One of the things that depresses me most is the tendency to write off whole swathes of humanity by sticking a label on them and dismissing them. I sat on the train this week and two guys, a Scotsman and an American with a comb-over, spent the whole journey doing just that. Huge numbers of people were judged, given a label and dismissed.
Here’s an example “I work with medics. I know what they’re like. They’re only interested in one thing. Money.”
Here’s another “Everyone below the Mason-Dixon Line is an in-breeder”
Want more? No, I didn’t think you would.
So here’s a counter to all that. There is a beautiful piece of journalism in today’s Guardian about people with Down’s Syndrome. Read right down to the last paragraph – it’s the clincher! I meet people who says things like this every week. It never ceases to humble me.
And here’s another counter. Sugar Mouse in The Rain sent me a link to a video on youtube. (By the way, go see his blog. It’s lovely and he’s a lovely man) Here’s the video –
some mornings as I walk down past the park to the railway station the dew or the frost makes literally dozens of spiders’ webs sparkle in the early morning light.
This one really caught my attention.
I think because sometimes, less is more……
A study into herbal medicine hit the headlines in the UK today. It was conducted by a researcher at the Peninsula Medical School, Dr Peter Carter. What his team did was trawl through the world literature to see what randomised clinical trials into “tailored” herbal treatments – this means the practice of a consultation with a herbalist who makes up a particular prescription of herbs for each individual patient. They only found three studies and only one of the three showed the herbal treatment to be better than the placebo. Now, I’ve no knowledge or experience of herbal medicine, and I’ve no axe to grind for or against (although I would declare that the belief that herbs are safe because they are natural is a silly belief which could kill you!).
I don’t have something to say about herbal medicine but what strikes me about this report are the conclusions and/or the way they are reported.
The headline to this piece on the BBC news website is
Tailored herbal medicine ‘futile’
I read the article thoroughly and can’t find the word “futile” anywhere. Is it in the original study? It’s not anywhere in the BBC’s own report. So does the study show herbal treatment is futile? Actually, it doesn’t. It shows that if you look for randomised controlled trials of herbal treatments against placebo you’ll find only three and only one of them shows statistical superiority of the herb vs the placebo. Well you certainly can’t conclude from that evidence that herbal treatments work but you can hardly claim that the fact that almost nobody has bothered to study the subject scientifically means that herbal treatment is “futile”! This study doesn’t tell you that.
This is either sloppy thinking or sloppy reporting. As doctors say “There’s a lot of it about!” Remember this?
Have you come across any other articles or studies which make claims way beyond what the original research actually shows?
One aspect of understanding someone is listen to their story and hear what they talk about – material, physical, practical issues? emotional and relationship issues? or spiritual issues of meaning and purpose? Another aspect is to find out what kind of ideas they have about themselves in relation to others – in particular to explore to what extent they see themselves as connected to, and identifying with, others, and to what extent they see themselves as separate and independant. I’ve explored this latter aspect in Parts 1and 2.
But another key issue for all of us is how we cope in the face of challenges, and how we adapt to change. Just as I have a map of body, mind and spirit in consideration of the kind of world a person lives in, so I have a map of coping strategies, and again there are three – action; control and withdrawal. Let me reiterate that this is a dynamic map and whilst some people almost always seem to default to the same strategy, most of us are more flexible and use each and all of these strategies to different degrees.
Let’s explore to activist – the person who when faced with a problem or a challenge, rolls up their sleeves and gets stuck into it –
You can see it takes a certain self-belief to be able to cope with challenges this way!
We’ll have a look at control as a strategy in Part 4
There are a couple of enormous advertising screens on the edge of George Square in Glasgow just now, and when I took this photo the other morning it had just changed to this “G1” display (which is the postcode for George Square)
This photo and the other one about the advertising banners on George Square just caught my eye.
This is one of the benefits of carrying your camera eveywhere – it helps you notice what you otherwise pass without seeing every day.
This is Part 2 in a series. You’ll find Part 1 here.
One of the major ways of creating a sense of self is through group identity. We see this especially strongly in small towns and villages where there are very real, very active communities. What I mean by that is not just people who live in the same street or same town but people who work together, play together, live together. Communities of people who share values and traditions which bond them together. I gave an example of such a community in the Part 1 of this series where I showed a clip about Hobbits. Well, hobbits are, of course, imaginary creatures, and some people find it hard to identify with fantasy so here are two clips from a movie entitled “Brassed Off”. This is an at times funny, at times tragic tale of a mining community in the north of England. It’s set in the Thatcher years when the coal mines were being closed down and these communities were being destroyed. A characteristic of these northern towns was the brass band. It was just one of the ways the community bonded. Mining towns would regularly have brass band contests – like this –
You can feel the spirit of these people and how the music, the beer and the comraderie created a cohesive, group identity.
The band leader is called Danny and in one scene he has a heart attack and as he lies, seemingly dying, in his hospital bed his band gather outside and pay their respects, by playing “Danny Boy”
Oops! I should’ve warned you to have your tissues ready! Moving, isn’t it? It’s probably the only time a brass band has moved me to tears!
Think back to the character we saw at the start of About a Boy. Can you imagine that he would have the same needs, the same desires and the same experience as these characters in this tale?
We are all different in so many ways and, in health care, to find the best treatment for someone, we have to discover who this person is who has this particular disease. Otherwise we’re probably going to fail to help them to recover.
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 –
What kind of world does this person live in?
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.
I welcome constructive criticism and suggestions. I will not, however, tolerate abuse, rudeness or negativity, whether it is directed at me or other people. It has no place here. ANYONE making nasty comments will be banned.
