Heroes Not Zombies

It seems like, however the government want to label it, the UK is about to enter into another phase of austerity…..because, apparently, they’ve “found a black hole” in the finances. This is such a common narrative. The one where governments say they need to “balance the budget”, match the government’s income to its expenditure, or vice versa. There’s talk everywhere about “deficits”, “the gap in the budget” and “cuts’. Yet all this comes at time of wage stagnation, deteriorating Public Services, schools, hospitals, hospices, care homes, GP Practices struggling to deliver the basics.

Well, I’m not an economist. I trained as a doctor, graduating in 1978, with no debt, because the State paid for my education. My generation experienced job security, were able to purchase their own houses or afford rented accommodation, had access to local libraries, sports facilities and so on, in ways which are no longer the case for my grandchildren. I can’t help but wonder why. Why could the country afford better services, a better NHS, free education and decent jobs back in the sixties and the seventies, but can’t afford them now? Has the country become so much poorer over the last fifty years? If not, where has the money gone?

But my first thought is “what is money anyway”? I understand that centuries ago the Knights Templar developed an early banking system, allowing someone to deposit gold in an abbey in one country, receive written confirmation of that deposit, then travel to an abbey in a completely different country, present that note and receive the same amount of gold. There was a link between the paper and the gold. As best I know that remained at the heart of finance for centuries. The paper notes in my wallet, and the coins in my purse, represented something physical stored somewhere else…..gold, or other “assets”. But that’s not the case any more. Now money, for me, is a number on a screen on my banking app. A transaction involves somebody’s account increasing by the same number as mine reduces. We don’t actually send each other anything. It’s a sort of balancing act. Money is no longer tied to gold, or to anything else.

I could understand that in the past, more gold could be mined, refined and stored, and that notes could be issued relative to how much gold there was, but maybe that was always a sort of fairy tale. However, nowadays, for any country which has its own sovereign currency, it’s the government who “issues”, or “makes” the money. I know they talk all the time about increasing the government bank balance by taxation – taking it from other peoples’ bank accounts – but how did it get into other peoples’ bank accounts in the first place? Actually, it was the government which issued orders to change the numbers in the Central bank upwards. Money doesn’t grow on trees. It’s created in spreadsheets.

During the pandemic governments suddenly “found” or “issued” billions more pounds, dollars, or whatever. They lent this “new money” to individuals and companies, and, apparently, billions have been “lost”, loans not paid back, and money “disappeared”. They spent “new money” on purchases of vaccines, protective clothing and testing materials. They didn’t have to say, “sorry, we haven’t got any money in our bank account”. As has been said before, in times of war, governments always find the money. It’s at other times that they choose to say there isn’t any.

Over the last decade or so, the number of millionaires and billionaires has increased, while average earnings have stagnated, or fallen. The profits of energy firms, pharmaceutical firms, and global corporations have soared. Money, what money there is, has moved….away from workers and families and Public services to private individuals and corporations.

It turns out the country isn’t poorer now than it was when I was at university. It’s just redistributed the money into the hands of fewer and fewer people, away from Public services to private companies.

So, when the government talks about black holes, and needing to balance budgets, it is choosing not to do at least two things….one, redistribute money away from those who have the most, and, two, create the money needed to fix what needs fixed.

It’s the system which is failing millions of ordinary people. It’s the system which needs to change, and the system won’t change until the values change. The covid pandemic showed us that we need each other, that our shared environments affect our chances of getting sick, that poverty, poor housing and chronic ill health are the biggest determinants of who gets sick and who dies.

It’s not a lack of money which is hindering our ability to create a better society.

Maybe it’s time to try kindness instead, to draw upon the wells of compassion we saw in the early days of the pandemic. Most human beings will act to try to help others when they can. We’ve seen that time and again, during the pandemic, during floods, earthquakes and forest fires. We need to nurture that basic quality, instead of promoting selfishness, greed, and hyper-individualism.

