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Archive for the ‘from the consulting room’ Category

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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Wow! Just look at this poppy which has opened up in the garden a couple of days ago. I went in close to take this photo because I think when you look really closely you see an astonishing creation.

This is like a work of art. In fact, who would have imagined something like this if they hadn’t seen a flower before? I was thinking, what if an alien landed on Planet Earth and encountered this poppy, wouldn’t they be utterly amazed?

Actually, I’m not an alien here on Planet Earth but I am totally amazed by this. Look at the details! As well as the gorgeous red petals, right in the centre we can see this rich, dark array of structures which make up the reproductive system of this flower. The thirteen stripes on the seedhead – what are they? And why are there thirteen? Don’t you think thirteen is a strange number?

Honestly, I think you can lose yourself in contemplation of a glorious flower like this. On single plant, one single blossom, totally captivating.

And it won’t be here for long. Within a few days, all the petals will fall to the ground, ultimately only leaving the seedhead behind. I think it’s amazing. I’m transfixed! In fact, a simple, astonishing, utterly beautiful, intricately complex flower like this, can make me lose my sense of boundaries and separateness. I can experience transcendence in moments spent with a flower like this.

I guess we humans have been, and continue to be, pretty blasé and unthinking about the plant kingdom. But without it, none of us would be here. It’s the plants which capture and transform the Sun’s energy. We can’t do that. We eat the plants, or eat the animals which eat the plants, so existing a bit further along that chain of energy transformation to get what we need to survive and thrive.

It’s not just that there is an emerging consensus that plant-based diets are best for us in terms of health, they are best for us in terms of the planet too. I’m not vegan. I’m not even vegetarian. But I don’t eat meat every day, and in all the studies I’ve read over the years, time and time again, the conclusions seem to be, if you want a healthy life, and if you want a long life, you could do worse than to limit your meat consumption and move towards a plant-based diet.

There are many many studies now which also show us the benefits to our immune systems, to our inflammatory systems, and to our mental health, of spending time in, and connecting with, the natural world. Primarily, that’s the plant world of trees and flowers. So, it’s not just about seeing plants as a source of nutrition. Engagement with the plant kingdom is good for us every day – noticing, stopping, gazing, contemplating, wondering about, and, especially caring about, flowers, plants, trees is one of the best ways I know to increase the quality of everyday life, and to set yourself up to live as healthily as possible.

Glory to the plant world!

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I was sitting in a cafe in Kyoto, looked out of the window and noticed that the reflection of one of the lamps was sitting right in front of one of the trees outside, so I took this photo.

Right from the start this has seemed a metaphorical photo to me.

I know the light is not “in” the tree but the image seems to capture that idea.

Every time I look at it I start to muse about “the light within” which is in us all. Sometimes I think of that light as being a manifestation of Life, of the presence and flow of the life force. It’s a strange thing, that life force. In fact, it’s not really a “thing” at all. It can’t be directly observed. It can’t be measured. But it’s a concept or phenomenon that few would deny.

I’ve seen people die right in front of me. I’ve seen some go suddenly, and others fade away over longer times. I’ve had to examine the newly dead to confirm that they are indeed dead, and to issue the “death certificate”. But death has always been a mystery to me. I don’t fully grasp it. I know about the shutting down of body systems and of organs ceasing to function. I know about “brain death” and I know that heart can just stop beating. But there is a distinct boundary between life and death. One moment someone is alive, and a few minutes later they are dead. It can be pretty straightforward to know which of the two states they are in. But I get caught up in a sort of Zeno’s paradox as I try to discern exactly the moment someone has moved from life into death. There is no “off and on” switch, yet sometimes it seems instantaneous. Organs fail, but more often than not, they do so over a period of time…..years, months, weeks, days, or even minutes. But our bodies are not machines and life doesn’t disappear the way a machine switches off, or a computer hangs.

So, many times I’ve wondered what brings about this “presence of life” which seems to shine like a bright light, and which goes out? Where does it go? If it isn’t even an “it”, does the question even make sense?

When I studied homeopathy I learned that Dr Hahnemann described something we call “the vital force”. He lived in days before we knew what we know now, and the objectification of “the vital force” into a material reality which nobody ever managed to find, directly observe or measure, led to the dismissal of the concept. But it still seems to me that there is indeed a “vital” phenomenon, a living “presence” or “flow” which we only find in those who are still alive.

Is this light within a sort of energy? There’s another hard word to pin down – energy. We can identify certain clear energies in physics, and even measure them. But the energies we humans experience are harder to define.

Not to know, but to define.

