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Archive for the ‘from the consulting room’ Category

Sometimes (quite often, actually) I find a particular subject or issue crops up from extremely diverse sources in the same day. Does that happen to you? I suppose Jung called it “synchronicity” but the first time I really thought about the phenomenon was a teenager when I read Arthur Koestler’s “Roots of Coincidence”  which explored this phenomenon from a rather paranormal perspective. 

I don’t know how these things happen, but they just do! 

Today it was the term “Homo Economicus” – not a term I was particularly aware of, though I was aware of elements of the neoliberal economic paradigm of “rational actors” and the centrality of “self-interest”. This morning I stumbled across it in a  podcast – the “Pitchfork Economics” podcast which I just subscribed to. Well, their latest episode is entitled “Homo Economicus must die”. 

 

I listened to it in the car while I was out and about and really enjoyed it. They interviewed an economist called Samuel Bowes and I thought he was both clear and convincing. 

Then when I came home I checked my Twitter feed and there was a tweet referencing the “Boston Review” It was headed “Inclusive economics is Complexity economics”. 

 

It was the reference to “complexity” which got me clicking through, because that’s a subject I’ve been interested in for many, many years. Well, the linked article quickly got onto discussing, yes, you guessed it, “Homo Economicus”.

Nick Hanauer, in the podcast, says –

Yeah. So Homo Economicus, just to remind everybody is a simplifying assumption that neo-classical economists make, about what humans are and how they behave. Basically it assumes that people are perfectly selfish, and perfectly rational, and that we are utility maximization machines, that we have consistent preferences, that we have no biases, or the biases are randomly distributed. We use probabilistic reasoning. That we are frame and context-independent. That we can do things like exponential discounting, and that we have infinite cognitive abilities, we have time and infinite willpower, and information and attention are broadly distributed.

Now here’s the thing is that we now know that with scientific certainty, that none of those things are true….

 

and he goes on –

the last 40 years of behavioral, psychological and sociological research shows unambiguously that people are not Homo Economicus, that we are actually Homo Sapiens and that we are other-regarding, reciprocal, approximating, heuristic, emotional and moral.

There follows a funny bit about how Spock and Captain Kirk might shop in a supermarket, then they bring in Samuel Bowes. He says the “Homo economicus” model arose from the reasonable belief that when we see people acting we can assume their actions are purposeful, then goes on to describe how people think and what they are thinking about. 

It assumes people think logically, and rationally, weighing up the probabilities of the utility value of various possible outcomes to each action. Except we don’t. Not all the time. In fact, maybe hardly ever. Instead we think, what he terms, “viscerally” – emotionally. This is behaviour which is instinctive and doesn’t involve looking forward into potential futures. 

Secondly, it assumes that what people think about is themselves. That self-interest is the basis of all our choices and behaviours. 

He explains why neither of these assumptions are true, and how the ability to act co-operatively and socially is now thought to give evolutionary advantages over acting selfishly. 

these ideas of incentivizing everything by essentially harnessing self-interest, they don’t work very [00:18:00] well and they certainly cannot address the basic problem facing humanity today. We cannot design incentives which would be good enough so that the environment will be saved for entirely selfish people who don’t care about future generations. There’s no way to design a kind of what’s called an economics, a mechanism that will do that.

These guys are arguing that prosperity doesn’t come from selfishness. It comes from acting on the basis of mutual interest. 

In the Boston Review piece, the authors state – 

Homo sapiens looks almost nothing like Homo economicus. Instead of asocial, transactional, self-regarding utility maximizers, real humans are intensely social, highly cooperative, and other-regarding creatures who make decisions inductively, heuristically, mimetically, and through group reasoning. Evolution has wired us to be both selfish and groupish. It has given us a repertoire of biochemical, neurological, emotional, and behavioral tools to help us successfully navigate life in groups and to help groups compete against other groups. These tools range from hormonal responses that trigger caring instincts, to neural capacities that vicariously experience the welfare of others, to behavioral strategies for reciprocity, cooperation, and punishment of those who violate group norms. These emotions and behaviors have in turn co-evolved with cultural norms, including our moral norms.

