Feeds:
Posts
Comments

Archive for the ‘from the reading room’ Category

It seems strange to me that so much of “health care” is focused on diseases and their management. A disease is always only a part of a patient’s life and experience. Whilst it’s important to deal with disease when it’s present, surely that’s never enough. Health is experienced by a person, a whole person, and care is expressed in relationships. Without a focus on health and care, what kind of “health care” do we get?

At times it seemed to her they were so focused on disease that patients and suffering were incidental to their work

Cutting For Stone. Abraham Verghese

Read Full Post »

Yesterday was the annual celebration of the birth of Robert Burns. As a Scot I’m pretty familiar with some of his poems but last night the last verse of one his most famous poems suddenly struck me.

In his “To a Mouse”, the last verse reads…

Still thou are blest, compar’d wi’ me

The present only toucheth thee:

But, Och! I backward cast my e’e

On prospects drear!

An’ forward, tho’ I canna see

I guess an’ fear!

Burns wrote this poem in response to accidently destroying a mouse’s nest whilst ploughing a field. In this last verse he recognises the difference between human beings and other creatures in terms of mental processes. The mouse can only focus on the present. It deals with life in the here and now. Human beings on the other hand have the continuous tendency to think back to the past, reflecting on hardships, hurts and grievances, or to cast their minds forward into the imaginary future where they worry about all sorts of things that might befall them.

This isn’t a new idea of course, and Tolle has reinforced the concept in his “Power of Now”, but I think this is beautiful, compassionate, wise writing. He doesn’t preach. He doesn’t advise. He just states it as it is.

Our so human tendency to hang on to the past, and frighten ourselves with imaginary futures, robs us of the capacity other creatures have to be continually present in the here and now.

Read Full Post »

Over the holidays I’ve been catching up on some of the TV programmes I’ve recorded on my hard drive and watched a spectacularly wonderful one about Norman MacCaig. There were many highlights for me, but the two which really stuck were his description of a friend as someone who showed him

the usualness of the extraordinary, or the extraordinariness of the usual

and a recitation of his poem, Small Boy

He picked up a pebble
and threw it into the sea.

And another, and another.
He couldn’t stop.

He wasn’t trying to fill the sea.
He wasn’t trying to empty the beach.

He was just throwing away,
nothing else but.

Like a kitten playing
he was practicing for the future

when there’ll be so many things
he’ll want to throw away

if only his fingers will unclench
and let them go.

 

Read Full Post »

Excuse the title – panto season is upon us!

Are you, like me, fed up with headlines suggesting that now “scientists” have found the gene for X then a cure for X is just around the corner? I think it’s such nonsense. This idea that we will be able to read someone’s DNA like a computer program and figure out exactly what diseases they are going to experience, and head those diseases off at the pass is mechanistic, reductionist nonsense.

A recent article in ScienceDaily is headed “The gene-environment Enigma”. What’s the enigma? Well, it turns out just having a gene doesn’t guarantee what effect that gene will have. What’s important is the “environmental” effect which is different for every individual so individuals experience different effects of the same genes.

The effects of a person’s genes — and, therefore, their risk of disease — are greatly influenced by their environment,” says senior author Barak Cohen, PhD, a geneticist at Washington University School of Medicine. “So, if personalized medicine is going to work, we need to find a way to measure a human’s environment.”

Hmm. Measure a human’s environment…..good luck with that one….ever encountered one of the characteristics of complex systems……that outcomes are not predictable in detail in individuals? It’s not possible to measure all the potential factors involved in producing the state of a unique organism which is embedded in multiple environments (physical, relational, social, cultural, semantic etc).

Still, scientists of faith find it hard to give up on their fundamental beliefs……

Cohen says he’s not hopeless when it comes to personalized medicine. As scientists conduct ever-larger studies to identify rare and common variants underlying diseases such as cancer, diabetes and schizophrenia, they will be more likely to uncover variants that have larger effects on disease. Even then, however, a person’s environment will be important, he adds.

