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Archive for the ‘from the reading room’ Category

Part of Nature, not outside it

Posted in from the dark room, from the living room, from the reading room, life, philosophy, photography, science on January 18, 2012| 2 Comments »

Is Nature “out there”?
Are we, as human beings, separate from Nature? Is Nature there for us to exploit? To have dominion over? To control? To dominate?
Much human activity seems based on this set of beliefs, but it is a delusion.
There is no separate “Nature” from “us”. Every creature, every life form, every natural force, energy and phenomenon is interconnected.
This idea that we are separate from Nature is deeply to connected to a way of thinking which separates the “subjective” from the “objective”.
The idea of “objective” contains a tendency to turn experiences, phenomena, even other people into “things”.
It’s a stance which dehumanises, and denatures.

Look at this fence –

the living fence

I love how this fence instantly challenges the view that it is a “thing” – you can see it’s a living organism.

Whilst on holiday recently, I stumbled across a book by a South African author, Ian McCallum. Ecological Intelligence. [978-1555916879]

He argues that we need to reconnect to other animals and to Nature, and interestingly writes a lot about the concept of the “field”.
I find that concept so useful.
In my Be The Flow, I muse about the relationship between a wave and the sea. In this analogy, the sea is the “field” and the wave is a person. We emerge out of the field assuming distinct, identifiable, unique form. But we don’t leave the field. The wave is at no point separate from the sea. The wave constantly changes throughout its life. It is transient, dynamic, and, soon, its gone. Where does it go? It returns to the sea which in fact, it never left. It “disappears” into the field.

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Slow Medicine

Posted in from the consulting room, from the reading room, health on December 23, 2011| 6 Comments »

Have you come across the slow movement yet? It started with “slow food”. Slow food, of course, is the opposite of fast food. It’s pretty easy to figure out what a “slow food” movement would be about. Fresh, locally sourced ingredients, individually prepared, and savoured as its eaten. Taking the time to really appreciate each and every mouthful. A bit like “mindful eating” really. 

Next came the “slow city”. The mayor of San Miniato in Italy, with local support declared his town a “slow city”, banning the opening of fast food restaurants and chain stores, encouraging walking, cycling and the nurturing of green public spaces. Several other towns have signed up to these principles creating the “slow city movement”.
There’s a lovely blog named “slow love life“. Read this phrase from its front page….SLOW LOVE means engaging with the world in a considered, compassionate way, appreciating the miraculous beauty of everyday moments, and celebrating the interconnected nature of life”
Then, recently some scientists have called for the formation of a “slow science” movement, posting this manifesto online  and asking for scientists to freed from the perpetual pressures to produce publishable results, to be less outcomes driven, and more exploration driven.
So, how about a “slow medicine” movement? Where doctors, nurses and other health carers take the time to fully understand a person’s illness, and are able to establish therapeutic, compassionate relationships. Where there isn’t a reflex to jump into a “quick fix” by prescribing a drug which will only mask the disease or temporarily modify it. Where it’s a fundamental value to discover what is unique about every individual and to help to stimulate and support every patient’s ability to self heal and self repair. In other words where the focus shifts from short term, outcomes driven goals, to improving quality of life and enabling people to actually develop and grow through the process of being ill.

Acute, fast Medicine
Acute, fast medicine has its place, and that place is at the edge of life. When your illness is sudden and severe I think the advances made in medical technology make a HUGE difference. Quick decisions, and rapid, precise actions bring the ultimate results – the difference between living and dying today.
Acute, fast medicine involves a sharp focus on only what is important to achieve a well defined outcome (not dying for example) in a short period of time (minutes or hours usually).
This model is just not appropriate either for trying to help someone to have a healthy life, or to live a good life in the presence of a chronic disease.
If someone has a condition like diabetes, multiple sclerosis, asthma etc, then using the fast, acute methods to rapidly change a very small part of the whole person is not enough. The timescale of a chronic complaint is weeks, months or even a lifetime. The outcomes which make a difference over that timescale can’t be so easily defined and measured. They are about qualitative rather than quantitative change.
The crucial shift from acute problems to chronic ones involves a broadening of the focus, a deepening of understanding to encompass the whole person inextricably embedded in the multiple contexts of their life.
This takes time, and it takes the establishment and maintenance of a relationship.



