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protoslackeranon · 10 years ago

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The Empathy Knob

Shrinkrants linked to an article in Scientific American, Why Doctors Should Be More Empathetic--But Not Too Much More.

Growing up my mother really believed in “painting” superficial wounds with Merthiolate tincture. It stings like fury! Even when noticing that other children’s parents tended to use less painful antiseptics, I still understood that my mother’s use of Merthiolate was both painful and coming from caring deeply about my welfare. So the point in the article that sometimes doctors need to suppress their response to others’ pain is something true in a way even kids can understand. But empathy seems more complex than the article allows.

The article concludes:

The key is knowing when empathy is called for and when it is detrimental. It should not be the goal of physicians, then, to be more empathetic. They should aim instead to find the right balance, the golden mean that optimizes care.

This bothers me a bit because one reading of finding “the right balance” is finding the right amount of empathy, as if adjusting the volume knob on a stereo.

A strange phenomena is common in conversations between non-native speakers of English and folks who only speak English: When the non-native speaker seems unclear about something just said, the native speaker repeats what was said louder. The higher volume never brings clarity. In a similar way, getting the right measure of empathy isn’t primarily a matter of enough of it, but rather getting it right.

From the article:

Furthermore, studies of physicians show that they are often the most empathic and caring towards the beginning of medical school, and that they become steadily less empathetic with more clinical training.

In the context of the article where empathy comes at a cognitive cost to problem-solving, the implication is the decline in empathy with clinical training can be interpreted as a consequence of greater effectiveness through clinical training.

Drs Haque and Waytz are heavyweights in the profession, but I think their perspective on empathy is muddled. The study linked doesn’t support their interpretation as a cost to problem solving.

It has got to be annoying for a doctor to hear a layperson like me opine about medicine. In this instance what’s interesting to me is how empathy can be thought about as “a pattern that connects” which is a phrase Gregory Bateson often used.

I entered “doctor” as a search term for my blog. The most recent link is to an article in The Atlantic, The Misery of a Doctor's First Days, about physician training and professional identity formation. For everyone, not just doctors, our most salient metaphor, as MC Bateson observes in Angels Fear, is the self.

Here I mean not only the psychological construct of the “self,” but the entire being, psyche and soma, for each of us the meeting place of Creatura an Pleroma.

Earlier, in April of this year, I posted a link to an address Francis Peabody made to the graduating class of Harvard Medical School in 1927, entitled The Care of the Patient. I’d hit upon the address after listening to a TED Talk by Victoria Sweet, The Efficiency of Inefficiency. About 3 minutes into the talk she tells a story how a colleague of hers at San Francisco’s Laguna Honda Hospital, the now extinct almshouse hospital, came to buy a patient a pair of shoes at WalMart. She tells the story as an example of how inefficiency is sometimes most efficient.

If I had to sum it up in one sentence it would be: Medicine is personal--face to face--and when it's personal it works.

So it’s in the context of the story of the shoes she was reminded of Dr. Peabody’s aphorism: “The secret in the care of the patient is in caring for the patient.” And she went on to say how she had it wrong until she looked it up. She thought “caring for a patient” was caring about a patient, liking or loving a patient. But when she looked the quotation up, she saw that Peabody was talking about doing the sorts of stuff nurses usually did, adjusting the bed cloths, giving sips of water, and in so doing creating a relationship between patient and doctor. Sweet points out: “that relationship is the secret to healing.”

Does the neuroscience of empathy have, as Drs Haque and Waytz contend, tell us much about physicians finding the mean between empathy and problem solving? My hunch is that empathy are qualities in relationships and thus “response in brain regions involved in empathy” says little about crucial relationships. It’s like how hearing only one side of a phone conversation can be misleading. It seems particularly daft to base physician training on small neuroscience studies. We need better reason that those!

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protoslackeranon · 10 years ago

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Narrative Empathy

Is “narrative empathy” something you want in your doctor? If so, why?

One night I was layin' down I heard mama and papa talkin' I heard papa tell mama let that boy boogie-woogie It's in him and it got to come out

From a patient's point of view I suspect it's a lot more important when "narrative empathy" is something that comes out of and in between interactions and relationship with a doctor.

Lots of the time "narrative empathy" isn't very important.

When I started college I had a pilonidal abscess. I went to the college clinic and the doctor pursued a story line of my complaint as venereal disease. I told him that I was not, nor had ever been, sexually experienced, but never mind, there was a story that had to be exposed. The next appointment the doctor told me that gonorrhea was not found and he would refer me to a dermatologist. I saw a dermatologist a week or so later and he wanted to prescribe a course of steroids.

My memory may be faulty, but I don't remember getting antibiotics or being told that I had a pilonidal cyst. My father didn't like the idea of me taking steroids so I didn't fill that prescription. The active infection went away with aid of stiz baths and clean underwear alone. But the infection reoccurred so I consulted with our chain-smoking family physician, who had "narrative empathy" in spades. He referred me to a surgeon.

I went to see the surgeon. I waited quite a while in the waiting room and then another long while in an examining room. When the doctor came in he was quite abrupt telling me to pull down my pants. Maybe within two seconds of visual examination he said, "Okay we'll schedule you." I turned my head around with my pants still to my knees and said, "Are you sure?"

The surgeon told me that I had a pilonidal cyst and he'd seen a thousand of them and he didn't need to look at my butt any longer to know. He told me my choice was to live with it or to have it surgically removed. I got the surgery.

Many years later my mother was diagnosed with intestinal cancer. This same gruff surgeon operated on my mother--the chain smoking GP was the one who identified that she probably had cancer. Post-surgery there were complications. I wasn't privy to the consultations, as I was living in Florida at the time, but both my father and mother loved the surgeon. My mother got through the ordeal okay, and I think the surgeon was just as important for my father getting through ordeal okay too.

My story is kind of a mess so as kind of a recap: I first tell a story of a doctor who seemed to be leaning on empathy rather too much. He read me as "gay" which was more than I could be at the time, but he wasn't "wrong" and he actually was very sympathetic to young people coming of age. Then a story of a surgeon who was all "just the facts”, and it turned out that's what I needed then. But when it came to the life and death seriousness of my mother's illness the surgeon was in there with them in heart and soul.

At least twenty years later I saw a news report about the first doctor who saw me. He was stepping down as chief of gynecologic oncology at Magee Women's Hospital well in advance of retirement age. He explained that he was too heart broken to continue.

What elements of narrative empathy are teachable (and/or learnable) skills?

Shrinkrants recently pointed to some video of Michael White doing the presentation portion of a workshop for counselors on trauma. An observation he made, but which he didn't elaborate on much--I suspect that it was dealt with in the inter-active parts of the workshop--was: "Burnout is the result of how counselors orient themselves to the work."

How doctors orient themselves to their work, there must be some teachable and learnable skills in that, or else how would we recognize what it is doctors do?

I went to a memorial for my friend Dr. John Moossy held in a lecture room at the University of Pittsburgh School of Medicine. The lecture room was a bit shabby in a 1950's turquoise and beige dinginess. But along both sides of the walls were large portraits of physicians associated with the school. Those portraits lent an august air to the occasion. The event was well attended and is evidence the physicians there--I was certainly one of the few who were not doctors--learned something from the man. The setting, the room, the school, the legacy, all these are part of what it means to be a doctor.

