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Archive for the ‘from the living room’ Category

inequality

What’s wrong with this picture?

Is this degree of inequality a problem? Is it sustainable? Should we try to address it?

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Blind Light1

Fritjof Capra, in his “the hidden connections” refers to anthropologist, David Gilmore, who studied images of men, or male “ideologies” in many cultures around the world. He found interesting, consistent themes.

Gilmore found that in culture after culture, ‘real’ men have traditionally been those who produce more than they consume. The author emphasises the ancient association of manhood with material production meant production on behalf of the community. ‘Again and again we find that “real” men are those who give more than they take; they serve others. Real men are generous, even to a fault.

I think that is striking – producing more than you consume for the benefit of the community sounds an excellent ‘manhood’ quality to aspire to. He goes on to say that over time this image has changed, so that now it is common to see the ‘big man’ as the one with the greatest personal wealth and most power over others. Sadly, I guess that’s the image we are more familiar with these days.

So here’s what I’m wondering…….how did that change? And why? How did the image of manhood change from one who serves and provides to one who hogs the most for himself and exerts power over others?

Those questions, naturally, lead me to wonder what we can do (if anything) to reclaim the ancient images of ‘real’ men, and to encourage boys to become such ‘real’ men…….

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Facing the Med

There’s a lot of talk around just now about “patient centred care”. It’s one of those concepts that nobody argues against. In fact, pretty much everyone claims to be doing it. If that’s true, then it must mean different things to different people. Or it must have so many aspects, that different people resonate with the concept because they understand and value one of those aspects.

There’s a vast and growing literature on “patient centred care” but I’d like to make a contribution to the debate. I’m writing here from the perspective of a generalist, holistic, integrative doctor. I work at the “NHS Centre for Integrative Care” which, we claim, is a patient centred service within the NHS.

Some health care services are disease centred. There are Diabetic Clinics, Asthma Clinics, Hypertension Clinics and so on. These are specialist services where only people with particular diseases are seen, and where progress is measured primarily by measuring changes in the disease activity.

Some services are therapy centred. When you attend one of those services, only particular therapies will be used, no matter what your diagnosis, or who you are. The two biggies are surgery and drugs. Most services are designed to support the delivery of one of those two therapies. “CAM” (“complementary and alternative medicine”) clinics are often therapy centred too. Acupuncture Clinics, Osteopathic Clinics, Homeopathic Clinics etc. When you go to one of those you will see someone who has specialised in that particular therapy, and they will try to help you using that therapy.

Integrative Care is a patient centred therapy. It delivers individualised, multidisciplinary care using a range of different therapies, based on a holistic, personalised understanding of the individual patient. It is generalist, in that it is not limited to patients with specific diseases, and it is integrated in that it is not limited to the use of one particular therapy.

Now, I’m sure, there are many who will explain why their disease-centred, or therapy-centred service is also patient-centred, but I hope it’s helpful to clarify why an “integrative care” service cannot be defined by either the therapies used, or the disease diagnoses of the patients attending.

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clouds

Jung said

life is a luminous pause between two great mysteries

James Hollis, in “The Middle Passage” ends that book with

A great mysterious energy is embodied at conception, bides a while and finally goes away. Let us be gracious hosts, let us consciously assent to the luminous pause

Isn’t that wonderful?

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floating petals

I came across this statement the other day

You can’t direct a living organism, you can only disturb it.

I think this is such an important truth, yet we lose sight of it all the time in health care.

Our current reductionist, mechanistic model of living organisms has resulted in our unsustainable version of health care, based on the premise that diseases are entities which can be defined, isolated, attacked and removed, using “evidence based” interventions which are certain to produce the outcomes demonstrated in clinical trials.

Life, of course, isn’t like that. The intended “outcomes” are difficult to achieve, impossible to predict in individuals, and turn out not to be the end of the story when life carries on.

Why is that?

One reason, it strikes me, is because you can’t “direct a living organism”. You can’t control a living organism. People aren’t like cars. Living beings contain many, many parts (cells which work together to create tissues, organs and networks), but those parts relate to each other in non-linear ways.

Simply, that means that doing X to Y will not predictably produce Z.

The failure to remember that leads to polypharmacy where each “evidence based” drug is prescribed to direct a part of the living organism – the heart, the brain, the lungs, the stomach etc – but when that part changes under the influence of the drug, it’s relationship to the other parts changes – unpredictably (and the drug, which is not specific to the part it is trying to direct, produces changes in many other parts at the same time)

If we remember that we can only “disturb” a living organism, not “direct” it, then we are called to be more humble, less certain (and so more aware, more reflective at every stage), and more holistic.  We are called to constantly return to the focus on the person, on this unique individual we are caring for, and to assess, with them, how life is changing as a result of this “disturbance”.

We can’t control individuals. But we can disturb them, and then ask with them, how is life now? What direction is life taking?

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the colour of light

Václav Havel said

[Hope] is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.

One of the commonest things patients tell me is that our work together has given them hope. That’s always very heart-warming feedback, because without hope, it is difficult to live.

But reading Havel’s statement about hope not being “the conviction that something will turn out well” got me thinking. I suppose because I completely agree. I don’t think hope is about giving people the conviction that all will be well. How could anyone give that guarantee after all? The future remains unknowable….whether we are well, or whether we are sick.

