In the obsessively micro-managed world we live in now it’s more important than ever for us to take a pause. We are being bombarded with talk of crises, of doom, of having to everything faster, consume ever more, do everything so-called more efficiently.
But we humans are not machines. And we shouldn’t lead our lives, or construct our workplaces according to industrial machine-like principles.
Time and time again you can find creatives….artists, writers, composers, musicians, sculptors and so on tell you they need to have some breaks, some times where they just sit, or they sit and daydream. We need times to just step off the treadmill. We need to pause to gather our thoughts, to become more aware of the present moment, and to restore our depleted reserves of energy.
What length should a pause be?
There is no fixed amount. It can be a short as taking three deep breaths. It can be a few minutes, or a few hours. We need bigger breaks than that too, which is why it’s important to take all your annual leave from work. For some people it’s a sabbatical that they need. But the kind of pause I’m thinking about here, is the kind we all need, every single day.
I’m impressed by how in France there is a habit of stopping for a proper lunch…not grabbing a factory produced sandwich and a can of coke on the way to work and wolfing them down at the desk. They take time to go to a restaurant or cafe, to sit down, have a meal and share some time with workmates or friends. Then back to get on with the rest of the day. There’s still a widespread tradition of working five days a week, not seven here, so that everyone can have some family time, some home time, to do with as they want.
How about you? What pauses do you build into your everyday? What pauses would you like to build in, and why not start today?
The nature of any system cannot be discovered by dividing it into its component parts and studying each part by itself, since such a method often implies the loss of important properties of the system. We must keep our attention fixed on the whole and on the interconnection between the parts
Planck 1936
The Physicist Max Planck wrote this almost a hundred years ago, and he wasn’t the first to make such an observation. Despite that breaking things down into parts and studying them separately is still the predominant approach in the world.
When I studied Medicine at the University of Edinburgh in the 1970s we were taught “Medical Sciences” for the first three years of the six year course. We dissected bodies in the Anatomy class, studied pathological change in tissues and organs in Pathology, learned chemical pathways in Biochemistry and so on. In fact, the first time I saw “cirrhosis” was a diseased liver stored in formalin in a plastic box marked “cirrhosis”. It wasn’t until year 4 that I met an actual patient who had “cirrhosis of the liver”. Maybe all that has changed. But we still practice Medicine by focusing on parts. I often hear from relatives that on a visit to their GP, they are told they can only discuss one problem per visit….so, their asthma today, but come back to talk about their joint pain.
It seems the modern management techniques applied to health care chop the system and the patient’s experience into pieces, sending them to one person for a diagnosis, another for a blood test, another for a prescription, another for advice…..it’s horrendously disjointed. When my dad was in his last month of life in hospital, every single doctor I asked about his progress started their reply with “I’m not your father’s doctor, but I’ll look up his records….” I never found the person who seemed to actually know him.
Yet, we know from research that continuity of care increases both outcomes and satisfaction ratings of patients and practitioners.
In this age where so many people experience multiple “co-morbidities” we need to keep our focus on the whole even more than ever. If we only focus on the parts we begin to believe we know exactly what each drug will do when we prescribe it, yet, not only are the effects different for different people, but in reality, many people are taking multiple medications at the same time (for a multiplicity of disorders)
We need to focus on the whole, and that means giving priority to human beings, their uniqueness and their relationships. It involves trusting doctors and nurses to practice professionally focused on their patients, not on their protocols and clinical guidelines. And we need a lot more whole of life research, which will help us to understand the complexity of the effects of any drug, and the course of any disease in a real person over their lifetime.
It was never a good idea to ignore, or to relegate holistic knowledge. Learning about the parts should include learning about the limitations of learning about the parts.
We have two focus modes in our brains, with each of our cerebral hemispheres using one or the other. The left hemisphere engages with the world through a narrow focus. It pays attention to re-cognising what we already know. It tries to help us identify objects, literally grasp them, or understand and manipulate them. The right hemisphere engages with the world through a broad focus, paying attention to the bigger picture. It seeks out patterns, connections and relationships. When the left hemisphere identifies something it should pass that info to the right for it to be contextualised. Sadly, we’ve developed habits of not bothering to do that, sticking with our generalisations and abstractions.