What do I mean by that? Well, imagine a scale from 0 to 10, where 0 represents the lowest energy you can imagine experiencing, and 10 represents the greatest amount of energy you can imagine experiencing. Tell me, right now, what number would you apply to represent your current energy level?

You managed to do that didn’t you? I have never met someone who couldn’t come up with a definite number when asked to do this.

But here’s my question, whether you said “5” or “8” or “2” or whatever you said, how did you do that?

You didn’t measure anything. You didn’t check your blood pressure, your oxygen saturation levels, or you blood sugar level did you? In fact you neither selected out a single organ or system of your body to assess, nor did you use any kind of measuring equipment at all, but you did it. You holistically, intuitively, know what your current energy state is. Nobody else can do that for you.

Let’s expand that idea and apply the scale now to “mental energy”. What number would you give for that currently? Is it the same number, or a different from the previous one? What is mental energy? Where might you find it? How could someone else measure it for you?

Challenging, huh? But, at another level, not challenging at all…..in fact, it’s utterly straightforward and easy to do. In fact, sometimes we can even pick up the energy level of someone else, can’t we? We can know that someone is “not on form”, is in a state of “low energy”. How do we do that? Not by using any measuring equipment either.

So sometimes this “light within” seems like the presence or the flow of Life to me, and sometimes it seems like an energy.

But I think there’s a third path to consider. Something to do with brightness. I don’t mean intelligence. I mean brightness – alertness, awareness, presence. You know that old saying that “the lights were on but there was nobody in”?

There’s a light in your eyes tells me somebody’s in

And you won’t come, the cowboy with me.

…..sang Kirsty Maccoll

So, this light apparently shining from the middle of this tree sets me off on all this routes – the life force, subjective energy and presence.

All subjects which I have dealt with almost daily, all subjects of which I am very, very familiar, and all subjects which I still don’t fully understand!

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I took this photo in a tea house when visiting Japan a number of years ago. That tea house was one of the most peaceful places I’ve ever been, and I think part of what made it feel such a positive, healing place, was that they slid back the paper screens over the windows to reveal a terrace with an awning, and then all you could see were trees, bushes, and grass.

I was very fortunate to spend almost half my career working in Glasgow Homeopathic Hospital, which became the NHS Centre for Integrative Care once it moved into new, purpose built premises. Although the location of the new build was at the back of a major hospital site, just next to the railway station, the architect designed the L-shaped building around a garden. All the patient care rooms and spaces faced into the enclosed garden, which could be accessed by stepping out onto decking once you’d slid aside the French windows. Everybody commented on it. Patients and staff. We all felt the peace, the calm, the comfort, and the security which seemed to come from such closeness to green nature.

There’s pretty famous research into that phenomenon in the world of architecture. We know that patients recover more quickly, with less complications and less need for painkillers post-op if their hospital room has a view of green nature (as opposed to having no window, or a view of a wall).

We know, too that there are social as well as health benefits from the “greening” of cities.

But the other thing which occurred to me when I was remembering my trip to the tea room, was that those moments of peace which we all need, don’t have to involve learning any special techniques. There’s no doubt that various forms of meditation, and of cognitive behavioural exercises can be helpful, but there’s something powerful, even necessary, about just taking a pause.

Maybe not even just pausing by sitting and looking, which I’ve recommended before, but sitting with a cup of tea, or coffee, or some other favourite beverage, sipping, gazing, and contemplating freely.

I think it add to the quality of life. It’s a way of slowing down.

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Sometimes it’s easy to spot the uniqueness in whatever it is we are looking at. Like this flower here, it is SO unusual to me that I could hardly have missed it. I’ve never seen petals forming this towering, layered shape before. And, of course, the reflection, as always at least doubles the impact of the flower.

In all my years working as a doctor I found that every single patient was unique. Everyone had a singular, personal, different story to tell. No two people had shared the same life, had identical experiences, responded to whatever they’d encountered the same way. No two patients had the same memories, the same imaginings which formed their fears, anxieties, hopes and expectations. Nobody had exactly the same beliefs and values. Nothing was black and white.

Every life was nuanced, shaded differently, shaped uniquely.

But superficially, it wasn’t like that. Superficially, patients were classified and categorised according to their diagnosis. Too often their pathologies were the sole presentation.

I even found that despite having an open, questioning style, when I asked patients to tell me their story, many simply told me their diagnosis, perhaps what treatments they were receiving, perhaps what interventions they had undergone already, but then they stopped. In other words they told me about the shared, common features of the disease they’d been told they had.

It could take a little more prompting to get them to describe their symptoms and their suffering and it could take a little more to get them to tell me who they were, to share with me their life story, their beliefs, values, expectations, fears and memories.

But the more personal the story, the more obviously unique it would be.

