Book review: "The Power of the 2 x 2 Matrix" ii

The Power of the 2 x 2 Matrix

 

Once again I will start by referring to a previous post:

Q. What is Hodges' model? A. It is NOT a 2x2 matrix.

 

The structure of Hodges' model, the two axes immediately suggests opposition, dichotomy and thoughts of polarities. 

 

Page 30, table 2.2 Principles of 2 x 2 Mastery, includes:

"Opposition: 

Opposition between forces is either direct or complementary. Direct opposition is Hot versus Cold or On versus Off. Complementary opposition is Size versus Speed or Growth versus Profit. Recognize the nature of opposition, and work with it." p.30.

Of the others, the creative tension in health is manifold. Out of a professional foundation comes the therapeutic relationship nurse - patient and then the tension of trying to provide person-centred care that also has integrity in having the courage to advocate or engage independent advocacy and address the political issues that may (will) arise. Iteration here is a gift in that Hodges' model is situated and can address the multiplicity of contexts that are encountered in health, education and business too. Iteration for me implies travel, movement between the domains in search of a new perspective, (ad-)vantage point. Combined with integrity, this can mean going were you are not necessarily comfortable and perhaps seeking help. I like transcendence a great deal as it refers to "Learning requires unlearning". This points to the outcomes of interventions and application of knowledge, skills supported by Hodges' model with positive change. Transcendence can encompass liminality as described in therapy and education - threshold concepts in particular.

If you seek proof of complexity in healthcare, nursing and medicine look no further than a business book. The book is a marvellous reference text on 2x2 frameworks. In the introduction the authors stress the work is not intended to be read cover to cover. Business readers will be drawn to specific types of framework. Well referenced and researched the index is also comprehensive (with one framework missing (of course!). As the year of publication indicates the references and business examples that are outlined are dated, but they still deliver in readable and meaningful terms the utility of the framework described.

The layout and organisation of the chapters retains a 'current' appeal. I mention proof of complexity after reading:

 "Strategy is the art and science of competing more effectively than one's competitors." p.91.

In healthcare the 'competitors' may be the patients themselves (self-stigmatising, fearing the future, helplessness, hopelessness, fatigue). Competition may lie in other agencies depending on the politics of local health care delivery. Some may argue that the commodification of health is a creative tension not a political one. Also in the sense that 'we' are duty bound to heal, cure, treat you and have you care for yourself in future. Art and science are needed in print and book-loads at present as COVID-19 pushes out other diseases, illnesses that patients and families still face.

More to follow ...

 

Book review: "The Power of the 2 x 2 Matrix" i

Alex Lowy, Phil Hood (2004) The Power of the 2 x 2 Matrix: Using 2 x 2 Thinking to Solve Business Problems and Make Better Decisions, San Francisco, CA: Jossey-Bass ISBN: 978-1-118-00879-9

With many thanks to the publisher for my review copy.

Book review - "Human Landscapes: Contributions to a pragmatist anthropology"

'After Ethnos', a previous book review was an enjoyable challenge. As a nurse, you are, to a certain extent several disciplines all rolled into one, sociologist, psychologist, diplomat, anthropologist ... but After Ethnos and now Dreon's 'Human Landscapes' bring their own demands.

If it was experiment that attracted me to Tobias Rees's book, Dreon's title works on two levels.

Hodges' model anticipates different 'landscapes'. The model also provides a lesson in pragmatism (another post) with pragmatism identified as a method to research Hodges' model.

On health care education programmes, how often do we write of human nature, cognition, or cognitive processes, qualitative and quantitative, subjective and objective? How quickly do we present ourselves, and the readers of assignments with dichotomies, dualities, and polarities?

Just 40 pages in they are here in expected and welcome abundance. I clearly have some reading to do [ that's why it's a review! :-) ] and from reading, much to critique in my differentiation between phenomena and as concepts presented here on W2tQ.

"... the conceptual framework for my approach to human nature is represented by cultural naturalism— that is, a nonreductive form of naturalism that assumes culture to be continuous with nature, rooted in the very organic and environmental conditions of human life, and yet irreducible to the mere association of preexisting resources." p.23

Human landscapes

"Nonetheless, even if we wish to focus on a theoretical analysis of the concept, the idea of human nature seems to display a tangle of problems, punctuated by distinctions that could be useful when treated as functional and connected to specific contexts, but which are actually turned into dogmatic oppositions. One first form of dualism concerns the opposition between the innate and the acquired, between the allegedly innate equipment existing on the genetic or neural level and the properties and ways of behaving this is assumed to give rise to. To give but one example, based on Chomsky’s influential hypothesis, the idea of a neural program for producing grammar encoded in our genes has been assumed to be an efficient (and sometimes sufficient) cause for specific linguistic practices. From this point of view, nurture, culture, and institutions seem to be something completely different from nature, since they supervene on an already fixed material substratum as an adjunct." pp.17-18.

"Taking this or that snapshot of a human could be a useful intellectual expedient in specific circumstances, but “[b]iologically all growth is modification and all organs have to be treated and understood as developments out of something else and as pointing forward to still something else” (Dewey 1985b, 32–33)." pp.19-20.

"I believe that the conceptual opposition between subjective and objective qualities is like a net with too wide a mesh, unable to catch the complexity of our interactions with the world. The problem, I would argue, is that this opposition often involves the idea that qualitative experience is a private, purely first-person experience, consequently posing problems of public access." pp.33-34.