What we pay attention to becomes magnified. It is the means by which we engage with the world. It creates our experience of the world. If we prioritise the left hemisphere focus we engage with a world of objects, of tools and “things”. We engage with a desire to manipulate and control. But if we prioritise the right hemisphere we engage with a world of relationships, of contexts and patterns, with a world of subjects. We engage with a desire to belong, to make connections, and to see the whole picture.
We live in what has been termed “the attention economy” where the big digital companies make their money through advertising, and advertising only works by grabbing your attention. Politicians have become adept at this too, casting out statements designed to shock, enrage or stoke fear….because shock, anger and fear are primary responses to threat.
But as you’re “doomscrolling” or reading social media headlines and posts, which of them command your attention? Are they the ones that make you feel enraged, afraid, insecure, inadequate? If so, those are the feelings which are going to get magnified. Those are the feelings that are going to shape your perception of reality. Or are they the ones which delight you, which stir feels of wonder, curiosity or joy? Do they put you in touch with the three classic values of beauty, truth and goodness? Do they increase your feelings of dignity, decency and compassion? If so, that’s how you are going to perceive reality.
What we focus on, and what’s important here is to be aware of what we are focused on, shapes our world and our day to day experience of life.
Our attention is our super power. We should use it wisely.
I’m a fan of the idea of “going with the flow”, and I’ve written about it often, but when I was in South Africa last January I saw this person in the sea….not so much going with the flow, as “riding the wave”. This latter phrase isn’t one I use so much, but these feel like turbulent times, and it feels as if the flow is also turbulent….there are great waves, one after another. Waves of significant change, eye catching, attention grabbing waves. It would be easy to feel submerged by waves like these. It would be easy to feel that they are going to wash us all away. So maybe this is a time to learn how to “ride the waves”, to “rise above” them. To tap into their energy and use that to go my own way.
I think it comes down to the attitude we strike – if we approach these waves with fear, then, surely, we’ll drown, or, at best, be driven this way and that, against our will. But if we approach them with confidence, with a sense of wonder and curiosity….then we can play with them, create what we want to create, drawing on the energy and power within the wave, without blindly following its direction.
This does feel a time of great change, but, that can be exciting when we begin to see a potential evolution, a possible phase change, allowing us, as individuals, as communities, and even as a species, to move on to very different world, a very different way of living.
How do we improve the quality of our everyday lives?
One way is to do whatever brings us joy, and makes us wonder. And we can do that, either by pursuing an activity which we know brings us joy, for example, listening to our favourite music. Or, and this adds in the element of wonder and discovery, pay attention to the hear and now.
As I wandered through my garden one day, just looking to see what I might notice, I spotted this tiny plant. First of all, I’d never seen a plant like this before, so I didn’t know what it was called. Secondly, I kneeled down, got up close, and just looked. Isn’t it beautiful? Isn’t it amazing? What an incredible structure, and what beautiful colours. I love those tips of purple emerging from the green. Then I got my phone out and took a close up photo….this photo.
I like to take a photo for two reasons. First of all, I can then go back and look more closely over and over again. I can enrich an already rich experience. Second, because my curiosity has been stimulated, I can touch the little “(i)” button on the phone screen when I’m looking at the photo, and it magically tells me the name of the plant.
Apparently, it’s a “self-heal”. Oh, like all plants, it has many other names too, but the name “self-heal” immediately appeals to me. After all, in all my years working as a doctor, that’s exactly what I was trying to do – to stimulate and support a patient’s self healing. I know we live with a kind of medical myth that doctors heal us with their operations and their drugs. But they don’t. Nobody repairs a single wound without the body’s capacity to self heal. Nobody recovers from a virus without the body’s defence and repair system doing its job. Nobody heals without the body’s complex system of self healing doing what it is designed to do. Doctors should remember that. They don’t heal patients. Patients heal patients and the doctor, when working at their best, support, stimulate and work with, the capacity if the patient to self heal.