The prompt is about skills. The lecture room, portraits and eulogies to a professor of medicine are hardly skills, they're something else. But what seems important is how much of what is transferred in becoming a doctor and in being a doctor is a story and not skills. The portraits in the lecture hall remind students that medicine is a human enterprise where an individual's success depends on a community of medicine.

In everyday parlance "pragmatism" means something like: "give me something I can use." Shrinkrants probably thinks about pragmatism more as a philosophical orientation. Philosophical pragmatism, for example the social philosophy of G.H. Mead, suggests that narrative empathy is as much a product of a community of medicine as it is something between doctor and patient.

Do you have life experience of either teaching or learning some element of this skill? If so, how would you describe the process through which you learned or taught this skill?

I'm no doctor, nor a teacher, but on the outside looking in, I'd say learning by negative example is important. However, asking regular folks what's messed up in medicine from their own experience probably would do little good. Nevertheless, doctors need to have expertise in getting to the bottom of what went wrong.

There's a sense in which the practice of medicine ought to lead to improvement, as in "practice makes perfect." An attorney friend commented recently that he was much better versed in the law back nearer the time he graduated law school than he is now, but with all his experience he's much better at making Solomon-like pronouncements. It's very difficult for physicians to stay on top of developments in medical knowledge. Of course they ought to try, but the sort of authority my attorney friend points to is a kind of wisdom I look for in an experience practitioner. It's the experience of knowing, and sometimes even forgetting, many different stories which makes an experience practitioner wiser.

There are 6 ACGME core competencies expected of a new practitioner. From the outside looking in, I resist locating "narrative empathy" skills solely in interpersonal and communication skills competencies. Being something of an unreconstructed hippie, I'd say: "It's the system, man." I would hope that narrative empathy extends beyond patient--physician interactions to a "reponsiveness to the larger context" of healthcare. Check lists, adverse incident reports, stuff that can be coded and parsed in a spreadsheet play a role in the development of narrative empathy. Context does matter, and all of the stuff that can be coded is relevant to the individual physician as a mean to orient themselves in ways that don’t lead to burnout.

Mary Catherine Bateson wrote a book entitled, Composing a Life. Probably in the professions women today are less likely to find themselves isolated as the only woman on a committee or in the room as Bateson found herself. Nevertheless part of what makes Bateson's book engaging is how she writes about the struggle to keep cherished values close whilst battling the assholes along the way.

Speaking as an old-guy, one's values seem less inculcated than they are struggled for. That's why my ears perked up when I heard Michael White say "Burnout is the result of how counselors orient themselves to the work." I'm sure he had much to say on the topic. How I imagine physicians orient themselves to the work is not set like a direction: "Head West, young man." Instead how they orient is an active process in multiple directions, an act of composing along the lines Bateson writes about.

From the outside looking in, values seem implicit within the list of core competencies expected of a new practitioner. I believe that helping young physicians make their values more visible, more explicit, to themselves is an important skill. It's not the values per se, but the process of valuing that's useful for keeping the craft upright even in stormy and disturbed contexts over a career.

Would you be willing to share with me what you consider to be important elements of this skill?

Well. . .these might be too lightweight, but I'll mention them anyhow. One of the first academic books I bought outside of any course requirement was a book by Louis Raths entitled Values and Teaching. Values clarification had a very brief time of popularity in schools, but got pushed back against hard by religious and ideological opinions. The reaction against seemed all out of proportion to me.

Loosely pragmatic, as in the vein of American pragmatism, Lewis Raths defined the process of valuing as having seven aspects:

Choosing: 1. to choose freely 2. to choose from alternatives 3. to choose from alternatives after considering the consequences of such alternatives

Prizing:

4. to cherish and be happy with the choice 5. to be willing to affirm the choice publicly

Acting

6. to actually do something about the choice 7. to act repeatedly to affirm the choice publicly

The beauty is in the simplicity here. By breaking down the process into aspects quick interventions can be made. In trying to teach the skills of narrative empathy, Raths's aspects of valuing provide objectives for learning lessons you might devise. The downside to this is Values Clarification is from around the same time as "New Math" and both are widely disparaged.

Another old-skool aproach is Paul Ryan's Threeing. Ryan calls threeing a yoga of relationships. It's based on Charles S. Peirce's theory of categories: Firstness, Secondness, Thirdness.

I think both values clarification and threeing appear somewhat superficial, but underneath both approaches is something substantial. The simple structure allows for development of related learning activities. The simpleness also can provide a structure for lifelong learning.

It's good to point to a list of scholars whose work seems especially important. I'm reminded of One Boring Old Man thinking about Karl Jaspers late in his career. So the syllabus you might provide, or a list of books of scholarship you think important, can be helpful to your students learning narrative empathy. That’s especially the case as part of life-long learning.

Do you have stories of what it is like to experience this skill when consulting with a doctor? If so, was it useful? What was important about it? How would you describe what “it” is? Do you have notions about how one would teach or learn “it?”

When I was growing up doctors in private practice were common. When I was a teen our doctor's office was in a working class neighborhood right on the boundary of an upper middle class neighborhood. I have little doubt that my doctor's sympathies were with the working class. In retrospect it's pretty clear that some his referrals were to doctors he knew from medical school. People from poor backgrounds who'd worked like hell to get ahead and a hellish war whose aftermath made possible a track for poor folk to become physicians.

My parents’s generation suffered through The Depression and WWII or Korea. The last time I saw our chain-smoking family doctor he was chewing frantically on nicorette gum. I asked him about it and he said he'd be long dead if he had kept smoking like he did. And he wrote me a script for it that I never filled. I always had the sense my family doctor had suffered a lot. Probably the war, the trauma that people had suffered in War wasn't talked about much, but something we just knew.

My dad never smoked and didn't serve in the armed forces. My father related well to our family doctor. My mother hated smoking, but liked the doctor in no small part because my dad liked him. Every visit, no matter what he collected a urine sample. I'm not even sure what simple tests his wife and office manager did, but she always did something and then handed her husband the patient's record, on a file card. My parents were treated by this doctor for twenty years or so. The trust and rapport were very high.

Networks are so different nowadays. The sort of practice of doctor as small business which allowed the sort of solidarity of my parent’s era, and of my youth, has long past.

Narratives about Medicine

I doubt the current model of medicine will hold. I wish young doctors had some alternative models somewhere in the back of their minds, if only as sort of a jump start to inventing something new.

Here’s a picture Dr. David Ores posted to his Tumblr today. I suspect the picture wouldn’t go over well among medical students: Scandalous a doctor of medicine would post a selfie smoking a cigar! But the sort of practice Ores has is probably worth students to know about. If not his practice, there are clinics all over who treat marginalized people. That there are alternatives to what is right now really does seem an important part of what I think doctors should know.

Dr. Ores cooperative was once a common type of medical practice in the USA. Business would essentially hire doctors to treat employees and their families.

Books like Robert Coles’s House Calls With William Carlos Williams, MD or John Berger’s A Fortunate Man: The Story of a Country Doctor probably ought to be on a list somewhere. There’s a history to medicine. It’s not so much the books have to be read, as it is that a territory outside the current, but well within the domain of medical practice be available to doctors.

