Our previous topic, Genius Out of the Box -- Creating the Empowered Patient, has provided us with some remarkable perspectives. Now we're ready to take a significant step forward.
As a precursor to this topic, I'd like to reflect on three different conferences I've attended over the last several months all of which were focused on creating a new paradigm in medicine. It's been very encouraging to hear the genuniely heart felt desire of physicians, medical directors, nurses, and administrators to reshape the healthcare model and to dramatically improve how healthcare is delivered. All of the approaches I've heard have focused on providing patient-centered care in a healing, inspiring environment (and have included much of what Michelle and WC spoke of in our previous topic).
Now, in this discussion, as we get down to some of the bare fundamentals, I think our biggest opportunity will be to think beyond our current restrictions. I'm aware that because we have all grown up with these restrictions, we are in some ways like the horse who stays in his corral because a single wire at knee height once shocked him when he touched it. Those boundary conditions are then etched in his mind as real and permanent.
I believe that one of the prime boundary conditions that we have become hard-wired to accept is the notion that healthcare is expensive, that providers, insurance companies, etc. are going to generate excessive profits and that we must simply accept this. I would like to propose, for the sake of this discussion, at least, that we assume for the time being that money is not an issue (we'll pretend that some new source of revenue has been uncovered that will cover all costs or whatever mechanism enables you to set aside the financial discussion for now).
What I'd like to see us do therefore, is focus on how we would go about interacting with a human being, who has come to us in a wellness center, who we recognize as a totally unique expression of the force that animates the universe. And let's also presume that we realize that this being and the very life force within them is of incalculable value. How would we go about treating such a being?
I look forward to your thoughts, questions, and ponderings.
P.S. We also have an active topic in motion entitled, Global Genius -- Creative Solutions for a Crazy World. Feel free to join us for that discussion as well.
P.P.S. As always remember that to see the comments in a separate window, click on the "Comments" link. To see the comments in the body of the topic, click "Links to this Post"
Views of those commenting have not been checked for accuracy and do not necessarily reflect the views of this blog publisher or his associates.
Monday, August 27, 2007
Incomparable Genius -- Treating an Irreplaceable Being
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I am happy to see that we have finally arrived at the beginning. This indeed is a good place to start. Perhaps you may laugh and say that Trinh is a silly old man. Of course we begin at the beginning. And you would be right. I am old and silly. My grandchildren tell me this many times.
ReplyDeleteBut there is another point to remember as well. Too often we begin at later step down the road forgetting that without the heart of the matter fully understood one may have forgotten where they are headed. Indeed a person might make well intended steps that lead them into the swamp.
Yes, life is a very precious thing. It's value is truly not able to be calculated for the number of its worth has no limits. But the question is how would I treat such a person?
With great respect, with joy to have the privilege to serve them. With great concern that I find from them their path. Where is it that they need to go in this life? What can I do to support this path?
And what I know because I start from the beginning is that nothing I do to support or serve or direct healing energy can go beyond person's own desire to receive such things. It is important that I know this and that, in case they have forgotten, that I remind them of this important truth.
The beginning is a good place to start. It brings much happiness to me in this discussion. I am now hopeful that we might find our way amidst the many distractions that call to us.
Trinh, of all of the charmingly wise comments you penned in your last post, one stands out for me and raises what for me is an important and fundamental question.
ReplyDeleteYou state that it is of great concern to you that you find the patients path; where it is that they need to go in this life. What precisely do you mean by this statement? How broadly might one interpret this?
This approach leads to your later comment that nothing you to do support or serve or direct healing energy (an interesting concept all on it's own) can go beyond a person's own desire to receive such things.
I'd like to know more of your thoughts or the underpinnings of your philosophy in this regard and to hear from others in our group as to your notions regarding a patient's willingness to be healed. To what extent do you think a patient's attitude or willingness affects the outcome? And if a patient dies or does not get well, do you think it is due to their lack of faith or desire?
This appears to present a very delicate area and one which includes a slippery slope which might leave us washing our hands of the responsibility we have toward our patients.
Your thoughts, please.
