way to understand a patient. Not symptoms.

I read a piece about a psychiatrist and neuroscientist, Karl Deisseroth, yesterday, and in that interview he said

Anybody can read a diagnostic manual and see a list of symptoms, but what really matters to the patient is a different story

see it here

which reminded me of a passage by the English philosopher, Mary Midgely, which I read many years ago –

One cannot claim to know somebody merely because one has collected a pile of printed information about them.

Wisdom, Information and Wonder. Mary Midgley

and of this passage from philosopher Richard Kearney

Telling stories is as basic to human beings as eating. More so, in fact, for while food makes us live, stories are what make our lives worth living.

On Stories. Richard Kearney

In fact, that latter passage came into my head as I took this photo – here’s a woman absorbed in stories, standing next to empty supermarket trolleys and with her back to the stalls of food laid out in front of the shop.

Stories, I found, weren’t just the way to understand a person (to make a diagnosis even), but they were also the way to heal. By helping someone create a new story, I could stimulate that complex of healing systems within them, and spur them on to more than relief from suffering…….More than? Yes, to more self-awareness, more self-compassion, and to a re-evaluation of their life choices, habits and behaviours.

Stories can set us free.

Mind you, it’s also true that we can get trapped by stories – the stuck, multilayered ones we’ve been taught as children, or been brainwashed into believing by others. But even then, the answer, the release, the movement forwards, lies in the creation of new stories……our own, unique stories which allow us to realise our hopes, express our singularity, and live the life we want to lead.

Stories, you see, have a magnetic pull. We don’t live without them.

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I think I first became aware of research suggesting that even a view of natural surroundings could be good for us in the paper about recovery times after surgery. The findings showed that post-op patients required less painkillers, had less post-op complications and required shorter stays in hospital if their bed had a view outside to a natural environment (as opposed to no view, or a view of a wall).

Then I came across the Japanese concept of “forest bathing” and work from a university in Tokyo which showed that spending a few minutes in a forest could increase the levels of helpful immune chemicals in the blood.

Today I read a paper about “Attention Restoration Theory” suggesting that spending time in nature improves the concentration levels of children with ADHD. This “ART” concept describes two kinds of attention – an easy, effortless, “bottom up” (neurologically speaking) attention to the environment, and an effortful, focused “top down” attention which we use when deliberately concentrating on something. We use the former when gazing out of a window to the natural environment, and the latter when trying to do a difficult mental task. The research study I read split children into three groups, putting one group in a classroom with no windows, one in a classroom with windows looking out onto a bare, built environment, and a third group in a classroom with windows looking out onto nature. They gave them all the same difficult lesson, took a five minute break where they stayed in their classroom, then tested their concentration after the break. Only the third group, the one in the classroom with a natural view, improved their concentration.

One of the things I like about this paper is that it showed two things – that turning our awareness towards the natural world is good for us, and, that the way to improve concentration wasn’t to “concentrate harder” but to build in a break where the mind could drift into a more natural state of open awareness.

Well, you know, I don’t really need any scientific research or “evidence” to convince me I like to have a view of nature from my window, or that I enjoy walking in forests, parks or along beaches, but, hey, it’s still good to learn about some of the measurable effects of open awareness and engagement with natural environments.

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There are a few stories circulating which I find really disturbing. Stories of EU citizens being detained at the UK Border when attempting to visit the UK for a holiday or to visit family or friends….detained then being refused entry and sent back home because the Border Guards didn’t believe what they were being told about the visitor’s intention. There are so many such stories now that some EU citizens are saying they’ll never try to visit Britain again. The Home Office response is to say that the vote for Brexit was one to make it more difficult for EU citizens to enter into Britain so they are are just doing what “the people” voted for. I’m not sure even the minority of UK voters who voted for Brexit really wanted stop young people from Europe visiting family and friends in the UK.

What especially bothers me about these stories is that they fit with the harsh rhetoric used against asylum seekers and immigrants. I think it was Theresa May who started the “harsh environment” policy which has been developed into this present form. “Harsh environment” – make life difficult for certain people – what a starting point! What a sad, hardening of hearts

Another group of stories which are disturbing me is about the daily abuse and threats directed at doctors, nurses, health care staff, and paramedics. The British Medical Association say a majority of their members receive abuse or threats daily, and England is currently considering fitting body cameras to all paramedics to try to protect them from abuse and violence, or to catch the perpetrators of such actions.

In my four decades as a doctor, half of them as a GP, I don’t remember a single episode of abuse or threat directed at me, at any of my colleagues, or at our staff. What a tragedy!

Isn’t that also part of a de-humanisation, or de-personalisation of care? A hardening of hearts? The entire health care system has been reformed along lines consistent with managerialism – it’s now the language of consumers, customers and clients, of targets, financial “efficiencies” and of tasks – the language of people has got a bit lost. Yet health care is surely based on the doctor-patient relationship – where the people involved – the doctors and the patients – should be paramount, not the protocols, the processes and the financial constraints.

I could go on…..we see a harsh language and deliberate cruelties inflicted on the most vulnerable who need State help. The Ken Loach film, I, Daniel Black, described very well the sad, and unnecessarily mean ways in which the poor and the sick are treated in society. Harsh environment seems to have spread to the treatment of the poor as well.

I can’t help thinking this is a loss. A loss of quality of life and loss of decency, kindness and justice.

Maybe its the result of the wrong “-isms”? Of the financial and economic wrongs wrought by “capitalism”, of the wrong-headed priorities set by financial-ism, and the dehumanising nature of materialism and managerialism. Maybe you could add a few -isms that you think are contributing to this?

I guess what I’d like to see is a rise in “people-ism” – in actions, policies, strategies and behaviours which put people first – people before profits, and before processes.

I’d like to see some softening of hearts as we allow ourselves to be curious about everyone, and to find out just how inter-related and inter-dependent we all are on this little planet Earth.

I’d like to see more priority given to open handed-ness, to open hearted-ness and to kindness.

Is that an unreasonable ask?

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