I stopped at a junction in Aix en Provence. The traffic lights in France include a set fixed at car level, as well as a set higher up. This particular set has been enhanced by someone with a sense of humour.
Emoticons on the traffic signals, huh?
Nice idea!
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Posted in from the dark room, photography | Tagged nature | 1 Comment »
I don’t know about you but in the middle of this “world economic crisis” I’m just not hearing what seems like a decent plan. The main so-called solutions seem to be about how to get people borrowing and spending again. But weren’t borrowing and spending actually at the heart of the problem? Wasn’t it the system which encouraged the unregulated pursuit of self-interest which produced exactly the current crisis? But tired old slanging matches between free market capitalists and state control advocates just seem like debates about who should hold the reigns of power. It feels like something more radical and new is needed. I found myself saying, don’t we need a society more based on love, than on power? (and does that mean I’ve never quite left Woodstock, flower power, and the “LA habit” behind?)
I’ve long since been impressed with the work of Richard Wilkinson and been convinced about his findings on inequality so when he commented on one of my posts recommending his latest book, The Spirit Level (ISBN 978-1-846-14039-6), I knew a trip to Amazon was imminent.
Most of The Spirit Level, which he has written with Kate Pickett, re-presents the findings and the arguments I’ve read before. If you’ve never read any of his work, then is, for sure, the best starting place. However, where it got exciting for me was at chapter 14. In fact, the last three chapters of the book were the three which gripped me most strongly.
The authors quote Thomas Hobbes who believed that there was always a danger of conflict in human societies as people competed over scarce resources, so the purpose of strong government was to keep the peace. You’ll be familiar with the Hobbes’ phrase that without such government life would be “solitary, poor, nasty, brutish, and short”. Against this view they propose
“As well as the potential for conflict, human beings have a unique potential to be each other’s best source of co-operation, learning, love and assistance of every kind. While there’s not much that ostriches or otters can do far an injured member of their own species, among humans there is.”
They describe the ‘ultimate game’ where volunteers are paired randomly, one is given a sum of money and told to propose to the other a share of the money. If the ‘responder’ accepts the proposal both keep the money. If they reject it, neither keeps the money. Interestingly, what happens is that the commonest offer is 50%. This is despite the fact it’s made clear that there will be only one ‘round’ of this game and the volunteers will never meet again. ‘Responders’ reject offers less than 20% on average, so punishing greedy proposers. This shows two interesting human characteristics – co-operation and “altruistic punishment” which reinforces co-operative behaviour.
Somewhat startlingly, but undeniably, they claim that human beings have lived for 90% of our history in egalitarian societies based on co-operative, hunter-gatherer groups, and only with the invention of agriculture did dominance hierarchies develop.
Their conclusion is to call for more “affiliative strategies”
At one extreme, dominance hierarchies are about self-advancement and status competition. Individuals have to be self-reliant and other people are encountered mainly as rivals for food and mates. At the other extreme is mutual interdependence and co-operation, in which each person’s security depends on the quality of their relationships with others, and a sense of self-worth comes less from status than from the contribution made to the well-being of others. Rather than the overt pursuit of material self-interest, affiliative strategies depend on mutuality, reciprocity and the capacity for empathy and emotional bonding.
I think this hits the nail on the head. I think we need some bright minds to come up with the detailed methods, but I do believe what we need now is a radical realignment of our energies and our structures away from the mistaken belief that competitive self-interest producing dominance hierarchies are the best model for society, back to our roots, to the 90% of our history, to
“mutuality, reciprocity and the capacity for empathy and emotional bonding”
Wilkinson and Pickett make it clear that their research has compared existing developed nations, not current models against a hypothetical utopian one. If we can reduce our enormous economic inequalities, we can look forward to less violent, more healthy societies. If you’re not convinced about that, read this book.
