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This is my personal blog. This is the place where I rant and witter inanely about all sorts of things that take my interest from opposition to odious far right groups to personal learning projects such as my intermittent study of evolutionary psychology or the history and development of civilisation.

If you’ve arrived here looking for information on my mental health and social care training and consultancy services you might want to click this link instead. That’ll take you to my commercial website: The Care Guy

You might also enjoy taking a look at Care To Share Magazine while you’re about it. That’s not affiliated with my business at all (or indeed anyone’s business). It’s a community of people who are interested in sharing ideas and insights into social care without any distractions from political ideologies, corporate agenda or media ‘fashion’.

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Civilisation 44: Galen

Welcome to the ‘Civilisation’ blog series. This is my attempt to categorise some of history’s most famous (and infamous) names. Sometimes it’s serious and sometimes it’s silly. I hope you like it.

galenGalen lived in the 2nd century AD, from 131 until his death around 70 years later. He was a student at the famous library of Alexandria (later sacked in an appalling act of vandalism by Christian crusaders) and rose to become the most respected physician of the Roman world. He was the personal physician of three Roman emperors, Marcus Aurelius, Commodus and Septimius Severus.

In his early thirties Galen took a prestigious post as chief physician to the gladiator school in Pergamum where his duties included not only general medical care but also the treatment of wounds inflicted in the arena, an experience that would serve him well throughout his career.

As we have seen history is full of claimants for the position of originator of the experimental method including those dating back as far as the ancient Egyptian physician, Imhotep and Galen is no exception. He was not the first to be credited with this momentous development and he will not be the last either. He was perhaps one of the most influential though. Galen’s theories and assumption survived him by around 1,500 years which should certainly give us pause for thought. Originator of scientific method or not, Galen was certainly a significant step along the way.

Galen correctly identified the role of the arteries in transporting blood, the kidneys as the site of urine formation and wrote a staggeringly large number of books and papers based upon his observations from dissection. So important were Galen’s observations that his work wasn’t really overturned until the Renaissance.

It is unfortunate perhaps that Galen was so ready to accept the assumptions of earlier physicians like Hippocrates and Celcus. He particularly admired the principle that nature must be allowed to run its course and like Hippocrates, Galen may well have been far too non-interventionist when it came to aggressive illnesses. Having said that, in the absence of modern treatments like antibiotics it seems that Galen and his contemporaries would have had few options in that regard anyway.

Galen endorsed the notion of the four humours which had dominated medicine for centuries already and it is due to ancient physicians like him that so many sick people were further weakened and no doubt killed in many cases by practices such as blood-letting to rebalance the humours in sick bodies. In truth the practice would serve only to inhibit the body’s own ability to fight off infection and to continue normal processes of life.

For all his methodological advances, Galen certainly didn’t get everything right.

I’m loathe to be too hard on this ancient physician though. He was a prisoner of his time, as are we all, and given the knowledge and tools at his disposal he did the best he could with what he had. Once again – just like us all. Like so many of the pioneers we’ll meet in this series, Galen was a man who made mistakes but who ultimately provided us with a step or two on the way to greater understanding as well.

You can find links for each post in the Civilisation series here.

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The Anzacs are (were) coming

Today is Anzac Day. 99 years ago the first Australian & New Zealand Army Corp soldiers (Anzacs) landed at Gallipoli. On April 25th 1915 one of The Great War’s war’s most futile campaigns began.
I’m not sufficiently expert to expound about the tactics and errors that caused the ensuing loss of life. I’ll just offer up a song that I first learned many years ago in my busking days.

And the band played Waltzing Matilda by Eric Bogle

Such a waste of life! Such futility!

Lest we forget.

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Privileged glimpses 20: Do we need help?

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

Do we need help?

Let’s look at two other ‘categories’ of challenging behaviour:

  • Behaviours that we can cope with;
  • Behaviours that are beyond our ability or authority.

Behaviours that we can cope with

These are behaviours that fall within our own skill set and area of expertise. For example a care home resident refusing to bathe from time to time. It is well within the authority of the staff to decide how best to handle it. However, if the refusal is accompanied by signs of depression or dementia for example then the larger multi-disciplinary team may well need to be involved.

For example, I remember working with a young drug-user who simply stopped going to bed. Instead he would sleep in the communal lounge on the settee. Speaking with him (not ‘to’ him, by the way) seemed to make him more determined to sleep in the lounge, even though the settee was too short and uncomfortable. So we decided simply to stop mentioning it.

We provided an alternative area for other service-users and ignored the fact that he was sleeping in the communal lounge altogether. We didn’t even mention it when he started to complain of back pain. We simply suggested that he might want to see his GP about pain relief. He didn’t make the appointment but he did stop sleeping on the settee.

The decision to stand back and wait for him to learn ‘the lesson of experience’ was ours to make and the situation was remarkably easy to resolve. Often ‘the path of least resistance’ really is the way to deal with things that are within our remit to solve.

Behaviours that are beyond our ability or authority to cope with

When I was a community psychiatric nurse I had a client who regularly called me reporting that she’d taken an overdose and asking for an ambulance. Actually I’ve had several clients who did that over the years.

