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Archive for the ‘from the consulting room’ Category

The Power of Empathy

Posted in from the consulting room, from the living room, from the reading room, health, life, narrative, personal growth on December 20, 2014| Leave a Comment »

 

I read about Irène Frachon the other day. She’s a French doctor who back in 2007 noticed a strange pattern of illness which seemed familiar to her. She noticed that a patient with “pulmonary hypertension” had developed the condition only after taking a particular medication for diabetes – “Mediator”. Then she came across one who had heart valve disease develop after the same drug. She remembered similar problems occuring with an earlier, but in some ways, similar drug, so started to investigate. It took several years, and the publication of a book, “Mediator 150mg. Combien de morts?” before the company Servier finally took the drug off the market. Various estimates of between 1300 and 1800 people may have died as a result of taking this drug.

It wasn’t the Mediator story itself which caught my attention (sadly, such drug stories are really not so rare), but it was Irène Frachon’s story. As she talks about her involvement in the Mediator story it is clear that from the very beginning it was not just her ability to recognise a pattern which was a great strength, it was her compassion and empathy which drove her to keep a single focus on the patients. This is what gave her the determination to have the problem recognised and dealt with. In fact, she is still astonished that neither the drug company, nor the regulators acted more quickly. She says “The elephant was in the room but everyone was turning their head away”. The story caused quite a disturbance in France (click through on my reference to Mediator to read a Lancet article about it) and has shone a light on drug company behaviour, the “spinelessness and credulity” of the regulator in relation to the drug companies, and the links between big business and politicians. But Dr Frachon fought on for the one single reason – to get justice for those who had been harmed. 

Where did she get this determination from? She says that as a girl she was inspired by the stories of Albert Schweitzer and his “empathie absolue” for those who suffered. When she heard those stories she decided to become a doctor. Interestingly, I would argue, those stories didn’t just prompt her to become a doctor, but to become a particular kind of doctor – one for whom “absolute empathy” was the core value.

A lot of thoughts arose for me when reading this article. Firstly, how lucky I have been to have encountered so many doctors, through my training and through my workplaces, who share this core value of empathy. It’s what characterises their everyday actions as well as their career choices. And, secondly, how stories we hear in childhood influence the rest of our lives.

I first said I wanted to be a doctor before I was 4 years old. But I didn’t come from a family where there were any doctors, so where did this come from? I don’t know but I do know I was very influenced by a fictional doctor – Dr Finlay – a GP in a small Scottish town who had all the characteristics of what would now be termed an “old fashioned family doctor”. I didn’t want to just be a doctor, I wanted to be a Dr Finlay kind of doctor. 

So, maybe one of the best things we can do is tell our children stories of inspirational, empathic people. Not that that should mean they all grow up to be doctors, but maybe they will take the core value of empathy into their adult lives.

What stories do you think influenced your career, or life choices? 

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Hugs

Posted in from the consulting room, from the dark room, from the living room, from the reading room, health, life, personal growth, photography on December 19, 2014| Leave a Comment »

Can hugs make you healthier?

Here’s an interesting study from Carnegie Mellon University. The researcher, Sheldon Cohen, said

We know that people experiencing ongoing conflicts with others are less able to fight off cold viruses. We also know that people who report having social support are partly protected from the effects of stress on psychological states, such as depression and anxiety. We tested whether perceptions of social support are equally effective in protecting us from stress-induced susceptibility to infection and also whether receiving hugs might partially account for those feelings of support and themselves protect a person against infection.

 

The researchers measured over a two week period, frequencies of interpersonal conflicts, the level of perceived social support and receiving hugs in about 400 healthy adults. They then exposed the participants to a common cold virus and monitored in quarantine to assess infection and signs of illness.

The results showed that perceived social support reduced the risk of infection associated with experiencing conflicts. Hugs were responsible for one-third of the protective effect of social support. Among infected participants, greater perceived social support and more frequent hugs both resulted in less severe illness symptoms whether or not they experienced conflicts.

