The subject of this blog is sensitive and difficult. It may stir up some difficult issues or memories for you, as you read. If this happens, then please take time to seek the help you need. I believe this blog and ones to follow might be some of the most important I have written to date.
I am currently reading a phenomenal book, sent to me in the post, by a dear friend of mine, who is a trained counsellor and knowing the work I do, felt that I should read it also. The book is called “The Body Keeps the Score” by the eminent Psychiatrist, Bessel Van Der Kolk. In my humble opinion, it should be compulsory reading for every person training in any of the clinical specialities, including public health and for those working in education. The book focusses on the detailed research and work done by Van Der Kolk and others at Harvard over the last 30 years in the whole area of Complex Post Traumatic Stress Disorder (CPTSD), or “Disorders of Extreme Stress, Not Otherwise Specified” (DESNOS). It is not a part of our vocabulary, unfortunately, because even now, after a huge evidence base and many studies, there still remains no such psychiatric diagnosis. However, it is a hidden epidemic affecting huge numbers of our population and is the root of many of our major public health issues. So what causes this problem and just how wide spread is it? The evidence shows so strongly that the cause of CPTSD or DESNOS is Adverse Childhood Experiences, which we more starkly call Child Abuse.
Child abuse falls into four main categories: Physical abuse, Sexual Abuse, Verbal Abuse and Emotional abuse – usually in the form of neglect. 10% of children suffer regular verbal abuse. 25% suffer regular physical abuse. 28% of women and 16% of men have suffered sexual abuse. 16% regularly watch domestic violence. 87% of all those who suffer one type of abuse, are also abused in other ways. Each of these forms of abuse
lead to major health problems later in life and studies are showing that it is not just mental health issues (many of which lead to inappropriate diagnoses like Borderline Personality Disorder or Bipolar Disorder and ineffective treatments) but also major physical health problems. Those who have been abused are twice as likely than others to develop cancer and four times as likely to have emphysema. The more difficult a person’s experiences, the higher the chance of developing heart, liver or lung disease at an early earlier age with much higher chances of taking more health risks with smoking, becoming overweight or having multiple sexual partners. There is good evidence to suggest a link with autoimmune diseases, such a lupus, and other complex conditions like chronic pain, chronic fatigue and fibromyalgia. The body cannot be separated from the mind and literally keeps the score of the internalised turmoil. So, even if the abuse happens before memories are formed, or our minds manage to forget or block out what has happened, the body simply cannot forget and sometime and in someway, the damage will show itself. Studies show that the overall cost of this appalling reality far exceed those of cancer or heart disease. In fact, eradicating child abuse would cut depression rates by over 50%, alcoholism by 66% and suicide, IV drug use and domestic violence by 75%. Antidepressants and antipsychotics are now some of our largest prescribing costs. We know this, but are doing very little about it. Perhaps it feels too big. Perhaps we don’t want to face the demons involved. Instead, we are numbing the problem, trying desperately to get people to be just functional enough to keep on serving the needs of our economic system, but we are not facing up to or dealing with this horrific problem, nor its true cost.
What can be done in the face of such evil? How can we develop a
culture of compassion and restorative justice in which we can find a new way through for humanity? It isn’t getting any better. It is just as widespread and far reaching in its consequences as it was a generation ago. Is it possible for us to face up to the startling reality we face? Van der Kolk offers much hope, but it is not within the gift of the health service and social services to tackle this alone. If we are to take this issue seriously, we must embrace what Bessel refers to (at the end of chapter 2) as four fundamental truths:
- Our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring wellbeing.
- Language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know and to find a common sense of meaning.
- We have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through simple activities such as breathing, moving and touching – (learning to be present in our own bodies is a vital way of separating out the memories of the past which can overwhelm us at times).
- We can change social conditions to create environments in which children and adults can feel safe and where they can thrive.
People can be healed of trauma. We need this at both an individual and corporate level. We have become so focussed on saving money, on quick fixes to ensure the NHS and Social Care System can survive, but we are ignoring the root cause of many of our ill health issues. If we are willing to face up to the truth of child abuse in our society and its long lasting and far reaching impact on overall health and wellbeing, then we might just be able to find a way through to healing and restoration of what has become an extremely broken society. In the blogs that follow, I will look at some of the ways we might find a way through this crisis of epidemic proportions. One thing we must face straight away is that we are spending our resources in the wrong places and are focussing our attention in the wrong areas. We must protect our children and help people learn how to be good parents. We must strengthen our school teachers and sense of community. We must invest in the first five years of life far more than we are doing so currently, especially those key first 12 months of bonding and attachment. Together, if we want to, with love, care, bravery and determination, we can change the future. There is hope. There is healing. Our systems are not yet designed to cope with this, but we must speak the unspeakable, break the silence and face up to the truth. The truth will set us free and enable us to develop the kind of wellbeing that every human being should be able to live within.