Read Full Post »

Mary Midgley is an English philosopher whose latest book, The Solitary Self [978-1-84465-253-2], develops a case she has laid out in previous books. I first read Mary Midgley in her Science and Poetry, which was so clear, readable and thought-provoking. In that book, she argued that the concept of atomism when applied equally to the parts of a person and to individuals within society didn’t make sense. She develops that argument here in a brilliantly focused attack on neo-Darwinists such as Dawkins, who, she argues, have reduced Darwin’s thought to the principle of survival of the fittest. Dawkins’ Selfish Gene being a classic example of such a world view – the world view that competition and fighting for individual advantage is the way of Nature, the way of human beings, and the way society should be run. The values they promote are the values of selfishness. She elaborates in detail, quoting from Darwin’s own writings, how humans are actually intensely social creatures.

In fact, you can’t reduce Mary Midgley’s arguments to simple sound-bites in the way the neo-Darwinists like to promote their ideas. This is because she completely accepts the complexity of life, and the inescapable conflicts at the heart of every human being.

I think this little book is terrific at putting the case for an understanding of the importance of collaboration, as much neglected in recent decades. She is also very strong on the irrationality of using reductionism to try to explain complex wholes –

One way and another, then, it emerges that, in general, the reductive thinking that theorizes about large-scale behaviour from analogy with the behaviour of small parts is not reliable or scientific.

Here’s one paragraph from her book, which I think, really does capture her most important argument.

All this later became part of a much wider campaign, conducted by thinkers such as Nietzsche and the existentialists, to exalt freedom above all other ideals, isolating modern individuals in pure and heroic independence. Like all such one-sided advice, this campaign ignores crucial aspects of our nature. It assumes that we are independent items, isolated brains, intelligent billiard balls that need no sustenance and could choose to live anywhere. But we are actually earthly organisms, framed to interact continually with the complex ecosystems of which we are a tiny part. For us, bonds, are not just awkward restraints. They are lifelines. Although we all need some solitude and some independence, total isolation is for us a desolate and meaningless state. In fact, it is about the worst thing that can happen to us.

Read Full Post »

Iona Heath writes in the BMJ recently,  that

we have somehow lost our way in the management of chronic non-communicable diseases. In this arena the largely unexpressed sense of medical impotence seems to have led to the frequent exaggeration of treatment effects and to an excessive emphasis on unproved preventive interventions.

She picks out two issues to highlight

Wishful thinking seems to be encouraged by two serious structural impediments within medicine: firstly, a diagnostic taxonomy that manages to be both rigid and intensely inconsistent; and, secondly, the unjustifiable manipulation of statistical information, with or without intention.
Experience is fluid and continuous, while diagnoses are discrete and dichotomise the normal from the abnormal in a way that has proved useful but that is totally artificial. The insistence that medicine is able to make a clear distinction between these two categories is a major constituent of the pervasive wishful thinking—perhaps particularly in preventive interventions such as mammography, where overdiagnosis of the abnormal can lead to mutilating interventions that have a minimal effect on overall mortality.
In his 2010 Bradford Hill memorial lecture at the London School of Hygiene and Tropical Medicine, Sander Greenland described contemporary statistical practice as perpetuating hopelessly oversimplified biological and mathematical models and of promoting excessive certainty through the promulgation of a two valued logic that allows only complete certainty of truth or falsehood.

She concludes

It is surely time for medicine to reassert a standard of integrity that seeks out and actively curtails wishful thinking and acknowledges the degree of uncertainty at every level of practice, even at the expense of admitting impotence.

As so often seems to be the case, I agree completely with her. Our current fashion for “evidence based” approval labels is built on the merging scientism, which in turn has arisen from logical positivism. It’s continued default to two value thinking (it’s either this or that, right or wrong, good or bad, works or doesn’t) is a ridiculous abstraction that increasingly bears little connection to reality. We live in a highly complex world where human beings are complex adaptive organisms embedded in our unique and multiple environments and relationships.

The claims for “cures” and the claims for “certainty” and rightness of point of view of “experts” is not doing any of us any favours.

Again, I think this illustrates how helpful Ian McGilchrist’s analysis is – there are two world views clashing here and we’ll only make progress if we can integrate both of our cerebral hemispheres and stop believing that only left hemisphere function gets it “right”.