 

“This suggests that being hugged by a trusted person may act as an effective means of conveying support and that increasing the frequency of hugs might be an effective means of reducing the deleterious effects of stress,” Cohen said. “The apparent protective effect of hugs may be attributable to the physical contact itself or to hugging being a behavioral indicator of support and intimacy. Either way, those who receive more hugs are somewhat more protected from infection.”

Hugs, however they actually do their stuff, have long been one of my most favourite ways of staying healthy! (And even if they had no “protective effect”, they’d still be good, wouldn’t they?)

 

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An ancient, but insightful teaching on placebo

Posted in books, from the consulting room, from the living room, from the reading room, from the viewing room, health, life, personal growth, science on December 4, 2014| 5 Comments »

Rainbow fountain

I’m using this photo of a rainbow appearing in a fountain because I think rainbows are a symbol of hope, as well as being a phenomenon which exists only in the presence of the subject (the observer), and a fountain which is symbolic for me, of the life force, that flowing healing energy which enlivens and heals us all.

Isaac Judaeus lived from 855 to 955. He was physician to the Fatimid rulers of Qairawan in Tunisia, and his works were amongst the first to be translated from Arabic into Latin at the time of the great translations which brought Arabic thought and science to the notice of the West. His books had a big influence on Western medieval medicine, still being read into the 17th century. There’s a small book of his, Guide for Physicians, which only exists in Hebrew translation, where he sets out his ethical conception of medical practice (remember this is writing from the 9th and 10th centuries). I’ve only read a few of his aphorisms, but this one, in particular, caught my eye.

Comfort the sufferer by the promise of healing, even when thou art not confident, for thus thou mayest assist his natural powers

What’s he saying here?

First of all that physicians should comfort the sufferer. Sadly, that’s an element of health care which patients don’t always experience. Shouldn’t physicians always offer care and comfort?

Secondly, they should do this “by the promise of healing”. He goes on to say “even when thou art not confident”. Wouldn’t this be deceit in some situations? One of my earliest experiences as a young doctor was admitting a very elderly, very ill lady to the ward where I worked. Her also very elderly daughters were hugging each other on the seat outside the ward, wringing their hands, crying and upset about what was happening to their mother. I thought I’d comfort them and said “Don’t worry. Your mother is in the right place now. I’m sure she will be fine” They smiled to me just as one of the nurses came out of the ward and called me aside. “That patient you just admitted doctor? She’s just died”. Well, that taught me a lesson. But it didn’t stop me practising with hope, practising with the expectation that there was a potential for things to go well. It just taught me never to assume I could accurately predict the future!

I still believe that. I believe none of us can predict the future….especially not in the case of the particular, the specific, individual circumstance. I was surprised many times throughout my career when patients did so much better than the textbooks would have predicted. So, I often thought, the truth is that as you look forward from this point in time, there are a whole range of potential paths leading from here into the future. In the situation of illness, some of those paths will be largely ones of decline, some of stumbling along, and some of steady, or sudden, improvement. And nobody, but nobody, can accurately predict which path this particular patient will take. Therefore, at each stage of the process, hope is not only possible, but is as reasonable an option as any other.

That’s what I understand about “the promise of healing” – it’s not really a promise, in the sense of a guarantee, but a potential (in the way we say something may be “full of promise”). And I think acting from that perspective contributed to the improvements patients experienced.

That’s the final part of Isaac Judaeus’s aphorism – “for thus thou mayest assist his natural powers”.

I can’t see there is any healing other than that brought about by the human being’s “natural powers”. I’d describe them now in terms of systems theory, or complexity theory. Those natural powers are the power shown in any “complex adaptive system” – the powers of self-regulation, self-defence, self-healing…..the “autopoietic” “self-making capacity” of a person.

