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Archive for the ‘philosophy’ Category

Constant creation

Posted in books, from the consulting room, from the dark room, from the living room, from the reading room, health, life, personal growth, philosophy, photography, science on September 24, 2015| Leave a Comment »

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Michael Foley, in his Life Lessons from Bergson, gives an excellent, concise description of the complex adaptive system model (even though he doesn’t actually use that term)

There is also the intellectual problem that, in a complex organism, the whole is never merely the sum of the parts and the parts are never entirely independent of the whole.
It’s amazing how often doctors forget this.
A whole person can never be understood from even the most comprehensive set of measurements from a laboratory and an imaging centre (where X-Rays and scans are carried out).
The whole person has to be encountered as the unique individual that they are.
As Mary Midgely, the philosopher, put it –
One cannot claim to know somebody merely because one has collected a pile of printed information about them
In complex systems, simple arithmetic doesn’t work, not least because the bonds between parts are so often integral parts of feedback loops, so a small change in one part can induce much greater change in another, and together the changes within the whole organism are way beyond what can be understood from analyses of single parts.
Also, there isn’t a single organ within us which acts by itself. In fact, there isn’t a single cell which acts in isolation. At all levels, from the molecular within the cell, to the whole person within a physical, social and cultural environment, nothing is “entirely independent of the whole”
An organism is a hectic, almost frenetic, process, operating far from equilibrium in a ceaseless metabolism that seeks out and draws in nutrients, converts them to energy, expels waste, and uses the energy to reproduce, and to regulate and renew its parts, so that its make-up is constantly changing though its structure is relatively stable.
We have such a sense of solidity, don’t we? We have such a clear sense of a unified identity which exists throughout the whole of a life. But our physical make up is really not so solid. As a living organism we are dynamic, always in motion, always processing energy, molecules and information from the environment and within us. We make ourselves anew every single day, our cells in a constant process of creation and destruction. I found that idea quite startling and exciting when I first encountered it. It means that life is a process of constant change and unceasing creation.
But there’s something else in that paragraph which I first read when studying the concept of complex adaptive systems – “operating far from equilibrium” – when I first studied biology I was taught about “homeostasis” – the processes which maintain the inner environment of the body is a state of equilibrium. I learned about many feedback mechanisms which sought to maintain a number of balances – blood pressure, muscle tension, the levels of various salts in the blood and so on. So learning that complex adaptive systems function “far from equilibrium” was a bit surprising. But then that’s how we change. That’s how we grow. It’s only by operating at the edge of the balance that we meet what is termed “bifurcation points” and undergo “phase changes” and “emergence”. I didn’t learn about those phenomena when I first studies biology or Medicine, but they are fundamental characteristics of all living organisms.
Shifting from a focus on checks and balances, to living complexity, can move us from seeing homeostasis as an end in itself, to seeing that it is only one element in the over all process of creativity and development.
As long as we live, we are never finished with these creative, developmental processes. As Michael Foley says –
there are no independent, isolated, finished organisms.

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Memory

Posted in books, from the dark room, from the living room, from the reading room, life, neuroscience, philosophy, psychology on September 23, 2015| 2 Comments »

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There are many theories about memory, and as far as I can see, nobody has really got it figured out yet. Probably one of our most common models is a filing cabinet. We have the idea that everything that happens and everything we ever learn is stored away in some drawer inside our brain. When we want to remember it, we just need to go to the right drawer and take it out.

The trouble is, we haven’t been able to find anything remotely like this filing cabinet in the brain. At the neurological level there seem to be many regions of the brain involved in the processes of memory, not just the hippocampus, although that does seem to be very important.

Rupert Sheldrake, in his Science Delusion, proposed an interestingly different model – one of resonance. Briefly, he suggests that memory is stored outside the person and in the universe, so recalling something is more like tuning in to a radio station. Once you hit the right wavelength you have access to the memory.

