Heroes Not Zombies

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.

I detest the xenophobic politics sprouting up everywhere these days.

Nature thrives on diversity and all areas of society do too.

If you work in a team you don’t want everyone to think the same way. Well you don’t if you want to promote creativity, innovation and resilience. You do if you want to impose conformity and control.

If you want an institution, whether a school, university, health service or company, diversity is essential for adaptation and survival.

Discrimination against people on the basis of where they were born, or where their parents or grandparents were born is simply wrong – morally and rationally.

Immigration is not a problem – integration is. We should be putting our energies and resources into integration – building mutually beneficial relationships between well differentiated parts – between people who are different from each other, between people and the rest of Nature.

This story – https://www.bbc.com/news/articles/ckkkgvl59x3o.amp – is a good example – a PhD student from Romania studying at Imperial College in London and working with the University of Edinburgh and Cancer Research Horizons to develop a home test which could replace uncomfortable, unpleasant smear tests. If successful this could make a big contribution to reducing the numbers of women who will die from cervical cancer.

It’s really not hard to find other great examples of integrated diversity.

Shame on those politicians who promote hatred and fear of “the other”.

We need more love in this world.

Love is a word we can use too easily (“I love chocolate”) and/or not enough (how often do you tell your loved ones that you love them?)

But I reckon it’s at the foundation and the core of a good life, of a good society, of a good relationship.

I’m thinking of the love we feel and give without any expectation of return. I don’t mean desire. Desire might be coloured by love, but it might not. I mean the love that directs and maintains our attention. The love that enables us to notice, to care. The love that doesn’t judge, the love that opens our heart to “the other”, not to possess, or own, or control, or to make them the same as we are. But the love that stirs curiosity, makes us want to know the other better, more deeply, more fully.

Is my action loving? Are my words loving? Am I thinking loving thoughts?

I wish we could all put love at the heart, at the core, in the foundations of all we do, say and think…..as much as we possibly can.

In a world riven with divisions, hatred and fear, the answer, surely, is love.

Here’s my challenge, to myself, and to you….this week, just notice each day every time you feel love in your heart. (and maybe note it down somewhere, in a journal, a notebook, on your phone). Then let’s reflect in a week’s time, and set an intention to love a little bit more.