P.S. Trinh, thank you for posting the first comment. As interesting and provocative as the invitation to this topic is, I was at a loss as to where to begin. It seems that when we arrive at the beginning we are at times more unsure as to which direction to go.
WC, I'm surprised at your questions. Certainly you of all people, my brilliant compadre, could recite the headlines in scientific journals:
ReplyDelete"Groundbreaking scientific studies find that genes can be turned on and off by environmental signals - including thoughts, feelings and emotions - from outside the cell."
What's up? Are you having a philosophical crisis, now, my friend?
I think we are accumulating hard data, to say nothing of the mountains of anecdotal evidence, which more than suggest that a person's state of mind has a great deal to do with their ability to heal and/or respond to a variety of treatments. Have you forgotten our many long evenings exploring the origins of sudden remission?
I do not see how the path we have thus far travelled together varies from what Trinh has suggested. Are we back to the old argument about the Hippocratic Oath again? If so, another way to look at it might be this. Perhaps doing no harm begins by understanding and respecting what the patient considers harmful and not harmful. Why do we assume that our definition of harm has any relationship to that of the patient?
I whole heartedly support the direction that this conversation is taking and invite us to work through our philosophical difficulties, but to do so with an openness that does not leave us with one foot still shackled to a past paradigm.
With much respect,
Silvio
I think I will cultivate a new strategy. Trinh and Silvio seem to have developed the habit of saying everything I wish to say, but much more deeply and beautifully than I ever could, so gentlemen, would you please continue to do so? I consider it a great service to all of us! :):):)
ReplyDeleteWC, I think you are shining the light right where it needs to be, and I am with all of you in being very happy with where we have arrived. I think we are in a position, as Trinh states, where we can truly begin.
My response to WC's post and I suppose, somewhat in support of Silvio's line of inquiry, is to resurrect a question I asked in a much earlier post, and then to ask a second one.
Question #1 - Are expertise and authority, particularly in matters of health, synonymous?
Question #2 - There are many studies that show, from one direction or another, that a significant proportion of patients will experience some degree of healing simply because they consulted someone, even when no overt intervention is performed. This phenomenon seems to hold true across disciplines, regardless of the kind of practitioner consulted, from shamanistic healer to surgeon. In many of the studies, the percentage of patients who improved can be as high as 25-30% of the sample population. In other words, a signficant percentage will experience improvements in their conditions strictly based on what the western establishment regards terms "placebo effects".
So, here's the question. If someone practices a discipline that is not currently accepted or understood by scientific medicine as "effective", but that routinely increases that "placebo effect" in 60, 70 or 80% of the patients they see, are they a quack or are they a healer?
BKO pays me a kind compliment. Clearly he has not realized that this old man is wandering in the woods like a stream that has lost its way. (A warning -- BKO is proving to be illusive -- his questions like a snake in your yard. You may put snake aside or even attempt to kill, saying it will do harm to you. But snake will follow you home. It's ghost will linger in your mind. Best not look at it. It may just be waiting to strike.)
ReplyDeleteBut I will answer his riddles, knowing that my answers are not correct and should be quickly ignored.
Answer to #1: Yes. (If one chooses to believe in this way and give away authority that has its root in the center of one's being.)
Answer to #2: A cure is cure if person returns to state of wholeness. Who is to say that something made in the laboratory is more important than the shaker of tribal leader? The question is did the body/mind/soul remember and return to its original design?
For me it is easy to answer such dangerous questions because I have no reputation to lose. Crazy answers like these are no surprise to anyone. I have no published articles whose value will be lost because I have now said something not supported by man's puny ability to measure the value of a cure with his fancy instruments (what is it they measure?).
Thank you for allowing me to share my thoughts,
Trinh
One more thought, if you will pardon me. BKO, do you have more such questions for us to answer? I find such dangerous things make me feel young again.
Trinh... my wonderfully wise and crazy friend... Silvio was laughing so hard when he woke me up with his call that he could hardly speak. As he said so well... the reason you have no papers to defend is that you continue to un-make your own case in everything you write.
