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Archive for the ‘from the reading room’ Category

An amazing story

Posted in from the reading room, life on December 13, 2007| 3 Comments »

The front page of The Independent today carried an amazing story of a Kenyan man, Sammy Gitau. Sammy was born and grew up in the slums of Nairobi, scavenging on the rubbish tips. He found a prospectus for Manchester University and it captured his imagination. He dreamed that one day he’d go and study there despite the fact he only had two years of formal education. However, people laughed at the ridiculousness of his dream so he stopped talking about it. Things got worse for him and he became the main family breadwinner at 13 looking after his 10 siblings after his father was murdered. He earned his family income through drug dealing and theft. Then he ended up in a coma after a cocaine overdose. He survived and said of this experience

“When you are dying you make a deal with God,” he said. “You say, ‘Just get me out of here and I will do anything. I will go back and stop children going through the same kind of life as me’.”

He set up projects teaching slum children skills like carpentry, baking, tailoring and so on and came to the notice of some charities working in the area, one of whose employees heard about Sammy’s dream and helped him apply for a postgrad course in Manchester. They accepted him but British immigration turned him down not believing that he had any chance of managing the university course. Seven months later a judge overturned that decision and Sammy, with financial support came to Manchester.

Today he graduated with a Masters degree and said

“For the past few days I haven’t been able to sleep – I’ve been too excited. So many doors had been shut in my face because I didn’t have this or that. Now, finally, I can think big. Now I can go back to my projects and make sure they do well.”

sammy

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Are we born empathic?

Posted in from the consulting room, from the reading room, neuroscience on December 10, 2007| Leave a Comment »

A colleague at work read my post on mirroring.

She said, if it’s true that different people have different scan findings in the areas of the brain associated with mirroring neurones (which, it is hypothesised, are responsible for empathic ability), then does that mean that some people are born with greater empathic potential than others? And can the potential be developed?

This is a common question in neuroscience – when we identify either physical structures within the brain responsible for certain behaviours and qualities, or differences in function in those areas as highlighted by functional scans, then are we saying that people are born with these brain differences which then determine their characteristics? Some people might make that claim but from my reading I’d say almost every scientist thinks that the physical characteristics of the brain, originating in genetic makeup and embryonic development, are important, and may even set the limits of possibility. However, the nervous system is more “plastic” (the specific meaning of this is nothing artificial, it means it can change), than a simple one-off scan will ever show. Neuronal pathways develop, grow or shrink, depending on demand. What this means is that while we are probably born with different potentials, everyone’s potential can be developed or suppressed by experience.

She asked the question because she was wondering why some doctors are more empathic than others. Specifically, she wondered if empathy could be learned. I’m pretty sure empathy can be learned. I’ve seen medical students and qualified doctors become more empathic as they train in homeopathy which emphasises the patient’s narrative and a clear understanding of the patients’ experience.

But the question got me thinking about the place of empathy in the consultation. How much is it a quality developed from “mirroring”? Difficult to answer, but I think there’s an even more important element – being interested.

If a doctor is not truly interested in what a patient has to say, then they won’t listen, won’t understand and won’t be empathic. Can being interested be faked? No, I don’t think so. You’re either genuinely interested in somebody or something, or you’re not. Pretending to be doesn’t work. I’ve often said, when discussing the art of medicine, that if I ever need to see a doctor because I’m not well, then I’ll want one who frankly gives a damn! I want a doctor who, at least for the duration of the consultation, is genuinely interested in me. In fact, I’d recommend that anyone who doesn’t find people totally, compellingly interesting, shouldn’t study medicine in the first place!

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Vonnegut on creativity and purpose

Posted in from the reading room on November 30, 2007| 2 Comments »

There’s a great post across in four hour week – a precis of Kurt Vonnegut’s last interview – it’s worth a read in full but these two answers really grabbed me –

Tell me the reasons you’ve been attracted to a life of creation, whether as a writer or an artist.

I’ve been drawing all my life, just as a hobby, without really having shows or anything. It’s just an agreeable thing to do, and I recommend it to everybody. I always say to people, practice an art, no matter how well or badly [you do it], because then you have the experience of becoming, and it makes your soul grow. That includes singing, dancing, writing, drawing, playing a musical instrument. One thing I hate about school committees today is that they cut arts programs out of the curriculum because they say the arts aren’t a way to make a living. Well, there are lots of things worth doing that are no way to make a living. [Laughs.] They are agreeable ways to make a more agreeable life.

In the process of your becoming, you’ve given the world much warmth and humor. That matters, doesn’t it?

