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March – the month of strength and assertiveness

Posted in from the living room, life on March 2, 2011| 5 Comments »

March is named after Mars, the God of War, although, actually you could argue, that he was a symbol of military power for peace. I thought this was a good opportunity to focus on strength and assertiveness for the month.

I find that people commonly have disorders of the boundaries, or their defences. When it’s hard to say “no” then it’s hard to have the self-care you need in order to respond to the desires or needs of others. Learning to say “no” appropriately requires assertiveness (not the same thing at all as selfishness or the pursuit of self-interest). When we find it hard to be assertive, our boundaries are weakened and we can either become overwhelmed, or our defences can go “hyper” to our disadvantage, driving everything from irritability with others, to auto-immune reactions. It’s really not uncommon to find this is an issue in a patient with an autoimmune disorder.

By strength, in addition to assertiveness, I also mean the ability to stick at things, to be both consistent and persistent. It’s not so much a matter of trying to have power over others, or trying to control life, but more a matter of resilience, resolve and stamina.

So, why not take the opportunity to reflect on that this month? How do you feel about your own personal strength? Not your power over others, but your autonomy, your resolve, and your staying power……

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Wonder and anger

Posted in from the reading room, life on February 28, 2011| Leave a Comment »

Another great post from Seth Godin

Great innovations, powerful interactions and real art are often produced by someone in a state of wonder. Looking around with stars in your eyes and amazement at the tools that are available to you can inspire generosity and creativity and connection. Anger, on the other hand, merely makes us smaller.

 

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How do we make decisions?

Posted in from the living room, from the reading room, from the viewing room, life, neuroscience, perception, psychology on February 27, 2011| 1 Comment »

Once you learn that most of the activity of the brain goes on without either conscious awareness, or with conscious awareness only kicking after the initial response, you begin to doubt that all our choices are conscious ones…..or rational ones. In fact, the brain stem and the limbic system are the key centres for our survival responses, our drives, our avoidances, and our emotional processing. How often do we behave in ways which really can’t be understood from the premise of consciously choosing once presented with the facts? Is that how human beings function? Would that even be the best way for human beings to function? (consciously and rationally, whilst discarding other ways of perceiving, processing our experience and responding). What do you think once you learn that there is an enormous neural network around the hollow organs of the body, the heart, and the gut especially, which we might well use to figure things out….where we might process and produce what we call “gut reactions”, or “heart felt” beliefs?

I’ve stumbled on two very different texts in this area in the last couple of days. Isn’t that weird, actually? It’s that old “coincidence” thing again…..never quite got to a point of really figuring out how those “coincidences” come about, or what they mean.

A few days ago, I read about a report for the WWF called “common cause“. The report, written by Tom Crompton. Essentially it argues that if we look at the research evidence, it would seem that human beings don’t make decisions using rational thought very much. Here’s a paragraph from the Summary –

There is mounting evidence from a range of studies in cognitive science that the dominant ‘Enlightenment model’ of human decision-making is extremely incomplete. According to this model we imagine ourselves, when faced with a decision, to be capable of dispassionately assessing the facts, foreseeing probable outcomes of different responses, and then selecting and pursuing an optimal course of action. As a result, many approaches to campaigning on bigger-than-self problems still adhere to the conviction that ‘if only people really knew’ the true nature or full scale of the problems which we confront, then they would be galvanised into demanding more proportionate action in response. But this understanding of how people reach decisions is very incomplete. There is mounting evidence that facts play only a partial role in shaping people’s judgment. Emotion is often far more important [see Section 1.3]. It is increasingly apparent that our collective decisions are based importantly upon a set of factors that often lie beyond conscious awareness, and which are informed in important part by emotion – in particular, dominant cultural values, which are tied to emotion. It seems that individuals are often predisposed to reject information when accepting it would challenge their identity and values.

That’s got me thinking about the importance of understanding our values (and/or our “virtues”) again.