Posted in books, from the reading room, life | Tagged affiliative strategies, economics, inequality, politics, public health | 2 Comments »
Where does your mind exist? There’s a longstanding “common sense” view that it’s inside your skull. But, it’s becoming apparent, that is far from the whole story. Yes, of course a lot of what we call the mind is related to brain activity and the brain is indeed inside the skull, but many researchers are discovering that just as the brain does not exist in isolation, neither can cognition, behaviour, a sense of self, for example, be understood solely on the basis of brain processes. If we want to understand the mind we have to consider the body in which the brain is embedded. Phrases such as “embedded mind” and “embodied mind” capture the essence of this view, and the more you think about it, the more your realise the importance of the incredible network of connections between the brain and the rest of the body.
I get frustrated by doctors and scientists who act as if we can divide a human being into two components – a body and a mind. Especially when they then use this arbitrary and false dichotomy to actually recommend treatments for people’s illnesses. The “embodied mind” concept binds the body and the mind inextricably. That makes a lot of sense to me. I’ve never met a mind without a body, and the only bodies I’ve met without minds have been in the mortuary.
However, some thinkers, scientists and researchers have pushed the idea of “embedded minds” a stage further. (the difference being that “embodied” is exactly what it says – “in the body”; whereas “embedded” argues for a broad contextual understanding which situates the mind in it’s multiple environments). Andy Clark, who promotes the concept of the “extended mind” is one of the writers who has taken this furthest.
I have three of Andy Clark’s books. The first one I read was “Being There” (ISBN 0-262-53156-9), which was given as a key reference in “Smart World” by Richard Ogle . That book deals with the concept of the “embodied mind”.
Might it not be more fruitful to think of brains as controllers for embodied activity? That small shift in perspective has large implications for how we construct a science of the mind. It demands, in fact, a sweeping reform in our whole way of thinking about intelligent behaviour. It requires us to abandon the idea (common since Descartes) of the mental as a realm distinct from the realm of the body; to abandon the idea of neat dividing lines between perception, cognition, and action.
Being There describes how this concept evolved and lays out the implications of the model. Six years later he published “Natural-born Cyborgs” (ISBN 0-19-517751-7). Here he challenges us to consider just how we, as human beings, extend ourselves outwith the bounds of our physical biology.
For what is special about human brains, and what best explains the distictinctive features of human intelligence, is precisely their ability to enter into deep and complex relationships with nonbiological constructs, props and aids. This ability, however, does not depend on physical wire-and-implant mergers, so much as on our openness to information-processing mergers.
He tracks the evolution of these interactions
….from speech and counting, morphs first into written text and numerals, then into early printing, and on to the revolutions of moveable typefaces and the printing press, and most recently to the digital encodings that bring text, sound and image into a uniform and widely transmissible format…..they constitute, I want to say, a cascade of “mindware upgrades”
What matters most is our obsessive, endless weaving of biotechnological webs: the constant two-way traffic between biological wetware and tools, media, props, and technologies. The very best of these resources are not so much used as incorporated into the user herself. They have the power to transform our sense of self, of location, of embodiment, and our own mental capacities. They impact who, what and where we are. In embracing our hybrid natures, we give up the idea of the mind and the self as a kind of wafer-thin inner essence, the human person emerges as a shifting matrix of biological and nonbiological parts. The self, the mind, and the person are no more to be extracted from that complex matrix than the smile from the Cheshire Cat.
I particularly like this phrase from his concluding chapter in that book –
Our most significant technologies are those that allow our thoughts to go where no animal thoughts have gone before. It is our shape-shifter minds, not our space-roving bodies, that will most fully express our deep cyborg nature.
In his most recent book, “Supersizing the Mind” (ISBN 978-0-19-533321-3), he reproduces the original article which he wrote with David Chalmers, where they both laid out this concept of an “extended mind”. That article alone is worth reading, and, in fact, he recommends you read it first before reading the rest of the book. He juxtaposes the concept “BRAINBOUND” with “EXTENDED”.
