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Archive for the ‘from the reading room’ Category

The Third Age

Posted in from the reading room, life, personal growth on January 3, 2008| 4 Comments »

Did Charles Handy come up with the concept of the “third age”? I’ve done a bit of searching online but I can’t find the answer to that. Wikipedia reckons the Third Age, is the history of Middle Earth in Lord of the Rings! In The Empty Raincoat, Handy describes four ages –

  1. Formation – education, training, life experience
  2. Endeavour – work, parenting, house-keeping
  3. Second Life – extension of the Second Age, or something different
  4. Dependency – the final years

He attributes roughly 25 years of life to each of these stages (or ‘ages’).

Whoever coined the term originally, the concept is a useful one, and as Handy points out, with increased life expectancy and quality of life for most of us, the Third Age is becoming increasingly important. He points out that the Third Age used to be what we called retirement and was seen as a time to do nothing, live off your pension, then die! Nowadays, with the changing demographics producing many more older, healthier people, and correspondingly lower proportions of younger people in society, he says we can no longer think of the Third Age as a time for doing nothing and earning nothing. He describes four sources of income in the Third Age –

  1. State pension
  2. Occupational pension
  3. Savings/inheritance
  4. Paid work

and he says that as neither State nor occupational pensions will be enough to live on in the future, that we’ll increasingly have to rely on paid word beyond the age of 65. This needn’t be a bad thing of course. Many people feel tossed on a waste heap on retirement day. But certainly, it’d be good if it wasn’t about just more years of 9 till 5 and wages! Given that most people will have some pension income, and maybe also some savings or inheritances, then paid work needn’t take centre stage but might potentially be more meaningful work – something which adds value to life beyond a simple income. But, then, that’s a pretty good goal to have at any age, isn’t it?

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The ‘S’ curve

Posted in from the reading room, life, personal growth on January 2, 2008| 5 Comments »

One of the concepts which Charles Handy writes about in The Empty Raincoat is the ‘s’ curve. Here’s an example of one –

S curve

We start something new, it develops and grows, then the problems and limitations start to appear so the growth flattens out, and in the final stage, decline sets in.

Handy says

It’s one of the paradoxes of success that the things and the ways which got you where you are, are seldom the things that keep you there.

In other words, when things are going well, we shouldn’t become complacent thinking that we’ve got it all sussed. If we want to keep growing (and if we don’t we’ll start to shrink or decline) then we have to change what we’re doing now. The future will be different from both the past and the present.

An example of this from medical practice would be the treatment of an individual with a chronic illness. The doctor might find some therapies which are helpful eg some particular drugs which work for this patient, but, as time passes, those therapies won’t be so helpful any more.

I find the idea of “proven” or “unproven” treatments to be very unhelpful. Not only because no treatment will work for every patient, so a treatment is only “proven” for that person when we see how things turn out for them, but that because everyone is always changing, what works now, what is “proven” now, will stop working, or at least stop working so well, as time passes.

If we are to continue to improve and to grow we need to understand the reality of this ‘s-curve’ and as

it’s easy to explain things looking backwards, we think we can then predict them forwards

we soon find that the next phase, the new medicine, the new way of doing things, will be quite unlike the present – related to the present and emerging from the present – but different.

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What’s an Empty Raincoat?

Posted in from the reading room, life on January 1, 2008| Leave a Comment »

Charles Handy wrote ‘The Empty Raincoat‘ in 1994. Strange title, huh? It refers to a sculpture he saw – ‘Without Words‘ by Judith Shea.

I canot forget a sculpture I saw….’Without Words’ by Judith Shea……a bronze raincoat, standing upright, but empty, with no-one inside it. We were not destined to be empty raincoats, nameless numbers on a payroll, role occupants, the raw material of economics or sociology, statistics in some government report. If that is to be its price, then economic progress is an empty promise. There must be more to life than to be a cog in someone else’s machine.

We shouldn’t be zombies, we should be heroes.