What do you think? Does this make sense to you? If it doesn’t, tell me why. I’m always keen to improve my knowledge and understanding. I just don’t think it’s necessary to make peoples’ lives harder.

I don’t understand xenophobia. Why fear, and/or hate, someone because of some way in which they are different from you?

The rise of political “populism” seems to be fed by, and feeds, xenophobia. Whether the targets are immigrants, asylum seekers, or those who adhere to a particular religion, those who promote “send them back home”, or “take back control”, or “secure our borders” always focus on a “them” who are not “us” and “shouldn’t be here”.

I don’t get it.

Every one of us is different. Every day of my working life patients told me stories I’d never heard before. No two of us share the same story. No two of us have the exact same history or experience. No two of us share the exact same face, the exact same voice, think in exactly the same way or respond to life’s challenges in exactly the same way.

It’s our differences which make us unique. I find that fascinating, and, an essential part of treating someone when they are ill.

And yet, despite our differences, we all share a lot. We have many, many points of connection. We share the same air, drink the same water, live on the same planet. People live in the same city together, they live in the same street together, they might buy their food and clothes in the same shops. Many of us enjoy the same music, participate in the same sports, work in the same offices, shops, factories, hospitals, or schools.

Our points of connection are infinite. How often have you had a conversation with someone and explored your shared tastes, experiences, similar memories, discovered shared contacts?

It’s our connections which make us unique.

Yes, it’s both our differences, and that unique set of relationships, experiences and connections which we have, which combine to show us, simultaneously, that we are different, and that we have much in common.

If we are to thrive together, we humans, we’re going to have to reject the poison of xenophobia, and replace it with kindness, curiosity, and compassion. Is that so hard?

When I noticed this design on a nearby sculpture I immediately thought of the two forces which create everything that is.

Flow, in the middle, representing movement and change, bounded by structure, which limits and contains.

Together they create a universe where everything is becoming (not being), emerging out of the flux, the web, to manifest temporary forms.

These forms persist. All that exists persists….for a while. Stars for millions of years, trees for hundreds or thousands, and us for a few dozen.

It’s amazing, beautiful and wonderful.

It’s impossible to really know someone if you don’t take into consideration their relationships.

None of us exist in isolation.

The human baby wouldn’t survive if it wasn’t for the care and attention of others.

We have evolved as social creatures and both the quantity and quality of relationships we create influences who we become.

There’s a theory of development which highlights the default patterns which we all share and which become apparent in the earliest years, even days, of our lives. When the umbilical cord is cut, suddenly the child “knows” (not consciously) that they’ll die if they don’t take their first breath, then another and another. In those first moments we each experience a mix of fear, anger and separation anxiety. Which of these emotions becomes the strongest manifests itself throughout the rest of our life. How we respond to and cope with those emotions shapes who we become.

There’s a danger that our society has become hyper individualistic which drives division, separation and disconnection. None of that is conducive to good mental health, to a healthy immune system or to positive levels of inflammation. What emerges is dysfunction and disintegration at multiple levels, from cellular, to systemic, to social.

We all need a healthy level of belonging. We all need to love and be loved. We all need to care and be cared for.

The healthiest bonds are “integrative” bonds – relationships between well differentiated parts, or people, which are mutually beneficial.

What’s good for “us”, is good for “you” and “me”.

Forming integrative relationships is good for everyone and good for the planet, as we create caring, loving, mutually beneficial relationships with others, with other creatures, with the rest of Nature, with the planet.

If I want to understand someone I ask them about the most significant events in their lives…the traumas which left wounds, the bereavements, injuries, separations and losses, but also any event which made an impact on them. Anything which made a lasting impression.

As doctors we often focus exclusively on the traumas. On the events which have left wounds. How someone copes with a death, with an injury or a loss, shapes the person they have become. But I think it’s as important to understand the, what we might term, positive events, too. The births of children, the first kiss, the achievements, and, pretty much anything which creates a feeling of awe. Because those experiences of awe, and how we respond to them, also shape the person we have become.

