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Archive for the ‘from the reading room’ Category

Now here’s an interesting concept – “free won’t” – which, it is argued, is an essential part of free will!

Neuroscientists have shown that we use two different parts of our brain – one to develop an intention to do something; and a separate part to hold off doing it. If someone can’t hold off then they act impulsively. For example, children with Attention Deficit Hyperactivity Disorder who tend to have big problems with self-control. The researchers who did this work are calling the holding off ability “free won’t”.

This is such an interesting idea. Probably somebody has told you at some stage in your life “Count to ten!” – that’s free won’t. This skill is the skill of choosing, so that your experience of life isn’t driven by unprocessed and uncontrolled feelings and urges (a life that is driven this way often feels as if it is happening to the person rather than giving them the sense that they are the active creators of their own lives).

Here’s a great quote from the researchers –

“The capacity to withhold an action that we have prepared but reconsidered is an important distinction between intelligent and impulsive behavior,” says Brass, “and also between humans and other animals.”

On the other hand, I wonder, do procrastinators have an overdeveloped “free won’t”? Is this the part of the brain they use to keep all those intentions under control?!

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OK, so this is how the web works. I sat down at my iMac and typed “Jack Kerouac writing tips”. Not sure why that came to me right at this moment but it did. I started clicking through some of the finds and came across a lovely blog called “myinneredge” where I read a post about Kerouac which mentioned Natalie Goldberg and I thought “it’s ages since I read Writing Down the Bones. I really enjoyed it” so I followed the link to her site and found she had just completed a film about Bob Dylan – “Tangled up in Bob” – what a great title! Not just because my name is Bob and I love the “tangled up” idea…….

So that’s how the web works with hops, skips and jumps. And the thing is, there is NO endpoint. As I typed “tangled up” I heard a Genesis song in my head –

where to now…….?

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When I was a GP (a Family Doctor) I had a pony tail but once I became a grandfather I cut it off. One of my patients brought her daughter to see me where I work now (Glasgow Homeopathic Hospital) having been to consult me herself several years ago. She said her husband asked her where she was going today and she replied “To see Dr Leckridge at the Homeopathic Hospital”. He said, “Oh, that hippie doctor!” “What do you mean?” she asked. “The one with the pony tail,” he replied. “Oh, he doesn’t have a pony tail any more” she told him and he replied “Aye, but it’ll still be on the inside!!”

“I hope it is!” she said to me.

Conforming is a zombie way of life in my opinion. It’s good to know your uniqueness and to be yourself. There’s a great post on this across on lifehack today. It’s written by Adrian Savage who writes the great Slow Leadership blog. I love his conclusion –

Conformity has very little to recommend it. Trust yourself and trust others. Our world has so little trust even a little more is precious. If you can’t trust who you are—the naturally valuable, curious, interesting, and exciting person you were born to be—why should anyone else trust you?

Mediocrity and inner frustration are the true price of conforming. Only those with the courage openly to live their dreams can ever hope to find lasting satisfaction with their lives.

I also love the quote he’s chosen from Rollo May’s “Man’s Search for Himself”

“The opposite of courage in our society is not cowardice…it is conformity.”

Go on, trust yourself, and be the hero of your own life story.

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I’ve recently been playing with Stumbleupon and stumbled across this page.

It’s good to read aphorisms and when they are spiced with humour they’re even better.

The “thought for the day” at the bottom of the page captures the tone of the whole piece –

Thought for the day: Never be afraid to try something new. Remember that a lone amateur built the Ark. A large group of professionals built the Titanic.

Check it out. I think you’ll laugh at (and agree with) all these “pearls”.

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Amy’s got a new blog going. Go have a look. Today, she’s put up a post about what we can learn from babies. It’s lovely and it’s spot on. She highlights some of babies’ most instinctive and distinctive qualities including wonder, curiosity, unconditional love and determination (and others too).

She’s so right. These are great qualities and it’s a shame that we tend to lose them in the busy-ness of adulthood.

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Leisure

Christopher Richards who writes slowdownnow said that the book that got him thinking about the whole slow idea was “Leisure. The Basis of Culture”, by Josef Pieper. So I got myself a copy – a lovely hardback edition published by Liberty Fund with an introduction by T. S. Eliot. I really enjoyed doing a dissertation at school (several decades ago!) on T.S. Eliot so finding an introduction by him was a special treat. Josef Peiper was a Catholic Philosopher (which is not something that would usually appeal to me!) and his writing can be both elegant and difficult. But this little essay certainly provoked my thinking.

