Helmholtz and the ophthalmoscope, Eurotimes, 2008

Helmholtz and the ophthalmoscope, Eurotimes, 2008

Recently I rediscovered some articles for Eurotimes, the European Journal of Cataract and Refractive Surgeons that I had forgotten I had written. I have posted here before some of my book reviews for Eurotimes. I also wrote some pieces on historical ophthalmological figures – the first on Goethe and his work in optics, the second on Hermann von Helmholtz who was one of those towering, foundational figures in modern physics but who also invented the ophthalmoscope


In the last article, I considered one of the towering geniuses of world culture, Johann Wolfgang von Goethe. Goethe made enormous contributions to world literature and philosophy, and significant contributions to the nascent sciences of visual perception, linguistics, plant morphology, and felt he would be remembered most of all for his work on optics. Goethe perhaps epitomises the “natural philosopher”, the original term for “scientist” – an individual of boundless curiosity and enthusiasm, a gifted amateur in the true sense. Science owes much to the activities of men and women who operated outside the dynamic of universities and in an age before the research institute or the grant.

Hermann Ludwig Ferdinand von Helmholtz (1821-1894) is a less towering cultural presence than Goethe. His scientific activities have had a more lasting influence. He bridges the worlds of “natural philosophy” and organised, university based science – both in terms of his lifespan (eleven when Goethe died, he lived to directly influence Einstein and Maxwell) and in his professional life (originally training under paternal pressure as a doctor, he was appointed Professor of Physics in Berlin in 1871). Much of his work attacked the speculative tendencies of the natural philosophers, and was grounded firmly in observation and experiment.

Yet such was the breadth of his activity that he reminds one of the multi-talented natural philosopher as much as a contemporary, specialised physicist or physiologist. The Oxford Companion to the History of Modern Science describes him in summary as “physiologist, physicist, philosopher and statesman of science.” This begins to capture the breadth and diversity of his interest and involvement. We will discuss his work on perception, and on ophthalmic optics, below, but it is important to recall he was simultaneously working on conservation of energy, thermodynamics, and electrodynamics, and developed the philosophy of science itself. His writings ranged from the age of the earth to the origin and fate of the solar system.


One of the more humbling characteristics of the scientists of the past was their seeming mastery of measurement. We are so used to highly accurate, precise computerised measuring apparatus that we can forget that until relatively recently, researchers often had to build and calibrate their own equipment. And going back only a little further, they had to invent it as well. Most readers of EuroTimes probably use one of Helmholtz’s inventions every day – the ophthalmoscope.

Invented in 1851, the ophthalmoscope is a perfect illustration of Helmholtz’s combination of experimental and inventive skill. The invention made him world famous overnight. Helmholtz was actually independently reinventing a device of Charles Babbage’s from 1847. As so often in science, it was the reinventor who recognised the usefulness and applicability of the invention, rather than the first inventor (Babbage, of course, also managed to invent but not complete the first computer) The handheld ophthalmoscope was developed by Greek ophthalmolosist Andreas Anagonstakis later in the 1850s, and in 1915 William Noah Allyn and Frederick Welch invented the self illuminating ophthalmoscope (and founded Welch Allyn) that is the direct precursor of the modern device.

Who was Helmholtz, this man of so many talents and interests and such lasting influence? Born in Potsdam on 31st August 1821 into a lower middle class family that emphasised the importance of education and cultural activities, his father Ferdinand was a teacher of philosophy and psychology in the local secondary school. His mother was a descendant of William Penn, the founder of Pennsylvania, and her maiden name was Penne. Ferdinand Helmholtz was also a close friend of the philosopher Fichte. The scientific and philosophical worlds of the nineteenth century often seem amazingly small and parochial.


Helmholtz’s natural inclination as a student was to pursue studies in physics – however his father observed the financial support available for medical students and the lack thereof for physics students, and persuaded him into medical studies. He enrolled in the Friedrich-Wilhelms-Institut in Berlin, the Prussian military’s medical training college. After this, the served as a medical officer in the Prussian military for a time, simultaneously publishing articles on heat and muscle physiology. In 1847 he published his treatise On The Conservation of Force, which was the clearest and ultimately most influential account of what would become known as the principle of the conservation of energy. From his observations of muscles physiology and activity, he tried to demonstrate that there is no energy loss in muscle movement, and no “life force” is necessary to move a muscle.