Dacher Keltner, in his book, simply titled, “Awe”, and subtitled, “The Transformative Power of Everyday Wonder”, explores this latter phenomenon in detail. He describes eight types of awe, as described in the narratives of over two thousand people from around the world. The top one is “moral beauty” which we encounter when we witness an “exceptional virtue, character or ability” in someone. This is something I experienced frequently when listening to my patients. Time and time again I was in awe of someone who was telling me what had happened in their life and how they had coped. The second is “collective effervescence” which I’ve experienced frequently at concerts, or when witnessing a sports spectacle. It’s that feeling we get when we feel connected to what is more than ourselves, and which we share with others. I expect “Swifties” get this a lot! The third is “nature”, and that’s my source of daily wonder. I am constantly amazed, and in awe of, the plants, trees, birds, butterflies, hummingbird moths, bats and so on, which I encounter every day. The fourth is “music” and this is also an everyday source for me. I listen to music every day. I listen a lot, and I share my greatest pleasures with four old school friends who were all part of the same “record club” when we were younger. Fifth is “visual design” which includes architecture, sculpture and painting. Sixth is “stories of spiritual or religious awe” (honestly, that’s not my most common one!), and seventh is “stories of life and death”, again, one I experienced most, and most deeply, as a working doctor. Finally, is “epiphanies”, those sudden profound, and life changing insights. I find these in science, in art, in philosophy, as well as in other people’s stories.

How about you? What kinds of awe have you experienced? How do you think those experiences have contributed to you becoming the person you are today?

From weather forecasting to medical prognosis, we love trying to predict the future.

We live in an ever changing universe, a universe which changes us and is changed by us.

Randomness, chaos and discernible patterns pervade our everyday reality. The constant interplay of structural “laws” and emergent new forms creates everything we can perceive.

I was taught “common things are common”, but “don’t hold onto your most likely diagnosis too tightly”. Learning both diagnosis and prognosis enables doctors to make the best decisions possible in the moment while continually observing, ready to change and adapt as the unexpected pops up.

But it’s not just a professional issue. Every one of us deals, for the most part intuitively, with these two forces – randomness and structure.

How do we do that? We make decisions based on reasonable expectations, experience and an acceptance of a certain amount of risk. When we set out on a journey we expect the train, the bus, the plane, boat, car or bike to get us to our destination. Otherwise we wouldn’t set off. When we encounter a cancellation, an accident or a breakdown we adjust. We adapt, alter our plans and carry on with life.

As a doctor I knew the importance of follow up and continuity of care – it was the only way to deal with the fact that no outcome can be guaranteed at an individual level. Just because a particular treatment results in a hoped for outcome for the majority of participants in clinical trials, we can’t be certain this person, this individual, will experience those same outcomes. We have to remain vigilant, build a long term relationship and change course whenever necessary.

It pains me to see the development of algorithmic medicine which attempts to squeeze individuals into preset moulds. Human beings are not machines and life just doesn’t follow fixed predictable paths.

Relationships and continuity of care are, and should remain, the bedrock of all clinical care.

In The Connectionist Café, people gather to discover and make connections.

In the chapter which describes a group of strangers and acquaintances getting together to explore the philosophy of connections and networks, the group leader gets them to write a list of what, and who, they love.

As they share their lists, she creates a map of who has what in common with who – a rapidly developing complex “rhizome” of their connections.

Why not try this for yourself? There are two phases, the first, where you make your own list, prompts you to reflect on what and who you chose to put on your list.

The second phase, is a group phase. You have to do it with several others – either people you are already familiar with, or people you’re meeting for the first time (for example at a workshop or other event).

The Connectionist Cafe is an interlinked collection of short stories about everyday Glasgow folk discovering connections in their lives which deepen their experience of life and help them to better understand themselves and others.
In the Connectionist Cafe people meet, talk, explore, learn and connect together. It’s a place to enjoy and a place to grow.

