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Editorial – Shifting the paradigm
The ultimate hidden truth of the world is that it is something that we make and could just as easily make differently.
David Graeber radical anthropologist
The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.
Albert Einstein
Every culture plays out against a mental backdrop of shared, mostly unquestioned assumptions about ‘reality’. It’s hard to notice this invisible water of ‘self-evident’ facts of life, though our minds swim like goldfish in a bowl of limiting suppositions, a web of half-truths that shape our sense of self and society and draw our map of humankind’s place on Earth.
Einstein is supposed to have said there are only two ways to live life: as though nothing is a miracle, or as if everything is a miracle. It’s clear to see where the current worldview sits on this spectrum: humans as isolated individuals struggling to survive in an accidental and meaningless universe, a species without purpose, in a world of random evolution, with material brains that secrete immaterial consciousness. Just to write this leaves me feeling empty!
It comes across as modern and scientific, but have we been taken in by the wrong story that reflects an antiquated worldview? Because a century and more ago, science moved on from certainty, objective observers, the one galaxy universe, as knowledge outgrew this mechanical worldview. Yet this widely tolerated materialistic worldview is surely stuck in a 17th century mindset. It was forged back when Newton was calculating a clockwork cosmos, Descartes was cleaving mind from the body and colonising freebooters were given an unlimited licence to exploit and exterminate. Mix this way of seeing the world with the idea that competition is evolution’s driving force and season it with the illusion of limitless extractive growth. What you get is the blinkered obsolete worldview that now dominates the world.
I write these lines as COP 26 takes place. All the signs are that those who live and profit most by this worldview can’t see that the health of people, populations and planet are interdependent. With the biosphere’s resilience at the end of its tether we humans have to change our ways: we need a new story, to see with new eyes. For we are not just lonely competing individuals, but also creative collaborative creatures who can learn to live more lightly on what was once a self-regulating planet, and so co-create health at every level, from the genome to the ozone layer. This emerging paradigm gives humankind in the Anthropocene vast responsibility but also a huge sense of our potential power and our purpose as agents of evolution.
Every society creates a system of medicine. Medical science and the way we apply it can’t help but reflect the home culture’s worldview. Modern medicine has done humankind a lot of good, but does it also perpetuate some dangerous delusory aspects of the dying worldview: that science can fix everything, that breakdown happens randomly and to ‘individuals’, that distress, injustice and inequality are unrelated to health, that disease is a purely biological mechanism in a mindless body, that medicine can be industrialised?
Truly we are in deep trouble. Business as usual is leading the planet into ecological and social collapse and the worldview that got us here won’t solve the problems it has created. Medicine as usual too is proving economically and emotionally unsustainable. These interlocked dysfunctional unstable worldviews have to play catch-up, and fast, to take on board that more is not always better, that preventing harm beats waiting until some things are too late to fix, that self-regulation is pre-eminent, that systems are intelligent, that there’s always a context to breakdown.
This issue of JHH reflects on the need for paradigm change and seeks some wisdom as to what the changing worldview might look like when it comes to healthcare. Priest, poet and nature writer Peter Owen Jones provides an opening parable, and cosmologist Jude Currivan offers us her WholeWorld View. London GP John Tomlinson maps out a way to reinvent the NHS, and palliative care consultant Marina Malthouse seeks to humanise dying. Paul Dieppe and his colleagues reveal something of their research into the meaning of love and its role in healing. Psychiatrist Alan Kellas writes about expanding access to the therapeutic powers of the natural world. Psychotherapist Roger Duncan outlines the scope of eco-psychotherapy and asks what we might learn from indigenous cultures where ways of reconnecting to nature have not yet been forgotten. Former business leader and organic farmer Alan Heeks promotes skilful ‘deep adaptation’ for the turbulent times ahead. Public health specialist Margaret Hanna and Jacqueline Nugent delve into the lifelong impacts of early adverse childhood experiences. New Zealand physician Sam Hazledine calls for a return to medicine’s foundational values and roots in compassion. Mac Macartney, visionary founder of Embercombe, sees with new eyes. Personal authenticity is the subject of Bruce Cryer’s proposed approach to heart-centred leadership. Medical teacher Louise Younie tells us how art can help broaden students’ imagination when medical education unintentionally constricts it. Medical curriculum innovator Trevor Thompson illustrates how debating long-haul electives can help ignite students’ ecological awareness. And this year’s BHMA student prize winner Deeya Kotecha offers her lively essay on health inequalities and the need to go beyond advice about individual behaviours. The planetary emergency and the need to re-imagine medicine go hand in hand. We intend these articles to spark debate, stir up controversy and provoke correspondence in your JHH !