Abraham Verghese's My Own Country and Victoria Sweet's God's Hotel would make a list I might put together, the movie Code Black too. Of course it’s precisely these sorts of suggestions, narratives about medicine, that your questions aren’t aimed. You know the literature of medicine so much more than I. And besides you already said this sort of idea of narrative medicine is important.

From the outside looking in, I repeat that I think it important too. The stories of history, the literature of medicine are an intrinsic to the imagination in medicine. From the outside looking in I would feel happy that young doctors might say or hold meaningful what Williams Carlos Williams said:

When they ask me, as of late they frequently do, how I have for so many years continued an equal interest in medicine and the poem, I reply that they amount for me to nearly the same thing.

#medicine #art #making meaning clear #doctors #stories #shrinkrants

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protoslackeranon · 12 years ago

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Hi,

I just moved my posts from Posterous! Do go though my blog for all the new posts.

Its easy to migrate try JustMigrate

3Crumbs app - Are you the local thrifter we all have been looking for?

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protoslackeranon · 12 years ago

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First Post

This is a place to put up random musings which I might like to share with others online.

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protoslackeranon · 12 years ago

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Story of Angelo

My name is Leondo Menodiado everyday I take my neighbors' trash to dumpsite. I met there four kids, but the one who especially got my attention was Angelo. The four kids names are: Jeff, Roy, Cathy and Angelo. Angelo is eleven years old. He has one sister five years old. Angelo's dream is to be a teacher someday. Even at his young age he really cares about his sister and mom. Everyday he's always getting the scrap on the dump to bring the scrap to the junk shop to earn some money to buy food for his mom and sister.

Angelo's mom is really ill with breast cancer. His father has left.

I was surprised a couple of days ago that Angelo found my house where I live. When I opened my door i saw him crying. He shocked me for the first time asking to help him because his mom is really ill now. They have decided to move to the province and live with relatives. Angelo needs to stay in Manila because he is studying. He will stay with friends of his mother's, but he will follow to his mom and sister this coming school vacation on March.

He is hoping to have $100 for his mom and sister to travel to province, because he knows that his mom is really ill

When first I met Angelo I interviewed him about his wishes. He wrote on a piece of paper all his wishes to have. To the list he wrote: a book bag, black shoes, a school uniform, some school supplies, and milk for his sister.

He didn't know that I had a plan to visit where they live. I found out that they live at lower part of dump. They don't have house, they stay at tent. Sometimes if Angelo's didn't earn enough money to buy food, they eat food which came from the trash. He gets it and brings to the tent and cook it again.

#JustMigrated

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protoslackeranon · 12 years ago

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Shrinkrants in answer to questions about "narrative empathy"

Something I enjoy about the Internet is the opportunity to opine on subjects that I know little about but which I find interesting. Because I don't know much, I tend to go on too long making all sorts of unjustified connections. It's the Internet, so naturally my prolix ramblings annoy the hell out of people. More than once the response to something I've written online has been, “that whereof we cannot speak we must consign to silence.” Mostly I've taken the response to mean, “Shut up, already!” But a part of me takes the response as a provocation: “Can we take it higher?” I've gone with the former interpretation rather than the latter. But I wonder.

Shrinkrants proposes some questions, he didn't number them but I count five, or seven, or nine, to fellow Tumblrs in re Narrative Therapy. I love Shrinkrants's blog, so hell yeah I want to play. But with a rush of thoughts that his questions provoke, I'm finding it very hard to structure answers to the questions. So I babble on.

The first question is: Is “narrative empathy” something you want in your doctor? If so, why?

In thinking about this question I was startled to realize that I'd replaced “narrative empathy” in my musings with “empathetic listening.” I must have heard or read the term “empathetic listening” somewhere along the line and labeled it in my head as a kind of hook to hang stuff on. Anyhow, seeing that I'd replaced one term with another seemed instructive. I had a hook with a bunch of ideas about communication already hung on it. So “empathetic listening” gave me something similar in which to compare “narrative empathy.” But since the question isn't actually about “empathetic listening” I'm also keen to notice differences between the two terms.

Cool, but even if I've got a bunch of ideas about empathetic listening on a mental hook, I don't really know much about it, and know even less about narrative empathy. What to do? Search!

I like this definition of empathetic listening:

“Empathetic listening is defined as: a way of listening and responding to another person that improves mutual understanding and trust. It enabling the listener to receive and accurately interpret the speaker's message, and then provide an appropriate response. It is also called active listening or reflective listening.”

I've not zeroed in on what “narrative empathy” is about. But to begin an answer using the notion of “empathetic listening,” I'd answer that yes of course I want my doctor to listen and respond in ways that improve mutual understanding.

I go to the doctor to say: Doctor, I have a problem. It may very well be the case that there is something, for example a cyst, that I want excised. The cyst might be a cause of my problem, but getting well is more involved than simply removing the cause. The doctor alone may do the surgery, but I will be engaged in the process of getting better. In this simple case the need for empathy isn't particularly in high relief. A gruff interaction with a taciturn surgeon who comes highly recommended might be just fine. But even in a simple situation like this, a mutual recognition between doctor and patient that there's a person involved in getting better seems highly desirable to me.

I want a physician to engage me as a person, not as just a body, or heaven forfend, just a disease. Still, the matter of being human together is a bit rattling because we all know “To err is human” and most patients and doctors would prefer not to think much about error.

The second question is: What elements of narrative empathy are teachable (and/or learnable) skills?

The quick definition of skill from Wikipedia: "A skill is the learned capacity to carry out pre-determined results often with the minimum outlay of time, energy, or both."

We can learn to become more skillful listeners and better in responding to others. We can learn about relationships both in abstract and formal ways as well as in practical and hands on ways.

The question brings up the notion that there are elements of narrative empathy that aren't teachable, and possibly not learnable. Leave it to me to start thinking about what those might be. I'll leave aside for the most part my musings about elements of narrative empathy which aren't teachable and simply say that matters of epistemology, what we can know and how we know it, are raised. And link to a very popular TED Talk by Brene Brown The Power of Vunerablity. One of the great virtues of Brown's talk is how she relates her commitment to a scientific view of knowledge where control and prediction are paramount rubs up against the reality of being human.

The Third question is: Do you have life experience of either teaching or learning some element of this skill? If so, how would you describe the process through which you learned or taught this skill?

I studied for a degree in education. Once credentialed, much to my dismay, it turned out that I'm not a very good teacher.

Education like medicine are professions which take to heart that they are both an art and a science. In both professions there's been a push, often from outside the professions themselves, that the practice become more “evidenced-based.” I think from a practitioner's point of view it's not so easy to distinguish where the art begins and the science leaves off because both are part of the practice. However the arguments about these professions generally follow an either-or logic which seems to miss the essential truth about what it means to be a teacher or physician. There's an art to it.

Based on standard tests and measures, I scored highly on the science part of education. So I guess what I'm lacking is artfulness. A negative example can be very useful, but I'm drawing a blank from my own experience of much of anything useful to say. What comes to mind is a story which seems a non sequitur. I'll tell the story anyway, and perhaps it goes to the second part of this question and in part to the fourth question: Would you be willing to share with me what you consider to be important elements of this skill?

