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I was recently asked to give a talk at a Palliative Care Conference in Dundee. One of the organisers had seen me use movies as a educational tool when teaching doctors and wanted me to demonstrate that. It was well received and I thought I’d put up a series of posts based on the talk. I hope you like them.

TWO QUESTIONS FOR ALL DOCTORS

I think the core of a doctor’s job is to try and understand people. One thing I find helpful in that regard is to have two questions at the back of my head during every consultation –

  1. What kind of world does this person live in?
  2. How does this person cope?

With the first question, I’m trying to understand what’s important to the person and how they create a sense of self. I won’t go into this in much more detail just now but one well-known way of viewing the world is through the triad of body, mind and spirit. I find that quite helpful. We can consider each of these as a focus and for every one of us we can place ourselves on the this map – the body, mind, spirit map.

For the purposes of understanding where someone lives on this map, I think that the body represents the physical. These are people to whom physical security and physical reality are paramount. They prioritise material issues and they tend to prefer to have a rational, logical approach to problems – you’ve probably heard someone say “Don’t give me your touchy-feely nonsense!” when asked to discuss how they are feeling. Utility and practicality are their key values. For others, emotional security is more important. They are very aware of feelings and of relationships. They see themselves in relation to others. The third focus is spiritual and by this I mean the need to make sense of the world and the idea that there is something greater than each of us as individuals. This might be religious but it might not. What is important to that person is that they need to have a sense of purpose.

This map, by the way, is not a set of boxes into which people should be placed. The map is more like a map of three areas or neighbouring countries with flexible, moving, overlapping borders. Some people spend all their lives in only one of the countries but most move around!

This, for me, is a fundamental way of creating a sense of self – a way of answering the “who am I?” question. But related to this there is another way, which is how we see ourselves in relation to others. For all of us we live with a tension of two opposites – the need to be separate, unique, individual AND the need to belong, to love and be loved, to identify with others. I say this is related because I find that often the physically-focussed person is more towards the pole of individuality and separateness and the emotionally-focussed towards the pole of identification with others.

So take a look at this movie clip and listen the main character’s monologue. Here is a man who has a sense of being self-contained and who is materially-focussed.

“I am Ibiza!”

To see the opposite pole, have a look at this clip. Here are people whose sense of identity comes from the community –

“It is no bad thing to celebrate a simple life”

These are two good examples of very different ways of experiencing the world, different sets of priorities and different ways of creating a sense of self.

OK, so some of you will be saying hobbits?? They’re not real! But, trust me, the Hugh Grant character in About a Boy isn’t real either! But let me address that in Part 2 where I’ll show a couple of clips from one of my favourite movies, Brassed Off, which is set in a Northern English mining community. You can compare that to the lifestyle of the hobbits in the Shire.

I stumbled upon this news item. It’s the story of Pfizer, an $8.5 billion law-suit and the Nigerian government. It’s one of those sad tales of a drug company testing out a new drug developed in Africa. The drug concerned is Trovan and the case relates back to 1996 when an epidemic of meningitis was raging in Kano, Nigeria. Pfizer gave Trovan to 100 children and another “proven” treatment for meningitis to another 100. Nigeria alleges that the deaths of 11 children and permanent health problems of many others were the result of Pfizer’s trial. Whatever the truth of the matter, and however the trial turns out, it raises an issue which is highly contentious which is the use of poor African’s in drug trials conducted by multi-nationals. The original story was broken by the Washington Post.

Did you ever see “The Constant Gardner“?

Love as a virtue

Robert C Solomon writes a lot about love in his book “The Joy of Philosophy“. In particular he argues that love is a virtue.

I am going…to defend what we now call romantic love, erotic love, as a virtue – indeed as an exemplary virtue. I want to defend what one might call enthusiasm as a virtue, the enthusiasm born of love’s attachments being the most obvious example.

and, later

The passionate attachment of one person for another is a virtue.

To love another, and to be enlivened by that love, to live a better, richer life because of that love, for love of another to be the source, the fountainhead of an enthusiastic, passionate engagement with life…….that’s the challenge. I don’t think we talk enough about this kind of love these days. In Professor Solomon’s terms we tend to think about love rather more “thinly”……we reduce it to something less than it can be.

As he says, love creates love –

Love tends to build on itself, to amplify with time, to find – through love – even more reasons to love.

Whilst it might be true that an unexamined life is not worth living, it’s even more true that a loveless life doesn’t feel worth living.

Love (or loving) itself is the virtue, a virtue so important that rationality pales in significance.

In the hour before sunset, looking out of the window, I see this……

DSC_0052.JPG

I decided to take a photo out of the same window every day at about the same time. I chose the hour before sunset because I’m usually back home by then and because that’s a time of day I’m always saying “Wow! Look at the sky!” HERE is a slideshow of 16 days in August/September – have a look.

