Naive holism, Hodges' model and a lesson from NeuroLinguistic Programming

The pen is mightier than the sword.

Words are indeed very powerful, which means we should be careful how we use them.

In the mid 1980s when artificial intelligence (AI) had a temperature well above normal limits, personal studies brought me to the words that represent commands in expert system and artificial intelligence applications. The question - how might language influence our expectations of such programs? In what was a major personal project at the time (which never saw the light of day - but whose effects may be evident in the main website and this blog?) I discovered and referenced work on problems discussed by McDermott (1985).

This included the choice of mnemonics used in AI programs, with McDermott comparing the mnemonics in two systems - Planner and Conniver.

True: things have moved on - but history, history....

Planner : Conniver
GOAL : FETCH & TRY-NEXT
CONSEQUENT : IF-NEEDED
ANTECEDENT : IF-ADDED
THEOREM : METHOD
ASSERT : ADD

Upon executing 'GOAL' or 'THEOREM' into a computer 'you can just feel the power at your fingertips. It is, of course, an illusion.'

'If a researcher tries to write an "understanding" program, it isn't because he has thought of a better way of implementing this well understood task, but because he thinks he can come closer to writing the first implementation.' Ibid.

Legally, today the world is very different and yet without care extreme enthusiasm and the market may blur our vision and (rather ironically) dull our reason; McDermott observes that:

'If he calls the main loop of this program "UNDERSTAND" he is (until proven incorrect) merely begging the question.' Ibid. p.144.

I believe there is a similar lesson in terms of 'holistic care'.
As the track is swept and the starting blocks are put in place for decision making in the clinical forum - what sense are the users to make of the language used? Will eagerness to engage ("wow!") the user community cause a false start and what might the impact be?

Words are like sub-atomic particles: strange, ordered, chaotic, true, honest, noisy, quixotic.

Repeat some over and over and they become nonsensical.

Repeat yet other words over and over at the behest of those who know and they
conjoin, concatenate
to become belief-bearing,
an energetic property with a sharp edge that can turn the tide of history
(departmentally, locally, nationally and globally).

Here are (just) two reasons why holistic care has proved so elusive:

1. It is easy to add 'holistic' into care and ward/service philosophies and policies.
2. Actually measuring holistic care is not straightforward, but the measures should be specified as the word is first used - enacted. (If the service in question has someone working in a professional practice development role this might well fall to them.)

The usual outcome is what we might call 'naive holism'. The word is there in policy (for all inspectors to see). There are concerted and authentic efforts to step beyond the physical and the interpersonal domains, but there is still much to do. As for the social and political - maybe tomorrow.

If such a thing is possible an evaluation of 'holistic bandwidth' would of course need to be done at upon completion of a care episode. Maybe there is a test...?

While physicists struggle on with it - perhaps String theory can assist us? More to follow....

McDermott D (1985) Artificial Intelligence Meets Natural Stupidity, In MIND DESIGN, Haugeland J (Ed), MIT Press, London, p.144-145.
(I hope the quote is correct - old notes - and no time to check, but you have the gist).

Well-being: a great place to be!

Working in mental health you certainly don't take mood, mental state and that nebulous notion of well-being for granted.

Depression is a terrible thing and given the thin red line that we all walk in terms of mental health, it's a place no one wants to venture.

There's a lot of emphasis being placed on well-being (happiness!) at present. The usual retinue of number of this and that measures count for little if at the end of the day well-being or the individual's happiness is not improved, or perhaps more accurately 'satisfied'.

Watching Glastonbury it's all about music and well-being amid lots of mud.

Well-being is taken for granted like so many things in life. Take it away and it's noticed - very quickly.

They say that the best lessons are those we learn for ourselves. Being lost and finding your way is another pivotal lesson. At key times and places this journey can be a rite of passage no less.

In order for health promotion to deliver, people need to understand well-being, that is the many ingredients that contribute to that feeling, that sense, that inner magic that lights us up and those around us...

Hodges' model can help people with that journey, especially at a time when a fellow traveller may be needed.

Health and social care services are so often about signposting these days.

Hodges' model can help people signpost for themselves...

Photo: BBC

i3: Inclusion, Integration, Informatics

As well as studying Bortoft over several months, I've been reading Oberski's (2003) paper 'A Goethean way of seeing inclusively' (ref. below) which discusses inclusion within special education. The second page in - I sat up. Although the subject is education, inclusion and integration are central drivers in care service development and improvement. Let's face it, you can't read or listen anywhere without coming across 'i' this and that.