Henri Bergson had a different theory –

His intriguing theory was that all memory is like the muscle memory that enables the body to recall how to ride a bicycle or to swim. These muscle memories are not stored as representations and, similarly, the mind does not store recollections but in perceiving a situation instantly brings into play the appropriate previous mental responses, just like the body discovering itself on a bike or in the sea. So memory does not wait patiently in some dusty archive but is constantly and urgently pressing forward into perception, to the extent that the characteristic movement of memory is not from present into past but from past into present

In some ways, this is close to the neurological teaching of “what fires together wires together”. Memory, in other words, isn’t like a photographic image, a book, or a film archive. It’s a constantly active process of engaging with the world. It’s not about a file waiting to be found with the help of the right card index. It’s more like the way we learn to use our bodies – to walk, ride a bike or swim. When we do those actions we don’t have to go back into our brain stores and find the manuals!

The memory functions involved in these skills are embodied.

This is a surprisingly holistic model to develop years before we began to uncover the ways in which all of our mental processes are embodied.

One of the enticing aspects of this theory is that all that we have ever done, experienced or learned, is actually ever present, ever “urgently pressing forward into perception” in ways which deeply influence what we perceive, and also, what we do, now.

Of course, I bet some of you are thinking “memory is constantly and urgently pressing forward into perception”? So, why can’t I remember somebody’s name when I think about them? Why do I come back from the shop without some of the things I went to buy?

I don’t think a dynamic, active model of memory means that we have 100% recall. In fact, clearly, that isn’t the case for any of us, and however memory works, it sure doesn’t include the ability to remember every experience and piece of knowledge we have ever encountered. That’s probably for a very good reason.

I suspect it would be impossible to get through life if we didn’t manage to forget, as well as being able to remember……but then, that’s probably the subject of another post!

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Respect for the individual

Posted in books, from the consulting room, from the dark room, from the living room, from the reading room, health, life, narrative, philosophy, photography on September 22, 2015| Leave a Comment »

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Michael Foley, focusing on Henri Bergson’s philosophy in “Life Lessons from Bergson”, writes –

there is a tendency to see what things have in common rather than what makes them unique, the source of a dispiriting sense of sameness.
As a doctor I need to know how to make a diagnosis. I also need a knowledge of the natural history of disease. However to actually help any individual patient I need something else as well – knowledge of this individual. So, I have to be able to see what things people have in common (certain symptoms and signs which indicate particular pathologies perhaps) and I need to be able to see this person sitting in front of me right now.
This person sitting in front of me right now is not the same as all the others. Every narrative I hear is unique and individual. No two patients have led, or are leading, identical lives, with identical bodies, minds, values and beliefs.
Reducing the individual to what they have in common with others is, in my opinion, “the source of a dispiriting sense of sameness”. That’s why I have such an aversion to Medicine by flow-chart, and the distorted practice of so called evidence based medicine which seeks to replace subjective human experience with data.
In short, we do not see the actual things themselves but in most cases confine ourselves to reading the attached labels.
Our left cerebral hemisphere is great for analysing things, sorting them into categories and applying labels, but it’s not enough. We have to attempt to “see the actual things themselves” and not be blinded by the labels. For doctors, that includes seeing the actual patients themselves, and not confining their understanding to the “attached labels” – diagnoses, categories or types.
I think the creation and appreciation of narrative is an important part of a doctor’s job and it requires more than a knowledge of the “medical sciences”.
Here’s Michael Foley again –
A crucial function of the arts is to prevent, or break down, dismissive labelling and reveal the singular instead of the similar, the peculiar instead of the familiar, and the inscrutable instead of the understood.
This reminds me so much of Deleuze’s three modes of thinking – science, which is thinking about function; philosophy, which is thinking about concepts; and, art, which is thinking about percepts and affects. Deleuze was a great advocate of thinking about difference too.
What an elegant phrase too – revealing “the singular instead of the similar, the peculiar instead of the familiar, and the inscrutable instead of the understood”.
What a great way to enhance respect for the individual – seeing them as unique and knowing you will never achieve a complete understanding them….which reminds me of Saint-Éxupery’s teaching that “What is essential is invisible to the eye”

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Heroes not zombies

Posted in books, from the dark room, from the living room, from the reading room, life, narrative, neuroscience, personal growth, philosophy, photography, psychology on September 21, 2015| Leave a Comment »

