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Prediction

When did science become about measurement, prediction and control?

The scientific method seems to have transformed from the pursuit of understanding through awareness and observation to a system which is predominantly about prediction and control.

My ideal scientist is someone who knows their knowledge is limited, not someone who claims they are certain that what the know is “the answer”.

Measurements are part of science but they aren’t everything. We can’t measure the whole of reality. When measurements, or quantitate approaches, are elevated above observation and qualitative methods, then we end up where we are – with a hierarchy which privileges materialism and objects over the experiential and the subject.

That always bothered me in medical practice because human beings can’t be reduced to a data set without dehumanising people. In my experience no two humans were identical, people constantly surprised and amazed me and it was only ever possible to control the experience of illness over the short term.

I’ve been driven by curiosity and wonder since childhood. There’s something deeply satisfying about learning and understanding.

It might be a truism but I too find that the more I know, the more I know I don’t know. The universe is a place of endless wonder and mystery to me. And I love that.

It bothers me that science has veered off into prediction and control. Because both prediction and control only deliver over the short term.

Think of the weather report. The further out the prediction the less accurate it is. That’s true of pretty much everything in Nature and Life. Because we’ve come to understand that reality is complex and massively interconnected we’ve discovered that prediction is not possible in detail. That should keep us humble.

I like the notion that a doctor’s job is to understand. And understanding is driven by caring. I want to understand this patient today because I care about them. It’s not a doctor’s job to control people.

But of course in Medicine there is more than diagnosis. There’s also prognosis – and that brings me to prediction again. Because prognosis involves understanding where we might be heading. It involves recognising patterns and learning from experience so we don’t stumble through life blindly.

I guess I return to “and not or”. We need both. We need measurements and predictions as well as experience and understanding. So in fact I’m not “against” measurement and prediction. It just disturbs me when we use them to bolster a false sense of certainty and control.

Why is this bothering me just now? Probably because it seems that autocracy is increasing around the world and that the experience this pandemic is being used to further attempts by those with power to decrease freedom and replace it with control.

Life is messy, individuals are unique and embracing that knowledge can be liberating.

I suppose I’m arguing for a change of emphasis. I’d like to see a shift towards caring and tolerance because I value uniqueness and diversity. And so I’d like to see less emphasis on prediction and control.

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This is one of my most favourite photos. I think it captures the dynamic of Nature’s seasons in a still photo.

This little leaf is frosted on the left half and still brown on the right. It’s as if we can see the moment when autumn turns into winter.

It surprises me that the temperature difference caused by the sun’s rays falling just slightly more on one half of the leaf than the other can make such a significant difference.

That reminds me that small differences can produce strikingly different outcomes – something we see in the “butterfly effect”. This partly explains why no two patients experience identical outcomes with the same intervention or treatment.

The future is not predictable in detail.

But I also see this half frosted leaf symbolically. It reminds me of the yin yang symbol which conveys the idea that opposites are inextricably entangled and work together to produce constant movement and change.

It even inspires me to reflect on the nature of the human brain with its left and right hemispheres.

Amazing where one little leaf can lead you…

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Émerveillement

If you put the French word I’ve used as the title of this post into the search box at the top of my blog, you’ll find quite a few posts where I’ve written about this.

Émerveillement has become one of my most favourite words. There isn’t a direct translation into English but it includes concepts such as wonder, amazement, awe and delight.

I feel all that when I come across something as beautiful and astonishing as the dragonfly in this photo. What an amazing creature! I look at a dragonfly and think I don’t know how anyone to imagine such beauty and structure. They way it flies and hovers boggles my mind. It can zip away in apparently any direction it wishes in an instant.

Compared to the admittedly superb technologies that we humans have invented Nature leaves us standing. And that humbles me. The powers of adaptation and growth which we see in all living beings far surpasses what we humans can create. Complex adaptive systems are at a different level entirely from complicated machines.

I believe that we have a LOT to learn from Nature and the better we understand plants, insects, animals and ecosystems, the better we will get at living healthy, sustainable, thriving lives.

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Persistence

When I came across this flat stone the first thing I noticed was the pretty large hole in the middle of it. The hole doesn’t actually go all the way through. It’s a wide and deep indentation.

How do you think that came about? My theory is that it was created by a constant drip, or steady flow, of water. Either from where it lay before it was placed here, or by water falling onto it on the path. I suspect the former because surely it must have taken many, many years to create an indentation this size.

You might argue it’s been chiselled out but I’m not convinced about that. It looks natural to me. However, even it’s been created by human hand, it’s going to have required a steady and lengthy effort.

Whatever the process involved in the creation of this indentation, the one thing I think about every time I look at it is the value of persistence.

