The Blame Game

….and so the blame game goes on. The latest is David Nutt over the regulation of addictive drugs. Before that, Robin Alexander and his Cambridge Primary Review over the continuing shortcomings in primary education. Two professors at loggerheads with government ministers. It fills up the pages of newspapers and broadcast air time and gives the people something to talk about over their pint or their coffee and ciggie, but does it move us on? Not only is there blaming going on but notice that the debate is about whether individuals have got it right or wrong, where it is a process for fixing a problem. How much serious debate is there about the role addictive drugs play in our society, why the people use them and how it is that the behaviour of so many five-year-olds cannot be contained in a classroom? – and what all this tells us about ourselves. Too often, the diagnosis is that someone else has screwed up – often politicians and teachers. We need a different way of thinking.

I’m struggling here because I am part of the system we call Western Liberal Democracy and it’s so hard to see from the inside! I’ve actually been asked by our Primary Care Trust to lead a health and wellbeing programme in my locality, starting from scratch! So that has concentrated the mind. These are my starting thoughts: firstly, I want to engage with positive health, and not so much with preventing disease in the guise of talking about wellbeing. Secondly, I want to take a systemic view: to understand the fundamental drivers of our health problems. Thirdly, I want to focus not just on the behaviour of individuals but on the context that encourages us to behave the way we do. The last two of these are about thinking in terms of systems, but I don’t want to fall into the trap of blaming the system or context and exonerating the individual. We must all be held responsible for what we do, and what we don’t do. It’s no good pleading: ‘I couldn’t help it your honour, I was abused as a child.’ It’s really the opposite of that: we take responsibility for ourselves AND for other people. I am inspired in this by John Donne’s much quoted entreaty:

No man is an island, entire of itself; every man is a piece of the continent, a part of the main. …..Any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee...

We are a long way from Donne’s vision. But if this is where we want to get to, how do we do it? I think it’s something like having a stronger sense of being in the same boat rather than different boats competing with one another. More soon……

Is it just vanity to write a blog? It might be. The way I think about this is to believe that my decision to act is mostly made at a intuitive level and then rationalized afterwards. I think first as the perceptive and instinctive animal that we all are. (But where do these instincts and intuitions come from? Our ‘free will’ is baffling to natural scientists, enshrined in Christianity as a test of our Godliness, a response to a Jungian Archetype, engagement with Quantum Consciousness, the Christmas play thing of marketers and so on). Then I use my reason to challenge that instinctive reaction. Gregory Bateson says that reason’s challenge has to do with our place in the social group – which is about relationships. Hence my musing over vanity, which most of the time is not good for relationships. Bateson also says that humans have big brains mainly to cope with the complexity of relationships. The fact that I am going ahead and writing this blog presumably means that my reason says its OK to go ahead, that it’s mostly not vanity, that the relationships I cherish will at least not be damaged by it. Truth be known, I wouldn’t be doing it at all if it had not been for the other BHMA trustees wanting a blog on the website - to give the BHMA the profile of an active and questioning and up-to-date organisation (which of course it is!). So it’s partly fashion (which makes me squirm) but it’s more about exerting influence – that is, power – which is where I ended up in the last blog before this stream of consciousness took over.

Power! We all have it. Those who weald it know they have it and know how to use it. Those who don’t weald it, don’t know they have it or don’t know how to use it or both. My biggest worry is about the purpose for which power is used. There doesn’t seem to be much connection between the exercise of power and the wisdom to know what needs to be done. It’s impossible to be a GP for so many years and not be tired of political gimmickry. As I said before, there seems be a process of power eroding wisdom, perhaps through separation of the powerful from the powerless. Our society’s answer to this is to rely on the collective good sense of the people through democracy. But Adolf Hitler was voted into power, so that ‘collective good sense’ is not proof against disastrous decisions. Our instincts can be aroused by a despot: instincts need to be checked through reason or we become fools. Maybe it’s Freudian Id coming through, or the ‘trickster’ archetype, or a dark bit of the quantum field etc ..but unreliable whichever the case.