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In Life Lessons from Bergson, Michael Foley writes –

What happens when we fail to live in duration, no longer hear the inner melody and lose touch with the intuitive self? We become frozen, petrified – automatons, slaves of habit or convention or both. 
“Living in duration” is living in the experience of life, being fully present, attentive and aware. The opposite is to live in our inner worlds of representations and labels. Iain McGilchrist describes this brilliantly in his The Emperor and His Emissary, showing how the right hemisphere of our cerebral cortex processes the raw information as we pick it up from the world, then hands off some of it to be re-presented and analysed in the left hemisphere. What should happen next is that the analyses and representations are fed back to the right side to be re-contextualised. McGilchrist makes the point that, sadly, we’ve created a world where we forget the importance of the activities of our right hemispheres, and give primacy to those of the left.
“Hearing our inner melody” is a beautiful phrase. When we experience music we don’t experience it as separate notes and pauses. We experience it as rhythm and melody.
And our “intuitive self”? That deep, natural, heart-focused knowing….
What happens when we lose touch with those things? We get rigid and stuck.
There is no doubt that the pressures to conform in our society are enormous. It seems to me we are becoming less and less tolerant of difference, fearing “others” and suppressing diversity.
Every day we need to freely choose what to do, what to say, and what to think. As Michael Foley says –
Our freedom, in the very movements that affirm it, creates the developing habits that will stifle if it fails to be renewed by constant effort: it is dogged by automatism.
This is the fundamental theme of this blog – we all tend to default into autopilot and in so doing we live in a more limited, and less fully human way – like zombies – with habits and routines and “norms” on loops. Our alternative is to wake up, become aware and consciously choose to become the author of the one unique story in which we are the hero, the protagonist, the main character.
William James, who shared many of the same views as Bergson said
Could the young but realize how soon they will become mere walking bundles of habits, they would give more heed to their conduct while in the plastic state. (Psychology: The Briefer Course, 1892)
My only issue with that statement is I don’t accept we completely lose our “plastic state” – what he means by “plastic” is dynamic, malleable, capable of being changed. Sure, as we become constrained by our habits and automatisms, it becomes harder to change.
But with awareness and will, change is possible!

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The ever-developing self

Posted in books, from the consulting room, from the living room, from the reading room, life, philosophy, photography, psychology on September 20, 2015| 1 Comment »

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In Michaei Foley’s Life Lessons from Bergson he describes the philosopher’s ideas about the “self”
Bergson constantly distinguished between two selves, meaning two levels of process – a superficial self whose reactions are socially conditioned and a deep, intuitive self capable of empathy and free will…..This deep self is always in danger of being misrepresented by the categorizing self, dismissed as irrelevant by the utilitarian self and snuffed out as a threat to popularity by the social self
It’s interesting that nobody has ever found “the self”.
We talk about the benefits of “self-confidence” but what is this “self” we have confidence in?
We talk about the benefits of having “self-awareness” but who, exactly, is aware of this “self”?
Whatever you think about the concept of the “self”, I think it’s pretty clear there is no fixed entity called the “self”….no unchanging thing.
I often found the concept of a “community of selves” to be a more useful model when working with patients. People often identify much more closely with one aspect of their personality, or with one role in life, than they do with their other ones. For example, I fully identified with my doctor self while I was at work, and yet in other times and places my dad-self, or husband-self, or my teacher-self would feel much more prominent.
So, I’m quite taken with Bergson’s two selves – the superficial and the deep.
I especially like his description of the deep, intuitive self as being capable of empathy and free will, whilst the superficial self is more reactive, more subject to the pressures and influences of others.
Read the last sentence of that passage from Foley’s book a second time….
Our deep, intuitive self is constantly interacting with our superficial self, but look at the potential “misrepresentation” of the deep self – by the “categorising self” (…our left hemisphere?), by our “utilitarian self” (….makes me think of evolutionary biology) and by our “social self” (…with all that pressure to conform and fit in)

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Measured time and experienced time

Posted in from the living room, from the reading room, life, personal growth, philosophy, photography on September 18, 2015| Leave a Comment »

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In Michael Foley’s Life lessons from Bergson he says this about Bergson’s concepts of time –

Bergson distinguished two versions of time – time measured, which he defined as clock time, and the experienced, which he defined as duration. Clock time, spatialised and uniformly calibrated, is obviously necessary, but only duration is authentic.

