Feeds:
Posts
Comments

rock, originally uploaded by bobsee.

For those of you who enjoyed the recent “What do you See Here?“……..here’s another one!

We do live in a “pill for every ill” society. Arthur Frank, in his “Wounded Storyteller” describes the commonest type of story told by patients in contemporary society as being the “Restitution Story”. By this he means “I’m broke, Doc, please fix me”. He says it’s the fast food approach to health, the quick oil change while-you-wait approach. It’s technological and it’s based on a conception of illness as being about a bit of the body that’s not working and on a conception of Medicine as being about applying the right technology for the quick fix.

Whilst this approach has delivered dramatic results in acute situations, it’s done really nothing in the long term for chronic ones. Even in societies where the burden of death and disability from infectious disease has been reduced we are seeing steadily growing rates of chronic illness. The quick fix approach doesn’t deliver long term health and it doesn’t deliver a very effective fix!

Here’s a paper from the “Harvard Health Letter“, headed “Managing Seven Common Conditions without Medication”.

In summary, they say Arthritis – lose weight, gain mobility and less pain; Cholesterol – drop your LDLs (bad blood fats) 5% by keeping saturated fats off your diet; Cognitive decline – brain exercise and physical exercise slows this up; Depression – regular physical activity lifts mood; Diabetes – regular physical activity drops sugar levels; High Blood Pressure – lose weight, regular exercise; reduce salt and drop your BP; Osteoporosis – lose weight and eat more vit D and calcium for stronger bones.

OK, so not exactly rocket science – basically lose weight and exercise more – but at least it’s a start. It’s the mentality behind this report that appeals to me though. When our first concern with an illness is what drug to take or operation to have, we’ve missed the boat. Our first concern should be “what do I need to do differently?” because if you keep doing the same you’ll just get more of the same! But I think we need to push this agenda a lot further and into areas so far pretty unexplored. Sure, things like smoking, alcohol, drugs, diet and exercise are all modifiable factors in our lives which can influence which diseases we get and how those diseases progress, but we need to think of whole people, and not solely in this kind of mechanical or reductionist way. Mental states are significant factors in maintaining health and in determining recovery – positive attitudes, empowerment, hope, loving and being loved aren’t talked about so much by doctors or health care providers but they should be. In fact, if we treat people as only physical bodies we don’t treat them as human beings at all. We are much more than our physical selves.

So let’s all agree that diet, exercise and drugs are important considerations in health and illness, but what other factors would YOU consider? What about writing for example? Or music?

What factors are important in YOUR life to keep you healthy, or that you’ve found were important parts of your recovery from illnesses?

In his Choice Theory, William Glasser make the point that we are all born “genetically programmed” to have five basic needs. However, we don’t all have each particular need to the same degree as another person. Our personal mix of these five needs will tell us a lot about our personal motivations and what lies behind the choices we make in life. The five needs are

  1. Survival
  2. Belonging (love and loving sex)
  3. Power
  4. Freedom
  5. Fun

He makes suggestions to help you figure out the strengths of these various needs in your own life.

If you have found that you are less willing to take risks than most people, you have a high need for survival.

The key to assessing the strength of your need for love and belonging is how much you are willing to give.

To assess the strength of your need for power, ask yourself if you always want to have your own way, to have the last word, to own people, and to be seen as right in most of what you do or say.

If you can’t stand the idea of following rules, conforming, or even staying in one place or with one group of people for very long, you have a high need for freedom.

If you enjoy learning and laugh a lot when you do, you have a high need for fun.

You get the idea? Of course, you could say that ALL of us have ALL of these needs. The point is to understand which of these resonate most strongly with you. Because that’ll be your prime motivator.

building, originally uploaded by bobsee.

Perception involves a lot more than just sensory inputs ordered by our eyes and brains in the way a computer would process an image.
We use memory to match the patterns we see to what we’ve seen before. And we use imagination to see more than could be seen by a machine.
What do you see when you look at this?
What do you see first of all, what does it remind you of, and, if you were to use your imagination, what would you see then?

William Glasser, in his Choice Theory, says this –

I disagree with the usual psychiatric thinking that you can learn from past misery. When you focus on the past, all you are doing is revisiting the misery. One trip through the misery is more than enough for most people. The more you stay in the past, the more you avoid facing the present unhappy relationships that are always the problem.

I’m with him on that – “One trip through the misery is more than enough for most people” – what a great quote! Whilst telling the story of the past can be important part of making sense of an experience and of understanding something of another person’s life, the solutions to the present suffering or distress don’t lie in revisiting. It’s not enough to just “get it out”. What matters is what you are choosing to DO today. How are you coping with life NOW as you are living it. That’s an empowering point of view because you can’t change the past, but you sure can change something about what you are doing today. Glasser believes that “present unhappy relationships that are always the problem”. Well, I’m always wary when I see that word “always”! It’s unlikely that there is a single cause, or type of cause, for all problems. He says –

What I will teach him is that he is not satisfied with a present relationship, the problem that always brings people to counselling. His past could have contributed to the problem, but even though most current psychotherapies initially focus on it, the past is never the problem.