Usually, ask a philosopher to justify their existence and amongst other earnest pursuits they will point to their detailed critique and qualification of the way words are used in our routine daily lives, both domestic and working. They do us a great favour, as the world would grind to a halt if everyone was blinded by the light of uncertainty and what would be perpetual philosophical deliberations.

In this paper, Oberski refers to sources that highlight some crucial differences between inclusion and integration. In this context inclusion means the school must adjust to accommodate and include the child with special educational needs.

As for integration, it is the child [individual] who must 'fall-in-line' and match themselves to the institution the school.

Of course, [special needs] education is not health - is it? Whatever the extent of education within health and social care, it must play a far greater role in future. That's why distinctions like this are important.

The policy push is ongoing - integrated services, public involvement (inclusion?), patient engagement (self-assessment, carer assessment, self-care = inclusion?). How does all this fit together and :-

1. is it generally consistent?
2. are these terms consistent as applied across the h2cm domains:

- INTERPERSONAL; SOCIAL; SCIENCES and POLITICAL?

There's an exercise here if you care to try?

Actually, if inclusion and integration are not used consistently across the care domains, what does that mean for #1 and the general situation? Surely declaring a conflict of definition - should any exist - is as important as declaring a conflict of interest?

If a conflict is found do we freeze in panic, transfixed in the glare of uncertainty?

Or do we just play it cool. Reach for the sunglasses and watch as informatics pulls it all together?

Oberski, I. (2003). A Goethean way of seeing inclusively, Eur. J. of Special Needs Education, 18, 3, 333-340.

Northern England CHE group; links and Mind Canvas

The Northern England Centre for Human Ecology interest group are meeting on the 30th June at Sedburgh. I've no exact details as yet, but plan to attend even though the following w/e I'm off to Charleston for the SPT conference. My wife and daughter may come along, we've never been to Sedburgh before, so we could meet up again after the meeting and have tea up there....

Here are a few links including an interesting site called Mind Canvas.

http://www.slideshare.net/

Slide share is really cool and well worth exploring.

http://www.themindcanvas.com/demos/

At the above link you will find the following methods and visualizations you can explore. I like the category sorting example. Now what could we use that for...?

MindCanvas Methods	Research Method	Visualizations
OpenSort	Sort top 20 movies from American Film Institute	Dendogram (to see structure) VocabularyBrowser (for labels) SimilarityBrowser (to see similarity)
TreeSort	TreeSort study of movies & genres	CategoryBrowser
Divide-the-Dollar	Choose Cell phone features	WeightMap (for importance) ClusterBrowser (to see groupings)
FreeListing	Cellphone freelisting study	List Map (for trends)
Sticky	What do you think of Gap design	CommentMap
Clicky	Quick: Find info on this Gap webpage	ClickMap

You can see how Web 2.0 makes it easier to create inviting interfaces and tackle quite complex research based questions. Could Web 2.0 also be a tool to support triangulation? This may still be quite a way off, but imagine what that could do for the research methods debate?

Anyway this reminds me: I've some slides to sort myself! Thanks for visiting.

To follow 'i3' - informatics, inclusion and integrated (and possibly Goethe).

Holistic care 3: Location

Through February and March I looked at holistic care definitions and other aspects. Now for location.

The place to look for holistic care is literally everywhere. Every - where?

Well yes, if we take holistic to really mean holistic.

There is the obvious physical where that applies in the various care sectors such as; primary, secondary, community and tertiary care and the places they all encompass and contain. The locations associated with buildings and other architectural and organisational structures however permanent: hospitals, hostels, surgeries and clinics, homes, schools, prisons, refugee camps and workplaces - including inner and outer space.

The other where comprises the cognitive and virtual. Our thoughts about care, the thought processes and conscious decision making about care assessment, planning, intervention and evaluation. Except in specific psychoanalytical therapies the unconscious is a less frequently acknowledged and yet undoubtedly factor. If values are to have an origin and a safe harbour (governance) then a light must be cast on the darker, uncertain places. Accepting and utilising these places facilitates a holistic perspective, an adjunct to the more usual analytically derived views.

