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Archive for the ‘from the reading room’ Category

Quasicrystals

Posted in from the reading room, science on May 24, 2007| Leave a Comment »

You should never believe a scientist who claims to be certain about what is possible and what is not possible. For most of the 20th Century physicists believed that crystals could only have certain structures (based on their “rotational symmetry”). In fact, until 1982 they claimed that is would be impossible for a crystal to have a structure based on a five-fold pattern (like a pentagon). Then in 1982 somebody discovered the “impossible” – a crystal which had exactly that structure. As is often the case in science, once one had been discovered several others then turned up (you only see what you can see!). These structures were given a new name “quasicrystals”. Now, mathematicians are beginning to understand these strange materials –

“Mathematically speaking, quasicrystals fall into a middle ground between order and disorder,” Damanik said. “Over the past decade, it’s become increasingly clear that the mathematical tools that people have used for decades to predict the electronic properties of materials will not work in this middle ground.”

This is such an interesting comment – the “middle ground between order and disorder”. Finding patterns in apparent chaos is always somehow exciting. But for me, this story has another interesting element. There’s a kind of arrogance in many scientists which is the arrogance of certainty. Any scientists who stands up and declares that either all that can be known about a subject is already known, or that anything which does not fit our current understanding is just impossible, will, time and again, be proven wrong!

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Meaning-full Disease

Posted in books, from the consulting room, from the reading room, health on May 14, 2007| 6 Comments »

Meaning-full Disease. Brian Broom
ISBN 978-1-85575-463-8

I read a reference to Brian Broom’s work in “Why Do People Get Ill?“, and like that book, his “Meaning-full Disease” should go on every doctor and would-be doctor’s reading list – not just on their shelves, but in their active reading list. Professor Broom leads the post-graduate programme in MindBody Healthcare at Auckland University of Technology and works as a physician specialising in allergies and clinical immunology, a psychotherapist and a mindbody specialist in Christchurch. That tells you something about what you might expect from this book. His main area of interest is psychosomatic disease. This is a term which has fallen out of favour and come to mean illnesses without any associated physical disease. However, it is making a comeback thanks to work like this and Leader and Corfield‘s work amongst others. It is particularly making a comeback because of its focus on the links between the body and the mind in illnesses where there are significant pathological changes to be found.
Broom explores the truly fascinating observations that patients’ physical diseases are often best understood by uncovering the meanings that their illnesses have for them. He pleas for a more holistic, more humane practice of medicine by placing the scientific world view in its rightful place – not as the bearer of all truth, but as a subset of experience.

“the lifeworld is a rich, multidimensional, experienced reality of which the scientific world is a part-representation, a reduction, or an abstraction.”

He sets out a powerful argument for seeing both subjective and objective experience as different manifestations of an underlying unified phenomenon, referring to both phenomenologists such as Merleau-Ponty and Husserl, and Japanese writers, Yasua and Ichikowa (the latter he quotes as saying “my ‘object-body’ and my ‘subject-body’ are inseparably united in their deeper layer, and cannot be separated clearly and decisively, except through intellectual abstraction”. I particularly enjoyed his reflections on this so-called divide between objective and subjective where he says to touch your left hand with your right – as you do this you experience you left hand objectively and in the same moment subjectively your left hand feels touched. He goes on to muse about the position of hands pressed together in prayer which similarly dissolves the barriers between subjective and objective. A lovely image and a nice way to get us thinking about these two ways of experiencing the world.
There is much more to illness than the biomedical model elucidates for us. This in no way devalues the model which is still a powerful way to not only conceptualise disease but to treat it, but trying to understand a person’s whole experience by seeking what lies behind the pathology requires quite other skills which doctors are sadly not so strongly encouraged to acquire. One of the best passages in Professor Broom’s book is where he describes the process of his work moving back and forth in a consultation between the “thing of the illness and it’s meaning”. Sounds like how a consultation should be.

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What’s Wrong with Doctors?

Posted in from the consulting room, from the reading room, health on May 13, 2007| Leave a Comment »

Richard Horton has written an excellent review of “How Doctors Think” by Jerome Groopman here.

The main point he makes is that doctors make mistakes primarily because of failures in the ways they think.