ReplyDeleteSelf-deprecation is fine from time to time... but you've made it a literal lifestyle.
Now... all of that being said... when should one give their authority away... if not to someone with more expertise?
And... if tribal shakers can be given efficacy... how would you propose testing it... and further... while all of these conversations are truly intriguing (to anyone who knows me... you know how true that is... just ask Christopher)... But what is the means by which the public can be protected from true quackery?
Remember... we're talking about people whose true value is incalculable... not lab rats (who I guess... according to the broader sense here... also have incalculable value... Whoa! Now there's a whole other subject!)
Trying to Rock On (but currently feeling wobbly),
JJ
JJ, as far as I'm concerned you're asking the really GOOD questions. The ones that don't have any absolute answers but generate a whole herd of other questions as they blow through.
ReplyDeleteAnd while trying, for the sake of Trinh's peace of mind, to avoid appearing in any way reptilian, here are two areas of questioning that come up in my mind after reading your excellent post.
1- Are great expertise and wisdom synonymous terms? Should they be?
2- How do you define quackery?
Oh, so much fuel for Trinh's fire.
ReplyDeleteJJ, my young friend, you should know that I undo my own case so as to have nothing to defend. Life is far simpler this way.
And, once again my scampering tigress, you have ignored this old man's advice and played with the snake. See, it is just as I told you. Now he asks more questions. Do not read them. They will only make you more wobbly.
(Keep asking these questions BKO, Trinh is only kidding young genius girl who thinks too much.)
My goodness! I know not where to turn. I look one way -- it's Trinh. I turn the other -- it's Silvio. And now, BKO has joined their ranks.
ReplyDeletePeople, please. I am not having a philosophical crisis. I am well aware of the placebo effect and, as Silvio well knows, of the research suggesting that everything from diet to attitude affect the way the epigenome functions. (By the way, what the studies on placebo effects typically do not reveal is whether the effects are lasting or temporary -- if you have more information on that BKO, I'd be fascinated to read more).
My questions, however, are legitimate and both JJ and BKO have hinted at the heart the matter. Should expertise and wisdom be linked (i.e. is one an expert without wisdom)? Most certainly the answer is yes, the two must be linked. But the deeper question is, what is the indicator of wisdom (and according to whom is the indicator chosen)?
At the heart of my question is this: If we are still desirous that patients be empowered and thus are educated about the choices they make, then simply asking them what they prefer may not be fair to them precisely because they are of great value. Would we not wish to fully inform someone whom we value before asking or expecting them to make a critical decision regarding their health, their wholeness or their life?
WC, I think your questions are legitimate and your point valid. I do think, however, that what some of our fellow blog mates are suggesting is that, at times, we in the healing community take on a responsibility for healing someone (as if we could without their participation) or for leading them on a healing journey or a particular healing journey before we check in and see what their desire is -- to see what they know and don't -- and to honor their cultural or personal take on the healing process and on the meaning of their condition.
ReplyDeleteAm I right, in my assessment (Trinh, BKO, Silvio)?
Loving this discussion,
Michelle
Michelle, you are correct -- from my standpoint, at least. And, WC, do pardon my tone and impatience. I am very passionate about this topic and was somewhat frustrated that we seemed to be cycling back around to the positioning of our previous paradigm.
ReplyDeleteYes, continual education opportunities are vital (and that education needs take place all around the circle, not just with the patient -- for they each have much to teach us as well).
I also believe that in terms of responsibility, it is our responsibility to partner with the person who comes to us -- instead of "taking charge" of the process. If we see ourselves as serving their need and their path, I believe it will have a very significant impact on how we approach and interact with each person with whom we have partnered. I also am a firm believer by applying this methodology we will be much more open to alternative healing and preventive measures that otherwise might elude us completely.
Do you see the difference I am describing? It may seem subtle, but I believe it is monumentally distinct and profound in terms of the mindset we will adopt with this perspective.
In spite of what some may consider the inherently spiritual overtones of this entire blog, I would like to enter the conversation, perhaps only briefly, to ask a question about which I am curious as it pertains to your particular group's perspective.