He makes the point that leisure, not work, is the basis of culture, and a fully human life. He also makes the point very, very clearly that leisure is not the same as idleness. It’s not about doing nothing, slobbing around, or just passing time. It’s about being fully engaged with the world in a non-active, non-doing way.

Whilst Max Weber said “one does not work to live; one lives to work”, Pieper instead reminds of Aristotle who said

We work in order to have leisure

(In fact, the direct, literal translation of this quote from Greek to English is “We are unleisurely in order to have leisure”)

In our frantic, Getting Things Done, To-do list obsessed society, this seems an incredible statement. But the Greeks had it right I think. They had two main “arts” – the liberal arts (ars liberales), and servile work (ars serviles). Work doesn’t sound so great when you add the adjective “servile” does it? But that captures so much of our experience in modern society. For many people, work is just something they have to do, but which is so demanding and consuming that when they are not working they are totally unable to experience leisure.

Pieper points out that leisure is……

a mental and spiritual attitude – it is not simply the result of external factors, it is not the inevitable result of spare time, a holiday, a weekend or a vacation.

and, that it is…..

an attitude of non-activity, of inward calm, of silence; it means not being ‘busy’, but letting things happen.

This description is highly reminiscent of meditation and it’s no surprise that Pieper frequently refers to the activity of contemplation as a way of experiencing reality.

I can see why this essay provokes self-questioning about the all-consuming busy-ness of current lifestyles. It reinforces for me the importance of one of the key groups of virtues is around “Calm” – for me, I’ve identified the three virtues of Slow, Silence and Tranquillity under this umbrella. This is not an argument in favour of doing nothing in life, it’s an argument which turns our priorities on their heads, stressing the absolute importance of leisure. I agree with Aristotle – we work in order to have leisure (and, I guess, many of us work to enable others, too, to have leisure)

I particularly liked his holistic description of leisure.

The point and the justification of leisure are not that the functionary should function faultlessly and without breakdown, but that the functionary should continue to be a man – and that means that he should not be wholly absorbed in the clear-cut milieu of his strictly limited function; the point is also that he should continue to be capable of seeing life as a whole and the world as a whole; that he should fulfil himself, and come to a full possession of his faculties, face to face with being as a whole.

OK, not the easiest sentence to read, but you get the point, don’t you? This is what life is about. This is what being a hero is about. To fulfil yourself, to be in full possession of your faculties and to be at one with life and the world. It strikes me that zombies aren’t fulfilled and although they might work or be idle, the one thing they cannot experience is leisure.

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The main theme of this blog is the challenge to reject the zombie way of life, stumbling unconsciously through the average, and wake up, get involved and consciously choose how to develop your way of life. In short, become the hero of your own story, the principal character in your own narrative, accepting challenges, reflecting on your experiences and growing.

I was struck by how well the problem was described by Sebastian Faulks in his Engleby

This is how most people live; alive, but not conscious; conscious but not aware; aware, but intermittently.

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Engleby

Engleby is Sebastian Faulks’ latest novel. It’s written in a very different style from his previous novels but touches on some of the same themes. I read Human Traces recently and really loved it. Both novels are concerned with ideas of consciousness and the creation of the sense of self, but they deal with this in very, very different ways.

The first thing which strikes you about Engleby is that it is written in the first person. It’s difficult to do this successfully for the course of a whole novel, but Sebastian Faulks is a great writer and handles it beautifully. It really works. You have the sense that you are inside the head of the narrator, seeing and experiencing the world the way he does, and, more importantly, getting some sense of his subjective, inner mental processes. The narrator, it quickly becomes clear, is not “normal”. At best he’s a misfit, and, at worst, may even be mentally ill. This reminded me of the excellent “The Curious Incident of the Dog in the Night-time” by Mark Haddon (excuse me while I digress, but I also recently read Stumbling on Happiness by Daniel Gilbert, and one of his chapters starts with a quote from one of the Sherlock Holmes novels where Holmes solves the crime by noticing “the curious incident of the dog in the night-time” – so THAT’S where the title came from!). In Mark Haddon’s novel the narrator is a boy with autism and the fact it’s told in the first person gives you an understanding of what it’s like to experience the world from the viewpoint of an autistic mind. I think “The Curious Incident…” is a much funnier book than “Engleby” (to be fair, Engleby isn’t supposed to be a funny book!) but it also packed a bigger emotional punch for me than Engleby did (“Human Traces” packs a more powerful emotional punch too). The narrator of Engleby has a mental disorder which means he has difficulty making healthy relationships so the whole experience of the novel is from the standpoint of someone who is a bit cut off from others, who finds social interaction difficult and who is seen by others as strange.