All this week on the BBC, there has been a focus on the NHS and the crisis we are in – don’t panic Mr Mainwaring…..There is a heady mix of opinions being thrown around – Question Time became quite a furore of ideas and thoughts last night – not enough beds, not enough staff, not enough money, too much money, too many patients, too many wasted appointments, too many malingerers, too many ill people, too many old people, too many managers, too many drugs, too many drunkards, disappointed clinicians, disappointed patients, disappointed MPs, a disappointed health secretary – what are we to think and what are we to do?
We love the NHS because it speaks something to us about our togetherness and our commitment to health justice for all. This circular argument about money is the wrong conversation and it is beginning to have a very nasty undertone about who we might be able to blame and scapegoat in order to solve the mess we are in. Let’s be very clear. The NHS is NOT in crisis because of refugees, asylum seekers, immigrants or health tourists. I’m going to stick my neck out here – it isn’t even the fault of the current and previous health secretaries, though it would be easy to play the blame game that way too. The NHS is in crisis, because the entire Western World is in crisis! Our economic systems are broken and our political systems are pretty defunct. We have built our nation state on the foundations of empire. We have built our economy on conquest and slavery and have used debt, violence and law to keep control….but everything is shaking.
brave enough to rewire our brains, realign our values and reimagine a different way of being together? If we accept that things simply cannot remain as they are, might we instead find one another in fresh ways and discover new ways of being in which we’re not always chasing the money, with all its strings attached, but choosing something altogether more life giving?
I would suggest we need two things (an ambidextrous approach) – both of which are already happening, we just need to recognise them, fan the flames and watch the new emerge, whilst Rome burns around us.
are beginning to think about how we are living and making a change. It’s a tough reality, but there is personal and corporate responsibility that we need to take. We cannot keep shoving poison into our bodies or treating them badly and expect that we will be well, or that we will be able to afford the drugs to fix us. Social movements are beginning to emerge and we need to be a part of them. Together, we can! Together we can cause corporations to change their behaviour and act in accordance with what is right, true, just, kind and loving. We can also choose to take responsibility for what we buy and how much exercise we do. Here in Morecambe Bay we are launching the Morecambe Bay Mile, encouraging everyone to move a mile a day without transport! We’re also working with our communities around diet. We’re also connecting with amazing people doing amazing things and seeing just how much kindness and goodness there is in the communities around us. Our happiness is directly linked to the quality and depth of our friendships. People being together and facing up to the issues together is absolutely key to our long term health.
Secondly, we must stop serving the system, re-humanise it, call it in line and cause it to serve the needs of the people and the planet (the right handed approach). Those in the health and social care system must refuse to be bullied by the powers into ways of behaving, stop thinking they have the answers and therefore coming up with another new scheme to do to people and be willing to listen to and work with the emerging social movements. This will allow us to see a society that is much more well and therefore in need of less care. But where care is needed, we have to accept that we have allowed ourselves to be competitive rather than collaborative, hierarchical instead of co-operative and our own attitudes and behaviours are stopping us from giving the compassionate care we long to deliver. We cannot make excuses. We must let go of self-protectionism. We must be willing to change the way we think and behave, breaking down walls, letting go of suspicion and cutting through red tape so that we provide the care which we can. This is happening, here in Morecambe Bay – but it’s not a quick thing. We are rediscovering the power of relationship and daring to make some bold steps into delivering care very differently – but for those of you outside the system, please understand, it takes time and feels pretty scary!
more healthy and well and we changed our ways of working to be more collaborative and kind. It is this ambidextrous approach to health and wellbeing, in which a heady mix of an invigorated people movement and a reorientated system working together for the good of everyone everywhere, might breathe hope into other parts of the world that out of the old can come something new. Maybe it is just possible that healthcare can be provided for everyone everywhere when people are brave enough to let go of old ways, embrace the brokenness of our reality and find a new way through together.
I’m telling you – it is nearly Spring time and the bulbs are beginning to break through. Can you smell the scent of something new emerging? Those rhizomal roots of the snowdrops – that interconnected underground network that shoots up its flowers, is telling us the winter of discontent is over. It’s time to turn off the radio, dial down the meta narrative of fear and instead, put on love, hope and faith, find each other, change our ways of working and step into the future we know our hearts yearn for.
