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Supersizing the Mind. Andy Clark

Posted in books, from the living room, from the reading room, life, neuroscience, personal growth, philosophy, science on April 10, 2009| 6 Comments »

Where does your mind exist? There’s a longstanding “common sense” view that it’s inside your skull. But, it’s becoming apparent, that is far from the whole story. Yes, of course a lot of what we call the mind is related to brain activity and the brain is indeed inside the skull, but many researchers are discovering that just as the brain does not exist in isolation, neither can cognition, behaviour, a sense of self, for example, be understood solely on the basis of brain processes. If we want to understand the mind we have to consider the body in which the brain is embedded. Phrases such as “embedded mind” and “embodied mind” capture the essence of this view, and the more you think about it, the more your realise the importance of the incredible network of connections between the brain and the rest of the body.
I get frustrated by doctors and scientists who act as if we can divide a human being into two components – a body and a mind. Especially when they then use this arbitrary and false dichotomy to actually recommend treatments for people’s illnesses. The “embodied mind” concept binds the body and the mind inextricably. That makes a lot of sense to me. I’ve never met a mind without a body, and the only bodies I’ve met without minds have been in the mortuary.
However, some thinkers, scientists and researchers have pushed the idea of “embedded minds” a stage further. (the difference being that “embodied” is exactly what it says – “in the body”; whereas “embedded” argues for a broad contextual understanding which situates the mind in it’s multiple environments). Andy Clark, who promotes the concept of the “extended mind” is one of the writers who has taken this furthest.

I have three of Andy Clark’s books. The first one I read was “Being There” (ISBN 0-262-53156-9), which was given as a key reference in “Smart World” by Richard Ogle . That book deals with the concept of the “embodied mind”.

Might it not be more fruitful to think of brains as controllers for embodied activity? That small shift in perspective has large implications for how we construct a science of the mind. It demands, in fact, a sweeping reform in our whole way of thinking about intelligent behaviour. It requires us to abandon the idea (common since Descartes) of the mental as a realm distinct from the realm of the body; to abandon the idea of neat dividing lines between perception, cognition, and action.

Being There describes how this concept evolved and lays out the implications of the model. Six years later he published “Natural-born Cyborgs” (ISBN 0-19-517751-7). Here he challenges us to consider just how we, as human beings, extend ourselves outwith the bounds of our physical biology.

For what is special about human brains, and what best explains the distictinctive features of human intelligence, is precisely their ability to enter into deep and complex relationships with nonbiological constructs, props and aids. This ability, however, does not depend on physical wire-and-implant mergers, so much as on our openness to information-processing mergers.

He tracks the evolution of these interactions

….from speech and counting, morphs first into written text and numerals, then into early printing, and on to the revolutions of moveable typefaces and the printing press, and most recently to the digital encodings that bring text, sound and image into a uniform and widely transmissible format…..they constitute, I want to say, a cascade of “mindware upgrades”
What matters most is our obsessive, endless weaving of biotechnological webs: the constant two-way traffic between biological wetware and tools, media, props, and technologies. The very best of these resources are not so much used as incorporated into the user herself. They have the power to transform our sense of self, of location, of embodiment, and our own mental capacities. They impact who, what and where we are. In embracing our hybrid natures, we give up the idea of the mind and the self as a kind of wafer-thin inner essence, the human person emerges as a shifting matrix of biological and nonbiological parts. The self, the mind, and the person are no more to be extracted from that complex matrix than the smile from the Cheshire Cat.

I particularly like this phrase from his concluding chapter in that book –

Our most significant technologies are those that allow our thoughts to go where no animal thoughts have gone before. It is our shape-shifter minds, not our space-roving bodies, that will most fully express our deep cyborg nature.

In his most recent book, “Supersizing the Mind” (ISBN 978-0-19-533321-3), he reproduces the original article which he wrote with David Chalmers, where they both laid out this concept of an “extended mind”. That article alone is worth reading, and, in fact, he recommends you read it first before reading the rest of the book. He juxtaposes the concept “BRAINBOUND” with “EXTENDED”.

According to BRAINBOUND, the (nonneural) body is just the sensor and effector system of the brain, and the rest of the world is just the arena in which adaptive problems get posed and in which the brain-body system must sense and act.
Maximally opposed to BRAINBOUND is a view according to which thinking and cognizing may (at times) depend directly and noninstrumentally upon the ongoing work of the body and/or the extraorganismic environment. Call this model EXTENDED. According to EXTENDED, the actual local operations that realise certain forms of human cognizing include inextricable tangles of feedback, feed-forward, and feed-around loops; loops that promiscuously criss-cross the boundaries of brain, body and world. The local mechanisms of mind, if this is correct, are not all in the head. Cognition leaks out into body and world.

