Feeds:
Posts
Comments

Archive for the ‘life’ Category

Who am I?

Posted in from the reading room, life, narrative on July 21, 2007| 5 Comments »

It is that loving you as much as I have been able to manage has defined the person that I am. That is who I have become.

Sebastian Faulks. Human Traces.

How do we gain a sense of self? How do we answer the question “Who am I?” It seems to me that we gain a sense of self through the stories we tell ourselves and others. It’s a narrative process and it’s an always unfinished, creative process. We are all unique. Every time I conduct a clinic I meet new patients. Never once have I heard a patient tell me the exact story I’ve heard before. Everyone has a new, unique narrative. But this implies that the creation of a sense of self is all internal. It isn’t. We create a sense of self through our boundaries, our connections, our interfaces and interactions. We create a sense of self through our experience of love – its presence, its absence, its possibility, its loss.

Loving you, I become me.

Read Full Post »

The evolution of heroes

Posted in books, from the reading room, life on July 21, 2007| Leave a Comment »

Evolution is a passage from the most automatic to the most voluntary.

Sebastian Faulks. Human Traces.

The zombie life is the automatic life. Becoming the hero of your own personal story involves developing awareness and making more and more conscious choices.

Read Full Post »

traces…..

Posted in books, from the dark room, from the reading room, health, life, photography on July 21, 2007| Leave a Comment »

ripples in the sand, originally uploaded by bobsee.

Then the long trail of her footprints, stretching back towards the sea, became slowly indistinct as each one filled with water and edged in upon itself; and in a matter of minutes, as darkness began to fall, the shape of the foot was lost at every place until the last vestiges of her presence were washed away, the earth closing over as though no one had passed by.

Sebastian Faulks. Human Traces

Read Full Post »

Human Traces

Posted in books, from the consulting room, from the reading room, health, life, neuroscience on July 21, 2007| 6 Comments »

Human Traces by Sebastian Faulks (ISBN 978-0-099-45826-5) is a novel of ideas. Set in the late 19th, early 20th century it tells the story of two young men who become idealistic doctors, determined to work together to understand mental illnesses so that they can cure them. In addition, they hope that in understanding the interface between the body and the mind they will understand what it is to be human.

I found it really absorbing. Much of the discussion was around subjects which are very familiar to me – consciousness, the relationship between the body and the mind, the debate about whether mental illnesses have neurological bases or not, and the still young area of evolutionary biology. However, as a doctor, the book has additional relevance. After all, my experience is also one of idealism and hope; the belief that doctoring will be about curing, and the gradual erosion of that to aim at managing diseases instead of curing them (that last is a painful loss – for sure, doctors have cures for many acute diseases now, but the burden of illness is chronic disease and, sadly, we seem a long way off from finding genuine cures for those)

Sebastian Faulks floats an incredibly interesting hypothesis about the hearing of voices, having one of the characters, Thomas, propose that this was a facility that all human beings possessed but which has since been lost by most of us. He cites the literary evidence of Man’s relationship to God/gods where the earlier stories show people hearing voices which they obeyed – they experienced the daily reality of their gods; and later stories showing that people no longer reliably heard those voices and had to throw lots, examine entrails, find unusual characters (prophets) who could still hear the voices, in order to know what the gods wanted. He links this idea to the emerging concept of evolution and natural selection by proposing that the hearing of voices was linked to the development of consciousness and the loss of the voices was related to the development of self-awareness through the acquistion of language. If you are not familiar with any of these ideas this novel is a great place to introduce yourself to this area of thought.

However, this 609 page novel did not engage me emotionally……..until page 595. From page 595 to the very last word of the novel, it hit me like a sledgehammer. I didn’t just cry. I sobbed. I was totally unprepared for it. This is quite honestly one of the most powerful pieces of writing I’ve read. Maybe it hit me so hard because it touched so many issues which lie in the core of my being – what is it to be a doctor? what use am I to others? how do we get a sense of self and how does it feel to lose that to an illness like dementia? what does it mean to become invisible? and, ultimately, what trace do I leave on this Earth?

There are a number of phrases and passages which have stimulated a whole lot of things for me, and I’ll return to post about some of them separately.

Thought provoking, educational, well-written, and, ultimately, powerfully emotional.

Highly recommended.

Read Full Post »

Becoming a hero…..slowly

Posted in from the consulting room, from the reading room, health, life on July 19, 2007| 6 Comments »

I read a great post on the SlowDownNow.org blog. In it Christopher Richards describes his experience of being looked after by a doctor who took his time, then his experience of trying to find a new doctor after this first one had retired.

