Heroes Not Zombies

Continuing on the theme of sense making…….I’m endlessly curious about how we human beings do three things – perceive the world, make sense of life, and influence our day to day experiences of reality. Each one of those contributes to the richness of our unique daily lives. No two of us have the exact same experience at the exact same time and place. Never. We will all bring our previous experience, our memories, habits and distinct patterns of being to the present moment.

I think that perhaps one of the most powerful, and certainly most magical, qualities we have is the power of imagination. Some people seem to think we can separate imagination from the perception of reality very easily, that there is a permanent and impermeable barrier between the two. Sometimes I wonder if there’s a connection between that thinking and what doctors used to describe as “the blood brain barrier”, an invisible border between the body and the brain which drugs couldn’t cross. We know it’s not that simple now. But is there a big stretch between that thinking and the idea that some illnesses are “all in your head”? I mean, whatever did that really mean? I remember hearing someone claiming that for a certain patient “her pain is all in her head”. What did that mean? That it didn’t really exist? That she was either lying or deluded? What a way to dismiss a person’s lived experience. What a way to undermine a relationship of trust. What a way to fail to understand.

I think our power of imagination doesn’t switch itself off and on. Blimey, it even keeps going while we are sound asleep!

Perception is a creative act. It involves memory, signals from the environment, signals from within our own bodies, as well as our creative powers of imagination which enable us to make connections, see patterns and create images which we hope provide us with good representations of the world.

Sense making is also a creative act. Whether we draw on numbers, words, stories, images or similarities, making sense of the world is an act of imagination, a creative act of imagination.

Our daily lives are creative acts. We are much more the active agents of our experience than we realise. We are not blank slates for someone else to draw on. We are not data to be fed into an algorithm. Algorithms, statistics and data do not KNOW us better than ourselves. We are creating ourselves every moment of every day.

This photo is of a public work of art, placed in a square in Malmo. It’s a griffin with a crown. A griffin? An imaginary creature. There are no griffins in Nature. But we respond to this, don’t we? We react to it. It influences us. Part of the genius of this sculpture, I think, is the crown. Placing the crown on this creature’s head increases its impact and magnifies its significance and importance.

I’m well used to living with imaginary creatures. I come from Scotland. And, no, I’m not thinking of the Loch Ness Monster. I’m thinking of the imaginary creature which adorns castles, flags and buildings throughout Scotland.

The unicorn.

A magical, mythical creature of incredible power.

I’m not going to describe my own responses to the unicorn today. Instead I’d like you to notice what your own responses are. When you look at an image of a unicorn, what do you experience? What images spring to mind, what thoughts enter your head, what feelings emerge within you? What do you imagine?

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When you look at this photo I think it seems to be a mountain with clouds and sky just above it. But you immediately recognise that’s not quite right.

So then you see this and you think it’s trees with the sky above….maybe one of those forest pictures where the photographer directs the camera straight up to the sky and catches the topmost branches of several trees. But that’s not quite right.

In the first photo, the apparent mountain in the foreground is an odd shape. Mountains just don’t look like that, then, in the second photo, what’s that rock doing balanced on top of the trees?

The thing is, these are both photos of reflections on the still water of a loch. Once you know that, the whole image makes sense.

This inspires a train of thought in my mind…..about how we perceive and make sense of reality. It’s a complicated business but it involves context. It helps to know where you are when you are looking around and what you can see in the immediate environment. There is nobody standing at the edge of this loch wondering what they are looking at. They know where they are and how they got there.

We make sense of reality by spotting patterns, but we need to learn the patterns before we can spot them. A bit chicken and egg-ish isn’t it? In normal life these two aspects of the same thing are iterative…..we are constantly learning and spotting patterns, the more we learn, the more we spot, and the more we spot, the more we learn.

Medical Practice is like that. Doctors learn pathology and the natural history of diseases. In other words, they the patterns of illness. The better a doctor knows the patterns, the more easily they’ll be spotted – or diagnosed. And the more diagnoses a doctor makes, the better the knowledge of patterns. We call it experience. I always felt that a good diagnosis was crucial in good health care. If the diagnosis was wrong, the chances are the treatment would be wrong.

In my first Paediatric job, my mentor told me on the first day that his goal for my six months with him was to teach me how to recognise a sick child. When he said that I thought it was a pretty bizarre thing to say. I mean, wasn’t it obvious when a child was sick? Wasn’t the goal to diagnose ie name the sickness? Well, of course, he was right. I was wrong. What he wanted to teach me was that very first important step…..how to recognise, in an instant, that this child was ill and needed immediate attention. Working out exactly what the disease was and how to treat it came a close second, but if you didn’t recognise that the child was sick, all was lost. It turned out that learning was by experience, encountering sick children and healthy children of all ages, to become familiar with what was normal behaviour and demeanour at different developmental stages. That teaching was crucial for my practice as a GP. It let me walk into someone’s house and know instantly that this child needed close attention and help.

The clues, and the signs, were in the contexts, the environments and the relationships. Yes, some were in bodily or facial “signs”, but mostly they were in behaviours and responses.

I suppose it’s that kind of experience and learning which made me suspicious of reductionism and generalisations. Every individual is unique and can only be understood within their contexts, their environments and their relationships.

Diagnose, like pattern spotting, is like joining up the dots. It’s got a lot to do with connections and behaviours. It’s not all about “data” and “measurements”. Especially when considering the real, actual, unique individual here and now.

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One of my most favourite sculptors is Antony Gormley, he who made “The Angel of the North” which stands beside the M1 in the North of England. His “The Field”, which I saw in Inverleith House in the Edinburgh Botanic Gardens years and years ago left an indelible mark on me. I recalled it in my mind time and time again as I wrestled with the paradox of what makes every patient unique and what they share with others.

But I was thinking again of his work the other day and I remember “Capacitor” which is what you see in this photo at the beginning of this post. This was one of the works he created from an outline shape of his body. In this case he made it with dozens of metal rods.

Maybe this came to mind because for the first time since I moved here almost six years ago I came across a hedgehog in the garden after dark, as I was out closing the shutters for the night.

I have such a clear memory of being in the same room as “Capacitor”….how awkward and dangerous it felt to be anywhere near this work. Like it could take your eye out, or pierce your body if you got too close.

So, you can see why that’s come back to me now. When I’m out and about now I sometimes think everyone has got on a suit that makes them look like “Capacitor”. Except all the spikes are invisible. Has this become the famous “new normal”? All of us increasing our stand-offishness (is that a word?). All of giving each other “a wide berth”. Everyone now regarded as a potential threat.

Then it struck me…have you seen the images of the coronavirus?

It’s a ball of spikes!

Yikes! It’s turning us all into images of itself!!

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