Monday, August 30, 2010

chapter 7/1

Magnetic Thinking

We seek stability. All our lives we seek the security, comfort, and peace of stability. We don’t like uncertainty. We want things to be settled, to be definite, to stay in place. The DIALECTIC, however, is dynamic and is the only appropriate response to a dynamic world of uncertainty. There is a special class of relationships in particular where we tend to claim certainty: things that we see as opposites, things where we either stand on one side or on the other, where there is a distinct right and wrong, true and false, black and white with no space between, no gray areas. We must choose one pole or the other. I call this a bipolar tension, a special form of the DIALECTIC: the DIALECT of bipolarity.

Saturday, August 28, 2010

Chapter 6/5

The DIALECTIC of Good Health

When it comes to our health, the DIALECTIC dictates that we consider more than going on a diet. Nutrition is a necessary, but not sufficient element of good health. Other considerations are essential, among them are: exercise, sleep and rest, sanitation, work, regular checkups, and attitude. We also must avoid certain abusive habits: drugs, including alcohol and tobacco; overeating and eating junk foods; becoming a couch potato; promiscuous sex; unsafe driving practices–we all know most of the rest of the unhealthy habits to be avoided. The maintenance and restoration of good health is many-handed; each item listed above has other hands of its own, and some of those hands have still other hands. Think Like an octopus.

Saturday, August 21, 2010

The Book Is Available

The book that I've been serializing on this post is now available at Amazon and at Barnes & Noble. Any reviews would be appreciated. I hope you find the book useful.

I will continue serializing until the end of the book is reached.

Chapter 6/4

Side Effects

The DIALECTIC of medications tells us that we must always consider side-effects, or as it might be called, “the law of unintended or unforeseen consequences.” This law states that often there are unexpected but logical consequences to our decisions and actions. We can almost say that we should always expect the unexpected, never be surprised by surprises.

All medications have side-effects. Some of these are positive, some are negative (usually when we speak of side-effects we are thinking of the negative). Some depend on other factors whether they work good or ill. Aspirin, for instance, is taken for relief of minor aches and pains. It also thins the blood, in some people, dangerously so. However, it is commonly prescribed, not for aches and pains, but specifically to thin the blood as a precaution against stroke.

Cancer is a particularly tricky illness to deal with. Radiation and chemotherapy (treatment with “poison”) have saved or prolonged many lives, but there is no guarantee. Side effects are almost guaranteed (although I have had two friends who took chemo with no apparent side-effects at all). With cancer treatment, the side-effects can be so serious that some prefer to take their risks or accept death rather than endure the misery of the side-effects of radiation or chemo. This is so with many medications. On one hand they are, or may be, salutary, but on the other hand they may have unintended consequences that cause some of us to forego the medicine, preferring to live with our problems, however severe they may be.

Thursday, August 19, 2010

Chapter 6/3

How Doctors Think

Doctors think just like the rest of us. Some of us are better thinkers than others. Most of us, as adults, think within the parameters of our training. Once we are well trained, we tend to fall into habitual patterns of thought. The farmer sows his wheat in September, the teacher continues to think that grades above ninety are to be graded, “A,” the merchant begins in September, if not earlier, thinking about Christmas sales. And the physician tends to use tests and follow procedures that have worked well in the past.

After I began writing this chapter, Dr. Jerome Groopman published a book, How Doctors Think. I revised this section and it is now greatly indebted to Groopman’s book. He addresses two fundamental issues: poor thinking on the part of many doctors, and the pathway to good medical thinking. Although he does not mention the word, the book’s thesis echoes the DIALECTIC. Doctors, he says, need to recognize the fact that it is always possible they could be wrong in their initial diagnosis, to realize there is always more to be considered and to thus ask what else it could be, even, what the worst might be.

Groopman introduces his book with the story of a woman who over a fifteen-year period had seen almost thirty doctors, had been examined and tested from seemingly all angles, and had grown steadily worse. A consensus had formed that her problems comprised an eating disorder, irritable bowel syndrome, and some sort of mental illness. As she went from one doctor to another, her records followed her, thus the previous diagnoses followed her. Each new diagnosis was some variation of what the doctors read on the records they received. This is a typical pattern in human thinking. If everyone else thinks a certain idea is true, we are apt to think the same way. It is easier than thinking for ourselves.