"The section 2 will focus on the Pragmatists’ conception of experience as something broader and richer than cognition—because, in turn, cognition is understood as a specific phase within experience, responding to the needs and problems emerging from qualitative experience and ultimately returning to it. In this approach, perception through the senses and pure sense data are reframed within the context of inquiry, as features that are pointed out, discriminated, and isolated from a more holistic field of experience according to an
idea, namely, the anticipation of the possible consequences of an action or a certain assumption." pp.37-38.

Not sure why, but at one point, reading prompted consideration of: 'lived experience' and the role of peer support workers?

Starting the book, Dreon is (naturally) laying out the scope and structure of the book. Not just a preface but first chapter, and it looks like - the second. As I get more accustomed to Dreon's style (I'm a nurse remember) there are valuable lessons in laying out arguments, with more reward to follow I trust. I have a sense of a wall, not an impenetrable one, but one that is well argued - the blocks shifting into place - even if I cannot grasp their true significance to specialists in this field.

More to follow.

Dreon R. (2022) Human landscapes. Contributions to a pragmatist anthropology. Suny Press, Albany.

Many thanks to Roberta and Suny Press for my copy (confession to follow).

The harmony of opposites: to relativize the continuous / discontinuous dualism by Michel Lussault

"If we accept a somewhat schematic presentation, we can estimate that the modern Western knowledge system has been deployed on the basis of opposition couples conceived as expressing unquestionable dualities. These couples organized thought, all its activities, under all its regimes including the knowledge of expertise and the knowledge of common sense, and they constituted a kind of cognitive dogmatics; That is to say, they made it possible to define the very relevance of the problems that could be posed. From these dualities, and for a long time from these dualities alone, it has been permitted and legitimate to pose a number of social, political and cultural problems and then to find ways of solving these problems. In view of our integration into the cultural space of the modern West, we all know and experience the prevalence of these antagonistic duos which have structured the thought and continue, albeit in a somewhat more discreet way, -tender." *

Google translation French to English from:

LUSSAULT, Michel. L’harmonie des contraires : pour relativiser le dualisme continu/discontinu In: Continu et discontinu dans l’espace géographique [online]. Tours: Presses universitaires François-Rabelais, 2008 (generated 22 July 2017). Available on the Internet: <http://books.openedition.org/pufr/2398>. ISBN: 9782869063198. DOI: 10.4000/books.pufr.2398.

Original:

"On peut estimer, si l’on accepte une présentation un peu schématique, que le système de connaissance moderne occidental s’est déployé à partir du fondement constitué par des couples d’opposition conçus comme exprimant des dualités incontestables. Ces couples ont organisé la pensée, toutes ses activités, sous tous ses régimes y compris les savoirs d’expertise et les savoirs du sens commun, et ils ont constitué une sorte de dogmatique cognitive ; c’est-à-dire qu’ils ont permis de définir la pertinence même des problèmes qui pouvaient être posés. À partir de ces dualités, et pendant longtemps de ces dualités seulement, il a été autorisé et légitime de poser un certain nombre de problèmes sociaux, politiques, culturels et de trouver ensuite des modes de résolution de ces problèmes. Nous connaissons et éprouvons tous encore, compte tenu de notre insertion dans l’espace culturel de l’Occident moderne, la prégnance de ces duos antagonistes qui ont structuré la pensée et continuent, fût-ce de façon un peu plus discrète, de la sous-tendre."

* sous-tendre - 'to underlie it'?

Hornberger (1989) 'Continua of Biliteracy'. Review of Educational Research

The axes of Hodges' model present a problem in:

• theory
• practice
• evidence - research terms (data!).

The easiest to resolve is practice, which is were Hodges' model can lay claim to being a pragmatic solution. Of course, it isn't the axes that are the difficulty, it is the labels that Brian Hodges originally applied in the early-mid 1980's, followed by other users of the model since. From:

INDIVIDUAL <> GROUP - variations here in 'Welcome to the QUAD' [W2tQ] Patient <> Carer - Family : Client <> Health professional. You can progress to the "patient zero" and a population in an pandemic.

These are fundamental elements in clinical encounters, whether face-to-face, online, and across settings.

The same applies to the horizontal axis: HUMANISTIC <> MECHANISTIC.

As presented - in the sidebar, and the two-by-two table found in many posts - the model has a distinct dichotomous quality. It seems to set up, or invite opposition, or polarities. Sometimes I've viewed the axes as continua, but they are not graduated, incremental in a quantitative sense.

Do the axes of Hodges' model serve a need (do their work) by allowing the user to differentiate through opposition and relational appraisal (testing)? Perhaps, qualified in a respective profession / subject area, the user of Hodges' is employing other axes?

This brings us to intersectionality and the cognitive work of placing the person (couple, family, community ... biosphere) at the centre of our deliberations.

In biliteracy studies, Hornberger (1989) is perhaps more accurate in seeing a series of multidimensional and interrelated continua (p.273) which form a framework.

There are three figures in this paper and many other points of use:

"Contexts of biliteracy are defined, then, by these three continua. Any particular instance of biliteracy is located at a point of intersection among the three." p.280.

In health care this is readily understood given the varied contexts of the centre, the nexus of Hodges' model. When we say Hodges' model is situated, the centre of the model is the sweet and sour spot. For Hornberger, the context determines the use and significance of the continua.

This opens up Hodges' model as a potential tool to better understand the dimensions of diversity, inclusion and intersectionality.