Why is all this important? Well, I think Andy Clark puts it well himself –

This matters because it drives home the degree to which environmental engineering is also self-engineering. In building our physical and social worlds, we build (or rather massively reconfigure) our minds and our capacities of thought and reason.

This is the why this way of thinking so exciting. How does our physical environment shape not just our patterns of thought, but our whole sense of personhood? How does it limit, or potentially expand, what we think we are and what we think we can be? Our social world is a fundamentally narrative one. So what are the stories we are told in our societies? And what stories do we choose to tell each other? How does this narratively-constructed world both shape our sense of personhood, and stimulate our imaginations to become something more than we are now?
If all this seems a little esoteric for you, read David Chalmers foreword to “Supersizing the Mind”. You’ll immediately grasp the everyday-ness of all this as he talks about how getting an iphone has changed his life, and, further, how the use of notebooks, and visual cues, can maintain independent living in patients with Alzheimer’s way beyond what would be possible were they to rely on the minds inside their skulls!

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The good life – the amazing everyday

Posted in from the dark room, from the living room, life, personal growth, photography, tagged on March 18, 2009| 4 Comments »

“All within the context of the daily reality, finding much to marvel at, to be amazed by, to be in awe of, in the present, in the here and the now”

I think the French words “emerveillement” and “quotidien” say so much about how to live.

I capture the amazing in the everyday with my cameras.

Here’s a set of a just a few of my favourites

 

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The good life – imagination

Posted in from the living room, life, personal growth, tagged , on March 14, 2009| 2 Comments »

To imagine actively, creating, expressing, dreaming and playing

To see the invisible
Imagination allows us to see the invisible. Saint-Exupery’s fox tells the Little Prince, “Here is my secret. It is very simple: It is only with the heart that one can see rightly; what is essential is invisible to the eye.”. We know that, don’t we? Love, passion, purpose, happiness, enlightenment……all experiences we have, all experiences that are important to us, but none of which can be seen, known or experienced by another, except by using our imaginations. Ian McEwan, the author, wrote after 9/11 that the biggest failure of the terrorists was a failure of imagination. If they could have imagined the lives of the people on the planes, and their families on the ground, they couldn’t, he argued, have committed their heinous crimes. I’ve always remembered reading that. I thought it was incredibly powerful and it’s true. Compassion emerges when we combine love with imagination. I’ll return to that in another post, but the important point for now, is that without imagination we cannot “see” what someone else is experiencing. Without imagination, compassion just wouldn’t exist.
We mustn’t mistake the invisible for the unreal however. There’s nothing unreal about love, or any of our subjective experiences. They are real, as real as physical objects. There’s a very common failure in contemporary societies which regards only the physical as real, or only the physical as important. It leads to that criticism of knowing the price of everything and the value of nothing. It leads to a distorted view of science which dismisses subjective, first person experience as, at best, a bias, and, at worst an irrelevance. That’s a failure of imagination. However, complexity science concepts such as emergence are beginning to address that failing.

To see the possible
Imagination allows us to see the possible. Human beings are great at invention, at problem-solving, at making things. All of these abilities stem from the imagination. Everything human beings make begin in the imagination. It doesn’t matter whether it’s a chair, or an aircraft carrier, a mug or a spaceship, none of them would exist had someone not imagined them first. If nobody can see the possible, then the possible doesn’t come into existence. We are creators. You could argue that the real Truth revealed in the claim that we are made in God’s image, is that we are creators. We ceaselessly create, continuously solving problems, inventing, making objects, expressing ourselves through stories and through art. If you stop to think about it, you’ll realise that there aren’t two kinds of people – those who are creative and those who are not. We are all creative. It’s an inescapable part of our make-up. The differences come in what we choose to do with that creativity and how we choose to manifest it.
Is it possible to achieve anything in life without having goals? And what are goals other than our imaging the possible? How do we grow without imagination? How could we change anything about lives without imagination?