I do think he’s onto something here, even if he’s pushing  things a bit with his “always” and “never”. There are, of course, a number of psychological approaches which focus on the present as opposed to spending hours digging through the past but not all so explicitly attempt to uncover the present unsatisfying relationship as the thing to focus on. The following three quotes make this very clear –

There is no need to probe at length for the problem. It is always an unsatisfying present relationship.

Since the problem is always in the present, there is no need to make a long intensive investigation of the client’s past. Tell him the truth: The past is over; He cannot change what he or anyone else did. All he can do now is, with my help, build a more effective present.

In traditional counselling, a lot of time is spent both enquiring into and listening to the clients complain about their symptoms [which makes it harder to get to the real problem]……..what the client is choosing to do now.

I remember the first time I realised I was on the wrong path when counselling a patient with postnatal depression who had been sexually abused as a child. On one of the one hour sessions she said to me “Look, I really do appreciate you taking all this time to listen to me, but every time I spend an hour talking to you about the past abuse I feel worse. I think I need a break from this. I think I need to live now.” Well, that woman taught me an important lesson about counselling – that it wasn’t enough to just let someone talk about the past, and that the present is where we live now so we all need better tools to live now, not better tools to remember the last miseries. I also realised at that point that different people had different needs and there was no one model of counselling which would fit everyone.

As I’ve learned from patients and learned from further reading and training, I’ve discovered I’ve a great affinity for focusing on what’s in life NOW and what coping strategies we’re using NOW. But I haven’t had the thought before that the problem ALWAYS lies in a current unsatisfying relationship. Maybe that’s worth exploring a bit more, but, what has made sense for me so far is that there are different areas of focus (and therefore different priorities) for different people. Sure, for many people, the most significant area is relationships, emotions and feelings. But for others the most significant area is something physical, practical, maybe work-oriented. And for yet others, the focus is on something spiritual, their disconnectedness to whatever is greater than themselves, or their search for meaning.

What do you think? Do these theories ring true for you?

Cedar

cedar

Looks quite strange, huh? Come back a bit and see more the tree – it’s a wonderful cedar!

cedar

One of the most powerful, and most challenging, characteristics of Reality Therapy, is Choice Theory. When you are suffering, or upset, it seems pretty normal to use what William Glasser calls External Choice Theory and blame somebody for it. But, as he points out, in all circumstances we have choices. Bad things still happen, and Choice Theory does not mean that we choose to have bad things happen. However, in any circumstances we can choose between different actions, and we can choose to change how we think about something. (There’s something here in common with Viktor Frankl’s logotherapy I think. He said that what matters is what “stand” we take – how we respond in the various situations which we find ourselves in, and what actions we take)

It’s strange how challenging and apparently harsh it can seem to focus on making choices. I think there is an assumption that if you can make choices then you must have chosen the suffering you find yourself experiencing, but I think this is a seriously misguided interpretation. There’s a world of difference between making choices and being in control of everything. The world is not only full of random events, from accidents, to earthquakes, tsunamis and floods, but it’s also full of other people, all following their own agendas and taking their own actions which affect both other people and the environments in which we all live. Making choices as a continual process is an incredibly empowering exercise. It’s the use of external choice theory which paralyses, despairs and makes victims of us all.

So, next time you’re not so happy about something, instead of looking for someone to blame, think what you’d like to do now instead – in other words, focus on not only making choices, but seeing them through. It feels completely different to do something positive instead of complaining and blaming!

Bonnieux.

Looking up towards Bonnieux. There are hundreds of lovely hilltop villages in France. I think the Mistral-driven wisps of clouds above Bonnieux made this view particularly lovely.

bonnieux

Down in the fields below the hilltop villages in the South of France there are typically lots of vineyards. At this time of year the vines look small and wizened but they’ll soon flourish!

vineyard

One thing which struck me here was how higgledy-piggledy (oh dear, I’m sure that’s not a real word!) the village is. There seems to be no order, just buildings on top of each other, crowded together in irregular streets. Really a chaotic and apparently random pattern. And yet, it was built by human beings. It didn’t just grow. Then down in the valley the order imposed on nature shows the straightest, most even lines of vines you could imagine.

So, here’s my dilemma. Why have people imposed such order on plants, but not on the buildings and streets they live in? (I mean the people responsible for these two views of course!)

I think you can understand what health is by considering the three main characteristics of healthy organisms – adaptability, creativity and engagement. In France, probably every town and every village has its “boulodrome” – a patch of sand where people play “petanque”. It seems completely informal. Just a space to use by whoever wants to use it. I think it’s a great example of designing social engagement into the spaces where people live.

Look at these guys enjoying themselves. It’s not hard to understand the importance of social engagement for human beings, is it?

petanque
petanque
petanque

I came across two very different examples of weaving yesterday

nets
nets and ropes

and, then, further on, outside a shop

baskets
baskets