ReplyDeleteAs you speak of physician and patient and of partnering in the healing process; and as you refer to such enigmatic terms as "life force" and so forth, have you taken into account the "Observer Effect" as it is referred to in Quantum Physics? Assuming that all of you are familiar with the term, I will simply reflect on the question that has been running through my mind as it applies to medicine.
Do you believe that the patient and physician cast an "Observer Effect" upon the process of diagnosis and healing? Now this could involve two possible paths of logic:
A. How (the point of view by which) the patient or doctor observes the patient's condition (i.e. what they are looking for -- illness, healing, specifics, etc.) literally manifests as the atomic matter of the patient's cellular structure aligns itself in response to the observation (this would be stretching the Observer Effect slightly, but is within the spirit of the concept); and/or
B. The Observer Expectancy Effect takes place, in that the patient and/or physician unconsciously alter or skew the conditions and/or results to comply with their unconscious expectation.
It would seem that this particular aspect of physics may have some bearing on your discussion. If you are amenable, I would greatly appreciate your comments in this regard.
With kind regards,
Nigel
Michelle, I agree with your statement. And WC, you say strongly that you aren’t having a philosophical crisis. My first question is “WHY NOT?” At this point that I will refer back to Silvio’s recent comments related to that centuries old backroom deal between science and the church. Many of the health care problems we’re having are due to the fact that the scientific establishment in some ways lost its soul right at that long ago point and conversations like this one are signs of the effort that science and the rest of us are making to regain it.
ReplyDeleteI share Silvio’s frustration with the limitations of the old paradigm, and I believe, however heretical it may sound, that science, or at least the contemporary structure around it, has become every bit as dogmatic in enforcing its canons as any church. But also, much like a church, the core insights of the founding adepts remain as valid and as valuable as ever, despite the calcified structure that’s accumulated around it over time. That’s a precise mirror image of the difficulty that those of us who take the non-biomedical disciplines seriously are faced with. There is plenty of crap piled everywhere on both sides, but there’s a lot of powerful stuff deep in the center of each that we need to save and find some new ways to recombine. And Silvio, we may come from opposite directions, but everything you say rings true in my world, and I share your passion when it comes to the space in which we encounter those who come to us for help.
Because of that, I found Nigel’s questions timely and very appropriate to the discussion. I have stated in earlier posts that while relative objectivity is crucial in healthcare, I don’t believe that absolute or “scientific” objectivity is even physically possible, and I think Nigel’s questions point directly to some of the reasons why. One of the reasons those of us who practice in disciplines outside the biomedical paradigm seem to get cranky in these discussions is that we’re trained from day one that consciousness - patient consciousness, practitioner consciousness, all consciousness - is a major part of the healing process, and that it is in fact prior to the formation of atoms and molecules and tissues. Although there are lots of people in biology and physics who talk about it, we get tired of waiting for people in conventional medicine to want to talk about it, and after a while, we just quit. In my world, there’s no way to take the practitioner out of the picture, nor would it be even remotely healthy to do so. That puts a much greater burden on the practitioner to make sure they’ve done the personal work to be able to meet people in compassion and equanimity even in the midst of our own human responses, and makes it impossible to wish away one’s own thoughts and emotions as “subjectivity”. Instead, it requires that practitioner’s hearts and spirits be trained as fully as their minds, because human beings are more than just biochemical machines, and because illness and disease occur in every area simultaneously. And it greatly increases the responsibility that practitioners have to those who come to them for help. I’ve worked with far too many great doctors and nurses to believe that although they might use different terminology, it’s any different for them. In any discipline, there are the technicians, and there are the healers, and the two groups are VERY different in their approaches. That’s part of why in traditional societies, the healers and the priests were always the same people, because this was understood. Most of what are called eastern “religions” (in many ways an inaccurate term for those systems) were created by adepts who understood the laws at the base of what Nigel is terming expectancy and observer effects, and whose lives and teachings were built around living with a day to day understanding of those principles as basic features of the life force. They believed there were ways of knowing the world and training the human system that far surpassed the limitations of the five ordinary senses. That “deal with the devil” that Silvio referred to earlier was the beginning of us in the West losing our chance to develop a knowledge gathering mechanism that didn’t amputate whole limbs of our human birthright in order to do its work.