When I was reading Deleuze’s work on cinema I came across Bergson’s concept of duration for the first time. That was my entry point. Realising that the way cinema artificially creates movement by showing you still images in rapid succession was the first time I had encountered the idea that clock time is actually artificial. We invented it. It wasn’t sitting there waiting to be discovered.

We experience time as a flow, not as a rapid succession of images or events.

For most of my working life a large part of the day was divided into blocks of minutes. A standard clinic of follow up appointments would be set out in 20 minute periods. A new appointment allocated 90 minutes. In General Practice the time slots were all much shorter than that. Our Practice was created around standard 10 minute appointments. Other groups used a standard of 5 minutes.

I didn’t wear a watch, and I didn’t have a clock on the wall, but I rarely ran late.

Same thing with giving talks or presentations, or teaching. Whatever time allocation I was given, most times (not always!) I said what I’d come to say in exactly that period of time.

Somewhere in me something kept me to time, but not by measuring minutes. I think that mainly arose through habit and experience. I became able to work according to duration.

Here’s more from the Life lessons of Bergson –

We should learn not to manage time but to let time manage us….the paradox is that the only escape from time is in submission to time. When we are flowing along with a process, awareness of time disappears.

We all know that one don’t we? When we go to a great movie we are surprised that two hours has passed already. When we are absorbed in a great book time disappears. When we are fully immersed in sharing a meal or being with someone we love, time disappears.

The “slow movement” is really based on this concept. In fact, the slow movement is, I think, not about being slow at all. It’s about immersing yourself fully in whatever you are doing. Sinking into, absorbing yourself in, fully enjoying and experiencing the present. The best book I know about the slow movement is Carl Honore’s “In Praise of Slow”. Why not buy a copy, and read it…..slowly?

I love Michael Foley’s suggested exercise of sitting on a sofa a dusk –

The gradual fading of the light is a perfect example of process, ‘succession without distinction’, impossible to catch in action but impossible to miss in effect. And the effect, especially if accompanied by a glass of wine, can be mysterious, enchanted, a spell that encourages reconciliation with process and time.

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Continuity and variation

Posted in books, from the consulting room, from the dark room, from the living room, from the reading room, health, life, neuroscience, personal growth, philosophy, photography, psychology, science on September 17, 2015| Leave a Comment »

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Reality no longer appears essentially static, but affirms itself dynamically, as continuity and variation. What was immobile and frozen in our perception is warmed and set in motion.

Those are the words of Henri Bergson, quoted in Michael Foley’s excellent “Life lessons from Bergson”.

I love that. The experience of life as dynamic, “warmed and set in motion”.

Life isn’t “frozen and immobile” to me, and that’s why I am wary of categories and labels. I’ve always resisted being put into a box, defined by one or two of my characteristics. When I think of that I recall the adage of the General Semanticists – “judgement stops thought”. So often fixing someone or something into a category or type stops us from really seeing, really understanding.

Reducing an individual to a type diminishes them in all senses of the word.

Every patient I ever encountered was unique, presenting experiences and stories unique to them. To reduce them to diagnostic categories, or to types of any sort, blocked my understanding of them. Everyone always has more to reveal, more to share, more to experience and be understood.

Michael Foley says he came back to Bergson’s work after dismissing it decades earlier. His way back is interesting. It’s not the same as mine. My first encounter with Bergson came when I was reading Deleuze but I didn’t find him easy. I later stumbled into complexity theory and, in particular, the idea of complex adaptive systems. At that point I remembered some of Bergson’s ideas and went back to explore his writings further. Michael Foley’s path was through his encounter with “process philosophy” and with particle physics –

I learned from twentieth century philosophy of mind that memory and the self are processes rather than fixed entities – and suddenly this connected with the theories of particle physics, which claim that at the heart of matter there are in fact no particles but only processes…….everything is process…and everything is connected to everything else.

