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We are not machines

Posted in Uncategorized on December 12, 2024| Leave a Comment »

We are not machines. We are not even “machine like”. Here’s Iain McGilchrist on this –

Machines are not social beings. They don't have Consciousness, feelings, personality, will or individuality. They have no appreciation of music, dance, poetry, art or nature. They do not fall in love and have no sense of humor and they do not have the ability to change their minds and have none of our capacity to sorrow over the past or project a delighted future and that's not even taking into account the far more complex issues entailed in human consciousness including imagination, morality, creativity, the capacity for Spiritual awe and allegiance to Beauty truth and goodness and in case that should sound the slightest bit rarified I'd like to mention that they don't have bodies either and they do not die. It is true of course that you're amazing we're all amazing but it's precisely because we're not just hugely complicated machines. If we carry on talking like this to the aspiring young we will get no better scientists than we deserve. In reality nothing in the entire universe is like a machine except the few lumps of metal we have made in the last few hundred years.

Iain McGilchrist

From health care to our relationship with the rest of the natural world, this machine metaphor is so damaging.

It de-humanises patients and their doctors. It distances us from the world we live in. And it obliterates wonder and enchantment.

Let machines be machines and let’s refocus on what makes Life so astonishingly different from technology and industry.

Machines, including “AI” machines, are tools. They aren’t a replacement for human beings. They aren’t a replacement for Life.

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Integration/cooperation

Posted in Uncategorized on December 11, 2024| Leave a Comment »

It was pretty late in my career when I came across the concept of “integration” in relation to health, and it took me a wee while to get my head around. It finally clicked when I read Dan Siegel’s “Mindsight” and I read his definition of integration – the creation of mutually beneficial bonds between well-differentiated parts.

Take a moment to let that definition sink in, because it’s pretty beautiful and it captures the key elements of integration – that involves very different entities establishing a relationship which enables each of them to better fulfil their potential.

When I understood this, I immediately thought of the human body. We think of the body as made up of very different parts – highly differentiated cells organised into tissues, organs and systems. We have a heart, a liver, a pair of kidneys, a brain…..and so on, and so on. Are these various organisms in competition with each other? Are they trying to outdo each other and grab most of the nutrition, the oxygen, the energy for themselves, even at the expense of the others? No they are not. They are not in competition. The co-operate. They collaborate. In fact, they are integrated. They are connected and they relate to each other in ways which enable every single organ and tissue in the body to flourish.

If you look at any other living organism you’ll see the same basic strategy – “integration”. If you see a healthy, flourishing ecosystem, you’ll see that it contains a diversity of plants and creatures and they are well “integrated.”

And yet, we have created a global, economic, social system based on competition. A system which creates a handful of winners, and a huge mass of losers. It doesn’t have to be that way. We could, if we wished, create a system where the core value is integration/cooperation instead of competition. Not to say that competition has no place. I think we understand that it does. But we’ve got the emphasis wrong. We need to shift our attention, our imagination, our energy towards integration.

What kind of world could we create if we worked to create human relationships based on integration, care and love, human to non-human creature relationships based on integration rather than dominance, human to planet relationships based on integration instead of exploitation?

A natural world – the way it evolved to be what the universe intended.

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Self healing and its limits

Posted in Uncategorized, tagged , , , , on December 10, 2024| 2 Comments »

I took this photo many years ago and I’ve shown it to many patients. I call it “the wounded rock”. Something struck this rock, probably a long, long time ago. It almost split it in two. Clearly, it was a heavy blow. It has left a clear wound.

Life is often like this. Something happens, something traumatic, which inflicts a wound on us, a wound which never completely heals. Powerful events change us. They might be violent events, either accidental, or malicious. They might be physical, or emotional. They might be serious illnesses. Or they might be big changes in life – loss of a loved one, loss of a job, moving house….

Life goes on, like the water continuing to flow around and over this rock. But the wound leaves us changed.