Medical acts, medicinal substances, physicians’ interventions are only truly healing when they work with, not against, this capacity. That’s why doctors should always remain humble. It’s not what we do that heals. It’s what we stimulate and/or assist….the astonishing self-healing powers of the human being.

In contemporary thought, these “natural powers” Isaac Judaeus refers to are often wrapped up in the idea of the “placebo effect”, but, sadly, that’s a concept so entangled with ideas of trickery and deceit that the “self-healing” powers get lost in it.

So, here’s what I get from that old aphorism –

  • offer comfort and care
  • offer hope and the promise/potential of healing
  • and in so doing assist the natural or self-healing powers found in every human being

One of my hopes for the future of Medicine would be that we learn many other ways to assist those “natural powers”.

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Thank you for December

Posted in from the consulting room, from the dark room, from the living room, life, personal growth, photography, psychology on December 2, 2014| Leave a Comment »

bell rope

In my monthly themes, December is the month to focus on gratitude.

I know, for many, your thoughts will be turning to gifts….what to give and what you hope to receive. I just wonder how your choices might be affected by keeping your focus this month on gratitude. Maybe then ever gift you give will demonstrate, somehow, something of the gratitude you feel towards the recipients of your gifts.

Many studies have show benefits, in terms of mental and physical well-being, which emerge from the practice of gratitude.

Have you ever thought about starting a “gratitude journal“? This might be a really great month to try it out.

Even if you don’t want to start a gratitude journal, why not take the opportunity of December to focus on gratitude anyway? Who do you want to say thank you to? Go ahead, tell them. What do you feel grateful for? Take a moment to think about exactly what it is, and to allow yourself the full benefits of feeling that gratitude swell in your heart as you contemplate it.

Or maybe you’d like to create, or participate in, a ritual of gratitude?

There’s certainly no single, only way to focus on gratitude, so explore a few ideas, and see what works best for you.

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Relational science

Posted in books, from the consulting room, from the dark room, from the living room, from the reading room, health, life, personal growth, philosophy, photography, science on October 30, 2014| Leave a Comment »

hollyhock

I recently stumbled across a reference to the paradigm of “relational science”. I hadn’t seen that term before but here are a list of characteristics of “relational science” with each one compared to its “Cartesian” counterpart.

  • PROCESS vs substance
  • BECOMING vs being
  • HOLISM vs atomism
  • RELATIONAL ANALYSIS vs either/or split analysis
  • MULTIPLE PERSPECTIVES vs dualistic objectivism/subjectivism split
  • COACTION vs split interaction
  • MULTIPLE FORMS OF DETERMINATION vs efficient/material causality

If you’d like to read about this in more detail google “Fundamental Concepts and Methods in Developmental Science: A Relational Perspective” – which is an article by Willis Overton and Richard Lerner. In that article the authors write –

As a derivation from these relational categories, the relational developmental systems paradigm characterizes the living organism as a spontaneously active, self-creating (autopoetic, enactive), self-organizing, and self-regulating nonlinear complex adaptive system. The system’s development occurs through its own embodied activities and actions operating in a lived world of physical and sociocultural objects, according to the principle of probabilistic epigenesis. This development leads, through positive and negative feedback loops created by the system’s action, to increasing system differentiation, integration, and complexity, directed toward adaptive ends.

Some of this language might be familiar to you from other posts I’ve written on this site, but I’ve never seen them pulled together as “relational science” or come across the concept of “relational developmental systems” before.

If change is the pervasive phenomenon which it seems to be, it makes much more sense to focus on process instead of arbitrarily separated parts. In terms of health, I think this means we need to understand the processes of repair, resilience and effective functioning of healthy organisms, not trap ourselves in the limited focus on pathological change within tissues or organs.

A focus on becoming instead of being also undermines the outcome based approaches to care which are so prevalent. Health is a dynamic, lived experiences, not a series of fixed states.

