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Archive for the ‘from the reading room’ Category

I’ve just finished reading Madeline Miller’s superb “Circe”. I can’t tell you just how much I enjoyed it. I found it a great read. I am a bit familiar with some of the Greek myths and legends, including the story of Odysseus, but this way of telling Circe’s story let’s Madeline Miller tell you some of those myths from a new perspective. I just loved it.

Last night I read a passage which made me think “Yes! I must share this!” Here it is –

When I was young, I overheard our palace surgeon. He said that the medicines he gave out were only for show. Most hurts heal by themselves, he said, if you give them time. It was the kind of secret I loved to discover, for it made me feel cynical and wise.

I have long believed exactly that. I used to say to patients something like “If you break a leg, the surgeon will apply a plaster to your leg to hold it still. The plaster doesn’t repair the fracture. It just holds the ends together while your body gets on with doing what it does – healing – or, in this case, repairing the fracture.” Or I’d tell someone “This antibiotic isn’t going to cure your bladder infection. What antibiotics do is to kill bugs. That’s a good thing. But your bladder wall is all inflamed because of the infection, and it’s that inflammation which is causing your symptoms. The antibiotic will have no direct effect on your inflammation. But it will reduce the number of harmful bugs in your bladder to allow your body to get on with doing what it does – healing.”

Does that seem unnecessarily pedantic? I don’t think so. I think it reinforces the patient’s belief that their body can self-heal – which is exactly what all “Complex Adaptive Systems” do – all living creatures have these abilities to self-regulate, self-defend, and self-repair. It’s what they do.

That’s the wisdom part.

But in Circe’s telling this knowledge also brings a certain cynicism, and for me, that’s always been about the place of drugs in health care. There isn’t a drug on the market which is designed to directly promote and/or stimulate self-healing and self-repair. Each drug attempts to redress an imbalance, or to suppress some symptoms or pathologies. The business of the body doing what the body does – self-healing and self-repair is left to be a hopeful sort of side-benefit at best.

There are ways to work more in harmony with the body’s natural powers, but, in my opinion, those ways aren’t taken seriously enough. Targeting pathology/disease and/or symptoms remains the dominant model. But I do dream of a time when the balance tips towards targeting health/healing and/or powers of self-repair, and self-healing. The present types of drugs and treatments will then be seen as the potentially useful adjuvants that they really can be. They will no longer be seen as enough by themselves.

Oh, by the way, “Circe” isn’t a book about health or disease. It’s a telling of some of the Greek myths. It’s just that passage really resonated with me so I thought I’d share it. And, on reflection, don’t those myths have something to tell us about disease and illness, and how we cope, heal and grow?

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I’ve got a lot of photos I’ve taken which are of this type. They are examples of Islamic art in Spain. Actually there are several different types in my collection, one of which is tiles, like these ones.

I adore these repeating, interconnected, geometric patterns. I love the stars you can see in them. There are small six pointed stars, small eight pointed ones, and small twelve pointed ones. Can you find examples of all of those? Then as the lines spread out from each star, they create hexagons, squares and diamonds.

What I see most clearly when I look at an image like this is a representation of the fundamental connectedness of creation – I see nodes and bonds – an intricately, inter-laced network where nothing exists in isolation and every part emerges from the creation of the web of connections.

Here’s a somewhat different example. Now, I’m not a scholar of art history, but I do know that there are elements of different cultures in this particular image. There is a hint of Islamic art, a thread of Celtic art, and across the middle there are three chimerical creatures – perhaps a “manticore”, a “mermaid” and a “centaur”?

I love seeing these interwoven influences of different cultures, and it isn’t hard to find examples in Spain which has such a rich history of different peoples living there at different, and even overlapping, times.

These chimerical creatures are really strange to our modern eye and they are often seen as imaginary beasts or monsters, but when I see them here in this panel embedded in webs of inter-locking links and lines, I wonder if they actually represent something of an origin story. Do these half man/half lion, half woman/half fish and half man/half horse actually remind us of our shared origins – we humans and the rest of creation?