I asked my son Mark what he thought life was all about, and he said, “We are here to help each other get through this thing, whatever it is.” I think that says it best. You can do that as a comedian, a writer, a painter, a musician. He’s a pediatrician. There are all kinds of ways we can help each other get through today. There are some things that help. Musicians really do it for me. I wish I were one, because they help a lot. They help us get through a couple hours.

I agree with these sentiments so much –  we should all practice something creative – it makes our souls grow. And we are here to help each other get through this thing – a life spent without this motivation is a life lacking something in my opinion.

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The influences on attractiveness

Posted in from the reading room, life, perception, psychology on November 30, 2007| 2 Comments »

Beauty is in the eye of the beholder it’s said, but maybe it’s not just in the eye? This study asked people to rate the attractiveness of others from photos along with short personality descriptions. They found that

individuals – both men and women – who exhibit positive traits, such as honesty and helpfulness, are perceived as better looking. Those who exhibit negative traits, such as unfairness and rudeness, appear to be less physically attractive to observers.

This reminded me of a study I read ages ago which got students to guesstimate the height of a lecturer who was introduced as either “Mr”, “Dr”, or “Professor”. There was a consistent increase in the perceived height of the lecturer when introduced as “Dr” over “Mr” and “Professor” over “Dr”.

It also brought to mind the effect of pupil size on perceived attractiveness. A study done using actors and actresses with sets of photos before and after having their pupils dilated showed that observers consistently rate the photos where the pupils are larger as being the more attractive.

So I guess there are many influences on our perceptions of the physical – personality traits, status and state of arousal. Are there others you are aware of?

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A Good Life

Posted in books, from the reading room, philosophy on November 20, 2007| 6 Comments »

What makes a life a good life?

Philosophers have struggled over this question for centuries. It seems such a simple question but it’s not so easy to answer. One of the biggest problems with the question, of course, is that what constitutes a good life for each of us is probably a bit different.

Despite what the self-help books in the Body Mind Spirit section of the bookstores tell you, there’s no magic formula.

A C Grayling has recently published a book about this, ‘The Choice Of Hercules: Pleasure, Duty and the Good Life in the 21st Century’. He was talking about it on ‘Start The Week’ on BBC Radio 4 on Monday morning (podcast available here)

In a nutshell, he is considering the often opposing drives of duty and pleasure, or as Oliver Sacks, one of the other guests on the show said, between work and love. How we balance these determines how good we feel our lives are.  A C Grayling concluded that those rare individuals who love their work, are amongst those who have good lives. Well, I can sign up to that one. I have a good life and I certainly love my work.

I’ve just finished reading ‘The Weight of Things’ by Jean Kazez (ISBN 978-1-4051-6078-0). I bought this after reading an excellent article written by her, where she reviewed and compared three books on happiness.  I was impressed with her balance, style and insight and I’ve really enjoyed ‘The Weight of Things’. It’s about what constitutes a good life. She’s very clear in her book that she is not writing a manual or even giving a set of recommendations about living well. It’s a much more thoughtful and thought provoking book because of that. She refuses to be pinned down to a fixed set of specifics and I think that is so right, although at first, I thought, why is she being so difficult? Why doesn’t she just list the necessary features of a good life? I realised I was chasing the magic formula that doesn’t exist. Jean Kazez is much more realistic than that and completely acknowledges that we are all different and it would be wrong of her to proscribe the features which she thinks make life good. This is such a refreshing approach. I can’t stress often enough how much I value individual difference and diversity. I just can’t accept formulaic, one-size-fits-all approaches, and I don’t see the world through a two-value lens. (Ok, you’re probably thinking, ‘a what?’ ‘a two-value lens’? Well, I mean the categorisation of everything into one of two opposites – good/bad; black/white; proven/unproven. Sorry, life just doesn’t seem to fit that straightjacket for me).

What she does in this book is to consider some (but she expects, not all) features which are probably necessities if you want to have  good life, then goes on to consider other features, which she calls the B list, which make life better, but probably aren’t essential.

Here’s her very nice way of putting it –

The target we should aim for, if we want our lives to get better and better, is not like the familiar set of concentric circles. It’s like a grid of different coloured squares with different hues representing necessary and optional ingredients. The necessities are different shades of green (say) and we need to aim at each one. The various shades of purple are worth aiming for too, but they’re not so critical. If we start out with a life that’s not going well, we need to aim at the various greens: happiness, autonomy and the other basics. They remain central throughout our lives. But the purple squares – balance, accomplishment, and the like – are also life-enhancing.