There’s a lot to be said for persistence and it’s a quality which I think I have in abundance. Stuff happens. Storms blow in and pass by. Crises appear, then they disappear. But when you keep on a steady path you can see your way through all of those challenges.

Persistence is a particular kind of strength. It’s not violent and not even particularly strong or powerful over a short period. It’s a gentle power. A steady strength.

Imagine how long it’s taken for soft flowing water, or little drips, to carve out this space in the stone.

I worked, one to one, with patients for about forty years. In both the GP and hospital clinics where I worked we prioritised continuity of care. We developed long term relationships with each patient. Doing that required persistence. It required the ability to stand with and be steady with someone through their crises.

Of course patient care requires flexibility too. You have to be able to change treatments if they aren’t helping, but in order to do that you need that continuity of care and that persistence to stick with them through any necessary changes.

So I just want to celebrate that quality today. Persistence.

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Metamorphosis

If you didn’t already know, then how could you imagine that a tadpole could turn into a frog?

If you didn’t already know, how could you imagine a butterfly would’ve spent part of its life as a caterpillar?

Some of the most memorable lectures at university were the ones on embryology. We had an amazing anatomy lecturer, Professor Romanes. The lectures were in one of the classical old lecture theatres in the Medical School, a horseshoe shape of steeply rising benches and desks curved around an immense rolling blackboard. Over the course of a 50 minute lecture Professor Romanes would create the most astonishing works of art on these boards using a set of coloured chalks. Mesmerising. He added to the magic of foetal development which, to be frank, still astonishes me. The metamorphoses over the first few days and weeks in the womb are utterly incredible. At the earliest stages it’s impossible to envisage how those few cells will turn into a human body.

At a completely different level I’m sure we all have that experience of looking at old photos and thinking “That was me?! I looked like that?!” Yes, we know who it is, and we might even remember the event, but the changes in appearance, and of course in personality, behaviour, knowledge and beliefs is a metamorphosis in its own right.

Development and growth are truly amazing phenomena in Nature. The future is indeed impossible to predict in detail. We can’t be certain about it.

But we can be sure that the best, the healthiest metamorphoses will come about when we pay attention to nurture and nourishment.

We know we can encourage growth, development and change towards a thriving existence through care, love and attention.

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Making your way

It’s a funny phrase that, “make your way”. When I go from one place to another it doesn’t occur to me that I’m “making” anything. Simply moving from here to there doesn’t seem to be a creative process.

But look at this path. Isn’t it beautiful? It takes imagination, creativity and effort to make a path like this. I took this photo in Japan, and you’d have a pretty good chance of guessing that I think. Isn’t that amazing too? That the look of a path can convey such a strong sense of place and culture.

That gets me thinking about the vast web of drovers paths which crisscross the wilder parts of Scotland. It makes me think of all the pilgrims paths which wind their way across Europe towards Santiago in northern Spain. It makes me think of the traces of Roman roads which can be found across most of Western Europe. And I’m sure you’ll start to think about ancient ways wherever you live.

But we “make our way” in other ways too. We find a path through life, or rather, we create a path through life. I’m a big fan of stories and have always been keen to hear a patient’s unique story. However, the metaphor of the path is an equally good one which can help to illuminate how someone got to where they are now.

When you reflect on your own life, what paths do you see? Who did you create them with? What stepping stones did you lay?

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Self healing

Self healing is our default. It’s what our bodies do. It’s a characteristic of all living organisms, of all “complex adaptive systems”. It’s an evolved phenomenon without which no Life is possible.

Think of a time you’ve been injured and a bruise appears. Over a few days, without your conscious involvement, the bruise changes colour, and fades away. Usually it’s gone without a trace of having ever existed, the damaged tissues now healed.

Or of a time when you’ve had a sore throat, a bad cold, or a tummy upset. A few days on and the symptoms have gone. Your body has done what bodies do. It’s healed.

But sometimes healing doesn’t return the body to its previous state. Like in this photo of a tree which has been damaged, presumably in a storm, bent over, almost in half. It survived. It healed itself, but it’s a different shape now, a dramatically, strikingly different shape. That injury has become part of its story, leaving it forever changed, but still living, still growing, actually still thriving.

Sometimes self healing fails catastrophically and the creature, or the person, dies. Sometimes self healing fails and an illness becomes chronic, never going away. But in the vast majority of occasions self healing works incredibly well.

Throughout my career as a doctor I tried always to support, stimulate or nurture self healing. It’s the best medicine after all. In fact there’s no healing which isn’t self healing. The difference I might be able to make is to assist, or accelerate it.

I still find it strange that this isn’t the main lesson taught to all doctors, nurses and therapists. And I still find it uncomfortable to hear healing described in war terms, as if we have to fight, conquer or overcome some enemy disease. Those metaphors don’t sit easily with me.