Grudgingly, Groopman says, the lady went to one more specialist, a doctor who recognized the symptoms for the earlier diagnoses, recognized that the correct measures had been taken to treat these problems, but felt something more was involved. Do you remember that at the foundation of the DIALECTIC is the idea that “no human statement (medical or otherwise) is ever complete by itself; there is always something more?” So, one more unpleasant test was run and it was discovered that she had a condition which, at the time, was relatively unknown: gluten allergy. It explained everything, and with proper treatment, she improved rapidly.


One of the most satisfying comments ever made to me by a student was when Oma came in after class one day and commented: “I notice something different about you from other teachers. No matter what question anyone asks you, you always begin thinking about it from scratch. Unlike other teachers, you don’t seem to reach into your mental cabinet and pull out the well-prepared answer.” Often doctors make the mistake of giving a standard diagnosis when faced with what seems to be a set of standard symptoms. If flu is “going around,” and you come in with the same symptoms, you are apt to be treated for flu with no thought given to it. Like all the rest of us, Groopman says, doctors tend to go with the quick and easy answers. They have other patients waiting.

There are several reasons for this tendency among physicians. They are human. In medical school–just as in our schooling--they are not trained in thinking skills. Rather, they are trained in scientific method. They locate the medical field in the domain of science and understand themselves as scientists. They are also trained to recognize certain patterns of symptoms, tests, and treatment. But the problem is that we don’t all fit these same patterns.

Another problem that mitigates against good thinking is the patient load that limits the doctor’s time to think things through. Good thinking takes time, and doctors simply don’t have time; they seem never to have enough time for all aspects of their work. This problem explodes, Groopman notes, in the emergency room with its crises, patient overload, bed shortage, and impatient patients in the waiting room.

If the situation is to improve, we must take the initiative and ask questions such as: “Doctor, what is the worst this might be,” “what else might it be,” and “why did you say that?”. We must tell our story and the doctor must listen. It is our responsibility to help our doctors think. The DIALECTIC must work if we are to get good medical attention. If your doctor won’t enter in dialogue, change doctors. Your health is at stake.

Monday, August 16, 2010

Chapter 6/2

Forty-some years ago I had a troubling medical problem myself, so I went to one of the most respected doctors in Fort Worth. After examination, he said, “As soon as you can take off work for two weeks, you need surgery.” The problem was that, at the time, I was dealing with the scholarly demands of doctoral studies, working a forty-hour job, and was married, with three teenagers. There was no way I would ever be able to take off two weeks without serious consequences at home, work, and school.

A friend suggested I see the school physician. He was an old elderly gentleman who devoted one day a week, pro bono, to the school. The rest of the time he was a member of the faculty at Baylor Medical in Dallas. After he examined me, he scoffed at the other doctor’s opinion and told me there was no need of surgery at all. He had a few suggestions for self-help and dismissed me. The first doctor’s call for surgery could be seen as the thesis–the starting point–and the school doctor’s opinion as the antithesis. My problem was real. It was aggravating. I wanted help, but I could see no way to take two weeks off. I felt the tension between the two opinions.

I could not trust expert medical opinion to make the decision. The experts disagreed. Which was right? Or was there, perhaps a third option? Two doctors and I were involved in this dilemma. Ultimately I was in the driver’s seat; I was the controlling agent in this DIALECTIC. The road signs pointed in opposite directions. I decided to trust the old physician and at least postpone the idea of the operating table. I learned to live with the problem and now, more than forty years later, although I still sometimes wonder about surgery, I am glad I went for a second opinion.

Monday, August 9, 2010

Chapter 6/1

The Medical Dialectic

In the summer of 2009, our daughter had four major surgeries to correct almost unbearable physical problems. It was a medically dialectical summer. The medical dialectic comprise three things: doctor/patient relationship; the doctor’s thought pattern, particularly in diagnosis and choice of treatment; and the nature of medications.

Doctors Are Not Gods

The Dialectic dictates that we live by dialogue with each other. In a medical situation, this means that: we should be prepared to tell the doctor clearly and concisely what we understand our problem to be; the doctor should be a good listener; and she should be prepared to engage her patient in question and answer dialogue. Too often we give our physician an incomplete and somewhat vague account of our symptoms and their history. If our problem is at all serious, we might be wise to take written notes with us lest we forget something important.