Isn’t it amazing? Totally amazing just how different the same part of the world looks every day! (Actually it doesn’t just change daily of course – it’s constantly changing)

The Joy of Philosophy

Some books you can gobble down quickly like fast food, but some just need to be sipped and savoured. I’ve been carrying around and reading The Joy of Philosophy by Robert C Solomon (ISBN-13 978-0-19-516540-1) for the last two or three weeks. Got some strange looks from people on the train who could only see the first part of the title…….”The Joy Of” (bet they never worked out the next word was “Philosophy”!).

I really enjoyed this book. You know how sometimes you read a book and it seems to open doors for you? Suddenly you see or hear something differently and the world and the way you experience it has changed forever. I played with an idea for a story once. I called it “Quantum Days” because I wanted to explore the phenomenon, that we all experience, of those days when something changes and its so dramatic, or so significant, that the world is changed for us so completely that we feel now we’ve moved to a new level (like electrons jumping from one level to another in the atom – quantum jumps). Well I will get round to writing the rest of that story one day. Quantum Days can come about from reading something though. Occasionally there’ll be an “aha!” moment and your world will be changed. This is one of those books for me.

The central thesis of the book is contained in it’s subtitle on the front page – “Thinking Thin versus the Passionate Life”. Throughout the book Professor Solomon uses a very interesting language device – the juxtaposition of “thin” and “thick”. For him, “thin-ness” of thinking is limited, reduced, somewhat sterile thinking. In particular it’s that form of rational thinking which deliberately attempts to be dispassionate.

my revolt against logical “thinness” is very much a celebration of the passions in philosophy and the richness they provide.

It’s amazing how in medicine as well as in philosophy (and I suspect in science too) the passions, or emotions, are frowned upon. There’s a belief around that “the truth” can only be discovered by the dispassionate, the disengaged, the distant, but Robert Solomon argues strongly against that. In fact he argues for the central importance of a passionate life. He doesn’t use the language of “subjective” versus “objective” but that debate fits well with his. I’ve always been amazed that anyone can think the subjective can be left out of health care (or even “controlled for”). The subjective self (an at least partially socially constructed self) can never be taken out of our experience. It’s just impossible to have an experience which isn’t coloured by, framed by, and reacted to by, the self. That’s why who the doctor is, is important in a consultation. Yet I’ve never seen a single research study in medicine which identifies and/or describes the therapists who are actually entering into the encounters with the patients. Sorry, I digress……..but that’s just one of the many trains of thought this book set off and running for me.

He questions the traditional notion in philosophy that a dispassionate thinking about life can lead to a “good” life

A virtuous life might be something more than becoming the congenial neighbour, respected citizen, responsible colleague, and affective zombie that many philosophers and contemporary moral pundits urge us to be.

Oh yes! I love that phrase “affective zombie”! Here’s more….

I do want to raise the question of whether mere proper living, obedience to the law, utilitarian ‘rational choice’ calculations, respect for others’ rights and for contracts, and a bit of self-righteousness is all there is to a good life.

What he is arguing for is a life of passion, an emotional life. What does he mean by emotions though? How does he understand emotion? Well, he definitely does not think we can fully understand emotions by studying brain chemistry, nor by psychoanalysis, or, I suspect, the research conducted into Cognitive Behavioural Therapy. Why not? Because he proposes (and this is one of his radical ideas for me) that we best understand emotions by not focussing on individuals but on relationships, behaviours, actions and society.

….an emotion is not a disposition: it is, first of all, an experience and a way of being-in-the-world

and, later,

it is the context and the social environment that make most emotions intelligible

and

an emotion is not so much an element or item “in” experience as it is the ordering of experience

I could go on……I’ve written down many quotes from this book. What is exciting for me about this thought is that it embeds the experience of emotions so firmly, so inextricably into the contexts of the world in which we live and it gives them a central role in our attempt to make sense of our lives and to act rationally and deliberately in life.

He writes a lot about love but I’ll explore that in a separate post. Let me finish this one with two more quotes from this stimulating book.

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Emotions are strategies

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I’m giving that space so you don’t miss it. Think about this. Are emotions the ways in which we effect change and make an impact on the world? Are emotions actually actions? What does happiness do? What does love do? Anger? Grief? This is a potentially liberating but also empowering perspective.

We too often opt for victimisation or cynicism, the products of our overactive faculty for blame and our extravagant sense of entitlement, or we take refuse in pessimism. But there are better ways to think about life…..

It’s the heroes not zombies argument. Instead of thinking that emotions just happen to us and that our experiences just happen to us, this perspective gives us the opportunity for a much more active and creative engagement in life.