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The Empty Raincoat

Posted in from the reading room, life on January 1, 2008| 7 Comments »

Here’s the trail…….a colleague emailed me about MacNamara’s Fallacy, which was mentioned in an article, by David Haslam, in the Journal of the Royal College of Practictioners. I really liked the quote and set about hunting it down. Turns out it was first quoted in a book by Charles Handy, ‘The Empty Raincoat’ (ISBN 0-09-178022-5). I found a hardback copy on sale for a penny on Amazon Marketplace. It was written in 1994 and a lot’s happened in the world since then but this book is still a refreshing and insightful read. I guess I’m going to be hunting down some more Charles Handy books in the future because I really enjoyed this one. It is full of creative ways of thinking about life, and, in particular, work and business.

I’ll do individual posts on some of his main ideas because I liked them so much but one of thing that really struck me was the advice he gave to his children as they came of age and began to look for work. He told them not to look for a boss, but to look for customers. Wise advice and, it turns out, very relevant to how work was already changing, but especially how work has changed since the book was written. And it struck me that this advice fits beautifully with the heroes not zombies theme.

To find satisfaction in life, it’s best not to try and sign up for, as Charles Handy puts it “100,000 hours of your life” sold to someone else, but, instead to think what do I have to offer people? Or how can I gain the experience, knowledge or skills that will allow me to offer something to people? Once you know what you have to offer, you can begin to set out to find the ways to provide it.

Being a hero, is writing your own story of your own life. It’s about having the personal confidence in what you have to offer the world and setting out to share it.

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Does the body make the mind sick, or vice versa?

Posted in from the reading room, health, psychology on December 29, 2007| 16 Comments »

David Corfield mentioned ‘When The Body Displaces the Mind’ on his blog. It’s by Jean Benjamin Storr who is a French ‘psychoanalytic psychosomatician’ – Wow! I’ve never heard of such a job, but I do understand both the idea and the relevance of having someone with such skills on a team.

We still have a very materialistic, very reductionist and dualistic concept of illness. It’s very common for illnesses to be divided into “real” diseases, and ones that are “in the mind”. I don’t find this the least bit helpful. I’ve always said I’ve never met a mind without a body and the only bodies I’ve met without minds are in the morgue. People present their whole experience and it’s not possible to have only symptoms related to the body, or only to the mind. OK, not everyone will agree with that, but that’s how I see it. Books like David Corfield’s own one (‘Why do people get ill?’ which is, I believe, now out in the USA with the title ‘Why people get sick?’), and Brian Broom’s ‘Meaning-full Disease‘, are, I found both easy to read and excellent at setting out a compelling case for the consideration of a patient in the wholeness of their suffering.

Stora’s book is not such an easy read. I think this is for a number of reasons. First of all, it’s originally written in French and the French have a way of writing that is really not the same as Anglophones. Even in French it can be challenging to an English speaker. In translation, something is lost. This makes it harder. And in the case of this particular book I think the translation is pretty clunky in places (although I’m sure it wouldn’t be an easy job). The additional complication is that the author is a dyed in the wool Freudian. I haven’t trained in Freudian analysis and the language of that particular approach has never really appealed to me. Of course, I think Freud’s concepts of pre-conscious, unconscious and conscious functions of the mind were amazing breakthroughs and I also think his Id, Ego and Superego were similarly insightful but all the oral/anal fixation, castration anxiety, sadomasochistic and oedipal drives…….nope! It doesn’t work for me! What I mean is that I just don’t find that kind of formulation of someone’s problem to be helpful. This book is steeped in that approach. That said, if you can let the jargon kind of wash over, the insights are still stimulating, and what impressed me most was actually the part of the book after the theoretical introductory chapters. That latter part is completely based on cases and as such I found it quite compelling. I can’t say I’d always sign up for the analysis but if you step up a level out of the Freudian School as such you can see a highly empathic, skilled practitioner, enabling a patient to create a story which pulls together all of the apparently diverse elements of their suffering, their biography and their cultural experience. His final case, of Nina, is totally fascinating because of the cultural overlay and the demonstrated need for the therapist to get onto the same wavelength as the patient to be able to help her.

