Teen Sexting - A Criminal Offence

02 Oct

This report states that both young men and women experience peer pressure to share sexual images of themselves in the phenomenon known as 'Sexting'. The study highlighted the pressure young people experienced from their peers to engage in sexting and the importance of their voice in developing ways to prevent and deal with the problem.  

Boys can be ostracised by their peers or called 'gay' if they fail to participate and show their friends images of girls on their phone or computer. Girls also feel under pressure to share images of themselves, especially if they have also viewed images of girls they know. A US survey found over 51% of girls had sent sexy images or messages as a result of pressure from a guy. 

However, this is not just harmless fun between teenagers. Some young people have been charged with child pornography (in 2007, 32 teens in Victoria, Aus were charged with child pornography offences) and placed on the sex offenders list for having explicit photos of young teens on their phone or computer. It is illegal to have a naked or semi-naked photo of someone under 18 on your phone or computer, to forward it to someone else and you can be charged even if the photo is of yourself and you agree to it being sent. Most young people are probably unaware of this and that a pressing 'send' could have devastating consequences for them and their lives. 

What may have started out as an exchange between two people can end up being shared between many at a school or even worse on the internet, with some even making their way onto porn sites. One girl's images ended up being shared around local schools and she was harassed, called names and bullied thereafter resulting in her commiting suicide. 

Young people are under pressure to fit in with the group, to do what their peers do so as they are not ostracised, excluded, teased, made fun of or laughed at etc. It can be a very powerful force that seems to make people do things against their better judgment and which if left to their own devices they may not choose to do. They may feel that it is not right for them, that they are not really comfortable with it and yet they feel forced or compelled to go along with it.

It takes a strong teenager to be able to say no to peer pressure, someone who has the self respect and self honouring to listen to what they truly feel and follow that - rather than the external pressure to conform. Perhaps the best thing we could teach young people would be to listen to what they really feel and to honour that, to be able to say no and stick with it. To know that even if that meant losing a few so called 'friends' that would not be the end of the world - for a true friend would respect your choice and not force you to do something against your will. 

There is of course more to the underlying reasons that young people engage in sexting. It is a way of seeking intimacy without actually forming an intimate relationship, without taking the risks that would potentially involve of being rejected or getting hurt. The desire to avoid being hurt or rejected can lead people into all sorts of difficulties when it comes to relationships - something perhaps many of us can relate to in one way or another.

However, imagine if we instead empowered young people to feel and know first not just that they are worth loving but that they are in fact love and to honour that by being self-loving, self-honouring, self-respecting. In that way they can feel for themselves the true harm of sexting and that it is coming from an emptiness and the seeking of love, affection and intimacy but in a way that is not true.  The more they realise, know and live that they are love, the more they will be open to forming an intimate relationship with another who is also self-respecting, self-honouring and self-loving. 

However, it is not just about teaching it but living it - not just talking the talk but walking the talk.  Thus a more powerful way for young people to learn from parents, teachers, relatives etc  is by how we treat them, how we are with them, by how we listen and respond to them, whether we truly see and 'meet' them, respect them or ignore them, dismiss them, talk down to them etc. It is for each of us to live in a self-loving, self-caring way ourselves and to offer that way of being to young people by reflection that they may choose it for themselves. 

Feel free to share your comments or insights re teen sexting.

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24 Apr

Abortion - how could you be so stupid? ..

“How could you be so stupid?”

“You are so stupid”

“You’re supposed to know better”

“You’re a doctor for f!*#s sake”

“You’re supposed to be intelligent”

“You’re not supposed to make mistakes”

“You stupid b#*!h”

“Why did you…?”

“Why didn’t you…?”

“This is your worst nightmare come true…”

“This isn’t part of the plan”

“What are you going to do?”

This was part of the internal dialogue that followed the light blue lines on the home test kit confirming what was indeed (one of) my worst nightmares come true – I was pregnant – an unplanned and unwanted pregnancy.

Growing up in N. Ireland had instilled in me a deep fear of becoming pregnant if I wasn’t married – it was, after all, the deepest shame a girl could bring upon her family. I had heard as a teenager how people spoke of young girls who ended up in such a predicament – that they were loose, sluts, slags, tarts, morally bankrupt, weak, silly girls, shameful – you get the picture. There was absolutely nothing positive about that scenario.

But I was no longer a teenager – I was in my thirties, successful in a highly professional job and had an excellent track record that affirmed a decent level of intelligence. Times had moved on – single mothers were a commonplace occurrence – but even so, the hangover of religious and cultural beliefs still coursed through my veins, even though I was not religious in any way at that time, nor was I living in N. Ireland. But the damage had been done. The seeds had been well and truly planted and embedded.

Shame on you.

 

You’re a disappointment.

 

How could you?

 

The collective cultural and religious voice echoed…

 

You see, in my head, I was not the ‘sort of person’ who had an unplanned pregnancy, who had a child out of wedlock – I wasn’t the silly irresponsible teenage girl… yet now I was the sort of person who had an unplanned pregnancy, as I was pregnant! There was no denying that. My body had told me even before the little blue lines confirmed it.

“What are you going to do?”

I saw two paths ahead of me, to continue with the pregnancy and have the child, or have an abortion…and it was very clear that there was only one option for ME, for who I was, given my history, my experiences, my beliefs, the influencing factors on my life that had led me to be the person I was at that time – and that was to have an abortion.  I was living in England, so gaining access to abortion was not the problem that it is for women in N. Ireland today. There were multiple factors that contributed to that decision and although it was definitely a true choice for me, it was not taken lightly. The circumstances around it were challenging for a variety of reasons; the relationship I was in broke up at the same time and I had the abortion one week before my final surgical exams; it was a stressful, messy and difficult time. 

But then unplanned pregnancies and abortions are part of the messiness of life. No young girl grows up thinking, “one day I want to have an abortion.” It’s not something we aspire to, dream of, desire or plan for – we don’t think “I’ll get pregnant in January so I can have my abortion in February or March”. It’s not part of anyone’s five-year plan.

In an ideal world there would be no need for abortions – but we do not live in and we will never live in an ideal world – so for the foreseeable future, abortion is, has been and will be part of life. Resisting and fighting this fact does not help – it is against the flow of life, the ‘what is’ of life – and is not actually pro-life.

So whether people agree with them or not, abortions are a fact of life and they are not going to go away. Whilst we might like to see the need for them diminish, that can be addressed in other ways, whilst simultaneously fully supporting those who choose them. That is the humane approach. We know banning them or making them illegal does not stop them happening – it just heightens the stress and suffering and makes what can already be a challenging situation, even more difficult.  For some women it can result in death or severe disease from complications of backstreet abortions, or as we have seen recently in N. Ireland, result in women being convicted of a ‘crime,’ that is not a crime in other parts of the world.

Indeed, the United Nations has stated that criminalization of health services that are only for women, including abortion, is discrimination against women.

I would add, it is not only discrimination against women, it is an abuse of women. It is abusive to force a woman to have a child against her will – which in effect is what criminalizing abortion is intended to do. It is an abuse of women to deny them the fundamental right to have agency over their own body and life and the right to choose if and/or when they have a family. Also just to be super-clear, for people who are anti-abortion – you don’t have to have one, you can choose to or not, no-one would force an abortion on you the way that some people and the law would currently force women to have children they do not want. Decriminalization does not mean you have to have it or do it; it just gives you and every woman a choice. 

Having an abortion can be the responsible and loving choice for both the woman and the unborn when the cycle of life is fully understood – it is not loving to bring a child into the world that is not wanted, where for whatever reason or reasons, the woman feels she does not have the resources to care for the child. Having a child, or children, is a big responsibility – one that perhaps people do not take seriously enough.

All too often we try to box and pigeon hole people into stereotypes – as I did myself, but the truth is, the ‘sort of person’ who has an unplanned pregnancy and an abortion as a way of taking responsibility for that situation, is a woman in her reproductive years and who has sex. End of. It’s as simple as that. Thereafter the identities and stories are as varied as women on the planet; they span the ages from teens to forties, from unemployed to highly professional (including doctors), from poor to rich, from working class to aristocracy, from those who used contraception to those who didn’t, from single to married, from childless to those with children, from one night stands to long term relationships, from atheist to deeply religious; basically from all nations and all walks of life. They are our friends, our sisters, our cousins, our daughters, our nieces, our aunts and mothers – they are all women and they are all, in one way or another, our sisters. 

But this sisterhood is in trouble – indeed the brotherhood of humanity is in trouble and this is exemplified in what is called the abortion debate. On one side we have those who identify as ‘pro-life’ and on the other those who identify as ‘pro-choice’ and ne’er the twain shall meet. There just seems to be perpetual arguing, fighting, abusing and condemning each other and making no progress on the subject in the process.

I find it interesting to consider how this debate would be if men were the ones to get pregnant and have children – how many of them would allow themselves to be forced to have a child they did not want? I have little doubt the law would have been changed years ago or indeed would never have been made in the first place. This isn’t just about abortion, but the empowerment of women and true equality.

‘Pro-life’ in this context is to me a misnomer. I consider myself to be very much pro-life: I fully appreciate and am aware of the sacredness and preciousness of life, I work every day to save lives, prolong lives, preserve lives and to care for lives – so I am very much ‘pro-life’. And I am also pro-choice and respect the right of every woman to make the reproductive choices that are true for her and to have agency over her own body and life. To me those who identify as ‘pro-life’ in the abortion debate are more accurately described as having views that are anti-women, anti-abortion and anti-choice (anti-w-a-c). 

For if we do not truly care for the walking, talking, fully living human being (woman) that is in front of us, then we cannot truly care for her unborn, but are just bringing an ideal and a belief of how we think life should be, rather than how it actually is. If we are not pro the life of the woman, then we cannot be truly pro the life of the unborn. 

That said, I also know that putting people into camps or categories creates ‘us and them,’ before the talking even starts. It is a polarized debate, where emotions run high, each believing with passion and conviction that they are right and the other is wrong.

How can we advance this conversation in a mature and responsible way? 

What if some of the current views are based on an understanding of life that is simply not true?

What if there is a way to understand life that allows the whole to be understood, not just a fragment or a linear snap shot of time?

What if these understandings can expand our understanding of abortion in a way that is healing and caring for all?

How can we get to the field beyond right and wrong – where we deal with what is true, what actually occurs in the world of energy that we live in?

So what is true?

