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Archive for the ‘philosophy’ Category

Let’s consider four verbs which highlight essential characteristics of human beings.

SENSING

All living creatures are sensate. All have sensory organs to pick up stimuli from the environment – light, sound, odours, temperature and so on. As human beings we have a particularly elaborate sensory system, possibly THE most elaborate of all creatures, however, being sensate is a characteristic we share with all animate beings.

FEELING

I have a large hardback copy of Gray’s Anatomy on my bookshelf. I bought it when I was studying anatomy at Medical School back in 1973. I still find it fascinating. The section on the nervous system and the brain shows something incredibly striking. All the nerves which carry the signals from the sensory organs travel first of all to what is termed “the old brain”, the “limbic system” more or less. That always amazed me. Why do all the sensory signals go there? This particular area of the brain is the main emotion generating and processing centre. It’s responsible for those feelings you get of fear, of arousal, of anger, and so on. Modern techniques of brain imaging are helping us to understand this better. It seems that we have developed in a way which allows signals from our sensory equipment to first of all create emotional states. This has a survival advantage. For example, we can quickly develop the “fight or flight” response to successfully deal with any threats around us. Obviously emotions are considerably more elaborate than this. Anthony Damasio is really interesting to read about this subject. “Descartes’ Error: Emotion, Reason and the Human Brain” is a good starting point. But I can also recommend his “The Feeling of What Happens” and “Looking for Spinoza”. You might also like “Consciousness Explained” by Daniel C Dennett and “Emotional Intelligence” by Daniel Goleman. What all of these authors show us is how this particular function of the brain allows us to respond to stimuli from the environment far, far more quickly than we could if we had to become aware of everything consciously first, then figure out what to do about it. That thinking thing comes next! Although it’s not possible to really know the emotional content of another creature’s mind, from observing behaviour patterns it would seem that other animals also have emotions.

THINKING

Those two great parts of the brain known as the cerebral hemispheres are responsible for what we term “cognition”…….thinking. In its entirety, the human brain is THE most complex structure in the known universe. Amazing, huh? And it’s inside your head! There’s way too much involved in thinking for me to explain here but it involves memory, imagination, awareness, concentration and systems of assessment. Once signals have been processed in the old brain (and acted upon!), this “new brain” picks up the trail and processes what’s going on. It’s thinking that let’s us make choices. Some other creatures think too, but, as far as we know, not to nearly the same extent as human beings do. One of the things we’ve done with these capacities is to develop language which gives us the ability to handle and manipulate symbols and to think both abstractly and synthetically. And that leads to the fourth verb – the one which seems to be uniquely human –

MEANING-SEEKING

We don’t just pick up signals, we don’t just generate feelings, we don’t just think about the signals and the feelings to make choices, we do something else. We try to make sense of things. We are always asking the questions “Why?” and “How come?” We are insatiably curious but we are also insatiably trying to understand the world and our experiences. The way we do this is by telling stories. We put everything together and attribute values and meanings to weave narratives which enable us to make sense of the world and of ourselves. We do this in a host of complex ways. Viktor Frankl showed how this is one of our most fundamental drives. See his “Man’s Search for Meaning”. Richard Kearney shows how we use storytelling for this purpose, and Owen Flanagan shows how we inhabit “spaces of meaning” to create our distinct worldviews and narratives.

So, there you have it. Four verbs which make us human – sensing, feeling, thinking and meaning-seeking.  Let me just add one further level of complexity. I’ve presented this is a logical, step-wise way – inspired by those evolutionary biologists – but on a moment to moment basis, these activities of the human being are continuously active and interactive. What sense we make of something influences what we sense and vice versa. Feelings influence thoughts and vice versa. And so on.

What do you think? Do you agree that these four verbs capture what it is to be human? Have you any others you think I should add?

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Maybe, like me, you have a collection of “significant” books. By that, I mean books which had a big impact on the way you think, or the way you understand life. I’ve written about some of those books here already, but here’s another one which I read a few years ago. Hans-Georg Gadamer‘s “The Enigma of Health: The Art of Healing in a Scientific Age” is a collection of essays by this professor of hermeneutics (I know, I had to look it up in a dictionary too, but, trust me, this man had a brilliant mind!)