But, actually, this tree in my garden, is a better metaphor, or, should I say, a better example. It would seem that one day, long, long ago, a storm blew through and felled this tree. It uprooted it. Its roots have been torn out of the ground, and we found them, standing upright, embedded with stones, and covered in ivy.

You’d expect that would be the end of the tree, but, no. It continued to grow, now turning its branches at ninety degrees to the fallen trunk. It started to reach for the sunlight again.

It’s a better example, because the rock is not a living organism. Having been struck, it can’t adapt. It can’t change. The tree, on the other hand, is more like us. Having been struck, it adapts.

Self-healing is an adaptive phenomenon. It is the basis of all cures, and, even, of all recovery. There is no healing without it. And yet, it has its limits. In both the case of the rock and the tree, there can be no going back. There can be no restoration to a “time before”, much as we might wish there was. In both cases, the flow of life carries on, shaping, and adapting, in surprising, fundamentally unpredictable, ways.

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Self healing and adaptation

Posted in Uncategorized, tagged , , , , on December 9, 2024| Leave a Comment »

You know if you cut yourself that, in the vast majority of cases, the cut will heal itself just if you keep the area clean. You know how, if you break a bone, that the fracture never heals without the body using its ability to knit back together the broken edges of the bone (sometimes you need something to hold the edges together – a plaster, nails or a plate – but the actual healing of the bone is done by the body). Well, in fact this is what all living organisms do – they self-heal, self-repair, and self-organise.

One model for living organisms is a “complex adaptive system” (search that term on this site and you’ll find several articles I’ve written about it). Complex adaptive systems have a key, core characteristic – they adapt. Self healing is an aspect of adaptation.

Yet, in Medicine we rather take self-healing for granted. We know that nobody recovers from anything without self-healing. We need the body’s abilities to repair, and to adapt and grow, in order to heal. Every single time. But how many treatments, specifically, how many drugs do we use which are developed to target the capacity to self-heal? How many drugs directly stimulate or support the natural processes of self-healing? I don’t know any. Instead we direct our treatments “against” – we use lots of “anti”s – antidepressants, anti-inflammatories, anti-hypertensives, antibiotics etc etc – you get the idea – and hope that in the background the body will self heal. I don’t mean these anti drugs are useless. Clearly they are not. In many cases they can rescue someone suffering from a life threatening episode of illness. But they aren’t enough. We also need to stimulate and support the natural systems of self healing and repair.

What are they?

Well, largely, they are environmental, psychological and social. We need light, clean air, clean water, nutritious food, shelter. We need hope and encouragement. We need to feel cared for and loved. We know that forests can help us heal. We know that time spent in natural environments can help us heal. We know that music, and art, and stories can help us heal.

So do we need drugs? Well, we do. The thing about self-healing is that it is limited by natural biological limits. We are mortal beings. None of us will live forever, and none of us will go through life without experiences diseases and illnesses. Drugs can help us by easing symptoms, addressing imbalances, and countering pathologies. But Medicine is, and always has been, more than just drugs.

But there is something else about self-healing that we should pay attention to and that is…..in common with all forms of adaptation, it is unpredictable at the level of the individual. Sometimes we pretend that all we need to go is a give an “evidence based” treatment and the outcome can be assured. That’s not the case. There is no treatment which produces the same outcome time and time again, in patient after patient. Adaptation teaches us to accept uncertainty. It teaches us to stick with a patient, to follow through and follow up, because only time will tell whether or not the treatment is proving to be useful or not for this person.

And there’s the other key lesson for Medicine from the science of adaptation and self-healing – patients do better when they experience continuity of care.

Over time, we have to adapt our treatments and our care, as the individual patient adapts to the changes brought about by the disease or injury which has made them ill.

It’s good to learn how to deal with uncertainty, because life isn’t predictable.

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Focus on uniqueness

Posted in Uncategorized on December 8, 2024| Leave a Comment »

Throughout my career as a doctor I always looked forward to meeting new patients, every one of whom would tell me a brand new story. By taking a focus on uniqueness I’d be unceasingly curious. Who is this person? What, exactly, are they experiencing? How did it come about? What are the circumstances of their life now, and what were they when their illness began? And so on and so on. You get the idea. When you focus on uniqueness, it opens your mind to find out more. Making a diagnosis, naming the disease, is no longer an endpoint of the consultation. Finding out just how different this patient is from the others you’ve met becomes an ongoing quest.