The paperback – https://amzn.eu/d/0dBoLdm8

The kindle version – https://amzn.eu/d/06trj5Xb

The Connectionist Cafe is an interlinked collection of short stories about everyday Glasgow folk discovering connections in their lives which deepen their experience of life and help them to better understand themselves and others.
In the Connectionist Cafe people meet, talk, explore, learn and connect together. It’s a place to enjoy and a place to grow.

I’ve been writing short stories ever since I retired from clinical practice. Over the years I developed the idea of focusing on the importance and power of connections in life and in the world. This collection of stories has grown from that idea.

You’ll find many references in my blog, here, to Iain McGilchrist’s insight into how our two cerebral hemispheres engage with the world. The left hemisphere uses a narrow focus to separate out elements from within the stream of phenomena and information within which we live. It sets them apart, labels them and allows us to grasp them. The right hemisphere uses a broad focus to see the flow as a whole. It enables us to see patterns and connections, to appreciate reality within its unique and diverse contexts.

As a doctor, I was constantly amazed by patient’s stories. Every story completely unique and every individual understood only by seeing them in their contexts, by listening to them tell me about the events in their lives and seeing how those events connected to form a cohesive personal narrative which would enable me to understand them, and, in the process, enable them to better understand themselves.

We’ve gone too far down the road of separating, dividing and isolating. We need to repair, to heal, ourselves and the world. I’m convinced we’ll do that by discovering and making connections, by building bridges, not walls.

We need to pay a loving attention to others, to the amazing everyday reality and to how we live together on our shared, little planet.

“The Connectionist Café” is available as a paperback or on kindle. Here’s the link to the paperback – https://amzn.eu/d/0dBoLdm8

And here’s the link to the kindle version – https://amzn.eu/d/06trj5Xb

We are a bit obsessed with “outcomes” and determining “cause and effect”. But look at this photo. Do you think this shows cause and effect? Do you think this little plant has split open the concrete path?

I don’t think so. Of course, I know the crack was there long before this little weed popped up. I don’t know why the concrete is cracked or when it happened. It was like this when we moved here over two years ago. But I do know that from time to time a weed will turn up here or hereabouts.

Plants are brilliant opportunists. Give them the conditions which they need and they will thrive (even if you don’t want them to!)

I think it’s the same with all forms of life. Create the right, supportive, environment and life will thrive. All living organisms are adaptive and opportunistic. All are utterly unpredictable.

The best way to create health is by providing the environment and opportunities for life to thrive.

A recent report in the U.K. focused on prevention rather than cure. It proposes a “pre-NHS Service” to deliver mass vaccination programmes coupled with blood tests including cholesterol levels and genetic testing to get “at risk” people to start taking lifetime drugs and changing their eating and exercise habits.

Although this is promoted as innovative, visionary and “personalised”, I can’t help feeling such an approach ignores the importance of the environmental and socio-political factors which underpin population health and well-being.

There’s something about a lifetime of drugs just doesn’t feel right to me – this is really a definition of “health”? You’re not healthy, you’re just not sick yet. You’re pre-sick and that needs drug treatment.

There’s another thread to this approach – the underplaying of the importance of emotions. We are not simply “rational” creatures. We are emotional and social creatures with rational capabilities. We process the world, first, emotionally and socially…then we try to rationalise our experiences.

Fear and despair lie at the core of much chronic illness and poor health. They charge up inflammation, damage immunity and can contribute to both ageing and cancer.

At a population level, poverty, job insecurity, poor housing, pollution, industrialised highly processed foods and climate change all contribute to massive insecurity which feeds both fear and despair.

So, if we really want to invest in prevention, it’s not a “pre-NHS” we need, it’s political and social action to reduce poverty and inequality. It’s work to improve the daily workplaces, and the job contracts which most people live with. It’s better housing, better insulation and less polluted air and water. It’s more respect for others, more kindness and care, more autonomy and acceptance. And, and, and……

In other words I think we need to put in the energy and resources to create better societies, and healthier environments. That way we create the conditions which can benefit everyone, not just those who sign up for a lifetime of drugs.