And as to expectancy? Of course! Expecting, coaching, cajoling, encouraging, visualizing and generally struggling along with patients are all just part of the picture. (See my earlier comments related to the “placebo effect”). Does using my heart and spirit as part of my work keep me from using my mind effectively and properly accessing the technical aspects of my training? Absolutely not. Does it affect the way I use that technical understanding? Absolutely. Have I made a lot of stupid mistakes while I figured out how to work all that out? Hell yes! And does that affect the outcome that patients can expect when we work together? I CERTAINLY HOPE SO!
BKO, you provided much more detail than I could have hoped for. Thank you kindly.
ReplyDeleteMy concern is this:
In terms of Observer Expectancy, several scenarios could emerge (and probably have).
One, mainstream practitioners or researchers may be expecting a more "experimental" or "alternative" approach to fail and actually structure the research and/or field trials to meet their expectation (this would all occur at the unconscious level); or two, the alternative practitioner or researcher may do just the opposite (both researchers having de-objectified the process).
Holding a positive expectancy, as you have described, is another matter. I believe that this approach falls more into the realm of positivistic energy manipulation (i.e. by strongly believing that one will be healed, one's body actually realigns itself to comply with that reality).
The latter example is remarkable. The prior two are dangerous. Your thoughts (or anyone's) in regard to having seen or experienced any of these three scenarios.
Respectfully,
Nigel
Nigel, I wouldn't worry yourself unnecessarily. First of all, no one in traditional science is really taking the time to look seriously into the level of healing that we're addressing here. Their Observer Expectancy has, I believe, kept them from even considering the research, let alone conducting it with bias.
ReplyDeleteBut as for the ability for the body intelligence to respond to healing and to work in tandem with our own deeper will -- these are topics that I feel are well worth continuing a discussion around. It's an interesting, yet largely unsupported notion, that the spontaneous remission and other returns to wholeness are directly related to the Observer Effect (I think that may lead us astray). But I do believe that there is a direct correlation between envisioning healing and wholeness and the body/mind aligning with such a vision (especially if it is done according to certain well-tested methods).
I'd be interested in some of the rest of the group's thoughts on this topic. Since we are talking about working with irreplaceable beings of great value -- what more important aspect to look at than how to awaken the original blueprint within a person.
Agreement, anyone? Disagreement?
Nigel, I think you're right, all three of the issues you cite do occur, in my experience, and I think they are very well worth considering, but I have spent some time thinking about it since you posted and some other questions have occurred in their wake.
ReplyDeleteAnd Sarah, I think there are actually some serious scientists looking into this, but I don't think your point is any less valid because of it. The scientists who are serious about it are all physicists and biologists. (Bill Tiller, Jahne and Dunn, Elmer Green, Rupert Sheldrake, to name a few) The medical community is, as you say, seems much less inclined to participation, at least on this level.
I wonder, taking both your comments into account, if part of the problem is that on the scientific level, everything has to be fit into the parameters of a study in order to become real, and that healthcare, particularly if we look at caring for ourselves and each other as "irreplaceable beings of great value", is fundamentally about relationship. Relationships, particularly one on one relationships are not easily quantified and graphed. They are by definition multi-variate equations, and in fact, contain many more unknowns at any one moment than can possibly be tracked by any statistical device, no matter how sophisticated. Is it possible that a lot of what we're looking for lies in regions of the human system that are not readily examined with purely "objective" tools? Could that be part of what we need to integrate with the very powerful insights that purely objective scientific inquiry provides us with?
I keep getting pulled back to the idea that unless we get beyond the purely subjective/objective duality, we're going to miss the real discussion. The narrow, objectivist model leads to an almost tyrannical requirement for rigid standards of “proof” that often have very little to do with what it takes to help an actual human being with an actual problem. That’s really effective for creating actuarial tables, but it handcuffs practitioners and consequently keeps a lot of patients from getting the help they need. Conversely, the lack of clear-minded rational enquiry on the part of many in the alternative community perpetuate a lot of fuzziness, naivete and just plain bad information that further confuses things, particularly when it comes to figuring out how to responsibly oversee the delivery of medically unfamiliar, but potentially helpful approaches to the population.