Once I had spotted this plant, identified it, explored more about it online later, then I suddenly saw it appearing everywhere in the garden. Well, not everywhere, but over a very wide area. Now there’s something else amazing about gardens. I didn’t plant this beautiful plant. I didn’t “propagate” it. But there it is, and it’s thriving. I find that wonder-full!
I read an article in the Guardian today entitled “Consuming arts and culture is good for health and wellbeing, research finds” It caught my eye – first because I thought consuming arts and culture ??!! I hate that. I don’t consume arts, I experience/enjoy/participate in…..not consume…. and what is culture anyway? Well, let’s leave that issue for another day. The next thought I had was “I don’t enjoy arts in order to improve my health or wellbeing, and this headline leads me to think these folk are about to try and justify arts on the basis of their utility. But, in fact, the article is even worse than the headline suggests. Here’s how it begins –
Most people are familiar with the buzz that attending a memorable play, film, concert or art exhibition can trigger. But now it is official: consuming culture is good for your health and wellbeing – and generates £8bn a year worth of improvements in people’s quality of life and higher productivity.
Seriously? I might have felt a “buzz” but, “now it is official” – “it generates £8bn a year of improvements in people’s quality of life and higher productivity”. Oh, thank goodness they’ve quantified that. Otherwise I’d have been stuck with my personal delusion that I was just enjoying something, or that it was adding meaning to my life!
Look, I understand what these people are doing, and, at one level, I commend them for it. They are trying to make an economic case for what isn’t measurable. We can’t measure paintings, poems or music. We can’t even really measure “health and wellbeing” (instead we invent questionnaires, the answers to which we allocate scores, then we say we are measuring the invisible – ok, another controversial view I can return to another day) They are claiming that, for example, going to a weekly drawing class at a museum is worth £1310 to each person from “going to see their GP less and feeling better about their lives”. Really? £1310? Not £1315? These apparently definite figures remind me of the old joke that 86.57% of statistics are made up……but, good on them for trying to make the case for arts funding to governments and policy makers who seem to understand only sums and measurements.
But, fundamentally, this makes me hugely uncomfortable. Can’t we make a case for the place of arts “and culture” in our lives without reducing them to arbitrary financial “values”, or so-called “measurements”. I don’t need any of those justifications to play music every day, to write, to read novels, to visit galleries and delight in their works, to feel the connections to their creators……
However, I read, just the other day, that more and more universities in the UK are closing down their Humanities courses, claiming that students don’t want them because they don’t see how they can lead to remunerative employment. Oh goodness, what has happened to our idea of education? What have we reduced that to? Is education only valuable if it lets you get a job managing a McDonalds outlet, or selling people “stuff”?
I hope reports like this one do stimulate debate about the Humanities. I hope they stimulate debate about what makes our lives valuable and meaningful. Meanwhile…..I’m going to continue taking photos, writing, sharing my creativity. I’m going to continue listening to music, reading novels, visiting museums and galleries – because those are some of the activities that bring me joy, that amaze me, that make me think, that help create meaning in my life. If all that contributes positively to my “health and wellbeing”, then so be it. But that’s not the reason I’ll keep filling my daily life with “arts and culture”.
One of the things which frustrates me most about Medicine is this question – “Is it physical?”, which may be asked in a slightly other form – “Is it organic?”, (or, the apparent opposite – “Is it functional?”), “Is it a problem of the body or the mind?”. This way of thinking which divides illnesses into two categories, separating out the mind from the body, is still way too common. It’s common in patients who refuse to accept their illness could have anything to do with their mind – “it’s a virus”, “it’s a hormone problem”, “it’s my genes” – usually because they have been led to believe that a problem involving the mind is a “mental problem”, which strangely continues to carry a stigma that an infection, or a broken leg don’t carry. Separating out the mind from the body is a common misunderstanding not least because it is promoted by doctors who should really know better by now.