According to BRAINBOUND, the (nonneural) body is just the sensor and effector system of the brain, and the rest of the world is just the arena in which adaptive problems get posed and in which the brain-body system must sense and act.
Maximally opposed to BRAINBOUND is a view according to which thinking and cognizing may (at times) depend directly and noninstrumentally upon the ongoing work of the body and/or the extraorganismic environment. Call this model EXTENDED. According to EXTENDED, the actual local operations that realise certain forms of human cognizing include inextricable tangles of feedback, feed-forward, and feed-around loops; loops that promiscuously criss-cross the boundaries of brain, body and world. The local mechanisms of mind, if this is correct, are not all in the head. Cognition leaks out into body and world.
Why is all this important? Well, I think Andy Clark puts it well himself –
This matters because it drives home the degree to which environmental engineering is also self-engineering. In building our physical and social worlds, we build (or rather massively reconfigure) our minds and our capacities of thought and reason.
This is the why this way of thinking so exciting. How does our physical environment shape not just our patterns of thought, but our whole sense of personhood? How does it limit, or potentially expand, what we think we are and what we think we can be? Our social world is a fundamentally narrative one. So what are the stories we are told in our societies? And what stories do we choose to tell each other? How does this narratively-constructed world both shape our sense of personhood, and stimulate our imaginations to become something more than we are now?
If all this seems a little esoteric for you, read David Chalmers foreword to “Supersizing the Mind”. You’ll immediately grasp the everyday-ness of all this as he talks about how getting an iphone has changed his life, and, further, how the use of notebooks, and visual cues, can maintain independent living in patients with Alzheimer’s way beyond what would be possible were they to rely on the minds inside their skulls!
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Look at these daffodils.
All daffodils, but all so different.
I love and am endlessly amazed by the diversity of Nature.
I am reminded every day how different we all are. Every patient I meet tells me a new story, one I’ve never heard before. The appeal of diversity and difference, of uniqueness, is probably one of the things that attracts me to a therapy which individualises the treatments people receive. I don’t think one size fits all. Dr Michael Dixon of the Prince of Wales, Foundation for Integrated Health, gets this right in the BBC’s Scrubbing Up column.
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In The Discoverer, Jan Kjaerstad mentions Liv Ullman’s “Changing”, and states that many people who read it changed their lives. Well, The Discoverer is a novel, so I wasn’t sure if such a book actually existed. A quick check on abebooks found that it did and I ordered up a copy for a few pounds. (Changing. Liv Ullman. ISBN 0297772856. Published back in 1977 and translated into English by Liv Ullman herself)
What an interesting book!
I really didn’t know anything about Liv Ullman before I read this book. I knew she was an actress and she’d starred in Ingmar Bergman movies but that was about it. This book is a kind of autobiography telling about certain parts of her life. It’s written in a mix of styles and a strange mix of first and third person sections. The third person parts strike me as most odd and feel the least natural but the first person writing (which is by far and away the greatest part of the book) reads very naturally. It’s as if she is chatting to you or sharing her thoughts with you.
What makes the book remarkable is how it shares the process of maturation and development of wisdom. Yes, wisdom. I’d go as far as to call this a wisdom book. It’s enlightening and inspiring and I say that as a man, even though much of what she writes about is sexual inequality and the struggle to be a single mother and a professional at the same time. I love her clear eyed, grounded focus on the real. There’s nothing polemic, and nothing starry eyed about this book. It’s a story of growing self-knowledge and with that self-acceptance, of the struggles with commitment and freedom, with mothering and professional development as an actress, with privilege and simplicity.
Here’s what she says about success –
The best thing that can come with success is the knowledge that it is nothing to long for.
And here’s what she says about the differences between men and women –
I try to put in words why I believe that all divisions of people into groups just increases our difficulties. Makes it harder to understand each other.
The importance of living NOW –
I think it is good to recognise what the moment is about and to accept it as a gift.
and
Why is it so frightening to reach sixty because one was once sixteen an believed that time existed in infinite supply? Why couldn’t one know that Time moves on with ever increasing speed and plays havoc with all the things we once thought we could leave for tomorrow?