Multiple perspectives allow to understand illness much more fully – again, not limiting ourselves to the pathological changes within cells, tissues and organs, but taking on board the subjective phenomena of illness (pain, stiffness, breathlessness, dizziness, weakness etc), as well as the narrative of the person who is ill through which we make sense of the experience, and beyond all that, to situate the individual person’s illness within the contexts in which they live – their relationships, family, genes, work, social and environmental conditions etc.

Co-action shows that change comes about not least from the interactions between individuals. This knowledge gives us the opportunity to shift the perspective of health care from that of a doctor treating an object, to that of a doctor and a patient co-creating better health for an individual.

Last but not least, all of this thinking leads us to a consideration of the emergent nature of change in living organisms – which means we can never be completely certain how things are going to go in any individual situation. Something which, surely, should bring some healthy humility to the practice of Medicine.

You’ll see this is all entirely consistent with the features of complex adaptive systems, and of integral theory. And it is also utterly consistent with my blog byline of “becoming not being” which I first encountered in the study of Deleuze’s work.

I really think this “relational science” explains reality much better than the old, reductionist, mechanistic, linear paradigm which is still so prevalent.

Let me finish this post with a re-iteration of Overton and Lerner’s excellent summary –

the living organism as a spontaneously active, self-creating (autopoetic, enactive), self-organizing, and self-regulating nonlinear complex adaptive system

 

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Beautiful, good and true

Posted in from the consulting room, from the dark room, from the living room, health, life, narrative, perception, personal growth, philosophy, photography, psychology on October 29, 2014| 1 Comment »

Autumn leaves

Hugs

heart in the keystone

I find Plato’s three “transcendentals” of Beautiful, Good and True a very fruitful concept to explore. When I first read about “integral theory” I was very taken by Ken Wilber’s four quadrants of the single-subjective, plural-subjective, single-objective and plural-subjective, and really liked the way the beautiful, the good and the true could be mapped onto that. (read a little more about that here)

Yesterday as I was looking through my photographs of autumn leaves I was enjoying finding the ones I considered to be the most beautiful.

The day before I was listening to a radio discussion about fairness. The concept of fairness seems to be innate, and the panel discussed a video of an experiment which seems to show how fairness is indeed innate in primates.

Last week I was struck again by the observation that most people seem to visit a doctor to make sense of something. In the Medical World, we refer to that making sense as ‘diagnosis’, and I’ve long since preferred to think of it as an understanding. Making sense of a pain, an itch, a dizziness, of anxiety or whatever, involves the co-creation of a credible story by the doctor and the patient working together.

As these three strands came together for me this morning, I got to thinking of the beautiful, the good and the true once more and two things occur to me.

Firstly, all three of these qualities are dynamic and relative. None of them are fixed. And none of them are universal at the level of the individual or particular. What is beautiful to me, might not be experienced as beautiful by you (on the other hand, we might agree!) And I don’t see beauty as a category either – at least, not as a yes or no kind of category – not as an either/or way of thinking. It’s not a box to tick.

Secondly, for me, I think the Good has a strong element of fairness. We tend to think of Justice as being about fairness, and it strikes me that I can ask myself how fair my judgements and actions are, as a way of considering how good they are. I do also think that the quality of integration is a key characteristic of all complex adaptive systems i.e. all living organisms, so an action or choice is better if it is more integrative (if it increases the mutually beneficial bonds between the well differentiated parts)

Thirdly, I see Truth as being about sense making. In some ways, the sense I make of my experience is the truth of it.

So, my current exploration of the beautiful, the good and the true, centres around wonder (émerveillement), fairness and integration, and sense-making.

I discover beauty through wonder. I am motivated to promote fairness and integration in the world. I make sense through the creation of narratives.

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The irrational arrogance of certainty

Posted in from the consulting room, from the dark room, from the living room, health, life, personal growth, philosophy, photography, science on October 17, 2014| 1 Comment »

As I was walking in a forest the other day I came across this –

 

new growth in the forest

I often feel a kind of thrill seeing new growth like this. It’s the emergence of Life on Earth. This little seedling might well grow up to be one of the great trees of this forest. How does it do that? How does this one little seed begin to sprout, begin to reach upwards through the decaying leaves on the forest floor, and seek out the sun, the air, and the rain?