  • Unplanned pregnancy is a reality of life
  • Banning or making abortion illegal does not stop it – so surely the true and loving response is to ensure it is performed in a safe and supportive environment
  • A woman is an autonomous human being who has the right to self-determine, to have agency over her own body and reproductive choices
  • A woman is responsible for her life, her choices and their consequences
  • No-one has the absolute right to impose upon another adult human being how to live his or her life
  • A foetus is dependent upon the life of the woman for its life, until such time as it is viable independent of her – until that time it therefore does not have independent rights that supersede the rights of the woman upon whom its life depends.
  • Human beings are multi-dimensional beings with physical and non-physical or spiritual dimensions
  • It takes three to make a baby – a sperm, an egg, and an incarnating spirit
  • The body is a vehicle for the spirit and soul
  • Birth and death are transitions from formless to form and form to formless – the spirit is there before birth and continues after death – so who we are as spiritual beings cannot be destroyed or killed. Death is a passing over, as who we truly are never dies
  • After abortion, the physical flesh is no more, but the incarnating spirit will incarnate again, either to the same or a different woman – so the cycle of life continues
  • Each of us has lived many lifetimes as men and women on the journey of life – a journey that is much bigger, much grander than the duration of any one physical incarnation, whether that is 8 weeks or 80 years
  • We are on a journey of return back to the love we separated from, a journey of the spirit returning to the soul, which calls us to choose to live with, from and in love in our daily ways of living and relating
  • The love that we are is not harmed, destroyed, killed or tainted by anything

 

If this is accepted as being true (as it is energetically true), it is clear that there is no need for any guilt or shame over abortion. Indeed in my experience, the guilt and shame comes not from having the abortion, providing the choice has been true, but comes from us taking on imposed religious beliefs that are not true. Beliefs that we are bad, sinners, evil, that we have destroyed life, that we only have one life, that God will punish us or that we will go to hell (a place that does not actually exist). Once we let these and other similar beliefs go, see them for the falsities that they are and come to know the truth of who we are and live from there – then we are free.

It seems to me that we have lost touch with our common humanity – the fact that there is no ‘us and them’ – only us.  No matter what we believe, no matter what we hold to be true, we are all human, we are all imperfect, we are all living our lives to the best of our ability given who we are, our upbringing, education, culture, religion and all our experiences. This should give us the grace and humility to know we have not walked in another’s shoes, we have not lived another’s life – so who are we to judge them or to impose our ways onto them?  We have replaced a true Christian response of acceptance, understanding, non-judgment, love and compassion with condemnation, judgment, denigration and a dehumanizing response that is far removed from the love of the Christ.

We have also lost touch with our innate divinity – we hold beliefs about ourselves that are not true, perpetuated by false religious teachings and so we hold ourselves as considerably less than the true Sons of God that we are, not appreciating the true glory, beauty and majesty of who we truly are. When we know the love of God by knowing who we are, we know that irrespective of the choices we make, we are always and forever held in the utmost love and never are we not.  

By reconnecting with our common humanity and our innate divinity, we can come to see beyond right and wrong, and instead speak up for what is true.

Do we really want to be part of a society that seeks to potentially imprison 1000-2000 women/year, removing them from their families (possibly their other children) and jobs, because they exercised their fundamental human right to self-determination, to have agency over their own body and to responsibly choose if and or when to have a family?

Do we really want to be part of a society that forces women to have children against their will and with absolutely no consideration for them or their circumstances?

Do we really want to be part of a society that is discriminating against and abusing women by failing to decriminalize abortion in this country and to have it safely and readily available for those who choose it

Patriarchal supremacy and religious fundamentalism are a toxic combination that at its heart is deeply anti-women and far, far removed from the love of God and the Christ. The way of the Christ, is the way of love, acceptance, understanding, non-judgment, equality and compassion – let those qualities be our chosen way.

Even though I have deeply healed on a personal level, I have been guilty of being a bystander, of staying silent and not telling my story or giving voice to my views on this subject, partly out of fear of the backlash, the judgment and whatever else might follow. But, knowing what I know, I can no longer stand by, stay silent and watch from the sidelines and allow this abuse and discrimination to go unchallenged.

If change is to occur then we, all who disagree with the current criminalization of abortion, must begin to stand up and speak up, to say that the current situation is unacceptable and untenable. We need to take whatever means possible, whether that is through local debate, government procedures, legal routes, the UK government, the European Courts, or the United Nations in order to bring an end to this blatant discrimination and abuse of women.

Watch Eunice's interview on the BBC. 

Abortion

Thank you for this frank and honest story. I have never had an abortion, have no children and am currently lying in bed 7 weeks pregnant, desperately hoping not to miscarry this pregnancy like I have so many previous ones. This pregnancy is my choice, as should ones desire not to have a child. Despite ten year struggle to have a family I 100% support a woman's right to choose a termination. As you say, a change to the law does not impact anyone other than the pregnant woman , therefore I cannot understand why the NI assembly continues to deny NI women a basic human right. Press coverage of this issue suggests that the assembly are supporting popular views, this is blatantly untrue as the consultation results show that there is support for a change in the law. I am unlikely to avail of a new law but I sincerely hope that it happens soon so that no woman is forced to travel or buy potentially dangerous drugs. Your story will help countless women, it is sad that they have to get support from a blog rather than their government.

Thank you so much for your

Thank you so much for your bravery in telling your story and for your compassion and vulnerability which we all can connect with .

Thank you Eunice so very much

Thank you Eunice so very much for sharing your story and speaking up against the criminalization of abortion. I have never had an abortion but I know plenty of women who have had and to consider that they could be classified as criminals is absolutely appalling. Women have a right to governance over their own bodies. You have introduced love and truth into this discussion on abortion and many women the world over will be very thankful for that.

It seems ridiculous that in

It seems ridiculous that in 2016 there is still a debate on whether women have the capacity to make such a decision for themselves. Because of the criminalisation and social judgement, those women who actually have experienced abortion are not likely to talk about it publicly, so those who stand in judgement have a louder voice. I am in awe of your willingness to share your story so openly and with such honesty - you are a voice for so many women who may not have the strength to do so.

Thank you Eunice, for the

Thank you Eunice, for the clarity and truth so beautifully presented here. I too had an abortion about 35years ago and the treatment I received was appalling and this further contributed to my guilt. Since then I feel I have cleared most of this but I know there are still some remnants of guilt there. What you have shared here is very healing for me in that I know that I am still innately divine and that this choice I made many years ago does not negatively define me in any way. Thank you.

Thankyou

Thank you Eunice for standing up and speaking so honestly and candidly on a subject that creates so much division. I too, had an abortion many years ago and was filled with guilt and remorse, which I can only say was so destructive to do that to myself. I have also kept this secret which was another load to bear and is a constant diminishment of who I am as a person and as a woman. What you have written is a healing balm for anyone that has been through a similar situation.
23 Apr

Mankind and Medicine - are we truly evolving?..

This blog was first published under KevinMD as Technology in health care: Is medicine really evolving? 

Evolution is part of life, something we accept as a fact and evidenced by the changes we see and know compared to hundreds of years ago. No one can dispute the great technological advances that have been made – transport has been revolutionized from the animal power of horse and cart to the mechanized systems of train, plane and automobile we have today.

Communication systems once reliant upon the written word and postal service are today instant through email, telephone, skype, and facetime. Radio, television, computers, tablets, ipads and iphones are all instant sources of information and entertainment. We can ask Mr Google any question on earth and get an answer – of sorts – from how to cook potatoes, the best way to get from New York to Dublin and how to treat piles or colon cancer and everything else in between and beyond. And of course, man can literally fly to the moon…surely all evidence of the fact we have evolved and are continuing to evolve?

Medicine has also been transformed and is considered to have evolved significantly since the days of blood letting and releasing of evil humors. We now have the most in-depth knowledge ever regarding anatomy, physiology, biochemistry, pathology, microbiology, pharmacology, anesthesia, surgery and I could go on…we know more and more about each and every part of the organs that make up the whole human being. So much so, that we have specialists, physicians and surgeons, for virtually every organ and system.

Yet…despite all these great advances, we seem to be getting sicker!

Obesity, diabetes and mental ill health to name a few are all increasing and each one alone could cripple the health economies in years to come. Certain cancer incidences are rising – with a 1 in 3 risk of each of us getting cancer in our lifetime. This isn’t just due to people living longer thus getting more diseases – people are also getting sicker at a younger age with increasing numbers of people having multiple conditions or multi-morbidity.

We champion living longer as evidence of our progression and our evolution, but what is the quality of that living longer? Is it really progress to spend the last 10 or 20 years of life medicated up to the eyeballs, or perhaps in a nursing home, doubly incontinent and not knowing who you are or who anyone else is either? We celebrate and prioritize longevity over quality – but which would you prefer? With a few exceptions, we do not seem to have mastered longevity with quality to date.

Taking everything into consideration, we would have to say that if we were to use the human body as a marker of evolution – we are not winning. Indeed, perhaps it could be said we are involving, not evolving. Surely, with the most advanced healthcare systems, technology and knowledge about the functioning of the human body ever to grace planet earth, the rates of illness and disease should, if anything, be decreasing not increasing? Would that not be a more true marker or indicator of evolution and progress than flying to the moon or the megabite capacity of our computers or the speed we can fly across the world or download to our computers?

Of course, let us not stop at the health of the human body, but what about the health of human relationships? What do the rates of wars, violence, terrorist activity, rape, paedophilia, murder, domestic violence, child abuse, corruption, fraud, financial impropriety, workplace bullying, harassment, emotional disharmony, relational stress, family discord and more tell us about whether we are evolving or involving?  You decide.

Whilst this is not to decry technological advances, is it possible we champion the tallest skyscraper, the fastest computer, the smallest camera, the fastest plane, the heart bypass machine and the myriad of technological advances in order to not stop and feel the extent of the worldwide violence, abuse and devastation of man fighting against man, whether that is due to a war of countries or a war in the workplace or the home; to not stop and feel the levels of rot in our own bodies as we abuse them with overeating, alcohol, drugs, junk food, stimulant drinks, excess sugar, toxic thoughts, emotions and more.

If we are to use man’s inhumanity to man, including our relationship with ourselves, as a marker of progress and evolution, then we have surely failed that test also. Is it really progress to go from a weapon that kills one by one, to one that can wipe out hundreds or thousands in a single blow? The relationship with ourselves is the foundation of the relationship we have with everyone and everything else including our bodies – so again the rates of illness and disease tell us that we are not as evolved as we like to think we are.