River Forth

As I was in a plane flying into towards Edinburgh Airport I decided to take a photo of the Forth Railway Bridge. Only after I’d taken it did I notice the large ship in the estuary – it’s the QE2 on it’s celebratory 40th anniversary tour.

QE2

QE2 and Forth Bridges

The Stirling Girl

The Stirling Girl, originally uploaded by bobsee.

Over recent months Stirling Council has erected some information panels around the city. On one side is a map of the area and on the other are some images of that area as it was along with interesting little histories.
On the panel at the foot of the “Back Walk” I found this image. I’ve never seen it before even though its from the 1920’s.
I find it quite captivating. I love how the more you look at it the more you see. Within the picture are many of Stirling’s famous landmarks – the Wallace Monument in the feather on her head, Stirling Castle on her hat, along with the Wolf and Robert the Bruce, then around her neck the Old Stirling Bridge.
Have you seen other examples of this kind of drawing anywhere?

Good science

I’ve always had a bit of a passion for science. But what does that mean? What is science? There’s a lot of talk these days about anti-science, as if it were some kind of political party or team to be opposed, or about bad science, which, strangely, tends not to be a discussion about either the philosophy of science or about more or less effective methodologies. In fact, people do tend to apply labels to the experiences of life and those labels, unfortunately, more often stop thought than promote understanding.

So, let me say what I mean when I use the word science. My understanding of what science is owes a lot to the philosopher, Gilles Deleuze. He said there were three ways to think about experience – science, philosophy and art. You can read more about that here. He said science was thinking about function. That makes a lot of sense to me. A scientific approach to a phenomenon is one of curiosity, one of wonder; it’s driven by a hunger to understand. Specifically, it’s about a hunger to understand how something works – whether that be the brain, evolution, or the weather. Indeed it’s about a way of trying to make sense of some aspect of the world. There are two important consequences to the Deleuzean definition for me – one is that science is only one way of thinking about the world, and the other is that it is the main way to think about how something works.

But there are other factors to consider when thinking about science. Popper’s famous principle of “falsification” really hit the mark too. The scientific method is not one of proving things; it’s one of attempting to disprove things. In brief, what Popper said was that we form a hypothesis (an explanatory theory of something) and then, as scientists, we conduct experiments to try to disprove that hypothesis. The more we fail to do that, the stronger the hypothesis becomes. In other words, good science is a process of never ceasing to doubt. A good scientist never says he or she has worked everything out and there’s nothing more to be discovered here. A good scientist must be humble, open-minded, curious and never cease to wonder. When you read the writings of a scientist who claims to be the holder of The Truth, or who claims to be absolutely certain of their position, beyond doubt, you know you’ve found a scientist who’s lost the plot. Scientists aren’t gods. They are people. When they get hooked on certainty conversation with them becomes uncomfortable or even downright unpleasant. That’s not a function of science though, because a scientific approach necessitates a perspective of doubt which should humble.

There’s another quality which is often mentioned in relation to science. One definition I read, (and I confess I can’t right at this moment remember where!), was that science is the study of what can be measured. Well, I’m not entirely comfortable with that definition but I can see where it’s coming from. It’s impossible for us to lead a value-free life. Everything we think and experience and do and influenced by our values. In the scientific approach, there is a tendency to value the physical over the non-physical and that’s what tends to lead to a view that science is about what can be measured. For example we can easily measure the physical dimensions of red patch on the skin of a patient with eczema but we can’t measure their itch, and we can’t measure their emotional experience of their eczema. If we dismiss what can’t be measured we dismiss the experience of eczema (as Cassell would call it, the “illness”) and focus only on the physical changes which are measurable (Cassell again – the “disease”)

So, let me say again. I’m passionate about science. Why? Because I am insatiably curious! I love to explore and discover. I love to understand the world, my life and the people I meet. I know that understanding is an eternal process. It has no stopping point. It’s never finished. It has no conclusion. So, for me, science is a way of understanding life better. That said, philosophy and the arts are equally important ways of understanding the world and each will shed a very special light which the other ways of thinking won’t.

I am equally passionate about philosophy and the arts.

I titled this post “Good science” because I want to highlight a positive conception of science – insatiably curious, constantly developing, continuously humble, practised with an intention of building our knowledge and understanding.

heading south

heading south, originally uploaded by bobsee.

Winter’s coming
Look! The geese are heading south. Such a lovely sight.
I’m sorry I didn’t get a better photograph of them but I’ll keep my eyes peeled and maybe I’ll see some more.
We had a thin frost yesterday morning so I guess the geese saw that coming!

the white house

the white house, originally uploaded by bobsee.

I just love the colours in the sky over Ben Ledi.
But see that white house over to the left? It’s catching the sun so it’s catching your eye.
We are very good at spotting what’s different, noticing what is unique.
I love that
I love that our perception allows us to focus on what’s different, what’s unique