To see the impossible
Imagination allows us to something else pretty amazing. It not only allows us to see the invisible and to make the possible probable, but it allows us to envisage the impossible too. In magic, fantasy and science fiction, we encounter the impossible and take it on board as if it were real. We can immerse ourselves in such stories and change our perspectives so that the boundaries between the possible and the impossible shift. Before the invention of aeroplanes, for example, anyone who imagined human beings could fly was imagining the impossible. Without imagination, this would never have turned into the possible, and further from the possible into the actual.

How imagination changes the world
Look at this –

magrittepipe

The surrealists were masters at provoking us to think about reality. Here, Magrite doesn’t just make us stop and think, “Well if it isn’t a pipe what is it? Oh, a drawing of a pipe!” He gives us the experience of creating reality through representation. He teaches us something profoundly important about the creative nature of perception and reality. We have a fabulous ability to create symbols and metaphors, both of which would be impossible without the imagination. This ability profoundly enriches our lives. It changes, what Robert Solomon would call a “thin” experience into a “thick” one. Here’s an example. Imagine someone buys a pottery mug. It’s just a mug. Maybe they associate the colour or the shape of it with some other mug they once handled, but maybe not. However, if this particular mug is a gift given to his loved one, and if later they sit together happily drinking from this very mug, lovingly sharing the one cup, then, at some other time, the person who bought the mug finds that it isn’t just a mug anymore. He can imagine his lover’s lips parting as she drinks from it. He can imagine her delicate fingers and her soft hands as she cups them around it. He now experiences that very same mug quite differently. In fact, using his imagination he can even do that when the actual mug is nowhere to be seen, just by calling it up in his mind.
Our living with objects, our experiencing and sharing the world with others, involves our imagination. Our imagination enables us to see the invisible connections. John Berger describes this beautifully by giving the example of the constellations. He says we look up at the stars scattered apparently randomly over the night sky and see invisible lines connecting some of them to each other to make constellations. The invisible lines are created and revealed through stories. We learn the stories of the stars and that allows us to name the constellations.
We change the world through the stories we create about it.

The danger of imagination
Imagination is a bit like passion. It’s a good thing, but not always. There’s a paradox in imagination, just like there’s a paradox in passion. Our imagination allows us to imagine death, disease, and all kinds of threats and dangers. Sometimes our minds get stuck on what we’ve been imagining, so that death, or cancer, or being robbed, or whatever, becomes the most important possibility in our lives and we make all of our choices in the light of that. This can really limit our lives. We can become paralysed by the fear which is the consequence of what we imagine.
And there’s another way in which imagination can be dangerous. Too much imagination can detach us from the real world. Mental illnesses which involve hallucinations and delusions, psychotic illnesses, are distressing and dangerous not only to the person who is suffering, but potentially to others too. We treat, by suppression, the diseases of the imagination. Of course, whether or not they are actually diseases, depends on a cultural, a social understanding. In some cultures a particular experience might be described as a spiritual one, whilst in another it would be interpreted as a sign of disease. Within the particular cultural contexts however too much imagination, or particular uses of the imagination can produce suffering.

Nurturing imagination
How can you improve your faculty of imagination to become more creative, and to experience a richer life? Through play, through art and through stories. Think of the rich imaginative world of children and how that is both manifested and nurtured through encouraging creative play. Childhood doesn’t last very long, and one of the forces which brings it to an end is anti-play. We insist that they become more serious, taking that as a sign of maturity. We replace play with work and responsibilities. In so doing, there’s a danger we inhibit the development of the imagination.
Art, in all its forms, is a way of activating and nurturing the imagination. Both the experience of art, and the creation of art. Experiencing art can profoundly provoke the imagination, whether we are looking at a painting in a gallery, listening to a performance in a concert or witnessing a play or an opera.
We create a sense of self through the stories we tell ourselves and others. Stories can provoke our imaginations and help us to not only have a rich, meaning-full life, but which can change the reality of our world.

In all their forms, play, art and stories, can stimulate and develop our ability to imagine, and consequently, to develop our capacity to see the invisible, the possible and even the impossible.

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The good life – passion

Posted in from the living room, life, personal growth, tagged , on March 11, 2009| 6 Comments »

To engage wholeheartedly, to be passionate about, absorbed in, immersed in activities

passionate red

Animate. Animation. Animal. Those words all share a common root – “anima”. Anima means “the life principle” or the “soul”, amongst other things. What is this “life principle”, this “soul”? Well, whatever your beliefs, I think you’ll agree that you instinctively know about “soul”. For example, most of us know soul music when we hear it. In fact, most of us know when any song is sung with “soul”. It’s something akin to passion isn’t it? It’s a song sung wholeheartedly, powerfully, movingly.

