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Diversity

These are not my photos, but here are two amazing revelations of diversity.

The first is a magnification of grains of sand…..yes, sand, the kind of sand you find on the beach. Did you have any idea that grains of sand were so diverse?

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Then, you might have come across these amazing photos of snowflakes…..here is just one of them.

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So, folks, if even grains of sand and snowflakes are so diverse, can you imagine how diverse more complex forms are….like lifeforms? Like human beings?

This is one of THE main purposes of the universe – to produce ever more uniqueness, ever more diversity

ferns unfurling

“There is nothing noble in being superior to your fellow man; true nobility is being superior to your former self.” – Ernest Hemingway

My favourite movie portrayal of Hemingway is in Woody Allen’s Midnight in Paris

One of the key themes of Marc Halévy’s work is the idea that the purpose of Life, indeed the purpose of the Universe, is “l’accomplissement” – the notion that everything that exists, every organism which exists, every person who exists, is trying to accomplish its, or their, full potential.

There is a direction to evolution, and its the same direction we see in every single life. The continuous striving to flourish, to be the best, the most, the greatest they can be. From a crystal, to a plant, to a bird, to every unique human being…..”true nobility is being superior to your former self”

paris park

Sometimes I think there are two kinds of people (that’s nonsense of course because there are as many “kinds” as there are people!). The two kinds I’d like to consider here are those who value stories, and those who value data.

I am still astonished when I remember the conversation I had with a young junior doctor who told me they were being taught “Don’t listen to the patient, they lie all the time. Only the results tell the truth” That is a data teacher talking, and, frankly, I think it’s scary to think such an attitude exists in doctors, especially doctors who are teaching young doctors. (by the way, do you remember a character called “Data“?)

What I love is the story. Every person I meet tells me a new story. It’s in the narrative that I can make sense of their suffering. It’s in the narrative that I can see the connections between the mind, the body and the spirit.

We all use narrative, not only to understand each other, but to make sense of our own lives.

When I first started to explore the use of narrative in medicine, I think the very first article I read was by Rita Charon. Here’s a passage from her book, Narrative Medicine.

What I am trying to convey is the kind of listening that will not only register facts and information but will, between the lines of listening, recognize what the teller is revealing about the self. Conventional medical care has not considered this kind of listening to be its responsibility. Except for some psychiatrists and psychoanalysts, health care professionals cannot give the time or get the training needed to listen for stories. Without knowing what is salient to an illness and what is not, many doctors and nurses fear that such listening will trap them for hours hearing information that is unrelated to disease. Listening to it, they think, will only distract them from the task at hand— to deal with the insomnia or to treat the abdominal pain. Unfortunately, sickness does not travel in straight lines, and we who care for sick people have to be equipped for circuitous journeys if we want to be of help. Although many health care professionals worry that they do not have the time to listen for stories, many of us who have incorporated listening into practice find that time invested early is recouped quickly. Indeed, the first few visits with a patient may take more time than in conventional practice, but time is saved shortly down the road by having developed a more robust clinical alliance from the start. The serious consequences of not being able to do this kind of narratively sophisticated listening is that patients’ symptoms get dismissed, their non-medical concerns get ignored, and treatable disease gets missed. More compellingly, only this kind of narrative listening will hear the connections among body, mind, and self, and disease recognition and treatment cannot proceed, we are beginning to believe, without simultaneous attention to all three.

I think that’s so right. The shame and weakness of the UK NHS is how it is constructed around routine encounters between doctors and patients which last less than ten minutes. What on earth can you understand about a patient in ten minutes? How do you make a diagnosis? No wonder doctors send patients off for X Rays, scans of this, scans of that, and blood tests so much nowadays. But what worries me most about our current model of care, is how prioritising data, results in just what Rita Charon says “patients’ symptoms get dismissed, their non-medical concerns get ignored, and treatable disease gets missed.”

Jennifer Percy, writing in The Atlantic, says

The language of science was unsatisfying to me. “The most incomprehensible thing about the universe is that it’s comprehensible,” Einstein said. But I don’t think human relationships are ever fully comprehensible. They can clarify for small, beautiful moments, but then they change. Unlike a scientific experiment with rigorous, controlled parameters, our lives are boundless and shifting. And there’s never an end to the story. We need more than science—we need storytelling to capture that kind of complexity, that kind of incomprehensibility.

