Conversations, Bohm and [be] Careful with that Axe Eugene

Tomorrow is the last day of the first month of 2011 – the first 31 days of the year will have passed, and the first month done. Like many of the previous 23 days, the last seven have also been extremely hectic, full on in terms of people and places to see and have been days filled with 100s of different conversations.

These were conversations to comfort the sick, or those that involved whispering the answers to difficult questions into the ears of others; there have been conversations that have challenged ideas and perceptions (mine and those of others), happy and humorous conversations that helped make light of difficult contexts, rhetorical conversations (I attended an action learning set on Monday), networking conversations with peers across the UK, snatched conversations spoken in code, relaxed conversations over a glass of wine (or two), and one slightly surreal conversation with a lady who made sandwiches for a living.

One of my favorite contributors to our thinking on conversations is the late David Bohm. Bohm, a quantum physicist was also interested in philosophy and in this context developed an approach to conversation that draws on the notion of dialogue. For Bohm, dialogue presents the opportunity for preconceptions, prejudices and the characteristic patterns that inform our thoughts, opinions, beliefs and feelings to be examined and explored in the context of the roles we choose to inhabit. For Bohm, dialogue represents ‘a flow of meaning’, whereas discussion implies 'a shaking apart'. Dialogue starts with 'listening and speaking with', discussion with 'talking, and talking to'.

In the year that I was born, Bohm published a work that examined the notion of thought as a system – this is a concept that resonates with my view of the world, although I have struggled and struggled at times in really understanding this aspect of his work. It was only when I re-discovered Bion (thanks Sue) that I began to have some idea as to what Bohm might be saying. I am fascinated by Bion’s notion of thoughts (being) in search of a thinker, and this is perhaps an idea as close to Bohms thesis as it is possible to get.

One of Bohms earliest influences would have been Albert Einstein, with whom he worked for a number of years in the US. And of course it was Einstein who noted: ‘that to raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advance in science’. Perhaps what Einstein was talking about, is the ability (or not) for any of us to see imagination as being more important than knowledge.

And much to my later discomfort, one of the conversations I had this week involved a colleague saying they could not imagine me doing such and such a thing, to which I somewhat thoughtlessly responded by saying this was probably because they didn’t have any imagination. I have pondered on this encounter since, and my discomfort remains. It was Gareth Morgan (of Imaginization fame) who once said that most of us are not very good at workplace conversations. We say things which we ought not to say and we do not say things which we ought to say.

Morgan’s work was highly influential in shaping what the linguist George Lakoff and philosopher Mark Johnson had to say about how we use metaphors to define our reality and then how we proceed to act on the basis of these metaphors. They argued that we draw inferences, set goals, make commitments, and execute plans, all on the basis of how we in part structure our experience, consciously and unconsciously, by means of metaphor.

My personal metaphor of the week draws upon the unknown but powerful axe wielding figure in Pink Floyds Careful with that Axe Eugene. This is an instrumental piece of music that only features an organ and base guitar. The music slowly builds upon an almost hypnotic rhythm which culminates in the song's only lyrics (the songs title) being whispered menacingly, once, followed by Roger Waters issuing a piecing scream. As it’s my metaphor, its meaning, in the context of my week, remains mine.

Finally, my youngest daughter congratulated me on my carbon footprint savings this week. These savings resulting from the choices I had made in travelling to Edinburgh for the Council of Deans of Health meeting on Monday and Tuesday. It appears that by catching a train there and back I only used 43 kilograms of CO2 compared to 92 if I had driven, or 111 by plane – a saving equivalent, apparently, to the CO2 emission of 170 TVs being left on for 24 hours. How quickly our children grow up.

Foucauldian Tendentiousness, Hot Water and Man-induced Man Flu?

Apart from Monday this has been a lovely week. Unfortunately, on Monday I was definitely up to my neck in hot water at home (something to do with tractors). However, the rest of the week was good.

This week I was privileged to be able to teach twice, with two different groups of year three students. These were mental health nurse students, and my task was to help them work through the possible implications of a rapidly changing policy landscape for the provision of mental health care in the UK. This is one of my favorite sessions to facilitate. My approach is based upon generating opportunities for the students to explore and learn at the edges of knowledge, knowing and not knowing. This approach can often result in students experiencing what has been described as troublesome knowledge. I think this a good thing. What worries me more is when students are not particularly worried about what it is they don’t yet know.