The more I responded the more frequently she called. She didn’t always tell the truth (sometimes she had overdosed and sometimes she hadn’t) but I had no way to know in advance.

I wanted to stop responding to these situations because by reacting to the phone calls I was only making things worse. However, I needed the support of the multi-disciplinary team first. So I called a meeting involving all the relevant workers, the service-user herself and (with permission) her brother was also present

We decided upon a new care plan. Essentially we all agreed (including the service-user) that if she was able to call me she was also able to call an ambulance if that was what she needed. We therefore agreed that I would expect her to do precisely that in the future. If she called me reporting an overdose I would advise her to call an ambulance and remind her of our scheduled appointment time (which may be some time in the future).

The behaviour stopped working for her and she stopped. She called in these circumstances only twice more before changing tack and talking about her real problems instead. I’m not going to pretend that the problem she presented next was easy to resolve by any means but at least we got to focus upon the thing that mattered instead of a haze of challenging behaviours that served only to distract us both from the real work we had before us.

The point here is that although I ended up doing precisely what I thought was right I needed the backing of the multi-disciplinary team first. Their ‘blessing’ was important.

Sometimes we need others to get involved when we discuss what we need to do about a situation. There’s no problem with that – it’s just appropriate.

Incidentally this doesn’t mean that the decision not to respond to my overdosing service-user was a ‘team decision’. It was always my decision how to respond when I picked up the ‘phone (and I could have changed my mind had circumstances demanded it). Team meetings don’t take away our responsibility for our own decisions – if you’re ‘on the spot’ you decide what to do – but they do make those decisions easier to defend if we need to. My decision was safer because I had discussed the situation with the team and they had agreed with my strategy.

Had I not discussed the situation with the multi-disciplinary team and my client really had overdosed I’d have had a hard time explaining my actions to the ensuing inquiry. As it was – had she come to grief (she didn’t but she might have) I’d have been able to defend my decision precisely because of the involvement of the team.

You can follow the entire blog series as it develops here.

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Privileged glimpses 19: Behaviours that harm other people

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

Sometimes the harm, or risk of harm, affects others and so we really must intervene. Service-users don’t have the right to hurt others, no matter how much they might learn from the experience.

If, for example you heard of an assault you must take reasonable steps to try to prevent it. If necessary and appropriate call the police or other outside agencies as needed. If an offence has occurred then always report it to the police. That’s part of learning from experience too.

Never fall into the trap of being too ‘understanding’ in these situations. Compassion is important but naivety is not. Shielding a person from consequence teaches them the wrong lesson – it teaches them that there are no consequences and that tends to encourage both more frequent and more serious challenging behaviour. Do you really want your service-users to believe that it’s OK to hit you or your clients? If you don’t then let them face the consequences of their actions while they’re still at the shouting stage.

We know that challenging behaviour, including violent behaviour, escalates if left unchecked. We know that some people are dangerous and that they tend to become increasingly violent so long as they continue to ‘get away with it’. So the obvious solution is to ‘nip violence in the bud’, thus preventing it from escalating.

If you work with people, be they mentally disordered or not, ask yourself this:

Do you ever excuse their hostility because you ‘understand’, because they’re ill, because they have anger ‘issues’ or they’ve been through such a lot of trauma in their early lives etc etc?

If so please understand that the more you excuse the behaviour the worse it will get. People learn through consequence – you did, from an early age. That’s why you’re able to hold down a job. You learned to behave appropriately in society by experiencing negative consequences when you transgressed. That’s why as parents we ‘ground’ our children for example – it teaches them ‘the rules’. We do people no favours by pretending that violence and aggression is acceptable.

When you or others are at risk intervene, do what is necessary to manage those risks but without focussing more than is needed on the behaviour itself and always encourage more appropriate alternatives.

You can follow the entire blog series as it develops here.

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Civilisation 43: Marcus Aurelius

Welcome to the ‘Civilisation’ blog series. This is my attempt to categorise some of history’s most famous (and infamous) names. Sometimes it’s serious and sometimes it’s silly. I hope you like it.

marcus-aurelius-pain quoteMarcus Aurelius Antoninus Augustus was born on April 17th 121 and died on March 17th 180 aged 59 (almost). He was known as ‘The philosopher king’ both during and after his lifetime. He also has the honour of being hailed as the last of Rome’s ‘good’ emperors. Ever the diplomat he co-ruled the empire with Lucius Verus until Lucius’ died in 169. Marcus didn’t appoint a successor to Lucius and ruled alone for the last decade or so of his life.

It was during these latter years that he wrote his famous ‘Meditations’ – a collection of stoic principles originally intended for his own use but published after his death, much to the delight of later Stoics such as myself. Marcus contribution to Stoicism cannot be over-estimated, not least because he shows us a marked contrast between the very highest and lowest ranks of society and yet the same problems (and solutions) remain.

Even as a child Marcus seems to have been attracted to the philosophy of the Greeks. His mother even had to persuade him to sleep in his bed. The young Marcus had taken to sleeping on the floor after the manner of the Athenian Cynics such as Diogenes. Perhaps his self-imposed preparation for hardship was fortunate as he was orphaned in his teens. Marcus’ studies in Cynicism and Stoicism presumably helped him to cope with the grief he must have felt at the loss first of his father and then his mother so early in his life.