After my younger brother started school, my mother began teaching first grade. We lived in the South and her career teaching corresponded with court-order desegregation of schools. One spring day she took her class for a picnic in a local park. My school session was out, and I must have been eleven or twelve. So I went to assist. Mothers had prepared goodies for all to eat and there was a plate of cupcakes with wildly colorful frosting. In my experience desserts had more restrained decoration.

My mother seeing me eye the cupcakes turned to me and sternly said: “If I hear one unkind word out of you about those cupcakes, I'll spank you in front of everyone.”

As a teacher my mother was opposed to corporal punishment in schools thinking it counter productive. As a parent, she was loathe not to have spanking in her arsenal, but the truth is I don't ever remember being spanked, or spankings of my brothers and sisters. At any rate I felt then that I was too old to be spanked and was deeply humiliated by her threat, not that I didn't take it seriously.

Just as she had said that to me I turned to see one of her pupils, a little Black girl with tight pink tails in her hair. She smiled at me sweetly, and with her arms crossed around her chest rocked her belly back and forth. I don't know whether she had heard my mother speaking to me, because my mother certainly hadn't yelled it. I was sure the girl felt good and happy. The lesson to me was that my mother's students were very important to her; not that she didn't love me, but that she loved them too.

An important reason my mother was a good teacher was her students knew that they mattered to her. She insisted that others respect her students. I feel sure she told her students this in many ways, if not in so many words. It's not a stretch for people to know that this sort of relationship is important for children's learning. We may not think it so important for learning as adults. I think it is.

Here's a link to Kurt Elling singing Nature Boy.

“The greatest joy you'll ever learn

Is just to love and be loved in return.”

The fifth and final question: Do you have stories of what it is like to experience this skill when consulting with a doctor? If so, was it useful? What was important about it? How would you describe what “it” is? Do you have notions about how one would teach or learn “it?”

My initial reaction to this question was to rant about stories where this skill seemed in absence. I care for my elderly father who's rather senile and failing. I feel a rage about certain interactions, the intensity suggests to me it's more me than the doctors. But, I'm bitter about my father's primary care physician and the practice that doctor manages. My frustration is the sense that it's right on its face but rotten at the core. That's hardly useful to answer the question. And certainly my relationships with various physicians hasn't been all bad.

My mother majored in bacteriology in college. She was more astute about disease and medicine than most. When I was a boy she took us to a pediatrician whose was a German emegre. I don't ever remember pitching a fit at the doctor's, but I do remember my little brother doing so. Dr. Brings seemed to me a severe woman. I remember not looking forward to visits to the doctor. Children of course don't like to be stuck with needles, and Dr. Brings always told me it would hurt. But on balance I remember Dr. Brings positively. I remember that the office waiting room had magazines and a few puzzles and toys. And while I wasn't so conscious of it then, after experiences with others, I know now she treated my body with respect. She once made a house call when I had bitten the end off a mercury thermometer. I remember that, and that for a while afterwards had my temperature taken rectally; my mother was data driven.

But here is the main thing I remember, I was probably only five or six. I got a shot. Then was left to go out of the examination room to the waiting room while my little brother got his. I could hear his screams. After a few minutes my mother came of the of the examining room with a very unhappy little boy in her arms and Dr. Brings by her side. As soon as they came through the door a man in working man's clothes stood up and walked over to Dr. Brings. He pulled some money from his shirt pocket and handed it to the doctor. I was fascinated by his face, it was both happy and sad. He profusely thanked the doctor and promised regular payments. I'm not sure what I understood about their relationship, but I am sure my esteem for Dr. Brings really shot up.

When I was fourteen or fifteen I was staying with my grandparents one summer with my brother. My grandfather was fairly senile then. My grandmother and brother were away somewhere. I was helping my grandfather straighten a twelve foot granite post, half of which was in a hole in the ground. We were rocking the post back and forth to get it straight when it broke in half and smashed my hand. Ouch, it hurt, but my grandfather hadn't even noticed me. I went inside and washed the wounds and saw that my middle finger was in bad shape. I called a neighbor who kindly came to take me to a doctor. The doctor who attended to me was a very kind older woman. She carefully washed the wound with peroxide and looked at both my hands carefully. An x-ray was taken, which she showed me after examining it. She explained that while the finger was broken, there wasn't any way to set the bone. The best thing to do was to simply immobilize the finger with a splint for a few weeks and hope for the best.

What I remember about the interaction was not feeling rushed. I appreciated her candor about the injury and most of all that she was treating me with respect. It was 1970, I know because I had one record album Deja vu by Crosby, Stills, Nash & Young. She didn't give me an anti-drug lecture, but she made a comment to me that illicit drug use wasn't something that this small community was immune. I was impressed that she was hip to the reality and she thought me mature enough to discuss it with me.

When I was in high school our family physician chain smoked Pall Mall cigarettes. Dr. Kun always demanded a urine sample at every visit. He was always cordial and relaxed. I feel very fondly about him mostly because of his good judgment in providing medical care for my family. He was especially good communicating with my dad.

Once my father insisted that I go for a check up. After my obligatory pee in a jar. I handed it to Dr. Kun and he then proceeded to ask me questions about sex and my sexuality. After the interview he called my father into his office for a few minutes. The thought that went through my head was something like: What a way to come out to my father! I'm not sure I had “coming out” in my lexicon then, but that was the essence of my thought. Here's the part that is relevant to the quality the question is concerned with: I trusted Dr. Kun not to be a jerk and a homophobe. At the time it seemed kind of a relief to have “that talk” without actually having to talk with my father about it.

What is “it” that connects my positive stories of relationships with doctors? They were authentic, genuine and trustworthy. The relationships felt easy because the doctors leveled with me. What was important was their kindness and clarity of communication which engenderd trust.

Teaching how to establish authentic relationships is a hard nut to crack. There's a children's song, My Body's Nobody's Body But Mine. I don't think the song would get through to an adult, but I wish the message would. Touch is a subtle thing. Clearly my pediatrician didn't ask my consent to be stuck, but she was always clear about what she was about to do. Her touching never startled me as have the touch of other medical practioners have since.

It's important for doctors to remember they are treating people and not just bodies. Many procedures hurt like hell. I think one way that doctors screw up the courage to do what they have to is to forget, at least temporarily, the person whose body is hurting. The trouble is, this kind of forgetting can become a pattern, such that even procedures that don't hurt at all are done with callous disregard.

I think it boils down to honoring the person. A while back an iron worker got his leg caught between two steel members on a bridge being dismantled. A doctor climbed up on the bridge to amputate his leg so to free him. The doctor introduced himself, explained the situation. He opened the sterile packaging and showed the man the saw. The amazing thing was to hear the iron worker tell the story. What was clear from his telling was that he felt a loving bond with the doctor. It was something monumental in both their lives.