I like that a lot. Maybe I wouldn’t pick green and purple but I like it all the same! The idea that a good life is not achieved through a recipe or formula but has ever changing variables which colour our lives in various hues and shades……that’s good. And it’s dynamic – she says –

a good life isn’t static, but involves some sort of growth over time.

I also like it because each of her characteristics, or squares is worthing focusing on and developing in its own right. She says that’s because making your aim a better life, as if ‘the good life’ has an independent quality you can aim at directly, is likely to fail.

Aiming for a better life is to be expected when life is going badly, but many of us take our focusoff our own lives when we feel like our lives are ‘good enough’. Many perfectly reasonable people with good lives will not aim for even better lives, let alone some conceivable ‘best life’. In some cases important things beyond ourselves start to take precedence.

How important is that last sentence? It’s a bit we often miss in our atomistic, disconnected lives. Remember the Hugh Grant character in About a Boy? That 80’s and 90’s idea of separateness, and, yes, selfishness, wasn’t enriching. Neither is the celebrity culture of our current times. Life really IS good when we get in touch with “important things beyond ourselves” – whether we see that in social, political, personal or spiritual terms.

Oh, I know, you still want her list, don’t you?

So did I.

(please remember – neither of lists should be considered definitive or complete!)

Here’s her A list (the fundamental essentials)

  • Happiness
  • Autonomy
  • Sense of identity
  • Morality
  • Progress

And here’s her B list (features which enrich life but needn’t be seen in themselves as essential)

  • knowledge
  • friendship, love, affiliation
  • play
  • religion
  • making music
  • creating art
  • accomplishment
  • balance
  • talent
  • beauty

She makes it very clear that different people will need each of these to different degrees to have a good life and that there may be other features others would add, and people might find for them that some of her B list needs to be on their A list.

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Changing perspectives. Paradoxes

Posted in from the consulting room, from the reading room, health, science on November 18, 2007| 19 Comments »

I think the only controversial principle of homeopathy is the degree of dilution of the medicines but one of the other principles that at first glance doesn’t make sense is that a smaller amount of something can have a greater effect. I think there are a number of reasons why that’s counterintuitive at first. One is that with poisons and drugs we’ve got used to the common phenomenon of bigger doses having more powerful, usually more toxic effects. You can be sure that if a small amount of a substance poisons you then a larger amount will poison you even more. In fact, it will probably kill you. That’s absolutely true. But if you reverse the direction, is it also true that a smaller amount of something will do the same as the larger amount did, but just more weakly? Strangely, the answer is……not always!

Here’s a couple of examples. Aspirin in large amounts increases body temperature. In fact, one of the signs of an aspirin overdose is hyperthermia. But a small dose of aspirin doesn’t put up the body’s temperature just a little bit. In fact it does the opposite. It lowers the body temperature, which is why we use it to treat a fever. Digoxin (from the Foxglove plant) in a high dose causes a highly irregular heart beat, but a small dose of digoxin doesn’t cause a small amount of irregularity, in fact it does the opposite. It produces a regulation of an irregular heart. An old term for this phenomenon is ‘hormesis’. It’s a term which fell into disuse but which has begun to reappear in two interesting areas.

First of all, in the area of toxicology. There’s an organisation called the International Dose-Response Society which seeks to promote research into hormesis. They distribute a newsletter from a scientific grouping which studies BELLE (Biological Effects of Low Level Exposures). You can find a radio item about this on CBC.

Secondly, Richard Bond, an Associate Professor of Pharmacology at the University of Houston, has proposed the term “paradoxical pharmacology” ( Bond, R.A.: Is Paradoxical Pharmacology a strategy worth pursuing? Trends Pharmacol. Sci 22: 273-276, 2001). This is a proposal for research to be done into the use of smaller amounts of drugs given intermittently in some situations to produce curative effects instead of the tolerances and toxicities which come from the use of large amounts constantly. His main area of interest is into the effects of beta blockers, which are drugs which are designed to block adrenaline and noradrenaline which increase the contractility of the heart. Logically, in a condition like heart failure where the body responds to the changed heart function by releasing more adrenaline and noradrenaline to increase the contractility of the heart, beta blockers should have made the situation worse. And in the short term they can do exactly that, but in the longer term they actually improve the situation. As he says –

Therefore, the paradox remains as to why impeding a contractile system results in an increase in contractility.

