Gardens of the Mind

I have put together this post in my appreciation for Geoffrey Jellicoe (1900 -1996).

Jellicoe was an architect, landscape architect, historian, traveller, lecturer and author. He has been a lasting inspiration for me.

When I studied landscape Architecture at the University of Edinburgh it was Jellicoe who was the guide for my mind’s eye. Without Jellicoe, I feel certain that I would not have gained distinction in all subjects along with the award of the Scottish Chapter prize. I was not a good draughtsman but I had ideas; uncultivated ideas. Six years of training in Medicine (at the University of Aberdeen) had rather stifled my creative and imaginative self and I was altogether rather too tight and rigid. In good part, I feel this a consequence of the unhelpful, and really too strict division between the so-called ‘two cultures’.

In what follows I have “borrowed words” of my betters, taking three quotes from a number of my favourite authors: marginalia and fragments that for me somehow seem to say something about Jellicoe and the ‘two cultures’. Interspersed are a few short clips of Geoffrey Jellicoe talking about draughtsmanship and gardens of the Mind.



 

‘It was odd being dead’

This is a fictional film. It is about a teddy bear, Dr Hale Bopp and a day of two halves. In the morning Dr Hale Bopp goes exploring in the Scottish Borders and he comes across the ruin of the Monteath mausoleum on Gersit Law. The oak door of the mausoleum has been breached and one can get inside and be with Monteath and the two angels that guard this forgotten statesman. Above him the dome has beautiful window stars to the universe beyond.

Dr Hale Bopp is a well-travelled bear and is constantly exploring, enjoying and reflecting upon the world in which he lives. The guid doctor has come to the view that life is complex, diverse and sometimes “messy”. He leaves the Monteath mausoleum with paws that were muddy and heads for a different afternoon. An afternoon of Appraisal to ensure that as a fictional bear and doctor that he is providing Good Medical Practice.

So that was the day of two halves. This film is about that.

Dr Hale Bopp is getting on a bit now and is at the end of his fictional medical career. One day soon he will retire from being a doctor but meantime he is of the view that his wanderings, philosophical and creative between the arts and sciences, has been nothing but to the benefit of the patients that he cares for.

Important note:
None of the words used in this film are those of the filmmaker. They are “borrowed” from C.P. Snow’s “Corridors of Power”; Evelyn Waugh’s “Decline and Fall”; and Jessie Burton’s novel “The Muse”.

‘It was odd being dead’ from omphalos on Vimeo.

Source material:
(1) Physicians of the future: Renaissance of Polymaths? By B F Piko and W E Stempsey. Published in The Journal of the Royal Society for the Promotion of Health. December 2002, 122(4), pp. 233-237
(2) Time to rethink on appraisal and revalidation for older doctors. By Dr Jonathan D Sleath. Letter published in the BMJ, 30 December 2016, BMJ2016;355:i6749
(3) Career Focus: Appraising Appraisal. Published in the BMJ 21st November 1988, BMJ1988;317:S2-7170
(4) Revalidation: What you need to know. Summary advice for Regulators. General medical Council.
(5) The Good Medical Practice Framework for Appraisal and Revalidation. General medical Council.
(6) Taking Revalidation Forward: Sir Keith Pearson’s Review of Medical Revalidation. January 2017.
(7) GMC response to Sir Keith Pearson’s report on Taking Revalidation Forward.

Music credits (under common license, thank you Dexter Britain):

(1) Perfect I am not – by Dexter Britain
(2) Telling stories – by Dexter Britain


The poem that time forgot

In 1826 Robert Pollok began an epic poem. Ten volumes later, and not even 28 years of age, Robert was dead.

His poem was called “The course of time”

I came across this poem through St Ann’s, Bridge of Allan, where my mother Margaret was born and where my daughter Rachel went to Nursery School.

Credits: Dexter Britain, Dylan Thomas, Raymond Tallis, Michael Mara, the BBC, old newspapers and a magpie.