I’m sorry to be a one note performer, but I still see the primary obstacle as the need to preserve profit. Many of these problems are relatively easy to fix on a clinical level because there are simple, highly effective and non-invasive techniques that work very well for a lot of things and that have existed for a very long time, not only in alternative fields, but in the past of western medicine, approaches that have fallen out of favor because of, frankly, money. I still think the profit motive, not the science, is the primary culprit in all this.
BKO, you are very much on the mark, by my estimation, in any case. This leads me to two quick comments that I will circle back to at a later time that are my suggested refinements on your comments.
ReplyDeleteRelationship -- in science the tyranny of "proof" more often than not is so deeply in search of a cause and effect that it ignores correlative evidence that points clearly toward a whole relationship (i.e. one is not the cause, the other not the effect, but the two are one whole) as a deeply inherent elements of cause.
Money -- I think we lose sight of what's really going on if we focus only on the money. The cash flow is only part of the scenario. The real game that's being played is for Power (of which money is one aspect).
When we begin to consider healthcare or wellness based on each being having insurmountable value we are messing with the very premise upon which most corporate and national decisions are made (that some people are more valuable than others based on their ability to affect the power structure). We are also suggesting that correlative relationships be given significant value, instead of purely relying on "causal evidence."
This is new and seemingly heretical territory for those of us initiated into "modern thinking." It is kindergarten material, however, to those who were brought up and schooled in many of the more indigenous and traditional modalities of healing.
I'm writing on the run, so I hope this all makes sense. Wanted capture it while it was fresh though.
Ellio,
ReplyDeleteAs usual, we are fully aligned. Thanks for the improvements.
The reductionist approach has, and no doubt will continue to yield great benefits, but it has been placed in a position of authority over areas in which it truly has no real application, or at the very least, offers only a part of a picture that needs a lot more in order to be effective. Starting with the whole and looking at how the parts relate yields a very different result than breaking everything down and trying to figure the system out as you reassemble it. Both approaches yield useful information, just not the SAME information. The old Taoist healers have an aphorism that applies. "One plus one doesn't equal two, it equals one plus one."
And you're right, it's probably better to start using power as the operating principle rather than money, exactly as you suggest. It dials the discussion in much more accurately in any sphere, but especially in healthcare. The question of expertise vs. authority is a big one that I don't think will go away easily, given how the present system is arranged.
Your statement about beginning to value "correlative relationships" is cool. I like the term. It could be considered redundant on its face, but after I sat with it a minute, it suggested a much more nuanced and multi-dimensional approach to dealing with the legitimate complexity of healthcare. Anyone who works with complex patients is required to do this routinely, but it feels good to see it made explicit in the language we're using. It can seem like kindergarten to those of us who do it all the time, but I'm still glad we're bringing it out for discussion, and I'm grateful to the folks for whom it's foreign for being willing to seriously consider the ideas. There is a whole other world there, and when we actually find a balancing point between the reductionist/materialist view and the vital force/ecological view, one in which both paradigms begin cooperating and empowering each other rather than competing for dominance, we'll really be getting somewhere.
Ellio's on the road, but I was asking him about "correlative relationships" before he left since I was thinking similarly to BKO -- that Ellio had slipped into the Department of Redundancy Department. BKO pretty much zeroed in though on where he was coming from with this one added nuance.
ReplyDeleteEllio is a big proponent of systems thinking and of holistic approaches to solving complex challenges. It is his belief that a correlative relationship is one in which the holistic relationships that exist in a given circumstance (A to B, A to C, A to B & C, A to C & B, A to A [the oft forgotten relationship), A to ABC, and A to what's not ABC, and what's not ABC to A -- then B to A, etc.) are all part of the conditions precedent to the occurance of an outcome.