Can we truly say medicine has evolved and progressed when it continues to treat the many parts as parts, without consideration to the whole being those parts belong too? Plato said it over 2000 years ago – “the part can never be well unless the whole is well” and whilst medicine is very good at the medicine of parts, it seems to have forgotten about the whole. For true progress and evolution to occur in medicine and amongst mankind we must resurrect the whole human being, for it is only by knowing and understanding the whole can we truly know why the parts become unwell or diseased.

This means understanding not just the body-mind as medicine tends to focus on, but all dimensions – body, mind, heart, spirit and soul, or the physical, mental, emotional and spiritual realms. We cannot hope to have a medicine that truly heals, evolves and progresses mankind as long as we continue with the fragmented medicine of parts that ignores the whole those parts belong to. And the most fundamental understanding of the whole human being we need to have and which modern medicine ignores completely and considers a taboo and unscientific even to mention, is that the essence of every human being is love.

How unnatural is it then for us to be terrorizing, bombing, shooting, abusing, dehumanizing, arguing, judging, fighting, gossiping, demeaning, bullying or behaving in any way that is unloving towards ourselves and each other? This includes all the ways we harm ourselves and our bodies through our negative self-critique, our judgments, our self-loathing and all the abusive and toxic ways we treat our body with drink, food, emotions, hard ways of living, moving and exercising, being tough and aggressive and much more…when in fact our bodies love to be treated with tender, loving care in all ways.

Imagine, or consider, perhaps even contemplate and ponder, how different the world and the rates of illness and disease might be if we had made the same progress in the depth of love, care, nurturing, kindness, gentleness, appreciation, regard, respect for ourselves, our bodies and each other as we have made with technology over the last 100 years?

Medicine of parts

I love your article Eunice. "Medicine of parts" is a spot-on phrase. Recently I have been offered removal of all my pelvic lymph nodes and some abdominal ones - as part of "gold standard" cancer treatment. When I queried the possibility of lymphedema, I was told it is one in four and the consultant seemed to be dismissive of it as though it is an irrelevancy. It may be a risk that he is prepared to take - on my behalf. I am not sure I am willing to risk that. It is difficult but I am trying to keep an open mind on the way forward. My choice will definitely be for quality of life and not quantity. I am not sick because I have cancer. I have cancer because I am sick. It is time to change how I am living. It is waking me up and that is definitely a good thing.

Eunice, you have exposed this

Eunice, you have exposed this so clearly - how can we champion the latest iPhone yet live in such disregard of ourselves and our fellow humans? Ignoring what we don't like to see and feel leaves us stuck, going nowhere except around and around the sun.

Mankind & Medicine - are we truly evolving

From the evidence you present Eunice, and from what I have observed, most people are indeed not evolving, and our systems do not support evolution, be they health systems, educational systems or political systems. In fact systems are a reflection of how we are living, so it is clear that we are not living well. It really does come down to each and every one of us to take stock of the measure of disregard and dysfunction around us, whether we live in an impoverished country where people struggle to survive or an affluent country where we are dying from obesity related illness, mental and emotional dis-ease, and other excesses. Clearly to truly arise from this downward spiral we must stand together to honestly address this problem. Hats off to Serge Benhayon and Universal Medicine for doing just that, and thank you for starting this much needed conversation Eunice.
26 Mar

The Way we are Living is Killing Us. ..

This blog was first published on KevinMD 

It is a common experience to feel that our body has let us down when we get sick. We may feel it is broken or flawed in some way and if only it was better designed we wouldn’t have to suffer illness and disease. Likewise, we tend to consider illness and disease as something bad that has happened to us and which we associate with suffering of some kind, be it physical, psychological, emotional or spiritual. This mindset or view of illness and disease is one that is deeply embedded in the biomedical model of illness and disease, a model which sees the patient as a victim of circumstances beyond their control, who is reliant and dependent upon the doctor and the medical profession to fix them.

Even though this model is well out-dated and has been replaced by newer models that place increasing responsibility at the feet of the individual for why they have what they have, it remains deeply engrained in the psyche of patients and doctors alike. Patients still come looking to be fixed, demanding to be cured or healed or that ‘something must be done’, whilst refusing to make any changes themselves or to accept any responsibility for why they have what they have. Doctors still play the role of the patriarchal ‘all knowing’ doctor, who is there to fix, mend, repair or replace without truly understanding what it takes to heal.

We examine, investigate, diagnose, prescribe medications, perform operations, administer treatments of one kind or another, all of which serve to alleviate symptoms without actually addressing the fundamental root cause of the condition. Avoiding the latter means we are just performing band-aid medicine, a temporary fix, a solution of sorts, improving function for a while perhaps, but underneath the same rot continues and just leads to another condition elsewhere in the body, that we then attempt to fix, mend, medicate, replace or repair, again without addressing the foundational ill. And so the cycle continues – the multi-symptomatic patient is now commonplace, as nowhere along the line has anyone stopped to address the root ill.

The ever-increasing number of conditions associated with lifestyle choices or which are called ‘lifestyle diseases’ tells us very clearly that the way we live every day is important, the choices we make matter, that we are in fact responsible for the quality of our own health. The WHO has stated that non-communicable diseases are the leading causes of death globally and that they are unequivocally largely preventable by changing lifestyle, in particular, diet, exercise, alcohol and smoking. 

Lifestyle encompasses much more than those four components – it is in fact about every choice we make in our daily lives including, for example, how we are emotionally. Over 90% of heart disease is likewise due to lifestyle choices and therefore preventable. Increasingly more and more evidence is accruing that shows the role of lifestyle in many conditions – from arthritis to diabetes to cancer, depression and many more.

How much evidence do we need before we stop and consider what is actually going on?

How much evidence do we need before we stop and begin to take responsibility for the way we are living, rather than continuing to poison our bodies and hope the medical system can put us right?

The way we are living is killing us – it may take many years – but nonetheless it is killing us. Whether it is from heart disease, diabetes, lung conditions or cancer – the buck starts and stops with us, and the way that we are living every day.

Consider the possibility that illness and disease is the body’s way of getting rid of all that we have accumulated through literally poisoning our bodies with the way we have been living. It offers us a chance to clear and heal what we have done to ourselves, and an opportunity to become more aware of our choices, and the consequences of them.

Furthermore, what if instead of seeing illness and disease as something bad, we saw it as the body’s way of bringing us to a stop, saying “please stop what you are doing to me, please change the way you are treating me, please change the way you are living, please stop putting food, drink, drugs, toxic emotions, critical thoughts and more into me that are harming for me, please be gentle with me, please look after me, please listen to me.”

Would these understandings transform our relationship with illness and disease?  Perhaps instead of seeing illness and disease as something to be gotten through or gotten over so we can return to our ‘normal’ lives, we would see it as a message that the way we are living is literally hurting, harming and eventually killing us. We then have the fantastic opportunity to change the way we are living, to examine our choices and to consider just how well am I treating my body – a body that is highly sensitive, delicate and tender and which does respond to lots of tender loving care, from ourselves first and foremost!

Many of us carry beliefs about ourselves that are not true – beliefs like we are not good enough, we are not worthy, not lovable, are bad or flawed in some way – and these beliefs can be hidden deep inside, but they feed into how we feel about ourselves. How we feel about ourselves then feeds into the types of choices we make and behaviours we have – so the better we feel about ourselves, the more care we will take in looking after our bodies, listening and responding to their needs, instead of over-riding those messages or partaking in behaviours that we know and can feel are not good for our bodies.

What we have to all realize is, we are all worthy of the deepest love, care and affection – from ourselves first and foremost! We do not need to achieve it or earn it or work hard for it, but we can start choosing to live it by the daily choices we make. 

The relationship we have with ourselves is the foundation to true health and wellbeing, as it will feed into every other choice and relationship we have – be that with food, work, sleep or people. It is the bedrock upon which we stand and the degree to which we allow abuse of any kind into our lives and our bodies, or not. And it is this relationship which medicine has failed to address in its approach to illness and disease, thus perpetuating the merry-go-round cycle of band-aid medicine, poly-symptomatic patients, and ever increasing rates of lifestyle related conditions.

The key to healing is founded upon a true relationship with ourselves first and foremost – a relationship that knows there is a part of us that is unaffected by any illness or disease, that remains pure and unspoiled as the day we were born, and which understands that illness and disease itself is a message from our body that we have wandered astray from living in a way that is truly caring and loving for our body, a message that comes not with punishment or blame, but simply the choice to observe and FEEL: What needs to be released, let go of, stopped or changed for me to deepen in love and care for my body?

 

.

Yes Eunice, it's one thing to

Yes Eunice, it's one thing to consider the possibility that we have some role to play in the illness that comes our way, but it is a huge shift to truly live and understand it as a blessing. Whilst on the surface this may seem like a denial of the very real physical discomfort we feel, the deeper fact remains, that to carry on existing in a way that is hurting ourselves, as if nothing is wrong is surely a much greater injury than any physical throb or niggle.
08 Mar

The True Power of a Woman ..

I have read a few articles recently about the oppression of women in Ireland; the refusal of the Irish and Northern Irish governments to recognise the right of a woman to have agency over her own body, her reproductive rights and the fundamental right for her to choose whether to allow a pregnancy to proceed or not should she choose to have an abortion. Being pregnant out of wedlock led to young women, in the not so distant past, being detained like prisoners in the Magdalene Laundries – shamed into hiding for partaking in an act that is a natural expression of all human beings.

The fact of the act being committed was revealed in the bulging abdomen of the resulting pregnancy and with no ring on the finger – well clearly a sinful crime had been committed. One that warranted not only locking away from the eyes of the ‘good-living’ people, lest they should be tainted by such a sight, but the enforced removal of those children from their mothers and selling off to the highest bidder – now that is a real crime. Some would call it trafficking – yet it was carried out by the nuns of the Catholic Church, who were supposed to be representatives of the love of God and Christ.

The lack of love, charity and compassion are all too apparent when we stand where we are today and look back – yet it was condoned and supported by prevailing attitudes and beliefs of the day, beliefs that were largely, if not totally, inculcated by the Catholic Church. The Catholic Church, indeed Christianity overall, has a longstanding history of male domination and supremacy with oppression of women that is still active today. ‘Barefoot and pregnant’ was considered the optimum state for Irish women to be in along of course with being ‘chief cook and bottle-washer’ and obedience to the so-called ‘Master of the house’ was expected.Christianity, and the Catholic Church in particular, have an entrenched fear of women and sex, perhaps harking back to Eve – the evil temptress who lured Adam to his fall. Even today in what is supposed to be Modern Britain – a woman is still blamed and shamed should she be molested or raped whilst under the influence of alcohol or if she happened to be wearing a short skirt and is assumed to have been ‘asking for it’, with little responsibility being laid at the feet of the men who commit such crimes.

