Euclidean or Projective Care?

How many dimensions does a written - narrative record have?

Sketching out some ideas, I asked the question on Google and as usual an AI Overview response followed - snippet:

AI Overview

A physical written record has two primary spatial dimensions (length and breadth/width) as a flat document, or three dimensions (including thickness or depth/height) when considering its physical form or binding. [1, 2]

In archival and Records Continuum theory, a written record exists dynamically across four conceptual dimensions: [1, 2].

I put the question to the Records Management list with the above snippet and received several useful suggestions and sources. Perhaps I can share that at a future point? 

Acutely aware of not pursuing maths and category theory for its own sake, the query was driven by an attempt to look at Hodges' model in mathematical terms. Starting, rather obviously with the models structure and axes. When the model is assembled, as per many posts, the vertical axis:

INDIVIDUAL
|
GROUP

- shouts out the issue of parity and the distinction between mind and body. It does this at the individual and collective level. If we were to draw a silo, a cylinder springs to mind, and there are specific reasons for silos adopting this shape. Descartes gives us the perfect excuse, in the ongoing legacy. 

     Mathematical Visions

The question above came up from Joan L. Richards book 'Mathematical Visions' (c/o Lancaster Univ. library). Euclidean and the emergence of projective geometry is described. There is an interplay between 2D and 3D representation, that made me think about the health record and its dimensions. Not in a dataset sense (multi-dimensional), more generally and concretely(?). A patient's record on paper has physical dimensions (A4), there is a flow. An EHR has its virtual dimensions (discuss!). Abstractly the content is a time machine. At some point in a health encounter it is a literal 'history', the level of detail in accord with the context. The record might present the problem, premorbid situation, diagnosis, current state, observations and prognosis and much more.

I can revisit this, Richards provides a series of figures. We progress from two distinct circles (my silos) through to examples with a discussion of continuity and projection that sees the circles touching, then intersecting. This is a radical axis.

Richards, Joan L. (1988), Mathematical Visions: The Pursuit of Geometry in Victorian England, Boston: Academic Press, ISBN0-12-587445

Book cover: Amazon.

Subjective-Objective: Thinking of Holistic Cake and Eating it

'Our natural awareness of our own activities is holistic. We experience ourselves as embodied beings, complete organisms, directly perceiving physical objects, making choices, engaging in conversation with other people. The attempt to split the human being into a combination of immaterial self and physical body makes a coherent account of these processes impossible. As Heidegger says, “The ‘scandal of philosophy’ is not that this proof has yet to be given, but that such proofs are expected and attempted again and again.”35 Given the Cartesian conception of the “real world”, organisms are “really” mechanisms, while “choices” and “actions” have no place in a world where there are only events, subject to the laws of mechanistic cause and effect. The whole person becomes a metaphysical oddity, straddling two incompatible metaphysical realms.

A theoretical framework that renders the previously straightforward inherently problematic is by no means an unequivocal advance. Materialist authors have attempted to “solve” this problem by denying the reality of the subjective side of the Cartesian picture, replacing his dualism with radical metaphysical reductionism.36 Such authors insist that the “objective” world (still understood as something devoid of phenomenal properties, containing only causes and effects as understood in reductionist science) is all there really is. On this view, we do not have to bridge the gap generated by Descartes, between the subjective and the objective features of human life, because the objective features are the only ones that exist.' p.20.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

My Mind Subjective	My Body Objective

Mitchell, D., Loughlin, M. (2023) The philosophy of person-centred healthcare, Cambridge: Cambridge Scholars Publishing. https://cambridgescholars.com/product/978-1-5275-9058-8/

Previously: 'Descartes' : 'mind' : 'body'

Descartes - alive and well ...

... within the Incident Reporting System

'Policy guidance on recording patient safety events and levels of harm 

This guidance is for users of the new Learn from Patient Safety Events (LFPSE) service, to provide context and guidance on selection of appropriate categories when recording incidents. It focuses on which Event Type is appropriate for different circumstances, and how to select the most appropriate options for the Levels of Harm categorisation required within Patient Safety Incidents.'

Previous harm grades

No harm

Low harm

Moderate harm

Severe harm

Death

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

New psychological harm grades No psychological harm Low psychological harm  Moderate psychological harm Severe psychological harm n/a	New physical harm grades No physical harm Low physical harm Moderate physical harm Severe physical harm Fatal

Q. 'n/a'. Discuss.

CPD reading.                      

Come on Healthcare: catch up will you!