In my last blog, I talked about the exponential potential of what could be possible if clinicians worked together in a more collaborative way. However, far more can be achieved if we work together in and with our communities to create a social movement together around being more healthy and well. I’ve talked previously about the “battle royale” that occurred between Béchamp and Pasteur over whether we should promote health or fight disease. The answer is, of course, that we need to do both, but the clinical community is not equipped with the resource or power to do it alone.
crises we now face are too much for us to do anything about. We are in the midst of a battle, which we are currently losing and it is time to gird our loins for a turning of the tide. Here in Morecambe Bay, we have started a conversation, not just among the Clinical Community but with the wider population about how we might become the healthiest place in the UK. Yes, we mean this in a very holistic way, but there are also some specific foci we have so we can together reverse some of the appalling health statistics we are facing.
I suggest that within a generation, if we wanted to, we could render Type 2 Diabetes a rare diagnosis. We can do this through encouraging far more healthy lifestyles in our children and young people now, like running a mile a day and learning to eat food that doesn’t actually harm them! I believe we could significantly reduce the need for so many people to be taking medication for hypertension and diabetes now, prevent many strokes and heart attacks, by being violent towards these conditions with major changes in lifestyle, though diet and exercise, rather than the prescription of drugs, using coaching, peer support and local champions to give psychological motivation and encouragement. We are beginning to have some excellent discussions and develop some exciting plans around this.
pull themselves back from the brink of a lifetime of medication and we should use all medication reviews as a chance to help people adopt lifestyles that might reverse the need for such drugs. In the process, we would also significantly reverse our number of cancer diagnoses – many of which are linked to our lifestyle choices. We simply can’t afford for our current and failing approach to continue. We need to be braver together! And this means the NHS must be willing to partner in new ways, not only with local people, but also with businesses like the major supermarkets to help reverse our current direction towards the abyss, in which there is no longer a healthcare system that serves the needs of everyone, no matter where they come from or how much they do or don’t earn.
We can absolutely do this!! It’s going to take some serious resolve and we’re going to have to withstand the fear and pressure of some pretty powerful lobbies, like the sugar, alcohol, tobacco and pharmaceutical giants, and perhaps even the government itself, but it is time for us to do the impossible. With love, hope and faith, we can do this! Yes we need to focus on schools and work places. Yes, we need to partner with organisations we’ve never worked with before. Yes, we need a far more effective media strategy and yes, we need to allow clinicians to work very differently. But we cannot do nothing. So let’s try something a whole lot more radical. That’s what we’re going for in Morecambe Bay – not just better care together, but better health together – you can watch and wait, and see if we sink or swim, or you can join us!
We need to reimagine ourselves as all being part of a team who are together tackling the health crises we are facing. We know only too well that, as just one example among many, we are failing kids with asthma because we have not joined up our resources or thinking adequately enough. Yes there are major issues with housing, smoking and pollution, but let’s not point the finger or push the problem somewhere else. Let’s use the phenomenal brains God has given us to pull the right people round the table and work out what we’re going to do about it. Let’s change the way we spend our time so that we’re in schools, we’re listening to our communities and we’re partnering together outside of our normal comfort zones to change the health of the generations to come. We know only too well, that if we don’t shift our focus towards population health and work more intentionally with our communities, doing things with them rather than too them, we will never win this battle. We’re not about playing political games. We are about working with our communities to create optimal health for every person no matter who they are or where they are from. We need to be braver, push the boat away from the shore we know and face the uncertain waters of working altogether differently. In my next blog I will explore some of the possible ways we could work differently.