Hornberger, N. H. (1989). Continua of Biliteracy. Review of Educational Research, 59(3), 271–296. https://doi.org/10.2307/1170183

No! This post hasn't been in draft since 1990. ;-)

Hodges' model - as 'a' philosophy c/o TPM

As much as I might like, or aspire to write, this is not a treatise on Hodges' model as a philosophy. Anyway: why limit ourselves to one 'philosophy', when several might apply, or at least be found?

Other TPM articles within the 50 new ideas issue point to Hodges' model (of course 😉).

Philosophy itself may benefit. Philosophy is "the love of wisdom". While there are dangers in siloed kowledge and the thought that put it there, what is classed as wise across the domains of Hodges' model in a given context? Contexts change, but how can philosophical reasoning help us 'keep our options open'? Or is the situation and context 'closed'? 

Again much as I might like, in response to Benatar's Forsaking wisdom (pp.23-24) I'm not trying to clever - even my sense of humour does not extend that far. We do want to apply Hodges' model  practically. Maybe disciplines exist in a perennial state of self-doubt? Peter Boghossian discusses Philosophy that matters (pp.29-30). Nursing is no exception being challenged still regards its professional and academic identity. In mental health nursing there are concerns about the field as a specialty being genericised. The nursing discipline for which identity and meaning is key finds its own identity challenged. Helen De Cruz writes of The Philosopher's rut (pp.41-42). A contributing factor is the tendency in philosophical debates to be dominated by two-well-outlined opposing positions. This framing can stifle exploration, and yet in Hodges' model with oppositions built-in the model as a whole provides conceptual escape; a series of conceptual spaces to explore. 

Hodges' model can help postpone what De Cruz refers to as cognitive closure, another reason for the philosopher's rut. We tend, psychologically to draw quick conclusions such that we are averse to ambiguity. This may be innate to a degree, as seen in 'black and white' thinking. Ironically, for me with Hodges' model is the counterposition of reflection as navel-gazing, resulting in too many options, and no decision at all.  

With the self, I, individual appearing to take a prime position in Hodges' model, Michael Cholbi reminds us of the philosophical significance and history of self-knowledge (pp.35-36). Student nurses need to acquire sufficient substantial self-knowledge to be safe, effective, competent, satisfied and lifelong learning practitioners. In another issue 98 4th Quarter 2022, Jonathan Matheson asks Why Think for Yourself (pp. 26-32), is there a rationale in intellectual autonomy and love of truth? You can exercise your intellectual autonomy and make it collaborative, by deciding on the port of entry to Hodges' model. This is a determinant in terms of the context, the situation that prompts you reach for the model in the first place. 

me - you INDIVIDUAL - the few
  |

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

others - GROUP - many

inherent philosophy in Hodges' model the mind - my mind Personal identity epistemology ontology - being - identity my - beliefs - (yours) abstraction logic - mathematics concept of opposition^ opposition of concepts^ representation of -isms ethics - moral reasoning values - value unconditional positive regard	physicality - materialism the brain - my brain - body Organic identity implicit binary structure superimposed relations vectors coding and classification language corpora reality as orientation: (e.g., what three things do we need to know?) personalised medicine ('up here') professional scope - curricula silos of knowledge scientific method/methodologies
language - semantics - meaning dialectics 'other minds' practical reasoning applied philosophy individual-collective debate: utilitarian principles social philosophy socialisation of learners (professions) conformance - group think	health in politics politics in health human rights the unborn - future humans protected human characteristics diametrical oppositions in Hodges' model (e.g., 1. my mental state - mental health law; 2. public understanding - of science; 3. my freedom - the law. 4. culture - (techno-culture!) - science...) power - freedom political philosophy

In John Corvino's Applied philosophy out of the closet (pp.39-40), I'm not sure if it was Martha Nussbaum who stressed the need for philosophy to be practical. Is this the same as applied? I note her work on capabilities. Hodges' model seeks to reduce the gap between the learning involved in (between - hence bridging) theory and practice - to achieve competencies. For the future of (Brian) Hodges' model this matters, as I understand that efforts are ongoing to apply category theory to the social sciences. It is a pragmatic conceptual structure. To return to identity, A M Ferner tackles (literally?) Organic identity (pp.49-50); while Kerrie Grain takes on what is next-door in Hodges' model - Personal identity (pp. 51-52). As I continue to sort papers, journals and books there is more to follow. 

The Philosopher's Magazine, "50 New Ideas", 1st Quarter 2016. Issue 72. pp.20-120.

TPM #72 cover image: https://ericthomasweber.org/correcting-political-correctness/

^Ack.

Needham, R. (1987). Counterpoints. Berkeley: University of California Press.

(Looking f/w - I think - to chapters 7-8. With specific post(s) to follow.)

Life, Literacy, Oppositions, Complexity and Information

Literacy in Traditional Societies

"Durkheim's work on primitive classification is being applied to societies within the orbit of major civilizations. The polarities and oppositions of la pensée sauvage turn up in ancient Greece, and tools developed in the study of the narratives of American societies are applied to the Oedipus story, the Book of Genesis and even contemporary literature, with little sense of the basic incongruity involved.

Polarities of some sort are of course present in all societies; their significance, however, varies widely. Aristotle describes one Pythagorean theory in the following terms:

 

Others of this same school say that there are ten principles, which they arrange in ten columns, namely:

limit unlimited
odd even
one plurality
right left
male female
at rest moving
straight crooked
light darkness
good bad
square oblong

. . . How these principles maybe brought into line with the causes we have mentioned is not clearly explained to them [quoted Guthrie 1962: 1, 245]."