It’s not just human relationships which are never fully comprehensible, it’s human beings. Can we really apply “rigorous, controlled parameters”, to lives which are “boundless and shifting”?

We do need storytelling to capture the complexity. And we do need to understand that these stories never end.

mitsudomo

So, I was told this week I was the most calm person someone had ever met, and asked how did I manage that?

This isn’t the first time. Not by a long way. So the truth is there is something about who I am which allows me to emit a sense of calm. When I was a young hospital doctor (25 years old) and in charge of a Cardiac Arrest Team, the other team members would commonly say that once I arrived on the scene, everyone felt their anxiety level dropped and everyone felt more calm. I never understood how that happened, because my heart would be banging away in my chest and I would feel that bucket loads of adrenaline were storming around my body. But somehow, what I emitted was calm.

However, what occurred to me in response to the question this time was, I’ve learned that calm and ease occur more naturally when we focus on the present. I sometimes say to people that suffering occurs in the gap between fantasy and reality, by which I mean, when we are wishing how things were, instead of experiencing how they are, then we suffer…..regrets, relived hurts, anxieties or fears. The way I practice, and have practiced now for many, many years (this is the year I turn 60), is to fully focus on the person who is consulting me right now. Whether it is for 90 minutes, 20 minutes, or, when I was a GP, only 10 minutes, that piece of time is always fully for this person who is with me. I will listen attentively, engage with them fully, and be completely present. My mind doesn’t wander off to the patient before, or the one about to come next. But whenever that person leaves the room, I let go. And the next patient walks in, and again, I’m fully present with this new person.

What struck me as I thought about that was “what a great meditation practice!” “what great mindfulness practice!” Repeatedly, gently, returning to the present. So maybe that is at least one of the reasons I still absolutely love daily clinical practice. If I’m ever feeling not so great, then a busy clinic gives me a lift. If I’m feeling a bit weary, then the clinic boosts my energy.

I owe a debt of gratitude to my patients over all these years. See what a lot of good they’ve done me!

(And I’m sure it’s a two way benefit. I’m told that all the time.)

Plant neurobiology

Oh, this is fascinating! We tend to think of plants as pretty static creatures, despite the fact that every large plant was a tiny seedling once upon a time. They move. They move a lot…..but slowly.

Time lapse photography reveals just how much a plant moves. I’m sure you’ve seen many such videos, but click through the link below and watch this one because this one reveals the plant’s neurobiology, its intelligence, and its ability to interact with, and respond to, other plants.

Seriously, I don’t think you will ever have seen something quite like this. You won’t look at plants the same way again!

In the A to Z of Becoming, the third verb is C, for “choose”

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Choose….hmmm, what will I write about choosing? I’ve got a few ideas rattling round my brain, so I’m going to share several of them, and then YOU can choose which inspire you most, or which you want to explore further for yourself.

The first thing I thought about was “choice theory” – the work of William Glasser. I like Glasser’s emphasis on how we create our own experience of reality through the choices we make. I like how he rejects the “external control theory” which suggests we are just puppets or automatons having our buttons pushed. I like his holistic approach to psychology, and, most of all I like his emphasis on verbs.

Secondly, I thought of how empowering it is to move your brain from default reactive mode, to response mode, and how a crucial step in developing that skill is to consciously, mindfully make choices. In reactive mode, we are pretty much on autopilot, blindly following the scripts of others, and it can feel like that. It can feel like we are the trapped victims of circumstances, of society, of others’ choices. Developing response mode, creates that little gap (see “getting neutral“) which allows us to become more conscious of what is happening, and, thereby, to take the opportunity to choose which response we want to make.

Thirdly, I thought of “Amor Fati”, the ancient teaching to “love your Fate”, which is actually advice to fully accept and enjoy the reality of the present, rather than suffering through wishing things weren’t the way they are (see the “suffering gap”)

Fourthly, I thought of choosing a path (like in the photo above which I took in a garden in Japan), and of how every path takes a different route, even if it leads to the same destination. I saw a TV programme during the holidays in December where a regular rambler walked from the West to the East of Scotland up in the far North. He came across countless old drovers paths (where the cattlemen would drive their cattle from the Highlands down to the markets in the South), and shepherd’s paths, and the paths the crofters would take to go from one croft to another, and the hiking routes, and…..well, you get the idea……the wild, open, sparsely populated areas of Scotland are criss-crossed by a myriad of paths, so when you want to walk from one coast to another, you have plenty of choices. Each of those choices will bring its own experiences and its own discoveries.