And then a little further on, I find this tree….

 

tree

Don’t adjust your screen – it’s the right way up!

Look at these twists and curves and corners, as the tree reaches first this way, then another. Who could predict which way any of these branches would grow? Who could predict what this tree would look like today if they were seeing it back when it was one of those little seedlings pushing its way towards the light?

I see this everywhere.

I saw it every day with every patient I ever met. Who could have predicted how this person would be today, what life they would be living, and how they would be experiencing it?

Nobody.

That’s what gets me about the irrational arrogance of those who claim to know. Those who claim certainty. I am never convinced by those who claim they know what the results will be of a particular treatment for a particular individual. They can throw the term “evidence based” about as much as they like, but if they think that label gives them some magical ability to predict the future for individual human beings, then they are quite likely to be mistaken.

I don’t like the irrational arrogance of certainty in any area. I don’t like it in politics, matters of belief, wordview (religious, atheistic or scientistic), in economics, or any other human domain. Life is not predictable. Living organisms cannot be properly understood if represented as mere objects. All living forms are dynamic, open, complex systems. All are unique and together they are diverse. Commonalities matter, but so do differences.

If there is one thing I always doubt, it’s certainty.

But then, like Montaigne, I’m fond of saying “mais, que sais-je?” (“but what do I know?”)

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Healing is normal

Posted in from the consulting room, from the dark room, from the living room, health, life, photography on October 16, 2014| Leave a Comment »

Dandelion

I am currently reading a fascinating book entitled “The Secret Life of Pronouns” written by James Pennebaker, a psychologist who has studied the way we speak and write and how that relates to our personalities, to our illnesses and to our ability to heal wounds.

I was really struck by the section where he is discussing traumas and how people deal with them. He made the point that despite the fact that everyone experiences different traumas in their lives, most people neither become ill as a result, nor need specialist help.

That was one of those moments for me which is, on the one hand, and “aha!” moment, and on the other a moment of recognition/reaffirmation.

I think this observation applies to the whole of life and is fundamental when we think about health and health care but we’ve forgotten it.

Working as a doctor it’s easy to get the perspective that everyone gets ill and needs medical interventions, but that’s such a distortion of the reality of life. In fact, I’m reminded of what the Professor of Obstetrics said to my wife at her first antenatal visit. He said, “I see your husband is a medical student. Tell him that pregnancy and childbirth are normal experiences. As a medical student he will only see the situations where something goes wrong but for the great majority of women, things don’t go wrong.”

I was very grateful for that advice and it came back to me from time to time throughout my career. For most of us, for most of our lives, we are not thinking about our health, and we don’t need to seek specialist health advice. Of course I’m not denying the reality of morbidity and mortality. It’s also true that we will all experience illnesses and we will all, finally, die. It’s just that we have amazing adaptive abilities.

Take something like a flu epidemic. Only a minority of the people who are exposed to the virus will actually contract influenza. Only a minority for those who contract influenza will need specialist medical help. All of those who recover from influenza will do so because their body’s natural healing functions do what they are designed to do.

We do really forget that. There is no healing, other than that brought about by the body’s natural, adaptive, healing capacity. Yes, medical treatments can make the difference between life and death at times, it’s not that they are in any way irrelevant. But too often we think that healing is about medical treatment alone. It never is.

We humans have astonishing, natural, default abilities to deal with what comes along in life – whether that be mental traumas, physical traumas, infections etc. And when we do become sick, in every single instance we need our body’s self-organising, autopoietic abilities to do what they are designed to do.

Yes, if you are ill, you may well need specialist help, and please do seek it when you think you should. But don’t ever forget have the natural human ability to recover, to heal, and to be healthy.

