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Archive for the ‘narrative’ Category

illuminate

One day, I stepped out through the back door of the cathedral in Segovia and onto a large paved terrace surrounded by stone lions. When I turned to look back towards the tall arched doorway I noticed that the plain glass doors which hung in the doorway perfectly reflected the buildings across the street. I took a photo.

When I loaded up the photo later I noticed that there were some strange lights above and on the roofs and when I zoomed in I saw more clearly that behind the reflection of the tiles and the satellite dishes some of the cathedral’s stained glass windows shone through the glass door.

That got me thinking……

For centuries the church has created images and told stories to convince people what the world is like, what life is like, and how we should live. With captivating art and gripping stories it presented a particular view of the world. More than that, really, because in presenting that view and spreading it so widely, it created a reality for the people who lived in it.

But look at those satellite dishes.

Who is creating the images and the stories now? Who is telling people what the world is like? What life is like? And how they should live?

Who is presenting a view of the world and spreading it so widely, that it’s creating the reality for us who live in it?

With the rapid development in communications technology, with powerful mobile phones, connected computers, the internet, social media, memes, images and videos which “go viral”, some writers say we have created a whole new layer of the environment in which we live – the “noosphere” (the sphere of human thought).

The truth is we’ve always had a noosphere. We’ve always lived, we humans, within this environment of human thought.

There are image creators and story tellers who fashion the patterns of thought in this noosphere, and in so doing, they influence many others. They create the reality we experience.

But we have a choice. We can be the image creators and the story tellers, or we can be passive consumers. If we choose to be passive consumers, whose world, whose idea of the world, are we choosing to live in?

If we choose to be the image creators and the story tellers, what images shall we share? What stories shall we tell?

Are we going to live as zombies or heroes? Let’s co-create the world we want to live in. Let’s “be the change [we] want to be”.

I think it’s time to resist, to refuse to accept the world view which is responsible for massive inequality, injustice and suffering through the promotion of selfishness, division and greed.

We can make a better world than that. Can’t we? Let’s share our images of beauty, truth and goodness. Let’s share our daily delights and our experiences of awe and wonder. Let’s tell each other our stories of kindness, love and generosity. And let’s promote the world view that we are all connected and interdependent in this one, small planet we call Earth. Let’s share our attempts to adapt and live sustainability so we can co-create a better future for our children and grandchildren.

Shall we?

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It strikes me that the practice of Medicine (I’m specifically referring to the world of Medicine for humans here), begins and ends with a relationship between human beings.

I’ll just focus on the doctor-patient relationship here, because that’s how I spent my working life. But I suspect that much of what is relevant to this relationship is also true for other health care workers, and perhaps even in other areas of human life.

When I say the practice of Medicine begins and ends with a relationship between human beings, I mean that the whole, unique person who is the patient has to be understood, cared about and attended to, by the whole unique person who is the doctor. Both individuals are important. I think this is partly why there are no doctors who are the best doctors for everyone, and I think it explains how in a group General Practice, each of the doctors in the partnership will have a specific loyal cohort of patients who always seek a consultation with that one particular doctor.

I also think this means that the whole person must always be considered. Anything less is reduced, and anything reduced is less than human.

In this context, I recently read “A General Theory of Love”, by Drs Thomas Lewis, Fari Amini and Richard Lannon. [ISBN 978-0-375-70922-7]. This book describes the model of the triune brain, which you might have come across elsewhere. (My introduction to that model was Dan Seigel, and later, Rick Hanson). It’s the observation that we have three brain regions – the brain stem, which is responsible for survival, and is found even in reptiles (henceforth to be known as the “reptilian brain”), the limbic system, which is responsible for memory processing and emotions (called the “mammalian brain”, because all mammals have this part), and the neocortex, which is massively developed in humans and seems to give us the capacities for abstract thought, conscious decision making and rational analysis.

In “A General Theory of Love”, Thomas Lewis and his colleagues focus on the limbic system – they describe in detail how this part of the brain helps us to “feel” other people’s feelings. It’s the kind of phenomenon that others call “heart feelings”. Without this part we’d have the reptilian survival strategies or the cold, analytic distancing of the neocortex. Let me be really clear here – this is a simplification and human beings are a lot more complicated than that. But this is a useful simplification which clarifies certain truths about what it is to be a human being.