Time passes. Listen. Time passes.

The funeral took place in radiant sunshine

Auchengray House has been a ruined shell since a catastrophic fire in 1937. At the time all was going horribly wrong for the multi-millionaire owner, J M Colville. Not only did he lose in the fire his collection of fine antiques and paintings, but not long before the fire his mother had died and then his sister jumped in front to a train.

It was this darkness that led to the building of Gribloch, the new hoose, one of light, designed by Basil Spence.

Epitome of current medical literature

This film takes as its title the opening section of the British Medical Journal of the last century.

The idea behind this film is to question what may be considered as “medical literature”?

I have deliberately placed myself at the centre of this film. What may appear as “monomania” is quite deliberate! I don’t know about you, but I read for pleasure and also because it gives me access to the lives of others. Literature opens up new worlds for me.

In this film I surround myself with some of those authors I have enjoyed reading and who have helped me to grow as a person and as a doctor.

We must remember that we are all subjective. We cannot put ourselves into the minds of others and truly share their lived experience.

This film also suggests, by including reference to the “modern ruin” St Peter’s Seminary in Cardross, (built in 1967, the year I was born) that we pass through time and that we age. I have included consideration of passing time as literature reminds us that medical science cannot ignore this.

In short this film is an artistic expression of the so-called “two cultures”.

Music credit: Spem in alium – Thomas Tallis

Locations:
(1) The Pineapple, Dunmore
(2) Mossgrove, Bridge of Allan
(3) Old Stirling Bridge

Backdrop:
Authors whose words have featured in my films.

Reductionism – truly, madly, deeply

On Friday the 25th of November 2016 I gave a talk for the Scottish Philosophy and Psychiatry Special Interest Group.

My subject was “Improvement Science”.

The following is based on the slides and the four short films that I presented.

My talk was entitled:
001-improvement-science The meeting was held at the Golden Lion Hotel, Stirling:golden-lion-hotel-stirling-25-nov-2016-1golden-lion-hotel-stirling-25-nov-2016-2I started the day off:
002-improvement-scienceI gave these declarations:
003-improvement-science
I explained to the audience that like Dr Rev I M Jolly I can be overly pessimistic:


005-improvement-scienceThe dictionary definition of ‘Improvement’:
006-improvement-scienceThe dictionary definition of ‘Science’:
007-improvement-scienceMy concern is any pre-determinism to science:
008-improvement-scienceThe Health Foundation have considered Improvement Science: this is from 2011:
009-improvement-scienceMany different terms are used including “QI” for “Quality Improvement”:
010-improvement-scienceThis is where improvement science began, in Boston, Massachusetts:
011-improvement-scienceThe Founder of the Institute for Healthcare Improvement (IHI) was Don Berwick:
013-improvement-scienceThe first description of this movement in Britain goes back to 1992 by Dr Godlee:
014-improvement-scienceFifteen years later, Dr Godlee, Editor of the BMJ, said this:
015-improvement-scienceOnly last month the BMJ briefly interviewed Don Berwick:
016-improvement-scienceIHI describes improvement science as being based on a “simple, effective tool”:
017-improvement-scienceThis tool was developed from the work of an American engineer, W. A. Deming:
018-improvement-scienceThe “Model for Improvement” Tool [TM] is described by IHI as a “simple, yet powerful tool”:
019-improvement-scienceThe current President and CEO of IHI is Derek Feeley:
024-improvement-scienceUp until 2013, Derek Feeley was Chief Executive [Director General] for NHS Scotland:
021-improvement-scienceIn April 2013 Derek Feeley resigned from NHS Scotland:
022-improvement-science22nd February 2015 it was reported: “The astonishing and largely hidden influence of an American private healthcare giant at the heart of Scotland’s NHS”:
023-improvement-scienceDr Brian Robson, Executive Clinical Director for Healthcare Improvement Scotland [HIS] is an “IHI Fellow”:
dr-brian-robsonProfessor Jason Leitch, National Clinical Director for the Scottish Government is an “IHI Fellow”:
026-improvement-scienceMight we be facing the biggest change to healthcare in Scotland since the NHS began?nhs-scotland-1947 Improvement science is moving quickly and widely across Scotland:
027-improvement-scienceThis “Masterclass 1” for Board members cost  £146,837:
028-improvement-scienceAn NHS Board member commented after the Masterclass:
029-improvement-scienceHealthcare Improvement Scotland is one organisation with a very wide remit over NHS Scotland and it works closely with the Scottish Government:
031-improvement-scienceNine cohorts of Safety Fellows and National Improvers have so far been trained following IHI methodology:
032-improvement-scienceI was reminded of the current enthusiasm for improvement science when the Convener of a recent Scottish Parliament Committee meeting said of targets (another approach enthusiastically taken by NHS Scotland):033-improvement-scienceWhat is the place of ethics in Improvement Science?
034-improvement-scienceIn 2007 the Hastings Centre, USA, looked into this in some depth:
035-improvement-scienceThe Hastings Centre argue that Improvement science cannot ignore ethics:
036-improvement-scienceIn 2011 the Health Foundation, UK, produced this “Evidence Scan”:improvement-science-2011a2The Health Foundation commented that “improvement science is just emerging”:
037-improvement-science
The Evidence Scan found a “real paucity of evidence about the field of improvement science”:
038-improvement-scienceI would also suggest that there is a real paucity of philosophy about the field of improvement science:
039-improvement-scienceThe Health Foundation did find papers on the conceptual nature of Improvement Science but concluded that:
040-improvement-scienceMary Midgley is a philosopher now aged 95 years who is widely respected for her ethical considerations:
041-improvement-scienceChapter 7 of her book “Heart and Mind: The Varieties of Moral Experience” begins:
042-improvement-scienceMary Midgley is concerned about the overuse of reductionist tests in medicine stating that:
043-improvement-science
This film is about the potential consequences of inappropriate reductionism:

Leon Eisenberg has written many papers about this subject. He argues that reductionism should not be “abandoned” but that we must keep sight of where such an approach is scientifically useful and also where it is inappropriate:
045-improvement-scienceIn the Hastings Report, Margaret O’Kane asks:
046-improvement-scienceIn my view the answer to this question is YES. I am hopeful that the National Improvers recruited to NHS Scotland would agree:
047-improvement-scienceAs an NHS doctor I have seen unintentional harm brought about by National improvement work in Scotland. This related to a “Screening Tool” that was introduced across Scotland as part of this work. I found that the unintended consequences of the use of the following tool included implications for patients’ autonomy and the risk of over treatment:
048-improvement-scienceBoth the Hasting Group and the Health Foundation are of the view that improvement science cannot separate itself from the ethical requirements of research:
049-improvement-scienceThis article published in February 2016 argues that individual “rights transcend all aspects of Improvement science”
050-improvement-scienceThe following is a verbatim representation of a conversation held by National Improvers working in NHS Scotland:
051-improvement-scienceIn November 2016 Professor Joshi, also a psychiatrist outlined his concerns about reductionism in a published letter to the BMJ:
052-improvement-science
In this short film the mechanical language of healthcare improvers is considered:

Professor John Bruce was a Moral Philosopher in Edinburgh University in the 18th century. He built this temple, the “Temple of Decision”, in the grounds of his home by Falkland Palace so that he could consider his thesis:
054-improvement-scienceProfessor John Bruce did not succeed in his endeavour. His Temple however stood for many years:
055-improvement-scienceBut it eventually collapsed and his endeavour to “reduce the science of morals to the same certainty that attends other sciences” collapsed with it.
057-improvement-scienceAny search of Healthcare Improvement Scotland for “ethics” finds this result:
056-improvement-science
This film is about more up-to-date buildings – the enthusiasm for which was based on improvement science: The Red Road flats in Glasgow:

 

                         Post-script:

The following is an edited clip of the evidence given to the Scottish Parliament by Healthcare Improvement Scotland (HIS) on the 31st January 2017:

The full session can be watched here

The Official Report can be accessed here

I am a severed head

002-parodiability-iris-murdoch

I recently read an article about Iris Murdoch in the London Review of Books by Colin Burrow. I found it most thoughtful.

iris-murdoch-young

Today, many in the profession of medicine associate Iris Murdoch not for her writings but for her development of dementia. I have to be honest this troubles me. I am not alone to be troubled. This is what the Edinburgh author Candia McWilliams said in her memoir, ‘What to look for in Winter’:

candia-mcwilliam-on-iris-murdochiris-murdoch-building-stirling-dementia

When reading the London Book review of Iris Murdoch my thoughts returned to a work by Raymond Tallis, ‘The Kingdom of Infinite Space: A Fantastical voyage around your Head”. In this book Tallis describes a paradox: that consciousness manages to be both embodied and disembodied. This is a book that fills the head with wonder and demonstrates silliness in Cartesian divides.

Dr Felix Post was a psychiatrist who was interested in an area of study known as ‘Pathography’. This is the search for psychiatric disorders in individuals after their death.

pathography-felix-post-2

I share the same career as Dr Post once practised. A career where Dr Post was a pioneer. However I do not share the determinism that he had to define people, or re-define people, after their death through a singular vantage.

I have worried enough about this approach –pathography– to make a short film about it:

severed-head2a-severed-headplace-for-the-arts

All this is necessary backdrop to Colin Burrow’s balanced article on Iris Murdoch. What follows are some of the passages that struck me [dare I say it] as both an embodied and disembodied head:

001-parodiability-iris-murdoch 003-parodiability-iris-murdoch 004-parodiability-iris-murdoch 005-parodiability-iris-murdoch 006-parodiability-iris-murdoch 007-parodiability-iris-murdoch 007b-parodiability-iris-murdoch 008-parodiability-iris-murdoch 009-parodiability-iris-murdoch 010-parodiability-iris-murdoch
iris-murdoch-older
a-severed-head-iris-murdoch 011-parodiability-iris-murdoch 012-parodiability-iris-murdoch 013-parodiability-iris-murdoch 014-parodiability-iris-murdoch 021-parodiability-iris-murdoch the-sea-the-sea-iris-murdoch 015-parodiability-iris-murdoch 016-parodiability-iris-murdoch 017-parodiability-iris-murdoch 018-parodiability-iris-murdoch 019-parodiability-iris-murdoch 022-parodiability-iris-murdoch 025-parodiability-iris-murdoch

Footnote: There is absolutely no doubt that Iris Murdoch developed
a severe dementia syndrome and that this was based upon biological 
changes in her ageing brain.

The questions that this Hole Ousia post asks are several:

(1) Would you want to be remembered for an illness first, 
or first as the brilliant person that you were?

(2) Can we define ourselves entirely through brain functions alone?

(3) What are your views on "Pathography"?

Sometimes history takes things into its own hands

This is a film about historic Bannockburn House.

I dedicate this film to Mick Collinson and feel fortunate that I was one of the last people to hold his hands in mine.

Sometimes history takes things into its own hands from omphalos on Vimeo.

Thanks must go to Terri Collinson, devoted wife of Mick. Terri somehow sensed I was an oddball lad of pairts and was so kind to me.

 

The city is yours

I recently transferred old family slide images to digital format.

Of the 1000 or so images, I was particularly struck by the panoramic, yet intimate nature of the photographs of my parents honeymoon in Paris in April 1964.

The city is yours from omphalos on Vimeo.

The most sign-packed surface in the universe

This film is about blushing, a very human phenomenon. Though very common it is still most poorly understood:

The most sign-packed surface in the universe from omphalos on Vimeo.