Then, this morning, I read a post about some interesting TED videos, and the first one was this, by Dan Airley. He makes the case that we suffer from “cognitive illusions” just as much, if not more than, we suffer from “optical illusions”. (It’s about how we make decisions. It’s VERY entertaining, and thought provoking, and it’s just 17 minutes long. Take the time to watch it)

 

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in praise of “and”

Posted in from the living room, life, philosophy on February 22, 2011| 2 Comments »

I was going to title this post “And not or”, but then I realised that very title was falling into the trap which “or” always poses – it divides. The General Semanticists talk about “two value thinking”. Others say this tendency to categorise into two categories is “digital” thinking, in the sense of “on” or “off”, “1” or “0”. Of course we are often faced with such simple choices in life – “go left” or “go right”, “stay home” or “go out” and so on. The drawback of “or” comes when one of the choices is rated as “right” and the other as “wrong”. When that happens, the digital choice is reduced to only one option – the RIGHT one, or as Mrs Thatcher famously said, “There is no alternative”. We see this in health care in the dangerous distortion of “evidence based medicine” to create a digital rating system – treatments “which work” and those “which don’t”, which is then extrapolated to those treatments which should be made available and those which should be withdrawn. In so many instances this is a delusion. Most drugs don’t do what they’re “proven” to do for most of the people who take them.

So, what’s the alternative?

“And”

This insight has emerged from the internet, but applies to everything which could be considered using networks as a conceptual framework. On the net, you don’t have to think, will I publish my work on “Flickr” of “Blipfoto“? Will I “tweet” or post on “facebook“? Will I blog, or will I “stumble“, or will I “posterise“? You can do them all, link them all, and communicate much more widely than I could if I had to choose only one, and discard the other options.

But “and” has another great power. Instead of considering a reduced set of information, say, for example, from using “the scientific method”, we can also consider the perspectives brought from subjective experience, from cultural mores, from both individual and group perspectives and so on.

Think of Deleuze’s three ways of thinking – science – thinking about function; philosophy – thinking about concepts; art – thinking about percepts and affects.

Think of Wilber’s “Integral Theory” with it’s elegant four quadrants.

Think of the benefits of truly multidisciplinary working where all the disciplines bring relevant insights.

I much prefer “and” to “or”, and I rarely believe Mrs Thatcher’s “There is no Alternative”. Alternatives are always there. We just need to open our eyes to see them.

Here are two songs about “and” and “or” – I love them BOTH.

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Irreducible

Posted in from the living room, life, neuroscience on February 6, 2011| 2 Comments »

Are you well? How’s your energy? If I were to ask you to rate both your well-being and your energy on a ten point scale where 0 is the worst level you could imagine and 10 is the best, what numbers would you give me right now? You’re able to do that. Instantly. But how do you do it? You don’t check your blood pressure, your pulse, your blood sugar etc etc. You assess it holistically. It’s not actually possible to reduce your well-being or your energy to any single element. Yes, of course, individual elements play a part. They are factors, and influences. But your well-being cannot be reduced to component parts. The moment we reduce a human being to a part of a human being we don’t know that human being any more. Maybe we can know how much haemoglobin they have in their red blood cells, but we don’t know them.
There’s a similar thing happens when people say to me when someone gets better, what is it that got them better? Patients regularly say after an admission to our hospital that it was “the whole package”, or “the way everything fitted together”, or they’ll say it was the rest, and the physio and the way they were listened to, and…and….and. It’s not reducible.
What’s our obsession with breaking things down into pieces? According to Ian McGilchrist it’s because our left hemisphere works that way. It abstracts, selects, and then re-presents information to us. Our right hemisphere however processes the world more holistically. Its main focus is the world as it is, without filtering, selecting and re-presenting.
The moment we select only a part of something, we see only what we’ve selected. Some people seem to think if you examine a part of the whole you’ll get closer to the truth. Actually, you get further away.
Maybe it’s time we engaged our right hemispheres more, and quieted down that noisy, rather arrogant left hemisphere.
Health is not reducible to component parts.
Human beings are not reducible to component parts, not even genes.
We should stop treating patients as if they are only the containers of parts, and deluding ourselves into believing we know exactly what produces healing and wellbeing. We don’t.

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February, the month of love

Posted in from the living room, life on February 2, 2011| 1 Comment »

february love

In my monthly themes, taking the mid-point of February (14th) as my inspiration, I’ve allocated the them of love to the month.

This photo is one I took in France last year and it’s the moment where I caught the light of the sun shining directly down on this couple holding hands.

