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Archive for the ‘from the reading room’ Category

Respect for the individual

Posted in books, from the consulting room, from the dark room, from the living room, from the reading room, health, life, narrative, philosophy, photography on September 22, 2015| Leave a Comment »

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Michael Foley, focusing on Henri Bergson’s philosophy in “Life Lessons from Bergson”, writes –

there is a tendency to see what things have in common rather than what makes them unique, the source of a dispiriting sense of sameness.
As a doctor I need to know how to make a diagnosis. I also need a knowledge of the natural history of disease. However to actually help any individual patient I need something else as well – knowledge of this individual. So, I have to be able to see what things people have in common (certain symptoms and signs which indicate particular pathologies perhaps) and I need to be able to see this person sitting in front of me right now.
This person sitting in front of me right now is not the same as all the others. Every narrative I hear is unique and individual. No two patients have led, or are leading, identical lives, with identical bodies, minds, values and beliefs.
Reducing the individual to what they have in common with others is, in my opinion, “the source of a dispiriting sense of sameness”. That’s why I have such an aversion to Medicine by flow-chart, and the distorted practice of so called evidence based medicine which seeks to replace subjective human experience with data.
In short, we do not see the actual things themselves but in most cases confine ourselves to reading the attached labels.
Our left cerebral hemisphere is great for analysing things, sorting them into categories and applying labels, but it’s not enough. We have to attempt to “see the actual things themselves” and not be blinded by the labels. For doctors, that includes seeing the actual patients themselves, and not confining their understanding to the “attached labels” – diagnoses, categories or types.
I think the creation and appreciation of narrative is an important part of a doctor’s job and it requires more than a knowledge of the “medical sciences”.
Here’s Michael Foley again –
A crucial function of the arts is to prevent, or break down, dismissive labelling and reveal the singular instead of the similar, the peculiar instead of the familiar, and the inscrutable instead of the understood.
This reminds me so much of Deleuze’s three modes of thinking – science, which is thinking about function; philosophy, which is thinking about concepts; and, art, which is thinking about percepts and affects. Deleuze was a great advocate of thinking about difference too.
What an elegant phrase too – revealing “the singular instead of the similar, the peculiar instead of the familiar, and the inscrutable instead of the understood”.
What a great way to enhance respect for the individual – seeing them as unique and knowing you will never achieve a complete understanding them….which reminds me of Saint-Éxupery’s teaching that “What is essential is invisible to the eye”

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Heroes not zombies

Posted in books, from the dark room, from the living room, from the reading room, life, narrative, neuroscience, personal growth, philosophy, photography, psychology on September 21, 2015| Leave a Comment »

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In Life Lessons from Bergson, Michael Foley writes –

What happens when we fail to live in duration, no longer hear the inner melody and lose touch with the intuitive self? We become frozen, petrified – automatons, slaves of habit or convention or both. 
“Living in duration” is living in the experience of life, being fully present, attentive and aware. The opposite is to live in our inner worlds of representations and labels. Iain McGilchrist describes this brilliantly in his The Emperor and His Emissary, showing how the right hemisphere of our cerebral cortex processes the raw information as we pick it up from the world, then hands off some of it to be re-presented and analysed in the left hemisphere. What should happen next is that the analyses and representations are fed back to the right side to be re-contextualised. McGilchrist makes the point that, sadly, we’ve created a world where we forget the importance of the activities of our right hemispheres, and give primacy to those of the left.
“Hearing our inner melody” is a beautiful phrase. When we experience music we don’t experience it as separate notes and pauses. We experience it as rhythm and melody.
And our “intuitive self”? That deep, natural, heart-focused knowing….
What happens when we lose touch with those things? We get rigid and stuck.
There is no doubt that the pressures to conform in our society are enormous. It seems to me we are becoming less and less tolerant of difference, fearing “others” and suppressing diversity.
Every day we need to freely choose what to do, what to say, and what to think. As Michael Foley says –
Our freedom, in the very movements that affirm it, creates the developing habits that will stifle if it fails to be renewed by constant effort: it is dogged by automatism.
This is the fundamental theme of this blog – we all tend to default into autopilot and in so doing we live in a more limited, and less fully human way – like zombies – with habits and routines and “norms” on loops. Our alternative is to wake up, become aware and consciously choose to become the author of the one unique story in which we are the hero, the protagonist, the main character.
William James, who shared many of the same views as Bergson said
Could the young but realize how soon they will become mere walking bundles of habits, they would give more heed to their conduct while in the plastic state. (Psychology: The Briefer Course, 1892)
My only issue with that statement is I don’t accept we completely lose our “plastic state” – what he means by “plastic” is dynamic, malleable, capable of being changed. Sure, as we become constrained by our habits and automatisms, it becomes harder to change.
But with awareness and will, change is possible!