I’m pretty sure we’re losing something really important with our current round of NHS reform. And its something related to speed. Sure you need fast, effective treatment when you are acutely unwell, but the surgeon or physician who is tending you still needs to take his or her time and not rush things or the job just won’t get done properly. However, the big demand in health care these days is chronic disease and here we really have been looking for quick fixes at the expense of taking our time to listen, to understand and to enable patients to adapt, to grow and to enlarge their lives in the presence of their diseases.

An American sociology professor, Arthur Frank, wrote “The Wounded Storyteller” (ISBN 0-226-25993-5) to describe his study of how patients talk about their illnesses. He identified three major “genre” of narrative – the “restitution” one – which is the quick fix approach to health care (“A bit of me’s broken. If you could just fix it or replace then I’ll be on my way”). This is appropriate in much urgent and acute medicine but is really of no use in chronic illness or in enabling patients to become genuinely healthy. He proposes that doctors should help their patients to create new narratives – “quest narratives” based on the principles of Joseph Campbell’s work on the structure of myths and legends (otherwise known as Hero stories).

That very process entails a shift from the quick, the immediate, the partial to the slow, the lasting and the whole.

I wrote here about countering Getting Things Done with Dolce Far Niente, and here about finding the spaces where you can relax, and here about becoming aware of the gaps in our experience.

What ways do you slow down?

Does slowing down improve your quality of life? Give you time to reflect, re-charge, and to grow?

Read Full Post »

Why your uniqueness matters

Posted in from the reading room, health, life, science on July 19, 2007| 4 Comments »

The Guardian today has an article about a research paper published back in May in the British Journal of Psychiatry. There are more and more attempts to control the future in our society. Predictive statistical models are increasingly being used by everyone from supermarkets (to “target” their marketing to you on the basis of what they think you might like to buy), to social work (to give special help to young mothers who they think might give birth to children who will become criminals), to the criminal justice system (to try and predict re-offender probability), to (my main area of interest) health care (where the experience of groups is used to determine what interventions an individual should or should not recieve – so called “Evidence Based Medicine”).

The paper discussed in today’s Guardian shows that the margin for error between the group studies and individual outcomes is so great that –

When applied to individuals the margins of error are so high as to render any results meaningless.

Almost every day I have a discussion with patients about risks and choices. I always emphasise that the statistical predictions are based on groups and averages and that there is absolutely no way of knowing to what extent they are relevant to this individual.

We are all different. Nobody, but nobody, can tell an individual what their future holds and to pretend they can on the basis of statistical modelling which isn’t up to the job is potentially very harmful.

This heroes not zombies site is about encouraging people to become aware, to think, and to develop their uniqueness. We need to celebrate individuality and difference more and we need to understand that people matter more than statistics – especially in social work, justice systems and health!

Read Full Post »

GTD or DFN?

Posted in life on July 14, 2007| 6 Comments »

You’ve heard of GTD haven’t you? It’s everywhere on the web (3,260,000 hits if you google it!) It stands for “Getting Things Done” and was invented by David Allen. Put simply, its a system to try and help you beat procrastination and clutter by focussing on actually doing what needs done instead of just thinking about it and hoping that one day you might get round to it. The basic idea is a good one – that things that need done but which you haven’t done yet clog up your brain like clutter clogs up your house. However, as with all “systems”, (especially ones which get trademarked), it all gets a bit too complicated for its own good. Zen habits is a personal organisation blog which I like and here you’ll find a simplified version of GTD.

I confess. I love notebooks and pens and diaries and calendars so this whole thing catches my attention. I’ve even read the book! More than that, I’ve changed my home filing system to the simple one he suggests and I try pretty regularly to action or file the pile of mail that heaps up on my kitchen windowsill – clearing that windowsill is a strangely life-enhancing experience!

But I’ve been on holiday for the last week and as I’ve had a busy week of NOT Getting Things Done (NGTD), an Italian phrase popped into my head for some reason –

Dolce Far Niente

First time I saw this I wrote it in the front of my then current Moleskine. In English it would mean “Doing sweet nothing”. I can remember when I was a busy GP rushing from surgery to housecalls and cutting through Holyrood Park. I would often see someone sitting on one of the park benches. Just sitting. And I’d think “How wonderful! To be able to just sit! No bag. No phone! Just sitting!” That’s one version of “Dolce Far Niente” (DFN). You can make up your own. What’s your favourite way to enjoy doing sweet nothing?

While thinking about this post I came across this painting by John William Godward

It’s entitled “Dolce Fa Niente”

Dolce Far Niente

Read Full Post »

Repair, Recovery and Resilience. The Three Rs of Health

Posted in from the consulting room, health, life on June 29, 2007| 4 Comments »

rrr.jpg

Here’s a diagram I drew last night.