In the process view nothing is fixed, nothing is final and no circumstances ever repeat in the same way.

This strikes me as very true. Dan Seigel, one of the founders of Interpersonal Neurobiology, worked with colleagues to come up with a definition of the mind. What they concluded was that ” the mind is a process of regulation of energy and information flow. ”

The mind is not an entity or a thing, it’s a process.

The body is not a fixed entity or thing either – it’s a dynamic ever changing network or community of cells.

Disease is not a thing either. That really startled me when I read that once I was a practising doctor. As a medical student I picked up the view that disease was pathology and pathology was the changed organs or cells. Once I became a GP I encountered dynamic, hard to pin down illnesses that certainly couldn’t be reduced to pathological entities. Hearing that disease was a process not an entity was liberating for me.

I will return to some of the issues raised by this thinking in other posts but let me finish this one by returning to the title, because once we gain the insight which shifts our attention from entities to processes we discover diversity – we find out that variation is a key characteristic of Nature and of Life. But I think we find out something else too – that the universe, the world, and our lives are not completely random, chance, accidental phenomena. Instead there is continuity. We are in a process of continuous creation and emergence. We are who we are in our networks of family, nature, society and the world. We emerge from the past, as the past encounters and interacts with the present. Our future doesn’t contain just anything you could ever imagine. It emerges from here and now, from that flowing river of life and connections.

Continuity and variation. Just like the flow of a river. Just like the natural history of a plant, an animal, or any other living organism.

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Henri Bergson

Posted in books, from the living room, from the reading room, life, philosophy on September 16, 2015| 2 Comments »

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When I started this blog, and came up with the title “Heroes not zombies”, I also chose a byline of “becoming not being”. Those choices were very influenced by reading two French philosophers – Giles Deleuze and Henri Bergson. Bergson wrote in the late 19th century, early 20th. His ideas preceded our discoveries which followed the splitting of the atom which led to a new physics. They also preceded the findings of neuroscience which have turned out to be consistent with his thought. Yet, sadly, his writings have been pretty much ignored for the last hundred years.

I am utterly delighted to have just discovered Michael Foley’s concise, crystal clear book, “Life lessons from Bergson”. I cannot recommend it too highly. Buy it! Read it! It might just change your world view.

Here’s a summary passage from the end of the book to whet your appetite.

he sought to protect the evolving self from finality, rigidity and circumspection, privileging the dynamic over the static, the holistic over the compartmentalised, the organic over the mechanical, the qualitative over the quantitative, the intuitive over the analytic, the continuing over the completed, the open over the closed and above all the free over the determined.

If any of that touches you, resonates with your values, then you will love this book. I’ll share some of the best ideas from it in future posts.

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Getting real

Posted in from the consulting room, from the dark room, from the living room, health, life, philosophy, photography, science on September 6, 2015| Leave a Comment »

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The thing that’s always bothered me about reductionist science is how quickly it becomes so abstracted from the world that it no longer usefully models the world.

Human beings, as living organisms, are complex adaptive systems. We are inextricably embedded in multiple contexts, physical, social, and cultural. You can’t truly understand a human being when you consider them isolated from the air they breathe, the food and water they eat and drink, the extensive web of relationships they live in, from family, friends and colleagues, to the networks of production of goods and services.

We are dynamic, open systems. That is, change is the constant of our nature, and there is a permanent flow of energy, information and substances between ourselves and the world in which we live.

A team of researchers in Montpellier has just published an interesting study beginning to try to examine and understand how chemicals in our environment bring about changes in our bodies.

They examined forty common chemicals which are found in the environment and in human bodies. Each of these chemicals has been tested on its own as part of state regulatory processes. Each one on its own has effects on the body, but not large effects (according to the studies). But of course, in the real world they don’t exist in isolation, so what happens when more than one of them is present at the same time?

As the researchers said, one and one normally make two, but when they studied the effects of the different pairs of these forty chemicals (780 variations of pairs in total) they found that sometimes one and one made fifty, or even a hundred. What they mean by that is that as they work together two chemicals don’t have a simple additive effect. Instead their combined effect can be many, many times greater than simple addition would suggest.