In Neil Ravin’s novel, M.D., he tells of a woman who after months of being treated for asthma, told her doctor that she only wheezed when she was in his waiting room, a room furnished with wool-upholstered chairs. And she was allergic to wool. When asked why she had never before mentioned this, she responded that he had never asked. Needless to say, her physician cancelled all her medicines and suggested she stay away from his waiting room. Who was at fault in this situation? Was it the doctor, or the patient? He had not asked, she had not told. No Dialectic at work.

We need to give our doctors the clearest and fullest information we can, and we need doctors who will listen and be willing to deal with our questions. Otherwise, the Dialectic will not work. If we find ourselves with a doctor who has a god complex, one who dictates without listening, a doctor who makes us uncomfortable, nervous, or angry, we should find another physician. If, for some reason, we question the doctor’s decisions, the Dialectic strongly suggests we get a second opinion before proceeding. The doctor-patient relationship is one of the most important elements in our ongoing health.

Earlier, I said that our daughter Cynthia had a medically dialectical summer. She dismissed her family physician and a prominent specialist because of, among other things, unsatisfactory doctor-patient relationships. Moreover, Googling led her to seriously question the procedure the specialist had scheduled. She searched for another specialist from whom she could get second opinion. When she did find the one specialist in the state who was qualified to deal with her specific condition, she found that, even there, she had to separate herself from one of his arrogant nurses.
Cynthia took the initiative for her life and health and did extensive research on her problem. On the World Wide Web, she found that the procedure recommended by the first specialist was dangerous and had many enduring side effects. But, she he was able to track down, via the Internet, the Houston specialist who, by way of three surgeries, ended her problems and restored her to a normal life.

Chapter 5/8 Correction

In Chapter 5/8 I noted that my wife and I had been married 58 years. I don't know where I got that figure. We have been married 55 years this past January.

Saturday, August 7, 2010

Chapter 5/8


Compromise

Compromise, for all its dangers, risks, and the warnings against it, makes human society possible. Marriage, the home, economics, and politics—whether local, state, national, or international— all live by compromise. It is the glue that holds social structures in place. It is not optional. It is a necessity, a daily necessity. Few things are as risky as compromise, but few are as essential.

One day, my wife and I were filling in and signing some legal forms. One question asked how long we had been married. The answer was fifty-eight years. The notary public who was assisting said, “Wow. That’s impressive. You don’t hear that much anymore. What is your secret?”
“Compromise,” I answered. “Daily compromise. A marriage cannot last, in fact, I don’t think it can exist, without compromise.” Those who study the causes of divorce commonly list—and link—a lack of communication, compromise, and commitment. Marriage is a daily OTOH, BOTOH. It is a complex of countless theses and antitheses, with a constant commitment to finding some degree of synthesis or compromise.

Yes, there are situations where we cannot compromise. When dealing with a state of affairs where the other entity is committed to upholding a single principle, we cannot compromise unless we are willing to subjugate everything else to their one principle. Abraham Lincoln said he was afraid of a “man of principle.” He found them very dangerous. He noted that although we could work with men of principles, with the man of a single principle, we waste our time offering any concessions. They would be taken as signs of weakness, and would change the other side not in the least.

Compromise is the law of life together. It is so necessary and so potentially dangerous, we need to be always prepared to make some concessions, except in those cases where compromise would be disastrous. There is one basic criterion for making a decision in these cases: our values. We need to know what we value, that is, what would we be willing to give up in order to hold on to the things we value. For Patrick Henry, liberty was the highest value. He would not compromise with anything that might cost him his freedom: “Give me liberty or give me death.” We should always be ready to consider making concessions unless we find ourselves in the place where we are unwilling to give at all, where we are prepared to say, “You can kill me, but on this point I will not change. I am prepared to die on this hill.”


Tuesday, August 3, 2010

Book Almost Complete

Today I received the galley proofs for this book on considerate thinking, Think like an Octopus: the Key to Becoming a Good Thinker. I should finish this last chance at editing in another day or two. Then it will go to press and be released for sale soon. I will let you know on this blog when the release date is announced.

Tell your friends.