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The ever-developing self

Posted in books, from the consulting room, from the living room, from the reading room, life, philosophy, photography, psychology on September 20, 2015| 1 Comment »

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In Michaei Foley’s Life Lessons from Bergson he describes the philosopher’s ideas about the “self”
Bergson constantly distinguished between two selves, meaning two levels of process – a superficial self whose reactions are socially conditioned and a deep, intuitive self capable of empathy and free will…..This deep self is always in danger of being misrepresented by the categorizing self, dismissed as irrelevant by the utilitarian self and snuffed out as a threat to popularity by the social self
It’s interesting that nobody has ever found “the self”.
We talk about the benefits of “self-confidence” but what is this “self” we have confidence in?
We talk about the benefits of having “self-awareness” but who, exactly, is aware of this “self”?
Whatever you think about the concept of the “self”, I think it’s pretty clear there is no fixed entity called the “self”….no unchanging thing.
I often found the concept of a “community of selves” to be a more useful model when working with patients. People often identify much more closely with one aspect of their personality, or with one role in life, than they do with their other ones. For example, I fully identified with my doctor self while I was at work, and yet in other times and places my dad-self, or husband-self, or my teacher-self would feel much more prominent.
So, I’m quite taken with Bergson’s two selves – the superficial and the deep.
I especially like his description of the deep, intuitive self as being capable of empathy and free will, whilst the superficial self is more reactive, more subject to the pressures and influences of others.
Read the last sentence of that passage from Foley’s book a second time….
Our deep, intuitive self is constantly interacting with our superficial self, but look at the potential “misrepresentation” of the deep self – by the “categorising self” (…our left hemisphere?), by our “utilitarian self” (….makes me think of evolutionary biology) and by our “social self” (…with all that pressure to conform and fit in)

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Measured time and experienced time

Posted in from the living room, from the reading room, life, personal growth, philosophy, photography on September 18, 2015| Leave a Comment »

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In Michael Foley’s Life lessons from Bergson he says this about Bergson’s concepts of time –

Bergson distinguished two versions of time – time measured, which he defined as clock time, and the experienced, which he defined as duration. Clock time, spatialised and uniformly calibrated, is obviously necessary, but only duration is authentic.

When I was reading Deleuze’s work on cinema I came across Bergson’s concept of duration for the first time. That was my entry point. Realising that the way cinema artificially creates movement by showing you still images in rapid succession was the first time I had encountered the idea that clock time is actually artificial. We invented it. It wasn’t sitting there waiting to be discovered.

We experience time as a flow, not as a rapid succession of images or events.

For most of my working life a large part of the day was divided into blocks of minutes. A standard clinic of follow up appointments would be set out in 20 minute periods. A new appointment allocated 90 minutes. In General Practice the time slots were all much shorter than that. Our Practice was created around standard 10 minute appointments. Other groups used a standard of 5 minutes.

I didn’t wear a watch, and I didn’t have a clock on the wall, but I rarely ran late.

Same thing with giving talks or presentations, or teaching. Whatever time allocation I was given, most times (not always!) I said what I’d come to say in exactly that period of time.

Somewhere in me something kept me to time, but not by measuring minutes. I think that mainly arose through habit and experience. I became able to work according to duration.

Here’s more from the Life lessons of Bergson –

We should learn not to manage time but to let time manage us….the paradox is that the only escape from time is in submission to time. When we are flowing along with a process, awareness of time disappears.

We all know that one don’t we? When we go to a great movie we are surprised that two hours has passed already. When we are absorbed in a great book time disappears. When we are fully immersed in sharing a meal or being with someone we love, time disappears.