I know we celebrate Valentine’s Day on the 14th, but why not take this as your opportunity to share acts of loving kindness all month long……?

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You only die twice

Posted in from the consulting room, from the living room, health, life on February 1, 2011| 1 Comment »

John Barry died this week. When you hear just some of the film soundtracks he composed you can’t fail to be impressed. His music is instantly recognisable, not least the Bond film music, Born Free and Out of Africa.

You could argue that through his music, John Barry will live on. Last week, in Scotland (and elsewhere), we celebrated the birthday of Robert Burns. He died in 1796 but in some way, he’s still around. His words, his ideas, the feelings and experiences which were unique to his life, continue to be accessible to us many years on.
I was recently reading about Lacan’s concept of the three realms, or worlds, the Imaginary, the Symbolic and the Real. It occurred to me that there’s something in that model which helps us to understand death (and therefore life) differently. If the Real is all that is, as it is, unfiltered and unprocessed, then it doesn’t take much thought to understand we can never fully know the Real. We process the Real through our sensory organs, our bodies and the activities of our brains, and in so doing, we experience only a small fraction of the totality of all that is at any given moment.

We only experience a small fraction because, first of all our sensory organs are only able to detect portions of reality (bees for example are able to see ultraviolet portions of the electromagnetic spectrum which our eyes are unable to detect, and dogs can hear tones well outwith our detectable range), secondly we only become aware of a portion of what comes through our sensory organs (we can’t pay attention to EVERYTHING at once), and, thirdly, we then use language and other ways of naming and symbolising all of that information to interact with it. From this perspective, each of us experiences a Symbolic world – our abstracted, selective, processed part of the Real.
Enough of that for now…….taking this model though we can see that there are two ways to die. There is the death of the physical body, and there’s the death of the Symbolic self. In the cases of Barry and Burns, the Symbolic self lives on well beyond the death of the physical body.
I recently saw a patient who is clearly experiencing these two deaths the other way around. Due to a progressively degenerative disease, this person has become unable to continue working in a job which gave them a powerful sense of who they were, and with further decline they have become housebound and socially isolated. Bit by bit, they’ve experienced a death of the Symbolic self, whilst the body lives on, albeit in significantly deteriorated form.

A way forward in this situation is to encourage and support reconnection to others, to Nature, to the sense of “emerveillement” which is always possible in the here and now. In so doing, the hope is to re-invigorate the Symbolic self – our personal experience of reality.

We do die twice, but it’s possible to nurture and to develop the Symbolic self, at least to the point of physical death, but with sufficient creativity, to well beyond that particular event.

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The Wisdom of Robert Burns

Posted in from the reading room, life, tagged on January 26, 2011| 2 Comments »

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

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

Still thou are blest, compar’d wi’ me

The present only toucheth thee:

But, Och! I backward cast my e’e

On prospects drear!

An’ forward, tho’ I canna see

I guess an’ fear!

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

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

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

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It’s 2011 and I’m back….

Posted in from the dark room, from the living room, life, photography on January 11, 2011| 1 Comment »

Happy New Year! I know, I’m a bit late, but, hey, I haven’t been well. Back to health now, though, so time to start blogging again.
Some time back I was learning a bit of Japanese, and was amazed to discover that the words for the days of the week had the same root as the French words for the days of the week. To cut a long story short, I discovered that in multiple cultures and languages we name the days of the week after the sun, the moon and five planets. Not only, the same five planets, but across cultures exactly the same ones for each particular day (Monday is associated with the Moon, Tuesday, the planet Mars, Wednesday, Mercury, Thursday, Jupiter, Friday, Venus, Saturday, Saturn and Sunday, the Sun – it’s less clear in English as we’ve swapped the planet names for Norse Gods on Tuesday through to Friday). Given the rich symbolism of the planets for human beings I thought it would be interesting to explore how the actual name of the day might influence our experience of that day (I’m not talking astrological influences here, but semantic ones). I then wondered about the months of the year. What’s the naming pattern behind the months? Are they planets too? The answer turned out to be immensely unsatisfying – it’s a mess! Some are named after Greek or Roman Gods, some Roman Emperors and some after a number – and not even the right number out of the twelve possible ones for a year of twelve months!
So, I thought, why not come up with a symbolic, or semantic marker for each of the twelve months? I could then interact with that throughout the year.
Here are the twelve themes.
So we start the year in January, named after Janus, who looks forward and backwards at the same time. Janus, the god of gates and gateways. It’s the month when people reflect on the year gone by, and resolve to do something different in the year to come. In other words, it’s a time for both assessing where you’ve got to and having some thoughts about where you might be going.
Here’s my image for this month.