This works for me as a symbol of what health care should do.

In the middle we see the symbolic representation of a person. All health care should be focussed on the individual. It’s this person with me today who needs my attention. It’s this person in their uniqueness who needs to be understood and cared for. It’s the whole of this person who is with me today (not just the bit of them that’s not working!)

There are three Rs –

  1. Repair
  2. Recovery
  3. Resilience

Most treatments are directed at repair. Dilating constricted airways, reversing spasm of arteries, killing infecting organisms etc. But we only become well again by recovering from an illness. If we have an infection then an appropriate antibiotic might kill the bacteriae but it’s our body’s processes of healing and recovering which restore our tissues and our whole beings to health. The processes of recovery are not so well understood and very few medical interventions claim to stimulate or enhance recovery, but we see reports like this which show that the patients’ emotional state influences recovery for example and some research has shown that the physical environment in which a patient is nursed influences recovery. In other words, recovery is not about just dealing with the disease, recovery is about addressing the whole person in the context of their environments.

Finally, after recovery, can we do anything to reduce the chances of this person falling ill this way again? Can we increase their resilience? So much of preventitive health these days is a technical fix – drugs – drugs to lower blood pressure and cholesterol for example – but the best way to be healthy and to stay healthy is to be more resilient – and that involves not just the physical body but the whole person in the context of their life. Not so much is understood about resilience and very, very little exists in health care to specifically address and enhance an individual’s resilience.

Wasn’t it Benjamin Franklin who said

God heals and the doctor takes the fees

Well, that’s not good enough any more. We need more research to understand the processes of recovery and resilience and we need to ask the question of health care – how does this intervention address the patient’s needs for Repair, Recovery AND Resilience? And if the intervention ONLY addresses repair, then what else are we going to do to address both Recovery and Resilience? Because without addressing these needs we are fighting a continually losing battle of repeated repairs.

When the NHS was created in the UK, the Labour government genuinely believed that providing health care for all would so improve the health of the nation that the costs of the service would fall year by year. It never happened. Quite the reverse. Why? Because they created a National Repair Service, not a National Health Service. (well, that’s part of the reason, another part is that health is a much more complex phenomenon than can be addressed by a health care service – poverty, housing, sanitation, education and work and so on are HUGE influences on health experience too)

There’s one final element to this little drawing. The circle around the person. This represents understanding that we need to address a whole individual within the context of their life, and also represents that a person needs cared for by a circle of carers. Health including recovery and resilience is influenced by that complex network of individuals – professionals, friends and relatives who surround the person.

Fundamentally, though, the circle represents CARE – nobody really gets better unless someone cares for them. All health care should be delivered by people who CARE.

Read Full Post »

Horizons and the size of a life

Posted in from the consulting room, from the reading room, health, life, photography on June 28, 2007| 2 Comments »

I’ve just started reading Sebastian Faulks’ Human Traces. On page 21 this sentence struck me

Do we already possess all we need to stop feeling the world as the sound of footsteps and the ache of our backs and to look up – to the woods and the hills and the oceans that stretch out in their immensity, just waiting to be seen?

I’m in the habit of drawing simple little diagrams to explain things to patients. I draw one which is just a circle. I say “This circle represents your life”. Then I draw a much, much smaller circle inside the first one and I say “When we have chronic pain, or sadness, or breathlessness, or stiffness, or whatever, our life becomes much smaller. Maybe we can’t go out so much. Maybe we can’t face other people. Maybe everything loses its joy. It’s necessary to do this to survive sometimes. We all need to feel safe before we can grow. If the treatment I’m going to give you works it’ll reduce your symptoms and stimlate your body’s natural healing processes and so let you begin to look up and start to see that you can move outside of this constricted, safe zone, and as you do, your world will start to get bigger and more enjoyable again. Then we’ll know you are getting well.”

We don’t grow with our heads down. We grow when we look “to the woods and the hills and the oceans that stretch out in their immensity”

These are the hills I see from my bedroom window

Read Full Post »

A site called TED

Posted in education, life, photography, science on June 28, 2007| 2 Comments »

If you haven’t discovered it yet, take a look at http://www.ted.com

There are loads and loads of interesting, educational and entertaining videos of presentations and talks.

Start here.  This is a talk by Frans Lanting, a wonderful nature photographer. It’s a slideshow of his own photos that he’s put together and narrates to tell the story of LIFE, of evolution, of how LIFE is about continual becoming (see that “becoming not being……” byline at the top of my blog? You can see why this talk appeals to me).

The photos are just stunning.

Read Full Post »

« Newer Posts - Older Posts »