Good doctoring is about listening and observing,
establishing a trusting environment for the patient, displaying
authentic empathy, and using one’s skills and knowledge to deliver
superb care. But a neglected aspect of this professionalism is getting
doctors to think about their own thinking. Only by doing so are doctors
likely to reduce the number of errors they make. What should they do?

Here’s a summary of his recommendations in answer to that question –

  • Encourage patients to tell and retell their stories. “a critical element of any mutually respectful therapeutic partnership
    that the doctor acknowledges the patient’s version of the truth of his
    or her story.”
  • Slow down. “The more time a doctor takes, the fewer cognitive errors he will make”
  • Once a decision is made, always retain an element of doubt.

None of these recommendations is in tune with current medical thinking. Doctors are encouraged to make diagnoses on the basis of the results of investigations. The art of listening to a patient’s story to make a good diagnosis even before a physical examination and any tests are run has receded as doctors are increasingly encouraged to treat patients according to protocols and guidelines created on the basis of statistical analyses of what’s measurable (stories are dismissed as anecdotes and unreliable subjectivity). Rather than slow down, health authorities around the world push doctors to see more and more patients more and more quickly. And doubt? Still, young doctors are encouraged to be certain and to believe in the rightness of their decisions. Retaining a healthy amount of doubt would make doctors more humble and more able to recognise when they are not getting it right after all.

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David Lynch

Posted in from the living room, from the reading room, life on May 7, 2007| Leave a Comment »

There’s an interview with David Lynch in this month’s AirFrance inflight magazine. In response the question “What kind of human being are you?” (I know, strange question!!), he replies

I’ve been practicing transcendental meditation for 33 years and it’s given me a profound love for the world and for life. It may sound slightly jarring, or seem a little out there to you, but I’m optimistic because I feel that humanity is growing more aware. I sense that a genuine dynamic for peace is emerging, and I’d like to convince people of the power that they have within themselves, of all the energy, the love, the fullness we have inside.

Well, David, what a delight to read that! That’s what this blog is all about. I hope some of these posts will contribute to that growing awareness that turns us from zombies into heroes.

He’s right you know, you DO have amazing powers of energy and love inside. Using them to grow, to connect and to create, is, I think, what life is about.

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Black swans

Posted in from the consulting room, from the living room, from the reading room, narrative on April 19, 2007| 5 Comments »

There’s a website called Change This. They publish articles which they call “manifestos”. I just came across this one. Nassim Nicholas Taleb argues that unpredictable events are like “Black swans” – until one is seen we lack the imagination to even think such a creature is possible basing our expectations entirely on our previous experience. Taleb says a Black Swan is rare, its occurrence has a large impact, and it is predictable only retrospectively (we explain it with a narrative we make up after the event).

It’s an interesting idea. There’s a phenomenon described in complexity science which is similar to this. It’s called “emergence” and it means the kinds of events and behaviours that occur which are brand new and have never been seen before. For example, when a particular hurricane suddenly starts to behave differently from all previous hurricanes. I see this all the time in patients. There is a terrible tendency in Medicine to focus on diseases rather than the people who have the diseases. Once a diagnosis has been made (the disease has been named) a prognosis is made on the basis of how other cases progressed. But the thing is that again and again patients just don’t comply with statistics. Take Stephen Hawking as an example. He has a disease called Motor Neurone Disease. Usually people die within two years of a diagnosis of this disease. Stephen Hawking was diagnosed over 40 years ago.

People are different. It is impossible to accurately predict an outcome for any single individual with a particular diagnosis. The future is, and always will be, uncertain. That’s not a bad thing, though we crave certainty. I once had a patient who told me her husband had been diagnosed with cancer and had been told he had six months left to live. I asked her how she felt about this and her answer took me completely by surprise (you could say it was a Black Swan!). She said “I’m angry. Very angry. It’s not fair. How come he gets to know how long he’s got and I don’t get to know how long I’ve got?!” I had to explain that actually he might not die in six months time!

But Taleb’s idea about Black Swans makes another interesting point which is about the human use of narrative to make sense of things. Even though an event might be totally unlike any event we’ve ever seen before we’ll do our best to explain it as if it had been predictable all along. This further feeds our tendency to believe in certainty and predictability.

The contemporary practice of Medicine as strongly based on encouraging decision making on the basis of what’s already known (this is called Evidence Based Medicine), but as I once heard Dr Harry Burns (Chief Medical Officer of Scotland) say “If we base all our treatments on what we already know how can we come up with new, better treatments?”