As clinicians we must, as many have stated this week, build bridges not walls. There is far too much division, suspicion and competition amongst us. (Here comes the swearing)…..I was in a conversation with a consultant colleague recently and he was relaying to me that another consultant referred to GPs as a “bunch of Fuck Wits”. In a separate conversation, one of my GP colleagues referred to consultants as a “bunch of arrogant Shits”. These kind of attitudes pervade the NHS and have created a culture of dishonour, distrust and division. Honestly! We’re better than this. How are we going to create the new workforce of the future that works across our currently artificial boundaries if we don’t teach them basic respect? This week a patient came to see me because he was dismayed at having to have seen a nurse at the hospital after suffering a significant condition and wanted to check that I, as a doctor, was happy with what he had been told. I could have laughed it off, but I wanted to stand up for my nursing colleague, who actually has far more expertise in this area of medicine than I do. The advice he had been given was perfect and completely in line with the best guidance available. We must not be afraid to challenge attitudes that are antiquated and out of place. More than ever, we need a culture of honour. A culture of honour is one in which we believe the best of each other, speak well of each other and appreciate our brilliantly necessary but differing gifts and expertise. We need to work out how we work effectively together for the best of the people we serve. We need to connect with each other and rehumanise the system in which we work. When was the last time you met as a cross cultural or multidisciplinary team and simply told each other what you love and appreciate about each other and the work you do? If we can’t learn to be more relationally whole, we will continue to work in the midst of serious dysfunction and strife. Come on – amongst us we have some remarkable gifts of wisdom, healing and hope. Let’s build the kind of culture and community amongst us that stands shoulder to shoulder, changes the story in the media and speaks with one voice to the powers that we are about the a new way of working together through relationship not hierarchy and fear. What might we really achieve together? It is this kind of collaborative clinical community that can change the future of healthcare, not just in the UK, but right across the globe.![forgive[1].jpg](http://reimagininghealth.com/wp-content/uploads/2017/01/forgive1.jpg?w=293)
Many of us feel that forgiveness is a good idea or it is something we would like to do, but when it comes to actually forgiving someone, it can be hard to know how to go about it. In my last vlog I talked about the extraordinary and healing power of forgiveness and how it helps us to be more healthy and well. In this vlog, I talk through a straight-forward process that helps us to actually be forgiving.
There are many times when people come to see me, as a GP, and I cannot find a physical cause for their pain. There are various other conditions when people have what we call “medically unexplained symptoms”. For others, they can get stuck in a rut with their mental health and feel unable to get out of it. In the west, we are not as comfortable as we might be in dealing with the concept of spiritual health. Our spirit, the true essence of who we are, can also suffer damage and ill health, which in turn can lead to physical and psychological manifestations of that same pain. One of the things I have seen time and again as one contributing factor is when someone is finding it difficult to forgive a past hurt. In this vlog I talk about the great power of forgiveness in helping us to be more well. In the one after this, I will talk about how we can actually go about forgiving someone who has hurt us.
It’s all over our news today – our health is in a real mess, and this is our wake-up call moment – we really do need to take it seriously. It’s all very well us protesting about the under-funding and under-recruitment in our NHS (and we are right to do so), but we can no longer shy away from the burden our own health choices are planting on the NHS. I’m telling you, it’s a mess and we have to do something, because genuinely, if we don’t there won’t be an NHS left for our children or their children. We simply cannot afford for 80% of us aged 40-60 to be overweight, exercising too little or drinking too much alcohol. We cannot afford to be spending 1 in every 5 pounds in the NHS as a direct result of our lifestyles or 1 in every 11 pounds on diabetes.
Do you know who doesn’t care? The sugar giants – they don’t care – they are more than happy to keep our kids eating a bath-full of sugar every year, and they are more than happy to take the lovely tax breaks from our government and not even contribute to the cost our NHS picks up on their behalf. The Chocolate industry – they too are pretty happy that chocolate is no longer a luxury (people used to have it as a real treat) and that we are so willing to turn a blind eye to the fact that their empires are built on the slavery of children, whilst we fulfill our insatiable greed. Who else doesn’t care? The Alcohol industry – they do not care that every time you drink one pint of beer, you are eating the equivalent of 16 fingers of kit-kat in one go – so a night out with 4 pints is 64
fingers of kit-kat in one evening – think about it! And by the way, they don’t pay their fair share of tax either, and yet what they cost our country is far more than they contribute. ….Then let’s not even go there with the huge Pharmaceutical giants, who are rubbing their hands together at the thought of how many of us will be prescribed medication for blood pressure, cholesterol and diabetes over the next couple of decades, when we could all do without most of it, if we made some simple changes now! And what of the Fast Food outlets that cram our high streets with ill-health choices – who makes these decisions about town planning?!
So, if these corporate giants don’t care, we should care – and maybe we haven’t until now, but it’s time we did!! And we should be pretty angry about the fact that successive governments have been on the side of greedy corporations, who are literally poisoning us. They have chosen, time and again, to support big business and the unaccountable growth of their money, above the wellbeing of their own people! And these companies have advertised the benefits of their delicacies, placed their products very carefully in collusion with the Supermarket giants and who are the fools who believed it all? That would be us! But we must not let our anger be a cause to blame someone else. We must fess up to our own weaknesses and vices, understand them and no longer let them rule us. We have been led right down the garden path of temptation, succumb to the the idea that we’re worth it and we can have whatever we want, without thinking of the consequences…..well…..now we’re at the tipping point. So let’s wake up!
 Power of Forgiveness){kind=link}