We have such a tendency to see human beings as separate from Nature. In fact there is a long tradition in the West in particular of seeing “Man” as superior to “Nature” and even having a God-given duty to subdue and control all the other creatures and forms of Nature on the planet. There are strains of religious teaching in there, but there are also roots in the origins of the “scientific method” and, in particular in a certain strain of darwinism (not put forward by Darwin himself).

We lose a lot when we separate ourselves from the rest of the planet we co-habit with all other forms of Life. We distance ourselves from other creatures and that seems to free us up to treat them with contempt and cruelty. There’s something deeply mistaken in thinking of all non-human reality as “resources” to be “exploited”.

But there is another way. I’m aware of at least three strands of knowledge which contribute to a more holistic, more inter-connected, and, I believe, healthier model.

I start with complexity science, and in particular the concept of the “complex adaptive system“. When I view myself, others, or any phenomenon on the planet through this lens, then the whole of Nature is one inter-connected organism. Nothing exists in isolation. Every action, every thought, every behaviour is influenced by, and influences the actions, behaviours and thoughts of others.

Next I am fascinated by genetics and embryology. It has always been a source of complete wonder and amazement to me that a single egg cell can be fertilised by a single sperm, then divide over and over and over again, differentiating the cells as it grows, to create the billions of cells which make all the tissues, organs and cells of the human body. And all in the right place! It continues to astonish me that all of our cells can be traced back to just two cells – one from each parent. But on top of that, it’s been amazing to see the incredible degree of “overlap”, or perhaps more correctly, of shared origin in the genomes of humans and other creatures. It’s pretty mind boggling to discover how many genes we have in common with earthworms for example!

Thirdly, I’m convinced about Lynn Margulis’ “endosymbiotic theory” – the idea that all multicellular creatures have evolved not only from unicellular ones, but that the individual cell components of nucleus, mitochondria, ribosomes, perhaps chloroplasts, were all originally separate creatures which evolved to live together and form these more complex structures of animal and plant cells. Each cell can be thought of as a little community, and each cell exists as a member of a larger community. This places co-operation, collaboration and symbiosis at the very heart of reality.

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We often look at the world this way….just a peek through a narrow gap. We can see a bit this way. It’s a way of being focused. If we narrow our gaze we can ignore everything except what’s in the target zone of our attention.

You know we have “two brains”, right? I mean the recognition that we have a cerebral cortex which is divided into two, non-symmetrical parts. Why do you think the brain is like this? Why not just have one, whole brain? Why did evolution prefer to develop the cortex in two significantly different hemispheres?

Well a lot of people have tried to claim that the right half does these things, and the left these other things….like the right is what we use to “do art” and the left is what we use to “do logic”. But we know that’s not true. The brain is not like a clock, a car, or a computer. It doesn’t function with one part doing “this” all by itself whilst other parts do “that”.

But Iain McGilchrist figured it out. In his “The Master and His Emissary” he lays out what I find to be a convincing thesis – each hemisphere engages with the world differently – in other words, each hemisphere gives us a different way of approaching, understanding and interacting with, the world.

What the left hemisphere allows us to do is like what you see in this image. We use it to narrow our gaze. We use it to focus in on “parts”, to analyse them, label them, categorise them, in order to try and “grasp” and manipulate them. The right hemisphere, on the other hand (see what I did there?), is used to enable a broad gaze. We use it to focus on the connections, to explore the bonds and relationships, to discover what’s new, and to see things in the broader view, or in “the whole”.

What amazes me about this is that we use both halves simultaneously pretty much all the time. They are in constant interaction, giving us the ability to “integrate” and “synthesise” what they focus on.

The trouble comes when we fail to pay enough attention to one of the halves – actually, in our modern world, it’s the right hemisphere we fail to attend to sufficiently. We get stuck in our world view of seeing reality as composed of separate parts which we can label, categorise and control. We get hooked on a mechanistic model. And, well, reality is not like that. That picture is incomplete and can lead us astray.