Instead of the neoliberal model based on self-interested rationalists, they argue that economics, and, hence, social and political policy, would be better based on an understanding of complex systems. This would allow us to acknowledge the importance of values such as fairness and reciprocity, to work with the natural diversity and heterogeneity of human populations, instead of flattening them all out into averages, and to deal with the world’s problems at a systems level which will take a multidisciplinary approach instead of a narrow, specialised one. 

Now maybe you’re not that interested in economics, or even politics, but I think both are aspects of human life that none of us can avoid. The “Homo Economicus” model seems bonkers to me from the start. It just doesn’t reflect reality. Maybe it’s time to get behind the challenges to the beliefs that we should encourage self-interest, selfishness and greed if we really want to deal with the problems we are all facing together. Maybe it’s going to turn out that empathy, compassion, co-operation and collaboration will be better tools to use.

Oh, before I go…..I liked how this discussion acknowledges that we are all BOTH selfish and altruistic, that we are BOTH rational and visceral. It reminded me of how we have two such different cerebral hemispheres with such different ways of engaging with the world, and how we have to use BOTH of them to be fully human. The Homo Economicus model seems straight out of the left hemisphere.

Isn’t it time to activate the other half of the brain? The half that looks for connections, and prioritises relationships?

 

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I read an article in the Washington Post about a  book entitled “Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference,” by Stephen Trzeciak and Anthony Mazzarelli. Well, there’s a new word – “compassionomics”! I guess they are picking up on all the other “-nomics” people are describing these days to highlight networks of influence. The key point of the book is that in hundreds of studies looking at a huge diversity of outcomes, it seems having a doctor who is compassionate produces better results.

They cite things like

Research shows that the odds of patients having optimal blood-sugar control is 80 percent higher, even after controlling for age, socioeconomic status and gender. It also shows 41 percent lower odds of serious complications from diabetes.

and

Studies show that warm, supportive interactions from either doctors or nurses right before going in for surgery resulted in patients being more calm (with better achievement of adequate sedation) at the start of surgery and a decrease in the need for opiate medication following surgery. Patients also spent less time in the hospital.

They say you can figure out if the doctor is compassionate if they have the following behaviours –

  • Sitting (versus standing) while speaking with you.
  • Facing you and making eye contact.
  • Caring about your emotional and psychological well-being.

And they shouldn’t interrupt you (remember that 2018 study from the Mayo Clinic which showed doctors first interruption occurs at 11 seconds into the patient’s description of their main problem?)

Patients who receive compassionate care recover more quickly from the symptom that brought them to the doctor, have fewer visits, tests and referrals. The proportion of these patients who are referred to specialists is 59 percent lower, and diagnostic testing is 84 percent lower.

And, to counter the belief that you might be best with a doctor who just has the best skills, irrespective of whether or not he or she is compassionate, they cite studies which showed “de-personalised” surgeons (the most distant ones) committed the greatest number of surgical errors.

Hey, who would have known? Giving a damn means you practice more carefully!

Now, I’m in two minds about this whole thing. I mean, I definitely believe that doctors should be compassionate. In fact, I think if you are a doctor or a nurse and you don’t care about the patients, you are in the wrong job. Compassion, for me, is THE core skill of any health care professional. Yes, yes, of course you want a doctor with good knowledge and good skills. That’s important too. But compassion is of fundamental importance. The whole philosophy behind these studies is utilitarian. It’s about producing “better outcomes”. That’s the bit I’m in two minds about. I’m not a die hard utilitarian but I do want patients to experience good “outcomes”. I guess I just think there’s more to it than that….I think the very experience of being cared for, being listened to attentively and non-judgementally….is a Good in its own right. I’d want that whatever the utilitarians could show….

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I was reading an interview with Harvard historian, Anne Harrington, who has written “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness”.