Manifesto for Slow Medicine

  • Every person is unique. It takes time to get to know a person. Appointment times should be long enough to discover a person’s uniqueness.
  • Good health care is developed from an understanding of the person who is ill or who wants to stay healthy. Understanding should take place before acting.
  • More than a knowledge of disease is required to deliver good health care. There also needs to be a knowledge of the person. Diagnosis should not be limited to knowledge of disease. It should encompass a knowledge of the person.
  • Doctors, nurses and other healthcare professionals  are people too. Every health care worker is unique. Recognising and nurturing this uniqueness is as important as defining knowledge, skills and attitudes required to carry out tasks.
  • Delivering good health care requires self awareness and understanding on the part of the person who is caring. Reflective practice should include working on personal growth.
  • The core of health care is the relationship between individual people – patients and carers. Priority should be given to the relationship.
  • Good health care is relationship based, not event based.
  • Continuity of care should therefore be given priority in order to support and develop healing relationships.
  • Health care is for life. Defined, time-limited outcomes are arbitrary and are not a substitute for life long care.
  • Health carers should work in supportive, understanding environments which enhance the delivery of healing relationships. These environments are co-created by the leaders, managers and health care professionals working in accord with compassionate, person centred values.

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Love from the beginning

Posted in from the consulting room, from the reading room, health, neuroscience, psychology on December 19, 2011| 3 Comments »

Last year I studies Interpersonal Neurobiology with Dan Siegel, whose book, Mindsight, I highly recommend. He teaches around the essential triad of brain, mind and relationships and understanding the links between these three turns out to be tremendously illuminating. On the relationship front, Dan draws on his training in attachment theory and demonstrates the links between early nurturing and personality later in life – particularly in connection with how we form relationships.

Sir Harry Burns, the Chief Medical Officer of Scotland, highlighted in a brilliant presentation earlier this year the key importance of early years in determining future health and health behaviours.

On top of this comes this research from the University of Minnesota demonstrating –

“Your interpersonal experiences with your mother during the first 12 to 18 months of life predict your behavior in romantic relationships 20 years later,” says psychologist Jeffry A. Simpson, the author, with University of Minnesota colleagues W. Andrew Collins and Jessica E. Salvatore. “Before you can remember, before you have language to describe it, and in ways you aren’t aware of, implicit attitudes get encoded into the mind,” about how you’ll be treated or how worthy you are of love and affection.

Wow! during the first 12 to 18 months! How important is love? You can’t over emphasise it.

You might be thinking yikes, if it’s set in the first 18 months, what hope is there? Well, it turns out we can have lots –

The good news: “If you can figure out what those old models are and verbalize them,” and if you get involved with a committed, trustworthy partner, says Simpson, “you may be able to revise your models and calibrate your behavior differently.” Old patterns can be overcome. A betrayed baby can become loyal. An unloved infant can learn to love.

 

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1Q84

Posted in books, from the reading room on December 14, 2011| Leave a Comment »

1Q84, the latest novel from the Japanese author, Murakami. In fact, it’s three novels, with the whole trilogy published at the same time, parts one and two in one volume, and the third part in a separate volume. I’d say this is my choice for fiction book of the year. It’s the first novel I’ve read as an ebook and the fact the entire trilogy was on my iPhone and my iPad meant I didn’t need to carry around three large books. I’ll return to that point later.

I loved reading this novel. It has pretty much everything I look for in fiction. Good writing, great storytelling and a book which either makes me think, or somehow changes how I experience the world.

1Q84 is set in Tokyo in 1984 and tells the story of two young people, one of whom is a hired assassin who murders men who abuse women, and the other who is a maths teacher by day, and a writer in his own time. The writer ghost writes a poorly written but fascinating story told by a strange, reclusive 16 year old girl. It becomes a best seller and brings unwelcome attention to highly secretive cult.

Both characters become aware that something isn’t right about the world, the most marked feature being the presence of two moons in the sky. To mark the difference between this world and the world of 1984, they refer to it as 1Q84. It’s this kind of plot turn which is typical of Murakami and which takes you into a border zone between reality and the world of imagination.

The fact that the unusual features of 1Q84 are described in the “novel” written by the 16 year old makes you wonder whether or not all the characters are now living in this novel within the novel you are reading.

This latter theme is probably the key of the whole novel. As well as being a page-turning great read, and a magical love story, 1Q84 really stimulates your thinking about the relationship between imagination and reality, the place of fiction in our lives, and the central importance of story in the creation of the lives we experience. Take a look at this extract –

1Q84

Isn’t that such a great point about stories? They reflect the messiness, the complexity and the uncertainty of reality, and they change us. In so doing, reading fiction does literally change the reality of the worlds we co-create.