He cites the use of stimulants such as amphetamines to treat hyperactivity in children and skin irritants such as retinoic acid and benzoyl peroxide are used to treat acne, which is an inflammatory skin condition as other such paradoxical examples. (it’s also known than giving sedative antihistamines, like ‘phenergan’ to children who don’t sleep makes them more awake!) His potential explanation for these effects is interesting –

acute and chronic effects of drugs often produce opposite effects. This is particularly true for receptor-mediated events. For example, acute agonist exposure can produce activation of receptors and increased signaling, whereas chronic exposure can produce desensitization and decreased signaling

We tend to think of the chronic effects of something as just being a linear extension of the acute situation but that’s actually not true. Here’s his rather startling conclusion –

if acute versus chronic responses are often opposite in nature, and if the contraindications [of drugs] have been made based on the acute effects, there is a suggested list of where basic research can begin to look for clues to investigate paradoxical pharmacology. It is the list under ‘Contraindications’ because the opposite of contraindicated is indicated. This is the list where one would have found β-blockers in CHF just a short time ago. I suggest we test the first precept of medicine, ‘do no harm’, and determine its validity by performing basic research with paradoxical pharmacology. If medicine and pharmacology behave as other areas where short-term discomfort produces longer-term benefit, it might well be that we have paid a high price for accepting a presumption.

This is really another example of the non-linear nature of reality. You can’t take a simplistic notion like more of something will do more of the same so less of something will just do less of what more is, and declare it as a Truth. Life, it turns out, is more complex, and way more interesting! It’s Good Science.

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A Whole New Mind

Posted in from the reading room, life, personal growth on November 8, 2007| 5 Comments »

I read this book some time ago but it came back to my mind when I stumbled across the dancer who claims to reveal whether your are dominantly left-brained or right-brained. The book in question is “A Whole New Mind”, by Daniel H. Pink (ISBN 1-904879-57-8). Let me say at the outset that I really liked this book. I found it stimulating, thought-provoking an useful. The basic thesis is that there has been a time of great progress in societies from left-brained dominance and, rather than argue that what we need is a time of right-brained dominance, Pink, I reckon, gets it right by arguing for a whole-brained approach. I like that. I find the left-right debate rather stale and unhelpful.

What he does is argue for the development of six, what he calls “senses”, which are, in effect attributes, or characteristics, which he says will give people who use their whole brains success over those who stick with old sided dominances. I really like all six of them. They are –

  1. DESIGN – products, services and experiences that aren’t just functional, but which are also “beautiful, whimsical, or emotionally engaging”
  2. STORY – it’s not enough to fashion effective arguments from information and data, “The essence of persuasion, communication, and self-understanding has become the ability also to fashion a compelling narrative”
  3. SYMPHONY – not analysis but synthesis “being able to combine disparate pieces into an arresting new whole”
  4. EMPATHY – “logic alone won’t do. What will distinguish those who thrive will be their ability to understand what makes their fellow woman or man tick, to forge relationships, and to care for others.”
  5. PLAY – there is a need for seriousness but there is also a need for play
  6. MEANING – many of us live in material abundance, and this has freed us up to “pursue more significant desires: purpose, transcendence, and spiritual fulfillment.”

The book has two sections. The first makes the case for a whole brain approach and the second devotes a chapter to each of these six “senses”. In fact, one of the things that takes this book out of the theoretical and into the practical is that he treats every “sense” to two chapters – the first clarifies what that sense is and the second is entitled “portfolio” which is a collection of exercises you can do to develop that “sense” in your own life.

You know what? I’m going to read it again!

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Componential explanations. Thin explanations.

Posted in books, from the reading room, philosophy, science on November 6, 2007| 1 Comment »

I understand the value of focusing on only the part of something to try and understand it better. It’s an essential part of the way we make sense of our world. BUT we must never lose sight of the fact that we CANNOT understand the whole by understanding the parts when we deal with complex adaptive systems.

My own area of medical practice is holistic and that’s not a New Age concept – it’s a focus on the person, rather than just a part of the person which is damaged (the pathological lesion).

A couple of authors I’ve read recently have used other vocabularies to address this issue. Robert Solomon describes a focus on parts as “thin” – it lacks “richness” and “depth”. That strikes me as very true. There’s too much left out of explanatory models which are reductionist. So much left out in fact that they fail to help us understand real life complexity. And Andy Clark uses the term “componential explanation”. Somehow this immediately makes sense to me. He shows how this only works when “the parts display the relevant behaviour even in isolation from each other.” Otherwise, we try a “connectionist explanation” similar to that described so beautifully by Barabasi in Linked. But, he points out, even a focus on the connections is not enough and he describes another model – “emergent explanation” (as explored in Dynamical Systems Theory). This is a good explanatory model for real life complexity and includes a study of “collective variables, control parameters, attractors, bifurcation points and phase portraits”.