In this post, I want to just bring to your attention some of the points the authors make when taking this perspective on the practice of Medicine, because I think health care is in a dire and degenerating situation in the world.

The last century saw a two-part transformation in the practice of medicine. First, an illness beset the relationship between doctor and patient, then radical restructuring attached the residual integrity of that attenuated tie.

I think the illness and the radical restructuring they refer to developed from a general reductive de-humanising of health care. Iain McGilchrist has shown how a “left hemisphere approach” has come to dominate society and I find that explanation helpful. Lewis says

American medicine has come to rely on intellect as the agency of cure. The neocortical brain has enjoyed a meteoric ascendancy within medicine even as the limbic star has fallen into disfavour.

Whilst this focus is a little different, the basic point is actually the same. By coming to rely on data, figures, statistics and techniques, we have reduced the human-ness of medicine. We’ve increasingly denigrated the patient’s narrative, the individual’s subjective experience, and the place of heart felt caring.

The limbic brain has a crucial role to play in attachment, and Lewis describes attachment theory along with the physical and social consequences of disordered attachment incredibly clearly. And here’s one of the most important points in this book – the physical reality and hence importance of relationships, emotions and attachment –

Medicine has lost sight of this truth: attachment is physiology

The radical restructuring they refer to is seen throughout Western Medicine – its the rise of bureaucracy. We see it in the proliferation of protocols and guidelines, of the prioritisation of measurement – what others have referred to as “Taylorism 2.0” (the modern equivalent of Taylor’s “scientific management”) – at the expense of what cannot be measured – the lived experiences of the patients and the health care workers.

Good physicians have always known that the relationship heals. Indeed good doctors existed before any modern therapeutic instruments did…

For many years, the medical community hasn’t believed that anything substantive travels between doctor and patient unless it goes down a tube or through a syringe.

They neatly sum up their thesis with

medicine was once mammalian and is now reptilian

Corporations and organisations have taken the high ground imposing their limits, their rules and regulations on those who try to care.

A corporation has customers, not patients; it has fiscal relationships not limbic ones.

The use of terms “customers”, “clients” and “consumers” in the area of health care has always disturbed me. Now I think I understand more clearly why!

I concur with this conclusion –

Before it is safe to go back to the doctor, a mammal will have to be in charge. And before that can happen, our physicians will have to recapture their belief in the substantive nature of emotional life and the determination to fight for it.

I’m not sure I’ve heard any politician, manager or profession leader say this so clearly – the problems facing health care are not ones of efficiency, targets and “better” guidelines. The problem is we need to make health care more human.

We need Medicine based on love, care and attention….where the heart is the keystone.

 

 

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Does the sky ever surprise you?

That’s a trick question really, because if it doesn’t, I have a hunch that you’re not looking!

The sky often surprises me. Sometimes it catches my attention because it is blue from horizon to horizon, or it is covered in fast moving, rapidly shape-shifting clouds, or because it catches fire and turns crimson as the sun sets. But other times it’s because something appears which I’ve never seen before.

This sort of rainbow is one of those. Two of them appeared at the same time, but in different parts of the sky, a couple of days ago. I guess it’s not really a rainbow because it isn’t a bow and it wasn’t raining! Perhaps it is more like what you would see if light is passed through a prism.

Given the age I am, it might not surprise you that when I think of light passing through prisms I think of the cover of Pink Floyd’s album, “Dark Side of the Moon” (google it, if you don’t know it)

I have a fascination for kaleidoscopes and one day I was in Kyoto and it started to rain quite heavily. We noticed that the building we were passing was called “The Museum of Kaleidoscopes” so we dashed in to get out of the rain. When we signed the visitors book and put our country of origin as “Scotland” the staff all gathered around and excitedly welcomed us. It turns out that the inventor of the kaleidoscope was a Scotsman, Sir David Brewster. Ha! Who knew? Not us! Well, I’ve never seen so many different types of kaleidoscope in my life, and if you ever visit Kyoto, I recommend a visit to that museum. I bought a couple of different types while I was there and I still enjoy looking through them, watching the patterns change before my eyes.

Well, those are some of the thoughts which came up for me as I looked at this colourful, but pretty subtle, display in the sky.

