Feeds:
Posts
Comments

To know someone

Stumbled across a fabulous extract from Marilynne Robinson’s new book. Here’s just one of the paragraphs which hooked me –

There is a great difference, in fiction and in life, between knowing someone and knowing aboutsomeone. When a writer knows about his character, he is writing for plot. When he knows his character, he is writing to explore, to feel reality on a set of nerves somehow not quite his own. Words like “sympathy,” “empathy,” and “compassion” are overworked and overcharged—there is no word for the experience of seeing an embrace at a subway stop or hearing an argument at the next table in a restaurant. Every such instant has its own emotional coloration, which memory retains or heightens, and so the most sidelong, unintended moment becomes a part of what we have seen of the world. Then, I suppose, these moments, as they have seemed to us, constellate themselves into something a little like a spirit, a little like a human presence in its mystery and distinctiveness.

She’s writing about writing fiction of course, but the insight is applicable to life too, don’t you think? I recall Dan Siegel’s great line about the importance of “feeling felt”. I think that, as a doctor, it’s these little moments which are all around us every day, if we can only be sufficiently present and aware to notice them, which embed their constellations of human emotion into our psyches. I do believe, it’s these, and all the others I encounter in the everyday clinic, which create the conditions for understanding – for my understanding of those who come to me to be heard and to be felt.

This is the essence of “healing”.

There’s been quite a drive to reduce human beings to purposeless, temporary clusters of molecules. I don’t buy into it. For me, to understand what it is to be human involves taking on board consciousness, an inescapable subjective experience of a self, the interconnectedness of a person with others and with the rest of the universe in which we exist, and, not least, through the development of symbol manipulation and language development, a constant bent towards storytelling and seeking meaning in every day existence. (Cripes! That was quite a sentence, and, believe me, I had to stop myself there…..I could see that sentence spilling over into an entire page…)

The NY Times recently published a piece, “In Defense of Superstition“, about Matthew Hutson’s “The 7 Laws of Magical Thinking”. This is one of those things which makes you wonder about the nature of reality. I don’t think reality can be reduced to its physical, material elements. There’s a lot about reality which emerges from the fact we live as conscious beings in an inextricably interconnected universe. From this perspective, what are we to make of magic, and magical thinking?

The article cites research showing that golfers told the golf ball they are to play with is a lucky ball are 35% more likely to sink the putt, and that people can improve their memory performance when in possession of a lucky charm. This doesn’t surprise me. What you believe, and what you experience emotionally and subconsciously significantly influences your behaviour and your performance.

Do you remember a movie entitle, “The Cooler“? I think it was William H Macy as an unlucky charm, employed by a casino boss to stand next to people on a winning streak, so they’d start to lose. When he falls in love, his ability to transmit bad luck disappears….fascinating movie.

We co-create our reality with the world we live in, and most of that creation doesn’t come from the “thinking” part of our brain!

The article sums up

But without it, the existential angst of realizing we’re just impermanent clusters of molecules with no ultimate purpose would overwhelm us. So to believe in magic — as, on some deep level, we all do — does not make you stupid, ignorant or crazy. It makes you human

I agree with the last two sentences, but I don’t agree with the assumption that we are “just impermanent clusters of molecules with no ultimate purpose”. Do you?

The French do seem to have a different way of viewing Life from the British. That’s one of the reasons I really enjoy reading French publications, and one of my regulars is a magazine called “Cles“. In the most recent issue they have a thought provoking and different article about dieting. In “Cles” there is a regular section dedicated to articles which promote a “Slow movement” approach to Life, and in this month’s issue they take on dieting. (“Slow minceur, le corps tranquille”).

Essentially, the article advocates this approach to diet.

1. Don’t go on a diet.

2. Instead, slow down and really enjoy your food. For the French enjoying your food is about more than just the taste, the colour and smell of the food. It’s about the whole experience of enjoying a meal….the environment, the aesthetics, the company you share. The article doesn’t use the word “mindful” but such a concept would be consistent with this message – eat mindfully – slowly, really savouring and appreciating what you are eating, and the experience of the meal.

3. Stop when you’ve had enough. Sound straightforward? Maybe not so easy because we tend to have bad habits related to eating way too large portions, either because we were taught to clear our plates, or because we think more food for less money is a bargain. However, if you are eating mindfully, you’ll become aware when your body has had enough. And at that point, you can stop!

4. Learn to handle your emotions without reverting to food. In fact, the article quotes a David O’Hare whose book is entitled “Maigrir par la cohérence cardiaque” (which sounds like Heartmath to me, but see here).

5. Finally, they recommend not cutting out anything, but instead steadily eating a little less, moving a little more, and accepting that it will take a long time to lose a significant amount of weight ie take away any performance or fear of failure anxiety induced by setting short term targets.

What do you think? Maybe this way isn’t for you, but it’s sure different, and as we are all different, it’s good to have a range of possible strategies available, isn’t it?

Transience

photo

Every year I look forward to the blossoming of this Magnolia in the garden outside my consulting room. It won’t flower for long but that makes it even more special. I enjoyed it today. What are you going to enjoy today?

Looking better

forest

When I looked across the forest from the path, the colours, the shapes of the trees, and the diversity of it all, caught my attention. Pointing my iPhone (only working camera I had with me!) at what I could see, I captured the scene. Mmmm…lovely colours.
Then when I got home, I viewed the photos on my Mac and what did I see first?
That bird of prey, soaring high above the forest.
Did I see it when I was actually there?
No, I didn’t.
But it’s the first thing I see now.
Reminds me to take my time, to see the wood (and the birds flying above it), for the trees.
It also reminds me that what we see is strongly determined by the context in which we do the seeing. We never see all there is to see at any particular time.