Read Full Post »

Tim Parks’ excellent “Teach Us to Sit Still: A Sceptic’s Search for Health and Healing” was recently reviewed by one of the British Medical Journal’s Associate Editors.

By now you must be as bored as I was. And we still haven’t reached the dénouement. I don’t think that I shall be spoiling anything for anyone if I say that eventually he found that learning to meditate brought an end to the pains, although he doesn’t say whether he can pee any better.
Obviously this book wasn’t written for doctors, and I’m doubtful whether they will enjoy it much. They will have heard versions of this story many times before from their own patients whom they tried hard, but failed, to help. Indeed at one level this particular narrative is little more than a long and self absorbed account of the inner journey of a man desperately seeking meaning in and relief from chronic (but not incapacitating) symptoms, who eventually manages to find both through visipanna meditation. Yet before dismissing it entirely it’s worth remembering that the author is a successful writer and academic—one of his novels was shortlisted for the Booker prize—and probably a lot cleverer than we are.

You can tell he didn’t like it.
Having just read the book myself and found it thoroughly engaging, and thought provoking, I thought the BMJ’s review showed just what’s gone wrong with medicine with these days – doctors shouldn’t find patients’ stories boring. They shouldn’t find them irrelevant, nor should they believe that their own take on illness or health is superior to that of the person they are trying to help. What happened to compassion? When did human beings become the boring part of medicine? Interestingly, there are clues in Parks’ own text. Consider these two statements –

What’s the point of speaking when you’ve arranged to do proper clinical tests? The tests will speak for you.

and

Without evidence of organic damage pains were perhaps unimportant. At least to doctors.

I’ve had junior doctors tell me they are being taught exactly these views – that only clinical tests show the “truth” and that patients’ stories don’t matter. This doesn’t bode well for the future practice of medicine.

In fact Parks predicts the BMJ editor’s response –

Doctors had never wanted to go into detail over this, as if afraid that an exhaustive description of symptoms would mean losing themselves in a labyrinth of highly nuanced but irrelevant sensation.

But the editor is right. This is not an uncommon story. That, however, certainly does not make it boring. This is a good read. It’s an engaging and thoroughly honest, open account of a chronic problem which the best of “evidence based medicine” could do nothing to help. That too, is not an uncommon story.

Given that Tim Parks describes himself as a “skeptic” (though I think that label is much misapplied these days….seems the average “skeptic” is actually someone arrogantly convinced of the rightness of their own personal view, only doubting everybody else’s!), it’s interesting to find him saying this (comparing his mother and father’s evangelical Christian fundamentalism to their belief in modern “scientific” medicine”) –

..like doctors’ syrups, divine healing required no effort or self-knowledge on the part of the sufferer; neither my father nor mother paid much attention to their bodies.

One of the most important points he makes is –

Wasn’t it weird, in fact, the way everybody imagined that when you were ill all you had to do was go to a doctor and get yourself prescribed a medicine? How did that happen?

He’s right. How did that happen? And isn’t it weird? Health isn’t about getting a pill, and doctors don’t always know best. Trust me. I’m a doctor.

Finally, referring to John Launer’s suggestion that “MUS” should mean “Medically Unexplored Stories”, instead of “Medically Unexplained Symptoms”, the reviewer concludes –

Perhaps he’s right. If so, the moral of the story told by Parks is that intelligent, educated, and apparently rational people may think about their health and illnesses in ways that hardly begin to overlap with ours.

You know, it’s not about intelligence, education or rationalism, it’s the biotechnical doctors who have lost the plot. It’s their way of thinking which hardly begins to overlap with that of their patients, and as health is a personal and individual experience, the most important story is the patient’s one.

Read Full Post »

The Other, by Ryszard Kapuciski (ISBN 978-1844674169) is a beautiful, thought provoking little book.

Here are a few quotes to whet your appetite.

[Herodotus] understood that to know ourselves we have to know others, who act as the mirror in which we see ourselves reflected; he knew that to understand ourselves better we have to understand others, to compare ourselves with them, to measure ourselves against them.

Xenophobia, Herodotus implied, is a sickness of people who are scared suffering an inferiority complex terrified at the prospect of seeing themselves in the mirror of the culture of others.