For example, not one of the students in both groups knew who Michel Foucault was. As I have possibly said before in these blog postings, Foucault is a favorite philosopher and sociologist of mine. He was ultimately a modest man. He didn’t see himself as a philosopher and described his ideas and concepts not as knowledge, but as a kind of tool box that others might rummage through to find the ‘tool’ that might help them in their own endeavors. This is a notion that fits very well with my own approach to becoming and being an academic. My goal, as an academic, is not to write about my ideas and thoughts for an audience to simply read, but rather to present these thoughts and ideas for people to consider, argue with and hopefully use.

I use Foucault in my session both because of the way he dealt with his own mental health problems, and because of his views on the society he found himself in. Tendentially, this was a society he saw as being regulated, anatomical, hierarchal, where time is carefully distributed, its spaces partitioned, and behaviours are characterised by obedience and surveillance. For the free sprit in me, such a state is an anathema.

Interestingly, at least for me, on this occasion I experienced the closure of the theory – practice gap. One of the examples I use to illustrate Foucault's notion of the pervasive and hidden hand of the State’s involvement in controlling our lives is the proposal by the previous Labour Government to insist that we all fitted something called a thermostatic mixing valve (TMV) to our baths to prevent people from inadvertently scalding themselves. Mary Creagh, Labour MP for Wakefield, in 2008 tabled a private members bill that proposed TMV’s were fitted to all new, refurbished and change of use homes. These devices ensure that water only reaches a maximum of 46° C well below the temperature that might cause injury. This technology is not new; it was developed in the Glasgow laundries in the 1920s and '30s.

The Bill never bcame law and up until this week, I have always said this proposal was something that would result in a gross infringement on our personal liberties and ability to choose to live a life as we wanted. Who, I thought, would be daft enough to run a bath that was so hot it would cause scalding as someone went to sit in it. How wrong could I be?

This week one of my colleagues badly scalded themselves stepping into a bath (run by their other half) entirely filled with very hot water. Unbeknown to me until this week was the fact that hot bath water is the number one cause of severe scalding injuries among young children, the elderly and infirm in the UK. Every year around 20 people die from scalds caused by hot bath water, and a further 570 people suffer serious scald injuries.

Whilst hot baths can therefore be dangerous, they have also been used as a form of treatment. In 100 BCE, the Greek physician Asclepiades initiated what was described as the humane treatment of patients with mental illness using hot therapeutic baths, massage, exercise, and music. And as late as 1930, ice water baths were used, along with shock machines and electro-convulsive therapy to treat those were said to have a mental illness.

As I write this week’s blog, I feel I am suffering from what appears to be a bad case of flu. On Friday I was given the flu vaccine, as a way of avoiding going down with the real thing. I was told (by the Nurse) the vaccination would protect me, which is possibly a good thing given a total of 254 people have died of flu in the UK since September last year with 195 of these deaths being associated with the H1N1 infection. Professor John Watson, the Health Protection Agency’s head of respiratory diseases, said on Friday, “We expect further deaths to be reported and confirmed by us over the coming weeks”. I am hoping I got the vaccination in time and the symptoms I am experiencing this morning are simply [sic] the side effects of the jab. However, I won't be getting up to have a hot bath to see if this helps make me feel better…

Talking Stoicism and the Telling of Touching Tales

I have been involved in a great deal of talking this week. Some of these conversations have been difficult and have appeared to evoke powerful emotions in others. Throughout the week, the impact on individuals has been plain to see. How one responds to such emotionality is important.

In the first week of their experience as a student nurse or midwife I meet  all as the students as a group to talk about what becoming a nurse or a midwife might entail. I believe that in order to care for others we must also learn how to care for ourselves. So part of my talk highlights the tensions involved in learning to become a professional, and how we all need to embrace rather than reject or suppress the emotionality of practice. I am interested in getting the students to start thinking about their understanding of their self and their self in relation to others. Critical to developing this understanding is the need to find different ways of communicating with each other. Such communication, between the carers and the recipients of care has to be so much more than simply talking (to each other). True therapeutic endeavour and communication involves recognising of the humanity in self and others. Getting to this place clearly takes experience, reflective thinking, and awareness of self. Arthur Frank, the Canadian sociologist describes the importance of achieving effective communication through dialogue: ‘To exist as a human is to communicate with others.’