When I was at university I was taught there were two types of depression – reactive and endogenous – the former occurring in response to specific events, and the latter seen as an illness of internal origin. It was thought that talking therapies, as they’ve come to be called, were the best way of dealing with reactive depression but that endogenous was a biological problem which required drugs. One of the main themes which emerged from that thinking was the serotonin theory of depression which was the basis for the great commercial success of Prozac, a drug which influenced the levels of serotonin in the brain.

Well, it all changed. Psychiatrists stopped distinguishing between “reactive” and “endogenous” and moved to thinking of all depression as biological and, hence, all requiring treatment with drugs.

But that didn’t last. As Anne Harrington describes, in the late 90s, “a range of of different studies increasingly seemed to suggest that these antidepressants – although they’re helping a lot of people – when compared to placebo versions of themselves, don’t seem to do much better.” As the “gold standard” of drug effect is its performance over that of placebo, and drug after drug was shown not to be that much better, it got harder and harder to bring new drugs onto the market. She says –

“But it doesn’t mean that the drugs don’t work. It just means that the placebo effect is really strong. But the logic of clinical trials is that the placebo effect is nothing, and you have to be able to better than nothing. But of course if the placebo effect isn’t just nothing, then maybe you need to rethink what it means to test a drug”

This is the same observation as Irving Kirsch made in his “Emperor’s New Drugs”. In that book he drew a graph which I found very impressive –

 

 

The point he was at pains to make was the same as Anne Harrington’s – well, actually, he was trying to emphasise that just because the drugs didn’t seem much more effective than placebo didn’t mean that doctors should stop prescribing them. But the main point, I think, is –

Placebo is not nothing

It seems crazy to me that people make decisions about whether or not a treatment should be offered to patients solely on the basis of its statistical difference to placebo if those decisions then lead to the withdrawal of treatments which were helping thousands of patients.

If the placebo effect is not the same as doing nothing (and it is clear that it is NOT the equivalent of doing nothing) then we should be exploring just what it is. That will involve moving on from the stigma of trickery, because that’s how the placebo effect has been portrayed. “Dummy pills”, “inactive pills”, “mock treatments” producing real life changes in the patients who receive them, only to reveal to them that, ha! ha! you got nothing!

I think it’s interesting that it is in the area of psychiatry that this debate has emerged. Because we know something of the power of placebo on our mental states. But as we are whole, body/mind, non-dual beings. What influences our mental states, influences our bodily functions too. Placebo effects are not restricted to changes in mental states, they are seen throughout the body, influencing organs, cells and circulating levels of natural chemicals.

Here’s the other thing – if placebo is NOT the same as doing nothing but a drug doesn’t show a substantial and significant benefit over placebo, then what else can we offer the patient? What else will be at least as powerful as placebo, but less harmful than the drug?

What about exercise, nutrition, the creation of significant social relationships, engagement with natural environments, meditation, learning how to handle our emotions for starters? And not forgetting demanding that we do something about the conditions in which more and more chronic illnesses are emerging – both mental and physical – poverty, poor housing, inequality, polluted environments, industrial, chemical methods of agriculture and food production and so on – have a look at the perspective I described in “There still aren’t enough”, and in “Inequality and health”.

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Sometimes I find threads which connect various, apparently completely different, books. Here’s one such example.

I’m reading Alain Juppé’s “Dictionnaire amoureux de Bordeaux”, and one of his entries is about Jacques Ellul, who was a Professor of Law and wrote about sociology, philosophy and theology, amongst other topics. One of his major themes was what he termed “Technique”. I won’t go into that in any detail here. I’ll write something else about it some other time. But here’s the phrase of his which hit me between the eyes – “Suppression du sujet” – the suppression of the subject. This is what happens when we turn a blind eye to the uniqueness of each human being, or when we reduce a “subject” to an “object”. This is an issue close to my heart and I’m going to explore it more, but what immediately came to my mind when I read that phrase were a few lines in the opening paragraph of Marguerite Yourcenar’s “Memoirs of Hadrian“. Specifically, this –

It is difficult to remain an emperor in presence of a physician, and difficult even to keep one’s essential quality as a man.