Health is normal. Healing is normal. We should never forget that in all circumstances we should support and encourage those natural mechanisms.

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What’s your tipple?

Posted in from the consulting room, from the dark room, from the living room, health, life, personal growth, photography, science on October 11, 2014| Leave a Comment »

Rose hips

Last few grapes

Human beings are very adept making medicines from plants.

Have you come across the Sacred Science project? (They have made a thought provoking documentary about plants used in healing in the Amazon – you can find it on vimeo, but google sacred science to learn more).

Many, many years ago in the Botanic Gardens in Edinburgh I saw an exhibition of the uses of plants by desert peoples. I’ve never forgotten it. I was so impressed with the market stalls they set up, with one displaying plants used to die clothes beautiful colours, and another one showing plants used to treat a variety of diseases. I remember thinking how on earth did they figure that this particular plant was great for dyeing your clothes purple, but this other is a great cure for diarrhoea?! It was that exhibition which introduced me to the whole field of ethnobotany……the study of Man’s relationship to plants.

A few years later I read that Samuel Hahnemann, the founder of homeopathy, first experimented with Peruvian tree bark (Cinchona). When I read about that medicine, which had been used to treat “swamp fever”, a disease we now know as “malaria”, I remember thinking how did the indigenous peoples of Peru know that this particular plant would treat this particular disease – a truth we confirmed many, many years later when we isolated the chemical, quinine, from this same tree, and found it was a good treatment for malaria.

I don’t know the answers to those old questions, but I am still fascinated by potential benefits we humans can receive from plants.

As I write this I’m watching the last few days of the grape harvest in Charente. Those grapes will be used to make cognac, using processes not that dissimilar to the ones we use in Scotland to make whisky from grain. I’m just learning that the various areas within the cognac-producing region of France produce extremely different flavours – just like the different regions of Scotland produce distinctly different whiskies. In both cases, the specific interactions between people and plants in these countries produce distinct and unique results.

What’s your favourite human-plant interaction?

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Healing wounds faster

Posted in books, creativity, from the consulting room, from the living room, from the reading room, health, life, narrative, personal growth, psychology on October 4, 2014| Leave a Comment »

I’m always interested in research which demonstrates ways in which we can support natural healing – after all, there isn’t any other kind of healing, is there?

Here’s an interesting study using writing practice

49 healthy adults aged 64 to 97 years wrote about either upsetting events or daily activities for 20 minutes, three days in a row. After a time lag of two weeks, to make sure any initial negative feelings stirred up by recalling upsetting events had passed, all the subjects had a biopsy on the arm, and photographs over the next 21 days tracked its healing. On the 11th day, 76 percent of the group that did expressive writing had fully healed as compared with 42 percent of the control group.

This particular exercise – writing about an important or upsetting event for 20 minutes each day for three days in a row – has been around for quite some time. James Pennebaker pioneered it, and has studied the effects of writing on health extensively. He says

People who are able to construct a story, to build some kind of narrative over the course of their writing seem to benefit more than those who don’t,” Pennebaker says. “In other words, if on the first day of writing, people’s stories are not very structured or coherent, but over the three or four days they are able to come up with a more structured story, they seem to benefit the most

What’s particularly interesting here is how the creation of story goes along with changing perspectives and understanding better what’s been happening.

Pennebaker’s research developed a computer-based, text analysis program to analyze word counts in different categories, such as emotion words (e.g. happy, sad, angry, joyful), cognitive words (e.g. realize, understand, think), self-reference words (e.g. I, we) and an additional 70 categories. Much to the surprise of the researchers, the change in emotion words didn’t correspond to improved health. The more powerful predictor of improved health was the use of cognitive words–that is, individuals who showed an overall increase in the use of causal words (e.g. because, reason) and insight words (e.g. realize, know, understand) showed improved health.

So it’s not just about telling a story, changing perspective or increasing understanding, it’s about improving immune function and both physical and mental health.

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