In 1848 he left military service and embarked on an academic career. In 1849, he became an associate professor of physiology in Konigsberg.. Shortly after he announced the invention of the ophthalmoscope and also made another discovery that would seal his fame – measuring the rate of conduction of signals in nerves. It had been believed that sensory signals arrived at the brain instantaneously, and it was considered beyond the capabilities of experimental science to measure the rate of nerve conduction. Using a new invention, the chronograph, Helmholtz measured the difference between stimulus and reaction times at different parts of the body, and found the speed of neural conduction to be comparable to that of sound, not light.

A full account of all Helmholtz’s discoveries and scientific achievements would take volumes. He had an intense interest in visual perception, especially visual illusions. This interest was based on his philosophical position that we are separate from the world of objects, and isolated from external physical events, except for perceptual signals which, not unlike language, must be learned and read according to various assumptions. These assumptions may or may not be appropriate. This philosophy underlay many of his research activities and interests, and also his idea that perceptions are “unconscious inferences.”

Most of what goes on in the nervous system, according to Helmholtz, is not represented in consciousness. Psychological and physiological experimental findings often surprise us for this reason, because we cannot discover by introspection how we see or how we think. We derive a perception from incomplete data, hence “unconscious inference.” This idea influenced Freud’s idea of the unconscious, and Helmholtz’s student Wilhelm Wundt, who took Helmholtz’s work and ideas further. Another of his students, Heinrich Hertz, further developed Helmholtz’s work on energy and electrodynamics.

Helmholtz had a huge impact on all areas of perceptual science, and many areas of physics. His name lives in a variety of laws and concepts (Helmholtz illusion, Helmholtz free energy, Helmholtz-Kelvin contaction) and that of an association of research institutes in Germany. And of course, for the humble working ophthalmologist, every day, almost without thinking, Helmholtz’s influence as the originator of the modern ophthalmoscope is literally palpable.

What’s Love Got to Do with It? A Longitudinal Study of the Culture of Companionate Love and Employee and Client Outcomes in a Long-term Care Setting, Barsdale and O’Neill 2014

I have blogged before about the relationship between morale and clinical outcomes. From 2014 in Administrative Science Monthly , a paper which links this with another interest of mine, workplace friendships .

Here is the abstract:

In this longitudinal study, we build a theory of a culture of companionate love—feelings of affection, compassion, caring, and tenderness for others—at work, examining the culture’s influence on outcomes for employees and the clients they serve in a long-term care setting. Using measures derived from outside observers, employees, family members, and cultural artifacts, we find that an emotional culture of companionate love at work positively relates to employees’ satisfaction and teamwork and negatively relates to their absenteeism and emotional exhaustion. Employees’ trait positive affectivity (trait PA)—one’s tendency to have a pleasant emotional engagement with one’s environment—moderates the influence of the culture of companionate love, amplifying its positive influence for employees higher in trait PA. We also find a positive association between a culture of companionate love and clients’ outcomes, specifically, better patient mood, quality of life, satisfaction, and fewer trips to the emergency room. The study finds some association between a culture of love and families’ satisfaction with the long-term care facility. We discuss the implications of a culture of companionate love for both cognitive and emotional theories of organizational culture. We also consider the relevance of a culture of companionate love in other industries and explore its managerial implications for the healthcare industry and beyond.

Few outcomes are as “hard” – or as appealing to a certain strand of management – than “fewer trips to the emergency room.” The authors squarely and unashamedly go beyond the often euphemistic language of this kind of paper to focus on love:

‘‘Love’’ is a word rarely found in the modern management literature, yet for more than half a century, psychologists have studied companionate love— defined as feelings of affection, compassion, caring, and tenderness for others—as a basic emotion fundamental to the human experience (Walster and Walster, 1978; Reis and Aron, 2008). Companionate love is a far less intense emotion than romantic love (Hatfield and Rapson, 1993, 2000); instead of being based on passion, it is based on warmth, connection (Fehr, 1988; Sternberg, 1988), and the ‘‘affection we feel for those with whom our lives are deeply intertwined’’ (Berscheid and Walster, 1978: 177). Unlike self-focused positive emotions (such as pride or joy), which center on independence and self- orientation, companionate love is an other-focused emotion, promoting interdependence and sensitivity toward other people (Markus and Kitayama, 1991; Gonzaga et al., 2001).