Trust gained by being tested in the small things can extend to the big things. I know that most doctors don't deign to measure patients' weight nowadays. But if I were to try to teach how to respect people and to treat treat their bodies with respect, I'd make doctors practice, practice weighing each other. It's such a simple thing that cockiness is bound to show up, with many iterations of weighing it would become obvious that even something so simple can be a cruel and humiliating experience. I should hope the advantages of not making it so would outweigh the perceived usefulness of intimidation would be the take away from this lesson.

"Power is a drug.” It's not the only drug physicians should be mindful about in their own health. I connect the appeal of power-over relationships over empowering relationships with harmful patterns of doctor's personal drug use. That's not well supported, nevertheless it does seem that doctors have in some ways a more complex road to follow in avoiding the pitfalls of harmful drug use.

From my patient's point of view alcohol, nicotine and pot use by doctors concerns me less than the cocktails of pharmaceuticals prevalent today do. The advantage of the more plebeian intoxicants is at least doctors know the dangers. Nonetheless, cocaine and opiates ensnare doctors even while their dangers are well-known. A local doctor over dosed on narcotics recently and many of her close friends had no idea she was using. I didn't know her, but hearing people talk sent chills down my spine to imagine the lonely terror she may have felt as her using spiraled out of control.

I'm skeptical about where addiction theory is nowadays. It may well “work” in clinical situations, but in thinking about the special dangers doctors face about drug use, I'm afraid that thinking of addiction as a brain disease works against doctors paying attention to the kinds of relationships which make drugs particularly dangerous for them.

What do I know? I'm not expert. Still, it strikes me that drug addiction prevention education might be helpful in teaching how to establish authentic relationships with patients. More generally medical education should include attention to the particular pitfalls doctors may face in their personal lives. Thinking of how to create learning situations about vunerabilites and how to avoid harm, one quickly realizes it's not easy.

A recent post by Howard Rheingold Assessment: Turning a Blunt Instrument Into a Powerful Learning Tool seems relevant to this idea of drug abuse prevention education for doctors. Doctors clearly have knowledge about the pitfalls and dangers of drug abuse. And they've got theories to analyse and use to apply their knowledge. But knowledge about drug abuse really isn't the point, rather strategies for ongoing learning are. The goal is to learn ways to navigate around future unknown hazards, the goal of drug abuse prevention lessons is to learn something about learning how to learn.

Rheingold asked education scholar Howard Levine about assessment. Levine noted that the difference between formative and summative assessment as "the difference between the cook tasting the soup to see what it needs and the resturant critic tasting the soup to give it a rating."

I'd have doctors try to make a curriculum for how to prevent doctors from developing harmful relationships with drugs in their personal lives. Asking doctors to construct lessons intended to teach doctors about drug abuse prevention is at least in part meant as a way for them to examine their ideas about assessment; that is, to recognize formative assessment as necessary in life. Maybe this idea of making doctors play teachers for a while is silly. But I suppose one other take away I'd hope for from an exerecise like this is the sense that we're all winging it here.

When they ask me, as of late they frequently do, how I have for so many years continued an equal interest in medicine and the poem, I reply that they amount for me to nearly the same thing.” ~William Carlos Williams

#JustMigrated

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protoslackeranon · 12 years ago

Text

Shrinkrants in answer to questions about "narrative empathy"

Something I enjoy about the Internet is the opportunity to opine on subjects that I know little about but which I find interesting. Because I don't know much, I tend to go on too long making all sorts of unjustified connections. It's the Internet, so naturally my prolix ramblings annoy the hell out of people. More than once the response to something I've written online has been, “that whereof we cannot speak we must consign to silence.” Mostly I've taken the response to mean, “Shut up, already!” But a part of me takes the response as a provocation: “Can we take it higher?” I've gone with the former interpretation rather than the latter. But I wonder.

Shrinkrants proposes some questions, he didn't number them but I count five, or seven, or nine, to fellow Tumblrs in re Narrative Therapy. I love Shrinkrants's blog, so hell yeah I want to play. But with a rush of thoughts that his questions provoke, I'm finding it very hard to structure answers to the questions. So I babble on.

The first question is: Is “narrative empathy” something you want in your doctor? If so, why?

In thinking about this question I was startled to realize that I'd replaced “narrative empathy” in my musings with “empathetic listening.” I must have heard or read the term “empathetic listening” somewhere along the line and labeled it in my head as a kind of hook to hang stuff on. Anyhow, seeing that I'd replaced one term with another seemed instructive. I had a hook with a bunch of ideas about communication already hung on it. So “empathetic listening” gave me something similar in which to compare “narrative empathy.” But since the question isn't actually about “empathetic listening” I'm also keen to notice differences between the two terms.

Cool, but even if I've got a bunch of ideas about empathetic listening on a mental hook, I don't really know much about it, and know even less about narrative empathy. What to do? Search!

I like this definition of empathetic listening:

“Empathetic listening is defined as: a way of listening and responding to another person that improves mutual understanding and trust. It enabling the listener to receive and accurately interpret the speaker's message, and then provide an appropriate response. It is also called active listening or reflective listening.”

</blockquote>

I've not zeroed in on what “narrative empathy” is about. But to begin an answer using the notion of “empathetic listening,” I'd answer that yes of course I want my doctor to listen and respond in ways that improve mutual understanding.

I go to the doctor to say: Doctor, I have a problem. It may very well be the case that there is something, for example a cyst, that I want excised. The cyst might be a cause of my problem, but getting well is more involved than simply removing the cause. The doctor alone may do the surgery, but I will be engaged in the process of getting better.In this simple case the need for empathy isn't particularly in high relief. An gruff interaction with a taciturn surgeon who comes highly recommended might be just fine. But even in a simple situation like this, a mutual recognition between doctor and patient that there's a person involved in getting better seems highly desirable to me.

I want a physician to engage me as a person, not as just a body, or heaven just a disease. Still, the matter of being human together is a bit rattling because we all know “To err is human” and most patients and doctors would prefer not to think much about error.

The second question is: What elements of narrative empathy are teachable (and/or learnable) skills?

The quick definition of skill from Wikipedia: "A skill is the learned capacity to carry out pre-determined results often with the minimum outlay of time, energy, or both."

We can learn to become more skillful listeners and better in responding to others. We can learn about relationships both in abstract and formal ways as well as in practical and hands on ways.

The question brings up the notion that there are elements of narrative empathy that aren't teachable, and possibly not learnable. Leave it to me to start thinking about what those might be. I'll leave aside for the most part my musings about elements of narrative empathy which aren't teachable and simply say that matters of epistemology, what we can know and how we know it, are raised. And link to a very popular TED Talk by Brené Brown The Power of Vunerablity. One of the great virtues of Brown's talk is how she relates her commitment to a scientific view of knowledge where control and prediction are paramount rubs up against the reality of being human.

The Third question is: Do you have life experience of either teaching or learning some element of this skill? If so, how would you describe the process through which you learned or taught this skill?

I studied for a degree in education. Once credentialed, much to my dismay, it turned out that I'm not a very good teacher.

Education like medicine are professions which take to heart that they are both an art and a science. In both professions there's been a push, often from outside the professions themselves, that the practice become more “evidenced-based.” I think from a practitioner's point of view it's not so easy to distinguish where the art begins and the science leaves off because both are part of the practice. However the arguments about these professions generally follow an either-or logic which seems to miss the essential truth about what it means to be a teacher or physician. There's an art to it.