As Stora himself says –

…the spiritual dimension plays an important role in restoring individual psychosomatic equilibrium for those who have received a spiritual education.

I really appreciate his understanding of complexity science as a way of illuminating illness. He situates illness in the life of the whole embedded person –

I favour a multi-causal approach to somatic patients; human beings are fundamentally integrated in three inextricable dimensions: a somatic; a psychic and a socio-cultural dimension……..the cause of an illness may lie in any one of the three dimensions……..Every therapeutic endeavour ideally should incorporate these three dimensions.

Dr Eric Cassell’s ‘The Nature of Suffering’ describes that extremely well from a clinical perspective.

Stora highlights something of the same kind of finding as Kroenke –

Surveys conducted among people who have consulted GPs reveal 50 – 70% of patients do not have lesional illnesses.

I like that language – ‘lesional illnesses’. Historically we can go right back to another French author, Bichat, who wrote the “Treatise on the Membranes” with one of the earliest descriptions of disease as an identifiable, physical entity, and whilst in his day that was a breakthrough, three centuries on we’re stuck with an inadequate view of illness as either having lesions or not being real.

This book is an interesting addition to the challenge to that way of thinking. However, in it’s introduction I thought it held out more potential than was realised. It remains firmly in the camp of explaining how emotional wounds can be the origin of physical disease, but I’m even more interested in both the other direction – how physical diseases impact on the mind, and then how both the mind and body interact to produce the full picture of the illness. I’m also more interested to know how to identify and effectively treat the great majority of patients who don’t have what Stora refers to as lesional illnesses. And in addition to that how we produce rational therapeutic interventions to treat whole, individual people, not just think the job is done once the pathology has been addressed. Only then will we have a system of health care which is genuinely healing.

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Inspirational doctors

Posted in from the reading room on December 24, 2007| 1 Comment »

The new Chair of the Royal College of General Practitioners is Professor Steve Field. In an interview published in today’s BMA News Review he says he was inspired to become a GP by his local family doctor – here is how he describes that man –

This GP was a listening, thinking person, who dealt with people as human beings, valued them, treated them….and saved the odd life.

I can understand why Professor Field was inspired.

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Randomised Controlled Trial of Parachute Use

Posted in from the consulting room, from the reading room, health, humour, life on December 20, 2007| 5 Comments »

Every Christmas issue of the British Medical Journal, now known simply as the BMJ, has some really fun articles. I haven’t opened this year’s issue yet but when I picked it up from behind my door just now a study from old BMJ Christmas issue came to mind. It was a systematic review of the evidence base for the use of parachutes. In the introduction they say –

The perception that parachutes are a successful intervention is based largely on anecdotal evidence. Observational data have shown that their use is associated with morbidity and mortality, due to both failure of the intervention1 2 and iatrogenic complications.3 In addition, “natural history” studies of free fall indicate that failure to take or deploy a parachute does not inevitably result in an adverse outcome.4 We therefore undertook a systematic review of randomised controlled trials of parachutes.

The authors completely failed to find a single randomised controlled trial of parachute use! This article is typical of the BMJ Christmas editions. It’s funny, tongue in cheek, but thought-provoking and makes serious points through the use of humour. I love their conclusion –

Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial.

Any volunteers? (and, no, you’re not allowed to volunteer anybody else!)

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Playing with language in French

Posted in art, from the reading room on December 19, 2007| Leave a Comment »

One of my main treats is to browse in a “Maison de la Press” in a French town and sit down in a cafe with a new purchase or two. I have certain favourite French magazines. One of them is called Senso. It is beautifully produced. I love the illustrations and there are really interesting articles about literature, movies and all aspects of cultural life. But one of the most enjoyable things is the French language itself. It’s a wonderful language for playing with words. Here’s an example –

Elle me donne les larmes aux mes yeux, parce que je suis epuisee.

This is by Nina Bouraoui, a writer. Translated, it says “She brought tears to my eyes, because I was exhausted”. The other meaning of the word “epuisee” is “out of print” – for a writer that’s a really clever word to use and conveys quite a special sense of exhaustion, doesn’t it?

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Physics-envy?