The human being is a living, multicellular organism. Starting from a single, fertilised egg cell, the foetus doubles and doubles and doubles the number of cells, until the fully formed human being is born with trillions of cells on board. Trillions. It’s too big a number to visualise. In fact, the number of cells in a human body are estimated, not accurately counted, partly because cells die and are replaced constantly. None of these cells exist in isolation. They are all in constant communication with, and respond to, other cells within the organism, so that although we each have a heart, two lungs, a stomach, a liver, a brain etc, none of these organs exist by themselves. Every single one of them is “integrated” with all the others – that means each is in an active two-way relationship with other organs, tissues and cells. The cells of your body don’t compete with each other. They collaborate. They work together to make the whole organism healthy, so that it can adapt and to grow.
The mind, as best we understand it so far, is more than a function of the brain. It’s embodied. There are extensive neural and endocrine networks throughout the body which work together to produce what we call the mind. This understanding of mind is sometimes referred to as “embodied mind”. Search for that term online to learn more if you like. It’s a useful concept which allows us to see that the mind is not confined to the skull.
It turns out that terms like “heart felt”, and “gut feeling”, are not mere metaphors, but reflect biochemical activities and phenomena which involve, not only the heart and the digestive system, but the whole organism.
I used to say to patients and medical students, I only ever saw a body without a mind in the mortuary, and I never met a mind without a body.
It makes no sense to me to separate out the mind from the body, because when illness occurs, it might arise in a specific tissue, or organ (or it might not), but the response to the disorder is a whole being response – we use the powers of every system within the body, and our abilities to think and to feel (I mean emotional feeling), to defend and repair.
The big problem with separating off the mind from the body and looking for “physical” or “organic” problems is that if all the lab tests and imaging comes back within normal limits, an illness ends up being classed as “mental” – and treatments for mental disorders are then offered. Or worse, it is dismissed as “not real”.
But there is another way to look at all of this – a holistic way – where we don’t separate out the mind from the body and whatever the disease, we seek to address the person, not simply some of their cells or organs. Yes, maybe there are cellular pathologies which can be, and should be addressed, but healing and repair always involves a whole person.
Wouldn’t it be better if we never limited ourselves to addressing “pathologies” in cells and systems, but, rather, in addition (and not or, remember), we engaged with the whole person through their story, their actions, their thoughts and feelings? Shouldn’t we address the circumstances of their lives, because nobody lives in isolation from environmental influences?
It makes no sense to me to address only a pathology found in a particular tissue or organ. Medicine isn’t a kind of mechanics. It’s an art, and science, of understanding and relating.
By the way, do you think you can see the suggestion of a heart on the bark of that sequoia in the photo I’ve posted above?
All my working life I practised Medicine as holistically as I could. I never made sense to me to split a human being into parts, particularly into a “mental” part and a “body” part. I was trained to practice holistically, even if my teachers rarely used that word. They taught me to listen to a person’s story, to listen with empathy and without judgement, in order to understand their illness, to make a good diagnosis and to plan what investigations and treatments should be considered. We started with the person, and drilled down to clarify what was happening in certain systems or parts, with the help of investigations.
This way of working emphasised that every single human being was unique, and that there were no one size fits all treatments. It taught us to remain ever alert, to follow up patients ourselves and to adjust our diagnoses, treatments and prognoses, as life continued to flow.
But was it holistic enough?
My chronic doubt, which, I confess, has grown over the years, was that it wasn’t. The reason for saying that is that whilst I knew everyone lived within a complex, layered web of relationships and environments, my interventions were almost exclusively individualistic.
But I know that our health is affected by traumas, by relationships, by work, by poverty, by housing, by pollution.
The Covid pandemic made all that clearer than ever, but still, we went for an individualised approach, focusing on vaccinations and personal hygiene. But we saw that the vulnerabilities and problems lay in insecure employment, poverty, racism, overcrowded and inadequate housing etc.
Sometimes I buy the idea that we can all be healthier if we exercise enough, eat a balanced nutritious diet, and manage our emotions, but then I see children in Gaza, people picking through the rubble of their houses in Ukraine, whole towns swept away in historic floods, and I realise, this individualistic holism just isn’t enough.
