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the moon tonight

the moon

closer….closer…..

the moon

Health is a state of being of a whole organism. It isn’t reducible to either single elements, or to a cumulative total of elements. The whole is more than the sum of the parts.

A number of years ago, I read Hans-Georg Gadamer’s stimulating collection of essays, “The Enigma of Health“. He wondered about the strange invisibility of health. For example, at the moment I’m not particularly aware of having a left foot, but if something heavy were to fall on it, injuring it, I’d certainly be aware of it! I’m reminded of the Roger McGough poem, “Bits of Me”, where he refers to the bits of him which are making their presence know, when normally, they don’t! (a great, thought provoking, and funny poem)

I’m also very aware of how little “health” is discussed, taught or researched, what with both training and service delivery in health care being focused on disease discovery and management. But don’t we need to have some useful concept of “health” if we’re seeking to support and/or create it?

I recently came across some writings by the biologist, Brian Goodwin. He captures the issue beautifully here –

I take the position that there is a property of health of the whole organism that cannot be described in terms of the functioning and interactions of the constituent organs or tissues or molecules—whatever level of parts one wishes to consider. Furthermore, this property of the whole influences the functioning of the parts in identifiable ways; that is, it has causal efficacy. The absence of such a conception from mainstream biology and medicine is evident from the fact that there is no theory and practice of health taught to medical students that develops systematically such an emergent property of the whole organism with which one can work methodically. Health in the medical model is absence of disease, not presence of a coherent state that can be recognized and facilitated by an appropriate therapeutic relationship.

Wonderful. This is the understanding we need if we’re ever going to develop a science of health and a practice of health care.

I work in the NHS – the National Health Service. I was just wondering the other day……..why isn’t the NHS primarily about delivering services which are intended to improve health?

Pardon?

Well, think about it for a moment. Almost all of the services in the NHS are organised around diseases or body systems. Next door to where I work is the “Cancer Centre”. Around the rest of Gartnavel site there are departments of Infectious Disease, Dermatology, Rheumatology, Gastroenterology etc – all with a clear focus on delivering care to people with specific diseases and administering treatments designed to modify or manage disease processes.

That’s what health care does. It conceptualises illness as disease, usually by identifying objectively measurable changes in the body, then uses either surgery to cut out diseased tissue, or administer drugs “proven” to modify defined physical parameters (blood pressure, blood sugar levels, inflammatory markers etc). The hope, I’m sure, is that in doing this, health will emerge or improve.

My point is, that very little of organised health care seems to be structured explicitly, or directly, to stimulate or create a condition called health.

In fact, when I ask groups of doctors or nurses to give me their definition of health without referring to either illness or disease, they frequently struggle. Health doesn’t even get an entry in standard textbooks of Medicine, and the stated goal of Undergraduate Medicine is to teach doctors how to make a diagnosis (of disease). Despite that, I’m pretty sure most doctors and nurses would say they go to work each day to try to improve the health of their patients. The odd thing is that by focusing on disease and it’s management, health improvement is left to Nature, or chance, or hope. It’s kind of a side effect of the interventions delivered. A hoped for side effect.

Wouldn’t it be a good idea to have some of the Health Service focused directly on health? Might not a focus on health produce some useful impacts on the presence or progress of disease? Wouldn’t it be a good idea, in other words, to have another approach which directly intends to stimulate and increase health, and which hopes for a side effect of reducing disease?

But here’s the main idea – what about an integrated health service – where, with the focus centred on the patient, care is delivered which impacts on disease AND care is delivered which impacts on health – in each case, directly.

We’re well placed on the Gartnavel site in Glasgow. We’ve got the services focused on disease, but we’ve also got the Centre for Integrative Care, Glasgow Homeopathic Hospital, (where I work) which is focused on health. Here’s a photo of the site

 

 

 

 

 

 

The red circle is around Gartnavel General, the physical disease hospital, the yellow is around Gartnavel Royal, the psychiatric disease hospital, and the blue is around the Centre for Integrative Care, the health-focused hospital.

Tiny little things

Sometimes it’s the smallest things which look so exquisitely perfect……

toadstool

I don’t know about you but it seems to me that there are some people around who seem to think that science can explain EVERYTHING. Personally, I think there’s a lot more to human endeavour and thought than the scientific method, but that’s another story….perhaps.

Here’s an article from Scientific American where they are posing the question “Too hard for science?” – a question which is actually wondering if there’s anything which can’t be explained by science. They put the question mark at the end because they clearly feel it’s unlikely that that sentence could be a statement. This particular article is by a sleep scientist who talks about how his subjects often want to tell him their dreams (I might be wrong, but I got the feeling he wasn’t that keen on hearing them!).

Dreams often feel profoundly meaningful, bizarre experiences often interpreted over the centuries as messages from the gods or as windows into the unconscious. However, maybe our brains are just randomly stringing experiences together during sleep and investing the result with a feeling of profundity.

Those last three words caught my attention – “feeling of profundity” – is meaningfulness a feeling? Would that make understanding also a feeling? Or insight? Are scientific insights feelings?

He goes on to scope out the “problem” as he sees it….

