Integrated

Whether we see the world as a collection of parts or as an interrelated whole makes a world of difference. In the one you see parts, and in the other you see relationships.

Blind men and elephant image 4766321-d329719d4cd128bcf865523b4150deee

Take the story of the blind men and the elephant …

Of course, these learned men all thought they were correct. After all, they were making observations from life. This is how we try to make sense of the world. Empirical observation is a key part of science.

Being integrated means being able to see how the parts form a whole. It’s easier to be deluded about this than you may think. We can all be blind to the bigger picture. This is a particular problem in medicine and in healthcare more broadly.

From Redcross Way 3smallYou walk down the street. You see cars and buildings. A car is parked beside the kerb. There is a surface water drain, a lighted entrance, tall buildings in the distance….

Is this painting about a collection of parts? What is going on that you cannot see?

 The English language is dominated by nouns – both the result and cause of understanding the world primarily through the lens of separation. We have a bias towards the parts.


GP+female patient 00124832-460x305A woman walks into her doctor’s consulting room. She sits beside the desk and describes a pain in her belly. She puts her left hand around her middle and strokes with sideways movements as she speaks. Is it her appendix, or her stomach, or her large bowel? Or maybe a trapped nerve in her spine…. Is this the train of thought in the GP’s mind? Or is she listening intently to the words the patient uses to describe her pain? Is she noticing the hand, the stroking? Is she reading her posture? Is she wondering, why has she come now?

gestalt or spaces in between 153733-157359Gestalt therapist, Malcolm Parlett, reminds us that the German language has a word for grasping the whole configuration of a situation: gestalt. ‘…to gestalt is an active verb (as well as a noun) – forming parts into wholes, sorting items into more complex and meaningful organisations of experience.’ ‘We are pattern-makers as well as pattern-finders.’ But often our patterns are too simple. It is easy to be blind! We miss the spaces in between.

Ian McGilchrist’s great book, The Master and His Emissary, identifies this tendency to concentrate on the parts and miss the spaces in between, with excessive dominance of the left cerebral hemisphere. The right hemisphere sees things whole, and in their context’ and ‘underwrites breadth and flexibility of attention’, whereas the left hemisphere sees things abstracted from context, and broken into parts, from which it then reconstructs a “whole”: something very different. In many spheres, particularly healthcare, we have become too reliant on the left hemisphere.
Left hemisphere dominance leads to understanding the world in terms of ‘linear causal thinking’ with its largely illusory need for control. It is a practical strategy for simplifying perception and decision-making, but when used excessively and inappropriately, it contributes to an enormous amount of anxiety and suffering for healthcare professionals. So entrenched is it in healthcare, that it almost seems to be the only way of understanding health and other sorts of problem for which over-simplified understandings are inadequate.

The Blind Men and the Elephant

It was six men of Indostan
To learning much inclined,
Who went to see the Elephant
(Though all of them were blind),
That each by observation
Might satisfy his mind.

The First approached the Elephant,
And happening to fall
Against the broad and sturdy side,
At once began to bawl:
“God bless me! But the Elephant
Is very like a wall!”

The second, feeling of the tusk,
Cried, “Ho! What have we here
So very round and smooth and sharp?
To me ‘tis very clear
This wonder of an Elephant
Is very like a spear!”

The Third approached the animal,
And happening to take
The Squirming trunk with his hands,
Thus boldly up and spake:
“I see,” quoth he, “the Elephant
Is very like a snake!”

The Fourth reached out an eager hand,
And felt about the knee.
“What most this wondrous beast is like
Is mighty plain,” quoth he:
“Tis clear enough the Elephant
Is very like a Tree!”

The Fifth, who chanced to touch the ear,
Said: “E’en the blindest man
Can tell what this resembles most;
Deny the fact who can
This marvel of an elephant is very like a fan.

The Sixth no sooner had begun
About the beast to grope,
Than, seizing on the swinging tail
That fell within his scope,
“I see,” quoth he, “the Elephant
Is very like a rope!”

And so these men of Indostan
Disputed loud and long,
Each in his own opinion
Exceeding stiff and strong,
Though each was partly in the right
And all were in the wrong!

John Godfrey Saxe (1816-1887)