We need imagination. Without imagination we cannot see what might be. Even with imagination however we’ll still have masses of experiences which we didn’t expect. That’s how life is… I don’t want a wholly predictable life. Do you? Understand me here, I’m not saying I want nothing to be predictable. I do want to know that when I catch the 0735 Glasgow train it’s got a good chance of getting me to Glasgow at 0820 (OK, maybe one day!!). I like routines and rhythms. But I like surprises too and the fact that every single patient I see tells me something I’ve never heard before makes my day. Every day.

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Creative space

Posted in creativity, from the reading room, from the viewing room on April 15, 2007| 7 Comments »

Morning pages, originally uploaded by bobsee.

What makes a space a creative space? Every Saturday in the Guardian there is a photo of a writer’s room. It got me thinking about the spaces which somehow make creativity flow.
A number of years ago I read The Artist’s Way and I two lessons really stuck with me (but for some reason I never got round to carrying them out until recently).
The first lesson was what Julia Cameron calls “morning pages”. Her idea is that you should write, pretty much stream of conscious writing, every morning until you’ve filled three pages of a notebook. Well, I never did it, until 27th December last year. Since then I haven’t missed a single day and it’s almost a kind of addiction now. If I don’t actually do it first thing there’s a kind of irritation in me, a discomfort, until I sit myself down and write the three pages.
I haven’t stuck to writing first thing but most mornings I do get up at 6am, shave, shower, dress, then sit myself down and write the three pages. If I’ve got time left, I have breakfast! I find it takes anything from 15 minutes to just over half an hour to write the three pages. I’m not precious about the stream of consciousness thing but I do try not to stop once I’ve started (I don’t pause for thought, worry about grammar or punctuation).
Sometimes I have written on the train, on a plane, in a cafe or in an airport. The variety gives me a bit of a kick. I let myself just ENJOY it and don’t give myself a hard time for not having written within an hour of getting out of bed. With this leeway, I’ve written 3 pages EVERY single day since December 27th and I really don’t see me stopping now.
I didn’t read what I’d written at all for the first six weeks and I haven’t kept up a time for writing what I’ve written (in fact, most of what I’ve written I haven’t read!). However, my creativity has been unleashed! I can’t tell you just how much but I take more photos than ever before, post up to Flickr for the first time ever, started this bog, wrote a few pages for a website……I could go on. I just feel that ideas don’t rattle around my head like hard peas in a tin any more, rather they come together, they develop and, more than anything, they turn into real world phenomena – words and images mainly.
I cannot recommend this habit highly enough. It is transformative.

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How to be creative

Posted in creativity, from the living room, from the reading room on April 6, 2007| 1 Comment »

I’ve just read a couple of books about creativity and it’s interesting to compare what they say. The first one I read was “The Creative Brain” by Nancy CAndreasen. (ISBN 0-452-28781-2). Nancy Andreasen sounds a really interesting person. Not only is she an MD who has specialised in brain research, but she is a PhD in Renaissance literature. Sometimes I think all doctors would be better doctors if they also studied a Humanities subject. Her final chapter is “Building Better Brains” and here she gives creativity exercises for adults and for children. Here are the paragraph heads –

  • Choose a New and Unfamiliar Area of Knowledge and Explore It in Depth
  • Spend Some Time Each Day Practicing Meditation or “Just Thinking”
  • Practice Observing and Describing
  • Practice Imagining

and for children –

  • Switch Off the TV
  • Read Together, Interactively
  • Emphasize Diversity
  • Ask Interesting Questions
  • Go Outdoors and Look at the Natural World
  • Get Them Interested in Music

The second book I read was “Window Seat. The Art of Digital Photography & Creative Thinking” by Julieanne Kost. (ISBN 0-596-10083-3). This author is a photographer and “evangelist and trainer for Adobe Photoshop software”. She took 3000 photos from the window seats of commercial aircraft as she travelled on business over a five year period. The 150 photos in this book are stunning and inspirational but what makes this an incredibly different photography book is that it is in three sections. The first section is “The Art of Creative Thinking”, the second section is the photographs, and the third is an appendix of the techniques she used to make the photos. Here are the paragraph heads of her first section on creativity –