What does it mean to “animate”? It means to make it move, doesn’t it? A computer animation creates moving images, moving images which make the objects or characters seem alive. There is something very important here. One of the key characteristics of a living organism is one of movement. Think of the beating of your heart, the flow of air in and out of your lungs, the constant activity of all the organs of your body. When all that movement ceases, life has ended.

This constant movement can be thought of as some kind of flow. In some countries there is a concept known as “Chi” – in fact, acupuncture is a therapy which claims to be able to influence the flow of this mysterious “chi”. However, in all cultures, I think, we experience this “flow” as energy. This energy we experience is quite a mysterious phenomenon. Think of a scale of 0 to 10 where 0 is the lowest energy you can imagine experiencing and 10 is the greatest energy you can imagine. Where are you right now on that scale? The vast majority of people can answer that in an instant. You don’t need time to figure it out. We do it intuitively and holistically. We can break it down though. What about mental energy? Or physical energy? Or emotional energy? Many people are able to report quite different figures for each of those “energies” in the same moment. I don’t understand exactly how we make those assessments but I’m pretty sure we’re becoming aware of the “flows” inside and that’s what we’re reporting.

flow

The psychologist Csikszentmihalyi has conducted a lot of research on the mental characteristics of this “flow”. He describes a flow experience (by which he means something optimal) as being when you are in the process of achieving a challenge you’ve set yourself. Reaching the top of a mountain you are climbing would be one example, playing a challenging piece of music on an instrument would be another. Both the physical and the psychological senses of flow can be understood as passion. When we are passionate about something, we can be totally absorbed by it, we can lose ourselves in it; we feel energised, buzzing, our hearts beat faster, our breath quickens. This feeling of passion is a basic need. It’s the need to feel, and to know, that we are alive.

But passion at its fullest is neither good nor bad, at least, not in a moral sense. Think of the French “crime of passion” verdict for example. It’s almost a kind of insanity, where the passions have overwhelmed the reasoning mind. Spiritual practices have traditionally aimed at teaching people how to manage or to control these “passions”.

But not all passion is this kind of an overwhelming phenomenon. It’s not always so dramatic. An aspect of passion is wholeheartedness – to do whatever it is that you are doing wholeheartedly, with commitment and attention and focus. All such activities which stimulate your passion in this sense, are absorbing. These are times when time itself flies past, where you feel temporarily out of the world and totally into your own world. On the other hand they can feel like transcendent experiences where you are so in the flow that you lose that sense of boundaries, of the margins between you and other or between you and the world, where you step into the full flowing river and you feel like you become that river.

in the flow

We need passion in life.

We need passion to feel alive.

The more you engage with life wholeheartedly, the more you will feel in the flow. The more you are passionate about something or someone, the more significant and important that activity or person will be for you.

Perhaps passion is not a simple good but without passion, or flow, how do you know you’re alive?

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The good life – understanding

Posted in from the living room, personal growth, tagged on March 8, 2009| 6 Comments »

To understand, to make sense of

We are meaning seeking, meaning creating creatures. We are constantly trying to make sense of our experiences, to understand our lives, our selves and others. We are always on the lookout for patterns, connections between events and experiences, for explanations.

The physical world

Let’s consider this from the perspective of evolutionary biology and from the science of complex systems. Look at the qualities and the characteristics of increasingly complex organisms. Think of the flow of life from the relatively simple to human beings, the most complex organisms in the world. From single cell creatures such as bacteria and viruses, through plants with their astonishing diversity and rich patterns and lifestyles, to animals which have developed high degrees of cellular differentiation, developing tissues, organs and whole body systems, to the animals with a nervous system and a brain, to, ultimately (so far!), the rich complexity of the human mind and body. At each stage of complexity we see the emergence of new and unique characteristics and abilities, not shared with simpler organisms, so by the time we consider the human being, we see the emergence of consciousness, of memory and imagination, with the capacity to develop language, to be able to create and handle metaphors, enabling us to communicate, to see patterns, to collaborate and connect and to develop deep and rich levels of understanding. It’s quite something. And we need this ability to make sense of things because these characteristics of consciousness, memory and imagination make us acutely aware of a number of problems. We become aware of our own mortality. We can imagine not existing any more. And that’s scary. We need some way to handle that, to understand it. And we become aware of the essential paradox which everyone has to wrestle with – that we need to know that we are unique, separate and individual but that at the same time we are connected, we share and we belong. Those two issues – the awareness of mortality and the awareness of the paradox of separateness and belonging – are at the heart of much distress and pain. Making sense of these issues and the effects of these issues in our lives goes a long way to making life a better life.