Chapter 5/7

Philosopher Alfred Whitehead called it “the fallacy of misplaced concreteness.” He was talking about the difference between our ideas and the world of concrete reality.

Concrete reality is the world as it is apart from our understanding of it, our idea of it. It is the world as it actually is—actual individuals, communities, love affairs, wars, businesses, grass, automobiles, clouds, and trombones. It is actual, specific instances of events and things, not our idea of family, of children dying of starvation, or of hurricanes. It is your family, this child named Ndondo that is dying, Hurricane “Katrina.”

The mistake—the fallacy, as Whitehead called it—is mistaking our ideas for actualities. Ideas exist only in our minds. Ideas are mental actualities. They do exist, but only in the world of our thought. The idea of marriage has no concrete reality, there are only actual marriages. The fallacy of misplaced concreteness is to believe we will find our actual marriage to be just like our idea of it. It is to misplace the concrete with the mental.


Barry and Rachel fell in love with each other, so it seemed to them, but more likely than not, they have fallen in love with their idea of each other. “Love is blind” to many concrete realities that the rest of us see. They, however, have composed an idea-lized image of their beloved, based on their dreams and their experience. In the illusory world of courtship, they see in each other only the idea-l.

Then they marry. The honeymoon ends when they find their marriage partner fails to conform to the idea. Marriage—this actual marriage of Rachel and Barry—is, at many points, not like they supposed it would be. Marital problems, at heart, arise from a refusal to accept and adjust to the concrete character of life together.

“You are not the man I married. You have changed.” These words are common in the early years of marriage. But no, neither the husband nor the wife has changed. What has happened is that they have become dis-illusioned. Quite often, our ideas of each other, and of the nature of marriage, are illusions. Yet we allow ourselves to believe the reality will match the illusion. We have made the mistake of misplacing the concrete with a dreamy idea.

Ideas are necessary guides, suggestive of life’s road, of its speed limit, its potholes, curves … but the ideas are not the road any more than a map is the territory it symbolizes.

No matter how good we become as thinkers, we must always remember the distinction between what we think and what actually is, was, or will come to be. This applies to the teacher’s idea of what she will do in the classroom today, the painter’s idea of the picture she is about to paint, our idea of what a church or minister is, or how the boss will respond to any one of our requests.

On the one hand, think, but on the other, remember there are always more “other hands” than we can wrap our minds around. Expect the unexpected.


Consider other perspectives. For some of us, that means we first must realize there are perspectives other than our own. Bill Hendricks, a theologian, was one of the finest men I have known, one of the most brilliant and learned—some believed he even thought in Latin. Some would also say he was rather arrogant. Everyone looked up to him. No one challenged him.

One fall, there came on the faculty a scroungy-looking little Dutchman, also a theologian, named Jan Kiwiet. He was, as someone who knew him said, “a Dutchman in whom there is no guile.” A modest man, he was a published scholar. At a faculty get-together before school started in the fall, Hendricks was pontificating about some doctrinal issue when, to the shock of everyone, Kiwiet, our new man, innocently, but without hesitation, said, “Bill, that’s just what you think. Other theologians, they think different.” Yes, Doctor Hendricks, there are perspectives other than your own, many of which are worthy of consideration.

I have written about considerate thinking and its part in the making of my long, rich, and satisfying marriage. Carol and I entered marriage after thinking, romantically, that we had talked through everything that could be considered. We had done this for more than four years before marriage. We thought we agreed on everything. But, we brought two widely divergent family perspectives to the actual marriage. I was not a considerate thinker at the time of our wedding.

It took years of obstinate and persistent challenges before I, rather than coming down to her level, realized that in reality I was not up to her level. She had a hard time convincing me, against my heritage, that she was a person as much as I was, with the same rights, with a mind of her own. And a sharp mind it was, sometimes coupled with a sharp tongue. I was a slow and highly resistant learner. She was not about to leave me, nor was she about to leave me with my obsolete mindset. I loved her and she persisted. She prevailed. And I became a better man.

She changed my views on sex, money, raising children, television, in-laws, and who knows what all else. I moderated her views on money, religion, housekeeping, and perhaps another thing or two. For long years now, we have thought through almost everything together and arrived at comfortable, practical consensus. Our minds complement each other. We have found that neither of us thinks clearly nor productively unless we depend on mutual input, checks and balances.