But a focus on uniqueness brings value to anyone’s everyday, not just to doctors and patients. The ancients taught us to begin each day with the knowledge that every upcoming experience would occur for the first time in our lives. We have never lived the day ahead before. And they taught us to begin each day with the knowledge that every upcoming experience would occur this time only. Today is our last chance to experience today.

A focus on uniqueness makes you aware of the here now, knowing, as Heraclitus taught, that we can never step into the same river twice.

A focus on uniqueness encourages a sense of wonder – l’émerveillement du quotidien.

A focus on uniqueness makes us more aware of transience and change. Transience is beautiful, and precious, teaching us to savour and relish every single moment.

And it does something else, too. It opens our minds to appreciate diversity.

Try it for yourself. Set out today with a focus on uniqueness.

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You are not alone

Posted in Uncategorized on December 7, 2024| Leave a Comment »

Sally Rooney, talking about her new novel, discussed the word “mutual”

mutual is a word and idea that repeats throughout Intermezzo. Henry James often uses that term to indicate the moment when subjectivity transforms into intersubjectivity, consciousness into shared consciousness—or, as you put it in Intermezzo, when two people’s “thoughts interpenetrate”

I love that phrase “the moment when subjectivity transforms into intersubjectivty”. That’s what I sought in every consultation in my clinic…that phenomenon where “two people’s thoughts interpenetrate”.

We live in a society, a world even, which is increasingly divided and people are alienated from each other and from the planet. Or in the terms explored here yesterday, increasingly we are “uncoupled”.

But the truth is we are not alone. The human being, with their long period of infancy, has evolved to be highly social, highly interdependent. As Thomas Berry said, we are not a collection of objects, but a community of subjects.

Our lives are inextricably entangled. Beautifully, wonderfully, amazingly entangled. Coupled, linked.

You are not alone.

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Uncoupling

Posted in Uncategorized, tagged , , , , , , on December 6, 2024| Leave a Comment »

I have long been a critic of reductionism. I mean, I get how it brings something to the table. Our ability to isolate a certain element from within the flux of phenomena and experience, to focus on that element closely, allows us to further our understanding of the world. I suspect it also does, what Iain McGilchrist describes as a left hemisphere trait….it allows us to grasp, to manipulate and control. Therein lies its power.

But it all goes wrong when we fail to integrate our new understanding of a part back into the reality of the whole.

In her novel, Elixir, Kapka Kassabova, writes –

Medicine emerged from alchemy’s noble attempt to marry the subjective and the objective, matter and mind, inner and outer, and in this way, to lift humanity out of superstition and senseless pain. 

But like magic, the bias of modern medicine went too far in the opposite direction. Like magic, it assumes too much and has many blind spots. 

These blind spots come from its many uncouplings, one of which is the uncoupling of psyche from soma, the soul-spirit from the body. Another is the uncoupling of one organ system from another, and another is the uncoupling of the human being from her environment. 

Both Folk Medicine and Western Medicine discourage you from taking ownership of your well-being through knowledge. Both of them keep you dumb and dependent. 

In this passage she critiques both Modern and Folk Medicine for taking power away from individuals. Too often Medicine, in all its forms, comes across as a body of secret knowledge, with an expectation that patients will have faith, and hand themselves over to the practitioner with the superior knowledge.

Personally, I think this is a terrible way to practice Medicine. Diagnosis, prognosis and potential treatment should be a joint process emerging out of a caring, open relationship between a practitioner and a patient. Ultimately, the goal should be to increase an understanding of the self, and to empower individuals towards greater knowledge and autonomy.