The relationship world

Let’s consider it now from the perspective of narrative. Richard Kearney, in his “On Stories”, says a lot about how we use stories to understand our lives, our selves and others. He says “Every life is in search of a narrative. We all seek, willy-nilly, to introduce some kind of concord into the everyday discord”. And Robert Coles in “The Call of Stories”, says of doctors, that “The people who come to see us bring us their stories. They hope they tell them well enough so that we understand the truth of their lives. They hope we know how to interpret their stories correctly. We have to remember that what we hear is their story.” Stories need an author and a reader, a teller and a listener. Stories are a shared activity. They are the way we create understanding and meaning together. Karen Armstrong in “A Short History of Myth” shows very clearly how certain kinds of stories are powerful tools for making sense of the deep paradoxes of life. Owen Flanagan in his “Really Hard Problem” puts forward a fascinating concept of “spaces of meaning” and shows how because we all have our own unique perspectives on the world that we create shared understandings by entering into “spaces of meaning” with each other. In a much simpler and more artistic way, Saint-Exupery makes the same point in his “Little Prince” who shows us how we all live on different worlds (when was the last time you said to someone “What planet are you on?!”) and that what connects us are our stories (and love!)

The spiritual world

Spiritual in the sense of that feeling of being connected to something greater than ourselves, or that sense of purpose and meaning in life. The spiritual way of looking at life is about taking a larger perspective, seeing ourselves in the flow of life, of history, of a planet circling a sun in a vast universe. Spiritual practices can be about experiences, experiences of transcendence for example, but they are also fundamentally practices of meaning creation. We understand, we make sense of, we create meaning through our values, our attitudes, our beliefs, our attractions and repulsions. Spiritual practice can be amongst the most powerful ways of understanding life.

Different ways of understanding

There are different ways to understand. The physical way can be seen in science which, as Deleuze says, is a way of thinking about function, a way of trying to understand how things work. The relationship way is seen in storytelling and in philosophy, and that leads to the third way, the spiritual, which is a way of understanding the connectedness to that which is greater than the self. There is no one right way. We really all are unique. Our views, our memories, our consciousness are all unique and individual. But we are also connected. We share environments, we collaborate, we compete, we form and break relationships. We share. What we all do is try to make sense of our lives, of the world and of our daily reality. We need to understand, to see patterns, to grasp that reality. When we don’t do that, we feel scared, confused, alone. We are meaning seeking, meaning creating animals. Nihilistic thought, randomness, chance and powerlessness can be overwhelming, can become unbearable, closing doors, squeezing out hope and leaving us lonely and in pain. Why me? What have I done to deserve this? What’s happening? What’s going to happen? We’re full of questions, and always seeking answers. We do that by using our ability to understand.

But we mustn’t forget that our understanding is always unique and personal, and the we need to negotiate, in our spaces of meaning, to create our communal visions, our shared purposes. With understanding comes humility, a humility which should prompt us to ask others What sense do you make of this? What does it mean to you?

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The good life – a palette

Posted in from the living room, personal growth, tagged on March 6, 2009| 6 Comments »

What makes life a “good” life?

This seems such an easy question to answer…….until you start to try and answer it! In fact, it’s puzzled philosophers and other thinkers for centuries. You can read the views of Confucius, Seneca, Aristotle…..and on down the line of Eastern and Western philosophers, and then there is the whole body of religious and spiritual teaching through the ages.

One clear thread that runs through most of the literature on the subject includes some consideration of “eudaimonia” – what is often translated as “happiness”, but which is, I think, more usefully translated as “flourishing”.

My daily work as a doctor is about not only trying to help patients to suffer less, but also trying to help them to “flourish”. That, naturally, leads me to read a lot about this subject, and to think a lot about it too.

I’m not claiming I’ve got new insights, or even to have nailed this issue down, but I have reached the point of achieving some clarity about it which I’d like to share.

Here’s what I think. A good life doesn’t just happen. It’s an active process. It involves individual choices and what constitutes a good life for one person would not necessarily be a good one for someone else. It’s a dynamic, constantly changing phenomenon. Like life itself.