Based on standard tests and measures, I scored highly on the science part of education. So I guess what I was lacking was artfulness. A negative example can be very useful, but I'm drawing a blank from my own experience of much of anything useful to say. What comes to mind is a story which seems a non sequitur. I'll tell the story anyway, and perhaps it goes to the second part of this question and in part to the fourth question: Would you be willing to share with me what you consider to be important elements of this skill?

After my younger brother started school, my mother began teaching first grade. We lived in the South and her career teaching corresponded with early court-order desegregation of schools. One spring day she took her class for a picnic in a local park. My school session was out, and I must have been eleven or twelve. So I went to assist. Mothers had prepared goodies for all to eat and there was a plate of cupcakes with wildly colorful frosting. In my experience desserts had more restrained decoration.

My mother seeing me eye the cupcakes turned to me and sternly said: “If I hear one unkind word out of you about those cupcakes, I'll spank you in front of everyone.”

As a teacher my mother was opposed to corporal punishment in schools thinking it counter productive. As a parent, she was loathe not to have spanking in her arsenal, but the truth is I don't ever remember being spanked, or spankings of my brothers and sisters. At any rate I felt then that I was too old to be spanked and was deeply humiliated by her threat, not that I didn't take it seriously.

Just as she had said that to me I turned to see one of her pupils, a little Black girl with tight pink tails in her hair. She smiled at me sweetly, and with her arms crossed around her chest rocked her belly back and forth. I don't know whether she ha heard my mother speaking to me, because my mother certainly hadn't yelled it. I was sure the girl felt good and happy. The lesson to me was that my mother's students were very important to her; not that she didn't love me, but that she loved them too.

An important reason my mother was a good teacher was her students knew that they mattered to her. She insisted that others respect her students. I feel sure she told her students this in many ways, if not in so many words. It's not a stretch for people to know that this sort of relationship is important for children's learning. We may not think it so important for learning as adults. I think it is.

Here's a link to Kurt Elling singing Nature Boy.

“The greatest joy you'll ever learn

Is just to love and be loved in return.”

</blockquote>

The fifth and final question: Do you have stories of what it is like to experience this skill when consulting with a doctor? If so, was it useful? What was important about it? How would you describe what “it” is? Do you have notions about how one would teach or learn “it?”

My initial reaction to this question is to rant about stories where this skill seemed in absence. I care for my elderly father who's rather senile and failing. I feel a rage about certain interactions, the intensity suggests to me it's more me than the doctors. I'm bitter about my father's primary care physician and the practice that doctor manages. My frustration about the situation is the sense that it's right on its face but rotten at the core. But that's hardly useful to answer the question. And certainly my relationships with various physicians hasn't been all bad.

My mother majored in bacteriology in college. She was more astute about disease and medicine than most. When I was a boy she took us to a pediatrician whose was a German emegre. I don't ever remember pitching a fit at the doctor's, but I do remember my little brother doing so. Dr. Brings seemed to me a severe woman. I remember not looking forward to visits to the doctor. Children of course don't like to be stuck with needles, and Dr. Brings always told me it would hurt. But on balance I remember Dr. Brings positively. I remember that the office waiting room had magazines and a few puzzles and toys. And while I wasn't so conscious of it then, after experiences with others, I know now she treated my body with respect. She once made a house call when I had bitten the end off a mercury thermometer. I remember that, and that for a while afterwards had my temperature taken rectally; my mother was data driven.

But here is the main thing I remember, I was probably only five or six. I got a shot. Then was left to go out of the examination room to the waiting room while my little brother got his. I could hear his screams. After a few minutes my mother came of the of the examining room with a very unhappy little boy in her arms and Dr. Brings by her side. As soon as they came through the door a man in working man's clothes stood up and walked over to Dr. Brings. He pulled some money from his shirt pocket and handed it to the doctor. I was fascinated by his face, it was both happy and sad. He profusely thanked the doctor and promised regular payments. I'm not sure what I understood about their relationship, but I am sure my esteem for Dr. Brings really shot up.

When I was fourteen or fifteen I was staying with my grandparents one summer with my brother. My grandfather was fairly senile then. My grandmother and brother were away somewhere. I was helping my grandfather straighten a twelve foot granite post, half of which was in a hole in the ground. We were rocking the post back and forth to get it straight when it broke in half and smashed my hand. Ouch, it hurt, but my grandfather hadn't even noticed me. I went inside and washed the wounds and saw that my middle finger was in bad shape. I called a neighbor who kindly came to take me to a doctor. The doctor who attended to me was a very kind older woman. She carefully washed the wound with peroxide and looked at my hands carefully. An x-ray was taken, which she showed me after examining it. She explained that while the finger was broken, there wasn't any way to set the bone. The best thing to do was to simply immobilize the finger with a splint for a few weeks and hope for the best.

What I remember about the interaction was not feeling rushed. I appreciated her candor about the injury and most of all that she was treating me with respect. It was 1970, I know because I had one record albumDeja vu by Crosby, Stills, Nash & Young. She didn't give me an anti-drug lecture, but she made a comment to me that illicit drug use wasn't something that this small community was immune. I was impressed that she was hip to the reality and she thought me mature enough to discuss it with me.

When I was in high school our family physician chain smoked Pall Mall cigarettes. Dr. Kun always demanded a urine sample at every visit. He was always cordial and relaxed. I feel very fondly about him mostly because of his good judgment in providing medical care for my family. He was especially good communicating with my dad.

Once my father insisted that I go for a check up. After my obligatory pee in a jar. I handed it to him and he proceeded to ask me questions about sex and my sexuality. After the interview he called my father into his office for a few minutes. The thought that went through my head was something like: What a way to come out to my father! I'm not sure I had “coming out” in my lexicon then, but that was the essence of my thought. Here's the part that is relevant to the quality the question is concerned with: I trusted Dr. Kun not to be a jerk and a homophobe. At the time it seemed kind of a relief to have “that talk” without actually having to talk with my father about it.

What is “it” that connects my positive stories of relationships with doctors? They are authentic, genuine and trustworthy. The relationships felt easy because the doctors leveled with me. What was important was their kindness and clarity of communication which engenderd trust.

Teaching how to establish authentic relationships is a hard nut to crack. There's a children's song, My Body's Nobody's Body But Mine. I don't think the song would get through to an adult, but I wish the message would. Touch is a subtle thing. Clearly my pediatrician didn't ask my consent to be stuck, but she was always clear about what she was about to do. Her touching never startled me as have the touch of other medical practioners have since.

It's important for doctor to remember they are treating people and not just bodies. Many procedures hurt like hell. I think one way that doctors screw up the courage to do what they have to is to forget, at least temporarily, the person whose body is hurting. The trouble is, this kind of forgetting can become a pattern, such that even procedures that don't hurt at all are done with callous disregard.

I think it boils down to honoring the person. A while back an iron worker got his leg caught between two steel members on a bridge being dismantled. A doctor climbed up on the bridge to amputate his leg so to free him. The doctor introduced himself, explained the situation. He opened the sterile packaging and showed the man the saw. The amazing thing was to hear the iron worker tell the story. What was clear from his telling was that he felt a loving bond with the doctor. It was something monumental in both their lives.