I love how Kapka describes Medicine as emerging “from alchemy’s noble attempt to marry the subjective and the objective, matter and mind, inner and outer, and in this way, to lift humanity out of superstition and senseless pain.” That’s exactly how it felt to me. Medicine, at its best improves the lives of others by “marrying the subjective and the objective, matter and mind, inner and outer.”

But in fact what really strikes me most in this passage is “These blind spots come from its many uncouplings, one of which is the uncoupling of psyche from soma, the soul-spirit from the body. Another is the uncoupling of one organ system from another, and another is the uncoupling of the human being from her environment. ” It’s that use of the word “uncoupling”.

I’ve never used “uncoupling” in this context before. But it resonates with me much more deeply than “reductionist”. This, surely, is the heart of the problem – when we “uncouple” one organ system from another, “uncouple” the mind from the body, “uncouple” ourselves from each other, and from the rest of the lived world with whom we share this one, finite, interconnected, little planet.

Here’s to undoing as much “uncoupling” as we can.

Isn’t that something to aspire to?

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Where’s the money?

Posted in Uncategorized, tagged , , , on December 5, 2024| Leave a Comment »

The economist, Thomas Picketty, recently wrote this on his blog – “In France, the combined wealth of the 500 largest fortunes has grown by €1 trillion since 2010, rising from €200 billion to €1.2 trillion.”

What he’s highlighted here is the massive increase in the wealth of the already wealthiest in the world over the last decade or so. There are lots and lots of other figures you can find if you go searching for them, but they are all examples of exactly this phenomenon – while there is great child poverty, millions of people suffering from a “cost of living crisis” and a decline in Public Services in European countries, some people……those who already hoard the most…..have been absolutely coining it in. This is despite such “crises” as the pandemic and the war between Russia and the Ukraine.

At the same time, politician after politician complains about “the National Debt” and how “we can’t afford” to give people decent lives, decent houses and decent jobs.

There have also been a number of articles in recent times about what has been coined the rise of the “inheritocracy” – increasingly, this large shift in wealth away from the general public into to hands of a tiny minority, is leading to more and more younger adults becoming wealthy because they happened to choose the right parents. This isn’t a meritocracy. And it isn’t about rewarding those who work the hardest and contribute the most. There’s a trend underway, and Picketty highlighted that trend in his best seller, “Capital” – that capital is growing faster than the economy, so inequality will continue to increase.

It strikes me there’s something seriously wrong with this system. But let me just pull another issue into this, because these are the things rattling around my brain this morning – the other thing we hear politician after politician go on about is “growth”. “Growth” – the answer the Life, the Universe and Everything! In the UK Labour have built an entire set of policies on this premise – get “growth” and all the good things will follow – better family incomes, better Public Services, less hardship. But, don’t you ever stop to wonder – “growth of what?” I do. Not least because it’s clearer than it’s ever been that we live together on one, finite, massively interconnected planet. We cannot keep growing the global temperature. We cannot keep growing the oceans of plastic waste. We cannot keep consuming more (just consuming more, it apparently doesn’t matter what) every single year. At some point, we’re going to hit the buffers. Aren’t we?

Look, I don’t have all the answers. It’s just that these are a couple of the issues which trouble me these days – both issues, which, along with Climate Change, pollution and species loss – lead me to conclude – there is something deeply wrong with this current world economic/political system.

What do you think?

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Let’s pay more attention to self-healing

Posted in Uncategorized, tagged , , , , on December 1, 2024| Leave a Comment »

We humans, like all other living organisms, are “complex adaptive systems”, and as such, we share a fundamental capacity to self-organise, self-defend, and self-heal. We know that, don’t we? Whenever you’ve had a cut, within a few days, the wound has been repaired, and often, without even leaving a scar. Whenever you’ve broken a bone, whether or not you’ve needed surgery or the help of a temporary plaster, your body repairs the damage. Whenever we’ve caught a virus, usually within a few days, our body has got rid of it, and repaired any damage done.

But in Modern Medicine, we don’t pay much attention to any of that. We are sold the idea that drugs “cure” or “heal”, when, actually, what they do is modify disease activity within the body.

There isn’t a single drug on the market which has been designed to stimulate and/or directly support self-healing.