It is the existence of these relationships that needs to be examined as to if and how they correlate to the outcome itself (he is very much an advocate, for example of not merely examining a biological compound and then simply synthesizing what are considered to be the active ingredients. His preferred method is to first use the actual biological compound and, if necessary, when synthesizing, synthesize the full complex (which is not simple, mind you), because of the potential correlative relationships between the supposedly inert or unnecessary ingredients and the outcome.
In examining a patient, it is the complex factors involved, as BKO stated, that make this methodology even more valuable from our current vantage point on this subject.
My goodness -- that's more academic than I've been since my days in the labs at college. Hope it all makes sense and that I've done Ellio's approach justice.
Love you all,
JJ
Thanks to JJ, for her valiant attempt to capture my less than clear explanation to her the morning of my departure. Having had some time to reflect more deeply on this entire topic (treating the patient of incalculable value), what I am striving to explain is something that has become so deeply ingrained and therefore intuitive for me that putting language around it (especially a second language) is at times very difficult because I gained much of this understanding from my father (though it took years for the understanding to really sink in at a deep and useful level).
ReplyDeleteTherefore, in an attempt to explain something that is so innate yet at times seems impossible to convey (it amazes me how easily it all made sense to my father -- he had no reason to question it, so his explanations for so simple, yet profound), what I believe we have come to call this methodology in the "modern" world is "systems thinking." In other words, not to bore you, but simply to create a common definition of terms, systems thinking could be defined as follows:
An approach to integration that is based on the underlying belief that the component parts of a system will act differently when isolated from the system's environment or from other parts of the system. This is a fact that we sorely overlook in regard to patients in several regards. In the synthesis of chemical compounds that are designed to act upon a human system the way whole biological compounds do (yet cannot because we have ignored the principle I just described); and in the diagnosis of a patient when we unwittingly isolate and then treat a symptom or a “disease” within a patient as if it were a disconnected occurrence instead of an indicator of something going on within the entire system (body/mind/spirit/emotion, etc.). This also leads to us addressing elements that are many steps of the ladder from actual cause (though we think we are treating cause), instead of deepening our awareness of how a human being functions as a whole system and getting to the actual root cause (which may require a far simpler and less invasive procedure to bring about a cure or at the very least set the pre-conditions in place that enable a curative measure on the physical level to work more effectively and have a more lasting and less harmful impact).
Our challenge is that this mode of systems thinking stands in direct contrast to Descartes' and others' reductionism and philosophical analysis, because it proposes to view systems in a holistic manner. While reductionism is a method or approach that has a long (and I believe scandalous) history, its effectiveness is alarmingly limited, but not obviously so. In other words, one might discover results that are actually "provable" with a laboratory setting because the limiting factors have been controlled. By the time they are then applied, however, in the whole system (the human being), they do (more often than not, if they are to meet FDA approval) what they were designed to do -- but also typically much more, much of which is often destructive in obvious and non-obvious ways (much of the non-obvious challenges occur by way of systemic interferences that have lasting ripple effects for years by unbalancing critical elements of a whole system and by not addressing the actual root cause, which may have only temporarily been driven into dormancy).
Finally, systems thinking, to get down to basics, concerns our willingness to understand a system by examining the linkages and interactions between the elements that comprise the entirety of the system. If we are to truly enable ourselves to do this with those we serve, we are going to have to understand how to function across disciplines with a far greater degree of openness, willingness, and humility. Our diversity, in this regard, is our obvious strength -- but only if we are willing to set aside our biases and put our ego in check as we work together.
In order to work on beings of untold value, the call to exercise such willing humility is something that is an absolute must.
Hopefully I've been able to state more clearly my intentions on this subject. I would sincerely appreciate your input -- agreement, disagreement, confusion, excitement, disdain, and so forth.
Well wishes to you all,
Ellio
Thank you, Ellio for bringing me back to the group (life had presented me with a series of rather compelling distractions). Having read through the more recent comments in this topic, I must say I think we (or should I say you since I've been very recalcitrant in terms of my participation lately) have begun to get down to the real crux of the topic now.
