Iain McGilchrist, in The Master and His Emissary, says we use our two cerebral hemispheres differently. The hemispheres, remember, control the opposite sides of the body, so the right control the left hand, and the left hemisphere control the right. It’s the same with vision where the right field of vision is the responsibility of the left hemisphere and the left field of the right hemisphere. I’m simplifying here, but you get the idea. In birds which have their eyes on the sides of their heads instead of in the front of their faces, each hemisphere controls the opposite eye but the idea is the same.
The right hemisphere supports a broad, vigilant attention. In a bird the left eye, therefore, is taking everything in to be aware of predators.
See how this duck is looking at me?
They use the left hemisphere to focus the right eye on details….for example, when picking out food.
There’s something else interesting about the field of view of interest to each hemisphere.
In we humans, the right hemisphere is more interested in what is far from us….
while the left is more interested in what is close up….
We need to use both hemispheres – a whole brain is better than half a brain! But Iain McGilchrist shows that we’ve all developed a rather bad habit – using the left hemisphere to focus on parts and utility to the extent that we ignore or disregard the right – which seeks out the personal, the particular, the connections and the whole.
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.
There are certain numbers which are described as magic numbers in particular cultures. Whether they are magic or not, there are clearly some numbers which are powerfully significant and which appear widely a huge variety of forms.
I could probably make the case for most single numbers to be thought of as significant numbers. But the one I want to highlight today is “3” because I just stumbled across this little group of photos I took during a trip to Japan some years back.
This symbol, of three “comas”, or “tomoe”, is one I kept coming across everywhere. The first photo shows it at the end of a roof, and this is really, really common in traditional Japanese architecture. The second one shows it on the lid of a pump at a fountain. I really like that something everyday, something otherwise quite functional or mundane, is made more beautiful this way. The third one is at the other end of the scale – it’s gold and magnificent. But perhaps the one I like the best is the biggest image in this collection. It’s embedded into one of those wonderful, standing rocks you find at temples and shrines. The white background looks like a light source, but it isn’t. I love the “wabi sabi” appearance of the rusty, reddish metal which forms the shapes of the three commas, and I especially like how the sun casts the shadow of the same symbol onto the white background.
Maybe I find this symbol of three commas especially attractive because it reminds me of the dual, yin yang, symbol, a version of which I wear around my neck. But more because the Celtic form, known as a “triskele” is a symbol which was around me as I grew up and lived in Scotland.
But to come back to the number 3……why do I, and I suspect, so many others, find that such an attractive, even magical number?
Well, for me, I relate it to “body, mind and spirit”, which is one of the key ways to think about an holistic approach to human wellbeing and health. Throughout my entire career, both as a GP in the first couple of decades, and as a Specialist in Integrative Medicine, in the second couple up to retirement, taking a holistic approach was the keystone of my everyday work.
As a medical student back in the 1970s I was hugely impressed with a “Biopsychosocial” understanding of Medicine. There’s another “3” – the biology, the psyche, and the social – all of which, my teachers impressed into me, were important in health care. In fact, it’s been the dominance of the “materialist” approach which has been my main source of discomfort in our form of health care which reduces human beings to data sets and Medicine to pharmacology. That never impressed me, and it still doesn’t.
It’s always struck me that whether I come from a “body, mind, spirit” position, or a “biology, psyche, social” one, that only one of the elements of those triples, is visible. Only the body, or the “biology”, can be observed, palpated, measured. The other two, the mind/spirit or psyche/social, are invisible, and, frankly, I’d say irreducible to measurements. Materialism can’t capture them. Maybe that’s why I’ve always given such emphasis to the individual story, to emotions, thoughts, values and beliefs.
As I understand it, it’s not completely clear exactly what the triple commas represent in Japan, but it’s sometimes related to something like three kingdoms – of Earth, of Heaven, and the Mundane World, or to the Gods who rule each of those kingdoms. In Western thought, perhaps the triad would be Heaven, Earth and the Underworld.