Marcus succeeded the emperor Antoninus Pius in 161 AD having been chosen by his adoptive father Hadrian (the previous emperor) in 138. The intervening years had been spent actively working in Roman politics and in studying Stoicism – an early fascination that he never tired of. It was presumably his Stoic devotion to duty and to the common good that led him to insist that he share the office of Emperor with Lucius. That wasn’t the original plan and a lesser man may well have chosen to rule alone. But Marcus was never one to let his ego get in the way of what he believed to be right. He considered Lucius essential to effective rule and stuck to his guns until the senate eventually agreed to his power-sharing plan.

wpid-20141128_154607.jpgAlthough significant in his day I don’t propose to say much about Marcus’ activities as emperor. That’s not what interests me here. Rather it’s his philosophy and writings that have earned him a place in this series. Written during the last few years of his life, whilst on military campaign in Germania, Marcus’ Meditations is one of the most accessible and useful introductions to Stoicism I’ve ever come across. It’s a book of its time, complete with all the references to Gods and the fates that we might expect from an ancient Pagan but that doesn’t detract from its simple brilliance.

If I remember rightly, Meditations was one of the first Stoic books I ever read – and I thank the long dead emperor for it from the bottom of my heart. Marcus Aurelius, the last ‘good emperor’ of Rome was instrumental in setting me on a path that has benefitted me greatly in both emotional and intellectual terms. I cannot recommend his little book enough. You can download it for free here. Go on – it just might change your life!

You can find links for each post in the Civilisation series here.

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The day Darwin died

Today is an important day for me. It’s the anniversary of one of my heroes. Charles Darwin met his demise on April 19th 1882. His death has been the subject of much debate and even outright deception courtesy of Lady Hope whose fabricated tale of the great man’s deathbed conversion is easily refuted even by creationists. As it happens Darwin’s final words are well known and not religious in the least.

And that lack of religion is one of Darwin’s most heroic characteristics, not because atheism and agnosticism are heroic per se (they’re not) but because apostacy takes real courage. I remember my own ‘deconversion’ and the agony of almost 2 years expecting damnation and yet unable to submit to the psychopathic God of Abraham. During those terrifying times (and for a former fundy, apostacy really IS terrifying) the example of men like Darwin was invaluable.

Darwin wasn’t the only apostate whose discoveries had forced him to reject bronze age superstition but he may be the most widely known. And his example is extremely significant. Perhaps that’s why so many creationists continue to discredit him with lies about religious redemption.

So for the record….

Charles Darwin died as he had lived – with calm, couragous acceptance of reality and a gentle, loving acknowledgement of the family he loved.

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Civilisation 42: Epictetus

Welcome to the ‘Civilisation’ blog series. This is my attempt to categorise some of history’s most famous (and infamous) names. Sometimes it’s serious and sometimes it’s silly. I hope you like it.

Epictetus greek stoic philosopherThe real name of the man we know as Epictetus (55 AD – 135 AD) is lost in the mists of time. The name we know him by literally means ‘acquired’ – quite a fitting name for a 1st century slave. He was born into slavery in 55 AD and remained so at least until the age of 13 and very probably much longer. All we know for sure is that he obtained his freedom sometime after Nero’s death in 68 AD.

Epictetus taught Stoic philosophy in Rome until 93AD when the emperor Domitian banished all philosophers from the capital. At that point he moved to Greece where he began a new philosophical school based on the Stoicism of Zeno, Cleanthes Chrysippus and Seneca. Not all the emperors disliked philosophy though. Hadrian seemed to have befriended Epictetus and Marcus Aurelius, himself a famous stoic philosopher relied heavily on Epictetus’ Enchiridion (AKA The Handbook).

I’ve blogged about Epictetus before, not least during my blog series on Stoicism, The Stoic. That’s because he was (and still is) one of my Stoic heroes. His straightforward wisdom and simple lifestyle encapsulate not just Stoicism but the key to ‘the good life’. That key has a number of elements to it but a very general overview can be encapsulated in these three principles:

  1. Concern yourself only with those things that you can control (and all you can really control is yourself);
  2. Be satisfied with what you have (even whilst working towards gaining something else);
  3. Don’t allow memories of past moments or anxiety about future moments spoil the quality if the present moment.

That’s only a superficial overview of Epictetus’ philosophies, let alone Stoicism in general.

James StockdaleEpictetus’ popularity was renewed in the latter half of the twentieth century courtesy of the Vietnam war POW James Stockdale. He described using Epictetus’ philosophy to survive over 7 years of captivity at the hands of the North Vietnamese. During this time he endured torture, brutal mistreatment and spent over half of the time in solitary confinement.

I strongly recommend learning more about this remarkable philosophical system of acquiring personal happiness and effectiveness. My own PDF on Stoicism, The Stoic may be a reasonably accessible starting place. After that why not read The Enchiridion or Marcus Aurelius’ Meditations.

Who knows – it might just change your life.

You can find links for each post in the Civilisation series here.

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