But why is there this fear of women in the Church? Is it all down to the fear of the evil temptress seducing a man who has no control over himself or his penis? 

What is really going on?

And how have we as women played into the hands of those who would perpetuate this patriarchal domination and supremacy?

What if the key to addressing this domination is not just a case of men piping down, coming to their senses and realizing we are all equal (which is of course needed), but that we as women also need to step-up and reclaim our true power in order to bring true harmony to our relationships?

What if patriarchal domination and male supremacy have been around for sooooo long and are deeply entrenched in many spheres, partly because we have been submissive and given our power away to men? OUCH!

If we subjugate our own needs and what we feel is true in order to please, not rock the boat, to keep the peace, to be accepted, to be seen, to earn a modicum of affection, to be liked and ultimately to be loved and not rejected – then we are also contributing to and partly responsible for the ongoing reign of male domination and supremacy. A BIG OUCH! A sobering thought perhaps – but one that needs to be considered if we are to truly address these issues in a way that is effective and not just produce a knee-jerk emotive response that doesn’t really get to the heart of the matter.

It becomes even more apparent when we consider the many ways that we as women not just subjugate our own needs but accept levels of abuse from some men that are deeply harming and in no way loving. Abuse is abuse – be it physical, mental, emotional or sexual – and none of it is loving or comes from love. Perhaps stating the obvious – but it needs to be said, for how many women stay with and put up with levels of abuse in order to have a partner, a husband, a boyfriend rather than being on their own? How deep is the lack of self-worth that we as women would prefer to stay with someone who abuses us, rather than be in our own loving company?

But perhaps the question is - are we truly loving in our own company? Do we hold ourselves with the same quality of love, care and kindness as we do for those we say we love or are we harder, more critical and judgemental of ourselves than we are to our friends or lovers? Are we truly gentle, tender and nurturing with ourselves, do we value and deeply appreciate all that we bring to the world, honouring our sensitivity, our delicateness and preciousness – a preciousness that is innate in every girl and woman.

Do we ever stop to appreciate just how delicious we are?

What if the Catholic Church fears not the evil temptress but the true power of a woman? It’s not the sexual seductress or the ‘hysterical’ emotional female that they fear but the divine glory of a woman in her true power and, dare I say, a woman who is Godly. Yes indeed, we may hear of Godly men but how often do we hear of Godly women – not the stereotypical humility, poverty and chastity of a submissive nun but a woman who is fully in this world but not of this world and knows it, a woman who embodies the fullness of love that she is and who is truly powerful?

Such a woman does not need approval from the Catholic church or any church or any body of people to live her life the way she feels to, she does not need to be liked or accepted, recognized or identified by anyone, for she lives knowing the truth of who she is, directed by an inner compass that guides her through the paths of life. Be the waters stormy or tranquil, she remains steady, consistent, dispassionate, calm, centered, gracefully gliding through with equanimity to the travails before her or around her. She is not given to emotional outbursts, rage, frustration, jealousy or anger and never does she compare herself detrimentally to another woman. She is attuned to a quality within herself that she knows herself by, a quality of stillness that is loving, joyful and harmonious. Such harmony is reflected in her innate ability to live according to her natural rhythms and cycles, in tune with all of life, yet unimposed upon by the outer tempo and fast pace of human life. She knows that by deeply honouring the sensations and feelings of her own body, that she is connected with all of life and has access to the wisdom of the ages.

She does not need to wear short skirts or sexy clothes to feel sexy – for she owns her innate sexiness – a natural confidence and joy of being who she is in her own body with no desire to be someone else or to be like someone else. She knows her true beauty and that of every other woman comes from within and is not defined by clothes or jewelry or outer accoutrements. That said, she does not hold back in expressing her essence and glory through what she wears, which for some may be short and sexy or bright, bold and dramatic, while for others it may be subdued, romantic, classic or natural. She does not dress to gain attention or to impress but wears the clothes that express who she is, in accordance with her inner knowing of exactly what is needed to be worn that day or evening.

A woman in her true power does not need a partner or children to feel whole and complete – she knows she already is that, and she brings all of her to all that she does including to her partners. An intimate partner for her is not about finding someone to fill the gap or hole of emptiness and the unmet needs but to grow and evolve ever more deeply in and with love with another that is then reflected in her relationships with all. She does not need to be a mother in order to mother – for a woman in her true power holds all equally in the womb of her loving gaze. She has the power of a smile that can melt the hardest of hearts, and her presence and light are felt and seen by all when she enters a room, whether they are aware of it or not.

Her eyes twinkle and sparkle reflecting the light of the stars, but she is not star-struck or hungry for fame. Playful and lighthearted she is a joy to be around. Intelligent and wise she knows more than her years portray, a wisdom borne of lifetimes of choices and lessons learned. She is responsible for her life and her choices, for she knows that how she lives matters, the quality of her choices matter, the way she moves, speaks, thinks, acts – everything matters.  She no longer entertains abuse of herself by herself or anyone else and is willing to call it out that others may know what is abusive and what is love.

She is sassy and sexy, beautiful and divine. 

For this Godly woman is not anointed or ordained by any church or religion in the land but lives from the God-given purity of the love in her own heart. A purity of love that has the capacity to hold the world and all of humanity with love, irrespective of their errant ways, a love that does not need to forgive for it never condemns nor judges. A love that observes all, holds all, heals all and reflects to all that they too are that love.

This is not a utopian ideal or made up caricature of a woman that is ‘too good to be true’ – for the true power of a woman lives in every woman in the land – but we have to live it and claim it and no longer persist with out-dated beliefs and absolute lies that we are not worthy, not loveable, not beautiful or any other denigrating view. An unfolding process, a work in progress for all of us – but it is a work worth progressing and living to the full.

No wonder then the Catholic Church fears such a woman, for it would be exposed as the sham and loveless institution that it is, with no resemblance to the true love of God. A love that knows men and women are equal; that being gay is not an ‘abomination’ but a natural expression and the love between two gay people is just as valid and deep as heterosexual people and ought to be honoured, respected and blessed in the commitment of marriage if it is so chosen; and that women have the right to have agency over their own body and their own lives with no need for guilt or shame should they choose to have an abortion for their own valid reasons. A love that loves and holds all equally so, no matter the story that be told.

Let us not allow more generations to pass where we as women remain submissive, subverting and subjugating our own needs, accepting abuse and loveless relationships and giving away our power to men out of a lack of love for ourselves. Let us own our own part in this dynamic and not sit waiting for men to change or to ‘get it’; we have to do our part and claim our true power, live and express from the innate stillness of love that lives within us all; for it might just be that when we claim our true deliciousness and preciousness, it allows men to claim their true tenderness and sensitivity and be the true gentle-men they innately are.

Now that’s a true win-win.

 

Addendum: If there is no true equality, then there is no true love - and is one reason why I say the institution of the Catholic church is loveless - as it is clear there is no equality in their all male hierarchical structure. This does NOT refer to the many loving and caring people who subscribe to the Catholic church and should not be read as such. I also fully respect the right of all to follow the religion of their choosing.  

Thank you Eunice

Thank you Eunice - this is such a beautiful and accurate expression of the qualities women actually carry. How far this world is, with its many institutions and systems, that do not allow and foster this very natural Divine expression. The true evil in this needs to be exposed, and equally we each can bring our awareness more and more to the choices we make that do not allow us to be the power-full women we are.

Wow, what an amazing

Wow, what an amazing description of a woman in her true power - I am inspired!
05 Mar

Breaking the shame and stigma of mental illness..

This blog was first published on KevinMD as "We are human beings before we are doctors". 

Mental illness has long been associated with shame and stigma. Although progress has been made through the efforts of global celebrities like Stephen Fry and many others to de-stigmatize mental illness – many are still ashamed to admit to it and the stigma is far from being annihilated.

Nowhere is this stigma more entrenched than within the Medical profession itself. A fact that should shock us out of our judgmental slumbers and wake us up to ask: What is really going on?

Anxiety and depression are equally prevalent in the medical profession as in the general population and more worryingly, addiction and suicide rates are actually higher than the general population. So there is no doubt that medical professionals are not immune to mental illness – indeed the opposite is true – for it seems that a medical degree is in fact hazardous to one’s mental health; hardly an advertisement for the profession!

It is hypocritical to talk about having compassion for patients who have mental illness when we still hold such stigmatizing views of it within the medical profession. It's as if we think it's ok for the group of human beings we call ‘patients’ to get it, but once we cross the medical threshold we enter a culture where such conditions are not permitted, nor admitted to.

Why is this?

Do we believe that a medical degree should render us immune from such ills?

Is it because we feel we should know better than to get ill?

Do we believe we are some sort of superhuman species, different to ordinary mortals or the group we call ‘patients’, that means we do not get affected by such conditions?

Do we (perhaps arrogantly) think that because we are intelligent we shouldn’t get ill?

Do we fear being perceived as weak, not coping, or perish the thought…. that we have failed in some way?

Doctors are high achievers, often perfectionists, with little tolerance for any element of perceived weakness and a profound allergy to any kind of failure.

Do we feel ashamed because despite our intelligence and our medical degree we have not been able to stave off the onslaught of illness and disease, and in this particular case, mental illness?

Are we in career fear? Concerned that any such admission will automatically compromise our present and future career prospects? Whilst there may be incidences where that is true depending on the severity of the problem – is it our default to assume it will be so and thus negate any other possibility?

Do we perceive a doctor who has been mentally ill to automatically be a less capable or competent doctor as a result?

Is it possible that someone who has recovered from mental illness will have a greater insight to the condition and be more able to relate to patients and provide a more understanding and healing presence than someone who is standing aloof in their ivory tower of perfectionism?

Will those who have come out the other side of mental illness possibly be stronger for the experience, not weaker? It is impossible to generalize for every scenario – but rather than assume the worst, we need to allow the space to consider and allow for the opposite: that healing from mental illness can and does occur and can lead someone to be in a stronger position than they were prior to the experience.

Doctors are just as human as everyone else and we are subject to the same ills everyone else. We are human beings before we are doctors, but this seems to be forgotten after entry into medical school and we become immersed in the medical culture where fear of admitting to any ill is far greater than our levels of acceptance that we too can get ill.