And I’m not aware that any drug companies or research groups are even working on trying to do that.

Yet, nobody, but nobody, will recover from any illness without the natural self-healing functions doing what they are designed to do. There is no “artificial healing” (just as you could argue there is no “artificial intelligence”) – there is only natural healing. Natural healing is limited, of course. We are mortal creatures. Every single one of us will die, one day, from something….trauma, infection, or disease. Despite claims that some drugs are “life saving”, the marketers don’t actually mean they can stop you from ever dying! Similarly, natural healing can only achieve what is possible within the biological limits of a living creature.

I’ve no doubt many drugs can make life more comfortable, and many can modify the life history of a chronic pathology. But is that enough? Shouldn’t we, routinely, be exploring, with our patients, what we can do to promote and sustain self healing?

Take the example of post-surgical recovery. When we create the conditions which support self-repair and healing, then patients require less painkillers, develop less complications and make a longer lasting, quicker recovery.

If we don’t use the methodologies which are directly intended to stimulate and sustain self-healing and/or we don’t help patients to access the care and environments which are conducive to self-healing, we aren’t really doing a complete job. Are we?

So, here’s my challenge. See if you can find out what we know supports self-healing….then look to draw upon some of that any time you, or your patient, is ill.

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General Practice

Posted in Uncategorized, tagged , , , , , , , on November 12, 2024| Leave a Comment »

A wide ranging review of General Practice in the UK has just been published in the British Journal of General Practice. It makes for disturbing reading. Here’s one of their conclusions –

Overall, these findings reveal a system that is approaching — or, in some cases, beyond — breaking point. Staff members are stressed, demoralised, and leaving; clinical care appears to be compromised; and many patients are dissatisfied, frustrated, and unable or less willing to seek care. We believe there are significant risks to patient safety and to the future survival of traditional general practice in UK.

Here’s another –

Quality efforts in UK general practice occur in the context of cumulative impacts of financial austerity, loss of resilience, increasingly complex patterns of illness and need, a diverse and fragmented workforce, material and digital infrastructure that is unfit for purpose, and physically distant and asynchronous ways of working. Providing the human elements of traditional general practice (such as relationship-based care, compassion, and support) is difficult and sometimes even impossible. Systems designed to increase efficiency have introduced new forms of inefficiency and have compromised other quality domains such as accessibility, patient-centredness, and equity. Long-term condition management varies in quality. Measures to mitigate digital exclusion (such as digital navigators) are welcome but do not compensate for extremes of structural disadvantage. Many staff are stressed and demoralised.

I first expressed the desire to be a doctor when I was three years old. The role model I had was the family doctor who attended the home birth of my younger sister. I was trained according to the dominant values of the time (which are referred to within this study) – “relationship-based, holistic, compassionate care, and ongoing support to patients and families”. The authors of this study find that it is increasingly difficult, and in many cases, impossible, to practice according to these values, even though, GPs still hold them. This results in stress, frustration, and burn-out which impacts adversely on both recruitment and retention of doctors in Primary Care.

So, what’s going on? How did we get here? This paper outlines several factors, not least financial austerity, underfunding, increasing inequality, increasing complexity of illness and an ageing population. But it also highlights a problems which arise from a particular management philosophy – the authors don’t actually use that term – where on the grounds of so-called greater efficiency, health care teams have become more diverse, digital and both algorithmic and protocol-driven services delivered by less qualified staff have increased, and the whole service is disintegrating. The efficiency actually goes down, the dangers increase, and dissatisfaction mounts (in both patients and staff).

The authors don’t give any quick and easy solutions but they shine a bright clear light on the problems, and put their finger on at least one issue at the heart of the problem – the loss of continuity of relationship-focused care delivered by holistically and compassionately.

They do use the word “dehumanised”, and that’s long been my experience. We need to get back to those traditional values and stop doing what impairs them. We need to get back to a health service which puts patients and their GPs at the heart of the system, and stop thinking we can use new technologies and industrial management practices to make things better.

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