He observed in his wonderful book, The Renewal of Generosity: Illness, Medicine and How to Live, that often such dialogue is replaced by a professional discourse. The use and reliance on this professional response might be both conscious and unconscious. Indeed twice this week, in different contexts, I was told I had slipped into therapist mode, when something different, more personal perhaps was required. Whilst I joked that being theraputic was the default postion for mental health nurses, in my heart I knew my response was a consquence of a defended me. Borrowing from what Winnicott describes in his work (Clinical Varieties of Transference) as: 'every failed analysis being a faliure of the analyst not the patient', my use of a professional discourse was detrimental to all of us involved. Franks links the need to achieve the dialogical communication to Stoic philosophy. Stoicism, whether espoused by the nurse, midwife, social worker or patient, asks: ‘who are you choosing to be’, regardless of where you find yourself, and ‘is that your best choice?’ It is the Dialogical Stoic which provides us with insight as to ‘how to be’ or ‘how to live’.

The experiences of this week have shown me that, ‘how to be’ in situations that might be experienced as stressful or difficult either by me or others can sometimes require more than just the verbal form of communication. In those difficult conversations this week with colleagues I clealry failed to recognise the need for or provide the holding environment Winnicott talks of,  made up of the physical, emotional and psychological, but also more than these.

As I have also been reminded this week sometimes it can be difficult to replace words with a gesture that allows us to reach out and provide that physical and emotional connection. Often simply a look or touch is more effective than words, and can demonstrate the generosity and consolation Franks describes as being an essential element in building effective relationships between the carer and cared for.

I am determined to try and remember that as all our worlds continue to change and become more turbulent we all need to be aware of the way in which such changes can challenge our ontological security, or the ontological security of others. Being there for our self of others is not only about what we say but what we do and the way we chose to be. Franks book is well worth a read if you haven’t already done so. Constructed around the stories of Franks own experiences and the experiences of others, the book provides and opportunity to truly reflect and better understand the nature of our intra, and interpersonal relationships. These are touching tales indeed.

A [Bitter] Pill to Take, Street Level Bureaucracy, and a Flying Friday

One of the first emails I received this week was from my colleague Phil Barker. He was alerting me to the first review of the Mental Health Ethics book posted on Amazon. Excitedly I opened the link to read the review. I had to read the comments three times and was beside myself with annoyance and guilt. The reviewer (Julie who?) considered much of the book to be good EXCEPT for Chapter 5, which she considered convoluted in its presentation. This is one of the chapters in the book that colleagues and I wrote. Despite my Fathers often aired opinion regarding what he feels might be some peoples inability to truly comprehend the articulation of my labyrinthine vocabulary at times, 'convoluted communication' was not something I recognised as being a characteristic of my work. For a few hours I fumed.

However after some self administered UPR pills began to take effect, my first visceral response eventually faded and was replaced by a more positive acknowledgment of the right we should all enjoy to express an opinion. Yesterday, a different review was posted, which provided a more up-lifting counter point to the first, and no, although very tempted, I didn’t post this more positive review!

As the week moved on, the School began to buzz. Colleagues were returning from their break, lectures, seminars and supervisory sessions were taking place and the movement, noise and colour was great to be part of. Walking around the School to talk to colleagues, students and visitors is a great way of feeling the emotional pulse of the School. It gives me and others the opportunity to promote what Michael Lipsky called street level bureaucracy. He argued that: ‘policy implementation in the end comes down to the people who actually implement it’. Although Lipsky’s concept was predicated on those professions, police, fireman and so on who literally walked the streets, the concept is good in other contexts, if recognised as such.

In my experience, our recent Whole School Project embraced the concept, allowing colleagues from across the School at all levels of responsibility and seniority to make a significant contribution to identifying the need for change, generating options to take any changes forward and then leading the change process through implementation. It may well be a concept that the transformational teams in the University might want to embrace as the next stage of the University Transformational Project starts to gather momentum.