january goals

It’s a photograph of a sculpture at the Gallery of Modern Art in Edinburgh. The sculpture looks like goalposts, so it made me think about the whole notion of having goals (something I’m pretty ambivalent about to be honest – I see their value, but think they can be overdone). When I took this shot, I was struck by how the sculpture framed the little tree and the idea of planting a seed, and nurturing it to full blooming was an even more appealing image for me.
So here it is, the combined ideas of a gateway, to pause and look back before venturing forth, of goals or targets or hopes, and of seeds planted with a vision to work towards, to nourish, cherish and bring to fruition.
I hope some of these ideas, and this image, might colour your January.

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Connections: wintering

Posted in books, creativity, from the consulting room, from the dark room, from the living room, health, life, photography on December 27, 2010| Leave a Comment »

I finished reading William Fiennes, The Snow Geese, this morning, then as I looked out of my window I saw this sight

flying south

I followed them round to the other side of my house….

flying south

I don’t really know what to make of these “coincidences” in life, but they certainly heighten the sense of emerveillement in le quotidien……

I really enjoyed ‘The Snow Geese’. It’s one of those books I’ve had lying around for a long time, but only recently decided to read. It has that wonderful combination of beautiful writing and fascinating, thought provoking facts, which I love. The main themes of the book, based around the writer following snow geese as they head north to their breeding grounds, are about freedom, our connection with nature, and the strong instincts to head home (migratory birds have two homes really…..one for the summer and one for the winter).

What I didn’t expect to find were some references to homesickness from a medical perspective, and, given that I’m a doctor, it should be no surprise that those passages leaped out at me.

Baron Dominique Jean Larrey, Inspector of Health of the French armies under Napoleon [described nostalgia in the following terms] First, an exaggeration of the imaginative faculty: patients thought of their homes as enchanting and delightful, and expected to see relatives and friends advancing towards them. Second, the appearance of physical symptoms: fever, gastric disturbance, ‘wandering pains’. Finally, depression, listlessness, weeping, and sometimes suicide.

How fascinating to see this holistic description and understanding, beginning with an individual’s inner, subjective, mental processes, leading onto whole body dysfunction with specific disorders in certain organs and systems, then progressing to a life-threatening state of mind. What cures did such doctors suggest? Larrey recommended distraction – through “music, recreation and regular exercise”.

In 1858, James Copland, in his ‘Dictionary of Practical Medicine’, described nostalgia as a cause of disease, rather than as a disease itself (where does a disease begin? Can you really say where health gives way to disease?) However, he still considered it to be a serious problem.

The patient nurses his misery, augments it until it destroys his nightly repose and his daily peace, and ultimately devours, with more or less rapidity, his vital organs.

Fiennes quotes from a 1996 edition of Psychological Medicine ….

What strikes one most in the sparse literature on help for the homesick is that often only returning to the old home environment brings real relief.

Well, well, well…..how often is it the case that the solution to a problem is to deal with the problem?! I know that seems obvious, but if it’s so obvious why do we persist in using drugs which merely mask symptoms as first line treatments for so many problems?

I’m particularly struck by the holistic, contextually bound understanding of the nature of homesickness in these works. How have we allowed the practice of medicine to decline to its currently dehumanised, mechanistic form? A doctor must understand the narrative context of a patient’s illness to arrive at a correct “diagnosis”, not just hunt a lesion and divide illness into real or imaginary, organic or functional. A person can only be fully understood as a whole person, body, mind and spirit, inextricably embedded in their unique physical and semantic environments……and, so, “cures” should be based on this perspective rather than the diminished, reductionist one, shouldn’t they?

We are connected. Intimately, complexly connected. ‘The Snow Geese’ reminds us how connected all creatures are to their environments and to the rhythmic change of the seasons. Good to be reminded of that in this snow and ice bound December in Scotland.

How are you going to spend your wintering?

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