Conquer, colonise, master, make dependent – this reaction to others recurs constantly throughout the history of the world. The idea of equality with the other only occurs to the human mind very late on, many thousands of years after man first left traces of his presence on Earth.

All this seems increasingly relevant in the growing xenophobia around the world. Yesterday I read Rachida Dati’s impassioned plea, in Le Monde, to stop setting French people against each other.

Cessons donc d’opposer les Français les uns aux autres, au profit d’un meilleur vivre ensemble !

Today, I read in the Guardian, Mya Guarnieri’s piece about islamophobia, where she talks about her feelings and memories aroused by the newspiece about a pastor from her hometown of Gainsesville, Florida, who is intending to burn copies of the Qur’an to commemorate September 9th.

When I was a child, some of my evangelical Christian classmates urged me to convert. Because I was Jewish and didn’t accept Jesus Christ as my personal lord and saviour, they told me, I was going to hell…….In the past, there was antisemitism, roiling just below the surface. Now, there is Islamophobia. If Terry Jones burns copies of the Qur’an in Gainesville, he’ll leave a shameful scorch on us all.

We definitely need a more positive attitude to the Other – to whoever is different from us.

Read Full Post »

Remember the X-files?

Well, the question about there being a truth “out there” is an interesting one. Out where, exactly? I’ve stumbled across an interesting couple of phrases recently which are getting me thinking about the nature of reality and how we experience it.

Our experience of the world helps to mould our brains, and our brains help to mould our experience of the world.

Iain McGilchrist, in The Master and His Emissary, uses a lovely word – “reverberative” – to capture the idea of reality being a dynamic interactive relationship between the subject and the object.

….right-hemisphere qualities of being a betweenness: a reverberative, “re-sonant”, “respons-ible” relationship, in which each party is altered by the other and by the relationship between the two..”

So, even if there is an “out there” it can only be known in the acting experiencing, a two-way, constantly changing experience.

Everything that we know can be known only from an individual point of view, or under one or another aspect of its existence, never in totality or perfection. Equally what we come to know consists not of things, but of relationships, each apparently separate entity qualifying the others to which it is related.

“…what we come to know consists not of things” – now that’s a thought-provoking phrase.

Then I came across an article by Professor Richard Conn Henry, from the Department of Physics and Astronomy at John Hopkins University. His article, published in Nature, is titled “The Mental Universe”, with the summary “The only reality is mind and observations, but observations are not of things. To see the universe as it really is, we must abandon our tendency to conceptualise observations as things”.

He quotes the physicists Sir James Jeans….

..the stream of knowledge is heading towards a non-mechanical reality; the Universe begins to look more like a great thought than like a great machine. Mind no longer appears to be an accidental intruder into the realm of matter….we ought rather hail it as the creator and governor of the realm of matter.

and Sir Arthur Eddington

It is difficult for the matter-of-fact physicist to accept the view that the substratum of everything is of mental character.

But, says Professor Henry, that’s exactly what quantum physics is showing us. In this article he says “The Universe is entirely mental…and we must learn to perceive it as such”, concluding with the following words –

The Universe is immaterial – mental and spiritual. Live, and enjoy

I have a feeling materialistic scientism is in its last days!

Read Full Post »

The Master and His Emissary

Thank you, Iain McGilchrist. This is not only a brilliant and comprehensive work, not only utterly convincing and erudite, but it shines the bright light of understanding on so many aspects of life. I can’t remember a time I enjoyed a book more than this one. I can’t remember a time I felt so enthralled by a book as this one. I’ve been busy underlining, making notes, looking up references and reflecting since I opened up this immense text. I haven’t rushed it, but I’m still a bit sad I’ve finished it. I’d have read more!

Iain McGilchrist is trained in both the Arts and Science, having taught English at Oxford University and worked as a Consultant Psychiatrist. The Master and His Emissary begins with a review of the science of the brain. Why is our cerebral cortex split into two halves with only a thin connection between the parts? Do the two halves do the same job? And if so, why have two halves to do the same job? This is no simplistic idea of “right brain versus left brain” however. He does make the claim that the two halves are NOT the same. In fact we can see that in the gross anatomy, but we’re also seeing it in the functions revealed through clinical experience (what changes for a person who loses the function of a certain part of the brain?), and through both neuroscience experiments and imaging work.