Companionate love is therefore distinct from the romantic love which so dominates our thought when we think about love. As is often the case, we moderns are not nearly as new in our thinking as we would like to see ourselves:

Considering the large proportion of our lives we spend with others at work (U.S. Bureau of Labor Statistics, 2011), the influence of companionate love in other varied life domains (Shaver et al., 1987), and the growing field of positive organizational scholarship, which focuses on human connections at work (Rynes et al., 2012), it is reasonable to expect that this basic human emotion will not only exist at work but that it will also influence workplace outcomes. Although the term ‘‘companionate love’’ had not yet been coined, the work of early twentieth-century organizational scholars revealed rich evidence of deep connections between workers involving the feelings of affection, caring, and compassion that comprise companionate love. Hersey’s (1932) daily experi- ence sampling study of Pennsylvania Railroad System employees, for example, recorded the importance of caring, affection, compassion, and tenderness, as well as highlighting the negative effects when these emotions were absent, particularly in relationships with foremen. Similarly, Roethlisberger and Dickson’s (1939) detailed study of factory life provided crisp observations of companionate love in descriptions of workers’ interactions, describing supervisors who showed genuine affection, care, compassion, and tenderness toward their employees.

There is nothing new under the sun. In subsequent decades this kind of research was abandoned.  The authors go on to describe the distinctions between strong and weak cultures of companionate love:

Like the concept of cognitive organizational culture, a culture of companio- nate love can be characterized as strong or weak. To picture a strong culture of companionate love, first imagine a pair of coworkers collaborating side by side, each day expressing caring and affection toward one another, safeguarding each other’s feelings, showing tenderness and compassion when things don’t go well, and supporting each other in work and non-work matters. Then expand this image to an entire network of dyadic and group interactions so that this type of caring, affection, tenderness, and compassion occurs frequently within most of the dyads and groups throughout the entire social unit: a clear picture emerges of a culture of companionate love. Such a culture involves high ‘‘crystallization,’’ that is, pervasiveness or consensus among employees in enacting the culture (Jackson, 1966).

An example of high crystallization appears in a qualitative study of social workers (Kahn, 1993) in which compassion spreads through the network of employees in a ‘‘flow and reverse flow’’ of the emotion from employees to one another and to supervisors and back. This crystallization of companionate love can cross organizational levels; for example, an employee at a medical center described the pervasiveness of companionate love through- out the unit: ‘‘We are a family. When you walk in the door, you can feel it. Everyone cares for each other regardless of whatever level you are in. We all watch out for each other’’ (http://auroramed.dotcms.org/careers/employee_ voices.htm). Words like ‘‘all’’ and ‘‘everyone’’ in conjunction with affection, caring, and compassion are hallmarks of a high crystallization culture of companio- nate love.

Another characteristic of a strong culture of companionate love is a high degree of displayed intensity (Jackson, 1966) of emotional expression of affec- tion, caring, compassion, and tenderness. This can be seen in the example of an employee diagnosed with multiple sclerosis who described a work group whose members treated her with tremendous companionate love during her daily struggles with the condition. ‘‘My coworkers showed me more love and compassion than I would ever have imagined. Do I wish that I didn’t have MS? Of course. But would I give up the opportunity to witness and receive so much love? No way’’ (Lilius et al., 2003: 23).

In weak cultures of companionate love, expressions of affection, caring, compassion, or tenderness among employees are minimal or non-existent, showing both low intensity and low crystallization. Employees in cultures low in companionate love show indifference or even callousness toward each other, do not offer or expect the emotions that companionate love comprises when things are going well, and do not allow room to deal with distress in the workplace when things are not going well. In a recent hospital case study, when a nurse with 30 years of tenure told her supervisor that her mother-in- law had died, her supervisor responded not with compassion or even sympathy, but by saying, ‘‘I have staff that handles this. I don’t want to deal with it’’ (Lilius et al., 2008: 209). Contrast this reaction with one from the billing unit of a health services organization in which an employee described her coworkers’ reactions following the death of her mother: ‘‘I did not expect any of the compassion and sympathy and the love, the actual love that I got from co-workers’’ (Lilius et al., 2011: 880).