Speaking of analytical: recently, working on a 2nd temporary secondment, I've been preoccupied (and still am) with PROCESS and CONTENT. We tend to lose ourselves in process; the nursing process, care process, process mapping workshops abound. The problems take centre stage and because they are the patient's problems that qualifies the process as being person-centred. A tick goes in the box.

At times outside of medical emergencies this may be a mistake.

In deploying 'IT' the argument goes that the benefits of information technology in health care (various reports, effective case management, safer practice...) should be transparent, that is -

a by-product of the care process: not an add-on.

To me this suggests that the care process, the energy spent negotiating the care pathway produces a reaction. Informationally this reaction can be desirable. (I'll leave you to contemplate the alternative.)

If the person is truly at the centre of care then maybe the reaction can also be characterised as precession? Just as the Earth precesses on its axis, so our care processes result in precession around the person - the 'whole' individual and their situation at the centre of care?

But only IF we choose to take notice, factually, emotionally and informationally.

There's no disputing that care is frequently wobbly. But this oscillation can provide a periodic peek into the four (5) care domains.

At times these presentations, or windows of opportunity may be physically and emotionally draining, and arise in a highly disordered manner, they are nonetheless there.

Allied with a problem space, that other for me essential location of holistic care, you have a potentially very powerful tool.

I know this may be twaddle and I may be on shaky ground, but at least I'm trying to follow the wobble...

As highlighted previously there are alternate ways of seeing.

Before I close and follow a countdown: Thank you Darcy - a star on stage : GO STS 117 stars in space.

Help Wanted: Arts, Media and Health Studies Students

It’s a regular student's dilemma: with assignment in hand find a worthy project that truly matches the brief and your creative talents.

For arts students a project that is in the form of a commission is highly desirable, reflecting the real world and future artist-client relationships. If there are any tutors reading, I (or h2cm) can provide several commissions, although I'm afraid without financial reimbursement. ...

The h2cm site would benefit from the attention of an artistic eye.

• A banner is still needed for the blog, preferably something that changes dynamically.

Here's one idea I worked up, but it's not exactly subtle?


• There are numerous images on the website that need a refresh of more than a coat of paint.

• Photoshop, Illustrator and other applications are often used to create montages. Hodges' model may at first appear blanc, but within the care domains lie hidden layers. A complex montage of ideas and concepts awaiting release and expression.

• If none of the above appeal, h2cm can help inspire and support any brief – being a regular smorgasbord for creative types.

Lecturers/tutors: if your students use Hodges' model from the outset, do they get extra marks if they include their 'working out - calculations'?

• I’ve often wondered about the model’s two axes being represented as a place.

What would it be like to take a walk along these streets illustrated using cut-outs of health and social care problems, solutions and issues like so many shop-fronts?

Over to you and as the (Northern) academic year closes - have a great holiday....

Ecotherapy: Hey Surf's Up - Better grab your sunbed

Having an eye for 'therapy-this' and 'that-therapy', a report on ecotherapy has appeared on the MIND website, blogs and other media. It's not new really, although the researched approach is very welcome. The mental health benefits of volunteering and the great outdoors have been recognised for countless years.

This summer - August in fact, there's an opportunity to do something different that also has an outdoor theme. It means putting that surf board down and getting the sun bed out: after midnight. Now is the time to do some networking and planning - at that time of night of course you must be safe and this is an experience to share with people you know and trust.

This is 'astrotherapy' which is connected to ecotherapy because venturing out you realise how light it is at night - where is the night sky!

Why go out and find dark skies? It's the PERSEID meteor shower and this summer with maximum the 12-13 August there is no full moon.

You can also check on whether the International Space Station (AND Space Shuttle on this occasion!) will pass within sight for your location.

When you can and do look at the stars it's quite a trip. If you are feeling depressed or lacking in self-esteem, if you let the view work its magic - it sure can make you feel insignificant and yet so very special. Gifted: to look the infinite in the eye...

Mind - Go green to beat the blues - Executive Summary
Some obvious tips: If travelling somewhere even with others check the site during the day. If needed: get permission - tell someone; take extra clothes and a hat - midges, mozzies. If you've a torch cover it with a transparent red film (red hanky even) so it doesn't mess your (and others!) night vision as much. Support your neck properly, you can't stand and crane your neck for hours - besides you'll look daft the next day walking into work - hey I know. If you are in the back garden and see a meteor don't shout out. The buckets of water will fly. Give yourself a good 10-15 minutes to light-dark adapt. Don't forget the flask! Be patient and I'm sure you'll be rewarded...