The “slow movement” is really based on this concept. In fact, the slow movement is, I think, not about being slow at all. It’s about immersing yourself fully in whatever you are doing. Sinking into, absorbing yourself in, fully enjoying and experiencing the present. The best book I know about the slow movement is Carl Honore’s “In Praise of Slow”. Why not buy a copy, and read it…..slowly?

I love Michael Foley’s suggested exercise of sitting on a sofa a dusk –

The gradual fading of the light is a perfect example of process, ‘succession without distinction’, impossible to catch in action but impossible to miss in effect. And the effect, especially if accompanied by a glass of wine, can be mysterious, enchanted, a spell that encourages reconciliation with process and time.

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Continuity and variation

Posted in books, from the consulting room, from the dark room, from the living room, from the reading room, health, life, neuroscience, personal growth, philosophy, photography, psychology, science on September 17, 2015| Leave a Comment »

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Reality no longer appears essentially static, but affirms itself dynamically, as continuity and variation. What was immobile and frozen in our perception is warmed and set in motion.

Those are the words of Henri Bergson, quoted in Michael Foley’s excellent “Life lessons from Bergson”.

I love that. The experience of life as dynamic, “warmed and set in motion”.

Life isn’t “frozen and immobile” to me, and that’s why I am wary of categories and labels. I’ve always resisted being put into a box, defined by one or two of my characteristics. When I think of that I recall the adage of the General Semanticists – “judgement stops thought”. So often fixing someone or something into a category or type stops us from really seeing, really understanding.

Reducing an individual to a type diminishes them in all senses of the word.

Every patient I ever encountered was unique, presenting experiences and stories unique to them. To reduce them to diagnostic categories, or to types of any sort, blocked my understanding of them. Everyone always has more to reveal, more to share, more to experience and be understood.

Michael Foley says he came back to Bergson’s work after dismissing it decades earlier. His way back is interesting. It’s not the same as mine. My first encounter with Bergson came when I was reading Deleuze but I didn’t find him easy. I later stumbled into complexity theory and, in particular, the idea of complex adaptive systems. At that point I remembered some of Bergson’s ideas and went back to explore his writings further. Michael Foley’s path was through his encounter with “process philosophy” and with particle physics –

I learned from twentieth century philosophy of mind that memory and the self are processes rather than fixed entities – and suddenly this connected with the theories of particle physics, which claim that at the heart of matter there are in fact no particles but only processes…….everything is process…and everything is connected to everything else.

In the process view nothing is fixed, nothing is final and no circumstances ever repeat in the same way.

This strikes me as very true. Dan Seigel, one of the founders of Interpersonal Neurobiology, worked with colleagues to come up with a definition of the mind. What they concluded was that ” the mind is a process of regulation of energy and information flow. ”

The mind is not an entity or a thing, it’s a process.

The body is not a fixed entity or thing either – it’s a dynamic ever changing network or community of cells.

Disease is not a thing either. That really startled me when I read that once I was a practising doctor. As a medical student I picked up the view that disease was pathology and pathology was the changed organs or cells. Once I became a GP I encountered dynamic, hard to pin down illnesses that certainly couldn’t be reduced to pathological entities. Hearing that disease was a process not an entity was liberating for me.

I will return to some of the issues raised by this thinking in other posts but let me finish this one by returning to the title, because once we gain the insight which shifts our attention from entities to processes we discover diversity – we find out that variation is a key characteristic of Nature and of Life. But I think we find out something else too – that the universe, the world, and our lives are not completely random, chance, accidental phenomena. Instead there is continuity. We are in a process of continuous creation and emergence. We are who we are in our networks of family, nature, society and the world. We emerge from the past, as the past encounters and interacts with the present. Our future doesn’t contain just anything you could ever imagine. It emerges from here and now, from that flowing river of life and connections.

Continuity and variation. Just like the flow of a river. Just like the natural history of a plant, an animal, or any other living organism.

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Henri Bergson

Posted in books, from the living room, from the reading room, life, philosophy on September 16, 2015| 2 Comments »

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When I started this blog, and came up with the title “Heroes not zombies”, I also chose a byline of “becoming not being”. Those choices were very influenced by reading two French philosophers – Giles Deleuze and Henri Bergson. Bergson wrote in the late 19th century, early 20th. His ideas preceded our discoveries which followed the splitting of the atom which led to a new physics. They also preceded the findings of neuroscience which have turned out to be consistent with his thought. Yet, sadly, his writings have been pretty much ignored for the last hundred years.