This is obviously a paper I could simply post extracts from all day but at this point I will desist. Perhaps rather than “What’s Love Got to Do With It? the authors could have invoked “All You Need is Love?

Irritating fictional doctors: Dr Gregory in F Scott Fitzgerald’s “Gretchen’s Forty Winks” and the balanced life

A while back I posted about the less-than-busy doctors of Victorian detective fiction. Another medical archetype of fiction is the irritatingly bluff doctor. While Dr Gregory in F Scott Fitzgerald’s short story “Gretchen’s Forty Winks” is a minor character, he encapsulates a certain cheery complacency.


This story is not among Fitzgerald’s best. An awful lot of Fitzgerald’s writing was for money, in the midst of a chaotic life. There’s nothing wrong with this – remember Dr Johnson’s dictum that no man but a blockhead writes except for money. However, “Gretchen’s Forty Winks” is no Great Gatsby. There is also much that would now be deemed sexist, not to mention casual gaslighting and slipping of Mickey Finns within the marital relationship . I firmly believe that Of course, no doubt there is much we find unexceptional or even virtuous in our own culture which will in nearly a century seem laughably unethical.and also some by-the-way flashes of Fitzgerald’s acuity and brilliance. It also has some historical interest as an portrayal of what might have been seen as a “balanced life” in 1924.

The story was published in the Saturday Evening Post of March 15, 1924.


It is a rather heavy handed spoof of the cult of the “balanced life” (nowadays we would say work-life balance). The protagonist, Roger Halsey, is an advertising man, who has struck out for himself having left “the New York Lithographic Company.” We meet him coming home to his wife Gretchen. Fitzgerald writes thus of their marriage: “it was seldom that they hated each other with that violent hate of which only young couples are capable, for Roger was still acutely sensitive to her beauty.” Halsey has to work for forty solid days to obtain “some of the largest accounts in the country”, to the disappointment of his wife – “she was a Southern girl, and any question that had to do with getting ahead in the world always gave her a headache.”

His wife introduces Halsey to George Tompkins, an interior designer and devotee of the “the balanced life.” An irritated Halsey asks for a definition:

“Well’ – he hesitated – probably the best way to tell you would be to describe my own day. Would that seem horribly egotistic?”

“Oh  no!” Gretchen looked at him with interest. ‘I’d love to hear about it’

‘Well, in the morning I get up and go through a series of exercises. I’ve got one room fitted up as a little gymnasium, and I punching the bag and do shadow-boxing and weight-pulling for an hour. Then after a cold bath – There’s a thing now? Do you take a daily cold bath?’

‘No,’ admitted Roger. ‘I take a hot bath in the evening three or four times a week.’

A horrified silence fell. Tompkins and Gretchen exchanged a glance as if something obscene had been said.

‘What’s the matter?’ broke out Roger, glancing from one to the other in some irritation. ‘You know I don’t take a bath every day – I haven’t got the time.’

Tompkins gave  a prolonged sigh.

‘After my bath,’ he continued, drawing a merciful veil of silence over the matter, ‘I have breakfast and drive to my office in New York, where I work until four. Then I lay off, and if it’s summer I hurry out here for nine holes of golf, or if it’s winter I play squash for an hour at my club. Then a good snappy game of bridge until dinner. Dinner is liable to have something to do with business, but in a pleasant way. Perhaps I’ve just finished a house for some customer, and he wants me to be on hand for his first party to see that the lighting is soft enough and all that sort of thing. Or maybe I sit down with a good book of poetry and spend the evening alone. At any rate, I do something every night to get me out of myself.’

Roger is unimpressed. As the story progresses, he keeps to his exacting work schedule, until he nearly has secured a major account. Gretchen has chafed all along at the economising, and the night before a crucial submission forces another dinner with Tompkins. At this, Roger and Tompkins end up having a blazing row, simmering with the fury of the man who suspects he be becoming a cuckold:

“‘Are you implying my work is useless?’ demanded Tompkins incredulously.