Four knowledge domains = four audiences?

I don't know if there is any sense in this, but people look for 'signs' all the time - don't we? With the last front-end revision of the website (early 2005) I had twigged that there are at least four audiences that an introduction to Hodges' model needs to address.

Looking at the care domains the following seemed to fall just right:

Patients and Carers : Students - Lifelong Learners

Public [Citizens] : Policy makers, Managers

These may be lost to many visitors (but not you!) given the surfing attention span. If people do access and digest the first page above, which acts as a general introduction, they may not reach the second audience specific page.

Should I swap these around?

What is provided on the first page of each, is a basic h2cm graphic showing some relevant concepts for that particular domain. (It's this representation that trivialises h2cm).

The introductions do need revising and updating. I found some typos on the student - sciences piece, so not the best effort.

I think overall though this approach works - and highlights the need for collaboration and engagement on so many levels.

What do you think, any suggestions?

Ecotherapy to follow...

Invitation to post to the QUAD & human ecology

I've sent out some invites to people I've either worked with, or had contact with over the years since starting the website in 1997. Invitees will be able to contribute directly to this blog.

It would be great to have other authors on board, but of course I realise everyone is busy so I'm open minded. This move is long overdue and does me good in terms of 'letting go' and releasing H2CM into the wild.

Switching to the latest Blogger I lost haloscan. I've added it again to manage comments: purely in response to a sense of anticipation than demand. In doing so it appears I've lost earlier comments; although the correspondence is saved the loss is still a pain.

Job-wise things are a bit up in the air at present. Clinical - Informatics: both...?

There are plans for another group meeting on human ecology to possibly establish a NW England group. Possible dates are:

• Sat 9th or Sun 10th June
• Sat 30th or Sun 1st July
• Sun 8th July

The venue could be Sedburgh (lots of bookshops apparently!) or Manchester where we met in March. Let me know if you would like more information.

With the Serres-Hodges chapter now out the door (what a relief!) it would be good to write something collaboratively using some of the available e-tools.

More soon...

Holistic Bandwidth: All or Nothing

Quite a few years ago (Jones, 2004), I took the term bandwidth from the information and communication technology (ICT) world and applied it to health and social care. We seem to have been trying to achieve holistic and integrated care for decades. When care assessment, planning, intervention and evaluation is limited in scope this creates a narrowing of perspective, a bottleneck. Just as bandwidth problems used to affect the quality of on-line experience, so the bandwidth in health and social services ultimately affects the quality of care.

There's nothing wrong with perspective.

It's essential to making sense of the world. And after all, that railway line travels all the way to the vanishing point and it doesn't stop there. Road or railway - there's enough space reading between the lines to launch a whole film and literary genre.

I've said it before – but it really is ironic that many of the constraints in ICT have been overcome through broadband, memory costs/capacity and multi-core processors; while health services still struggle, still need to change:

From DISEASE - TREATMENT to PREVENTION - ENABLING ...

Single-track thinking is no longer sufficient, even if it is reassuring being able to see where you came from.

There’s an interesting non-trivial aside that follows from this bandwidth notion. The old conundrum of quality versus quantity.

Quality and quantity are the ties that bind, the Gordian knot. Cut this one at your peril!

Failure to focus on priorities, to take in that single, that utmost life-threatening perspective could result in disaster. Intensive care is the obvious example. Failure to attend to the physical priorities because of what seem new-age, airy-fairy ideas will quickly get you noticed.

There’s probably a paper out there on quality, quantity and appeals to holistic care. Returning to bandwidth I have wondered about how to measure this? Integrated care pathways and variance might be one approach, serious incident reports may be another revelatory approach? If it’s a care concept and moves ((uses energy) has currency) measure it!

There are a raft of measures for all sorts of things including, mood, behaviour, nursing care related, quality, risk and dependency. If you know of any that might measure holistic bandwidth, please let me know and add a comment here.

In the meantime I’ll ramble on - travelling h2cm's tracks…


Jones, P. (2004). Viewpoint: Can Informatics And Holistic Multidisciplinary Care Be Harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.

Gordian knot image c/o Bernice Steinbaum Gallery.