I am utterly delighted to have just discovered Michael Foley’s concise, crystal clear book, “Life lessons from Bergson”. I cannot recommend it too highly. Buy it! Read it! It might just change your world view.

Here’s a summary passage from the end of the book to whet your appetite.

he sought to protect the evolving self from finality, rigidity and circumspection, privileging the dynamic over the static, the holistic over the compartmentalised, the organic over the mechanical, the qualitative over the quantitative, the intuitive over the analytic, the continuing over the completed, the open over the closed and above all the free over the determined.

If any of that touches you, resonates with your values, then you will love this book. I’ll share some of the best ideas from it in future posts.

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Kenzaburō Ōe

Posted in art, books, creativity, from the living room, from the music room, from the reading room, life, narrative, writing on September 4, 2015| 1 Comment »

September’s issue of Philiosophie magazine has an interview with the Japanese author, Kenzaburô ôe who won the Nobel Prize for literature in 1994.

It’s a fascinating and striking article. He has been a controversial figure in Japan because of the subject matter of his novels, one of which challenges the official version of what happened in Okinawa at the end of the Second World War. Officially, 100,000 Okinawans committed suicide claiming loyalty to the Emperor rather than be over-run by the invading Americans. Kenzaburô says this is a lie. He says the Imperial Army massacred the Okinawans and they died called for their mothers, not swearing loyalty to the Emperor.

He has also shone a clear light on the reality of life for those who survived the blasts in Hiroshima and Nagasaki. Telling their stories shows how these particular bombs didn’t just kill and wound when they were dropped, but continue to damage those who survived right into the present day.

It’s no surprise then to read that since Fukushima he actively campaigns for the abandonment of nuclear power in Japan.

A big part of the story of his life is the birth of his son in 1963. Hikari was born with a severe brain defect and his parents had to decide to either let him die, or have an operation which would likely leave him severely mentally handicapped. They chose the latter. In addition to his severe handicap he has autism and he didn’t speak until he was six.

His first words were actually a sentence. The family was walking in the forest and at the sound of a particular bird call, Hikari said, in exactly the same way a radio presenter of a nature documentary would, “that is the call of the (such an such bird)” – and it was! After that his parents started buying bird song CDs and Hikari learned them all. They moved on to music, playing him Bach and Mozart, and were astonished to find, as he got older, that he could transcribe into musical notation perfectly any piece of music after hearing it just once. More than that, he went on to compose his own music.

Kenzaburô says his son has never expressed any emotion but his music is deeply emotional. His first CD sold 400,000 copies in Japan.

Here’s a video clip of one of his pieces.

Kenzaburô’s daily life is spent in his study reading and writing, while his son sits by him listening to, and writing, music.

A remarkable man.

Right at the end of the interview he says of creative work that it is important to find your own voice, or your own style – to be careful not to “get lost in the universal”.

I like that a lot. Too often we lose our singular uniqueness by trying to be accepted, or to fit in, or to be popular. Isn’t it more important to be the one unique person who only we can be?

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Not knowing

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 on August 16, 2015| 1 Comment »

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The skies above this part of the world are often very clear so I’ve taken to star gazing at night when I can. Wherever I point the telescope it shows me more stars than I ever knew existed. It’s hard not to be humbled by the immensity of it all. But what struck me last night as I looked at the stars was how much I didn’t know.

It’s not a new thing for me to wonder about what I don’t know. I remember years ago reading an article in the British Medical Journal about medical education saying that all the best ongoing education starts with saying “I don’t know” – yet that was the one phrase we were all terrified to say as we our teachers singled us out to ask us questions on teaching ward rounds or in the lecture theatre. It’s a phrase which brought shame and condemnation. If you didn’t feel an idiot before you said it, you sure did afterwards! So, it was refreshing to read the opposite – to read the idea that only if you could say “I don’t know” could you open up the chance to learn something.

Many, many years later I came across the works of Montaigne, and was delighted to find that one of his most used phrases was “Que sais-je?” (not exactly I don’t know, but “what do I know” – still a humble admission of the limits of personal knowledge).