It does strike me as interesting that Freud came up with Ego, Id, and Superego, as his tripartite model of the human psyche. And Lacan, I believe, wrote about the Imaginary, the Real, and the Symbolic in his model of the psyche. I’m also struck by the more modern psychoneurological triad based on the structure of the central nervous system – the “triune” model of the “reptilian”, “limbic” and “neocortex” structure, something which I used a lot with patients after I learned Dan Siegel’s “hand model of the brain“. By the way, he also describes the “map making” capacity of the frontal cortex as an ability to create maps of “me”, “you” and “we” (another interesting triad)
Hey, I could go on, but I’m sure you could add your own favourite triads and triples to this understanding.
Powerful as the number 3 is, I often think in terms of other numbers. I’m quite a visual thinker and as I explore ideas I’ll often find I’ve created little maps of 4 zones, or 5, 6, or 8 pointed stars. How about you? Are you aware of these numbers and their symbols in your thinking and your culture?
For me, it’s the sort of symmetry you can see here between the rows of vines covering the hillside and the rays of sunlight shining down through the gaps in the cloud.
There’s a resonance there. A sort of harmony which catches my attention. I think “as above, so below”, which is an old esoteric teaching about the way in which this physical world and the spiritual world are connected….or, if you prefer, how the Earth is connected to the Sky or Heavens.
Our brains are brilliant at spotting patterns. In fact, we don’t just spot patterns in the way that a mirror might reflect what stands in front of it, we create patterns. We learn patterns. We remember patterns. Think of the night sky, for example. Once you’ve been taught to see the invisible lines between some of the stars you call them constellations. And then you can find them again much more easily in the millions and millions of stars shining down on a clear night. But someone imagined those lines. They aren’t the same as the threads which make up a spider’s web, or the lines of minerals running through stones you find when you are out for a walk. Our ancestors created those patterns, and told stories so that others would be able to see them and share them.
So we are brilliant at spotting “similars” – we see patterns and attempt to match them to ones we know already, or others we can see, or create in the same moment. When we spot a similar it’s exciting. It’s “remarkable” – it’s attention grabbing and potentially meaning-creating – because that’s something else we are great at – making experiences and perceptions meaning-full. We constant attempt to make sense of the world we are living in, and to connect our experiences to a sense of purpose.
Some of these matches, these “similars” are like resonances – and this is one of those. Resonances are like harmonies. They delight. They spark a little joy, set off some feelings of awe or wonder. They are special.
This is one of the ways in which we can live a more “enchanted” life. A more “meaningful”, “rich”, “deep”, life. A life of soul. A life of spirit. A connected, “integrated” life. A healthy life. A life of flow and movement.
What patterns do you notice today? And what resonances, or similarities, do you see between those patterns, both between them and ones you already know, and between them and the others around you today?
I saw this woman yesterday standing outside a supermarket in the middle of town. I was struck by the size of the books she was holding, and which she couldn’t resist opening and starting to read. It turns out they are a trilogy of YA fiction by a famous French author, the third volume having just been published, which is maybe what inspired this woman to buy all three.
I understand this compulsion. I’ve always had way too many books on my shelves….well, way too many in the sense that I couldn’t read them all in one lifetime. But that doesn’t stop me buying new ones. Suffice it to say I read a LOT!
I’ve had a fascination for stories all my life. In my earliest years I remember my Grandpa reading to me – he read me all of Walter Scott’s “Tales of a Grandfather” and he read me collections of myths, legends and fairy stories which he bought for me when I was born. My mum used to have a photograph hanging on the wall of her living room. It was a black and white print showing my Grandpa reading in the local library. I guess I got that gene!
I’ve told countless people that when I worked at the NHS Centre for Integrative Care (which I did for the latter two decades of my career), I used to look forward to meeting a new patient every Monday morning because I knew they would tell me a unique story – one I’d never heard before. In fact, story was the very heart of my engagement with these patients who, largely, suffered from long term conditions which had failed to respond to drug treatments.
Did it surprise me that they had failed to respond to drug treatments? Nope. Because there aren’t any drugs for people, there are only drugs for diseases and drugs to suppress symptoms. Drugs don’t heal. At best they create an environment conducive to healing. It turns out it’s people who heal, not drugs. It’s people with self-defending, self-repairing, self-balancing, self-creating and growing interwoven complex systems who heal.