ReplyDeleteI do believe that Ellio's thoughts on systems thinking (one of my favorite topics, as he well knows), are, of course, brilliant. Systems thinking has been the drum I have been beating loudly for some time in regard to a variety of topics. I am only slightly chagrinned that I did not bring this up myself.
Thank you also to JJ for her keeping her herd of wandering braniacs, as she refers to us, in line -- and also to BKO who has been the stalwart of focus in terms of bringing us back to the nexus point of this discussion.
The only thing of substance I would add to what has already been said is this. The human being is a very complex system, yes. But we also reside as part of the web of a much more complex system called our environment (physical, social, micro-systems, spiritual). We must be aware of this larger context as well, as we work with patients, if we are to truly serve them in an even more complete fashion.
Best wishes to everyone,
Silvio
Silvio's comments are very much on the mark, I believe. Very often when we seek to take more holistic approach to our work or analysis we forget that we too are part of a larger and even more elaborate ecosphere which both impacts us and is, in turn, impacted by us.
ReplyDeleteFirst, thanks Ellio for your beautifully detailed statement. Nailed it, as far as I'm concerned.
ReplyDeleteTo the point raised by Nigel and Silvio most recently, that's the thing that hangs me up most in trying to figure out how to write about this subject in this context. I know how to approach an individual client from this perspective. I do it every day. But how to talk about that in the context of changing the system we currently have is much more difficult for me. That speaks to the idea that at some point, everything becomes healthcare. If we start consciously incorporating the reality described by systems theory into our approach to patients (a surpassingly good idea, BTW!) we can no longer leave out anything related to their lives, which also means that we can't leave out the society in which they live, etc. I think that's why it's easy for this discussion to get stalled out, because I think we all realize, in our deepest hearts, that we won't be able to overhaul healthcare without simultaneously overhauling an awful lot of other things, like for example, our entire worldview. Besides the money/power nexus, which I still think is the biggest stone in the road, another really big issue is the fact that it's a lot simpler to stay focused on symptom elimination and injury repair and life-threatening traumas, because that stuff can addressed without having to handle, at least in the short term, the larger and much more difficult issues related to glitches in the larger system. The existing system is really good at those areas, and its power base is rooted in that end of things. Unfortunately, that leaves out a very large part of the human experience, and that's what I'm working on finding a way into in this discussion.
This discussion has had a profound impact on me -- quite moving, actually. It reminds me of something my grandfather read to me when I was a girl -- a passage I have saved out of love of that moment and the essence of the powerful words encapsulated in the quote itself:
ReplyDelete"All things are connected like the blood that unites us all. Man did not weave the web of life, he is merely a strand in it. Whatever he does to the web, he does to himself."
I am sure most of you recognize those words as the ones uttered by Chief Seattle in what amounted to prophetic pronouncement made by the Native American leader to the U.S. Government.
It appears that we may finally be ready, in this country, to begin considering the deeper wisdom of that knowledge in our "modern" society. Thank you to each of you for reminding me of this wisdom and its relevance to all of our work.
Kindly,
Michelle
Oh, I think there have been a number of people considering and trying to model and live by that statement for some time. However, to your point, Michelle, it appears that this understanding may have finally risen into the mass consciousness. If any of us who find wisdom in such statements can continue to model them and convey the inspiration of that vision through our actions, perhaps the ripple effect may continue to become even broader.
ReplyDeleteIt appears our conversation has stalled……or maybe that is just my inborn impatience speaking…..At any rate, in an attempt to move the conversation and regain some momentum (as I actually have enjoyed this forum immensely during past months) I am about to sort of “change the subject” and ask you all, have you seen, and in case yes, have you given any thought to the content of Hilary Clinton’s health insurance plan?
ReplyDeleteFeel free to disregard this comment and go on with the conversation from where it is currently sitting should this be too much of a diversion or digression from the subject at hand.
Anonymous, thank you for your invitation. Please re-invite us all November 1st. Due to my work and travel schedule the blog is taking a much need holiday. I look forward to re-connecting with all of you then.
ReplyDeleteMuch love to all,
Christopher