Healing takes time and therapy should support it through care, support and loving attention.

Perhaps the most fascinating thing I discovered as a doctor was the uniqueness of every single patient. We heal through the, largely unconscious, strategies of adaptation. With apparently similar diagnoses and symptoms some patients will find movement helps, others that movement makes things worse. Some find heat helps, others cold. Some get increased thirst or food cravings, others don’t. And so on over a seemingly endless set of variables.

Uncovering an individual patient’s adaptive strategies is often the key to discovering how to support their systems of self healing.

There really is no one size fits all chemical or technological fix in Medicine.

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Liminal

Last night the spectacular sunset compelled me out into the garden again, camera in hand. As I looked across the vineyards to Salles d’Angles I saw a mix of mist and woodsmoke lying in front of the village. It looked both beautiful and mysterious.

Twilight seems a magical time. It’s where the Sun has dropped below the horizon but it’s light still illuminates the sky. In that liminal time between day and night the world seems filled with half seen objects, semi-obscure plants and buildings, hints of things which draw us towards them stoking my curiosity and stirring my heart

Mists do something similar. They too create liminal spaces where the world fills with hints and suggestions. They too spark the imagination and stir a sense of wonder.

I enjoy the liminal spaces. They feel full of potential and possibility. They engage me. They fire up my imagination. They make me aware of “becoming not being”.

As I write this I’m struck by the fact that a very different take on all this would be to see obscurity and uncertainty. How often do we find ourselves lost or disoriented in liminal spaces just because we focus on uncertainty and demand it’s opposite, certainty, that slippery, impossible to achieve alternative.

We can’t bear too much uncertainty however, can we? We don’t want to feel lost all the time (although I’m reminded of Rebecca Solnit’s brilliant writing, “A Field Guide to Getting Lost” which I’ve written about before).

But can we bear too much certainty either? Too much predictability and sameness?

I don’t think we can.

Hey, once again, I find I need “and not or”. I need times of bright sunny certainty and twilight times of obscurity. I need knowledge and wonder.

To be fully human we have to embrace these opposites, polarities and paradoxes. How do we do that?

Well, I think it takes a blend of wonder, awareness, acceptance and gratitude.

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kind and gentle

There’s something very delicate about this little petal. Delicate, soft, precious, beautiful.

When I see something as delicate as this I feel kindness stirring in my heart. I feel moved to care for it, to be careful with it.

We talk about a softening of the heart don’t we? And when the heart softens, the eyes soften too. When we see that softening we see kindness, gentleness and care.

I often think this is a fundamental requirement in health care. If you can’t soften your heart and your eyes then you probably shouldn’t be a nurse or a doctor.

But the need for kindness and gentleness goes way beyond health care. It’s a fundamental requirement in teachers too.

And, actually, I think it’s a fundamental requirement in living. The world becomes a better place through soft eyes. The world becomes a better place when we meet with soft hearts, defaulting to treat each other with kindness and gentleness.

I know. There’s a lot of cruelty and hatred in the world, but there’s lots of kindness too. I think that together we create the conditions and environments which enable and nurture the main emotions we feel.

Let’s create and feed the conditions which enable and nurture kindness and gentleness.

That’s something we can all do. That’s living by the heart.

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The unknown

I like this photo of a forest at night, lit just by moonlight. There’s something gently beautiful about moonlight. It stimulates the imagination.

Imagination must be one of our most remarkable powers. We use to see into the future, even the immediate future as we find our way from one place to another.

We use our imagination to make maps. Dan Seigel, the psychiatrist and neuroscientist who coined the term “Mindsight” said that we use the very front part of the brain to make three kinds of maps – a me map, a you map and a we map. These are special kinds of maps or patterns that we imagine to enable us to know ourselves and others.

We use our imagination to put ourselves in the shoes of others, to feel empathy and compassion.

We use our imagination to express ourselves creatively. It seems we are the most creative of all the species, painting, singing, dancing and telling stories.

We are essentially story tellers, which would be impossible without imagination.

We use imagination to solve problems, to create solutions and find ways out of difficult places.

However imagination does something else too….it shows us possible futures including the one where we don’t exist any more. It could be that we humans are the only creatures able to imagine our own deaths. We know we are mortal and that can be difficult to bear.

Fear would be impossible without imagination, and existential fear, the fear of death, is thought to be at the root of all fear. After all people don’t really fear flying in a plane. They fear crashing in a plane and dying.

Imagination stirs our curiosity too, though. When we think about the future we don’t fear it all the time. Rather we wonder about it, anticipate it, can feel excited about it, the way children look forward to Christmas.

I think imagination is something we all have. But we all use it differently.

How about you? What are you going to use your imagination for today?

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