Throughout my career, although I practiced as a holistic doctor and was fortunate enough to work for much of my life in a service which prioritised time spent with patients, I often found myself saying to patients that even if they’d told me things they’d never told another soul (and that was a common remark made by patients), I thought it took a lifetime to try to really know yourself, let alone another person, so although I was about to share some insights with them about what was happening in their life, those insights were limited by the small amount I knew about them. You see, how much you know is always a relative term, but it surely is always (in the bigger scheme of things) a small amount.

When I posted yesterday about the Japanese lantern I had to check out on wikipedia just what those lanterns were and yet again I was faced by having to say to myself that I didn’t know enough about botany.

Strange that that awareness and the sharing of it is still something which comes with a discomfort, because, really, I believe that the world would be a much better place if we were all more aware of the fact that what we don’t know is always so much more than what we do know.

While I was writing this, Hilary (who didn’t know what I was writing about) read out a quote to me –

The problem with the world is that the intelligent people are full of doubts, while the stupid ones are full of confidence.

……Charles Bukowski

Earlier today, what provoked me to write this post was reading the following quotation from Parker Palmer on the Brainpickings site –

What I really mean … is be passionate, fall madly in love with life. Be passionate about some part of the natural and/or human worlds and take risks on its behalf, no matter how vulnerable they make you. No one ever died saying, “I’m sure glad for the self-centered, self-serving and self-protective life I lived.”

Offer yourself to the world – your energies, your gifts, your visions, your heart – with open-hearted generosity. But understand that when you live that way you will soon learn how little you know and how easy it is to fail.

To grow in love and service, you – I, all of us – must value ignorance as much as knowledge and failure as much as success… Clinging to what you already know and do well is the path to an unlived life. So, cultivate beginner’s mind, walk straight into your not-knowing, and take the risk of failing and falling again and again, then getting up again and again to learn – that’s the path to a life lived large, in service of love, truth, and justice.

I couldn’t agree more.

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Lost in the system – Taylorism 2.0 and health care

Posted in from the consulting room, from the dark room, from the living room, from the reading room, health, life, philosophy, photography, psychology on August 11, 2015| 1 Comment »

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In 1911 Frederick W Taylor published the “The Priniciples of Scientific Management”. This approach to work had a profound influence, leading to the use of the term “Taylorism” to capture the essence of his message. It’s a message which still holds sway today. In fact, the term “Taylorism 2.0” is being used to describe the modern form.

It’s clear that Taylor’s idea of science was not that curious, exploratory discipline based on wonder, but the desire to control – the desire to produce pre-determined outcomes through systems created by measuring what could be measured.

Right there, in that text is his declaration of intent – one which chills me every time I read it!

In the past the man has been first; in the future the system must be first

If there was one thing I would say to try to improve health care, for example, it would be put the human beings first, and the system second – the system and the management created to deliver the system, should, in my opinion, be the servants of those human beings who are caring for, and trying to help, the other human beings (the patients).

Is it any wonder that professional satisfaction amongst doctors is so low when they’ve signed up to something they probably didn’t understand was “Taylorism 2.0”

So what is this “Taylorism 2.0”?

I first came across it in an article about workers in a French supermarket internet-ordering section. Let’s call it “click and collect” – in the UK, there are now many “click and deliver” services from supermarkets, but in France, the delivery bit doesn’t seem to have taken off yet. Instead you can order your shopping online, then you go to the “Drive” and pick up your order.

But what happens between clicking on the items you want on the web catalogue and finding your shopping at the counter in the “Drive” building of the supermarket?

Well, you have staff who are called “pickers” – they go round picking the products off the shelves  – either of a supermarket (often a “hypermarket”), or from a warehouse (more commonly the former so far) – and collecting them into boxes ready to be handed to the customer when they turn up at the “Drive” counter.

These pickers are managed not just according to the principles of “Taylorism” – which involves measuring whatever can be measured and setting the targets and goals to be achieved i.e. the time taken to get a particular item from the shelf, the number of items an individual “picks” in an hour, in a shift, or whatever. As the article made clear every aspect of the job which could be measured was measured and monitored. Each picker has a portable device strapped to their wrist and receives the instructions for what to pick next from the computerised control office. The device shows exactly where they are at all times of the day, and measures the time taken for each and every action. What can’t be measured and monitored this way is the interaction between the staff and customers, so that is controlled by teaching them scripts which they have to learn by heart and stick to – you’ll know the kind of thing – “have a nice day”, “happy to be of service”, “thank you for waiting” and so on….