I found that stories were the way to understand a patient. Not symptoms.
I read a piece about a psychiatrist and neuroscientist, Karl Deisseroth, yesterday, and in that interview he said
Anybody can read a diagnostic manual and see a list of symptoms, but what really matters to the patient is a different story
which reminded me of a passage by the English philosopher, Mary Midgely, which I read many years ago –
One cannot claim to know somebody merely because one has collected a pile of printed information about them.
Wisdom, Information and Wonder. Mary Midgley
and of this passage from philosopher Richard Kearney
Telling stories is as basic to human beings as eating. More so, in fact, for while food makes us live, stories are what make our lives worth living.
On Stories. Richard Kearney
In fact, that latter passage came into my head as I took this photo – here’s a woman absorbed in stories, standing next to empty supermarket trolleys and with her back to the stalls of food laid out in front of the shop.
Stories, I found, weren’t just the way to understand a person (to make a diagnosis even), but they were also the way to heal. By helping someone create a new story, I could stimulate that complex of healing systems within them, and spur them on to more than relief from suffering…….More than? Yes, to more self-awareness, more self-compassion, and to a re-evaluation of their life choices, habits and behaviours.
Stories can set us free.
Mind you, it’s also true that we can get trapped by stories – the stuck, multilayered ones we’ve been taught as children, or been brainwashed into believing by others. But even then, the answer, the release, the movement forwards, lies in the creation of new stories……our own, unique stories which allow us to realise our hopes, express our singularity, and live the life we want to lead.
Stories, you see, have a magnetic pull. We don’t live without them.
I walked into the courtyard of a temple in Kyoto one day and saw this display of flowers. Well, actually, this first photo is what I saw once I got closer to the display which had caught my attention.
When you look at these flowers, all you see is some flowers. It’s not possible to see the pattern which is revealed only from a distance.
This is what you see when you stand back…
Isn’t this amazing?
Actually, whether you encounter the full image first, then get closer in order to realise that it is constructed from hundreds of flowers, or whether you start close up seeing only the flowers, and gradually stand back to see the full image, the two positions are a huge contrast, aren’t they?
These are the two perspectives we bring to everything. We use the left cerebral hemisphere to zoom in on individual elements. To do that it focuses on parts and identifies them, matching them up to whatever we have previously encountered and categorising them. In this case, it identifies the objects as flowers and labels them according to their colour. But at the same time, we use the right cerebral hemisphere to take in the whole picture, to see whatever we are looking at within its contexts. To do that it focuses on the connections and relationships, and, at the same time brings a heightened awareness for novelty – it homes in on whatever is new, whatever is unique, whatever is special.
You’ll know already from my writing that I believe the principle of “and not or” is a good one in life, and that’s in no small part due to the fact that this is exactly how we have evolved. We don’t have only one way of looking at things. We have multiple ways, and we throw them into the complex mix of reality so that we can do more than perceive the world in which we live, we explore, play, learn and create. We adapt, we grow and we evolve.
I’m very wary of black and white, rigid, fixed, narrow views of reality. The world is richer than any of us can conceive. The universe has more potential than any of us can imagine. And there is much to gain from diversity and tolerance.
I think I first became aware of research suggesting that even a view of natural surroundings could be good for us in the paper about recovery times after surgery. The findings showed that post-op patients required less painkillers, had less post-op complications and required shorter stays in hospital if their bed had a view outside to a natural environment (as opposed to no view, or a view of a wall).
Then I came across the Japanese concept of “forest bathing” and work from a university in Tokyo which showed that spending a few minutes in a forest could increase the levels of helpful immune chemicals in the blood.
Today I read a paper about “Attention Restoration Theory” suggesting that spending time in nature improves the concentration levels of children with ADHD. This “ART” concept describes two kinds of attention – an easy, effortless, “bottom up” (neurologically speaking) attention to the environment, and an effortful, focused “top down” attention which we use when deliberately concentrating on something. We use the former when gazing out of a window to the natural environment, and the latter when trying to do a difficult mental task. The research study I read split children into three groups, putting one group in a classroom with no windows, one in a classroom with windows looking out onto a bare, built environment, and a third group in a classroom with windows looking out onto nature. They gave them all the same difficult lesson, took a five minute break where they stayed in their classroom, then tested their concentration after the break. Only the third group, the one in the classroom with a natural view, improved their concentration.