It’s a bit of a whodunnit too because one of the students Engleby knows disappears and for much of the novel it’s not clear what’s happened to her. I’m not going to reveal any of the endpoints of this novel because I do think the suspense adds to the enjoyment of reading it.

Consciousness, memory and the self are core themes of this novel and that really appeals to me. Consciousness, for example, is still not clearly understood and I do think our understanding of it increases by considering it using ALL the tools of philosophy, neuroscience, cognitive psychology AND literature. Drop any of these approaches and it’s harder to understand.

Taken together, “Human Traces” and “Engleby” really contribute to our understanding of the workings of the human mind. I highly recommend both of them but the reader should be prepared for two VERY different books.

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I’ve been reading some of the happiness literature recently. Not because I’m not happy – I am! But mainly because the area of medicine in which I work is based on two things – taking a holistic view, which really just means engaging with a person instead of just a person’s disease! And, secondly, it’s based on trying to aid recovery and increase resilience, as opposed to just trying to rescue a situation, or repair some damaged tissues. There’s a lot involved in helping someone to get better including enabling self-understanding, instilling hope, encouraging a positive attitude, as well as tackling disease processes. I’m especially interested in an approach to medical care which seeks to understand the uniqueness of each and every patient I see and enabling them to develop in the face of their illnesses – by develop I mean to adapt, to become more creative and to be more fully engaged with their lives (see here)
I read The Happiness Hypothesis and thoroughly enjoyed it. Thought provoking and enlightening. I then moved on to Stumbling on Happiness, by Daniel Gilbert (ISBN 978-0-00-718313-5). These two authors have completely different styles but both are tackling the question of what makes people happy. Gilbert’s book is much more a psychologists approach – in fact, I’d go as far as to say an experimental psychologist’s approach. In the opening chapters he lays out his strong belief that the way to understand how the human mind works is to study phenomena of large numbers of people. He says we can’t rely on the experiences of individuals but we can rely on phenomena which can be demonstrated time and again in group studies. That made me a bit uncomfortable because as a clinician I find that often the statistical “evidence” from group trials turns out not to be appropriate for an individual. Drugs are a great example of this. There isn’t a single painkiller on the market which you can guarantee will take away the pain of a particular patient. It doesn’t matter how many hundreds of thousands of people have benefited from a particular treatment, this particular patient today may well turn out to be the one who gets no response at all. We see the same phenomenon with blood pressure pills, sleeping pills, anything really. Obviously a doctor should recommend the safest treatment which seems to have helped a significant number of patients but he or she must remain open to understanding that for this patient this pill just might not work. We are all actually different. I’ll return to this issue shortly.

I really didn’t want to like Gilbert’s book because of the cover. It looks cheap and puerile. However, you can’t judge a book by its cover! Once I started to read it, I loved it. I’ve read criticisms of his familiar, humorous writing style but it really works for me. It’s a treat to read and it often made me laugh. His cultural references, especially to Beatles songs hit the spot for me. The content was fascinating too. OK, many of these studies published by psychologists have been written about in other books, but Daniel Gilbert presented a fair number of interesting studies which I’ve never read anywhere else.

After a while, psychology experiment after psychology experiment begins to feel like a magic show. So often the result is a surprise. I could almost hear “abracadabra!” in the background! This is fun and interesting but its novelty begins to wane. (Actually his section on magic tricks themselves is particularly interesting – check this post) Throughout the book he held my interest, and he made a good, clear case for the claim that memory, perception and imagination are all imperfect representations of reality –

Foresight is just as fallible as eyesight and hindsight.