Within philosophy it is recognised that Immanuel Kant provided a means by which the rationalists and empricists can be reconciled. Some background:

In philosophy, rationalism is the epistemological view that "regards reason as the chief source and test of knowledge"[1] or "the position that reason has precedence over other ways of acquiring knowledge",[2] often in contrast to other possible sources of knowledge such as faith, tradition, or sensory experience. More formally, rationalism is defined as a methodology or a theory "in which the criterion of truth is not sensory but intellectual and deductive".[3]  https://en.wikipedia.org/wiki/Rationalism

In philosophy, empiricism is an epistemological view which holds that true knowledge or justification comes only or primarily from sensory experience and empirical evidence.[1] It is one of several competing views within epistemology, along with rationalism and skepticism. Empiricists argue that empiricism is a more reliable method of finding the truth than purely using logical reasoning, because humans have cognitive biases and limitations which lead to errors of judgement.[2] Empiricism emphasizes the central role of empirical evidence in the formation of ideas, rather than innate ideas or traditions.[3] Empiricists may argue that traditions (or customs) arise due to relations of previous sensory experiences.[4]

Historically, empiricism was associated with the "blank slate" concept (tabula rasa), according to which the human mind is "blank" at birth and develops its thoughts only through later experience.[5] https://en.wikipedia.org/wiki/Empiricism

If health and social care, must be evidence-based, then as far as Hodges' model is concerned we are then duty-bound to use the most readily available 'evidence' to us, including (while taking liberties?):

• The structure of national health and social care organisations (NHS, DHSS ...)
• Physical infrastructure
• Human Resources Organisation
• Unions and Labour relations
• Texbooks, journal papers, conferences
• Organisational structures from the regional to the local
• Professional bodies and governance of licensing/registration
• Curricula that students follow^
  
• Models, frameworks, teaching and learning tools and methods
• Data, statistics, information and reporting (national, international)
• Research projects ongoing (whatever scale, methods, methodology)
• Accounts from lived experience of patients, carers and public (^and students)
• Policy
• Funding
• Law relating to Health and Social Care
• Public (Mental) Health? Discuss
• Media (Social) Control, Advertising
• . . .
  

Hodges' model: Structure and Content

Using this evidence, we still see the Cartesian divide, the mind-body distinction writ large in health and social care. The continuing impact is evident in theory, practice, (hence) lived experience, policy and managment. Since its creation in the 1980s, Hodges' model mirrors (literally) this philosophical, epistemological and ontological legacy, thereby acknowledging the ancient history of medicine, and 'modern' development of healthcare and nursing. Through this device, Hodges' model can facilitate debate, critique, reflection, and critical thinking; to encourage progress in our thought, motivations, action and subsequent evaluation.

This explains the structure of Hodges' model and predicts the range (contextual signature) of content when the model is applied.

Evidence permitting of course!

See also: BBC The Great Philosophers:

Series 1: 4. Descartes

Series 1: 5. Spinoza and Leibniz

Series 1: 8. Kant

n.b. I video taped this marvellous series when first screened. When studying for my BA(Hons), audio taped, they also provided a great learning resource in the car. The programmes are on BBC 4 (UK) once again, but are readily accessible.

Rediscovering nursing ...? [ concepts-maths i/iii ]

   Individuals

 

'In the Introduction to his landmark book, Individuals Peter Strawson talked of the “massive central core” of human thinking that has no history … categories and concepts which, in their most fundamental character, change not at all”.'

'Strawson’s central core revolved around the need for us to identify persistent objects in a unified framework of space and time. He was not troubled that with the arrival of special and general relativity our concepts of space and time had changed, nor that our concept of middle-sized dry goods had changed to accommodate what we suppose to be their constitution by quantum particles.'

Blackburn, S. Rediscovering the Past, The Philosopher's Magazine, 1st Quarter 2018. 80: 72-73. 
https://archive.philosophersmag.com/rediscovering-the-past/

Strawson, P.F. (1964). Individuals (1st ed.). Routledge. https://doi.org/10.4324/9780203221303

https://www.taylorfrancis.com/books/mono/10.4324/9780203221303/individuals-strawson

See also:

How 'divine' is the language of care?

Care concept engineering - anyone? [ concepts-maths ii/iii ]

So, I can proceed, fall flat on my face - [ concepts-maths iii/iii ]

Book: [ii] 'The Systems View of Life - A Unifying Vision'

The introduction highlights the oscillation through history between reductivism, holistic and integrative perspectives; the relationship between theology and the claims for and crystallisation of knowledge and the sciences. The development of cybernetics and systems theory in the 1950s and 1960s does not have it all its own way: 

'The eclipse of systems thinking from pure science had become so complete that it was not considered a viable alternative. In fact, systems theory began to be seen as an intellectual failure in several critical essays. One reason for this harsh assessment was that Ludwig von Bertalanffy (1968) had announced in a rather grandiose manner that his goal was to develop general systems theory into "'a mathematical discipline, in itself purely formal but applicable to the various empirical sciences.'' He could never achieve this ambitious goal because in his time no mathematical techniques were available to deal with the enormous complexity of living systems.' p.11.