As I look at the image again now it seems that the colours are pouring out of a spout-shaped cloud – and one of my friends said it looked like a rainbow genie escaping from a bottle!

Ooh, I love that! So, have a look at this rainbow genie and make a wish. Let’s see this as a good omen, a symbol of hope, a sign of better days ahead.

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At one point in my life I was reflecting on what I was trying to achieve as a doctor. Maybe that seems an odd statement to you, but I think we fall very easily into routines and paths which we then “live” largely unconsciously. That’s what’s behind my “heroes not zombies” blog title. Whether it’s about saying “an unexamined life is not worth living”, or it’s simply about wanting freedom and autonomy, I’m wary of the automatic pilot approach to life. I want to be aware, to understand and to consciously choose, as much as I can. I want to move from being a zombie, controlled by hidden, and some not so hidden, forces, to being the hero of my own story – the main character, the subject, the one who is living this life.

I’m sure we all go through cycles and phases of self-reflection. For many people there is a peak of this around the age of 40, but, really it can happen any time and at any age. I believe it’s a good thing to pause and reflect from time to time. I think that’s essential to our personal growth.

So, as I reflected on that question which would appear to me from time to time – “what does a doctor do?” – I looked at a spider web like the one above, early one morning as the dew drops sparkled on it, making it all the more beautiful, and revealing both its presence and its structure. What struck me was that whilst there were many elements coming together to make this web appear as it was, that morning, one element, light, suddenly seemed the one I wanted to focus on.

As I played with the words we use which are based on light, I hit upon three which I thought captured some of the most important aspects of my job.

Lighten. In all cases, I saw my job as trying to lighten other’s load. Maybe this was the first, and most important, part of all that I did. My job was to alleviate suffering. When someone left my consulting room, their life should feel a little lighter than it was when they entered. Certainly, it shouldn’t feel darker, and it shouldn’t feel heavier. Even when I’d had to give news of a serious disease. Giving news wasn’t enough. I needed to lighten the burden of that news by increasing how much the person understood, helping them to make more sense of what was happening, and helping them to realise that they were cared for, that they weren’t alone with this.

In fact, “diagnosis” is a big part of that. To me, diagnosis is not simply an act of labelling and categorising. It’s an act of understanding. It’s taking the messy chaos of experience and saying “I recognise this pattern” “I know what’s going on here”. What I found, time and time again, was that the very act of diagnosis lightened the load. Almost universally people start to feel better once they have a sense that they know what they are dealing with. Understanding, in my experience, shines a light.

Brighten. But then I thought, that’s not enough. Well, maybe it’s enough for some people who will go off with their new understanding and deal with it in their own way, but for many patients, I could do more. I could start to relieve the suffering, but I could also begin to help them build the positives in their life. I could help to actually brighten their days, both by giving reasonable hope, and by establishing an ongoing relationship of care focused on identifying and supporting their inner strengths, and teaching, coaching and enabling them to begin to grow in the light of this illness. This was a kind of turning a negative into a potential positive, because I’d find that for many of us, an illness was telling us something. It was suggesting that we should change something. And that required a development of strengths and skills.

Enlighten. In some cases, that work went to a whole other level. Someone would get nothing short of a revelation. They would suddenly understand the origins of their suffering, and they would gradually become aware of their own thought patterns, their own behaviours, and of the conditions in which they were living which were impacting on them so adversely, and they would say “That’s it. I’m changing.” Not just they would change some habit or other, but they would change direction. Get out of a toxic relationship. Leave a soul crushing job. Enter into education or training, or take the leap to begin something their heart had longed for, for many years. It was like they had a sudden enlightenment and said “I’m not going to live my life this way any more. I’m going to choose this other path instead”.

So, there I had it. My three light-based verbs. Lighten, brighten and enlighten. And of course, what happened from there? I applied those same three verbs to myself. That’s how I made the biggest changes in my life…..seeking some understanding which would lighten my load, turning towards positives, strengths, and emotions like joy, awe and wonder to brighten my days, and thinking outside the box I’d built, to change direction in the bright light of enlightenment.

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Look at this amazing pattern left on the sand by the action of the water after the tide has gone out again at the beach.

When you look at this you know immediately that the sand has been shaped by the water, although, to be honest, I don’t understand how water manages to make such intricate patterns like this on the sand. Maybe somebody does!