I downloaded this trilogy as a Kindle book and fired it up on both my iPad and my iPhone. I don’t know if you’ve used this technology for reading but it’s great. Both of these devices have lovely, bright, clear screens which make text very readable, and as you progress through the book the different devices keep up with you – so when I would open the book on my iPad, it would automatically offer to jump forwards to the place I’d reached when I last read it on my iPhone, and vice versa. That might sound a little clumsy but it’s a seamless and brilliant experience. It meant I could have a quick read in any few spare moments using my phone, and settle down with the iPad to enjoy the larger screen when I had some more significant reading time. I think this was partly responsible for making this such an immersive experience. I could feel I was living in Tokyo at the same time as living in Scotland.

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Optimist or pessimist?

Posted in from the living room, from the reading room, life on December 6, 2011| 3 Comments »

One of my most favourite magazines in the world is a French language one entitled “Cles“. In the current issue they have a theme about optimism.

I love their exploration of the different ways of understanding the thinking patterns of optimists and pessimists. They quote Winston Churchill, who famously said

“The optimist sees the opportunity in every difficulty. The pessimist sees the difficulty in every opportunity.”

The introductory article says

L’optimiste relativise ses echecs (je ferais mieux la prochaine fois) et generalise ses succes (j’ai vraiment de la chance), alors que le pessimiste generalise ses echecs (je suis decidement un nul) et relativise ses succes (c’etait juste un coup de bol)

Here’s my translation (I’m not an expert!) – The optimist puts his failures/setbacks into perspective – “I will do better next time” and generalises his successes – “I’m really lucky”, whereas the pessimist generalises his failures/setbacks – “I’m really an idiot” and relativises his successes – “It was just a stroke of luck”.

I think one of the interesting things about thought frameworks is how they tend to create the outcomes expected, so we really do find that some people are generally luckier than others. Can you just decide to become more optimistic? I don’t want to over-simplify this, but, yes, I think you can (but then I would, wouldn’t I? I’m an optimist!!).

The issue of “Cles”, explores the “science of optimism” – now there’s a scientific discipline I’d be keen to know more about…..

They suggest the “golden rules” revealed by the science of optimism include the importance of “vigilance” – attentiveness; curiosity; the “capacite a rebondir” – the capacity to bounce back, or to be resilient; and, altruism.

What do you think? What qualities facilitate the tendency to optimism?

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The meaning of life?

Posted in from the reading room, philosophy on November 12, 2011| 2 Comments »

I was struck by a strange juxtaposition of readings this morning. First of all, I was reading a piece by Raymond Tallis (excellent, by the way, read it here!) where he quotes Professor John Gray, from the London School of Economics

For Gray the animal nature of man leads him to the chilling conclusion that ‘human life has no more meaning than the life of slime mould’. Man (whom he re-names Homo rapiens) ‘is only one of many species and not obviously worth preserving.’

Then I read Antonovsky’s definition of “coherence” –

We are coming to understand health not as the absence of disease, but rather as the process by which individuals maintain their sense of coherence (ie sense that life is comprehensible, manageable, and meaningful) and ability to function in the face of changes in themselves and their relationships with their environment

Well, what do you think? Do you think human life has no more meaning that a slime mould? Or do you find Antonovsky’s definition of a healthy life more appealing?

Frankly, and this is the thrust of Tallis’ argument I believe, attempts to dehumanise what it is to be human by excluding the rich reality of consciousness, is not only unappealing, even frightening, but it diminishes the potential for compassion, and, hence, the potential for a better world.

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Healing narratives

Posted in from the consulting room, from the reading room, health, life, narrative on October 21, 2011| 10 Comments »

One of the main themes of this blog, and probably a core theme of my daily work as a holistic, integrative doctor, is the place of narrative in our lives.

I recently mentioned in another post that working with patients’ narratives was a part of what I and my colleagues do every day at the Centre for Integrative Care in Glasgow. A couple of readers have asked me to say more about that and I thought I’d pull together some thoughts into this post.

One of the first books I read which impressed me about the importance of stories in medical work, was Arthur Frank’s “The Wounded Storyteller”. In this book, which is the product of years of research, Frank claims that there are two very common types of story patients present to clinicians – “restitution” stories, and “chaos” stories. He proposed that we can think of these as two primary “genres” of story. The former is probably the commonest in biomedicine healthcare. It can be captured with the phrase “I’m broke, please fix me”. It’s an approach to illness and health which considers that disease is a dysfunction or lesion somewhere and that if the bit that’s wonky could just be fixed then all would be well. The latter is also very common, especially when there are a multitude of symptoms and the person has  become lost in the illness.

Frank proposes that a clinician’s job is to help patients turn these stories into “quest stories” – based on the principles of Joseph Campbell’s hero narrative.

The integrative journey from stuckness or chaos to flow and coherence emerges out of this creation of a new narrative.

Another reason to work with narratives is the human need for myth creation. We are meaning seeking creatures, and the myths, or universal stories, as Karen Campbell calls them, shape our lives. So it makes sense to understand which myths we’ve incorporated into our stories.