When I read that two thoughts jumped into my mind. One was how I had never experienced intimidation when I consulted with a patient. No matter whether or not the person was a celebrity, a Lord, or a Professor. It wasn’t that I felt better than them, but I saw everyone as unique, wounded and suffering. But I only thought about that because this is an emperor speaking. The other thought, which I reckon is more important, was the second phrase in the sentence – “…..difficult even to keep one’s essential quality as a man” – there is something potentially de-humanising about health care. It happens when doctors and nurses refer to a patient by their diagnosis instead of by their name. Indeed, not only refer to them as “a case of X”, but treat them that way too, considering only the “data”, the “results”, as important and not the lived experience of this unique person.

When visiting my mum in hospital recently, I overheard one nurse in the corridor say to another “Have you taken the blood from Bed 14 yet?” I thought, good luck getting blood out of a bed!

Sadly it’s not uncommon to witness health care based on the “suppression of the subject”. Outcomes, targets, measurements, doses, and all the technical paraphernalia of machines, tubes and flashing lights can obscure the human being completely.

When I read the sentence in The Memoirs of Hadrian, I wrote in the margin, some lines from T S Eliot’s “The Cocktail Party” –

In consultation with the doctor and the surgeon

In going to bed in the nursing home

In talking to the matron, you are still the subject,

the centre of reality. But stretched on the table

you are a piece of furniture in a repair shop….

All there is of you is your body

and the “you” is withdrawn.

The subject as the centre of reality – is that basis of our health care? Is it the basis of our politics, our economics, our schools, our workplaces? Because if it isn’t….it should be!

This “subject” which Ellul says is suppressed, this “essential quality” of Hadrian’s, this “you” which Eliot says is withdrawn. What is it?

That’s my thought for the day – how do we get to know the subject, the “me”, the “you”, the “self”, the “person”? And how do we make that REALITY the core of our societies?

Because when we objectify human beings we lose touch with reality, and we open the door to all kinds of cruelties and suffering.

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I heard that word, “fragments”, used by a historian in a podcast recently. He was explaining that history wasn’t fixed, was never “complete”, that in every event, every circumstance involving human beings there are multiple stories to tell, multiple, often entirely contradictory experiences to explore. He used the term fragment, to communicate that. That all of history is fragmentary, and all human stories are too. I liked and disliked the word “fragment” equally at the same time (I don’t think there are any fragments, in the sense that there is nothing which isn’t connected to anything else, but, on the other hand, as it seems impossible to ever know “the whole”, maybe fragments are the very essence of reality), but it’s wormed its way into my mind and I’m turning over this issue of fragments ever since.
Here’s where I’ve got to so far – I see two different kinds of fragments in the world. There are pieces, like pieces of iron, or pottery, or whatever, that archeologists might find. These are pieces which have lost their connections. And it’s the archeologist’s job to piece the pieces together. Like putting together a jigsaw. Once the pieces start to fit together, the connections become clearer. The picture emerges. We can say, oh, I see now! So there’s that kind of fragment.
But there’s another, something more dynamic, more fluid, almost a kind of perceptual fragment. You know like when you go to the movies with a couple of friends and in the conversation afterwards the experiences can be so different that sometimes you even wonder if you all saw the same movie? Well, that kind of fragment.
And that kind of fragment is what every single story is. It’s what every single relationship is. It’s what every event and experience is. No single story is something called “the whole story”. I don’t know if such a thing as “the whole story” exists, but, if it does, I don’t know how any single human being can know it. For instance, it wasn’t unusual for me to find that several months, or even years, into an ongoing therapeutic relationship with a patient, that they would reveal something fundamental about themselves, tell some story which suddenly explained mysteries about them. This would happen with people who I had really convinced myself I had heard and understood. At times, the new story, previously untold story (commonly the patient would say “I’ve never told this to a single person before”), would be nothing short of a moment of enlightenment. With experience, I grew to understand that even these moments were never the final ones, that there never was something called “the whole story”.
I see the Self like that too. Whether that’s the “community of selves” idea (The Scottish Psychologist, Miller Mair, coined this term – “His 1989 book Between Psychology and Psychotherapy was subtitled “a poetics of experience”, and this theme recurs throughout his written and spoken work. He saw therapist and client as reaching towards understanding through conversation and metaphor, through engaging with the “community of selves” of which they were personally constituted, and through striving to “tell stories” that would illuminate the conditions of their lives.”) or the idea of multiple facets, roles or aspects of the same person – differences which are so different that sometimes that we wonder if there can be a ‘thing’ called “THE SELF” – and, I don’t think there is. Whatever a SELF is, it’s not an object, not a thing. It’s a subject, a complex web of woven threads, a continually changing, evolving, dynamic host of energies. And maybe, just maybe, one of those aspects overwhelms the others, at least for a while, but they all exist, all come into being, all ebb and flow….all “interfere” with each other, in the way that waves and ripples “interfere” with each other.
I guess at times some of the threads that make up YOU pull or rub against each other in uncomfortable ways and you think “wouldn’t it be simpler if I had less threads?”
And maybe it would.
But would the tapestry be as beautiful?
Only you know.