There are other striking patterns on the wet sand at the beach, some clearly made by plant material, seaweed I expect, and some obviously from the imprints of shells, some little worm-shaped piles caused by burrowing creatures throwing up the sand behind them, and often many footprints of birds which have run across the beach.

What impresses me most about all these patterns is that they are the traces left by some activities which occurred a little while ago. They are the evidence of the past imprinted on the present. That reminds me of how we are shaped by the events and experiences of our lives. Our encounters with others change us. Our experiences don’t just create memories, they set up patterns of chemical, electrical and cellular response in our bodies.

We can become aware of some of that in bodily changes, from tightenings of muscles, to changes in heart rate and breathing, to sweating and trembling, and so on, usually before we are even aware that we reacting to something.

I spent much of my career working with patients who had chronic, long-standing illnesses, and we could often make some sense of what was going on by teasing out the threads and themes which ran through their stories over many years. It certainly wasn’t always the case, but sometimes the actual disease and its precise location in the body was clearly related to the body’s responses to events or experiences long forgotten.

It’s pretty clear to me that just as the movement of the water shapes the sand in the way you can see in this photo, so do our experiences and relationships shape us. Realising that makes me want to be more aware of my own actions and words. It makes me want to choose to spread constructive, supportive and creative waves in the world. After all, whatever we do, whatever we say or write, has effects far beyond the limits we could imagine.

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Sometimes you come across a stone that just demands to picked up, turned over, contemplated and brought home. That was the case with this one which I still have with me. I like it partly for its almost heart shaped form, but I like it most for the pattern you can see on it.

When I look at this, I see a number of lines of varying breadths and lengths, criss-crossing the surface and I think of each of them as a representation of a path, or a journey.

When I trained in Medicine, we were taught “how to take a history”. While I developed a bit of discomfort around the use of the verb “to take” there, I kept the concept of the history. In fact I’d tell people a large part of my work was about enabling people to tell their own personal history…..or their story. I used the idea of “story” a lot in my work. I’d ask people to tell me about their present experience in the light of past events and within the scope of their fears and hopes for the future. The traditional life story has a clear timeline, starting at birth and ending with the person’s death. Except, I quickly discovered, that in order to understand a person well I had to explore the family stories too….in other words to hear what happened before the patient was even born……as well as exploring the stories of many of the others (brothers, sisters, other relatives, friends and colleagues) whose stories intersected with the patient’s story.

So, I was quite surprised when I read a small article in “Philosophie” magazine about maps – they described how the French philosopher, Giles Deleuze said that our “subjectivity” was created from our movements, from our meetings, and from the relationships we had with other beings, other things, and other places. He said the map was an imprinting of all these movements, encounters and relationships which was laid down in our psyche, and so, when analysing ourselves we had to explore more as a geographer than as a historian.

Now, as you know, I’m a great “and not or” person, so I wouldn’t replace the work I did, or the way I make sense of my life with a geographical approach instead of an historical one, but I find that notion incredibly appealing.

What if, next time you are exploring your life, your experience, and your “self”, you make a map – a map of the journeys you’ve taken, the places you’ve gone, the experiences and encounters you had there, and the relationships with people, other living creatures, things and places which you’ve woven into your soul as you have lived?

What might that map look like?

It strikes me that adding this geographical approach to my life opens up new insights because it reveals and highlights the interactions, relationships, encounters and experiences of my life. The historical approach, of course, can reveal the characters, the events and the chronology of a life, but this shift of focus from my “story” to my “map” has, I think, loads of potential.

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I reckon we pretty much expect trees to grow straight up, then branch a bit, then grow further, still straight up. But, actually, of course, this is seldom the case. Trees, even their main trunks often veer off this way and that, or bend in one direction, only to turn in a totally different one a few metres further on. I confess I don’t know what makes a tree take the twists and turns that it does.

Look at this one for example, not only has it swerved around an almost 90 degree angle but it seems to have entwined itself on the neighbouring tree. What do you think? These trees are lovers? They’ve entangled themselves in each other’s lives forever?

It looks that way to me.