Posted in from the reading room, health on December 18, 2007| Leave a Comment »

The slowleadership blog has an interesting post today. It’s about management and sales methods, but in particular it’s about an obsession with what can be measured –

For over a century, many academic disciplines — including business, more recently — have had a case of “physics-envy.” They believe that only “real” data is meaningful, only particles and precision make for real “science.”

The writers make the point that relationships are more important –

Selling is not at root, despite what web-searches will tell you, about process. It is about people and relationships and trust.

Well, it’s interesting isn’t it? You could say the same about health. Health care is ultimately about people and relationships and trust – not either only, or even primarily, about what can be measured. We’ve really forgotten that though in modern health care management. There’s been an obsession with targets and not only targets but targets of what can be measured. And in the midst of all that we’ve lost sight of the fact that medicine is a caring profession. It’s about people, it’s about relationships and it’s about trust.

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The Roads to Modernity

Posted in books, from the reading room on December 17, 2007| 7 Comments »

This is the title of a book by Gertrude Himmelfarb. Why did I try to read it? Well, it’s subtitle is “The British, French and American Enlightenments” and the phenomenon of the Enlightenment fascinates me. I have an anthology of Scottish Enlightenment writings edited by Alexander Broadie and I enjoyed Arthur Herman’s “The Scottish Enlightenment” and Christopher Berry’s “Social Theory of the Scottish Enlightenment”. The idea of Modernity is also fascinating and I thoroughly enjoyed Stephen Toulmin’s books on that (“Cosmopolis”, and “Return to Reason”). But the other reason was that I read in a newspaper that Gordon Brown, our PM, is a big fan of Himmelfarb’s work and has this particular work on his bookshelf. I’m not sure what makes Gordon Brown tick but he strikes me as a thoughtful man and I wondered what it was about this book that he found appealing.

Well, dear reader, I failed! I gave up. Here’s why………

In the prologue she goes to great lengths to diminish the French. In particular she attacks their Enlightenment agenda of reason, and is quite, quite scathing about Diderot and les philosophes. I found that pretty irritating. OK, I thought, it’s refreshing to read such a different and skeptical view of the French Enlightenment project, but as the pages turned it felt increasingly like she just dislikes the French and French thought and culture. Well, I don’t. I enjoy French thought and culture and their philosophes, but you don’t have to agree with everything an author writes. We can all have different opinions. But then she laid into the Scots, going to great lengths to try and make the case that the Scottish Enlightenment was really just a part of the British Enlightenment (whatever that was!) and going to even greater lengths to claim that the great Scottish thinkers of that time didn’t like to be known as Scots at all but preferred to downplay their Scottishness and claim Britishness instead! (now I see why Gordon Brown likes this!). OK, so she was really losing me now, and we’re still in the Prologue! I kept going though, but didn’t feel any greater affinity with the text.

However, I finally gave up when I got to the American Enlightenment and read –

America was, however, saddled with two problems that Britain was happily spared, the Indians and slavery, both of which proved to be very nearly intractable.

Ouch! Is it just me, or is there something very uncomfortable about that sentence?

She goes on –

For economic if for no other reasons, the displacement of the Indians was the precondition for the very existence of the settlers.

and

What they did have [the settlers] in addition to a clear recognition of their own interests and needs, was a strong sense of their superiority, as human beings, as Christians, and as citizens. “Savages”, in popular parlance, was almost synonymous with Indians….

Is she just unemotionally describing how things were in those days? Or is this a justification for these attitudes?

The problem of slavery was even more formidable than that of the Indians

There was a widespread and deeply held conviction of the ineradicable differences of the races and the inferiority of the blacks.

Now I don’t know if it’s just her style to write in this matter of fact way, but I found this whole section deeply disturbing. And I don’t get it either…..this is a description of some kind of “Enlightenment”? Some kind of “politics of liberty”?

However, I did find her very neat summary of the British, French and American Enlightenments very appealing –

The sociology of virtue, the ideology of reason, the politics of liberty – the ideas still resonate today.

I like that little phrase. I just don’t like this book. I didn’t finish it.

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