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tree blossom

Here in the Charente, March is a month of emergence. Officially, it’s Spring. Well, I’ve read three ways to determine Spring actually – you can go by the appearance of Spring flowers, like the crocus, or you can take the “meteorological Spring” which falls on the 1st of March, or you can wait till the “Spring Equinox”, one of two days in the year where the number of hours of day and night are equal (that’s March 20th in the Charente). Well, in the Northern Hemisphere, anyway (you guys in the Southern Hemisphere have your Autumn Equinox when we, here, have Spring – and vice versa). Oh, and, it’s not exactly equal day and night, but pretty close.
I think of Spring as a time of awakening. The bare branches of the trees begin to bud and flower, and the Spring bulbs push up their green leaves and unfurl their gorgeous petals. It’s a sort of time of beginnings.
Mind you, I also feel that Autumn is a time of beginnings, but that’s because I started University (Edinburgh) in the autumn, and began my first job as a Junior Doctor on the 1st of August (1978). In those days there were two variations of training doctor contracts, six month ones and twelve month ones, so we all started jobs on 1st August, or on 1st February. It’s probably changed since then. However, that rhythm of new academic years and new training posts over a decade has embedded a sense of beginnings for me every Autumn.
Spring, though, feels like a more Nature-attuned time of beginnings.
So, I went off yesterday on a blossom and bud hunt. I took quite a lot of photos. Up top here is the kind of phenomenon I was looking for.
And here’s one of many cherry blossom photos I took. I love the delicate pink colours against the blue sky, and the delicacy of the stamens reaching for the sky!

cherry blossom

Back home I found a tulip which had revealed her red petals since the day before ….

red tulip

and the tree peony has five buds this year. Here’s one of them, just beginning to show a hint of her pink petals.

tree peony bud

The appearance of the cherry blossom is greatly celebrated in Japan, with daily reports on TV and the front pages of newspapers, showing maps which follow its path from the south to the north of the country, and thousands of people setting off to have picnics under the trees, or to stroll around admiring them and photographing the blossoms.

So, here’s what I recommend for the next few weeks. Take a local safari. Go out, on foot, on your bike, or drive around and see if you can spot buds and blossoms. When you do, take some photos. They don’t have to be works of art. It’s just a great delight to focus in on emergence, to get up close and personal to new signs of life, new expressions of Creation, new beginnings.

What you do after that is up to you. My hunch is that kind of experience changes how you feel about the day.