I have somehow got back to the very beginning of this series of blogs: then it was the foolishness of the blame game, now it’s the foolishness of choosing the wrong leader. In both cases the foolishness is ours. Perhaps mine is to write this blog. Foolish it may be, but I don’t think there’s much vanity in it. I think it’s more an exercise in trying to work out what to do about our society. There is a discipline imposed by doing this in public! More next week!

Is this a fool's guide to voting for the oddity...

Is this a fool’s guide to voting for the oddity who is sane and wise or the oddity who is really mad. Some might say that even if politicians are sane and wise when they are elected, power gets to them in the end. ‘Power tends to corrupt, and absolute power corrupts absolutely.’ said Lord Acton in 1887 (according to my thematic dictionary of quotations). I’m tempted to say that I’m safe from corruption because I have no power, but really powerful people tell me they don’t feel powerful either. On the same page of my quotations dictionary is one from Harold Macmillan: ‘Power? It’s like a dead sea fruit; when you achieve it, there’s nothing there.’ But perhaps that was a moment of modesty, false or otherwise. And what is a dead sea fruit anyway? A mirage in the desert I suppose.

This line of thought (scarcely that, more of a zigzag) started with blame and the foolishness of locating fault somewhere, anywhere but in yourself. Maybe the same goes for power? To really know your own power for what it is could be too scary. Someone might blame you for something! So no power, no fault. Totally safe? Sadly not. I think there is no hiding place. Your expenses claim will find you in the end.

So it looks like we all have more power than we think and we might as well speak out because even if we don’t, sooner or later we’ll get blamed for doing nothing. We should find and know our power and use it. But how? Write a blog perhaps? But surely that is just vanity?

Mad I may be! An upright citizen, pillar of the community, husband, father, householder, member of a learned profession and yet mad. I might ‘benchmark’ as sane, where benchmarking is looking at how someone is relative to others – these ‘others’ being the benchmark. This is what philosophers call relativism. So long as we are all mad, we will all seem to be OK. Folie à millions.

But why mad? The madness is being caught up a culture of blame. Consumer societies cultivate expectations that other people will do things for us or to us. If we don’t get what we expect we are encouraged to go elsewhere or complain. We are not encouraged to wonder whether we are expecting too much, or what we can do differently to help things to turn out better. It’s mad because ultimately it’s unsustainable. Of course, some argue that high expectations raise standards, which is often true. But if those high standards are unsustainable in the long term or they happen at the expense of others who suffer, then sooner or later we, or more likely our children, will pay the true price of our ‘folie’.

So what should we do differently? Maybe we should look out for people who are saying or writing things that feel uncomfortable. They may be the sane ones – the ones that benchmark off the scale. Or they may be even madder than the rest of us. Who knows! Perhaps as we head for the general election we’ll have plenty of chances to try this out, to see whether we have the wisdom to vote for the sane and not the insane oddity. But though there are plenty out there, these oddities are seldom heard, and that’s another story for another time.

Blog the first: political pathology

“The political pathology is inscribed in our patients’ bodies and souls”. This rings so true to me. It comes from a Norwegian professor of general practice, Per Fugelli. When I first read it in 2001 it fed my anger at incompetent politicians. I then knew with certainty that (like the professor) my life consisted of patching up other people’s mistakes – not just the politicians but the drug companies, greedy employers, polluters of the atmosphere, George Bush, Sadam Hussein and even the patients. In fact, anyone but me! Thirty years of hard graft clearing up a mess – someone else’s – had taken its toll.

Then I retired as a full time general practitioner and over 18 months the world has taken on a different hue. The posturing of the politicians is still absurd of course, but so is my righteous indignation. I think I can see that the politicians behave the way they do because we behave the way we do. It’s what medics call ‘Folie à deux’ – two mad people living together seeming sane to one another – perhaps in a muddle and each blaming the other – but sane nonetheless.

So there we are! My first blog. The beginning of journey towards …. who knows! More soon.