Goody, J. (1968) Literacy in Traditional Societies, Cambridge: CUP. pp.10-11.


Taking each of these in-turn as may relate to Hodges' model (I may update/edit these):

limit  unlimited

As a template the model invites both a limit (boundaries) and some-thing unlimited.

odd  even

There is a symmetry - evenness to the model, but the invitation noted above is also a prospect for odd-ness. This may extend to the frustration experienced when a phenomena, account (patient's narrative . . .) defies explanation and classification.

one  plurality

This polarity is key in Hodges' model. 'One' refers to the person, patient, carer, any - individual who the model is applied to. In respect of plurality this can include the dyad of patient - nurse, couple, family, team, community, national or global population (and Biosphere).

 

right  left
 

The horizontal axis is not the last word in Hodges' model, as intra-domain we also find right and left. Of course, the vertical axis (indeed, the whole model if required?) can also be repeated in a domain.

 

male  female

 

You quickly recognise the potential for disagreement* which is fundamental in dichotomous situations, a point further reinforced below.

at rest  moving

 

The model is 'at rest' as a snap-shot, but as a frame it can represent the change over time and so has its own dynamic potential.

 

straight  crooked

 

The axes as continua are 'straight' but this distinction (as noted above) has distinct psycho-socio-political connotations. In the model, line-of-sight is acknowledged, while 'crooked' might suggest what is uncertain, and unseen?

 

light  darkness & good  bad

 

Again, these two oppositions seem 'loaded': especially socially - politically.

Tread carefully. If you have light, that's good, but if lost: bad.

 

square  oblong

 

Viewed as containers, or sets the model's domains can be represented as several shapes, as long as the axes are retained as part of the structure. The adopted rectilinear form is an affordance of the (underlying) HTML, and the traditional (paper-based) tabular format. From the domains being of equal area, the point where the axes intersect could be shifted, such that a single domain is enlarged (prioritised?), at the expense of another.

*Incredible harmony too!

Then prior to an anticipated move, and sorting through books and papers:

Complexity:
Life on the edge of chaos

“The discovery that universal computation is poised between order and chaos in dynamical systems was important in itself, with its analogies to phase transitions in the physical world. It would be interesting enough if adaptive complex systems inescapably were located at the edge of chaos, the place of maximum capacity for information computation. The world could then be seen to be exploiting the creative dynamics of complex systems, but with no choice in the matter. But what if such systems actually got themselves to the edge of chaos, moved in parameter space to the place of maximum information processing?” p.54.

Lewin, R. (1993) Complexity: Life on the edge of chaos. London: Phoenix.

The conclusion? 

Perhaps, the ubiquity of polarity, opposition and dichotomy is that they anticipate and presage an increase in information processing (for good or ill: there we go again!). 

This is also a ( the ) function of Hodges' model.

Previously:

Opposition  . . . See also - Polarity , Dichotomy , Literacy . . .

The 2025 peace laureate

The 2025 peace laureate

'The Norwegian Nobel Committee has decided to award the Nobel Peace Prize for 2025 to Maria Corina Machado “for her tireless work promoting democratic rights for the people of Venezuela and for her struggle to achieve a just and peaceful transition from dictatorship to democracy.”

In the past year, Ms Machado has been forced to live in hiding. Despite serious threats against her life she has remained in the country, a choice that has inspired millions of people. She has brought her country’s opposition together. She has never wavered in resisting the militarisation of Venezuelan society. She has been steadfast in her support for a peaceful transition to democracy.'

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC =========================  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

María Corina
Machado	Ill. Niklas Elmehed © Nobel Prize Outreach

municipal SOLID waste: Activist tinder - the perpetual fuel

There is nothing like a little bit of local politics to ignite the activist tinder - a perpetual fuel - that can be found in the POLITICAL care domain of Hodges' model.

At the end of February there was a knock at the door @2130 hours on a Sunday. It was a neighbour who lives a few doors away. What transpired was news of plans to extend an existing solid municipal waste plant in the valley between the communities of Blackrod and Horwich.

There was a meeting of the local council the following night and it was vital that people attend to learn of the plans and act on the information as they see fit. The proposal was summarised in the local press as copied below from the The Bolton News:

• The plant would be capable of processing up to 75,000 tonnes of household and commercial rubbish.
• It would create recyclable materials and biofuel products and would operate 24 hours a day, six days a week..
• Four 38ft high bio-filters would need to be built to clean the air produced by the processing plant.
• Owners say the facility would mean that 48,000 tonnes of waste, including recyclable glass, metal and plastics, would not be sent to landfill sites and that it would produce bio-fuel products, which could be processed to create environmentally friendly fuels. It is estimated the plant would create an extra 20 jobs.
• Environmental health officers and the Environmental Agency have raised no objections to the plans.

While in the garden last summer I'd wondered about the occasional loud crashing noise. It couldn't be from over the wall (Halloween was ages off). Walking Sam I'd noticed rubbish on the road past the station, but thought it was just vehicles passing through. Well... they were passing through all right. Hearing the details at the council meeting and the smaller group who gathered together made me wish I'd been more curious and not lost in the virtual world. Station Road had been dusty for ages and suddenly it all clicked into place.