So, we do need these abilities to focus narrowly, to separate out elements, analyse them and organise that knowledge, but we ALSO need to be constantly aware of the big picture. We also need to see the contexts, the connections and the circumstances. It’s this that enables us to see uniqueness.

When it comes to this pandemic, we need to understand and analyse the COVID-19 virus. It will be a real boost to us to discover how to improve our treatment of people who are infected with it to try and reduce the potential damage they might suffer. But we need to use that other half of the brain too and see what the circumstances are in which this pandemic has arisen. We need to join up the dots. We need to see the connections and the contexts.

Isn’t it clear that one reason why this pandemic is so damaging is that we don’t have enough good health care? I think this issue is the same whether you live in the UK, France, the US, Spain, Belgium….you name it. It’s not the sheer number of people who are suffering from significant effects of this virus – after all, it seems about 80% of those who catch it don’t even get any symptoms. It’s that the small percentage of people who DO suffer serious effects from it still constitute numbers potentially too big for our health services to cope with.

Why do you think there is this constant message about “protect the NHS” in the UK? The NHS shouldn’t need “protecting” from sick people! It’s very purpose is to treat them. But the truth is there aren’t enough staff, there aren’t enough hospital beds, there isn’t enough equipment, there isn’t enough PPE, there aren’t enough testing materials, or laboratory resources.

There isn’t enough decent, safe social care available for the elderly. There isn’t sufficient support for people whose incomes are hit by forced closures of their workplaces. There isn’t enough decent housing. There isn’t enough decent nutrition because the current model of industrialised farming and processed food production is feeding both obesity and nutritional deficiencies of important vitamins and minerals which are needed for healthy immune systems.

And so on……

Unless we use our whole brains and address the underlying weaknesses, vulnerabilities, insufficiencies and injustices in our societies we will find not just this pandemic hard to handle, but we’ll set ourselves up for more of the same.

It’s time to change.

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I saw this on the wall of a church in Saint-Jean-de-Luz in Southwest France. A “rencontre”, as you can probably tell from the drawing, is a meeting. I haven’t seen this portrayed in other churches but I really liked that it was displayed so prominently in this one.

For me, the key to understanding Life is revealed in connections, relationships, or bonds. In fact, it is revealed in a very special kind of connection – one which increases “integration”.

Integration is “the formation of mutually beneficial bonds between well differentiated parts”. I think this is easily understood when you think of the human body. We have several organs, from a heart, a liver, a pair of kidneys, a pair of lungs, a brain, and so on. All of these separate, distinct, structures have their own particular functions to carry out and they must carry them out in a way which is more than harmonious…..they must act to promote mutual benefit. The “integrative” connections exemplify collaboration and co-operation. Our organs do not compete with each other….not for energy, food, or protection. Not in a healthy state, anyway.

So, here is the basis of natural health – harmonious, well-integrated, collaborative relationships between distinctly different parts.

You can scale that up – so that a healthy society is a diverse one composed of unique individuals who relate to each other in mutually beneficial ways. You can scale it up further to consider whole ecosystems, or even the global biome, and see that this is the basis of Nature.

Much has been made of the role played by competition in Nature, and in particular in the story of evolution. But, competition has only ever been one part of the story. Without collaboration, without the creation of mutually beneficial bonds, Life would not exist, and it certainly wouldn’t evolve.

When I see this image of a “rencontre” I’m also reminded of the story of the Little Prince and the fox, as told by Saint-Exupery in his “The Little Prince”. In particular I remember the passage where the fox asks the Little Prince to “tame” him – by which he means to create a bond between them, and gives the example of rose which the Little Prince tended to in his home. The Little Prince claims that his rose, of all the roses in the world, is special to him. He cares for her, looks after her, and feels for her. What makes her special is the bond – the bond of care. The fox points out that if he and the Little Prince form such a bond, then they will be very upset when they have to part – because these bonds of care matter to us. They matter to us more than anything.