I have no doubts about that. However, for me, I’m more comfortable with the understanding that memory, perception and imagination are all creative processes – individual, subjective, creative processes.

Having demonstrated that we are not reliable judges of either what did make us happy, or what will make us happy, he ends up with a recommendation that totally baffled me. In his final chapter (the one before the “Afterword”) he seeks to answer the question “how should we decide what to do?” Somewhat astonishingly he says that as we can’t rely on our memories or our imagination, we should rely on the experiences of others. He claims this will work because we have an over-inflated sense of our individuality and uniqueness. He says “What makes us think we’re so damned special?” and argues “Our mythical belief in the variability and uniqueness of individuals is the main reason why we refuse to use others as surrogates……..surrogation is a cheap and effective way to predict one’s future emotions, but because we don’t realise just how similar we all are, we reject this reliable method…”

Pardon?

The best way to predict how I’m going to feel in a situation is to ask others who have already been in that situation? Yes, I understand the importance of empathy and of sharing stories and learning from others, but, you know something? There’s only ONE Daniel Gilbert! And there’s only ONE me! I liked some of the same Beatles songs as you, Daniel, but I don’t rate statistics and experimental psychology as highly as you do because we’ve lead different lives, in different cultures with a myriad of different experiences.

Just stop for a moment and think about taking his recommendation to rely on the reports of others to predict how you’re going to feel in a certain situation. When was the last time you read a movie review, went to see the movie and had such a different experience from the reviewer that you thought “did we see the same movie?!” In “Who Wants to Be a Millionaire?” you can go 50/50, phone a friend or ask the audience – you might get some clues from what they say but they don’t always give you the right answer – why not? Well Daniel Gilbert answers that himself – they too are humans with fallible memories, fallible perception and fallible imagination. Why should the report of someone else be more reliable than what I know about myself?

I think there are two crucial elements missing from this exploration of happiness – narrative and the importance of meaning. We experience life through the creation of stories – the stories we tell others and the stories we tell ourselves. Storytelling involves using memory, perception and imagination. Through the creation of stories we gain a sense of self AND we make sense of our experiences. Human beings are meaning-seeking, meaning-creating creatures. And two people in the same circumstance will have vastly different experiences because the circumstance is interpreted differently, made sense of differently, means something different to each of them.

Yes, yes, yes, we share more than we often realise. With a bit of empathy we can realise just how much we do share with other people, but I insist, we are all different, all unique and, you know what?

YOU ARE SPECIAL!

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The BMJ published a study today which has been reported across at ScienceDaily. This is an incredibly thoughtful article which questions the prescribing of lipid-lowering drugs (statins) to the elderly. Whilst there is good evidence that lowering lipid levels in younger patients reduces their risk of suffering from cardiovascular diseases, there is not good evidence that the same benefits can be achieved with the elderly. However, doctors are being encouraged to treat the elderly with the same assumptions as they make when treating younger patients. Worryingly, one of the studies conducted in the over-70s who take statins shows that while there did seem to be a reduction in death from cardiovascular diseases, the overall mortality remained the same. In other words they died from something else. In this particular study there was an increase in deaths from cancer. The authors of this paper ask a question which I’m astonished has not been asked before.

Is it possible, they ask, that by introducing preventive treatments in the elderly aimed at reducing the risk of a particular cause of death, we are simply changing the cause of death without the patient’s informed consent?

Too often drugs are presented to the public and the medical profession in terms of “saving lives”. Drugs don’t save lives. However, they do alter the experience of dying, and, of course, therefore, the experience of living. But when coerced into taking medication to “prevent” future diseases, patients are not being told exactly what not dying from this particular disease might mean for them. What are they more likely to die from if they don’t die from heart disease for example? This is not a question that should only be asked when treating the elderly. It’s time we had some decent research on how medication changes the experience of living and dying, not just research which only focusses on single diseases. Only then can doctors and their patients make truly informed decisions.

However, the issue of treating the elderly as if you can expect they will receive the same benefit from a treatment as a younger person is also something we need to think about. It doesn’t make sense. People are different and “evidence” from drug trials conducted on younger people may well not be at all useful “evidence” when making a prescribing decision for an elderly person. To be useful, evidence has to be relevant to the individual patient who is being persuaded to take medication.

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