But especially I like what she says about self-acceptance and finding what’s important within –
Sometimes the sense of security is within myself.
and
Pointless to seek refuge in someone else from what was my loneliness and insecurity
and
I realise I was brought up to be the person others wanted me to be, so that they would like me and not be bothered by my presence. That person was not me. When I began to be me, I felt that I had more to give. Life was richer.
and
Perhaps maturing is also to let others be. To allow myself to be what I am.
She completely grasps the dynamic of life –
Is this not where life’s possibilities lie? Not necessarily to arrive, but always to be on the way, in movement.
She says that one of the greatest compliments she ever received was a zen saying –
You have allowed the cloth to weave the cloth
I like that very much!
I don’t think reading this book changed my life but it was certainly an inspiring read.
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Patients present their problems to doctors as stories. Stories are the way we attempt to communicate what’s invisible – the inner, subjective reality that only we can experience. Take pain as an example. There is no way to see pain, or to experience another person’s pain. There are no instruments to measure it. So when someone presents with pain, doctors try to hunt down any physical abnormalites, any “lesions”, which might be the source of the pain. The trouble is, whilst the physical, the objective, the “lesion”, can be seen, or measured, or even touched, none of those qualities make it more real than the subjective experience of the invisible, un-measurable, symptoms. That’s not the way most doctors see it though. There is an enormous tendency to rate the “lesion” above the experience. Why is that a bad idea? Well, not least because the relationship between lesions and symptoms is non-linear at best, and coincidental at worst!
I came across an interesting article recently about how misleading MRI scans can be. It cited two fascinating studies.
An infamous 1994 study published in The New England Journal of Medicine imaged the spinal regions of ninety-eight people with no back pain or any back related problems. The pictures were then sent to doctors who didn’t know that the patients weren’t in pain. The end result was shocking: two-thirds of normal patients exhibited “serious problems” like bulging, protruding or herniated discs. In 38 percent of these patients, the MRI revealed multiple damaged discs. Nearly 90 percent of these patients exhibited some form of “disc degeneration”. These structural abnormalities are often used to justify surgery and yet nobody would advocate surgery for people without pain. The study concluded that, in most cases, “The discovery by MRI of bulges or protrusions in people with low back pain may be coincidental.”
So lesions without stories are just misleading aren’t they?
A large study published in the Journal of the American Medical Association (JAMA) randomly assigned 380 patients with back pain to undergo two different types of diagnostic analysis. One group received X-rays. The other group got diagnosed using MRI’s, which give the doctor a much more detailed picture of the underlying anatomy. Which group fared better? Did better pictures lead to better treatments? There was no difference in patient outcome: the vast majority of people in both groups got better. More information didn’t lead to less pain. But stark differences emerged when the study looked at how the different groups were treated. Nearly 50 percent of MRI patients were diagnosed with some sort of disc abnormality, and this diagnosis led to intensive medical interventions. The MRI group had more doctor visits, more injections, more physical therapy and were more than twice as likely to undergo surgery. Although these additional treatments were very expensive, they had no measurable benefit.
You might have thought that the “better” imaging technology would reveal the “real” lesions and so guide the doctors to the best treatments. Turns out that just wasn’t the case.
It’s very frustrating for a patient when their symptoms are dismissed because no lesions can be found (no physical diagnosis can be made), but it’s equally frustrating when the removal of such a discovered lesion fails to produce any lived benefits for the patient. We are beginning to see a greater use of “quality of life” questionnaires, and of “PROMS” (Patient Reported Outcome Measures) but there’s still a huge tendency to rate what can be measured over what can’t be.