Shifting from the materialistic, reductionist myth to a soulful, heart-focused, holistic one, allows the creation of a much more positive story, one which brings hope, and which opens up the possibilities of a different future path.

A key component of the creation of a future with a more clear set of potentials is choice. William Glasser’s Choice Theory, turns our narratives on their heads, and focuses us on the verbs we use to describe our experience. What emerges is a much more autonomous, more powerful story – a shift from passivity to activity, from victim to autonomous individual, from zombie to hero.

But it’s not just the verbs in our stories which are important. It’s the metaphors too. The amazing work of Lakoff and Johnson demonstrates the embodied nature of metaphor, and in so doing gives us the opportunity to pick up on the metaphors we are using, including the bodily locations of our diseases or disorders, and gain a profound understanding of the meaning of our illness experiences.

I hope for stories of improvement as I work with patients, but the stories which excite me the most, are the ones of transformation. Yet again, this week, I’ve heard several such stories. That makes it a complete thrill and delight to be able to practice Medicine this way.

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Against the industrialisation of health care

Posted in from the consulting room, from the reading room, health on October 13, 2011| 1 Comment »

Pamela Hartzband, MD and Jerome Groopman MD from the Beth Israel Center writing in the New England Journal of Medicine make a strong plea for a return to professionalism and humanity in health care. Here’s the problem, as they see it….

We are in the midst of an economic crisis and efforts to reform the health care system have centered on controlling spiraling costs. To that end, many economists and policy makers have proposed that patient care should be industrialized and standardized. Hospitals and clinics should be run like modern factories and archaic terms like doctor, nurse and patient must therefore be replaced with terminology that fits this new order

It strikes me this current model of health care is not sustainable. Drug costs are spiralling way out of control and those in power seem to think the answer to health problems is to use a “Fordist” solution, creating health care facilities as factories – treating the mass with pre-ordained treatment plans delivered by people with technical skills.

They highlight the distorted use of “evidence based” approaches as a key problem

the new emphasis on “evidence-based practice” is not really a new phenomenon at all. “Evidence” was routinely presented on daily rounds or clinical conferences where doctors debated numerous research studies. But the exercise of clinical judgment, which permitted the assessment of those data and the application of study results to an individual patient, was seen as the acme of professional practice. Now some prominent health policy planners and even physicians contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints, written by experts.

This “industrial” way of delivering health care diminishes the professionals as much as it does the patients.

Recasting their roles as providers who merely implement prefabricated practices diminishes their professionalism. Reconfiguring medicine in economic and industrial terms is unlikely to attract creative and independent thinkers with not only expertise in science and biology but also an authentic focus on humanism and caring. When we ourselves are ill, we want someone to care about us as people, not paying customers and to individualize our treatment according to our values. Despite the lip service paid to ‘patient-centered care’ by the forces promulgating the new language of medicine, their discourse shifts the focus from the good of the individual to the exigencies of the system and its costs. We believe doctors, nurses and others engaged in care should eschew the use of such terms that demean patients and professionals alike and dangerously neglect the essence of medicine

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Compliance and standardisation

Posted in from the reading room, life, personal growth on October 10, 2011| 1 Comment »

Stumbled across this quotation from Mencken yesterday –

“When they speak of the dangers of Americanization… [it] may be described in general, as the decay of spiritual values that has gone on among us during the past two generations. It may be described, in particular, as our growing impatience with the free play of ideas; our increasing tendency to reduce all virtues to the single one of conformity, our relentless and all-pervading standardization. This is what all Europe fears when it contemplates the growing importance and influence of The United States… By Americanization it means Fordization – and not only in industry but also in politics, art and even religion.”

When I read this, a passage from Seth Godin’s “We are all Weird” sprang to mind….

Mass is withering. The only things pushing against this trend are the factory mindset and the cultural bias toward compliance.

The control culture is crumbling. Remember that classic Apple ad?

Think Different

Celebrate your uniqueness. You really are a one off, and nobody, but nobody is a better expert in your personal experience than you are. We should resist being standardised. Be a hero, not a zombie.

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Writing

Posted in books, from the reading room, writing on October 8, 2011| Leave a Comment »

I love to write. Why is that? Well, Nicole Krauss, writing about Roberto Bolano in the Guardian last week beautifully describes one of the main reasons….

Writing is always an expansion: a writer, given only one life, is compelled to manufacture other lives, other stories, other realms. The one life is not enough; it is necessary, for whatever reason – an overabundance of language or imagination, curiosity, desire, a distaste for finalities – to multiply the possibilities.

 

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