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I’m a great fan of stories. In fact, I think we understand ourselves and others by using narrative, and the central way in which I work as a doctor is to hear people’s stories, and help them to change them from stories of being stuck or in chaos, to stories of flow, and flourishing and growth.

I’m also a great fan of fiction and the importance of the imagination. I vividly remember Ian McEwan writing this, about this day, ten years ago…

If the hijackers had been able to imagine themselves into the thoughts and feelings of the passengers, they would have been unable to proceed. It is hard to be cruel once you permit yourself to enter the mind of your victim. Imagining what it is like to be someone other than yourself is at the core of our humanity. It is the essence of compassion, and it is the beginning of morality.

So, this recent article in the Guardian caught my eye, “Reading fiction improves empathy, study finds”. There are a number of studies described in this article, and it’s introduced me to something called “the pyschology of fiction”, and, specifically to the work of Keith Oatley. If I wasn’t so insatiably curious I wouldn’t keep finding these amazing new worlds to explore! One of the studies described in the article compared the effects of reading Harry Potter with the effects of reading Twighlight. They used a new measure – “Twilight/Harry Potter Narrative Collective Assimilation Scale”! Don’t you love that? Look at this conclusion from that research –

“The current research suggests that books give readers more than an opportunity to tune out and submerge themselves in fantasy worlds. Books provide the opportunity for social connection and the blissful calm that comes from becoming a part of something larger than oneself for a precious, fleeting moment,” Gabriel and Young write. “My study definitely points to reading fulfilling a fundamental need – the need for social connection,”

and read this fascinating comment by Keith Oatley

“I think the reason fiction but not non-fiction has the effect of improving empathy is because fiction is primarily about selves interacting with other selves in the social world,” said Oatley. “The subject matter of fiction is constantly about why she did this, or if that’s the case what should he do now, and so on. With fiction we enter into a world in which this way of thinking predominates. We can think about it in terms of the psychological concept of expertise. If I read fiction, this kind of social thinking is what I get better at. If I read genetics or astronomy, I get more expert at genetics or astronomy. In fiction, also, we are able to understand characters’ actions from their interior point of view, by entering into their situations and minds, rather than the more exterior view of them that we usually have. And it turns out that psychologically there is a big difference between these two points of view. We usually take the exterior view of others, but that’s too limited.”

Spot on. He really nails the importance and value of fiction as a tool for building empathy. We reduce the place of the Humanities in our education system at our peril!

So just what IS the vision of those who deliver our health services these days? Is this the message they’re giving us…….?

Listen carefully…….

Take a few moments and watch this short video clip (about 7 minutes).
It’s the last part of Sir Harry Burns, Scotland’s Chief Medical Officer’s excellent address to the NHS Scotland Conference 2011.
In this part of his talk, he eloquently makes a strong case for the central importance of compassion in health care.

You can see his whole talk, and download his powerpoint slides here

We’re all waves

symmetry of land and sea

This is how I see Life.
We are all like waves on the surface of the sea.
We all emerge, temporarily, from the universe, from the cosmos, from the continuous, and inseparably connected all that is.
Slow down the movie of the sea, and you’ll see that each wave is unique. It has its distinct form. It appears in a specific time and place and it is constantly changing.
It never disconnects from its source and it returns to the sea, from whence it came.
We are like that. We emerge from the cosmos, never separate from it, constantly changing and in existence for a very short time in the history of the universe.
Of course, waves make an impact too. Together, and with other forces they create the specific shapes of the islands and the coasts of the land masses.
We make an impact too. Some impacts affect only a few people around us, other ones spread far and wide. Some are brief, and others last for generations….

Head in the clouds

the cloud face

Ensō cloud

strange cloud

Look at this cloud! What do you think about that?

A man

One and a half?

A whole man?

september learning

I remember taking part in a small group once which opened with asking everyone to say which month was their favourite month, and why. One of my colleagues said September because that was the beginning of the Academic Year. I liked that response and I’ve always remembered it.
I have many criticisms of our educational system and institutions, and what I really believe is that everyone should learn all the time. I am insatiably curious which drives my constant desire to learn.
However, this time of year is the time when the universities and colleges publish their programmes for “adult” or “continuing” education classes, so I think it’s a great time to plan what you’d like to learn in the coming weeks.
My most recent experience was a course in artists photographic book self-publishing. If you’d like see what I produced have a look here.
What would YOU like to learn next?

One of my most favourite environments is the traditional ryad in Morocco. One of THE loveliest hotels I’ve ever stayed in was in Marrakech. I especially like the internal courtyard, with a fountain, and in the one where I stayed, there were orange trees growing there. Every late afternoon, traditional musicians would sit and play in the courtyard and we’d drink mint tea while relaxing in the alcoves.

So, I was particularly taken by this piece on the Guardian’s website about doctors playing music to their patients in Turkey

“It’s complementary treatment. Without having to prescribe additional drugs, five to 10 minutes of a certain musical piece lowers the heart rate and blood pressure. “Medieval hospitals were built around a courtyard with a fountain. The sound of the water, the colours of glass windows, the intensity of the light, the types of flowers and plants – all of it was part of the complementary treatment of patients,” Sönmez explains. “We are thinking of changing the light in the intensive care unit to pink,” he adds with a smile. “Pink light has a soothing effect.”

Here’s my vote for re-learning what those medieval hospitals got right! Too often “progress” and “modernity” means rubbishing the past and losing so much valuable knowledge. Imagine how health care could be transformed by this kind of attention to both the environment and the arts, and not reducing our focus to a materialistic concept of the body.

Sensation

I got thinking about sensations the other day. Patients talk to me every day about their sensations – pain, dizziness, nausea, itch, numbness and so on. The medical concept of such sensations is “symptoms”. Interestingly, not a single one of these symptoms are objective. Nobody can know them, experience them or measure them apart from the person who has them. But what are they? According to psychologists, sensations are the effects of sensory stimuli, and perceptions are our awareness, or understanding of them.

So, are sensations in the mind?

Well, that’s not where we tend to situate them. We situate them in the body. Pain is usually described as being felt in particular parts of the body. Pain in the leg, an itchy arm, a numb patch on the back of the hand….and so on. That suggests sensations are in the body, not the mind. But what about phantom limb pain? A sensation which is specifically located in a part of the body which no longer exists?

Where do doctors look for a problem when someone describes a sensation? The part of the body the sensation “belongs to”. If someone has chest pain, doctors go looking at the chest and its contents for an explanation of the pain. If they can’t find any abnormalities there, then the focus shifts to the mind – “it’s not in his chest, it’s in his head”. In other words, in the absence of physical pathology in that part of the body, the explanation given is a disorder of the mind.

Do you find this an adequate understanding?

I don’t.

It seems to me that sensations are phenomena of the person, and shouldn’t be attributed to either the body or the mind. They should be situated in a person’s story, because it’s the narratives we tell ourselves and others which create not only a sense of self, but all of our sensations too. Sensations may have locality, but that doesn’t make them the markers of pathology. They can be the expressions of meaning.

If you’re not sure what I’m on about here, check out this post. And if you’d like to read more about the idea of meanings behind sensations, you could start with the excellent “Why do People Get Ill?” or “Meaning-full Disease“.