There’s an obvious reason for this. As complex adaptive systems, the cells in a human body are connected in a non-linear way, not a simple, linear one.

This study examines the effects of these particular chemicals on a particular receptor in a cell, (“pregnane X” receptor). They looked at this because chemicals have been shown to affect hormone systems within the human body causing widespread changes in the immune and inflammatory systems by interacting with such receptors, potentially setting off chronic metabolic and physiological disturbances in a person.

There study showed that one particular pairing of chemicals worked together as a kind of double key i.e. neither chemical could fit the receptor site, but when the two types of molecule combined they made the shape of a key which resulted in a much better fit to the receptor. So, singly, they produced little activity in the cell, but together their effect was multiplied 50 to a hundred fold. (The two they highlight are a pesticide and chemical from the contraceptive pill)

This is a small study only looking at the effects of pairs of chemicals in a set of forty, and only looking at the effect on a single receptor site. They point out that there are over 150,000 man made chemicals in our environment.

I’ll say that again.

There are over 150,000 chemicals in our environment.

Not just 40.

How many combinations can there be? How many combination effects might there be? Besides this particular one they have demonstrated. And the receptor site they studied is only one of many such sites in human cells.

A bit scary, huh?

They say they would now like to study the effects of pairs of 1600 prescribed drugs.

Are you a little surprised that we know so little about the real world effects of the presence of combinations of chemicals and medicines in the human body?

Well, thank goodness, we are beginning at least to explore real life complexity and stop pretending that single agents can be sufficiently studies in isolation.

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Taste

Posted in from the consulting room, from the dark room, from the living room, health, life, personal growth, philosophy, photography on August 29, 2015| 1 Comment »

I moved to France last November, so this has been my first summer in the Charente. Before moving here I lived for many years in a top floor apartment on the edge of Stirling in Scotland. We had fabulous views of the mountains and the volume and light in the flat, created in an 1830s textile mill, was fantastic.

Moving to France gave us the chance to live in a traditional Charentaise “long house” with a garden and a “potager” (a vegetable plot).

Here’s a photo of yesterday’s harvest. We don’t have a large potager, but look at this!

What a photo can’t convey however is taste. The taste of vegetables straight out of the garden is something else. The yellow courgettes are a relevation to me. I could really take or leave courgettes up till now. These fresh yellow ones are like something I’ve never tasted before.

We’ve tried a range of varieties of tomatoes this year and they sure would all fail the supermarket standards of shape and size but, wow, what the supermarkets are missing out on! Turns out flavour trumps size and shape by a long, long way. I didn’t know tomatoes could taste this good. I didn’t know tomatoes could taste this different!

Finally, look at the huge, red chilli peppers. For some reason, fresh chilli peppers are not easy to find in this part of the world, and we were advised that whilst they might grow outside here, they wouldn’t have much taste. The advice was correct in that they sure do grow outside here. Our chilli pepper pland has produced these beauties in abundance, and there are many, many more just waiting for a bit more sun to turn this glorious red. But the advice was definitely wrong about taste. They could blow your head off! Zinging with spice!

My general theory of a good diet has been pretty similar to Michael Pollan’s food rules – “eat food, mainly plants, not too much”. But one of the things he misses in those rules is flavour. And is there any better reason to eat something than that it delights your palate?

So, what I’d add in is, try to eat food which has traveled as short a distance as possible from where it grew to your plate. When you do that, you get the following –

  • food which is the freshest it can be
  • food which has had the least amount of processing
  • food which has the greatest variety of sizes and shapes
  • food which is most likely to be seasonal

I reckon that, depending where you live, you might not manage this “rule” – let’s call it “advice” – too often, but you know what they say – “every little helps”.

Oh, the other thing I think that Michael Pollan’s food rules miss out on is where you eat and who you eat it with. There’s more to food than “fuel” or measurements of constituents – so much vitamin whatever, such a percentage of protein, fat, carbohydrate, and so on – food’s to be enjoyed, savoured and shared, as well as digested!

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