I never thought I would be asking myself - "Hey are you playing the NIMBYist?" Getting involved with the Environmental Action Group [EAG] I discovered that NIMBY is not alone:

... As the waste problem gets more acute, site selection for waste facilities becomes conflict-ridden, and the decision is usually met with considerable local opposition, e.g., with BANANA (Build Absolutely Nothing Anywhere Near Anyone), LULU
(Locally Unwanted Land Use), NIMBY (Not in My Back Yard), NOPE (Not On Planet Earth), or NOTE (Not Over There Either) arguments. Therefore, the solution should not be only cost effective but also environmentally and socially acceptable. Hence, the waste management facility location–allocation problem is characterised by multiple, often conflicting objectives. ... p.1405.

Erhan Erkut, Avraam Karagiannidis, George Perkoulidis, Stevanus A. Tjandra (2008) A multicriteria facility location model for municipal solid waste management in North Greece, European Journal of Operational Research. 187, 1402–1421.

As the environmental action group [EAG] stated at a further public meeting we really DO need new technologies and innovative ways of dealing with waste. Not everyone recycles. Local and national governments are under (fiscal) pressures to reduce landfill. I was immediately struck by the topography: at what height would the proposed chimneys be in relation to the surrounding homes and schools...? What impact would there be on people's mental health, a factor that was already an issue for many homes nearby? Investigating this to put together and articulate objections some key points had been omitted:

• The publications from the company concerned and DEFRA highlighted these as new technologies, so what about the need for the precautionary principle?
• Due diligence needs to be demonstrated and proven.
• The estimates for the increase in traffic and noise did not seem realistic.
• Contrary to claims made, the citizens impacted by the potential development were not informed.
• Mention was made of another existing (new) plant, but how did its location compare with that proposed?

The EAG were able to make use of individual and professional knowledge. Other [EAG] people put a lot of work into this, collating, producing and delivering handouts, site visits and making contact with key people. Being at work I could not attend the main council meetings. Over a 1,000 letters of objection were submitted, with contingency plans in waiting.
The news is that the planning application was withdrawn 3 hours before Bolton Planning Committee was due to make a decision: Success (with eyes, ears and heart on the future)!
So, if you're making decisions that affect whole communities - think holistically - it is always best to avoid the BANANAs.
(I would love to map this onto Hodges' model, but no time....)

Book review i. General Psychotherapy: Principles and Common Theoretical Aspects - Rediscovering Humanity

   General Psychotherapy

Predictably, the title of this book caught my attention.

I did do some homework before requesting a review copy, but it was still a surprise that this book by Prof. Dr. med., Dipl. Psych. Lotte Hartmann-Kottek is not edited. It is a comprehensive tome at 491 pages. As a mental health nurse with experience of cognitive, behavioural and family therapy, I am not an expert, but Prof. Hartmann-Kottek's experience in psychotherapy, the history, theoretical development, clinical application, theoretical underpinnings (including physics) and political machinations are well demonstrated.

A disappointment for me is the lack of an index. This seems a major omission, and yet a comprehensive index here, might itself be difficult to navigate. There are some errors in word-use, repetition but they do not detract from the book and reading experience overall. The book is apparently translated from German. The book is expensive, but students may have access through their institutions and special schemes(?).

The book's subtitle: Principles and Common Theoretical Aspects - Rediscovering Humanity is delivered. The title General Psychotherapy - attracted me for several reasons:

'General' - the (seeming) opposition of generalist-specialist is relevant to the theory and application of Hodges' model.

'Psychotherapy' - I was interested to see how Prof. Hartmann-Kottek dealt with the disparate schools of psychotherapy, given some awareness of the politics and efforts to integrate and reconcile therapeutic approaches, philosophies, and legacies. 

Consequently, the chapters address multiplicity, systems, efficacy, commonalities and interspaces. If a book should benefit its reader, rewarding time/cost then this text has contributed to my continuing professional development. Discussion of systems, individual, whole, humanistic, interdisciplinarity, integration, the therapeutic relationship, transcripts and therapy scenarios provides ongoing stimulus for my efforts with Hodges' model.

"The increasing joint adoption of methods and methodological aspects through the partitioned barriers of the otherwise politic(al)ly competing schools in recent decades has, of course, been met with mixed reception, especially when the adoption was coupled with contemporary political and social repression.

However, it may be precisely this difficult topic of the mutually uncoordinated, intellectual adoption and incorporation of vicinity aspects on a macro scale that may indicate that the time has come for an integrative reconciliation or fusion of the essence of psychotherapeutic approaches. As perhaps needs no mention, this path will require an extensive field of play." p.viii. Preface.

'I' - 'Individual' 'SELF' 'Patient' 'Client'

|

     INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

dyad / couple  family  GROUP community population

psychological systems MIND psycho- identity psycho-therapy / therapies subjectivism cognitive  access	physical systems -somatic BODY identity? evidence objectivism physical access
social systems culture history community of practice social access	political systems power professionalism health systems/services funding political access

Many thanks to Prof. Hartmann-Kottek and Springer for the review copy.

More to follow.

Hartmann-Kottek, L. (2022). General Psychotherapy, Principles and Common Theoretical Aspects - Rediscovering Humanity. Springer. https://doi.org/10.1007/978-3-030-87466-7

The symbol '+'

Apart from a multitude of symbolic meanings the figure below also provides the structural foundation for Hodges' model and as symbols.com notes:

The cross with arms of equal length is an extremely old ideogram used in most cultures. It is also one of the basic gestalts in Western ideography (as opposed to the basic elements, which are derived entities). The cross is found in every part of the world, in prehistoric caves and engraved on rocks.