So maybe some of the shape of this tree can be understood in relationship to the other tree. Now how often is that the case with we humans? Do we ever reveal our character in any other way than by responding to what we encounter and by acting in response to the others in our social world? Can you really understand anyone without understanding their place in a family, in a community, a society? Can you really understand anyone without seeing how they respond to others, without exploring the nature of their relationships? I don’t think so.

A belief in the uniqueness of every single human is at the core of my world view and my practice as a doctor. But I never attempt to understand a person solely in isolation. I can only get an idea of who they are by hearing the stories of their experiences and relationships, and by observing how they respond to others….including myself.

I’ve no doubt that all our interactions with others change us. I would not be who I am today without having been changed by all the doctor-patient relationships I experienced in my life. You could say patients made me who I am. Not only patients of course, you also have to take into account the others in my life, family, friends, colleagues, even those who challenged me, or disliked me.

Our lives are entangled.

That’s just how it is.

But we can make choices, and we choose both who and how. We can choose to pay attention to certain people, to care for them, to engage with them, to collaborate with them, or to compete with them. All of those choices weave our unique, personal web of inter-relationships. And that constantly evolving cloth forms the very tissue of our being…..or should I say of our “becoming”.

When I look at this photo today it leads me to contemplate the people in my life, those who are no longer present, those who I’m actively relating to, and those who played significant roles in fashioning my experiences and creating the memories I have. You could say, it leads me to consider the characters in my life story. Who they are, who they were, what experiences we had together and how we become entwined and entangled.

I am grateful to them all. We made each other who we are…..together.

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One of the most beautiful things to see in any garden is the unfurling of the petals of a flower. That phase where the bud opens up and the gorgeous coloured petals unfurl themselves captures an essence of Life for me.

I see this and I think “becoming not being” – you’ll have noticed that phrase at the top of my blog? I wrote that as a subtitle because it is the most fundamental lens through which I see and understand the world.

The difference between those two words is movement…a particular kind of movement…..movement of change from one state to another.

Everything is in the process of becoming. It’s easy to see that in living organisms. The trillions of cells which make up the human body are in constant process of birth, growth, maturing and dying. They are replaced at different rates according to their type (blood cells living much shorter lives than bone cells for example), but none of them stay the same for the whole lifetime of the person.

When we look at an old school photo we might recognise ourselves, but when we compare that to one taken a decade later, then another and another, we see very, very images of the same person. All might be photographs of me, but all look utterly different.

This process of growth and development is a key characteristic of health for me. When I was working as a doctor, it was important for me to have a positive definition of health. I wanted to to help people to become healthy, and healthy, I think, is a positive state in its own right, not just an absence of symptoms or disease.

When I used to look out of my window in Central Scotland I could see the mountains, and the distinct shape of Ben Led always caught my eye. It amazed me that every day it looked different. Of course, I wasn’t close enough, or around for long enough, to see the physical structure or the surface of the mountain change (though change it did, over millennia). But my daily experience of the mountain was created more than rocks and earth. It was created by the light, the clouds, the sun, and the seasons. And all that changed all the time.

Nothing is fixed.

That’s my point.

Nothing can be understood in isolation from its environment, from its network of connections and relationships, or from its unique history and potential.

Stories….narratives….are always in the process of becoming….because stories weave together the past, the present and some possible futures, into one beautiful cloth. A dynamic cloth, which is always unfurling, always becoming, not being.

This image stirs all of this for me. I love how the “becoming not being” lens makes every day so much more alive!

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I love a blue sky. It lifts my spirits and warms my heart.

A plain dull grey sky has the opposite effect.

But wait, the sky isn’t featureless. Even a horizon to horizon cover of grey cloud is never completely homogenous. There are always variations there. There are thickenings, patches where the sun almost breaks through, or lighter patches which are backlit by the sun. There are swirls and lines and sheets and all kinds of forms. You just need to slow down, pay attention and notice.

I think the richness of features in the sky are partly down to the water molecules which make up the clouds, partly down to the light from the sun, partly down to the temperature changes and air currents, but it has another layer of richness added by the human imagination. We are the pattern seekers, and pattern creators par excellence.

Look at this sky for example.

There’s the silhouette of the edge of a tree on the far right of the image. Let your gaze drift across leftwards from there. What do you see?

I see the shape of an eye. The way I’d start to draw an eye by marking two lines in the shape of connected ellipses. There’s no sign of an eyeball, so this is either a closed eye, with the darker edge of the lower lid representing eyelashes, or it is the eye-shaped hole we often see in masks.