‘No: not if it brings happiness to some poor sucker of a pants manufacturer who doesn’t known how to spend his money'”





After ejecting Tompkins from his house, Roger resorts to obtaining something unmentioned from the local drugstore, and putting “into the coffee half a teaspoonful of a white substance that was not powdered sugar” before giving it to his wife. He also hides all her shoes in a  bag.

This allows him to spend all night working on the account (not before giving his grumpy landlord the bag of shoes as a guarantee, having missed that month’s rent) with ultimate success. A contrite Gretchen awakes after a full day going missing from her life thanks to her husband’s deployment of white powder, and so distressed is she at finding her shoes missing that Roger agrees to take her to the doctor.  Enter Doctor Gregory, a man for whom the word ‘confidentiality’ has no meaning:

The doctor arrived in ten minutes.

‘I think I’m on the verge of a collapse,’ Gretchen told him in a strained voice.

Doctor Gregory sat does on the edge of the bed and took her wrist in his hand.

‘It seems to be in the air this morning.’

‘I got up,’ said Gretchen in an awed voice, ‘and I found that I’d lost a hole day. I had an engagement to go riding with George Tompkins -‘

‘What?’ exclaimed the doctor in surprise. Then he laughed.

‘George Tompkins won’t go riding with anyone for many days to come.’

‘Has he gone away?’ asked Gretchen curiously.

‘He’s going West.’

‘Why?’ demanded Roger. ‘Is he running away with somebody’s wife?’

‘No,’ said Doctor Gregory. ‘He’s had a nervous breakdown.’

‘What?’ they exclaimed in unison.

‘He just collapsed like an opera-hat in his cold shower.’

‘But he was always talking about his – his balanced life,’ gasped Gretchen. ‘He had it on his mind.’

‘I know,’ said the doctor. ‘He’s been babbling about it all morning. I think it’s driven him a little mad. He worked pretty hard at it, you know.’

‘At what?’ demanded Roger in bewilderment.

‘At keeping his life balanced.’ He turned to Gretchen. ‘Now all I’ll prescribe for this lady here is a good rest. If she’ll just stay around the house for a few days and take forty winks of sleep she’ll be as fit as ever. She’s been under some strain.’

Dr Gregory’s utter disregard for confidentiality is impressive in its brazenness (and if he could make a house call in ten minutes he is himself presumably impressively non-busy) but, for me, the height of his irritatingness is still to come:

‘Doctor,’ exclaimed Roger hoarsely, ‘don’t you think I’d better have a rest or something. I’ve been working pretty hard lately.’

‘You!’ Doctor Gregory laughed, slapped him violently on the back. ‘My boy, I never saw you looking better in your life.’


“slapped him violently on the back” – truly Dr Gregory is a prince among doctors… (the phrase also pops up in James Herriot

As for the more general spoof of “the balanced life”, it is surely wise to reflect moderation in all things is wise, especially moderation. A suspicion of overly-programmed approaches to nature and leisure underlies my mild suspicion of “forest bathing” One of the founders of The Idler once wrote about having a breakdown due to his frenetic life of writing and talking about the wonders of idleness.

But it might also be wise to recall that Fitzgerald’s book of autobiographical writings was called The Crack-Up.


Information underload – Mike Caulfied on the limits of #Watson, #AI and #BigData

From Mike Caufield, a piece that reminds me of the adage Garbage In, Garbage Out:

For many years, the underlying thesis of the tech world has been that there is too much information and therefore we need technology to surface the best information. In the mid 2000s, that technology was pitched as Web 2.0. Nowadays, the solution is supposedly AI.

I’m increasingly convinced, however, that our problem is not information overload but information underload. We suffer not because there is just too much good information out there to process, but because most information out there is low quality slapdash takes on low quality research, endlessly pinging around the spin-o-sphere.

Take, for instance, the latest news on Watson. Watson, you might remember, was IBM’s former AI-based Jeopardy winner that was going to go from “Who is David McCullough?” to curing cancer.