Gadamer died in 2002, and while I was visiting Tokyo, a copy of the Japan Times slid under my hotel room door early one morning, included an obituary about him. I’d never heard of him, but it’s amazing what you’ll read in the wee small hours in a foreign country when your body and your head are still half a day away in your home town! I was completely fascinated with what I read and his thinking about health really captured my imagination so I went online and ordered up “The Enigma of Health” from Amazon. By the time I got back home it was waiting for me. Let me share a few quotes with you. I wrote them down in my Moleskine (as I do!)

Although health is naturally the goal of the doctor’s activity, it is not actually ‘made’ by the doctor.

I make this point with every new patient I see. It’s the big unspoken truth about medical practice. Doctors’ treatments might reduce or remove a pathology, might even redress an inner imbalance, but they don’t cure – only the body does that. He says more about here –

Yet the goal of the art of medicine is to heal the patient and it is clear that healing does not lie within the jurisdiction of the doctor but rather of nature. Doctors know that they are only in a position to provide ancillary help to nature.

Franklin put it another way when he said “God heals and the doctor takes the fees”

I often ask medical students to tell me the answer to this – if a patient with a urinary tract infection gives a urine sample which grows bacteria which the lab shows are sensitive to a particular antibiotic and the patient is prescribed that antibiotic, what will the antibiotic do? The ones who don’t think carefully say the antibiotic will cure the infection. It won’t. It’ll kill the bugs. That’s it. The inflamed bladder wall, which might even be bleeding from the effects of the infection will be restored completely by the body’s repair processes. The healing is natural. The antibiotic only removes the offending bug to let the healing system do its job. This might seem like nit-picking, but it isn’t. It involves a profound change in thinking. Doctors aren’t gods. At best they assist healing and all healing is a natural process.

…the doctor’s power of persuasion as well as the trust and the co-operation of the patient constitute essential therapeutic factors which belong to a wholly different dimension than that of the physico-chemical influences of medications upon the organism or of ‘medical intervention’.

There are some who think that health and illness can be understood in purely physical terms and that treatments can be understood to work, or not work, on the basis of their physico-chemical effects. That’s a limited way of thinking. Healing involves more than that, and may not even involve any physico-chemical intervention at all. Those who think medicine can be reduced to a science (as opposed to a science and an art) rely on measurements of phenomena. Gadamer is brilliant about this –

….modern science has come to regard the results of such measuring procedures as the real facts which it must seek to order and collect. But the data provided in this way only reflect conventionally established criteria brought to the phenomena from without. They are always our own criteria which we impose on the thing we wish to measure.

I believe it was Max Planck who said “facts are what can be measured”. Well, reality cannot be reduced to facts. The tendency to reduce understanding to physical measurements is accompanied by a concept of health as some kind of product – an end point or state which can be known and measured. Gadamer argues instead –

…physicians do not simply create a product when they succeed in healing someone. Rather, health depends on many different factors and the final goal is not so much regaining health itself as enabling patients once again to enjoy the role they had previously fulfilled in their everyday lives.

This clear statement suggests to us that health is an experience and it’s an experience which in its detail will be different for every person depending on the characteristics and environments of their lives. Later in his essays Gadamer considers how far from being a measurable product, health is really what is experienced when illness is not present or goes away. This is the “enigma” of health – that we only know it by its absence. Consider the fingers of your right hand. Right now you’re not really aware of them. Trap them in a car door and then you instantly become aware of them. You get the idea?

This post could go on forever! I’ll stop, but suffice it to say this is a deeply thoughtful consideration of our concepts of health, illness and healing.

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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.

Robert Coles in “The Call of Stories”.

Stories have always fascinated me. I love them. Every day when I sit in my consulting room patients tell me the most amazing, fascinating and unique stories. As a medical student I was taught how to “take a history” – I hate that phrase actually – who’s doing the “taking” and what exactly are they “taking” and from whom? Doesn’t seem right to me at all. Instead I prefer teaching medical students how to listen to patients’ stories. However, the point is that this is the beginning of all diagnosis. To a certain extent listening to the patient’s story is a diminished art. There’s an over-reliance on technology and a lot of doctors just don’t seem to be able to make a diagnosis without a test these days. Diagnosis is a form of understanding. It’s a process of trying to make sense of somebody’s experience.