  • Master your tools
  • Listen to what your life is trying to tell you
  • Be open to whatever comes your way
  • Share what you know and learn from others
  • Collaborate with other creative people, especially the quiet ones
  • Be flexible. Learn to negotiate
  • Fix whatever you complain about the most
  • View every challenge as a possible discovery
  • Take 15 minutes for yourself every day
  • Figure out what you need to do to reach your “zero point”
  • Integrate work and art; both will benefit
  • Take up an interest in something you know nothing about
  • Look at new stuff – and at what you already know – with a fresh perspective
  • Keep a journal
  • Visualise first, Photoshop second
  • Replace your thoughts with intuition
  • Play! Play! Play!
  • Know when you’re done

Even although I’m not writing about the detail of any of these paragraphs here you can see a large potential consensus. Both of these authors write clearly, simply and are very down to earth. There’s nothing “airy-fairy” about them.
Having read not only these two books but many others on the subject of creativity here are the practical steps I think lead to becoming more creative in your life –

  1. Take some time each day to think and reflect – you might call this meditation, you might go over something in your head, or write down your thoughts – but however you do it, actually take some time each day to think.
  2. Notice more. Actively try to observe more consciously.
  3. Explore. Be curious. Find out more about something every day
  4. Be passionate. If you have a passion for something, pursue it!
  5. Share. Spend some time talking or playing with other people – adults or children – every day.
  6. Accept challenges as opportunities to grow
  7. Focus on difference. Seek diversity and variety
  8. Create your own rhythms. Certain habits or disciplines are not constraining but instead they release – this is one of the bases of poetry which is not just words which rhyme but is words chosen within certain disciplines of pattern.
  9. Capture something every day – either write in a journal, take a photo, record a video or audio clip. What you capture will be your treasure chest!
  10. Schedule. I don’t just mean schedule what needs to be done, I mean schedule in some periods of time just to pursue creativity

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Why Do People Get Ill?

Posted in from the consulting room, from the reading room on April 2, 2007| 11 Comments »

Why Do People Get Ill. Darian Leader and David Corfield. ISBN 978-0-241-14316-2. This is a book written by a psychoanalyst and a philosopher. Amy spotted a review of it in The Observer. It gripped me from the outset – always a sign of a good book I reckon. In the first few pages these statements caught my eye –

3.5% of the decline in mortality due to infectious disease since 1900 can be attributed to pharmacological intervention

5 – 10% of healthy adults and 20 – 40% healthy children carry it [streptococcus pneumoniae]

Typhus and dysentery will flourish with greater success in defeated armies rather than victorious ones.

The first of those quotes is really interesting because there is now a huge emphasis on drugs as being, if not the only, then certainly the best, treatments (and cures) for most illnesses. Antiobiotics in particular have achieved almost mythological status as saviours of suffering humans. Yet they are only responsible for a tiny percentage of the lives saved from death from infection. What are the big saviours then? Well, clean water, effective sewerage systems, better housing and reductions in poverty are amongst the main ones. This is not news. I learned this in “Sociology in relation to Medicine” (a course in my undergrad medical course at the University of Edinburgh) in 1972 (and it wasn’t new then!)

The second quote tells us that loads of people have “nasty” bugs (we have a terrible tendency to describe some bacteria as nasty and some as nice, entirely on the basis of the potential harm they can cause us – nothing to do with the personality characteristics of bugs!) which apparently don’t seem to be causing them any harm. How come?

The third quote claims that mortality from a serious infection like typhus is affected by the mental state of the individuals who catch the bug. This is one of the key points of this book. These observations are not new to me and they probably are not new to you but when you stop for a moment to think about them they are startling and they tell us loud and clear that illness is not a mechanical process. Illness is always multifactorial. That’s part of the nature of complex systems – they aren’t simple! This sets the tone for the whole book. The thrust of the argument is that it’s whole people who get ill, body and mind, inextricably interfunctioning, and not only that, but it’s whole people, embedded within the environments of their lives who get ill. I use the plural there deliberately. We are embedded in multiple environments, not just physical ones, but also social, cultural and narrative ones. We are meaning-seeking creatures and the fascinating examples in this book illustrate that point beautifully.

The question the authors ask of us is to consider not just what is this disease? but doctors should ask their patients to talk about themselves

No hospitalised patient should be deprived of the opportunity to speak about themself.