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Spring is a great time to be amazed. All the buds and blossoms……
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Surgeons are doctors of the visible par excellence. They explore their patients’ bodies to find lesions, swellings, ulcers, abnormal pieces of tissue or abnormal organs. My trainer taught me “If you send your patient to a man with a knife he’ll use it”. That was good advice. When you present your symptoms to a surgeon he or she will try to find a lesion which might explain them. They use their eyes and their hands, and, increasingly they use technology to explore the inside of the body, and discover the lesions which can’t be seen with the naked eye. Their treatments, as you might expect, are similarly very physical, very visible. They use knives, lasers, needles and thread.
Physicians are also doctors of the visible, but their concept of the lesion which might explain your symptoms can be much more diffuse than that of the surgeon. Physicians increasingly focus on the physical changes which can only be revealed by technology. Not just the imaging equipment loved by the surgeons, but also the vast array of lab tests which reveal quantities of particular molecules circulating inside their patients’ bodies. They even explore the molecules within DNA to find the “causes” of disease. Physicians, in other words, as just as concerned about the visible, the physical, the measurable, as surgeons are. Their treatments similarly match their understanding of illness. Just as surgeons use highly visible, physical tools, so physicians use those tools which are visible – drugs. This is different from the surgical toolkit of course because although a tablet, or a cream, or an injection might be very visible, the actual tools which do the job are the molecules which the visible “medicine” contains. You can only make these tools visible by using technology. The molecules can’t be seen with the naked eye.
Psychiatrists are doctors of the invisible. They explore the subjective content of human minds. You can’t see anxiety, depression, compulsive thoughts or psychoses with the naked eye and you can’t find them with technology either. These symptoms are like the wind in the trees. You can only see the effects of the symptom, not the symptom itself. It’s interesting to see how psychiatrists have used both visible and invisible tools to address these invisible diseases. The main invisible tool they use is language. All the psychoanalytic and cognitive behavioural approaches are based on listening and talking. The patient tells their story, the therapist interprets it and works to enable the patient to tell a different story, one which is healthier. But psychiatrists also use drugs the way a physician uses drugs, either to modify behaviour, or to alter levels of brain chemicals and in so doing alter behaviour. The most physical/visible part of psychiatric treatment is brain surgery, removing or inactivating parts of the brain to alter behaviour or experience.
I’m a doctor of the invisible but I’m not a psychiatrist. My everyday work consists of listening to patients’ stories in order for them not just to reveal the subjective contents of their minds, but of their bodies too. I’m interested in such invisible phenomena as pain, nausea, light-headedness, itch, numbness, well-being and exhaustion, as well as more mental ones such as depression and anxiety. Because I specialise in the invisible, in most cases I refer visible manifestations of disease to a colleague, but in acute situations I’ll initiate physical treatments myself. However, most patients who are referred to the hospital where I work have already had the visible addressed and are referred because their continuing distress or disability caused by the invisible. It’s interesting that the treatments I use, homeopathic medicines, are also invisible. Not just invisible in the way that a drug is invisible until analysed, homeopathic medicines don’t reveal their characteristics to either the naked eye or to technology. They only reveal their characteristics to the individual patient. It’s the change in subjective experience which shows the effect.
I’ve compartmentalised here to make a point. However, the reality is that most doctors deal with both the visible and the invisible. Most doctors are concerned not just with the lesions which might be found, but also with the lived, inner, subjective experiences of their patients. It’s just that most doctors are trained with a biomedical model in mind, and that gives a huge priority to the physical, the visible. With the growth of understanding around concepts such as biopsychosocial models, phenomenological and narrative approaches, and so on, we are beginning to pay more attention to the invisible, to patients’ lived experiences. It’s not only the physical that matters, and subjective experience is neither irrelevant, nor is it less important than the presence of a lesion. What we are beginning to understand is that the relationship between the visible and the invisible is a non-linear one, and that the presence or absence of a lesion may or may not be relevant to a patient’s actual experience. The logic and the science of human functioning demands that we should at least redress the imbalance between the visible and the invisible in health care, and in many cases, actually reverse the current situation.
It turns out that what is most important in health care is what the patient tells the doctor, not what the doctor tells the patient.
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