But there is little point in talking about having understanding, acceptance and compassion for patients if we do not have those same qualities for ourselves, or our colleagues, when similarly afflicted. If the stigma and shame associated with these conditions is to be truly dissolved then we need to take the lead, to be open to raising and discussing this within and without the profession and show the world by our example that there is no shame in being ill  (mentally or physically) – but there can indeed be tremendous healing, if we are open to it.

One of the steps involved is abolishing the separation of mental and physical illness and the assumptions that go with them. Just consider how we treat or judge people differently according to the condition they have. For example, observe within yourself the immediate judgments or perceptions that come to mind when you think of someone who has:

1)    Cancer

2)    Diabetes

3)    Heart attack

4)    Depression

5)    Schizophrenia

6)    Anxiety

7)    Alcohol Addiction

8)    Genital warts

9)    HIV infection

10) Obesity

There is this notion that those who have a physical condition are more worthy or deserving of compassion than those with a mental ill health condition, but if it is perceived to be a condition that is in some way self inflicted like a sexually transmitted disease, addiction or obesity, then forget about compassion altogether – ‘you deserve it’ – or so the thinking goes. However, with the increasing recognition of the role of lifestyle in many conditions, the number that are not self inflicted in one way or another is ever diminishing. 

The point is, it is irrelevant whether the condition is physical, mental or considered to be self-inflicted or not – the true response to those who are ill or suffering in any way is to bring understanding, acceptance and compassion. To see the true person behind the condition whatever the condition may be, a person that has a body and mind that are intimately interconnected and interdependent. To see the body and mind and treat them as two separate parts is archaic, unscientific and totally flawed and only perpetuates the stigmatization of those with mental ill health conditions.

Physician Heal Thyself: Before we can offer healing to another we need to heal ourselves, and as long as we continue to stigmatize ourselves and others in the profession who have or have had mental illness, we will never be able to offer true healing to those we treat. If we in any way see ourselves as ‘other’, ‘different’, ‘superior’ or ‘better than’ those we call ‘patients’ then we are setting ourselves up to have our hubris tempered with a fall. It behoves us to address the mis-beliefs that currently pervade the culture of medicine regarding ourselves and illness and disease and it is imperative we find a new narrative – one that is accepting, allowing and healing for all.

 

I agree, there is a sense of

I agree, there is a sense of omnipotence and an unrealistic expectation of perfection in the medical field. Maybe our job is not more stressful or the work is not harder than other jobs but maybe it is our own isolation in our ivory towers and lack of vulnerability that leads us not to ask for help or admit we are not infallible. Maybe if we accepted that we do feel lonely, afraid and insecure at times we could start to heal. We could start to see ourselves in a more compassionate light and see others in the same way. Maybe, instead of us in here and you out there, we could all be somewhere together.
23 Feb

FIRST Trial in Surgery Explained: Surgeons are NOT human! ..

The FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees)1 trial randomized American surgical residency programs to one of two arms – either to continue with their current standard restricted hours practice of 80 hours per week with time for breaks/rest and a limit to hours of work at any one time, or to have ‘flexible’ hours which involved removing current restrictions on hours worked at any one time and waiving the need for breaks etc., whilst somehow maintaining the same overall 80 hour per week averaged over four weeks. Data was collected via systems and surveys that are already undertaken in the USA to establish if there was any detriment to the patient or the surgeon.

It has often been considered by those outside and inside the profession that surgeons are not human (possibly subhuman or superhuman depending on your experience!) – and now we have it confirmed, as this trial, which included an intervention that impacted human subjects (I am making the assumption here that trainee surgeons are in fact human) – was somehow classified as ‘non-human subjects’ research, thus not subjecting it to a more in-depth review.

How did it get classified as ‘non-human subjects’ research?

A look at the supplementary information shows the box was ticked that claimed it was LIMITED to the use of existing or collected data. Whilst the study team did not collect primary data and other sources were used, it was not solely limited to that. An intervention was applied – an intervention which, whilst it was applied to residency programs, impacted and affected the lives of human subjects and was therefore not limited purely to the collection of data that already existed or was being collected. Calling the intervention a ‘policy change’ that randomised residency programs (not individuals) does not take away from the fact that this research involved an intervention that affected living human subjects. Has the correct box been ticked? Has there been fudging of information so as what is in fact human subjects’ research is somehow classified as not? All very convenient when you have a specific aim and agenda to fulfill with the backing of the American College of Surgeons, the American Board of Surgery and the Accreditation for Graduate Medical Education – I imagine any IRB (Institutional Review Board) would have difficulty contravening the weight of those establishments!

I also question how it is possible to maintain 80 hour week average over 4 weeks for both groups and yet have one group work normal duties plus waive all restrictions on their work hours? Sounds like magic to me – how to make 100 hours of work fit into 80! There is no mention of days off in lieu or how the study arm group limited their overall hours to 80 per week. And what is even more concerning is the statement that ‘monitoring to ensure strict adherence to study arm conditions was not undertaken’ or in other words, ‘we have no idea if the total hours worked in the study arm exceeded 80 or not and we don’t care if it did.’

Even the use of language in this paper is misleading – calling the study arm group the ‘flexible working hours’ group when really there is no flexibility – it is prolongation of hours. Flexible hours implies one can decide to start late or finish early – neither of which are options in this trial.

It is clear that from the inception of this trial that there was a predetermined agenda to find that long hours were not detrimental to patient care or quality of wellbeing for trainees. Using gross measures of outcome like patient mortality is also not an accurate marker as teams of nurses and doctors – not just one trainee – care for patients. More sensitive measures of outcome were not utilised.

It does report that there were subtle differences in wellbeing, with those in the ‘flexible’ hours group reporting negative effects on activities away from the hospital like time with friends and family, extra-curricular activities, research time and rest/health – again suggesting that the 80 hours limit was most likely exceeded or else they would have had the same amount of time outside work.

In addition, they report that the resident survey was conducted half way through the trial, not at the end of the trial, when a bigger discrepancy may have been noted. Surgeons are pretty resilient, they want to work hard and do well for their patients, often to the detriment of their own health and wellbeing, and are used to overriding bodily needs, often priding themselves on their levels of stamina, endurance and ability to go not just the extra mile, but perhaps the extra marathon. But if there are differences at 6 months, what would they be at one year? At 2, 5, 10 years, at 20 or 30 years?

If there are no detrimental effects to long hours of work then why are burn out rates amongst surgeons in the USA around 50%?

This perception of not being human plays out in many ways. We arrogantly believe we can work extremely long hours yet not get affected or have our work or our own health detrimentally affected. I used to be of that view too. Proponents of this trial will say that this is the case and that it has been confirmed or validated by trial, opening the door to abusively long hours of work once more. Yet other humans like airline pilots and lorry drivers are restricted in their hours of work because it has been shown that human error increases with fatigue. So is the answer that surgeons are indeed not human and not subject to the same laws of life as everyone else or is something else going on?

As trainee surgeons, we love what we do and we are happy to spend long hours in theatre or at work, to provide good quality care and to get the experience needed to be a competent surgeon. I get it. I’ve been there, done it, got the tee shirt. And nobody would have convinced me otherwise. I was a strong proponent of such a system. I have experienced both ends of the spectrum – working continuously 24/7 with only 48 hours off somewhere between every two to six weeks, with night after night of sleep deprivation culminating in a cotton wool head where I could hardly string two words together. I remember handing over to my colleagues on a Friday evening at 7pm, when I was going off for 48 hours, and hearing them fall asleep on the end of the line as they continued on duty. One even recounted how he fell asleep whilst assisting, standing up! And we think all of this has no effect on our performance or wellbeing? Come on!

If there are no detrimental effects to long hours of work then why are burn out rates amongst surgeons in the USA around 50%?

It’s not rocket science! Yes, multiple factors contribute to that, but we have basic human needs that, if we override for long enough, will come back to bite us in the bum.

On top of that there is all the research showing the detrimental effects of sleep deprivation and an association with a multitude of conditions like heart disease, diabetes, dementia and more. Our lifestyle is a major determinant of our health and wellbeing – and whilst we may not believe or notice these effects when we are young, they undoubtedly take their toll on the human body over time. This does not mean we cannot work hard, but we have to know how to do that in a way that is not detrimental and that is currently not mainstream knowledge and is certainly not part of surgical training.

I have also worked in a system where hours of work are restricted and I know the frustrations that can come from there being a lack of continuity of care by junior staff. I understand the surgical mindset that laments the days of yore – but those days, at least in the UK, are gone. It is not about returning to those days, but how do we improve our systems, structures and personal levels of wellbeing such that quality of patient care is maintained? I know from personal experience there is much we can do to help ourselves so that we can work hard, play healthy, and not get so detrimentally affected by the work we do. John D Birkmeyer reaches a similar conclusion in his editorial on this trial, that surgical leaders, rather than endeavouring to turn back the clock, should focus on developing safe healthcare systems that ‘do not depend on overworked physicians’.2

And so whilst I fully appreciate the need for continuity of care and high quality surgical training, I also am acutely aware of the need to not abuse trainees in the process or to have them exploited by programs and people who do not care for the wellbeing of the trainee and assume that just because they did it, everyone should do it.  

If we do not care for ourselves, we cannot provide a true quality of care to others – for we cannot give what we do not have. A trainee who is self-caring, alert, vital, vibrant, aware and fully present undoubtedly delivers a quality of care that is superior to one who is tired, exhausted, sleep deprived, falling asleep on duty, and who overrides their own bodily needs. The environment within which we work can be supportive and engendering of such qualities or it can be highly abusive and detrimental to the trainees’ own wellbeing – and trainees in pursuit of their dream job are all too often only too willing to subjugate their own needs for professional progress.

It is common sense that excessively long hours of work are detrimental to our own health and wellbeing and affect performance – it does not even need a trial to tell us this, as our own bodies will do the job if we listen to them honestly. So just for the record – surgeons are human, not superhuman, we have the same bodies made of the same stuff as everyone else, we get just as tired and detrimentally affected by persistently long hours of work devoid of self-care as other professions, we are perhaps just better at denying, ignoring and overriding the fact that we do. 

Unfortunately this trial belongs to the waste paper bin for it is nothing more than a biased, pre-determined, agenda-laden study, undertaken on false pretences of being a non-human subject study designed to permit the ongoing abuse and exploitation of trainee surgeons – who themselves are often so enwrapped in their desire to pursue a surgical career that they do not even recognise when they are being abused or when they are abusing their own bodies.