And it’s a creative process. We create the flourishing in our own lives. That’s not to say that others have no part to play, or that events outside of our control don’t have an impact. Of course they do. But as Viktor Frankl and William Glasser, amongst others, have said, what’s important is how you respond to the situations you find yourself in. You can’t always choose the situations but you do have some choice about your responses and your next actions.

Here’s one way to think about it. If it’s a creative process then what do you need on your palette? What paints do you need to create your good life?

The GOOD Life – the palette

  • Love
  • Understanding
  • Passion
  • Imagination
  • In the amazing here and now.

The GOOD life – a summary

To love and be loved

To understand, to make sense of our lives

To engage wholeheartedly, to be passionate about, absorbed in, immersed in activities

To imagine actively, creating, expressing, dreaming and playing

All within the context of the daily reality, finding much to marvel at, to be amazed by, to be in awe of, in the present, in the here and the now

I’ll post about each of these in turn, but this is my key, these are my elements, my building blocks, the colours on my palette from which to create my experience of a good life.

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Suffering and good lives

Posted in from the consulting room, health, narrative, personal growth, philosophy, science on March 2, 2009| 5 Comments »

My daily working life is that of a doctor. That only tells you a little because Medicine is a very broad subject and doctoring can require extremely different sets of skills. Sometimes I muse about just what is the job of a doctor? Or what makes for a good doctor? I’m pretty sure it involves trying to understand people better. I’m also pretty sure it involves helping people. It involves never thinking you know everything or that you are definitely right! (I know that’s a surprising conclusion but there’s a difference between being decisive and being certain…..read the linked post for more on this). I think it’s also a common experience that a good doctor is one who gives a damn ie one who cares. However, the specifics of the working life of a doctor depend a lot on the context of the doctor’s work. I made myself a “human spectrometer” to clarify this point.

Human spectrometer

Most health care is created around systems. There are whole departments defined on the basis of their focus on a system – Neurology, Urology, Gastroenterology etc. The focus of a doctor in that department is a particular system of the body. He or she becomes expert in the diseases and disorders of that system and acquires the knowledge, tools and experience to intervene, to either resolve, or to manage those disorders. Some doctors specialise more than this. Move left a little from the system on the spectrometer. We have both medical and surgical specialists who focus on one particular organ, or part of a system, like liver specialists, hand surgeons, and so on, and following that path further left we have biochemists and geneticists who concentrate on the functions right down at cellular, or intracellular levels. Jumping to the other end of the scale, there are the epidemiologists and the Public Health doctors who consider disease at a population level. I’m a great admirer of the work of Prof Richard Wilkinson who makes clearer than anyone else I know just what an impact inequality has on population health. The knowledge, skills and experience he needs to do his job are quite different from those of the hand surgeon. Move left again along the spectrum from the right hand side. There are doctors who focus on families, whose everyday lives involves working with whole families, or parts of families. Then there’s me. Right there in the middle. There are lots and lots of doctors like me. Our days are spent largely in consulting rooms with individual patients. Our approach is a generalist one, not a specialist one. We focus on the person. The skills, knowledge and experience needed to do this kind of daily work is holistic, narrative-based and focused on the ability to listen, to communicate and to understand at an individual level.

So each doctor needs the skills and the knowledge appropriate to their practice but there’s something else all doctors share. We are all trying to relieve suffering.

Suffering isn’t a word you’ll find in medical textbooks (just like you won’t find the words “health” or “healing” in textbooks of clinical medicine either!) but it’s our raison d’etre. You can judge me by it. I judge myself by it. When I go to work any day, I want to relieve suffering. If I interact with a patient and don’t feel that I’ve contributed to a relief of their suffering by my involvement and my actions then I don’t feel I’ve done my job. Dr Eric Cassell’s book, “The Nature of Suffering”, deals with this issue beautifully. He says in this book, and in his others, that he changed his clinical practice by deciding to focus on the issue of the patient’s suffering. In fact he explicitly asks his patients to tell him about their suffering as a powerful way of allowing them to set and declare their agenda and for him to focus his care where it matters. In that book he shows how suffering might lie in an individual patient, but it might lie in their relationships, their family, their workplace or community. You could, in fact, ask that question at any point on the “human spectrometer” above. Just where on the spectrum does the suffering lie?