One of the things I like about this paper is that it showed two things – that turning our awareness towards the natural world is good for us, and, that the way to improve concentration wasn’t to “concentrate harder” but to build in a break where the mind could drift into a more natural state of open awareness.
Well, you know, I don’t really need any scientific research or “evidence” to convince me I like to have a view of nature from my window, or that I enjoy walking in forests, parks or along beaches, but, hey, it’s still good to learn about some of the measurable effects of open awareness and engagement with natural environments.
I came across this old stone bowl in the middle of a forest over ten years ago. The bowl was full to the brim with water. I don’t know what the bowl was doing there. I don’t know if someone threw it away, or placed it carefully here. I don’t know if they filled it with water, or if the rain fell day after day, between, and onto, the leaves of the trees which surround it. I don’t know its history.
But it stopped me in my tracks because of its beauty. Beauty can do that. It can be what we call “arresting beauty” because it captures us, catches our attention, slows right down and pulls us in.
I crouched down and took this photo. This is one of my photos which I return to again and again. Yes, partly because it gives me pleasure just to gaze at it. Within seconds I’m transported back into the depths of the forest. I can smell the damp bark of the trees, see the rich diversity of greens in the ferns, the bushes, the mosses and the trees. I can hear the birds singing.
But also because this is one of those images for me which works as a powerful metaphor of the mind.
When I look inside the bowl, the first thing I notice is the surrounding forest reflected on the still surface of the water. Isn’t that interesting? The first thing I notice is the world represented in the bowl. The first thing I notice is not the water itself. In fact, it’s quite hard to really see the water. When I look more closely I see ferns and I see tall trees and I see patches of blue sky above the roof of the forest.
Isn’t this a bit like how we perceive the world? Don’t we allow all the stimuli from the environment to set off cascades of chemicals and electricity inside our bodies and send them up towards the right cerebral hemisphere where we explore them, appreciate them, connect to them, and hand off some of that activity to the left cerebral hemisphere where we re-present it all to ourselves, match it against memories and knowledge, re-cognise it, analyse it, name and categorise it? Then send out the ripples and waves of that mental activity back towards the right hemisphere to be re-integrated into the whole, to offer it back to ourselves to give us the opportunity to make sense of it all, to seek meaning in it and weave the threads into our unique, personal stories.
I look more closely into the bowl to try to see the water itself, but it’s still not so easy. After all, how do we manage to see our own minds? How do we manage to see the processes which are going on which allow us to have this experience?
What do I see next? The hint of something below the surface. Are those brown leaves lying there? What else lies in the depths of the bowl? That gets me wondering again about the unconscious – all that activity which goes on just beyond our ability to be aware of it – all the processes of the mind and body which keep us alive, which nourish us, which defend us, which promote our growth. Now and again we catch some glimpse of what might being going on below the surface of awareness, of consciousness. We might glimpse it in our dreams. We might glimpse it in coincidences, synchronicities, in our imagination. We might glimpse it in meditation.
And what if the water in this bowl represents the self, the ego, the “I” who perceives and experiences? The water, the consciousness, which is filled with the reflections of the world in which we live our embedded, embodied lives?
The water, the deep subconscious below, and the bright reflective, surface above?
And after all this wondering, and mind wandering, I return to the sheer beauty, the magic, of this simple, old bowl of water lying in the depths of the forest, waiting for the opportunity to make my day special.
I graduated in Medicine from The University of Edinburgh back in 1978. During my medical education and training I was taught about the heart. I remember we were taught about the heart muscle, the system of electrical conduction which produced the rhythm of beats, about the heart valves and how to diagnose different valve problems according to the sounds we could hear when we listened through our stethoscopes. I learned how to administer and read an “ECG” – that series of spikes and waves you see on heart monitors and printed out on long strips of paper.