(With Zeeman's book on Catastrophe Theory on-loan at present the above is helpful.)

I've picked up a book of Arne Naess's, put it down again: or did I buy 'The Ecology of Wisdom'? I can't check at present (the books I've left are all boxed / created), but Naess sets the scene for the mechanistic worldview.

'Care flows naturally if the 'self" is widened and deepened so that protection of free Nature is felt and conceived as protection of ourselves. .. Just as we need no morals to make us breathe... [so] if your "self" in the wide sense embraces another being, you need no moral exhortation to show care.. . You care for yourself without feeling any moral pressure to do it. (quoted by Fox, 1990, p. 217)

'What this implies, according to the eco-philosopher Warwick Fox (1990), is that the connection between an ecological perception of the world and corresponding behavior is not a logical but a psychological connection. Logic does not lead us from the fact that we are an integral part of the web of life to certain norms of how we should live.' p.14.

Science fiction gives you an appreciate of 'deep', even if not initially the philosophical connotations. Deep space, A.C. Clarke's Deep Range, and more recently deep time brought me to consider deep care on the old website and here on W2tQ with Hodges' model a means of navigation. Naess refers to shallow and deep ecology. Now we also have deepfakes, although the climate change deniers may struggle to believe their deepfake - that is: reality.  Although the book was published pre-sustainable development goals, sustainable development is discussed in detail. For me, the climate change and the SDGs demand we consider ecology, ecosystems, life, and the Earth across the domains of Hodges' model and the spiritual explored in chapter 13.

 

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

	shallow | DEEP

A table on page 13 contrasts several opposites across thinking and values:

As usual, I can't shift beyond the book's introduction, but these points for me underscore the value of the book and Hodges' model. Throughout the blog and papers various dichotomies, polarities, oppositions arise. The structure of Hodges' model lends itself to this, and consequently finding the middle. All the above can be reflected upon in relation to Hodges' model, and also searched.

Chapter 1 explains how the discoveries of Galileo, Descartes, Bacon, Newton and Darwin contributed to the world and life - in biology being viewed mechanistically. The focus of the book is 'Western' and the developed nations; as the main contributor to the current state of the planet. The Cartesian divide - mind & matter/body distinction (p.24) is implicit within Hodges' model:

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

res cogitans	res extensa

Newton's work is described and the limitations of Newtonian physics - the social sciences presented a challenge(!). Thermodynamics is introduced helpful for subsequent chapters.

For general science students the book provides a historical primer, and even an introduction to the philosophy of science. Chapter 2 is short but conjoins cells, molecules, genes (Mendel, Watson & Crick; Franklin & Wilkins, and others), and mechanistic medicine. 

'This will not change until medical science relates its study of the biological aspects of illness to the general physical and psychological condition of the human organism and its environment, The conceptual problem at the center of contemporary healthcare is the confusion between disease processes and disease origins. Instead of asking why an illness occurs and trying to remove the conditions that led to it, medical researchers try to understand the mechanisms through which the disease operates, so that they can then interfere with them. These mechanisms, rather than the true origins, are seen as the causes of disease in current medical thinking. In the process of reducing illness to disease, the attention of Physicians has moved away from the patient as a whole person.' p.43.

Thinking about this in basic instrumentalist terms the reliance on optics, the craft of telescopes and microscopes to discover the very large (our Milky Way as 'a' galaxy) and the invisible - germs, bacteria must have been a profound factor.

If you are selecting subjects for age 16 exams, do not underestimate the value of SOCIO-ECONOMIC history. It has helped me as a community mental health nurse. Especially in light of austerity (UK), the cost of living and energy crisis and the 'housing disaster' (book 2024 with) posts to follow. Chapter 3 uses b&w illustrations of key figures, such as, Locke, Adams, and Marx. I remember in the media, economics education being questioned. That is part 1: concise (p.59!) and yet still relevant today.

Many thanks again to CUP for the pb copy.