If stories are so important in clinical practice, then how can I learn to handle them better I wondered? There is a developing area of medicine known as “narrative-based practice”, with associated “narrative-based research” methodologies, but materially-orientated, reductionist scientists look down on narrative. They prefer data. So, when I started to study narrative (which, technically is the story AND the way that story is told), I couldn’t find much work from a scientific perspective. I had to turn to the humanities.

One of the books which I really love in this area of study is “On Stories” by Richard Kearney (ISBN 9-780415-247986). Not only is it a fabulous exploration of the place of story in human life, but it’s written completely beautifully. Richard Kearney is a philosopher but he’s also a magnificent writer. This one book taught me more about the importance of story than any other.

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.

This sets stories at the heart of human existence – not optional, but essential.

Aristotle says in “Poetics” that storytelling is what gives us a shareable world.

The key word there is “shareable”. It’s through the use of story that we communicate our subjective experience and its through the sharing of subjective experience that we connect, and identify with others.

Without this transition from nature to narrative, from time suffered to time enacted and enunciated, it is debatable whether a merely biological life could ever be considered a truly human one.

Beautifully expressed. Sets narrative at the heart of what it means to be human and stands it against those who would take a materialistic view of life which they claim can be reduced to data sets and DNA.

Every life is in search of a narrative. We all seek, willy-nilly, to introduce some kind of concord into the everyday discord.

This is one of my favourite lines in the whole book. This is exactly the power of story – it enables us to “get a handle on” life, to bring some kind of order out of chaos.

What does Richard Kearney mean by story then? Well, I’ll finish this post with two more quotes from his book which make it very clear and very simple.

When someone asks you who you are, you tell your story. That is, you recount your present condition in the light of past memories and future anticipations.

This shows that story collapses time, bringing the past and the future into the present. Story telling requires memory, imagination and expression.

Every story requires –

a teller, a tale, something told about, and a recipient of the tale.

Nice and simple, but what profundity lies in there. For every story, there is a unique human being doing the telling, there is the story itself and its subject matter, and, very importantly there’s the recipient – the listener or the reader. Story is, as Aristotle said, a way of creating a shareable world. That’s the greatest potential of blogs, I reckon. By sharing our stories we create a shared world. Yes, sure, stories can divide as well as connect, but without stories, there is no potential for connection, no potential for compassion and no potential for the creation of a meaning-full, and better world.

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What’s important in your life? Go on, take a pen and paper and make a list.

What’s on your list?

I’ll bet that much of your list will be invisible things – relationships, love, meaning, purpose, happiness, health, safety……..I don’t know – you tell me – what would you include and what’s the ratio of invisible things to visible, material things on your list?

Robert Solomon uses the idea of thin-ness to rail against the sterility of a life which is based on logic, but excludes a consideration of emotions. I think a materialistic life is a thin life – not that we don’t need material things (like food!) but that to consider only the material, physical phenomena of life as real, is both a delusion and, frankly, a poor experience of life. Life with the life taken out!

Saint-Exupery had it right in his Petit Prince –

“Goodbye,” said the fox. “And now here is my secret, a very simple secret: It is only with the heart that one can see rightly; what is essential is invisible to the eye.”

“What is essential is invisible to the eye,” the little prince repeated, so that he would be sure to remember.

 or – in the original –

– Adieu, dit le renard. Voici mon secret. Il est très simple: on ne voit bien qu’avec le cœur. L’essentiel est invisible pour les yeux.

– L’essentiel est invisible pour les yeux, répéta le petit prince, afin de se souvenir.

so, do you agree? Are the most important things in life invisible? Are they exactly what cannot be measured?