Once I’ve seen this I can’t un-see it.

Isn’t that strange?

It takes the imagination to “see” an eye in the sky, but once it’s there it has an impact. I feel watched. I feel seen. I can understand how ancient peoples believed that multiple gods and spirits lived with them. And even if those gods and spirits don’t seem real any more. There was a time when we humans had an awareness of a shared cosmos. They experienced wholeness and connections in their everyday. They didn’t have to question or analyse it, reality just seemed to be that way. Everywhere they looked they saw patterns, told stories, made sense of the phenomena of the ordinary day. Everywhere they turned they brought their imagination to bear and saw connections, discerned meanings, and drew upon what they learned to create art, to find their way across the planet, and to learn how to adapt to the changes and the seasons.

I don’t think there is any way to go back to those times, and I also believe that we have learned a lot since then, that we have deepened our understandings, broadened our knowledge. But I have a nagging feeling that we live in more superficial times now. That life seems somewhat thinner without that rich imaginative layer of stories, shapes, forms and patterns.

But, hey, none of that has gone away. We are able to slow down, to pay attention and to activate our imaginations any time we want. We can see more than a passing glance will reveal. We can make connections of greater depth and significance. We can new stories of the wholeness of Gaia, of the interconnectedness of all beings, of the constantly changing evolution and development of forms and diversity.

We can enrich our lives with art, poetry, stories, music, dance, ritual and loving relationships.

Well, why not?

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This cut crystal really hits the spot for me – firstly, I see it and I think it is really beautiful. The beauty of it delights me. Secondly, I’m amazed by it. The craftsmanship involved in imaging then fashioning a piece like this utterly astonishes me. Thirdly, it fascinates me. I gaze at it and look at the way the light travels through it. I see how each facet acts like a lens through which I can see the other facets, and how all the facets act as lenses on the window and the rest of the room.

I can have that blend of responses to many of the photos I have and I think that’s got a lot to do with my decisions about which to gather together into my “best photos” folder. Beauty, amazement, wonder and fascination. Altogether they bring me joy. And, without falling into the habit of ranking and creating hierarchies, I think joy is one of the most emotions we can have in our daily lives. Joy activates a whole set of physical and psychological changes in us. And, it just feels GOOD.

But this image does one more thing for me, the thing I really look for in my special collection of best of the best images – it inspires, stimulates thought, curiosity, wonder, and a potentially infinite web of threads of thought.

This idea of a multi-faceted interface gets me thinking about how we humans are like this. Whenever a patient told me their story, as we explored different themes, events and experiences, I’d see them shining like this – each aspect, each theme, each way of behaving, of experiencing, of engaging with the world glimmering like one of these facets. There are many selves within each of us. In 1977 the Scottish psychiatrist, Miller Mair, described a model of the “self” coining the term “community of self” – his idea was that none of us can be reduced to one simple set of characteristics, behaviours and qualities. Each of us exhibits a different self in different contexts – for example, there would be differences in how I was with patients, from how I was with my family, with colleagues and with friends. But that each of these selves were not separate, at least, if we were mentally healthy. Instead, they would all be integrated into one – into one community where they all interacted to give us the sensation of a unitary, or single, self. I liked that model. It opened up the possibilities of exploration of different aspects of a person, often contradictory or opposing aspects, while allowing every one them a place where they could be accepted.

This idea also makes me think of Indra’s Web – that beautiful idea of the universe consisting of an infinite be-jewelled web, where everything is connected, and every gleaming jewel reflects all the other jewels. I think that’s a great model for understanding the world in which we live.

It also makes me think of how we use multiple lenses through which to see, and understand, the world. In fact, if we reduce ourselves to seeing everything through just one small lens or window we find that we tumble into division and conflict with others who don’t share that single lens. But when we embrace the multiplicity of lenses through which we can see the world we can find points of connection with others.

That’s my final thought for today – not only are we all like this multifaceted cut crystal, but when one of our facets lights up in connection with one of someone else’s facets, then we don’t just make a connection, we can brighten each others lives.

I hope this lens, this shining small facet, here today, brightens your life today, and that you, too, feel the stirrings of joy, of wonder, of delight and of connection.

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