Sometimes I have to remind myself of that. It’s easy to judge and dismiss people we don’t know – celebrities, politicians, strangers – to put labels on them and then to look no further. But the truth is, the more we get to know someone, the more unique we realise they are, and the more unique we realise someone is, the more we have the chance to understand them.

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At one point in my life I was reflecting on what I was trying to achieve as a doctor. Maybe that seems an odd statement to you, but I think we fall very easily into routines and paths which we then “live” largely unconsciously. That’s what’s behind my “heroes not zombies” blog title. Whether it’s about saying “an unexamined life is not worth living”, or it’s simply about wanting freedom and autonomy, I’m wary of the automatic pilot approach to life. I want to be aware, to understand and to consciously choose, as much as I can. I want to move from being a zombie, controlled by hidden, and some not so hidden, forces, to being the hero of my own story – the main character, the subject, the one who is living this life.

I’m sure we all go through cycles and phases of self-reflection. For many people there is a peak of this around the age of 40, but, really it can happen any time and at any age. I believe it’s a good thing to pause and reflect from time to time. I think that’s essential to our personal growth.

So, as I reflected on that question which would appear to me from time to time – “what does a doctor do?” – I looked at a spider web like the one above, early one morning as the dew drops sparkled on it, making it all the more beautiful, and revealing both its presence and its structure. What struck me was that whilst there were many elements coming together to make this web appear as it was, that morning, one element, light, suddenly seemed the one I wanted to focus on.

As I played with the words we use which are based on light, I hit upon three which I thought captured some of the most important aspects of my job.

Lighten. In all cases, I saw my job as trying to lighten other’s load. Maybe this was the first, and most important, part of all that I did. My job was to alleviate suffering. When someone left my consulting room, their life should feel a little lighter than it was when they entered. Certainly, it shouldn’t feel darker, and it shouldn’t feel heavier. Even when I’d had to give news of a serious disease. Giving news wasn’t enough. I needed to lighten the burden of that news by increasing how much the person understood, helping them to make more sense of what was happening, and helping them to realise that they were cared for, that they weren’t alone with this.

In fact, “diagnosis” is a big part of that. To me, diagnosis is not simply an act of labelling and categorising. It’s an act of understanding. It’s taking the messy chaos of experience and saying “I recognise this pattern” “I know what’s going on here”. What I found, time and time again, was that the very act of diagnosis lightened the load. Almost universally people start to feel better once they have a sense that they know what they are dealing with. Understanding, in my experience, shines a light.

Brighten. But then I thought, that’s not enough. Well, maybe it’s enough for some people who will go off with their new understanding and deal with it in their own way, but for many patients, I could do more. I could start to relieve the suffering, but I could also begin to help them build the positives in their life. I could help to actually brighten their days, both by giving reasonable hope, and by establishing an ongoing relationship of care focused on identifying and supporting their inner strengths, and teaching, coaching and enabling them to begin to grow in the light of this illness. This was a kind of turning a negative into a potential positive, because I’d find that for many of us, an illness was telling us something. It was suggesting that we should change something. And that required a development of strengths and skills.

Enlighten. In some cases, that work went to a whole other level. Someone would get nothing short of a revelation. They would suddenly understand the origins of their suffering, and they would gradually become aware of their own thought patterns, their own behaviours, and of the conditions in which they were living which were impacting on them so adversely, and they would say “That’s it. I’m changing.” Not just they would change some habit or other, but they would change direction. Get out of a toxic relationship. Leave a soul crushing job. Enter into education or training, or take the leap to begin something their heart had longed for, for many years. It was like they had a sudden enlightenment and said “I’m not going to live my life this way any more. I’m going to choose this other path instead”.

So, there I had it. My three light-based verbs. Lighten, brighten and enlighten. And of course, what happened from there? I applied those same three verbs to myself. That’s how I made the biggest changes in my life…..seeking some understanding which would lighten my load, turning towards positives, strengths, and emotions like joy, awe and wonder to brighten my days, and thinking outside the box I’d built, to change direction in the bright light of enlightenment.

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The day I walked in a forest and encountered scattered, gorgeous red petals from some bushes, I came to an intersection. The path split and you had to choose which way to go. Smack on the intersection was this guidepost, which clearly directs you to go right. The fact that the arrow was painted the same shade of red as the petals strewn on the path struck me as not a coincidence. Somehow, it gave weight to the instruction. It helped me feel, yes, this is the best way to go. It “fitted” with what else I could see.

I’ve often wondered about this whole instruction/direction thing. I mean, who decided the path to the right was the best one to take? And why? I suspect it was laid out like this to make sure that everyone went the same way as they walked through the woods.