Having been there myself – I know it only too well.

In the words of Dr Marcia Angell, the former editor in chief of the New England Journal of Medicine, ironically where this study was published:

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”3

  

References:

1)    Bilmoria, K., Chung, JW., Hedges, L., et al. (2016). National Cluster Randomized Trial of Duty-Hour Flexibility in Surgical Training. NEJM Feb 2 http://www.nejm.org/doi/full/10.1056/NEJMoa1515724#t=article

2)    Birkmeyer, JD.,(2016) Surgical Resident Duty-Hour Rules – Weighing the New Evidence. NEJM Feb 2 http://www.nejm.org/doi/full/10.1056/NEJMe1516572

3)    Angell, Marcia (2009) Drug Companies and Doctors: A story of corruption. In the New York Review of Books.

http://www.nybooks.com/articles/2009/01/15/drug-companies-doctorsa-story-of-corruption/

 

Why are burn out rates amongst surgeons in the USA around 50%?

Interesting article, thank you. I'm not sure I've understood the answer to this question. As a US surgeon trained before, and then just at the start of the work hours reduction, I initially had high hopes for what a sane work schedule might do for my profession. ("What, wait, it's been REDUCED to ONLY 80 hours? ONLY 80? What were they before?" my non-surgical friends asked.) What I've actually observed is that high achieving, young surgery residents do not decrease their sleep deprivation just because their work hours are limited by government intervention. They do what their 30-something peers do - they stay up late on the internet, they go out and look for mates, they spend the whole night in the ER with their sick kids, they do not 'clock out' and go home and take care of themselves. Perhaps what is needed for the 50% of surgeons burning out is serious training in maintaining personal resilience rather than mandating an external limitation.

Eunice that research is

Eunice that research is counter to what commonsense and experience clearly tells us - who has not experienced the fuziness that comes from being overtired, and the poor choices in self-care that are made when one is in a state of exhaustion. The quote by Dr Marica Angell is also very telling - 'research' appears to be used as a sophisticated means of 'justification' in many cases, and without a basis of intent to uncover the truth. Hands up any one who wants to be cared for my a surgeon towards the end of an 80 hour stint without a break!

Revealing Eunice. This makes

Revealing Eunice. This makes a nonsense of 'evidence based research'.
23 Feb

"Liver Transplant Surgeon Addicted to Alcohol"..

This blog was first published on KevinMD as "can we truly heal another if we can't heal ourselves."

.............................................................................................................

“Liver Transplant Surgeon Addicted to Alcohol” – reads like a headline from a tabloid paper selling sensationalism.

How could it be?

How could a liver transplant surgeon, someone who sees up close and personal the devastating effects of alcohol on the body, be addicted to alcohol? Surely the diseased, fibrosed, hard, shrunken cirrhotic livers with dilated and engorged veins that can rupture and bleed catastrophically; the yellow eyes and skin of the patient with end stage liver disease; the muscle wasting, the confused and addled brains in a body unable to clear the toxins; the smell of imminent death – would be enough to get someone to see the error of their ways and cease drinking alcohol excessively? Or so the thinking goes.

It seems the ultimate irony – that someone who is intelligent enough to study medicine and train as a surgeon to know about the body, health, illness and disease, who intimately knows the harm that alcohol wreaks on the body both personally and professionally, who helps others survive the life threatening condition of alcohol-induced end stage liver disease through liver transplantation – finds they are unable to help or extract themselves from the grip of alcohol addiction.

It’s in the realm of the incredible, the ‘hard to believe’ or perhaps even the ridiculous or crazy. Is such a person just weak? Stupid? Irresponsible? Foolhardy?  Incompetent?  Blind? Morally bankrupt? Ethically deficient? Devoid of sense and reason? Or is there more to it?

What is it that drives someone to continue to abuse herself with a substance that she clearly knows and can feel is harming and can see the full detrimental consequences in vivid technicolour detail? If working with patients with end stage liver disease isn’t enough to ‘make someone see sense’, to correct their errant ways and stop drinking excessively, then what on earth would?

It takes a certain level of stamina and a bucket of stubbornness to go to work with a hangover day after day, to put on the face that says, “I’m fine”  – when clearly everything else says otherwise. The professional face of the successful surgeon, who works hard, demands high standards of themselves and others, stays late at work, puts their utmost into the job of caring for patients, but paradoxically is unable to truly care for him or her self.

But can we truly care for another if we are not caring for ourselves?

Can we truly help another to heal if we too have the same ill and are not yet healed ourselves?

Is this a case of the wounded healer who is just as or maybe even more wounded than those they are in the process of healing perhaps?

Those long days of stress and tension, “have I made the right decision,”  “should I do this…or that…?” the worry and fear of getting it wrong, making a mistake, harming a patient or even worse….all seemingly eased by the nocturnal consumption of liquor; blotting out the day, numbing the stress and tension, taking the edge off the worries and fears. Yet it never quite seems to do the trick…and another day dawns and we have to face it all again.

Each day of recurrent poisoning with alcohol adding to the cumulative weight of sorrow, shame and sadness that comes with all the previous days of broken promises – ‘tomorrow I’ll stop’, ‘today is the last day – I promise’...and not living true to ourselves. 

For we know we are slowly but surely killing our self-respect, killing our self worth and ultimately killing ourselves. It saps our energy, our will and motivation, ‘getting through the day’ is just enough – until the call of the thirsty beast reigns once more and any thought of stopping is cast aside along with another chunk of our self-respect.

We did not come into this job to help others heal, only to end up hurting ourselves – something, somewhere has gone wrong. The individual stories and experiences are all unique, the tales told of trauma and suffering vary, but what is true for every person addicted to alcohol – be they a doctor, nurse, liver transplant surgeon, banker, mother, priest, hairdresser, secretary or homeless person – is that they are already hurting inside.

No amount of intelligence, degrees, achievements or accolades can assuage emotional pain – a pain that Medicine has largely ignored, denied and dismissed  ­– just like the addict. It is a pain that is buried, sometimes deeply so, often with feelings of self-hatred, self-loathing or even disgust – feelings that we don’t want to feel and thus choose our numbing vice.

For the addict to heal, the denial must cease, the hurts and traumas admitted and exposed to air, to be felt and dealt with, understood, allowed and accepted, in the knowing that we are not our sadness, our pain, our anger; that any feelings of self-hatred and self-loathing are not who we are; that we are greater than we consider ourselves to be; that we are actually worth loving and caring for, first and foremost by ourselves.

There is an age old saying that ‘love heals’ and in this case it is the only true healer. Coming to know, understand and feel that we all have a loving essence that is unaffected by any trauma, hurt, abuse or wound provides a platform upon which we can feel, deal with and heal our hurts. No hurt, no trauma, no abuse is immune to the healing power of love.

And so like the addict, Medicine too must cease its denial if it is to heal the wounds that currently afflict the profession. Its arrogance has been somewhat humbled, its hubris tempered, for a medical degree does not render us ‘superior’ or ‘better than’ any other person. We have been put on pedestals and we gladly jumped up there too, we enjoyed the ‘Godly’ status, the power, the superiority of knowing more and flaunting our intelligence to feel better than – lest it should be exposed that we actually felt unsure, uncertain, insecure, incomplete, weak, vulnerable, imperfect or not good enough.

But we are just as fallible as every other human being on the planet, we get hurt, wounded and traumatised by the process of life and growing up in a world that has relegated love to the bedsheets, Valentine’s day, romance, a partner, friends & family, chocolate, ice-cream, wine, dogs, or something that is pink and fluffy and definitely not for the serious business of science, medicine and healing. The price of our arrogance and ignorance has already been too high – let us not continue to tread the same well-worn path. The time is ripe for change, for openness, transparency and healing.

How many more suicides will it take? How many more addicted doctors do we need? What level of burnout is required…. before we say ENOUGH!  The fact that doctors have higher levels of suicide and addiction than the general population, that 50% are burnt out, should already be more than enough to call for a radical overhaul and re-think of how we train and work. What will it take to humble the arrogant lens of the scientific mind further, to be open to other ways of understanding human beings, life and illness and disease, to expand our horizons and to reawaken to the truth of the fact that love is the greatest healer of all?

It was love that saved this liver transplant surgeon and healed my addiction to alcohol such that the desire to drink alcohol has been completely annihilated, for the level of regard, respect, love and care for myself and my body means such abuse is no longer entertained. This love, by the way, is an inside job – no partners, dogs, chocolate or pink fluffy clouds required.

Medicine is suppose to be the caring profession – but when it comes to its own, it is punishing and blaming not healing or caring. It likes to think it can keep addicted doctors hidden from view; the culture of fear prevents doctors from speaking up and so the façade that there is ‘no problem here’ is maintained whilst the profession is crumbling to its knees. It is time for medicine to cease punishing people for suffering, and to start being a truly caring profession by first of all caring for those it trains and employs.

It is common for such admissions of addiction by doctors to be accompanied by anonymity, amidst the fear of professional regulation and reputation damage. But we can never heal that which we keep secret within, and that goes for organisations too. 

And so “Liver transplant surgeon heals addiction to alcohol” –  you decide – a story to share to breakdown the myths of addiction, that others may know there is a way out of that prison, or one to keep to myself, hidden from the world, lest I should be punished for bringing the profession into disrepute by ills of the past? Which one is the caring, healing and loving act?

We cannot give what we do not have, so just as we as individuals need to love ourselves to love another, so too does the profession of medicine need to reintegrate love into medical education if we are to engender doctors that can work hard, play healthy and truly assist those seeking healing, by firstly healing ourselves.

 

thank you for such an

thanks Aidan for your comments and feedback - much appreciated. You are right - the wheels of medicine turn slowly and the culture of medicine even slower! But it is currently being brought to its knees and that perhaps will allow some humility to see a different way. 

"Liver Transplant Surgeon Addicted to Alcohol"..

Hi, Your article states clearly an obvious truth to those who see Love as you and many others do (including myself). It also places an onus on the medical profession to rethink its place in the world. There is a book by Matthew Syed called 'Black Box Thinking' that investigates why some organisations/professions learn readily from their mistakes and others do not. Medicine unfortunately is among those organisations/professions that have a culture that is not open to self-examination or the admission of mistakes. Such organisations/professions are exceptionally difficult to change from within. But one of the necessary prerequisites for change is for enlightened voices within the profession to show leadership and demonstrate how things can be in the future rather than how they have been in the past. You are to be highly commended for taking a much needed and positive stand to show what needs to be done both at a personal level and at an institutional level. Given your own personal difficulties and self-transformation your voice has the true ring of authenticity. Aidan
08 Feb

How do we as surgeons deal with our mistakes? ..