In my interview with Brian Hodges' over 10 years ago in May 1997, Brian provided an account for how he arrived at this structure (summarised below). As mentioned elsewhere on this blog, the website, symbols.com and other sources - the cross, or 2x2 matrix is a common device to explain and structure. The four elements, the four humours (or humors) yellow bile, black bile, phlegm and blood, the seasons; there are so many things that can be characterised in this way.

With '+' as a starting point for me to reflect on Hodges' model I see each line as an individual. This agent or subject could include patient (person) and health care worker; lecturer and student and many other examples.

The act of cros-sing, the intersection of the axes represents two human beings being in a situation.

Space and time brings people together:

and also forces us apart - physically and temporally.

Adding an arrow to one end of these axes creates the dynamic of communication.

The angular distance in the alignment of those arrows offers hope -

• in our common humanity we are never in 180 degree opposition;

and yet acknowledges:

• the isolation of the individual -
  
• and the challenge.

The work that must done. Hence the primacy of communication skills and values; in order to bridge individual being, ti:me and space.

Perspective is helpful here as an extension:

While we may get close to another person, through relationships that entwine the lines - be they spun by professional obligations, friendship, family ties, or intimate sexual relationships - the two lines are always distinct: part of an elaborated knot.

Is it just the special ties that must forever seek to be one+

---

The best way to explain h2cm is to review the questions Brian Hodges originally posed.

To begin, who are the recipients of care? Well, first and foremost individuals of all ages, races and creed, but also groups of people, families, communities and populations. Then Hodges asked: what types of activities - tasks, duties, and treatments - do nurses carry out? They must always act professionally, but frequently according to strict rules and policies, their actions often dictated by specific treatments including drugs, investigations, and minor surgery. Nurses do many things by routine according to precise procedures, rather like the stereotypical matron with machine-like efficiency? If these actions are classed as mechanistic, they contrast with times when healthcare workers give of themselves to reassure, comfort, develop rapport and engage therapeutically.

This is opposite to mechanistic tasks and is described as humanistic; what the public usually think of as the caring nurse. In use this framework prompts the user to consider four major subject headings or care domains of knowledge. Namely, what knowledge is needed to care for individuals - groups and undertake humanistic - mechanistic activities? Through these questions Hodges’ derived the model axial structure.

Environment, Social, Governance [ESG]

As Greeta Thunberg arrives in New York for the:

CLIMATE ACTION SUMMIT, 23 SEPTEMBER 2019

... it is interesting to consider not just where 'health' sits within business and commerce, but the themes and issues that it has reached. Now, we are more aware of the dependencies, for example air quality, physical and mental health, but we are still to finish the chapter titled: "The Damage Done".

'Capitalism' remains rapacious in terms of resource use (ironically if the market and prices are cyclical) and we must acknowledge all of economics, from stock exchanges, to cities, to villages in developing countries, but the challenge remains to transform the geometry of our economics to that of a sustainable circle. As per the climate debate, in some instances, we might close certain industries and leave some classes of minerals, elements, fossil fuels in the ground. We should accept that while some economies are more circular than others, sometimes you cannot circle a square?

Below is an investment hierarchy in which I have highlighted health. Education, literacy and environmental awareness are, if not issues (which they are, especially their respective economics) they are much needed individual actions to achieve progress.

The media notes that next month's summit will include 'world leaders'. I wonder how many business leaders will be present? This would be an indicator of corporate social responsibility, looking very positive in the annual report (even if the self-regulation has not yet achieved homeostatis). If you can advise with figures, or if I find the information later next month I will post here.

MSCI ESG Key Issue Hierarchy

3 Pillars	10 Themes	37 ESG Key Issues
Environment	Climate change	Carbon emissions  Product carbon footprint  Financing environmental impact Climate change vulnerability
	Natural resources	Water stress  Biodiversity & land use  Raw material sourcing
	Pollution & waste	Toxic emissions & waste   Electronic waste Packaging  Material & Waste
	Environmental opportunities	Clean tech  Green building   Renewable energy
Social	Human capital	Labor management   Health & safety Human capital development Supply chain labor standards
	Product liability	Product safety & quality  Chemical safety Financial product safety  Privacy & data security  Responsible investment  Health & demographic risk
	Stakeholder opposition	Controversial Sourcing
	Social opportunities	Access to communications  Access to Health care Access to finance   Nutrition & Health
Governance	Corporate governance*	Board* Pay* Ownership* Accounting*
	Corporate behavior	Business ethics Anti-competitive practices Tax transparency Corruption & instability Financial system instability

* Corporate Governance Theme carries weight in the ESG Rating model for all companies. In 2018, we introduce subscores for each of the four underlying issues: Board, Pay, Ownership, and Accounting. https://www.msci.com/documents/10199/123a2b2b-1395-4aa2-a121-ea14de6d708a

My source (MSCI ESG Key Issue Hierarchy p.27):

Norrington, J. (2019) Future Proof Investments, Investors Chronicle, 18-25 April. pp.24-28.

Dear McKinsey and Company, Re. "The era of exponential improvement in healthcare?"

Re. Your article:

The era of exponential improvement in healthcare?

(By Shubham Singhal and Stephanie Carlto)

Technology-driven innovation holds the potential to improve our understanding of patients, enable the delivery of more convenient, individualized care—and create $345 billion to $420 billion in value by 2025.