Trust gained by being tested in the small things can extend to the big things. I know that most doctors don't deign to measure patients' weight nowadays. But if I were to try to teach how to respect people and to treat treat their bodies with respect, I'd make doctors practice, practice weighing each other. It's such a simple thing that cockiness is bound to show up, with many iterations of weighing it would become obvious that even something so simple can be a cruel and humiliating experience. I should hope the advantages of not making it so would outweigh the perceived usefulness of intimidation would be the take away from this lesson.

Power is a drug.” It's not the only drug physicians should be mindful about in their own health. I connect the appeal of power-over relationships over empowering relationships with harmful patterns of doctor's personal drug use. That's not well supported, nevertheless it does seem that doctors have in some ways a more complex road to follow in avoiding the pitfalls of harmful drug use.

From my patient's point of view alcohol, nicotine and pot use by doctors concerns me less than the cocktails of pharmaceuticals prevalent today do. The advantage of the more plebeian intoxicants is at least doctors know the dangers. Nonetheless, cocaine and opiates ensnare doctors even while their dangers are well-known. A local doctor over dosed on narcotics recently and many of her close friends had no idea she was using. I didn't know her, but hearing people talk sent chills down my spine to imagine the lonely terror she may have felt as her using spiraled out of control.

I'm skeptical about where addiction theory is nowadays. It may well “work” in clinical situations, but in thinking about the special dangers doctors face with drug use, I'm afraid that thinking of addiction as a brain disease works against doctors paying attention to the kinds of relationships which make drugs particularly dangerous for them.

What do I know? I'm not expert. Still, it strikes me that drug addiction prevention education might be helpful in teaching how to establish authentic relationships with patients. More generally medical education should include attention to the particular pitfalls doctors may face in their personal lives. Thinking of how to create learning situations about vunerabilites and how to avoid harm, one quickly realizes it's not easy.

A recent post by Howard Rheingold Assessment: Turning a Blunt Instrument Into a Powerful Learning Tool seems relevant to this idea of drug abuse prevention education for doctors. Doctors clearly have knowledge about the pitfalls and dangers of drug abuse. And they've got theories to analyse and use to apply their knowledge. But knowledge about drug abuse really isn't the point, rather strategies for ongoing learning are. The goal is to learn ways to navigate around future unknown hazards, the goal of drug abuse prevention lessons is to learn something about learn how to learn.

Rheingold asked education scholar Howard Levine about assessment. Levine noted that the difference between formative and summative assessment as "the difference between the cook tasting the soup to see what it needs and the resturant critic tasting the soup to give it a rating."

I'd have doctors try to make a curriculum for how to prevent doctors form developing harmful relationships with drugs in their personal lives. Asking doctors to construct lessons intended to teach doctors about drug abuse prevention is at least in part meant as a way for them to examine their ideas about assessment; that is to recognize formative assessment as necessary in life. Maybe this idea of making doctors play teachers for a while is silly. But I suppose one other take away I'd hope for out from a lesson like this is the sense that we're all winging it here.

When they ask me, as of late they frequently do, how I have for so many years continued an equal interest in medicine and the poem, I reply that they amount for me to nearly the same thing.” ~William Carlos Williams

</blockquote>

#JustMigrated

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protoslackeranon · 13 years ago

Text

Shine Light on WQED's "Managing Marcellus"

Please come out to WQED thursday evening at 8pm ... with a flashlight to symbolically shed light on the corruption caused by the fracking industry's money in state government... and apparently this "forum" on WQED.

WQED's Managing Marcellus Web page.

Managing Marcellus Facebook Page.

Twitter @MarcellusWQED

WQED is producing a round table discussion show about fracking. The panel members substantially represent views in favor of exploiting the gas from the Marcellus Shale layer by high-volume hydraulic fracturing (hydrofracking).

The funding for the program is under a special grant from the Colcom Foundation.

The Southern Poverty Law Center provides a page with information of some of the Colcom Foundation's funding of hate groups listed by SPLC: The Foundations: Funding the Greenwashers.

PBS Editorial Standards and Policies read in part:

The Public Broadcasting Service ("PBS") is committed to serving the public interest by providing content of the highest quality that enriches the marketplace of ideas, unencumbered by commercial imperative.

Be counted. Be Heard. Come out.

Thursday January 26, 2012 at 8 PM

Shine a Light

WQED 4802 5th Ave., Pittsburgh, Pennsylvania

#JustMigrated

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protoslackeranon · 13 years ago

Text

A Protoslacker's Guide to Artificial Intelligence and Other Topics

I was trying to edit a collaborative wiki page where I'm really an odd ball. The people working on the page actually know a thing or two about the subject and I don't. I'm a slacker. That term gained particular significance about Gen X folks, As a Baby Boomer it probably makes more sense to call me a "dirty hippie," but that seems to sting more than calling me protoslacker.

There maybe a little historical interest in some old links, stuff I got exposed to in the 1970's. Perhaps the larger advantage is how the older questions taken on in these links are somewhat basic or elementary. Clearly fields grown such that elementary questions feel just that to practitioners in the field. As I'm not a practitioner elementary questions don't seem easy. More than anything else perhaps what I have to offer is my ignorance; that is a glimpse of how someone outside the field is trying to begin to make sense of it. So here are some links which I imagine may be of interest.

Biological Computer Laboratory

On that Web page is a link to an abstract to a talk given last year by Bruce Clarke Heinz von Foerster in the Systems Counterculture It's a rather handy link because it connects to the sorts of links I have in mind.

Stewart Brand of The Whole Earth Catalog asked Heinz von Foerster to review G. Spencer Brown's book The Laws of Form. That review made a lot of hippy folks like me think very fundamentally about mathematics. I think the jury is out about how valuable a contribution G. Spencer Brown has made to mathematics. And maybe he's a bit nuts. Still the book was important in changing how some ordinary people thought. Here's a Web site with some links about The Laws of Form.

At that Web site is a rough transcript of Spencer Brown's presentation at a 1973 American University Masters (AUM) Conference at Esalen where many counterculture luminaries participated.

John Lilly said something to the effect that he was the scientist that the wives and children were most likely to have read. I'm not sure today how many people know about John Lilly, but he certainly was popular. It seems he was one of the first to poplularize the notion of the human bio-computer. Here's a link to Lilly's book Simulations of God.

So far as I know Jack Balkin doesn't once mention John Lilly in his book Cultural Software: A Theory of Ideology, but I can't help but think that Lilly's popularizing the notion of the human bio-computer made Balkin's metaphor of cultural software easy to accept.

What a Frog's Eye Tells a Frog's Brain (PDF) is a seminal work in many fields, among them artificial intelligence. The authors of the paper were: J.Y. Lettvin, H.R. Maturana, W.S. McCulloch and W.H. Pitts. Those people all make me think of all sorts of links but I don't really have a scheme for how to connect these links and I don't want to go off on too many different tangents.