So how has this worked out? Four years later, Watson has yet to treat a patient. It’s hit a roadblock with some changes in backend records systems. And most importantly, it can’t figure out how to treat cancer because we don’t currently have enough good information on how to treat cancer:

“IBM spun a story about how Watson could improve cancer treatment that was superficially plausible – there are thousands of research papers published every year and no doctor can read them all,” said David Howard, a faculty member in the Department of Health Policy and Management at Emory University, via email. “However, the problem is not that there is too much information, but rather there is too little. Only a handful of published articles are high-quality, randomized trials. In many cases, oncologists have to choose between drugs that have never been directly compared in a randomized trial.”
This is not just the case with cancer, of course. You’ve heard about the reproducibility crisis, right? Most published research findings are false. And they are false for a number of reasons, but primary reasons include that there are no incentives for researchers to check the research, that data is not shared, and that publications aren’t particularly interested in publishing boring findings. The push to commercialize university research has also corrupted expertise, putting a thumb on the scale for anything universities can license or monetize.

In other words, there’s not enough information out there, and what’s out there is generally worse than it should be.

You can find this pattern in less dramatic areas as well — in fact, almost any place that you’re told big data and analytics will save us. Take Netflix as an example. Endless thinkpieces have been written about the Netflix matching algorithm, but for many years that algorithm could only match you with the equivalent of the films in the Walmart bargain bin, because Netflix had a matching algorithm but nothing worth watching. (Are you starting to see the pattern here?)

In this case at least, the story has a happy ending. Since Netflix is a business and needs to survive, they decided not to pour the majority of their money into newer algorithms to better match people with the version of Big Momma’s House they would hate the least. Instead, they poured their money into making and obtaining things people actually wanted to watch, and as a result Netflix is actually useful now. But if you stick with Netflix or Amazon Prime today it’s more likely because you are hooked on something they created than that you are sold on the strength of their recommendation engine.

Let’s belabor the point: let’s talk about Big Data in education. It’s easy to pick on MOOCs, but remember that the big value proposition of MOOCs was that with millions of students we would finally spot patterns that would allow us to supercharge learning. Recommendation engines would parse these patterns, and… well, what? Do we have a bunch of superb educational content just waiting in the wings that I don’t know about? Do we even have decent educational research that can conclusively direct people to solutions? If the world of cancer research is compromised, the world of educational research is a control group wasteland.

Less-than-busy doctors: “The Beetle Hunter” Arthur Conan Doyle

S J Perelman wrote a series of New Yorker articles titled “Cloudland Revisited”, wherein he re-read or re-watched various books and movies of his youth. In what now seems a slightly grating way , he invariably finds them ludicrous pulp. Anyhow, in “Doctor, What Big Green Eyes You Have”, Sax Rohmer’s Fu Manchu stories come in for the treatment. In this, Perelman writes:

“Petrie, I have travelled from Burma not in the interests of the British Government merely, but in the interest of the entire white race, and I honestly believe – though I pray I may be wrong – that its survival depends largely on the success of my mission.” Can Petrie, demands Smith, spare a few days from his medical duties for “the strangest business, I can promise you, that ever was recorded in fact or fiction”? He gets the expected answer: “I agreed readily enough for, unfortunately, my professional duties were not onerous.” The alacrity with which doctors of that epoch deserted their practice has never ceased to impress me. Holmes had only to crook his finger and Watson went bowling away in a four wheeler, leaving his patients to fend for themselves. If the foregoing is at all indicative, the mortality rate of London in the nineteen-hundreds must have been appalling.


My understanding is that Arthur Conan Doyle had a quiet career as a private ophthalmologist before literary work overtook his medical efforts. Of course, the structure of medicine as a career was very different then. The medical student and junior doctor of popular and popular-ish fiction tends to have more free time than is the norm nowadays.

Conan Doyle’s short story The Beetle Hunter is very much in this mould. Perhaps this paragraph reflects more about Conan Doyle’s own view of the medical professional than strictly being a piece of social history, but there you go:

I had just become a medical man, but I had not started in practice, and I lived in rooms in Gower Street. The street has been renumbered since then, but it was in the only house which has a bow-window, upon the left-hand side as you go down from the Metropolitan Station. A widow named Murchison kept the house at that time, and she had three medical students and one engineer as lodgers. I occupied the top room, which was the cheapest, but cheap as it was it was more than I could afford. My small resources were dwindling away, and every week it became more necessary that I should find something to do. Yet I was very unwilling to go into general practice, for my tastes were all in the direction of science, and especially of zoology, towards which I had always a strong leaning. I had almost given the fight up and resigned myself to being a medical drudge for life, when the turning-point of my struggles came in a very extraordinary way.