However, human beings have a complex relationship with suffering. It might even be extolled as something good – “No pain. No gain” “I have to suffer for my art” I’ve read more than one book which considers the place of a serious illness in an artist’s life and puts forward the hypothesis that it was their suffering which enabled them to produce their distinctive, great art. I recently read David Lynch’s book, “Catching the Big Fish; Meditation, Consciousness and Creativity” (which I highly recommend actually!) where he powerfully refutes that argument, claiming that Van Gogh might have had the chance to produce even more and even greater art if he hadn’t had all that suffering to cope with in his life. Suffering gets a good press in many religious teachings as well as in a certain kind of New Age thinking. There are many spiritual practices based on inflicting suffering on the body and there’s even a belief in destiny, or Fate, or karma, which states that if you are suffering it’s because that’s what your soul requires. Even the “quest story” of Arthur Franks, as exemplified in Lance Armstrong’s “It’s not about the Bike” shows how suffering can be a path to growth and development.

I’m not denying any truths which lie in those beliefs. Nor am I claiming to know better. But let me be very clear, as far as I know, nobody, given the choice between a path of suffering and one of bliss, chooses suffering. We only choose suffering if we can see no other way to get to where we want to be. If we can find another way that doesn’t involve suffering we’ll choose it. So, yes, maybe my job involves helping people to make the most of their suffering, or to even get something good out of it, but, my first priority, my prime motivation is to do my best to relieve it.

Whether I can help relieve someone’s suffering or not, the inextricably related goal I have is to help that person to have a good life. The point of relieving suffering is to enable a person to experience a good life. But as suffering is an inevitable thread that winds its way through all lives, a doctor’s job is to help people to have a good life, whether they are suffering or not.

Doctors are not the only people to help others to lead good lives of course, but I do think a doctor who loses sight of this goal, loses sight of what it is to be a doctor.

PS Now you’ll be thinking “ah, but what is a GOOD LIFE?” Me too! (I’m working on a post about this but here’s an earlier one to be going on with)

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The “butterfly effect” in real lives

Posted in from the reading room, personal growth, science on January 28, 2009| 5 Comments »

Maybe you remember the story from last year about the Spanish woman whose trachea (windpipe) had been destroyed by TB, and how a team of doctors in Bristol grew her a new one from her own stem cells? Well, it was a pretty remarkable story, but here’s an interestingly different angle on that story.

Prof Anthony Hollander was responsible for developing the technique of using stem cells in this way and in producing this particular patient’s windpipe.

He recalls this event from his childhood –

One day in 1973 Anthony – a “sickly child” – was off school and at home with his mother, when he found a fatally injured bird in the paved area of their garden in north London. “It was in some distress,” he recalls today. “My mum was too squeamish to deal with it, so I put it out of its misery. For a nine-year-old it was hard to have to do that.” As he remembers it he got to thinking, about death, and about how he might be able to keep people alive. “So I did what all sensible children do when in need of practical help with an idea. I wrote to Blue Peter,” he said. “I can vaguely remember I was thinking about re-routing the blood out of the heart and recirculating it. Then they could fix up the heart and it would be alright again. I just didn’t want that death stuff to happen.”

Blue Peter is a long-running childrens’ programme on the BBC which encouraged interaction with its viewers from the outset. In his letter he described his “strange belief” that he “knew how to make people or animals  alive” and asked for help – including a “model of a heart split in half” and “tools for cutting people open”. Well, the Blue Peter programme editor replied to the letter, as she and her team did to every one of the thousands of letters received every week. She encouraged him to seek information for his idea from the family doctor.

Listen to what he says about receiving the encouraging reply –

“If her letter had shown any hint of ridicule or disbelief I might perhaps never have trained to become a medical scientist or been driven to achieve the impossible dream, and really make a difference to a human being’s life,” …….. ” If you had failed to reply, or had treated my letter as a joke (as perhaps others might have done) it could well have altered the course of my life……..”I remember being thrilled at the time to have been taken seriously. Actually, even nowadays I am thrilled when people take my ideas seriously. I know that might sound strange to you. But my way of doing science is to think up a hundred theories, however mad, and work through them until I find one that fits the data.”

Isn’t that an amazing story? Just to make it all the more amazing, it’s emerged now as a story because Prof Hollander recently wrote to Biddy Baxter, the Blue Peter editor, to tell her how important her letter had been to him and discovered that she was in the process of compiling a book of the childrens’ letters and had already picked his out as one of the letters to include. Coincidence?

I’ll finish this little tale with another quote from Anthony Hollander which, I believe, completely hits the spot –

“As adults we can tend to lose the capacity to dream and think big. Children will dream unselfconsciously. I still do that – I still go around telling people ‘these are the things I want to do’. I don’t have time for any kind of scepticism.”