Now doesn’t that sound much richer than the reductionist approach?

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Being There

Posted in books, from the reading room, life, neuroscience, philosophy on November 6, 2007| 2 Comments »

Being There, by Andy Clark (ISBN 0-262-53156-9) is one of the most interestingly challenging books I’ve read for a long time. Let me say first that it’s taken me longer to read than I’d have expected it to. There are whole swathes of it which just didn’t engage me easily. In fact, a few times I thought I’d pack it in, then I’d come across a few sentences or a paragraph that not only would grab me and turn my thinking upside down, but it’d be exciting, visionary and, yes, down right thrilling.

I really enjoyed Robert Solomon’s, The Joy of Philosophy, not least because I feel he gave me a new vocabulary. His one word/concept of “thin” really expanded my thought. You can read more about it here, but what really excited me about this word was the way it captured the inadequacy of logical/analytical/reductionist thought.

I then read Barabasi’s Linked, which homed in on the key concepts of connections and nodes. I especially liked the way he demonstrated that the world, though a complex and at times chaotic system, is not random. Randomness turns out not to be the explanation for the phenomena we experience daily. That changed the way I thought about the world – there are patterns to be discovered, and phenomena to be understood. Sure, there is such a thing as chance, and life is often extremely unpredictable, but we can begin to unravel the connections between things and events, and in the process we can improve our understanding of the world.

Now I’ve just read Andy Clark’s Being There and he puts forward concepts that similarly change the way I understand the world and uses language in some novel ways which open the doors to other ways to explore life.  His main thesis is that to understand the mind we have to step outside of the study of the brain – not that the brain is not important of course – but we need to understand the environments in which brains exist. He draws the connections between the brain and the physical, social and symbolic environments in which we live and shows that to fully understand how the mind works we need to explore the interactions between brains and the world. He calls this concept of the mind, the “extended mind” and in the process he nicely shows how we use our brains primarily for pattern recognition and for creating change in the world. In particular how we create the structures in the world that we can then use to extend the functions of our minds.

Let me highlight one simple example – doing a jigsaw. To do a jigsaw we don’t work it all out in our heads but we use our hands to literally manipulate the pieces, turning them around to view each piece from different angles, so stimulating our pattern-recognising brains, and moving the pieces towards and away from different sections of the puzzle. In other words we manipulate the physical environment to help our pattern-spotting brains do what they do best, and to do that more quickly. Andy Clark nicely shows how we do exactly the same thing with our social environment and, crucially, with our ability to handle symbols and signs, which has reached its highest point in our development of language.

What does public language do for us? There is a common, easy answer, which, though not incorrect, is subtly misleading. The easy answer is that language helps us to communicate ideas. It lets other human beings profit from what we know, and it enables us to profit from what they know. This is surely true, and it locates one major wellspring of our rather unique kind of cognitive success. However, the emphasis on language as a medium of communication tends to blind us to a subtler but equally potent role: the role of language as a tool that alters the nature of the computational tasks involved in various kinds of problem solving.

I’ve never read this idea anywhere else – it highlights language as not only being a tool of communication but also being a tool we use to reshape the world to enable our brains to more effectively use their capacities.

This whole thrust can feel a little vertiginous. Look at this for example –

Every thought is had by a brain. But the flow of thoughts and the adaptive successes of reason are now seen to depend on repeated and crucial interactions with external resources. The role of such interactions, in the cases I have highlighted, is clearly computational and informational: it is to transform inputs, to simplify search, to aid recognition, to prompt associative recall, to offload memory, and so on…

and this –

Our brains are the cogs in larger social and cultural machines – machines that bear the mark of vast bodies of previous search and effort, both individual and collective. This machinery is, quite literally, the persisting embodiment of the wealth of achieved knowledge. It is this leviathan of diffused reason that presses maximal benefits from our own simple efforts….

Well, I don’t know about you but this embedding of the brain in the web of relationships, stretching backwards, sideways and forwards in time, makes my head spin! It turns the mind into an even more dynamic phenomenon than I had previously realised and at the same time it turns it into a much less isolated phenomenon too.

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About me (updated)

Posted in from the reading room on November 5, 2007| 1 Comment »

My fellow blogger, sugarmouse in the rain, suggested I update my about me page to include a photo and something about why I blog. So, I’ve taken his advice.

Click on the “me” tab at the top of the blog to go and read it.

By the way, I really am open to suggestions, love to get creative feedback and am happy to respond to requests if I can.  Let me know if there’s an issue you’d particularly like me to cover (for example, damewiggy recently asked for a post on nutrition and mental health)

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