I argue that the promotion of Lipsky’s concepts requires Transcendental Leadership. Such leadership draws upon values, attitudes, and behaviours (altruism, hope, faith and vision) to intrinsically motivate others. Such motivation is concerned with giving others a sense of calling (life has meaning, it’s possible to make a difference) and belonging (to be understood and to be appreciated). As individuals gain a sense of self in this way, the impact on their contribution to the group, organisation and community they belong to becomes more positive, creative and effective.

Transcendental leaders do not desire to manipulate others. They are motivated by altruistic love, a sense of wholeness, harmony and well-being produced through care, concern, appreciation of self and an authentic selfless concern for others – and all without a UPR pill in sight!

And Friday was a very interesting, slightly scary and yet ultimately rewarding day. I spent much of the day involved in interviewing candidates for Lecturer posts in Aeroplane Structures and Systems. The University requires that such interview panels are chaired by an independent Head of School. That was me, and I was having to perform way outside of my Comfort Zone.

At times I felt a little like Sefton Goldberg, the ‘hero’ of Howard Jacobson’s first novel, 'Coming from Behind’ published in 1983, such was my fear of not being good enough in what was a very unfamiliar situation. In the end I thought it was a great experience. And I now know considerably more about ‘solid shapes’, ‘shearing forces’, ‘composites’ and ‘the way air flows across exposed surfaces’, than I did before the day! For me the experience reminded me that it is always possible to learn something new.

Much of Jacobson’s work is concerned with the Jewish experience – his latest book, The Finkler Question, (which won the Man Booker Prize in 2010) is a captivating story of exclusion and belonging, justice and love, ageing, wisdom and humanity. It has been described as being funny, furious, and unflinching, a bit like I might describe my week.

The Janus Blog 2010/11

 It’s the 2nd of January, and the start of a new year. It was Roman God Janus, who was said to be the God of beginnings, endings and time. Most often Janus is depicted as having two heads, facing in opposite directions; one head looks back at the last year while the other looks forward to the new, simultaneously taking a look into the future and the past.

As this is my first blog of 2011, I decided to take a quick look back at some of the blogs from 2010 as the way to start the blog of the future. One of the things I wrote about in January 2010 was a book chapter I was writing on the need for all of us to learn the value to our mental well becoming more resilient. Patience is a part of resilience, which is just as well as the book has still not been published! February touched upon Tesco’s, Boy Scouts, the wearing of pyjamas, and smoking (both of which, I have to say, are very unhealthy habits).

 Whereas in March it was all long legged blondes, hunting and nurses. The somewhat Janusesque poster in the blog attracted the greatest number of responses to a posting on my blog site ever. April was about embracing troublesome knowledge (and not knowing), and in May I recalled where I was when I heard about the attack on the twin towers and 2011 marks 10 years since this dreadful event.

In June one of my blogs celebrated the arrival of my fifth grandchild, whilst July heralded the arrival of the sweeping economic measures to be taken across all sectors of the UK including the £21 billion savings required of the NHS. August was also about numbers, but this time the poor numeracy abilities of some nurses and the problems this brought for educationalists and practice partners alike. September was new students, and reminders of unconditional positive regard for others, whilst in October I recalled my desire to change the face of nurse education and where this 10 years project had got to. November brought with it the brilliant and breathtaking release of Aung San Suu Kyi in Burma - such wonderful and long over due news.

December featured Angels and Demons and that particular posting, got the second highest level of responses in the year. Not sure why, but thanks for the feedback.

So it has been a year where lots of things have happened, there has been much turbulence, moments of pure excitement but also some sadness, and where above all else, change was all around. I am really looking forward to the challenges and changes 2011 will bring. I hope to continue capturing my thoughts about these experiences in my weekly blogs.

I hope you have enjoyed reading my take on the events of the year as much as I have enjoyed writing the blogs. I don’t usually have a shortage of ideas on what I want to write about when I open up my lap top at 5am on Sunday mornings. Whilst sometimes it is simply thinking about individuals that inspire the story lines which eventually become the week’s blog, often my ideas are sparked by reading or hearing the stories, reports, and experiences of countless other people who I have never met. So thanks to all of these people, and all of you who have let me know in many different ways what you thought about the blogs. I remain constantly surprised at the reach of the postings.

And finally, as 2011 starts, (Janus?!) I would like to take this opportunity to say to all those people who, for lots of different reasons, I didn’t get to meet or speak to over the Christmas break; I hope your new year brings you everything your heart and mind desires!