Fritjof Capra and Pier Luigi Luisi (2014) The Systems View of Life - A Unifying Vision. Cambridge: Cambridge University Press.

https://www.cambridge.org/gb/universitypress/subjects/life-sciences/genomics-bioinformatics-and-systems-biology/systems-view-life-unifying-vision?format=HB&isbn=9781107011366

Being constantly rational - in pursuit of evidence . . .

. . . while being chased by the absurd . . .

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

Descartes’ - cogito ergo sum^ A psychological case formulation for ...?	(Being constantly …) rational^ ... in pursuit of evidence
Drama: A case formulation for the audience.	Absurd: When £££$$$ meets health  - the where of when the audience aren't interested in the how, and why of the case formulation.

The theatre of the absurd does not need language.

Hodges' model?

In absurd terms the structure must go! No ifs ands or buts ...
Replace the intellectual concepts with poetic images
 but before you do optimise for distance from sense. 

"In the Theatre of the Absurd, the audience is confronted with actions that lack apparent motivation, characters that are in constant flux, and often happenings that are clearly outside the realm of rational* experience. Here, too, the audience can ask 'What is going to happen next?' But then anything may happen next, so that the answer to this question cannot be worked out according to the rules of ordinary probability based on motives and characterizations that will remain constant throughout the play. The relevant question here is not so much what is going to happen next but what is happening? 'What does the action of the play represent?'" Esslin. (p.416).

*and relational?

^D’ANDREA, F. (2017). BEING HUMAN. A FEW REMARKS ABOUT DESCARTES’ COGITO ERGO SUM. Studi Di Sociologia, 55(2), 135–146. https://www.jstor.org/stable/26479662

Esslin, Martin. Chapter 8 The Significance of the Absurd. The Theatre of the Absurd. London: Pelican, 1982. (3rd Ed.).

Previously: relational - rational

Questions in eclipse

 Last Friday 9th I had a Zoom chat for 30 mins, regards Hodges' model with faculty in the USA.

We touched upon:

• background to Hodges' model
• courses taught across the water and interests
• overlaps, inc. person-centered care - socio-technical
• informatics & literacies
• maths/logic

As an outcome it was suggested I forward some questions I'm currently of Hodges' model. Questions that for me, are challenging, put me in the dark, and may not even be valid?

Going through my draft notes I picked out 20, beginning with the working title:

Hodges’ Model as a mathematical object and relational ontology:
category theory or category mistake?

1. Can it be argued there is what amounts to a care locus - that can 'locate' person-centredness?
   
   
2. Can the model's domains be seen as functions?
   
   
3. Are the domains placeholders?
   
   
4. Is there a case to test, and if logical implement co-domains (e.g. parity of esteem)?
   
   
5. Are there other 'structures' in Hodges' model,  for example L-shaped forms, that is relations that involve three domains and (seemingly) omit one?
   
   
6. Are there practical - case studies - that can be associated with such structures?
   
   
7. Can Hodges' model be considered as a single conceptual space (Gärdenfors), or a series of four? (blog posts)
   
   
8. Can Hodges' model be used to identify and apply threshold concepts (Meyer & Land)? (blog posts)
   
   
9. Can we argue that the structure of Hodges’ model as defined by the axes extent, provides and invites inverse relations?
   
   
10. Is Hodges' model as a structure only (a template) equivalent to an empty set (empty set as an initial object)?
11. Is this a mathematical analogue (being neutral) to a practitioner's unconditional positive regard?
    
    
12. Taking its axes and four (care/knowledge) domains can Hodges' model be reduced to a graph?
    
    
13. If Hodges' model acknowledges/incorporates Cartesian duality, are there Cartesian products?
    
    
14. In these Cartesian products are critical operations, e.g. relating to psychotropics - physical health; eating disorder - physical/mental health; complex emotional needs - policy (evidence-based care)?
    
    
15. If the model is inverted, mirrored ... what follows: is the structure - function - consistency retained?

    
    
16. Is Hodges' model 'closed' in comparison with Buzan's (open?) approach to mind-mapping?
    
    
17. There is an 'equation of time': is there an 'equation of care'?
    
    
18. Thought experiments: (semantic distance... cognitive linguistics)
    
    

    Which concept (INTERPERSONAL :: SCIENCES) is closer to the ‘INDIVIDUAL’ axes; which is closest to the ‘GROUP’ (SOCIOLOGY :: POLITICAL)?

    
    

    Which concept (SOCIOLOGY :: INTERPERSONAL) is closer to the HUMANISTIC axes; which is closest to the MECHANISTIC (SCIENCES :: POLITICAL)?

    
    
19. Role of 'types' in Hodges' model - that is, patient / model as a whole as objects (with identity)?
    
    
20. What significance can be gleaned given commonality between several mathematical terms, e.g. group, object, (co-)domain and Hodges' model?