We can’t have too much of this type of connection in our world. In fact, we need a whole lot more of them – we need the bonds of “integration”, the “mutually beneficial” ones, the bonds of “care”.

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I saw this framed poster a couple of years ago in a shop in Copenhagen. I kinda wish I’d bought it! It’s a simple but elegant representation of something which has become my core model when I consider reality – networks.

When people say everything is connected to everything else they are right and the easiest way to both visualise and explore that is the network.

A picture of a network is simply some nodes connected by lines. The nodes might be people in your life, including you, with each line representing relationships. The nodes might be cells in your body, some more directly interconnected than others but all living in each other’s influences. The nodes might be neurones in your brain, each of which is connected to up to 50,000 other neurones! Can you imagine that? It’s literally mind boggling.

Networks can map thoughts, feelings and actions. They can help us trace the influences on any single moment cast by the past and the future if each node is an experience, real or imagined.

We have two halves to our cerebral cortex and it seems the left half is particularly good at noticing and exploring the nodes – the parts, the elements, the items, components or data. The right half, on the other hand, is particularly good at noticing the links, the bonds, connections and relationships.

Think of the constellations in the night sky, each twinkling star a node. When I look out now I see Orion has reappeared and makes his way each night across the winter sky from east to west. He’s been gone all summer and now he’s back I know winter is coming. But how do I see Orion? By tracing the invisible lines which connect the individual dots (stars).

When I first read about complexity science it was this model of networks which made it all clear to me, and, in particular, learning about the non-linear nature of the relationships between the nodes in living creatures helped me grasp the concept of the “complex adaptive system”…..which shone a bright light of understanding on everything from self-healing, to uniqueness.

If you’d like to explore this subject a bit more, here are some of the best books I’ve read about this concept of networks, connections and links.

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We humans seem to develop the habit of making binary choices. You can either choose this OR you can choose that. I suppose we make either/or choices on multiple occasions every day. It’s not something to avoid. If we tried to avoid it, we’d be paralysed. What would we have for breakfast? Where would we go today? Which tasks would be pay attention to and put our energy into? Let’s be clear, we make, and we need to make, binary choices all day long.

But I think this becomes a problem when we try to see the whole life through this lens. It’s a problem when we select out too little of complex reality to try to reduce it to either/or choices. That’s too simplistic, and it detaches us from the real world, leads to mistakes and regrets, pushes us into divisions and conflicts.

So we also need to see the “whole”, to look at “the bigger picture”, to take a “view from on high“. In other words we also need to explore the contexts and connections which exist, to follow the trails, the feedback loops, the influences and flows.

To do that, we need to stand back from time to time, take stock, pause and reflect. I think that’s happening a lot during the time of this pandemic. A lot of habits, routines, behaviours have changed now, or at least, for now. We are having to adapt. Is this virus going to go away any time soon? Doesn’t look like it. So, how am I going to live now? What’s important to me? What paths aren’t looking so clear now, and which other ones seem to be opening up?

Our brains have two enormous divisions – the left and the right cerebral hemispheres. Each of these halves engages with the world differently, and if, Iain McGilchrist’s thesis is correct (which I believe it is), then we’ve been paying way too much attention to the way the left hemisphere engages, and not nearly enough to the right. Here’s one of the key differences – the left makes binary choices. It separates, divides, and abstracts. It simplifies, categorises and labels. The right, however, seeks connections. It synthesises, contextualises, looks for the bigger picture, the “whole”. It prioritises relationships over objects.

The truth is we need both halves of our brains. Surprise, huh? But we need to learn to get them working together better than they’ve been doing. We need to learn the habits of joined up thinking, of humility, and of open-ness.

And not or – that’s the way I see it!

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“Words were originally magic”

Have you ever read that sentence before? It was coined by Freud in 1915, and used by Steve de Shazer as the title of his book about his “solution focussed approach” to brief psychotherapy.