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A time to reflect….

Posted in from the dark room, from the living room, life, personal growth, photography on January 1, 2009| 4 Comments »

We all need to pause now and again and reflect. Reflect on the past, browsing through some memories; reflect on the present, taking a look at ourselves, and our lives, with fresh eyes; and, reflect on the future, imagining where our current paths might lead.
You’ll be doing some of that today I bet. Take your time. And do it again, often.

The past….where we come from, where are roots lie, where we grow from…..
Lundin stone circle

The present….constantly changing before our very eyes, what we notice, what we become aware of…..
freezing loch

The future…..where the old paths and the new ones might lead…….
loch and sky

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Happiness, wellbeing, love……

Posted in life, personal growth on October 14, 2008| 3 Comments »

The “self-help” industry has been around for many years, but it seems to be growing ever larger. There are countless books, websites and courses on this subject. However, it’s hard to find anything which takes a fresh angle on the subject. One change is that increasingly the explicit language used is about “happiness” or “wellbeing”. But the focus is still, largely, the same – SELF. We read about “self-help”, about “getting what you want”, about “personal growth”. Has it ever struck you how often it’s about “me”!

There’s a change in the air however. Roman Krznaric writes about “outrospection” as a counter to the predominance of “introspection”.  And Mark Vernon has recently written a book on “Wellbeing” which also seems to develop this way of thinking. Here’s a great review of his book on Mark’s own blog. The review is by John Armstrong, and he writes…

Losing weight, taking exercise and eating the right food, improving your looks, making a sea change or a tree change, simplifying your life: these are strategies for wellbeing and they are the stock topics of a million and one newspaper articles. But the avalanche of advice suggests collective desperation: we have to tell ourselves so much about how to be happy, and say it so often, because things aren’t going well. It’s striking that the kind of advice that’s given tends to target the body first: it’s all about how you look, how healthy, fit and active you are.

He goes on to say….

In this pointed little book, British philosopher Mark Vernon argues that we’ve been looking for happiness in the wrong places. He draws attention to two aspects of life that are deeply connected to living well: love and what he calls transcendence. Love involves caring profoundly for something apart from yourself, and doing so requires that you discover capacities for generosity and self-sacrifice. Love, in a curious way, is intensely unfashionable. That’s because love isn’t egotistical; it isn’t cool; it doesn’t focus on how sexy or hip one is; and you can’t possibly love another person for being trendy or famous or rich or wearing the right clothes. So real love is counter-intuitive in a shallow world. And that’s ironic because love is central to leading a good life, and to being happy. Our world is addicted to the idea of happiness but rejects a crucial way in which happiness isattained.

That particular sentence about love – “Love involves caring profoundly for something apart from yourself, and doing so requires that you discover capacities for generosity and self-sacrifice.’ – really struck home for me. I think “health” is a positive experience which has distinct characteristics, and one of these characteristics is “engagement”. When we are engaged with what lies outside us – Nature; other people; Art; community, and so on – then we experience “flow”, “happiness” and “wellbeing”. In that sense, “health”, strangely, isn’t really found inside a person, it’s found in the contextualised person, the connected person, not in a separate, discrete individual.

Even more of a challenge is what Armstrong writes about the place of suffering in life –

These are not in any way recipes for a painless life and that’s how it should be. Understandably, we seek to avoid pain. But much of what is important and valuable in life is inescapably connected to suffering. You cannot form a deep relationship with another person unless you worry about them, fear what could happen, get bitterly disappointed with yourself for letting them down or for causing them anguish or frustration. And eventually you will have to mourn for them or they will have to mourn for you. You can’t engage with the things that make for a good life unless you are able to cope with suffering. It’s the same with any worthwhile creative effort, with noble political hopes, with any desire to improve the world: worthwhile, valuable, but a hard road.

What this paragraph provoked for me was Wim Wenders “Wings of Desire” (remade in English as “City of Angels“) which tells the story of an angel who becomes a human in order to fully experience the pleasures and the suffering (ultimately, the mortality) of human life. It’s a great movie and is, I think, one of the greatest celebrations of what it is to be human.

There’s definitely something worthwhile and interesting here. What I like about it is a change of direction away from looking inwards, towards emphasising what we’re connected to which is greater than ourselves, towards looking outwards – it’s about becoming more loving.

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