I can no doubt structure - group these questions, and I've not picked out many concerned with Hodges' model as a set, or, as yet, those venturing into category theory. I am wondering, what the commutative law might tell us about holistic, integrated care, and parity of esteem when applied through Hodges' model? Also refining 3-4 case examples to explore and illustrate the same?

While it is maths that prompts this diversion, perhaps ultimately health care disciplines can determine its own formal approach that can produce its own context-sensitive rules, that straddle mathematics/logic and the humanities?

In initial emails, I'd noted the forthcoming eclipse across the USA. Checking, my interlocutor is just N of the path of totality (I wish!) for April's total eclipse. I'm enjoying the darkness here too.

https://science.nasa.gov/eclipses/future-eclipses/eclipse-2024/where-when/

#TotalEclipse2024 #SolarEclipse2024

Hodges' model: How the I-G axis is idealised

As a conceptual model, Hodges' model is idealised.

As an example, take the concept individual in the vertical axis. Whether a patient, client, carer, student or teacher, the individual is where the self also resides.

'I' - INDIVIDUAL 'Self'

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

spiritual - emotional self (my mind) Identity?	material / physical self (my body) identity?
social self (realised, or not; loneliness, excluded, isolated, ostracized, or loner by choice/character. Socio-Politically we arrive at 'civil society', if indeed it is civil.)	political self (whether or not politically motivated / engaged. Self as a citizen arises here, with the law in whether in States voting is mandatory.)

 James, W. (1892). The conscious self. In W. James The principles of psychology (Volume 1), Chapter 10. Harvard university Press: MA.

"From the very beginning of the chapter, James established that he was going to take a fresh approach to his subject. "In its widest possible sense," he wrote,

'a man's Self is the sum total of all that he CAN call his, not only his body and his psychic powers, but his clothes and his house, his wife and children, his ancestors and friends, his reputation and works, his lands and horses, and yacht and bank-account.' (p. 279) 

The explication James offered for this claim is telling: All these various things and persons are part of an individual's self insofar as they give that individual the same emotions (pp. 279-280). In pointing thus toward the emotional foundations of the self, James indicated right at the start that he was going to follow Bain (1859, chap. 7) and others in reaching beyond the old rationalist approach to "the soul" in order to ground his treatment of the human self on the experience and makeup of the whole person, emotional as well as intellectual." (p.107)

 
Leary, David E. "William James on the Self and Personality: Clearing the Ground for Subsequent Theorists, Researchers, and Practitioners."Reflections on The Principles of Psychology: William James after a Century. Ed. William James, Michael G. Johnson, and Tracy B. Henley. Hillsdale, NJ: L. Erlbaum Associates, 1990. 101-37. Print.

'The Body Politic' c/o Dennett

 "Evolution embodies information in every part of every organism. A whale's baleen embodies information about the food it eats, and the liquid medium in which it finds its food. A bird's wing embodies information about the medium in which it does its work. A  chameleon's skin, more dramatically, carries information about its current environment. An animal's viscera and hormonal systems embody a great deal of information about the world in which its ancestors have lived. This information doesn't have to be copied in the brain at all. It doesn't have to be 'represented' in 'data structures' in the nervous system. . . . 

By using the old bodily systems as a sort of sounding board, or reactive audience", or critic, the central nervous system can be guided - sometimes nudged, sometimes slammed - into wise policies. Put it to the vote of the body, in effect." p.79.

INDIVIDUAL
|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

MIND CONSCIOUSNESS COGNITION	ANATOMY - PHYSIOLOGY EVOLUTION BODY
	POLITIC

Dennett, D.C.  (1996) Chapter 3. The Body and its Minds. In. Kinds of Minds: Towards an Understanding of Consciousness. Basic Books.

Descartes' asunder c/o Intima: A Journal of Narrative Medicine

 I THINK therefore I AM       

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

Original image: MindBody

© Pain Scale for Chronic Patients ‘MindBody’ by Sal Marx Fall 2021

In Intima: A Journal of Narrative Medicine
Copyright ©2022  ISSN 2766-628X

Previously: 'Cartesian'

Peter 4.0* surely?

Or, more modestly Health 4.0?

No, it's ...

individual
|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Mind Personality Identity Hope Love ...	Peter 2.0

 

*'Peter 5.0' more accurately, the four domains embedded within the 'spiritual'.

My sources:

C4 UK Documentary and Reid, M. The making of a human cyborg, Saturday Review, The Times, April 3, 2021, p.16.