Do you think writing “freedom” repeatedly over the front of this office block works some magic? Who decided to write this in this particular place? Were they being ironic? Pointing to the fact that offices are actually soul-less, regimented places of control….the antithesis of freedom? Or were they trying to cast a spell….to make people feel more free by presenting the word to them?

I don’t know. I don’t know the history of this office block in Malmo.

We are told we now live in a world of “post truth” where words are used to confuse, misdirect, obscure, lie and evade…..where words are used to persuade and manipulate……where words are propaganda….ways to influence and control whole populations one three word slogan at a time. “Take back control”, “Get Brexit done”, “Build, build, build”………

Well it seems that words are losing their magical power when they are used so cynically and when they aren’t backed up with actions. But still, they work a magic over millions of people who voluntarily give up their freedoms and quality of life for the sake of a privileged few (just as Montaigne’s friend, Étienne de La Boétie, described in “Discourse on Voluntary Servitude” back in 1577)….inequalities are increasing massively, wealth and power is becoming ever more concentrated while “strong men” narcissists bewitch large numbers of people into supporting them.

Ok, political rant over! Back to health care….my specialist subject! As a doctor you have to be really careful about the words you use. Telling someone they have X months to live can become a self-fulfilling spell. People give up, or gain hope, depending on the words the doctor uses….and how they use them (by which I mean the contexts in which they use them, and whether or not they are used within already established relationships of trust). In a good consultation the doctor is on the alert for specific words which the patients might use, words which might hold the key to both diagnosis and prognosis. Which words does the doctor pick up on, and ask you to say more about?

We have to be especially careful of using words as labels…..such labels can put people into boxes. It’s a danger in health care, but also in wider society….the fast track path to prejudice and injustice.

Words are still magic. They still have enormous power. It’s worthwhile staying aware of that……

Be a hero, not a zombie!

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I’ve had a couple of days thinking about beginnings, so it seemed kind of obvious to have one about endings!

This photo shows a number of berries, all part of the same plant, even the same part of the same plant, but each in a different stage of maturation. Some are still green, some have turned yellow, some red, and some are even beginning to get wrinkled (like me, ha! ha!) and so appear the most mature.

When I think about beginnings, I realise that they are all pretty arbitrary – a beginning is where we begin – if you pick a thread or two you’ll always find your way back to an earlier beginning.

I don’t think that means there are no beginnings. I think there are. All the time. Every day. Every moment of every day. There are beginnings. There are phenomena and experiences which have only this moment come into being for the first time ever. It’s pretty great to notice that.

Endings have exactly the same quality. It’s not that there aren’t any. There are endings all the time. Every day. Every moment of every day. There are endings. There are phenomena and experiences which have only this moment slipped into the past. You’ll never have them again. It’s pretty great to notice that.

Outcomes, targets and goals

In Medicine, there is a lot of focus on “outcomes”, sometimes called “clinical outcomes”, which, somehow are a bit different from “patient reported outcomes” (“PROMS”). These are all endings. They are points to be reached. Measurements to be attained, or ratings to be completed. But when your working life is that of a family doctor, (a “GP”), then you’re never done with outcomes. The patients don’t reach the intended outcomes then go away. Life, it turns out, goes on. What was an ending today, turns out to be just another chapter in an ongoing story, just another time and place sensitive reading in the midst of a flow of a whole life.

Oh, yes, you’ll say, but there is one outcome which isn’t like that isn’t there? Death. The final outcome. The ultimate ending. Except it’s not really, is it? Well, it is for the physical body of the person who has died, but we are more than physical bodies aren’t we? We are experiences, stories, events and memories, aren’t we? And those continue long after the physical body has gone. Are the people you loved who are no longer alive completely gone from your life? I don’t think so. Their life continues to influence our lives. The experiences we shared, the memories we made, whatever we created together, the stories told, the photographs taken, the objects held…….