Fifthly, I thought of how sometimes I deliberately choose to walk down a different road, or to visit a different cafe, or to catch a different train, just to wake myself up and keep me aware that today is indeed a unique and amazing day.

Does any of this inspire you?

Which of these five explorations of choosing appeals to you most?

Which will you choose today?

 

The Resilience Alliance give this description of resilience, using forests as an example of a complex adaptive system which exhibit resilience.

Natural systems are inherently resilient but just as their capacity to cope with disturbance can be degraded, so can it be enhanced. The key to resilience in social-ecological systems is diversity. Biodiversity plays a crucial role by providing functional redundancy. For example, in a grassland ecosystem, several different species will commonly perform nitrogen fixation, but each species may respond differently to climatic events, thus ensuring that even though some species may be lost, the process of nitrogen fixation within the grassland ecosystem will continue. Similarly, when the management of a resource is shared by a diverse group of stakeholders (e.g., local resource users, research scientists, community members with traditional knowledge, government representatives, etc.), decision-making is better informed and more options exist for testing policies.Active adaptive management whereby management actions are designed as experiments encourages learning and novelty, thus increasing resilience in social-ecological systems.

The main point made here is the importance of diversity. They mention “socio-ecological” systems, but in fact organisations can also be considered as complex systems. This is one of the ways we are going wrong with the way we deliver health are these days. Due to the vast diversity of human beings, and the reality that large organisations behave as complex systems, we need diversity in our organisations and in our practices.

There just is no one size fits all when it comes to health care and a health service managed by protocols, rules and tight controls, will ultimately fail.

Half a brain…..

Take 20 minutes to watch this brilliant TED talk by Iain McGilchrist.

 

I agree with everything he says in this, but I was especially struck by his mention of the gene which codes for eyes. It’s the same gene which codes for a fly’s eye, a frog’s eye and a human eye. What makes the difference? The context of the other cells in the separate creatures. We are not just our genes, and our genes only express themselves in the contexts of the cells in which they exist.

I also really like what he says towards the end of the talk about protocols and the practice of medicine. How on earth can a protocol devised by a committee somewhere tell a doctor how to treat this particular, unique, individual patient today? It’s nonsense.

Rain lenses

 

Look carefully at these raindrops and see what you can see within them.

There are all kinds of theories about reality and how we experience it, but in this Age of Modernity, the object, what’s “outside”, what can be measured, what is “physical” has gained almost a monopoly over what is accepted as “real”.

What a patient’s tests or scans show are believed to represent what’s really wrong or right. What a patient reports, relates or describes of their experience – their symptoms, their personal narrative, is often dismissed by researchers as anecdote, or by clinicians as unimportant – “I’m happy to tell you your results are all normal” (“now go away and stop bothering me with your complaints!”). Somehow the lived experience of reality has become less relevant than the measurement of reality. The object trumps the subject.

Yet that objective, physical reality can only be experienced by, can only be measured by, the human subject.

So, in this dialectic, is there some way to grasp reality, to know what is REAL?

I’m not about to solve this one here, but one way of approaching this which appeals to me a lot, is to ask the question “what are these the two poles of?” “Inside and outside of what?” Or to put it another way……If the subject and the object are two sides of the coin, what’s the coin?

Is it the continuous process of becoming which we see everywhere in the universe? Is it the vital force, the Life force, the universal spirit from which all form emerges?

Can we take a perspective on reality which sees BOTH the inside and the outside as valid and important?

That’s why I don’t accept the proposed duality of mind and body, and any understanding of a patient is incomplete without exploring both.

waterfall

Is time linear? Is it like this waterfall? Does the future rush towards us, the present pour past us in a constant stream, and the past disappear into the far distance carrying the our daily experiences off into the vast oceans of memory?

Or is it more like a tree?

zen garden

Does time accumulate, like the growing sapwood just under the bark, laying down this year’s experiences on top of last years, each and every ring layered over the previous ones?

The forest becoming

Does the present grow out of the past which doesn’t disappear, but which perpetually lies beneath us, our daily experiences emerging from, growing from, all that has occurred before?