I do want to link to Warren McCulloch's essay What is a Number, that a Man May Know It, and a Man that He May Know a Number? (PDF)

And with McCulloch in mind to point to an essay by Gotthard Gunther Number and Logos: Unforgettable Hours with Warren St. McCulloch. Gunther tells about how he came to the idea of polycontecturality. In that telling he talks about conversations with McCulloch about number which seem to complement G. Spencer Brown's explorations, even though Gunther travels from there in quite a different direction.

Humberto Maturana makes me think of links in many different directions. One link I think of really ought to be fleshed out, because I suspect the chain I have in mind isn't very strong. I'm not sure why I'm drawing a connection between Maturana and Niklas Luhmann, but for today's purposes I'll just say that I am. And the connection between number and sociology isn't present in mind either. So I'll just link to an essay by Takis Fotopoulous Systems theory and complexity: a potential tool for radical analysis or the emerging social paradigm for the internationalised market economy?

Lazy as I am I'm not going to look for links to support an assertion that Maturana has been quite cautious about the application of the construct of autopoiesis to a sociological context. Fotopoulous's essay seems very good in providing a critique of Luhmann's theory. I add it here because Fotopoulous is concerned about change towards inclusive democracy and how theory relates to that end. In that respect I wish to point back to Balkin's theory of cultural software and his explanations of how change might occur.

How these links connect together seems a bit fishy. On one hand there are links to some formal thinking about mathematics and on the other hand links to biological and social systems. How do they hang together is the meta-theme of this post; that's the big question. If that question seems of interest, I wonder what the best way to group these links so to encourage the addition of further links? I'd welcome thoughts on that matter. I'd welcome any thoughts actually.

#JustMigrated

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protoslackeranon · 14 years ago

Text

Some links to share with a friend

Something you said reminded me of a few links I've wanted to share with you for a while.

One way to share links is for me to send you email. Another would be toshare them on a service like Google+ or Facebook, but you don't use them. I think it's nice to have a place to put links together, so I thought I'd make a post here.

Dr. Marcia Angell who was the editor of the New England Journal of medicine wrote two very important and influential articles for The New York Review of Books; they are reviews actually. The issue of psychiatric drugs is complex and especially in reference to the upcoming DSM7. Angell does a brilliant job of making the complex understandable. So while these articles are important for the medical community, Angell has succeeded in engaging ordinary people in the discussion about psychiatric drugs.

The Epidemic of Mental Illness: Why?

The Illusions of Psychiatry

Also in the summer there was a remarkable article at 3Quarks Daily that I've been meaning to share. It's by Kate Fincke, a therapist in private practice.

MR. NOBODY: HOW CHILDREN USE METAPHOR TO GET TO SLEEP, COPE, GRIEVE AND GROW

You've probably heard of the book Metaphors We Live By first published in 1980 written by George Lakoff and Mark Johnson. There are some excerpts here which provide a good shorter- version of the book by way of excerpts. It's sort of a classic and both Lakoff and Johnson have gone on in interesting directions. Johnson is a well-regarded philosopher, and honed the theory in his book The Body in Mind: The Bodily Basis of Meaning, Imagination and Reason. It's quite brilliant and connects in someway with Kate Fincke's artical.

If I'm smart when I think of links to articles I think you might enjoy, I should add them at this page. LOL, or not.

It's a bit besides the point but I save bookmarks on my browser as well as on the Web. I put links up on the Web in a number of places, among them a bookmarking service called PinBoard; you can see my messy links here if you are interested.

Before I used Pinboard I used a service which was almost exactly like calledDelicious, my Delicious links are here. Yahoo! had bought Delicious and then after years of neglect was trying to sell it. I was afraid they'd just go out of existence so I moved my links over to Pinboard. Yahoo! sucessfully sold Delicious--to my surprise--to a couple of the fellows who came up with Youtube. One feature they've introduced at Delcious is this notion of stacks. Here is a stack I'm making on Music Blogs.

I know you're not particularly interested sites like these. But something people do nowadays is to find ways to share links. One of my favorite observers of the Web is Ethan Zuckerman. A recent article impressed me.

Former purveyor of discarded paradigms, at your service.

It's a bit computer geeky, but Zuckerman makes an important observation:

"The more important shift in metaphor was from pages to streams. In the mid-1990s, we understood the web in terms of pages. Some pages were meant to be permanent, others changing, others completely ephemeral. Blogs updated the paradigm somewhat – they were pages we expected would change, daily, perhaps weekly. But they were pages, with permanency and permalinks. And you controlled what went on them, even if you permitted comments on your blog. Conversations took place between spaces – I link to you, you link to me. In the age of Twitter and Facebook, pages feel too permanent, too fixed. You produce a stream of updates which flow past your friends. If they follow you closely, they might hang on your every update – more likely, they dip their feet into the stream now and again, seeing what you’re up to, chiming in with a comment or an upvote."

"It would be a mistake to visualize these interactions as buildings composing a city. They’re rivers, distinguishable by path and magnitude, but shifting and ever-changing. You can never step into the same lifestream twice."

Interacting with this lifestream reality which so many people engage in is hard to grasp. But in a way, it's become an important skill.

This post on this blog, is more like a page, whereas most of the place people put links nowadays are more like Zuckerman's lifestream.

Anyhow my links at Pinboard are rough, just marking articles which I want to find again. Another way that I mark some articles I read is using readon.ly Sometimes I come across a sentence or a short passage which contains an important idea. readon.ly allows me to highlight that portion of text and send it to the site--also a Tweet on Twitter if I want. So my links on readon.ly are a sort of currated version of Pinboard links. So I also post these links on a Tumblr blog called Three Good Links.

This post is on Posterous. I came here and also to Tumblr because you had asked about ways to put put stuff up on the Web relevant to your workshop. I knew that both Posterous and Tumblr made posting very easy, but I had not actually used them. Using them I can say with confidence they are very easy to use.

LOL, I count 13 links in this post. Each of the 4 articles I've linked to will take about 20 minutes to read. It's not the sort of thing you'd necessarily do in one sitting. That's why it's nice to have a place to find links later.

Many people use their phones as a reading device. Because I don't have a smart phone or a Tablet computer, I can't really play around with that. However it maybe something you would play around with. You might imagine that lists of links would be useful for this purpose. LOL there are many services useful for reading on smartphones or tablets. One I'll mention, because it's something we've talked about together before is Readability.

Oh these modern times! It's funny that you're more heavy on gadgets than I am and that I'm the one linking to various places to get use of these gadgets. Funny because I doubt your so interested in Internet stuff.

Another place I put up links is Koowall. I think you have to sign up for the service; that is I'm not sure that people can discover the Koowalls without being members. It's easy to be a member, just an email. I would send you a invitation if you like. Anyway the Beta status makes it unclear to me if you can see this post whether or not you simply see that particular post or whether you can see it in the context of the larger wall of posts. It's just another link list, but a currated one like my Tumblr blog. That particular post is from a wall called Creative Hairstyles. I think Koowall has potential, and am particularly interested to see how the site looks on an iPhone.

I know your eyes glace over with this sort of thing. Still I think you might find some of these links useful to you. Koowall is particularly interesting as a colaborative environment. The privacy settings for the walls are very easy to set. So it's not hard to make a wall that only a specified group can see. Ah, and I think there are public walls too. What I can't figure out, however is if you have to have signed up to see the public walls.

#JustMigrated

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