 

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There’s a doctor and bluegrass musician called Dr Tom Bibey left a comment on one of my posts and you know how it is with the net…..you can’t resist following the trails, so I popped across and browsed his blog. What a treat! Here’s a quote from one of his posts –

Folks who believe they know a patient by the paper they keep are so naive.  The impact of sitting at someone’s kitchen table and sifting through the array of pills from different Docs the patient ”thinks” they might be taking is powerful.  Everyone trying so mightily to pass rules to govern human behavior needs to make a few house calls before they get so dadburn high and mighty as to their perceived importance.

See, to me, that’s wisdom. Yes, we need our statistics and our research, and our science, but there really is something called the art of medicine, and people who have no experience of it, probably don’t understand it. To be a good doctor though I think involves making use of the whole self – the brain and the heart – understanding how things work, how to interpret science, but also learning how to relate, how to be compassionate and caring every single day, with every single patient. Without that, you never really get to know anyone and without knowing them, you’ve no way of understanding them, and without understanding you’re working in delusion not reality.

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A Good Life

What makes a life a good life?

Philosophers have struggled over this question for centuries. It seems such a simple question but it’s not so easy to answer. One of the biggest problems with the question, of course, is that what constitutes a good life for each of us is probably a bit different.

Despite what the self-help books in the Body Mind Spirit section of the bookstores tell you, there’s no magic formula.

A C Grayling has recently published a book about this, ‘The Choice Of Hercules: Pleasure, Duty and the Good Life in the 21st Century’. He was talking about it on ‘Start The Week’ on BBC Radio 4 on Monday morning (podcast available here)

In a nutshell, he is considering the often opposing drives of duty and pleasure, or as Oliver Sacks, one of the other guests on the show said, between work and love. How we balance these determines how good we feel our lives are.  A C Grayling concluded that those rare individuals who love their work, are amongst those who have good lives. Well, I can sign up to that one. I have a good life and I certainly love my work.

I’ve just finished reading ‘The Weight of Things’ by Jean Kazez (ISBN 978-1-4051-6078-0). I bought this after reading an excellent article written by her, where she reviewed and compared three books on happiness.  I was impressed with her balance, style and insight and I’ve really enjoyed ‘The Weight of Things’. It’s about what constitutes a good life. She’s very clear in her book that she is not writing a manual or even giving a set of recommendations about living well. It’s a much more thoughtful and thought provoking book because of that. She refuses to be pinned down to a fixed set of specifics and I think that is so right, although at first, I thought, why is she being so difficult? Why doesn’t she just list the necessary features of a good life? I realised I was chasing the magic formula that doesn’t exist. Jean Kazez is much more realistic than that and completely acknowledges that we are all different and it would be wrong of her to proscribe the features which she thinks make life good. This is such a refreshing approach. I can’t stress often enough how much I value individual difference and diversity. I just can’t accept formulaic, one-size-fits-all approaches, and I don’t see the world through a two-value lens. (Ok, you’re probably thinking, ‘a what?’ ‘a two-value lens’? Well, I mean the categorisation of everything into one of two opposites – good/bad; black/white; proven/unproven. Sorry, life just doesn’t seem to fit that straightjacket for me).

What she does in this book is to consider some (but she expects, not all) features which are probably necessities if you want to have  good life, then goes on to consider other features, which she calls the B list, which make life better, but probably aren’t essential.

Here’s her very nice way of putting it –

The target we should aim for, if we want our lives to get better and better, is not like the familiar set of concentric circles. It’s like a grid of different coloured squares with different hues representing necessary and optional ingredients. The necessities are different shades of green (say) and we need to aim at each one. The various shades of purple are worth aiming for too, but they’re not so critical. If we start out with a life that’s not going well, we need to aim at the various greens: happiness, autonomy and the other basics. They remain central throughout our lives. But the purple squares – balance, accomplishment, and the like – are also life-enhancing.

I like that a lot. Maybe I wouldn’t pick green and purple but I like it all the same! The idea that a good life is not achieved through a recipe or formula but has ever changing variables which colour our lives in various hues and shades……that’s good. And it’s dynamic – she says –

a good life isn’t static, but involves some sort of growth over time.

I also like it because each of her characteristics, or squares is worthing focusing on and developing in its own right. She says that’s because making your aim a better life, as if ‘the good life’ has an independent quality you can aim at directly, is likely to fail.