A story in which a recent medical graduate now is immersed in idleness would be seen as fatally implausible. He or she would be doing pro bono work down the lab, sequencing some beetle genome or other. Of course, this striving means we are Much Better People than those of long ago. Doesn’t it?








#OceanOptimism, powerlessness, hope, and change.

The current BBC Wildlife Magazine has a fascinating article by Elin Kelsey, of the Ocean Optimism Project, on how media-fuelled environmental despair and nihilism ends up demoralising people to the degree that positive action seems impossible. She cites much research on the “finite pool of worry” and the paralysing effect of despair, and the power optimism to reverse this trend. The article isn’t available online, but in the post below from my other blog I highlight relevant passages from a Kelsey piece in Smithsonian Magazine on similar themes.

This article is obviously focused on ecology, but is all too true of our healthcare systems. For similar reasons to those Kelsey ascribes to environmentalists who are wary of being overly focused on good news, frontline workers in the health service naturally tend to focus on what is wrong, what is proving impossible, what needs to change. This is necessary, but can become an overwhelming counsel of nihilism, fostering cynicism and very often helping to entrench negative practices.

This is very relevant to the various themes on valuesmorale, “blame culture”, and possibility of positive change within not only the HSE but any healthcare organisation.

Séamus Sweeney

The current issue of BBC Wildlife Magazinehas a fascinating cover story by Elin Kelseyon hope and optimism versus despair in how we think about they environment. Essentially, much media discourse on the environment tends to be gloomy, doom, and generally despairing. Kelsey cites a wide range of research on how this negativity effects how we think about the environment and our beliefs about what can be done – and therefore what is done – to improve things. The full article is not available online. This article from Smithsonian Magazine is briefer, but captures her idea:

Things are far more resilient than I ever imagined. Me, green sea turtles, coral reefs blown to bits by atomic bombs. In a twist of fate that even surprised scientists, Bikini Atoll, site of one of the world’s biggest nuclear explosions, is now a scuba diver’s paradise. Bikini Atoll located in the Pacific’s…

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What practice which seems perfectly fine to us now will seem weird/unethical/laughable in fifty years?

On my other blog I posted a quote from James Jeremiah Sullivan’s essay  on the polymath Constantine Samuel Rafinesque:

That’s what’s so terrifying but also heroic in Rafinesque, to know he could see that far, function at that outer-orbital a level intellectually, yet still wind up viciously hobbled by the safe-seeming assumptions of his day. We do well to draw a lesson of humility from this. It’s the human condition to be confused. No other animal ever had an erroneous thought about nature. Who knows what our version of the six-thousand year old earth is. It’s hiding somewhere in plain sight. In five hundred years there’ll be two or three things we believed and went on about at great length, with perfect assurance that will seen hilarious to them.

One could cite many many examples of “safe seeming assumptions” in every sphere – moral, scientific, social, cultural – which as time went by became unsafe and then positively harmful, laughable or just plain weird.

There is a self-congratulatory tendency to exaggerate and outright distort how wrong people were in the past. This is a form of epochalism, the belief that we live in a time unique in human history  True in a trivial sense, but blind to the patterns of human life and what could be called the human condition. One of the recurrent themes on Stephen Pentz’s poetry blog First Known When Lost is that the modern belief that We Are Somehow Unique is an illusion. Other people, at other times, have struggled with mortality, the passing time, what is a good life, and in times in their own way as complex and baffling as our own.

Anyhow, the point of this post is really to post a question, and a question that is in principle unanswerable. What will the practices in medicine in healthcare that, in fifty years, will seem either weird or unethical or simply bad, that we take for granted today? The nature of this question that these are not things that, by and large, are objected to today, but seem a normal part of practice. One could put forward many obvious answers about eHealth or about health insurance, but of course values change over time and assuming our values now will be the normative values of fifty years is a fool’s game.