Healthcare advances have delivered great benefits to society, bringing material improvements in average life spans and quality of life.¹ Yet these improvements have come at a cost—an ever-expanding portion of the US GDP is being consumed by healthcare expenses.² Could technology, enabling delivery of healthcare advances while improving affordability, be part of the solution? We have reviewed the evidence, done the math, and identified technology-enabled use cases that could create between $350 billion and $410 billion in annual value by 2025 (out of the $5.34 trillion in healthcare spending projected for that year³ ).

Read more ...

<>

But how would we recognise the era of exponential improvement in healthcare?

SELF - individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - POPULATION

The exponential benefits realised 'elsewhere' in global, local and glocal health and healthcare systems finally sees the achievement of parity of esteem with mental health not only fully funded, but designated as the key that must be turned 4 happiness. Despite the diametrical opposition of this domain to the political domain, there is a breakthrough in policy makers and the body politic prioritising "The Long Now"

"Predictions of an exponential increase in people living with dementia in the coming 30 years require evidence-based strategies for advancing dementia care and maximizing independent living. However, the evidence required to inform priorities for enabling improvements in dementia care is rarely presented in a way that stimulates and sustains political interests."  Martin, O’Connor, & Jackson (2018).

Community-based healthcare becomes  the norm and the educational, preventive and sustainable ethos for health and healthcare systems is adopted globally. Look at the readiness and response-to potential epidemic crises, plus  interventions in population health.  Exponential benefits are accrued. Evidence - look at the number of  (new) hospital beds. The community IS the market.

Exponential growth in global healthcare funding, health information for all, access to universal health care.  Social Determinants of Health not just a vision: but enacted and ongoing #SDoH-X. Evidence - climate change slowing, air quality improving - the 21st Century truly begins ...

Martin, A., O’Connor, S., & Jackson, C. (2018). A scoping review of gaps and priorities in dementia care in Europe. Dementia. https://doi.org/10.1177/1471301218816250

My source:
email - McKinsey Insights

Review: ii "Climate Change and the People's Health"

Climate Change and the People's Health

You could read this excellent little book in a couple of hours, but me being me ...

Part of a Series of 'Small Books, Big Ideas' in population health this is an important and timely text of a type that sadly will need to be a constant stream. Constant, not only to keep the message and issue in people's consciousness, but to update the research of a still new interdisciplinary field. Not only that but some sense (measure) of the socio-economic-political state must be realised to identify change (progress). This small book argues for the big change in attitudes, behaviours and systems that must follow.

The book prompts me to imagine the day (whether or not in my future) when the media can report on the gradual reverse of climate change? We have heard of positive changes in the size and behaviour of the Antarctic ozone layer for example; only for progress to be challenged once again. It is not enough to hope for our children, their children ...  and the biosphere of Earth.

The book has just three chapters in 146 pages; 188 pages including the references and index. The 'small' quality relates not only to page number but a hardback size of 18 x 15 cms, such that my copy has been on tour (petrol car and alone) over the summer. A Forward by Nancy Krieger refers to the book series as a whole and points to the political dimensions and how inevitably practitioners must be part of this 'game'. Not just what we oppose but what people stand for. The dynamism in this field is apparent in the reference to expressed opposition alone given rise to despair. This book is very current (2019) but 'eco-anxiety' did not make the index, such is the pace of events (Greta Thunberg). This is not a criticism but speaks of the dynamism and hope that action can (and must) bring as Krieger writes. The fact of this being a political struggle is acknowledged by Friel in the conclusion.

This is not just important but critical. You should never generalise and many nurses (for example) are politically very literate and Active. They seek to protect, sustain and improve the values, the health and health care systems they hold dear. Many other nurses focus on the 'job' of caring. The thought follows that while politics starts in the staff-room and rota; the Politics begins in the ward office and the various meetings and committees. They conclude that they'll leave that to others. For all healthcare workers we can no longer take this stance. Population health demands a population response.

To be continued (of course you don't have to wait to obtain your copy - this is essential reading):

Chapter 1. Climate Change, Global Justice, and Health Inequities

Chapter 2. It's a Consumptagenic World: Producing Climate Change, Exacerbating Health Inequities

Chapter 3. Challenges and Future Prospects


Friel, S. (2019) Climate Change and the People's Health, Oxford University Press, New York

Due South - 360 degree perspectives

Andy Goldsworthy "Touching North" (1989)

Being a cultural theorist the concept of ‘the south’ is particularly interesting to me (as are the other points of the compass, since they are often set in binaries and have values attached to them when set in opposition – for example the North/South divide in Britain). Coverley begins the introduction by showing us a 17th century map of the south pole and then describes the work by the artist Andy Goldsworthy entitled Touching North (1989) (see below). Touching North was situated at the North Pole, with the four individual parts of the sculpture facing each other and also outwards, with holes in the centre providing them with an opening which enabled them a space accessible from anywhere and everywhere. Coverley says that the sculpture “demonstrates how the directions of the compass may effectively be rendered meaningless: emerge through any of the four arches and one finds oneself heading south” (page 9). From:

http://particulations.blogspot.co.uk/2016/12/south-by-merlin-coverley.html

INDIVIDUAL

|

interpersonal : science

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

sociology : political

|

GROUP and POPULATION

	N S
	NORTH? SOUTH?