Aiming for a better life is to be expected when life is going badly, but many of us take our focusoff our own lives when we feel like our lives are ‘good enough’. Many perfectly reasonable people with good lives will not aim for even better lives, let alone some conceivable ‘best life’. In some cases important things beyond ourselves start to take precedence.

How important is that last sentence? It’s a bit we often miss in our atomistic, disconnected lives. Remember the Hugh Grant character in About a Boy? That 80’s and 90’s idea of separateness, and, yes, selfishness, wasn’t enriching. Neither is the celebrity culture of our current times. Life really IS good when we get in touch with “important things beyond ourselves” – whether we see that in social, political, personal or spiritual terms.

Oh, I know, you still want her list, don’t you?

So did I.

(please remember – neither of lists should be considered definitive or complete!)

Here’s her A list (the fundamental essentials)

  • Happiness
  • Autonomy
  • Sense of identity
  • Morality
  • Progress

And here’s her B list (features which enrich life but needn’t be seen in themselves as essential)

  • knowledge
  • friendship, love, affiliation
  • play
  • religion
  • making music
  • creating art
  • accomplishment
  • balance
  • talent
  • beauty

She makes it very clear that different people will need each of these to different degrees to have a good life and that there may be other features others would add, and people might find for them that some of her B list needs to be on their A list.

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Heads up

Heads up, originally uploaded by bobsee.

I took three of my grandchildren to the Kelvingrove Gallery last week.
I’d seen photos of these heads but I’d never actually been to see them in situ so to speak.
It’s a great experience. You can stand and look at them for ages and you keep seeing something new, something different. Some of the expressions make you laugh. In fact, I think the whole installation makes you laugh and that is SO Glasgow! Glasgow people have quite a reputation for their sense of humour. I think it’s one of their greatest qualities.
I like art that makes you think and/or makes you feel. It’s that old Deleuzean thing again – the three ways to think – science, art and philosophy. It’s not a competition between those perspectives – they work together to reveal more than any one approach can do by itself.
If you ever take a trip to Glasgow I’d recommend taking in the Kelvingrove while you’re there.

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According to Deleuze and Guattari (see a thousand plateaus, and other writings too), the dominant model of thought which we employ is what they term the arboreal model. By this, they mean, tree-like.

tree

You’ll be familiar with this. Think of how we categorise using this model. It creates a hierarchy with layer after layer of subdivisions, branches or roots. But everything is connected back to the trunk, or up to the top level of the hierarchy. They say

The tree imposes the verb “to be”

It attempts to nail down exact definitions, to fix things in their place, to pigeon-hole them.

They challenge us to think instead using the rhizome as a model.

the fabric of the rhizome is the conjunction, “and….and….and…”

In a rhizome every element is connected to every other. There is no central trunk and no hierarchy. Think of a web

web

This is a non-linear model. You can’t fix things into pigeon-holes this way. It’s dynamic and flowing, without clear beginnings or endings.

I love this simple analogy. It’s one of my favourite parts of Deleuzean thinking. I find it liberating, even to the point of being dizzying. It’s got life and movement and creativity and flow. It helps us understand by considering difference rather than by categorisation.

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I understand the value of focusing on only the part of something to try and understand it better. It’s an essential part of the way we make sense of our world. BUT we must never lose sight of the fact that we CANNOT understand the whole by understanding the parts when we deal with complex adaptive systems.

My own area of medical practice is holistic and that’s not a New Age concept – it’s a focus on the person, rather than just a part of the person which is damaged (the pathological lesion).

A couple of authors I’ve read recently have used other vocabularies to address this issue. Robert Solomon describes a focus on parts as “thin” – it lacks “richness” and “depth”. That strikes me as very true. There’s too much left out of explanatory models which are reductionist. So much left out in fact that they fail to help us understand real life complexity. And Andy Clark uses the term “componential explanation”. Somehow this immediately makes sense to me. He shows how this only works when “the parts display the relevant behaviour even in isolation from each other.” Otherwise, we try a “connectionist explanation” similar to that described so beautifully by Barabasi in Linked. But, he points out, even a focus on the connections is not enough and he describes another model – “emergent explanation” (as explored in Dynamical Systems Theory). This is a good explanatory model for real life complexity and includes a study of “collective variables, control parameters, attractors, bifurcation points and phase portraits”.