Seth Godin is sharing his thoughts about education and they are very stimulating thoughts! His ebook (which is free) is entitled “Stop Stealing Dreams“.

The basic thesis is that our education system is designed to produce compliant producers and consumers. Compliant producers/workers tend to end up in hourly paid jobs and with the globalisation of large corporations, there’s been a race to the bottom. If you work for an hourly rate, you are disposable. In fact, increasingly it’s likely your employer will seek to replace you with someone who will work for less – either in your country, or in another one.

There’s not much of a future for any of us down that road, so what we need instead are unique, autonomous, creative individuals – artists (he says) and scientists (of the ideal type – the ones who are truly constantly skeptical, not the ones who think they are the new guardians of THE TRUTH!)

Schools need to change to meet the changing times. In particular we need to move from FEAR – which is used to induce compliance – to PASSION – to encourage self-starters, innovators and life-long committed learners.

Part of that process is to encourage our children to dream (hey, we need to encourage our ADULTS to dream too!) – to dream BIG, but to dream REALISTIC. In other words, not to accept the status quo, but not to opt out by dreaming the dreams sold by those in control – dreams of celebrity for example.  No, the kind of dreams we need to encourage are the dreams which motivate people to engage with working towards making them happen.

Here’s a quote or two –

 19. The dreams we need are self-reliant dreams. We need dreams based not on what is but on what might be. We need students who can learn how to learn, who can discover how to push themselves and are generous enough and honest enough to engage with the outside world to make those dreams happen. I think we’re doing a great job of destroying dreams at the very same time the dreams we do hold onto aren’t nearly bold enough

11. School’s industrial, scaled-up, measurable structure means that fear must be used to keep the masses in line. There’s no other way to get hundreds or thousands of kids to comply, to process that many bodies, en masse, without simultaneous coordination. And the flip side of this fear and conformity must be that passion will be destroyed. There’s no room for someone who wants to go faster, or someone who wants to do something else, or someone who cares about a particular issue. Move on. Write it in your notes; there will be a test later. A multiple choice test. Do we need more fear? Less passion?

29. There really are only two tools available to the educator. The easy one is fear. Fear is easy to awake, easy to maintain, but ultimately toxic. The other tool is passion. A kid in love with dinosaurs or baseball or earth science is going to learn it on her own. She’s going to push hard for ever more information, and better still, master the thinking behind it. Passion can overcome fear – the fear of losing, of failing, of being ridiculed.

Seth highlights a problem I see in health care, even though he is focused on education in this ebook. He describes Taylorism and Scientific Management –

“measure often. Figure out which inputs are likely to create testable outputs. If an output isn’t easily testable, ignore it.” It would be a mistake to say that scientific education doesn’t work. It creates what we test.

That really is the trouble with health care – see my recent post about finding the person in the patient,  and the earlier one about people not processes.

Here’s his definition of an artist by the way –

“An artist is someone who brings new thinking and generosity to his work, who does human work that changes another for the better.”

He uses the same definition in his We are All Weird.

And, just to finish with here, he highlights the issue of getting people to give a damn –

“Can we teach people to care? Can we teach kids to care enough about their dreams that they’ll care enough to develop the judgement, skill, and attitude to make them come true?”

“seeing the person in the patient” caught my eye as I read this letter in last week’s BMJ –

The key to the successful management of comorbidities (and all illness) is to “see the person in the patient.” That is not easy for doctors who see patients only briefly and tend to use that time to focus on their patients’ illnesses. At 68 years of age and with a fine collection of comorbidities of my own, I speak from experience. The key to success in treating comorbidities is to discover what motivates patients, what their ambitions and aspirations are, what they would like to be able to do, and then to agree with patients an individual care plan that accommodates all of their conditions, is practicable from their point of view, and which will—as far as possible—enable the fulfilment of those aspirations. Kamerow is right that dealing with such patients is logically a primary care issue but, in the UK at least, that is not simple. In my GP practice, I rarely see the same GP twice in succession, so continuity of care has something of a hollow ring to it. Perhaps there is a case for a GP with a special interest in comorbidities, or are there so many of us with comorbidities that no GPs would be left to treat acute illnesses?

The letter is written by Peter Lapsley, who is described as the BMJ’s “patient editor” (not sure what that is, but I really agree with his comments). He was writing in response to a piece by Kamerow about the difficulties in dealing with patients who have more than one thing wrong with them – “comorbidities”. The problem is that the reductionist approach to illness compartmentalises people into bits, trying to find and define the wonky bits (my term!) and fix them. This approach uses guidelines and algorithms created from reviews of research into treatments for individual diseases – pretty much always conducted on patients with just one thing wrong with them.

Actually, as Peter Lapsley points out, the problem is resolved by focusing on the person instead of the individual diseases.

The trouble is that takes time, a holistic, patient-centred approach, and a real effort to understand what’s important to the patient and responding to their aspirations and values. It absolutely is not a one-size-fits-all approach to health care. It’s time to stop trying to squeeze everyone into protocols and rediscover the value of both continuity of care and the importance of focusing on the human, or the “person”. This is especially true when dealing with people who have long term conditions.

(I’ll declare an interest here – where I work we deliver 100% continuity of care, and we completely focus on the individual and help them find a way to better health according to their aspirations and values)

As we walked through the Birks o’Aberfeldy yesterday we came across this amazing performance by a leaf dancing in the wind.
Mesmerising.

photo

photo

In the main foyer of the National Portrait Gallery in Edinburgh, as well as the spectacular friezes, there are these stunning lamps.
I was especially taken by the design of the chains supporting the lamps – look at the lovely three circles within a greater circle, creating an inner Celtic triskele….

photo

Complexity

looking up at the roof while standing in Waverley Station, Edinburgh yesterday….

photo