Shortly after I moved to this village in South West France, I came upon a panel near the church. It had a large map of the village and surrounding countryside and it had a couple of suggested walks traced out in coloured, broken lines. You could choose to follow the yellow walk, the blue walk or the green one. They were connected, so if you followed the shortest one, you’d find an intersection, where you had the opportunity to leave that route and expand into the intermediate walk, and, in that walk, there was a point where you could choose to leave that and follow the longest path. All the walks began from, and returned to the church. The panel said there were markers along the way. A bit like this red arrow, but rather than arrows, the markers were just “way markers” with dabs of paint according to which walk you were following. Some of the markers would have all three colours on them, and some, just one. You get the idea? Well, we set off to take one of the walks but pretty quickly, the markers vanished. Every intersection we came to seemed to lack any kind of marker whatsoever. Well, we eventually found our way back to the church, but wondered if the markers had all long since disappeared. The next time we decided to follow the route “clockwise” instead of “anticlockwise”, and guess what? There were clear markers at every junction. Whoever had set out the paths had painted the posts so they could be seen clearly as you followed a clockwise direction round the vineyards. But because they only painted one side of the posts, when you followed the paths anticlockwise, you couldn’t see a single marker!

Who decided there was only one way to follow the circuit? And when they did decide that, why didn’t they make that clear on the map at the start?

So, what’s this all about?

There’s no doubt directions and markers can be helpful. Very helpful. But rather too often they are a bit rigid, assuming that there is only one “right way” to go, and that everyone should go the same way.

That’s when I have a problem with them.

Life isn’t set in stone. Human beings are not all identical. There really is no such thing as “one size fits all”. So, I’m wary of “guidelines” and “direction indicators” and want to understand what lies behind them. So often nowadays, even the markers and signposts are missing. We are fed into a computer algorithm and coerced, pushed or pulled, along the same “choices” to make the same ones as everyone else. That problem is compounded by the way companies keep their algorithms secret. You don’t get to see the values, beliefs and intentions which the companies use to create them. And what if your personal values, beliefs or intentions are different from theirs?

In health care there are metre high piles of “clinical guidelines” and “protocols” now which every practitioner is expected to follow. I understand the good intention behind the creation of these things, but we have to accept that the future can’t be predicted, and that every patient is actually different, so there can be no single guideline or protocol which will guarantee the best health care for everyone.

Alongside that, I think the overuse of guidelines and protocols undermines the healthy development of both expert skills and “professionalism” and tends to give more weight to “processes” than to people (patients and practitioners).

That whole thing has got much worse during the pandemic, with an explosion of plastic arrows on the ground directing your movement and coloured strips setting new, otherwise invisible boundaries and limits. It all leads to a feeling of being micro-managed. It’s not comfortable.

How do we go forward in a better way? I suspect we need more transparency, more accountability and more flexibility on the part of the creators of these directions. A bit more humility would also help to prevent arrogance and righteousness in those who think they know what’s best for you better than you do yourself.

What’s your experience of directions, of markers, of guidelines, protocols and algorithms?

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I’ve long thought that there is a dilemma at the core of the human being which comes from two apparently opposite needs. The need to belong, and the need to be an autonomous, unique, separate self.

How do we achieve that?

We are social creatures. We’ve evolved that way. We have the most sophisticated and complex neurology which allows us to do much more than create connections and relationships with others. It allows us to empathise, to get in tune with, others. It enables us to influence and be influenced by others.

This pandemic has shown us even more clearly than ever that we are social creatures. We need our relationships. We need our families, friends, colleagues.

From the moment we are born we need to create healthy, strong relationships with others…..without them, we would die.

It’s also pretty clear that we all share this one little planet, and that the air, the water and the nutrition that we all need exists in inter-connected cycles and ecosystems – all without borders.

But we are all unique and separate individuals. We each have a finely tuned immune system which recognises anything which is “not me”. We have well-developed personal boundaries and borders. And we are all actually unique. The universe has never created you before, never created anyone identical to you before, and never will in the future. As we weave the events, experiences and relationships of our lives into our personal biology, we develop a completely unique set of memories, beliefs, values, characteristics and behaviours. We are all different. We all have a unique narrative to share.

You might think what we need is a balance between these two needs – a balance between separateness and belonging. But balance doesn’t seem to be quite the right concept to me.

It seems that we need to be healthily separate and healthily connected, both a the same time. We need to see, acknowledge and respect the uniqueness of every human being we meet, AND we need to build bonds of commonality, as well as understanding the vast interwoven networks of co-dependency and co-creation without which none of us could exist.

I guess it’s back to my favourite “and not or” – we really, really need to pay attention to, and nurture, both of these needs – in ourselves and in others.

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