Now doesn’t that sound much richer than the reductionist approach?

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Being There, by Andy Clark (ISBN 0-262-53156-9) is one of the most interestingly challenging books I’ve read for a long time. Let me say first that it’s taken me longer to read than I’d have expected it to. There are whole swathes of it which just didn’t engage me easily. In fact, a few times I thought I’d pack it in, then I’d come across a few sentences or a paragraph that not only would grab me and turn my thinking upside down, but it’d be exciting, visionary and, yes, down right thrilling.

I really enjoyed Robert Solomon’s, The Joy of Philosophy, not least because I feel he gave me a new vocabulary. His one word/concept of “thin” really expanded my thought. You can read more about it here, but what really excited me about this word was the way it captured the inadequacy of logical/analytical/reductionist thought.

I then read Barabasi’s Linked, which homed in on the key concepts of connections and nodes. I especially liked the way he demonstrated that the world, though a complex and at times chaotic system, is not random. Randomness turns out not to be the explanation for the phenomena we experience daily. That changed the way I thought about the world – there are patterns to be discovered, and phenomena to be understood. Sure, there is such a thing as chance, and life is often extremely unpredictable, but we can begin to unravel the connections between things and events, and in the process we can improve our understanding of the world.

Now I’ve just read Andy Clark’s Being There and he puts forward concepts that similarly change the way I understand the world and uses language in some novel ways which open the doors to other ways to explore life.  His main thesis is that to understand the mind we have to step outside of the study of the brain – not that the brain is not important of course – but we need to understand the environments in which brains exist. He draws the connections between the brain and the physical, social and symbolic environments in which we live and shows that to fully understand how the mind works we need to explore the interactions between brains and the world. He calls this concept of the mind, the “extended mind” and in the process he nicely shows how we use our brains primarily for pattern recognition and for creating change in the world. In particular how we create the structures in the world that we can then use to extend the functions of our minds.

Let me highlight one simple example – doing a jigsaw. To do a jigsaw we don’t work it all out in our heads but we use our hands to literally manipulate the pieces, turning them around to view each piece from different angles, so stimulating our pattern-recognising brains, and moving the pieces towards and away from different sections of the puzzle. In other words we manipulate the physical environment to help our pattern-spotting brains do what they do best, and to do that more quickly. Andy Clark nicely shows how we do exactly the same thing with our social environment and, crucially, with our ability to handle symbols and signs, which has reached its highest point in our development of language.

What does public language do for us? There is a common, easy answer, which, though not incorrect, is subtly misleading. The easy answer is that language helps us to communicate ideas. It lets other human beings profit from what we know, and it enables us to profit from what they know. This is surely true, and it locates one major wellspring of our rather unique kind of cognitive success. However, the emphasis on language as a medium of communication tends to blind us to a subtler but equally potent role: the role of language as a tool that alters the nature of the computational tasks involved in various kinds of problem solving.

I’ve never read this idea anywhere else – it highlights language as not only being a tool of communication but also being a tool we use to reshape the world to enable our brains to more effectively use their capacities.

This whole thrust can feel a little vertiginous. Look at this for example –

Every thought is had by a brain. But the flow of thoughts and the adaptive successes of reason are now seen to depend on repeated and crucial interactions with external resources. The role of such interactions, in the cases I have highlighted, is clearly computational and informational: it is to transform inputs, to simplify search, to aid recognition, to prompt associative recall, to offload memory, and so on…

and this –

Our brains are the cogs in larger social and cultural machines – machines that bear the mark of vast bodies of previous search and effort, both individual and collective. This machinery is, quite literally, the persisting embodiment of the wealth of achieved knowledge. It is this leviathan of diffused reason that presses maximal benefits from our own simple efforts….

Well, I don’t know about you but this embedding of the brain in the web of relationships, stretching backwards, sideways and forwards in time, makes my head spin! It turns the mind into an even more dynamic phenomenon than I had previously realised and at the same time it turns it into a much less isolated phenomenon too.

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