Put simply, he claims that the two halves of the brain are used to engage with the world in two different, but essential, ways. While the right hemisphere has an open and wide focus on the world, noticing connections, or the “between-ness” of things, the left has a narrow focus, noticing the parts. Both of these forms of attention are important to us.

Things change according to the stance we adopt towards them, the type of attention we pay to them, the disposition we hold in relation to them. This is important because the most fundamental difference between the hemispheres lies in the type of attention they give to the world.

He postulates that the brain has evolved this way to allow us, first of all, using our right hemisphere, to be aware of life as it is, or in its wholeness, then the left hemisphere selects some of that information from the right in order to focus on part of life in order to exert power over it. In other words, the left has a focus on utility to allow us to interact with specific parts of reality. Having focused on part of reality, the left then sends this information back across to the right, for the right to incorporate it in its over all understanding. Drawing on an old tale of a Master and his Emissary, he identifies the right hemisphere as the Master, who sends out his Emissary (the left hemisphere) to do specific work for him.
He then goes on to show how dominance of either the right or left ways of engaging with the world create the culture of the time. Having done so, we come to the final part of his thesis. By describing the culture of different eras, examining everything from philosophy, art, music and writing of each time, he shows how there has been a progressive shift in power from the Master to his Emissary, so that by now we are experiencing a world created by the left hemisphere as if the right is either redundant, or doesn’t exist.

Let me be clear here. He is not simplistically saying right side good, left side bad. Rather he continually reminds us that we need a healthy integration of both of these ways of understanding and engaging with the world.

Ultimately we need to unite the ways of seeing that are yielded by both hemispheres. Above all the attention of the left hemisphere needs to be reintegrated with that of the right hemisphere if it is not to prove damaging.

He gives us plenty of evidence that the dis-integrated dominance of left hemisphere thinking is damaging ourselves and our planet.

Here’s one of his many summaries throughout the book of the differences between these two approaches.

The world of the left hemisphere, dependent on denotative language and abstraction, yields clarity and power to manipulate things that are known, fixed, static, isolated, decontextualised, explicit, disembodied, general in nature, but ultimately lifeless. The right hemisphere, by contrast, yields a world of individual, changing, evolving, interconnected, implicit, incarnate, living beings within the context of the lived world, but in the nature of things never fully graspable, always imperfectly known – and to this world it exists in a relationship of care.

I wish we had a course based on this book. A course which ALL health care professionals would complete. If we did, we’d counter the increasing objectification of patients as examples of diseases to be manipulated on the basis of abstracted and generalised research as if they are objects without individuality or context. We’d counter the increasing fruitless or delusional pursuit of certainty. We’d have a chance of increasing empathy, a respect for difference and individuality, of increasing our understanding of patients as people in a holistic and contextually embedded way. We’d move from agendae of “management” and “productivity” to ones of care and experience.

This book has taught me so much. The discussion of the relationship between music and language was a complete eye opener to me. I’m learning a lot about neuroscience just now as I’m taking Dr Dan Seigel’s “Mindsight” course, and his focus on “integration” fits right in with this thesis, as does Dan’s definition of mind – “an embodied, inter-relational, process of regulation of energy and information”. It connects to other books I’ve read, such as Daniel Pink’s “Whole New Mind”, Richard Ogle’s “Smart World”, Robert Solomon’s critique of the “thin-ness” of much philosophical thought in “The Joy of Philosophy“, and Lakoff and Johnson’s “Metaphors We live by”.
It helps me to make sense of both “scientism” and “scientific materialism” and gives me insights which clarify why I find those approaches to life to be so profoundly lacking and unsatisfying.

Guess what I’m going to do now? Yep, I’m going to start to read it again. I’m convinced this is an important and much needed book published just when the world needs it. We need to prioritise integrative approaches to life, and certainly to health care, and, I believe, we need to increase the amount of empathy and understanding in the world. Iain McGilchrist has shown us how to enrich life with the rewards which can come from a reactivated right hemispheric approach to reality.

Read Full Post »

« Newer Posts - Older Posts »