Have you ever seen a BBC TV programme called “The Repair Shop”? I love it. People bring old objects to a workshop of artisans. The old objects are usually in a poor state of repair, but they mean something to the person who has them. Once restored by the craftsmen and women, the person comes back to reclaim the object, and time and time again, it is an immensely emotional experience. They are put in touch, deeply, and significantly with a loved one, long gone. It’s lovely to watch and it shows how a person, an individual, continues to influence others long after they’ve gone. How their “presence” I suppose you could say, is made more real through what they’ve touched, what they’ve handled, what they played with, or made.

Targets are a kind of outcome. They are useful as ways of getting you to somewhere you want to get. For example if you want to save up a certain amount of money then setting a target of that amount is a good aid to getting there. The trouble is that targets are used inappropriately. Whose targets are they? And are they the same, most important targets, which others want to achieve? Because the selection of targets is an individual, value-based, subjective, exercise of choice. But if they are set for others then they direct the efforts and lives of others towards those targets instead of others. I’m not a fan of targets. At least, not ones I don’t have a say in the creation of!

Goals are a bit like targets. I’d say the same about them. They can be helpful to get us to places we want to get to. But they are aspirations, not predictions. And they are not endings. Or at least, they are not final endings. Are they?

I think this unique and unpredicted pandemic is forcing us to face up to the reality of beginnings and endings. It’s making us more aware of connections, of webs of influence, of the non-linear, multifactorial, dynamic, ever flowing, ever changing nature of reality.

This morning I read an article in Le Monde about how management methods are already starting to change in the light of this experience. Here’s the main point I got in that article – management is having to move away from “control” to “coaching”. Three things have come to the fore – the need for individual autonomy, the need for good team working and relationships between workers, and the need for transparency.

Well that all seems pretty good to me! I look forward to seeing the end of de-humanising “Taylorism” and “command and control”, and the beginning of an emphasis of autonomy, relationships and transparency. Imagine if we governed countries according to those principles?!

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Here in Europe the school year is starting and for most children they haven’t been to school since about March or April because of this pandemic. Although we know now that children under the age of 14 seem to be almost unaffected by COVID-19 there is a lot of anxiety about children spreading the virus through the community, and, perhaps more specifically, to the adults who work in the schools. So each country has been making cautious preparations for the re-opening of its schools, looking at everything from cleaning regimes, the use of hand gels and masks, and the way children spend their time in the school buildings.

Out of all this, at least in the UK, has emerged a concept of “bubbles”. The idea is to have children spend most of their school day with a small group of other children and teachers…..often much smaller than a regular class size. The same concept of “bubbles” has also been used for the wider community in the UK, with lockdown rules easing gradually to allow slightly more people to interact on a daily basis – two households meeting up, then three perhaps; limitations to the number of people who can gather in any one place but allowing particular groups or families to meet up and spend regular time together.

I think it’s an interesting idea. And, as this photo shows, a potentially beautiful one. This photo is of breaking waves on a beach in Western France where the land meets the Atlantic. The bubbles forming in the surf are just gorgeous, aren’t they?

It strikes me that this bubbles idea highlights a major issue for our societies and the way we organise our daily lives. It’s the issue of size. Mass gatherings, mass transport, mass tourism, have been shown to be amongst the most vulnerable points for us…..the circumstances which lead to most infections. The social distancing measures that each country has brought in have been based on the understanding that the more you keep people together in closed spaces the more the disease spreads.

So now we are seeing a huge increase in “home working”, and, it would seem, a large number of people find they actually prefer that to spending time every day packed onto buses or trains with hundreds of strangers, then working all day in the shared spaces of offices. People are learning to live locally, enjoying their local parks, shops, cafes etc now, instead of traveling long distances to share time with masses of strangers in huge workplaces, shopping centres and so on.

I’ve decided to re-read a book which made a huge impact on me when I young – “Small is Beautiful” by E F Schumacher. It’ll be interesting to revisit it in the light of what we’ve learned since it was written in 1974, and in the light of our experience of this pandemic. What I remember of the book is the key point that big is not best…..that we should try to create societies at human scales instead of around mass production and mass consumption.