If you’re in the Southern hemisphere, then its time to capture a different phase of change. Here’s a link for Australia. And here’s one for South Africa.

But you tell me……wherever you are in the world, what changes do you notice this week, as we move towards the Equinox?

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IMG_1130

Let’s talk about death.
Because we don’t.
Somehow it’s not acceptable to talk about death, almost as if it’s bad manners, or maybe just that you’re going to make someone uncomfortable by talking about it because death is something we all hope to avoid. Today, anyway! Maybe we think that if we don’t talk about it, don’t even think about it, then it won’t happen. Which is equivalent to a child covering their eyes to hide and thinking nobody can see them.
Death is certain. It’s inevitable, inescapable, unavoidable.
Yes, yes, I know that, but let’s deal with it when it comes along, and, look, it’s not coming any time soon, right?
I don’t have the impression that death is difficult for the dead, but, then, what do I know? I’ve never talked to a dead person. Or, more accurately, no dead people have ever talked to me.
Dying, on the other hand, can be really difficult. I’ve seen difficult deaths, been present through those final weeks, days, minutes of final struggle. Some of those deaths make the moment of death like a release, a final end to suffering.
And death is difficult for the living. It’s loss, emptiness, sadness, distress, grief….It changes the lives of the living permanently. Life is not the same after death.
But life is never the same anyway. Life is a process of constant change. Even in the midst of our most fixed habits and routines, life changes. Relationships are formed, relationships fall apart, new jobs appear, old jobs go, people enter our lives, and they leave, some temporarily, some permanently. Isn’t death just one of those changes? A kind of ultimate experience of transience?
How many deaths have you witnessed?
I’ll never forget the first time I had to certify someone as dead. As a Junior Doctor working in a hospital, one of my responsibilities was to confirm that a patient had died, and initiate the formal recognition of their death, writing in their case file “Time of death” and entering the time I declared it. The first time for me I was called, as on call doctor, at about 3am, to a ward I’d never visited before. An elderly patient there, whose death was expected, had just died. It was my responsibility to examine him for signs of life. I took my time. I didn’t want to get it wrong! I listened to his chest for a long time, but couldn’t hear any heart beats. I tested for various reflexes and got not response. I stared long and hard into his eyes, using a device called an ophthalmoscope, shining a light onto his retinae to look for the signs of death I’d been trained to see. Finally, I was convinced. Looked at my watch, and retired to the little office at the end of the ward to write the formal statement of my examination and the date and time of his death. As I walked back along the empty main corridor I began to think about what I’d just experienced. I wondered whether or not it was true that we each have a soul, and whether or not that soul hovers around the body for a little time after death, before departing. I wondered if the man’s soul had been hovering around behind me, as I checked his body for signs of life. I wondered if his soul might have started to follow me from the bedside to the office, and maybe, now, as I walked down this empty corridor. I started to walk faster and wondered whether or not a soul could keep pace with a living person. My heart started to beat faster and as I turned into the on call rooms corridor to go to bed I flicked on the light switch in the stair well and “bang!” the light bulb flashed on then immediately went out again. Well, that spooked me! I ran up the dark stairs taking two or three steps at a time, fumbled as I tried to get my key into the on call room door, eventually managing, throwing the door open wide, then slamming it hard behind me. As I stood, breathing heavily, with my back to the door, I suddenly thought. “Hey, surely ghosts can walk through walls!” At that point I realised how absurd it was to be imagining such things. Took me a while to settle though!
I’ve seen many deaths since then. I don’t think it ever became routine. I didn’t imagine souls hovering around me any more, but I always found the experience disturbing. Maybe that’s just normal.
For most of us we won’t have experienced many deaths directly. When they happen, they are significant events. They feel like something has gone wrong. Maybe somebody is to blame. Maybe someone has failed. Maybe we even feel the dead person has failed….failed to rage against the dying of the light.
When you talk to people who have had an encounter with death, a near miss, a sudden, or unexpected one, brought on by an accident or an illness, it’s not uncommon that they will say it’s made them realise how precious life is, how fragile, how maybe until that moment they hadn’t really known that. Well, known it as a sort of fact, but not known it as a person. There’s a difference. Maybe they’ll say they’d have a wake up call. A wake up call to what? To the knowledge of the shortness of life. They might say it’s made them realise that if they want to make the most of life, then it might be a good idea to start now.
Or they might have a heightened sense of reality, of the unpredictability of life, or even of the inevitability of its ending.
Thinking about death because you’ve survived a serious accident, recovered from a serious illness, or have just experienced the death of a loved one, a friend, or a colleague, can make you re-evaluate your life.
Re-value your life.
Feel how precious and fragile it is and decide to make some changes, to stop procrastinating, to stop living this way in the hope that one day, in the distant future, you’ll be able to live a different way.
That’s the gift of death. The gift of life.
Do we have to go through such an experience to get there? Can we only wake up, reassess our choices and values by having personal encounters with death? Or can we make such decisions, initiate such changes, by thinking about death, or talking about it?
If you knew you had one year left to live, what would you do differently?
Stephen Levine, who passed away in January, 2016, wrote a best selling book entitled “A Year to Live” where he describes the process of living as if you have only one year left. Many people have followed his programme since.
But the whole idea of thinking about death as a way to a better, or should I say, more considered, life, goes all the way back to Socrates (there are whole schools of thought on this subject from many other cultures too)