I didn’t learn that there was a neural network around the heart, nor what that might do. Back then if we thought about it all, the heart was a sophisticated pump for keeping the blood flowing around the body, and phrases like “heart felt”, “broken heart”, “having a heart to heart conversation”, and so on, were considered flowery or poetic metaphors.
I know better now.
We now know that there are sophisticated networks of nerve cells around all the hollow organs of the body, but especially around the heart and the gut. We also know that there is a LOT of communication between the heart and the brain, and that, contrary to what we used to believe about those connections, most of the flow of information is from the heart TO the brain, not the other way around.
We’ve also learned that the beating of the heart creates electromagnetic waves which radiate out around the whole body, and can even be detected outside the body. Those rhythmic waves seem to have a role to play in co-ordinating, or “integrating”, a wide range of functions of the whole body, and even connect with, influence and can be influenced by the waves radiating from other peoples’ hearts.
It turns out that those metaphors we use have a biological, neurological, physical basis in the person. We have a certain kind of “heart intelligence” which allows us to “know” and to “communicate” from one heart to another.
Isn’t that amazing?
Since I came to understand all that I’ve realised just how important it is for we humans to have a “heart focus” – to try to connect to others and communicate with others “from the heart”, not just from the rational brain.
We all love to find heart shapes in Nature, don’t we? Like this little flower in today’s image. Or in the bark of a tree, the shape of a stone, or in a work of art. Why is that, do you think?
I think it speaks to the core importance of everything we think of when we use these heart metaphors in our language, in our poetry and in our songs.
After all, who thinks it’s a good idea for someone to act in a “heartless” way?
My daughter, Amy Palko, who produces a knitting blog on youtube, entitled “The Meaningful Stitch” did a poetry advent in the month of December with one of her online friends from the knitting community, Jackie, of Cady Jax Knits. You can find their videos here –
One of the things they discussed was creating a personal anthology of your favourite poems. I thought that was a great idea and got out this handmade notebook which my wife, Hilary, had created and given to me, and started writing some of my favourite poems in it.
I think it’s important to actually write the poems in, not to print them out from the internet and paste them in, though, if that would work better for you, then go ahead. I find that taking the time to hand write each poem enhances my experience of the poem itself.
I keep this notebook on my desk beside my computer and from time to time I read a poem or two, or I copy in another poem that I really love.
I really recommend this. It’s one of those practices which takes something meaningful and enjoyable – in this case poetry reading – and increases the time and attention you give to the poems you select. In the process you create a unique collection of exactly the “best” poems for you.
If you’ve read a few of my posts on this blog, I’m sure you’ll be aware of how Iain McGilchrist’s thesis on the differences between the left and right cerebral hemispheres. Well, if he’s right, which I think he is, then there is an imbalance for each of us, and for our wider societies, between the approaches, the world views, or the ways of engaging with reality, which each hemisphere offers us. We have become left brain dominant, and it would be much better to use our whole brain more, and re-set the balance, to put the right brain back in its rightful role as “The Master” and use the left brain “Emissary” to do what it does best. Since I came to understand that thesis, I’ve been more aware of trying to support and develop what the right hemisphere can bring to my life.
Well, there are many ways to do that, but I’ll just share three with you here.
The right brain loves novelty and finding connections, so as I practise curiosity and the sense of “émerveillement du quotidien” I’m building up the right hemisphere.
The second thing is music. The right brain relishes music – both creating music and listening to music. I play music a lot. Mostly I listen to music, but I also try to play a bit of piano and guitar from time to time. Music is very personal and what I like, you might not like, but I’ve recently discovered Paradise Radio, a commercial free, internet radio station from the US, and I love, love, love it. You can select between “main mix”, “mellow mix”, “rock mix” or “world mix”. Check it out.
The third thing I’ve identified is poetry. We activate our right hemispheres a lot when we read and write poetry. More so than we do when reading stories, or articles.
So, there are my three daily practices, which I hope lead to development of a more whole brain way of living……curiosity, music and poetry.
I welcome constructive criticism and suggestions. I will not, however, tolerate abuse, rudeness or negativity, whether it is directed at me or other people. It has no place here. ANYONE making nasty comments will be banned.
Heroes Not Zombies 