The problem: The difficulty in exploring this idea is that how meaningful something is might be too hard to measure. “It’s a bit like beauty — it’s in the mind of the beholder,” Stickgold says. “It’s not like heart rate or the level of electrical conductivity of the skin, which you have outside evidence of. If a person says something is meaningful, you’re not sure how to measure that, and you’re not sure how, if at all, that applies to others. One has to come up with a meaningful definition of meaningful.”

That’s the “problem” with the scientific method, isn’t it? It’s all about measurement.  Meaningfulness, beauty (go on, add your own list) aren’t measurable. They’re a subjective expression. Not only that, but one person’s subjective expression is often not at all like another’s. What are we to do with that?

Ken Wilber would point out, I’m sure, that only surfaces are measurable, but depth requires interpretation. I deal with the subjective experience of health and illness all day. It’s only through the telling of their story that an individual can communicate that to me, and it requires me to listen, non-judgementally and compassionately so that I can interpret what they tell me. It wouldn’t be helpful to reduce people to what’s measurable in my opinion. Brian Goodwin, the biologist, also used to point out that objective, “measurable” scientifically described phenomena are only the result of intersubjective consensus anyway, and I think that’s also true.

This distinction between what is “objective” and “measurable” and subjective experience isn’t as helpful as it first appears. Whether we are observing, measuring or interpreting, we need reach a consensus about our subjective experiences. That’s the bottom line for me with patients – it’s their experience, as told by them, which is most important and reliable if I’m going to help them to find greater health.

I guess what I’m saying here is that I don’t think science is “the way, the truth and the light” – it’s an appropriate way to increase understanding in some circumstances, and not so appropriate in others. Or is that just too narrow a view of science?

The Edge recently had an issue on predictability. You can predict why! From the financial collapse of 2008, to the earthquakes, tsunamis and hurricanes which have devastated so many parts of the world in the last three years, certainty seems increasingly misguided. The first main article in the piece is from Bruce Parker, an oceanographer. He starts with this –

Prediction is the very essence of science. We judge the correctness a scientifictheory by its ability to predict specific events. And from a more real-world practical point of view, the primary purpose of science itself is to achieve a prediction capability which will give us some control over our lives and some protection from the environment around us.

Oh, that bothered me. It’s bothered me since I first read it, and it’s continued to bother me since. You see, I like science. I love those scientific stories of exploration and discovery. But I don’t like the kind of science described in this opening paragraph. “Prediction is the very essence of science”….really? I know what he means, but isn’t there a lot more to science than prediction? I went back to Richard Holmes, “Age of Wonder“. No, it’s not a tale of prediction, it’s a tale of wonder and discovery. And what about this aim of science – “give us some control over our lives and some protection from the environment around us”. Again, I understand why he says this, but isn’t this too narrow a view of science? Doesn’t complexity science itself show how unlikely it is that we’ll be able to predict and control ourselves or the natural environment of which we are a part (not “apart from”)?

So, it was with great interest that I read and article from the biologist, Brian Goodwin, entitled “Towards a Science of Qualities….”

Reductionist science is essentially a strategy of divide and conquer: dividing the world into constituent systems whose parts are simple enough to allow prediction of their behaviour, and hence to exert control over their activity. This has worked remarkably well in many physical systems and even, to some extent, in biology. The approach exemplifies the principle that can be described metaphorically as linear thinking, which regards a whole as no more than the sum of its parts. Manipulation of the parts then results in control over the whole.

He goes on in the article to describe characteristics of complex systems and to argue (convincingly in my opinion) that we cannot hope to predict and control such systems. What we need to focus in instead is to further our understanding of complex systems and to learn how to increase things like “fitness” and “resilience”.

I think that’s the right approach. There’s too much “command and control” in our world – and it’s flawed. Let’s restore a sense of wonder, a desire to discover and understand, and to develop a good, scientific understanding of how to adapt, how to be flexible and how to increase our resilience and our creativity.

Here’s another study showing how pain can be reduced without using drugs.

In this particular study, the researchers had the subjects do one 20 minute focused attention meditation session daily for 4 days. The subjects rated the painful stimulus applied as “57 percent less unpleasant and 40 percent less intense”.

This is interesting for two reasons. Firstly, it’s another study showing the potential benefit of simple meditation techniques which anyone can learn and integrate into their daily lives. Secondly, as the article points out, it shows how quickly a benefit might be obtained.

If you do suffer from some painful condition, do you practice daily meditation? If not, why not? What’s to lose?

 

Here’s an interesting piece of research. Viewing pictures of a romantic partner can stimulate the “reward” parts of your brain and reduce your experience of pain.

In this trial the researchers compared three interventions – viewing a photo of your romantic partner, viewing a photo of another attractive person and a standard distraction test. The first and the third of these reduced the pain experienced most, and the parts of the brain “activated” by viewing the romantic partner were not the same as those areas “activated” in the distraction test.

I should just add that in this particular trial the subjects were in the first nine months of a romantic relationship……but, still, it’s interesting to see the demonstration of the impact of love (and desire?) on the pain reducing mechanisms of the brain.

The art of Nature

fallen blossom

This is typical of what will catch my eye. It’s a single fallen cherry blossom lying on other plants. The way the different leaves, petals and colours come together just looks like a work of art to me – a spontaneous, serendipitous, natural creation….

Here’s a very entertaining four minutes or so of Kurt Vonnegurt explaining the shapes of stories, using a blackboard……