In the Phaedo Plato has Socrates claim that in death the soul is released from the impure and contaminated body, and thus becomes able to attain pure knowledge of Truth. In the dialogue Socrates says: “It really has been shown to us that, if we are ever to have pure knowledge, we must escape from the body and observe things in themselves with the soul by itself. It seems likely that we shall, only then, when we are dead, attain that which we desire and of which we claim to be lovers, namely, wisdom…”
Thus according to Plato upon death the philosopher achieves that which he has been striving for his entire life. Because of this Plato has Socrates claim that the practice of philosophy in life is really a dress rehearsal for what comes in death: “…those who practice philosophy in the right way are in training for dying, and they fear death least of all men.”
Since the time of Socrates and Plato philosophy has assisted countless individuals confront their own mortality, and provided consolation in the face of what many consider the greatest of all evils – death.

A related train of thought is wondering what you would do differently if somebody you knew had only a year left to live. What if that somebody was your mum or dad, a brother or sister, a lover, partner or friend?
And what if it wasn’t a year? What if it was five years, or, ten? Would that change anything? Would either of those scenarios lead to different choices?
So, a little contemplation on death from time to time, might have a serious impact on both the way we live, and the way we are with others.
You know, I think there’s an awful lot more we could consider down this road, but maybe that’s enough for now.
Before I finish, though, when I was researching life expectancy figures for the articles I was writing about health, I discovered that a male Scot aged 65 (that’ll be me in a few months time!) has a life expectancy of a further 19. 7 years. When I read that I had mixed feelings. I mean twenty years seems quite a long time, right? But on the other hand, it feels as almost no time at all! But what I realised I was doing with that figure was considering it as an end point. I thought, well I might just see the start of 2040 then! But then I read what “life expectancy” is. It’s a median. That means that in 19.7 years time, 50% of male Scots, aged 65 today, will be have died. But 50% will live beyond that timescale. It’s not an end point. It’s the 50/50 point!
Hey, how human is it to grasp at offer of hope?! (Well, that’s another subject to consider….the importance of hope)
OK, this is like a PPS but I must tell you about the patient I saw one day. I knew her from previous visits, but this day she seemed particularly out of sorts. I asked her what was bothering her and she said “My husband’s been diagnosed with cancer. He’s been told he’s got six months to live”
I sympathised with her and asked how that news had made her feel. Her reply took me completely by surprise.
“I’m angry. Really angry. I mean how come he gets to know how long he’s got and I don’t get to know how long I’ve got?!”
We had an interesting conversation about uncertainty after that!

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