Maybe the “new normal” will involve a lot less “mass” anything – maybe we will move towards a more human scale everywhere, overturning the industrialised principles of the last century to abandon so called “efficiencies of scale” (which have probably only ever been useful in the manufacture and delivery of products). Maybe we will start to create smaller schools, smaller classes, smaller hospitals, smaller communities. Maybe we will move towards more diversity and less uniformity.

We are more able to do that now. We now understand that complex systems are like vast interconnected networks of nodes and links. We know that the most robust and most resilient systems are diverse and adaptable. We know that distributed power and responsibility produces more sustainable systems and organisations than hierarchical, command and control, massively scaled ones.

Integration is the creation of mutually beneficial bonds between well differentiated parts. It’s how the body works. Not with a command centre, but with interconnected, responsive, open networks. It’s how Nature works, through inter-dependent, diverse elements within ecosystems.

Is this our model for a “new normal”?

Human scale. Small. Diverse, open and healthily inter-connected? Can we see a future way to live in this beautiful image of bubbles?

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Yesterday I wrote about new beginnings, about choosing what and when to start, but I’ve been thinking about it since then and I realise beginnings are paradoxical. They are both easy to find and impossible to find. Why do I say that?

Well they are easy to find because every action, every thought, every experience is, in fact, brand new. Life moves and flows continuously. This present moment has never existed before, not for you, not for anyone you know, not for the planet, not for the universe. So every present moment is a beginning (and, yes, it’s an ending too, because no experiences are exactly repeatable)

They are also impossible to find because everything is connected. We human beings are “complex adaptive systems”. That is we are massively interconnected, both in our own being, and in our contexts, relationships and environments. We are “open systems”. That is there are no impermeable barriers between an individual and the rest of the universe. The atoms, molecules and cells which make up our bodies are changing all the time, as we breathe in, ingest and absorb new materials, and breathe out, expel and excrete other ones. Energy and information flow into and through us continuously.

So what? Well, all this means it can be very hard to trace back from now to a “start point”, or a “beginning”. For example, when a patient would come to see me and complain about a particular problem, and I diagnosed a certain disease, where did that disease start? With the first symptom? With the first symptom which was troublesome? With the pre-conditions before the first symptom began? I was taught to explore a patient’s “past history” to see how this illness might fit in the trajectory of their life. I was taught to explore their “family history” to see if there were family patterns or dispositions. I was taught to explore their “social history” to find out what was happening in their work and social life. I could go on……

A beginning is pretty much arbitrary. It’s where we choose to begin. Think how you would tell your life story to another person. What would you say first?

As I progressed in my work experience I changed my introductory question to each patient, from something like “What’s the problem?”, or “How can I help you?” to “Tell me your story”.

Yep, “tell me your story”. Sometimes a patient would be a bit taken aback with that beginning, but I’d just maintain eye contact, show I was listening and wait. Sometimes I’d have to say a little more to get things going, for example to explain that I wanted to understand what they were experiencing and how it might have come about so I’d like them to just tell me about it in their own way, but usually, people would just start to speak.

Where a person chose to start, and how they told their unique story, was always interesting and relevant. As the consultation progressed I’d often ask another question “When did you last feel completely well?” This was a particularly useful question to be followed up with “Tell me about the weeks and months leading up to that time”.

Those were beginnings. Different beginnings. All useful and all relevant.

I came across this photo of the seed head of a poppy the other day and it’s so beautiful that I just decided I’d like to share it with you. How does it fit with today’s thoughts about beginnings? Well, all plants live cyclical lives, with phases passing through seed, germination, growth, perhaps blossoming or fruiting, and scattering the new seed before dying back for the next cycle. Does the beginning of that cycle start with the seed in the ground, or the seed in the seed head waiting to be dispersed? Or somewhere else?

So, back to beginnings. Whatever you want to begin, begin today. Even if its a habit, a routine, a task you’ve experienced before and stopped, because even when you stop, you can start again. You can start today. After all, you’ve never lived this day before.

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