What takes all this measurement and control to the next level is not just the introduction of the new technologies which allow better monitoring and measuring, but the introduction of game theory.

Yes, you read that right. Game theory. The big new addition is “gamefication” – or how to introduce principles from cognitive behavioural psychology and game theory to get the most out of the workforce.

Just to give you a taste of this, it can include awarding points for numbers of items picked and delivered, numbers of customer orders completed, shortest times taken to get frozen goods from the shelf to the customer and so on. The points are fed back to individuals and teams and the scores are ranked. So an individual can see instantly at all times their best times, their highest number of order completions and so on….which inspires them to try to always get personal bests. But more than that, the team, or all the members of a particular shift will get collective scores and be ranked against other teams, other shifts or even other stores across the country – an enormous expansion of the “employee of the month” idea.

There can be a number or rewards attached to the rankings as extra incentives.

There’s a lot more involved than this but maybe this introduction will give you an idea.

So, what’s this got to do with health care?

Again, just as an example, let’s look at one particular system – the application of “QOF” (“Quality Outcomes Framework”) points in Primary Care in the UK.

General Practitioners have a substantial amount of their income pegged to their “QOF” points – these are points allocated for achieving particular targets on management-set protocols, mostly they related to the numbers or percentages of patients in a practice who have been entered onto particular disease registers, who have been asked about smoking habits, have had a BP check and so on, or the numbers of percentages of patients with specific conditions who have been prescribed the recommended drugs.

Not only does this prioritise the things in health care which can be measured at the expense of things which can’t (like communication skills, empathy, creation of therapeutic alliances, depth of understanding, caring etc) but it gamefies the whole system by awarding points, ranking individuals and practices, and rewarding points with income. So the doctors motivate themselves to try to achieve what the management want them to achieve.

Welcome to Taylorism 2.0 – where the system comes first – more now than ever before.

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How to create uniqueness

Posted in from the dark room, from the living room, from the reading room, life, personal growth, philosophy, photography on August 4, 2015| 2 Comments »

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What makes this rose special? (Ah, some of you will be looking at this saying, “that isn’t a rose, it’s a hollyhock!” But a hollyhock in France, and there are masses of them here in the Charente, is a “rose trémière”).

Well, it’s special to me, because it’s growing in my garden and I’ve become pretty fond of all these incredible flowers in this garden.

When I think of roses now I think of the story of the Little Prince, and in particular, the section of the story where he meets the fox, and learns the secret the fox has to tell him.

The secret, apart from the much quoted “what is essential is invisible to the eye”, is that we make individuals special to us by creating relationships with them. In the story, the fox asks the Little Prince to “tame” him, and I tripped up over that word a few times (even checked out all the possible means of the original French word “apprivoiser” that I could find). I don’t really like the word “tame” as it seems to include changing the creature which is “tamed” to make them docile, and subjugated in some way. However, in the context of the story, it is clear that what is meant is how we create special bonds by paying attention, caring for and looking after another, and that when we do that, that person, or animal, or plant, becomes special to us. He, she or it becomes unique.

That might not seem that comfortable a thought at first. After all don’t we like to think of ourselves as compassionate and caring, so we should be able to “care for” or “care about” pretty much anyone? Well, that may be true, but any potential we have to do that remains just that – a potential – until we create actual, real bonds with actual, real individuals.

In the story, the fox explains to the Little Prince that the garden full of roses shouldn’t make him sad that his rose is not as unique as he thought. His rose, in fact, is still unique, and how the Little Prince feels (or doesn’t feel) about all the roses in the garden even emphasises that point.

Here’s a nice reflection on this whole issue.

So, as we create a relationship with the particular – with this rose, with this creature, or with this person – we reveal their uniqueness. And as we continue and develop that relationship, they become even more unique, even more special to us. That’s one of the essential kinds of bonds we have to make to deepen our experience of living in this world.

And it takes nothing away from the fact that, potentially, any person, any flower, any creature can become special to us.

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