Let me clarify – I’m not knocking holistic medical practice – it’s far superior to reductionist, materialist, industrialised models. But we need to be much more aware of the circumstances of our lives, and, in particular, of the shared circumstances of our lives. If we can’t do anything about climate change, plastic pollution of the oceans, chemical pollution of the soil, the waterways and air; if we can’d do anything about poverty, social exclusion, hatred and prejudice; then we’re going to be fire fighting, and applying bandaids, when we could be creating a better world for all of us to live in.
How do we do that?
Ah, that’s the big question, and it’s not an easy one to answer. But we have to start somewhere, and awareness might be a good place to start. We need to talk to each other, to express our desire for more justice, more care, more understanding of how we all share this one, massively connected world.
I’ve read that we live in an attention economy. Marketers, producers, companies and individuals are all competing for our attention. They pay the social media companies to promote themselves to us using attention grabbing, and attention holding tools and techniques. “Influencers” can only influence if they attract attention, so they do whatever they need to do in order to achieve that goal.
I was pretty shocked on a recent trip to Milan to discover how “instagrammable” has become a major force. Certain buildings, certain viewpoints, or “attractions” were surrounded by dozens of, mostly young female, photographers, either taking pictures of themselves in front of whatever it was that had become “instagrammable”, or having someone else take their portraits there. Some even used portable reflectors, to “get the light right”, and had changes of clothing to model. I joked that my wife and I, standing in front of the Duomo, were the only people in the crowd actually facing the building. Most were trying to make it more beautiful, or more interesting, by putting it in the background, and themselves in the foreground.
That’s not a new phenomenon. A few years ago on a visit to the Alhambra in Grenada, I was surprised to find that most people who were taking photos of the amazing art and architecture, were only doings so by putting themselves into the foreground of each frame.
But attention is important. It’s how we see and experience the world we live in, and it influences our moment to moment moods, thoughts, and actions.
Ellen Langer, who studies “mindfulness”, describes it, simply as, “actively noticing things”.
I love that.
This “heroes not zombies” blog is all about living a more mindful life, and, I believe, that requires two things, both created out of attention. The first is, “noticing”, or as Ellen Langer says, “actively noticing”. When we pay attention, when we set out with an intention to notice – to notice the world around us, to notice others, to notice our thoughts and feelings – then we move into a more active, more conscious mode of existence. We reduce the chances of blindly following the influences and powers of others who try to shape our lives. The second is, to pay “loving attention”. I think whatever we pay attention gets magnified. If we focus on problems, we fill our lives with problems. If we focus on joys, of moments of awe and wonder, then we fill our lives with amazement and delight. But when we pay attention from a loving position – from a position of care, of empathy, of genuine interest, and love – then our attention changes, not only our own lives for the better, that of others…..whether they be other people, animals, plants, the environment, or the planet.
So, I’m all for paying attention – do it actively and do it lovingly – not mindlessly.
There’s a chapter in James Hollis, the Jungian analyst’s book, Creating a Life, entitled, “Attending the Soul”. This particular chapter is about the practice of psychiatry and he completely nails an important point.
In seeking scientific verification of success, many of these practitioners [psychiatrists] have narrowed the definitions of pathology to behavioural patterns, faulty cognitions and flawed chemistry. While it is certainly true that we are behaviours, and behaviours may be corrected, and we are cognitions which may be challenged by other cognitions, and we are chemical processes which may be compensated by other chemical processes, none of these modalities – behaviourism, cognitive restructuring and psychopharmacology – should be confused with psychotherapy.
He goes on to say that psychotherapy seeks to address the whole person, even the meaning of the person, the meaning of their suffering or even the meaning of their life.
This same point applies across the whole of Medicine. Illness may include physical pathologies which can, and may, be addressed with drugs or surgery, or it may include adaptive, or protective symptoms and behaviours which can be changed. However, if we are interested in healing, in facilitating the experience of wellbeing, resilience, and health, then we face the fact that a whole human being is more than the sum of his or her parts.
Here’s how he concludes his chapter…
To stop at behavioural change, as important as it is, or cognitive restructuring, liberating as it may be, and pharmacology, necessary as it sometimes becomes, betokens a failure of nerve and sells the soul very short indeed.
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.