This blog was first published on KevinMD entitled "How do surgeons deal with their mistakes" and is re-published here as well. 

As surgeons we are privileged to have our hands work inside someone’s body with the intention of alleviating suffering, removing sources of pain, excising diseased organs, fixing this or that, ultimately to improve someone’s quality of life, prolong it or at times even save it.

Yet we also know that people can suffer complications from surgery, that in some cases are fatal, and where our good intentions seemingly backfire. Patient deaths and complications can be related to the quality of the body that the patient brings to the operating table, as well as technical factors that occur during an operation and errors of judgment or decision-making by the surgeon. The only way to totally avoid complications is to not operate – not a viable option for most surgeons or for the patients seeking help and where surgery is the mainstay of treatment!

Our intention is always to help, to care, to heal and never to harm patients – but how do we stay healthy when our healing intentions turn into actions that harm? We are all human, we are all fallible and we all make mistakes – but the price of our mistakes can be another person’s quality of life and even life itself.

People can and do die when we make mistakes.

How do we deal with these mistakes – both personally and professionally?

How do we make sense of them in the privacy of our own hearts and minds?

Do we internalise them and go on a feast of self-reproach, recrimination and judgment, punishing ourselves with our harsh words and thoughts, the long list of:

“I could have done this”

“I should have done that”

“What if I had or hadn’t done this or that?”

“How could you be so stupid?”

“What were you thinking?”

“You should have known that”

“You should have done better”

“You’re not good enough”

“Another surgeon would have done this or not done that”… and on and on the endless tirade can go. I know them all well.

Do we externalise them, deny we had anything to do with them and instead seek to blame anyone and everything outside of ourselves – the assistant, the scrub nurse, the suture material, the stapling gun, the blood transfusion, the instruments, the theatre temperature, the anaesthetic, the junior doctor, the nurse, the anaesthetist – you get the picture? Anything to not feel we may have had a part to play in someone’s surgical complication, or even his or her demise?

Do we bury them, suppress them and numb them with alcohol? A favourite drug of choice for many medical professionals (and one that I chose myself for many years)  – unless of course its grip takes hold and we spiral into the shameful cesspit of addiction – overflowing with the pain and hurts we have perceived but have had no idea how to address.

How many dead or harmed patients are swimming in the whirlpool minds of doctors who are addicted, and whose intentions were to help and heal; not maim, harm or kill?

Alcohol is just one such tool, but I could have used other drugs, food, sex, work, porn, exercise, gambling, over-achieving and on and on are the many forms and ways that we use to distract ourselves from feeling what is really going on inside ourselves, from feeling those things we don’t want to feel.

How we treat ourselves when such situations occur is reflected in how the system treats us. It is little wonder then that this translates into a culture of medicine that is equally harsh, punishing and blaming – even if it professes not to be! The professional bodies put their reputation over and above the humanity of the people they are in charge of teaching and regulating. They set curriculums devoid of care for the people they are supposedly training to care for others, and then wonder why there is a lack of compassion in the profession, when it has been absent from the culture of how the regulating bodies treat their subjects, how doctors treat doctors, how senior doctors treat junior doctors and how all grades of doctor treat medical students. And so the cycle continues.

Ask yourself this – has self-critique, judgment, reproach, recrimination, bashing, punishment ever worked?

Has it ever made you feel better about yourself or the situation?

Has it enhanced your level of acceptance of yourself or of the events that occurred?

If the answer is no – is it possible then that there is another way? A way that brings understanding, acceptance and healing to all concerned? A way whose voice is gentle, caring and loving, that understands there is a bigger picture to everything in life, that even though we may not know or be able to fully comprehend all the details, that ultimately there is an order, there is a reason for why things happen the way they do. A way where we can take a step back and begin to observe and have compassion for ourselves (and others) rather than judge, bash, and criticise ourselves (or anyone else).

For it is only when we start to nurture a more caring and compassionate way with ourselves that we will then grow, develop and nurture a culture of medicine that is equally so for all.  

We are all responsible for our choices and actions in any moment, but what if there are a host of seen and unseen factors that are influencing those choices and actions?

What if in any moment we are all doing the best we can, given our upbringing, our experiences, our culture, our religion, our education, our training, our relationships, our ideals and beliefs, our past hurts and traumas and so on?

And what if in the next moment we can always choose to be more caring, considerate, kind, compassionate and loving towards ourselves? In doing so, it then becomes a natural consequence that we will bring those same qualities to our patients and everyone else.

Why not give it a go and see what happens?

 As surgeons we do not intentionally kill or harm patients – but patients can die or their lives can be affected as a consequence of a complication of surgery that may be related to technical factors or errors of judgment or management by the surgeon. It goes with the territory; it’s part of the job, as any honest surgeon will tell you.

But what if there is much more to it, what if it’s not as simple and straightforward as we like to believe? What if there are other unseen factors at play that mean, although we are always responsible for doing the best we can to care for the patient in every way, we are not ultimately responsible for the trajectory of another’s life, including their death?

Staying healthy when I make mistakes – when my healing intentions are betrayed by technical complications or errors that may cause harm or even death ­– has required me to no longer deny, bury or suppress what I am feeling, but to feel it all and to understand that there is always a bigger picture than the one I see with my eyes, and that bigger picture has love and only love as its calling card for all.

 

02 Feb

Why Equality Legislature needs to Trump Discriminatory Religious Belief : the Gay Cake Case update..

I previously blogged on the ‘gay cake case’ as it is known – whereby a bakery in N.Ireland, Ashers, refused to bake a cake with the words ‘support gay marriage’ on it because of their Christian beliefs. They lost the court case and the judge ruled they had discriminated against the consumer who was gay.

Asher’s have decided to appeal the case, which starts this week. I read an interview with Daniel and Amy McArthur from Ashers bakery, in the Belfast Telegraph where they explain why they feel they have ‘done no wrong’. There is no doubt about their religious conviction and how they endeavour to live the teachings of the Bible and Jesus Christ as they understand and interpret them.

I agree with them that religion is not just for Sundays. Indeed a true religious way of being is something that permeates all aspects of life, including in particular how we treat all our fellow human beings on this planet - and the basis of that is to be with equalness and love - in recognition of the fact we are a one humanity, deeply interconnected and all Sons of God. A work in progress for sure for all of us but we ought not to lower the bar any less than that.

And this is a key point. Their defence is that it is a human right to express their (religious) beliefs at work – well, not if those beliefs result in discrimination against fellow human beings – for that is neither a right nor a belief, be it religious or not, that is worthy of upholding in any way, shape or form. So no, it is not a human right to express discriminatory beliefs of any kind at work, religious or otherwise. There is this arrogance that thinks just because it is a 'religious belief' that we have the right to express it even if it goes against our fellow man - well, no, we don't - that is just a fancy way of trying to justify that which in truth cannot be justifed - discrimination against another - which in this case is simply because of a different sexuality! 

Daniel and Amy McArthur sincerely believe that they are doing no wrong and that they are following the teachings of Jesus Christ and the Bible. And there are many in this country, N.Ireland, who would agree with them and support their views. However, even should all ‘Christians’, even all people, agree with them – that does not mean it is ‘right’, or the way of God, or the way of Jesus Christ. The number of people who agree on something is not an arbiter of whether it is true or not. Indeed, paradoxically, whilst endeavouring to live the way of Christ, they are in this example doing the opposite, for it is in my view profoundly opposed to the way of God and Christ.

The way of God, the way of Christ is the way of love, inclusivity, equality and universality – there is no room for any form of judgment, discrimination, ‘them and us’ or any form of separation or holding others as lesser in any way in the heart of God or the Christ. Equality legislature needs to trump discriminatory  religious belief as it is founded upon the truth of the fact that we are all equal, a fact that is deeply religious and intimately entwined with the true way of God. Equality is foundational and a basic pre-requisite to the living way of God, to see and know and treat all others as equal – anything other than that definitely does not come from God.

The source of universal omnipotent love thankfully does not have the prejudicial and judgmental mind of men! And is definitely not so petty as to rule out a section of his Sons just because they love the same sex! No, the opposite is true – for all are held in and with love irrespective of sexuality, gender, race, nationality or indeed religion. Gay people who love each other and are loving of their fellow human beings are actually displaying more of the qualities of Christ than those who profess to be Christian but who hold beliefs which cause them to discriminate against and judge their fellow human being. 

Peter Tatchell, a well known pro equality and gay rights advocate writing in the Guardian explains how he has changed his mind on the gay cake case as he now feels the ruling infringes vital freedoms and he says:

“This raises the question: should Muslim printers be obliged to publish cartoons of Mohammed? Or Jewish ones publish the words of a Holocaust denier? Or gay bakers accept orders for cakes with homophobic slurs? If the Ashers verdict stands it could, for example, encourage far-right extremists to demand that bakeries and other service providers facilitate the promotion of anti-migrant and anti-Muslim opinions. It would leave businesses unable to refuse to decorate cakes or print posters with bigoted messages.”

However, this argument is fallacious and does not stand up to scrutiny. NONE of these examples are based on true equality, love and respect for fellow human beings. And in my view equality legislation should act to prevent all such forms of discrimination and to call people to live to a standard that at the very least recognizes our common humanity and is not disrespectful, disregarding or hateful to others. Freedom of speech does not mean to freedom to abuse – we should not support any form of discrimination or hateful speech.

It is a sad indictment on our society and interpersonal relationships as human beings that we need equality legislature to uphold such a basic tenet of human life.

And so rejecting the appeal by Ashers is the true way to proceed to maintain and ensure equality for all. If religious beliefs result in people being discriminated against in any way then those beliefs need to be challenged and not kowtowed to just because someone holds it as a ‘belief’ – no matter how sincere they are. If Ashers win the appeal then it opens the door to all kinds of religious discrimination based on ‘belief’ alone – and that would be a dangerous precedent. “No gays here” signs would surely follow in bed and breakfasts, hotels, bars, restaurants etc and potentially much, much worse. It opens the door to all kinds of evil acts against fellow human beings justfied on the grounds of 'religious belief'. 