But if hope is not about believing a disease will go away, what is it? Havel says it is the “certainty that something makes sense” and I think that is right. One of the values of integrative practice is that it is sense making. Taking a holistic, individualised approach to a person, listening empathically and non-judgementally, with full attention and acceptance, sets up the potential for understanding – for the practitioner to understand the patient, and, for the patient to understand themselves, their illness and its place in their life. Understanding is sense making.

I think hope is something else too, though. A lot of people who consult me feel stuck, trapped, suffering, or in despair…..they are scared that this is now how life is going to be. Hope emerges when it becomes clear that change is not just possible but probable. Havel uses the word “certainty” and as the future is unknowable in detail we can’t offer certainty about specific outcomes.

But change is one of life’s certainties. As every individual is actively involved in creating their own experience, hope emerges when we realise life can be different, and that our choices can influence how different it can be.

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sunset

 

Thoreau writes, in Walden –

I learned this at least, by my experiment; that if one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unimagined in common hours.

There’s a lot in that sentence. Does it inspire you? If it does, what does it inspire you to do?

It inspires me to become more aware of my dreams (and to try to distinguish my dreams from the dreams I’ve acquired). It inspires me to experiment, to see whether or not I’m surprised by how well those dreams can be realised if I take action – if I choose to “advance” in the direction of my dreams.

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moonlit forest

 

James Hollis, in his “Creating a Life” says

As powerful as the will is, as urgent and insistent the élan vital, the imagination creates the world in which we live. The only question is: whose imagination, whose images, whose myth are we living in the course of that which we call our life?

I couldn’t agree more. Imagination is one of our most powerful qualities. We need imagination to see the possible. We need it so see the invisible. We need it to create. We need it to put ourselves into the shoes of others (and without that, where is compassion?). We need it for hope.

But imagination also allows us to fear – and how often is fear used now to control us?

So whose imagination are you living?

 

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I read a lot about “complex adaptive systems“, and so a lot about “complexity science”. I think this gives me a set of concepts to create a framework for myself which helps me understand life. I think it gives me a language with which to think and communicate, but the trouble is the word “complex”. When people hear that word they think of “complicated” – which isn’t the same thing at all.

What’s the difference?

A machine can be complicated. A machine is constructed from parts, each of which can be understood separately. A machine can be understood by examining the parts and how they interact with each other. You can take it to pieces and build it back up to be the same machine. You can predict how the machine will behave….what it will do. The more parts a machine has, and the more connections there are between the parts, the more complicated it is. That means it is harder to understand. But it can be understood.

A living organism is not complicated. It’s complex. A living organism might have billions of parts (cells, for example), but there are two distinct features about how they interact – they are all “agents” – that is every single part affects, and is affected by, other parts; and the nature of the interaction is “non-linear” – that means you can’t add one part to another and predict what the result will be…..a small change at the beginning, can produce enormous differences in how the organism as a whole changes – think of the “butterfly effect”.

Once you grasp the basically simple concepts which underpin this idea of “complex systems”, then you can look at everything from living organisms, to ecosystems, forests, organisations, communities or institutions from this perspective. I think it’s amazing what such a perspective reveals.

One paper I read recently looked at understanding leadership from the complex adaptive system perspective. The author, Kowch, highlights three characteristic of organisations which learn, adapt and grow. Each of these characteristics is worth thinking about because the less your organisation has of these, the less healthy it will be, the less likely it will thrive, or even survive in these rapidly changing times.

  1. Diversity – Nature loves diversity. The more conformity and uniformity in a system, the less adaptable it is. Monoculture might produce large quantities of something for a while, but, ultimately, it becomes vulnerable. Yet, command and control seems to be the preferred management method. Great effort is put into achieving conformity and uniformity. With globalisation, and the power of oligopolies, differences are often seen as problems to be removed.
  2. Specialisation – nobody can do everything. Although Darwinists have pushed the idea that evolution occurs through a “survival of the fittest”, with a perspective of continuous competition and warfare, in fact, others argue that its the ability to co-operate which has allowed human beings to develop as a species. Co-operation involves both good relationships (integrative relationships ie where the relationship is mutually enhancing for all the individuals involved), and specialisation – some develop a lot of skill in one area, whilst others in quite a separate area.
  3. Redundancy – this means duplication, or having “more” than it seems the organism “needs”. In organisational terms, if all the staff are fully employed, fully scheduled, each in their own specialist area, then when something changes (such as sickness, increase in demand etc) then there is no way to cope with that – there’s nobody to cover, and there’s no ability to meet the change in demand.

So, what does your organisation look like? How’s it doing in terms of diversity, specialisation and redundancy? How healthy and adaptable do you think your organisation is?

floribundance

 

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The local robin

This robin isn’t any robin. This is THE robin whose territory includes the bush which grows right in front of the space where I park my car at home.

I’ve often tried to capture a photo of him, but he is camera shy and disappears too quickly for me. But this time…..oh, isn’t he wonderful?!

If one does not become the eccentric, unique, one-of-a-kind person he or she was meant to be, then a violation of some large purpose of the cosmos has occured. James Hollis

Every one of us is a one-off. Every one of us is unique. My local robin reminds me of that.

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