Intruigingly they explore the potential for illnesses to emerge at symbolic times and in symbolic ways

Human culture is built up of symbolic structures, involving language, social laws and ritualised practices…..growing up involves the absorption of the social and linguistic structures into the very fabric of the body.

This is a plea for a more human, more humane practice of medicine. A plea for the recognition of the importance of a person’s narrative and the importance of human relationships. They question, for example, the wisdom of a system of delivering health care which results in the patient never seeing the same doctor twice. The current emphasis on protocols and targets is dehumanising. It assumes that every patient with disease “x” can be treated with therapy “y” and it doesn’t matter who actually delivers the treatment. How did we come to value drugs more highly than human beings? Technologies more highly than caring attentiveness?

The health services and bureaucracies of contemporary society are based on a rejection of the very dimension of human narrative.

Their final challenge is –

challenge the thesis that the disciplines basic to medicine are physics and chemistry. Would it be absurd to suggest that literature and philosophy would make better candidates, as they encourage the study of human beings living in a world of meaning.

Hear, hear, guys! Occasionally you read a book you wish ALL doctors would read. This is one such book. Sadly, a lot of doctors don’t read very much, claiming to be “too busy”. Suggest your doctor friends buy it for “holiday reading”.

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Phantoms in the Brain

Posted in books, from the reading room, neuroscience, perception on March 25, 2007| Leave a Comment »

Phantoms in the Brain by Sandra Blakeslee and V.S. Ramachandran (ISBN 1-85702-895-3). Ramachandran is a specialist in brain research and I’ve both read some his previous writings and have often seen him referred to by other neuroscientists. His particular interest is in perception which he researches from a neurological perspective. The mechanisms of perception are much more complex than they seem. Take vision for instance. Many people have a vague idea that the way we see things is by light passing through the lenses of eyes, setting off some kind of impulses down the nerve fibres which connect to the backs of our eyes (the retina, which is made of of cells called rods and cones). These signals are then sent to brain, maybe you even know that they go to an area of the brain called the visual cortex. I guess many people who even know this much think of a kind of screen on the back of the brain where the images are projected, a bit like being at the cinema. It doesn’t take long however to figure out that this can’t be right. Who’s watching the screen? And how do “they” turn what they “see” into an image? No, it’s more complicated. In fact, creating an visual image involves some 30 distinct areas of the brain all working together! Ramachandran is great at explaining this kind of thing and in his book he covers not only vision, but all kinds of perception, discussing phantom limbs, memory, emotions and beliefs. He even has a chapter entitled “The Zombie in the Brain” about some of the automatic functions of the brain that go on below the level of conscious awareness.

There’s not much new in this book. If you’ve read works by Antonio Damasio (Looking for Spinoza, Descartes’ Error and The Feeling of What Happens) and Oliver Sacks (The Man who Mistook his Wife for a Hat, An Anthropologist on Mars, Awakenings) you’ll be familiar with most of the issues explained here. However, if you’ve never read anything about perception and the brain before this would be an easy and informative place to start.

One thing that really strikes me about these neuroscientists is how important individual experiences are to them. Ramachandran declares this at the outset. He says –

“More was learned about memory from a few days of studying a patient called H.M. than was gleaned from previous decades of research averaging data on many subjects.”

Individual case reports, case studies, real peoples’ stories, are dismissed by many scientists as anecdotes (and they never mean that as a compliment!), but in cutting the human uniqueness out of research conducted on groups of people and concentrating only on what is in common, on what the statistical averages show, learning is impeded. The “Evidence Based Medicine” movement (“EBM”) has created a whole hierarchy of evidence that tends to rate what is found in common (group trials and reviews of groups of group trials) much more highly than individual experiences of patients and their doctors. I understand that this method can throw some light on the usefulness of certain therapeutic interventions but unless we consider individual experiences our understanding will remain unnecessarily limited. Ramachandran points out that if I show you a talking pig, you’ll say “how amazing!”, you won’t say “Oh yes, show me more talking pigs then I’ll be interested!”

So that’s what I liked best about this book. It is scientific, easy to read, and based on the real experiences of real people. Individual human beings are completely fascinating and their stories are frequently utterly amazing. Phantoms in the Brain is full of amazing stories and after reading it you’ll never think about perception the same way again.

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