This is an example, of where even so called well-meaning and sincere people can be side-tracked down an alley to believe something through a religious teaching that is actually deeply harmful and separative and has nothing to do with the way of love, the way of God or the Christ. An example of religion ( as it currently is) yet again getting in the way of love, the way of God. The real evil here is the bastardisation of religious teachings that perpetuate the ‘them and us’, the Christian and the non-Christian, the heterosexual and the gay person – when in my experience true religion does not separate at all, it is unifying, loving and caring for the whole and sees beyond all labels and outer identifiers to the true heart and soul of everyone.

So let us not be fooled by niceness or sincerity or politeness when they are used to sell a message that is deeply harming – it is easy to see the evil of horrid and vile acts like murder, rape, paedophila and so forth, but it is not always so easy to detect the harm that comes wrapped in well-meaning niceness and politeness but with a dark underbelly that sees fellow human beings in any way lesser, not worthy, not equal to the same rights as every other human being on the planet. Gay people are people first and foremost – equal to every other human being on the planet. Their sexuality does not in any way interfere with their right to live as equal human beings; free to love and marry the person of their choosing, if they so wish.

They have as a group been subject to and still are subject to some of the most vile slurs, abuse, bullying, discrimination, torture and in some cases even losing their lives either through being killed or killing themselves as a consequence of the abhorrent bullying and abuse they experience. I have no doubt that the true Christian response is to welcome them with open arms, to support gay marriage – a celebration of love between two people, in the knowing that they too are Sons of God, just like everyone else. Let us not allow false religious teachings to get in the way of love and equality any more – but to stand united by the true religion of our inner hearts where there is no room for any judgment or prejudice, only the fullness of love for all. 

Equality

"It is not always so easy to detect the harm that comes wrapped in well-meaning niceness and politeness but with a dark underbelly that sees fellow human beings in any way lesser, not worthy, not equal to the same rights as every other human being on the planet" This is absolutely true Eunice and cuts through issues of nationality, gender and class just like that. Awesomely written.

As one who has a same sex

As one who has a same sex partner, it is at one level amusing to observe that others can judge that the quality and expression of love is more or less deserving of public celebration and legitimisation because of different body parts! We are so much more than our bodies that we express through. We are all capable of touching the depths of our human frailty and power. When this is limited to our gender, we fall far short of and indeed constrict the possibility for humanity to feel the truth of our commonality and unite as one body. Discrimination is a distraction from going deeper within and connecting with the depth of our love and how it encompasses all, not compartmentalises because of physicality which we already know is so limiting....Love is love.

Wise words

Thank you for these wise words which bring sanity back to the table. Besides the fact that no true religion ever sanctions mistreating others, it is ludicrous to attempt to go against human decency and blame it on "my religion said so"! We have had enough attrocities thoughout history AND in modern time because of individuals choosing to re-interpret religious teachings into reflecting and sanctioning their personal issues and agendas. Enough is enough.

Equality for all

The essence of what Jesus expressed is that we should love one another. It is time we stopped this divide between people, the them/ us that seems to be rooted deep in all the religious institutions. Is it not time that we moved beyond this divisiveness and simply got on with loving each other?

Hear, hear, Eunice, I

Hear, hear, Eunice, I absolutely agree with every word you have written here. God's love is for all of us equally, with no discrimination. True religion embraces us all, whatever colour, race, sex, we are all absolutely equal. Discrimination is discrimination and is not what Jesus was teaching. I stand with you in all you have said here.
24 Jan

What is 'evidence'? ..

The modern day world of medicine and science seems to revolve around this one word ‘evidence’. We have for example, evidenced-based medicine, evidence-based practice, best-evidence medical education, evidence guided education and the question – “what is the evidence for that?” dominates the worlds of academia, research and clinical practice. 

There is a faction within science and medicine that is purporting that no treatments or modalities should be available unless they are supported by ‘evidence’.  This seems to be a reasonable and logical suggestion, so that people can be assured of the treatment they are receiving. 

But what if specific factions within medicine and science are more concerned with maintaining power and control over knowledge and thus support a narrow and restrictive view of what is ‘evidence’ in order to maintain their power and control, rather than being truly concerned with the welfare of mankind? 

What if there are other forms of evidence that are currently dismissed by those in science and academia not just because they do not fit into their narrow way of understanding evidence based on a hierarchy of study design, but because to accept them would mean they could no longer dominate the conversation, no longer have power and control over knowledge and evidence? 

And so the question arises – what is ‘evidence’? Given the demand for ‘evidence’ it is vital we explore and know what it is and consider the possibility that there is more to evidence than we have been led to believe.

The randomised double blind controlled trial (RCT) and subsequent meta-analyses of trial data is currently considered by many to be the ‘Gold standard’ when it comes to evidence and that unless treatments or modalities have this type of evidence they should not be supported or funded. Whilst this might be reasonably straightforward for a medication trial, it is clear that there are certain fields where such trials are just not feasible nor appropriate – and where different forms of evidence are called for (Thistlethwaite).  Different purposes call for different sources and types of evidence and it is important we do not restrict ‘evidence’ to a one form or definition only.

Increasingly people are questioning the validity of the RCT being the gold standard and realising it is definitely not the only form of valid evidence. Furthermore, the general adoption of the double blind RCT was itself based more on theory rather than a compelling body of data (or evidence) and indeed attempts to systematically investigate its assumed objectivity have been relatively scarce (Kaptchuk). How ironic that the Gold standard for ‘evidence’ is itself not supported by that same ‘evidence’? Giving the RCT a sanctified status within science research is misplaced – it is definitely not infallible ( Ioannaidis) nor is it as methodologically fullproof as it is assumed to be and in many instances it is simply not the correct method to use.

All evidence is context dependent, research data is inanimate until processed through a human mediator to give it action, agency and narrative. Research does not speak for itself and only becomes knowledge or evidence that provides meaning or motivation when activated by a human being, who themselves have a historicity that can influence and shape the way the data is portrayed. Without understanding the different influences on what is evidence – we can be easily fooled into thinking and believing it is black and white whereas it often has many shades of grey.

Historically in medicine ‘evidence’ for the efficacy of treatments accumulated through the practice of trial and observation – applying a treatment or operation and observing the outcome. Indeed research today is often informed by such observations – and we then use research to gather the data and the statistics to confirm what we have already observed! 

Indeed we use the power of observation in our own lives every day to make decisions based on the evidence we have received from our observations and Scriven makes the point that perhaps this is the true gold standard? 

The Body as Evidence

Ultimately, when we consider what is evidence we also need to ask what is the evidence for? What is our overall purpose within medicine in performing research, drug trials and so forth? Is it to enable people to live with a greater quality of life in their own bodies? To be healthy, vital and free of illness and disease or alleviated from the suffering associated with illness and disease? If this is so then would it not be reasonable to suggest that the body itself is a valid form and means of evidence? It is through the body that we know when we are in pain or unwell, it is through the body that we know when we feel vital, energetic and healthy. So this being the case, why then do we ignore the personal evidence of a person’s lived experience in their own body by calling it anecdote? 

Why do we only consider anecdotes valid when they are collected together to form a body of data we then call evidence? We had it driven into us at medical school that the key to understanding and knowing what is making a patient sick is in their history – the story they tell from their own bodies about what is happening in their own bodies. Why is that only considered valid when someone is sick? Why are we so quick to ignore and dismiss this ‘evidence’ when people report what happens when, for example, they adjust their lifestyle – their diet, sleep, emotional wellbeing and so forth?  If we valued and listened to the evidence of our body we would know with only one hangover, and no formal research required, that alcohol was harming for the body. A truth that many prefer to ignore and dismiss, so as not to relinquish their regular tipple or binge. A life without something to take the edge off it seems too scary a prospect for many. 

What if we accepted that everyone’s body is a valid form of evidence, indeed a 'body of evidence' that reveals the consequences of the choices of the life lived thus far?  What if we empowered people to know this for themselves so that they can learn how to read their own body, gather their own evidence so that they can make more healthy choices? 

Evidence is not gathered for an end in itself but is to be applied and actioned – every day we get to feel the evidence in our own bodies of how we have lived that day and by making different choices and feeling their consequences in our own bodies we become a living, breathing, walking experiment in action – continuously observing and feeling the consequences of our choices on our bodies and modifying the experiment accordingly. 

It is increasingly clear that there is more to evidence than the ‘evidence’ suggests. The RCT is not the only means of valid evidence and to persist in this misbelief is to deny the real benefits that can be derived by using other forms of evidence – including that obtained through the simple principle of detached observation.  

 

References 

Ioannidis JP, Why most published research findings are false. PLOS Med 2005 Aug 2 (8): e124

Kaptchuk TJ. The double-blind, randomized, placebo-controlled trial: gold standard or golden calf? J Clin Epidemiol. 2001 Jun;54(6):541-9.

Scriven M. A Summative Evaluation of RCT Methodology: And an Alternative Approach to Causal Research. Journal of Multidisciplinary Evaluation, Vol 5, No 9 pp11-24 http://journals.sfu.ca/jmde/index.php/jmde_1/article/view/160/186

Thistlethwaite J, Davies H, Dornan T, Greenhalgh T, Hammick M, Scalese R. What is evidence? Reflections on the AMEE symposium, Vienna, August 2011. Medical Teacher 2012 1-4 Early online

Powerful stuff

This is very powerful Eunice - how ridiculous is it to reject the experiences and observations of the individual as evidence when it is in fact the basis of any collection of 'evidence' that we use? Unfortunately we have lost what true research is all about - and how to use the evidence of the individual experience in a meaningful way. I love how you have brought it all back to the foundations again.

Brilliantly written Eunice.

Brilliantly written Eunice. "Every day we get to feel the evidence in our own bodies of how we have lived that day" This turns the tables to show that a body of evidence begins with physical being and the story all of ours bodies collectively have to tell.

Evidence

I really like this paragraph Eunice, "Evidence is not gathered for an end in itself but is to be applied and actioned – every day we get to feel the evidence in our own bodies of how we have lived that day and by making different choices and feeling their consequences in our own bodies we become a living, breathing, walking experiment in action – continuously observing and feeling the consequences of our choices on our bodies and modifying the experiment accordingly" How awesome it would be if every'body'realised they were their own science project, a living, breathing, walking experiment. How rich and interesting the research to be done,and how much more purposeful life could become. We get presented every day with what works for us and what doesn't. Oftentimes we persist with what doesn't but the body in its infinite wisdom continues to offer us the evidence of our choices.

I really enjoyed your article

I really enjoyed your article Eunice it puts the evidence concept into perspective very clearly. What I have learnt about what foods my body best tolerates has come from my own observations/experiments. Which has proven to me that we are all very different when it comes to what is considered the right diet/food to eat.
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