Photo: "Touching North" from:
http://beautifuldecay.com/wp-content/uploads/2014/01/goldsworthy-andy-1989-touching-north.jpg

Additional link:
http://www.goldsworthy.cc.gla.ac.uk/

Hodges' model: What is the Question? (ii)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

What is the basis for meta-cognitive and meta-conceptual claims for Hodges' model? Does Hodges' model have a role in secondary education and if so, what is it? If Hodges' model facilitates reflection and is reflexive how is this achieved and demonstrated? Is Hodges' model a meta-semantic framework and if so, is this what provides genericity? What is the foundation of the axes in Hodges' model and what characteristics can be described?

Is Hodges' model safe? "Cold, Warm, Hot, Hotter!" nearer to 'navel gazing' than 'reflective practice'? Are 'concepts' sufficient to explain the structure of Hodges' model, and account for its claimed role(s) in assessment, planning, evaluation and assurance? Is Hodges' model a constant: as the contemporary model? Are 'individual', 'group', 'humanistic', and 'mechanistic' sufficient as conceptual anchors; and if so are they sufficient to give rise to the two continua that then invoke four knowledge (care) domains?

Can Hodges' model simultaneously preserve, protect and assure 'patiency' whilst also facilitating self-care? What forms of literacy are encountered by users of Hodges' model and are they accessible to the public, patients and carers? Hodges' model: Show me the praxis. What does Hodges' model say about holism (and consequently reductivism) and why should anyone listen?

Is there such a thing as a generic 'model of care' in a multidisciplinary world? Is there a 'logic' to the seemingly diametric opposition of 'power' as exercised here and the two individual domains in Hodges' model? If claims for Hodges' model of universality, genericity and global scope are 'true' is this also a risk for healthcare professions and specialisation, as it supports the 'universal worker' and automated processes?

 

h2cm: fixed or primary concepts the push and pull of nursing

When commentators, students and others write of the primary or core concepts of nursing what does this mean in terms of Hodges' model [h2cm]?

For quite some time I have been describing Hodges' model as a cognitive - conceptual space. This suggests that there are fixed concepts within the care domains. Yes, they may vary according to the context and over time, but if concepts were arrows and our aim is true then h2cm would provide the ideal target. It on this care matrix that we really could take aim and nail the kernels of knowledge that make up our care activities.

Is it a mistake to venture that for people to talk of basic nursing care, essential care needs, that there must be some fixed ideal out there; an ideal that nurses, society and policy makers can hang discussion and debate upon? And let's face it there is much to debate - mental health stigma, obesity, nutritionism, heart disease, dementia, unplanned pregnancies, funding, access, poverty. ...

Medical sociology has done and continues to do society at large a great service. It forces practitioners to look over their shoulder and take in the social and cultural forces that influence health. As a question for further deliberation within medical / clinical sociology we might ask: How are the concepts in Hodges' model fixed? There are several possible answers:

1. Someone determines that concepts a, b, c, d are in care domains 1, 2, 3, 4. The question of whether Hodges' model (or any other conceptual resource) is classed as evidence based depends on how that determination is made.

2. Alternately, the structure of the model provided by the axes, could act as a skeleton. This might serve as a boot strap breathing life into the empty spaces created by this structure. The first instances of concepts might then arise like some sort of quantum event - self, other, temperature, time, height, mood. ...

3. As (medical) sociology, philosophy and psychology continue to reveal, we also need to accept of course that society, culture and language are all inextricably linked and they pre-empt that empty space, predetermining what will be written (thought and reflected) there.

4. This external influence is a must if those working in the health and social care professions are to communicate with those 'outside' (public involvement can only run so far?). It is not so much a case of common ground, as common space and the freedom and opposition that this affords. this is essential for communication amid what is variously called - multidisciplinary working and integrated care. Here there must be a degree of latitude between different disciplines' usages of terms. This must provide common understanding or some close approximation and yet still be safe.

So rather than empty space the care domains are really full of care concepts all waiting on tenterhooks, to see whether they will get to aggrandise and become 'complex care needs'. Will the assessor / care evaluator pick them - from what is initially a virtual crowd? Go on make their day: care-fully!

Relative poverty (2) - political

[The introduction is repeated across these posts: intrapersonal, sciences, sociology]

There are many paradoxes in life and many are concentrated in the realm of health and medicine (the  major sub-division of life and death).

For decades the link between poverty and standards and quality of health has been recognised and politicised in the media and policy. Just this past week was news of a Bill to make the eradication of child poverty a legal obligation not something that can be the political objective at the start of a Government and then cast aside.

Many things are relative and poverty is often described in this way applying to individuals, social classes, communities, regions and whole nations. Using the domains of Hodges' model what reflections does this prompt? Let us see:

POLITICAL: Although we are told that change is happening swathes of humanity face -

poverty of choice or no choice but poverty.

There are those who are able to decide and yet denied choice due to a politics or state that spits explicit corruption denying the people their expressed and collective will. Although previously described as 'black and white' politics must become participative AND must become 'green and (truly) global'. As events in 2009 attest here in the UK, politicians, those key workers / case practitioners in this domain (should paradoxically) disavow personal ambition and at times yet to be decided the party whip system. Yes, these matter, but again space (vacancy) is needed to accommodate - permit and facilitate true focus.

This is no chance opposition of domains in Hodges model.

The diagonal of INTRAPERSONAL and the seat(s) of power and governance
is mediated through the social domain.

Like health professionals, politicians and civil servants must wipe the slate clean: constantly. This is why transparency in politics is so crucial to trust, engagement, and grounded politics. ...

'P' is for politicians not just the 'people'.
Politicians need to be engaged coherently.
Touch is the interface for them too.

A week is a long time in politics because the sun never shines (not even in 'victory'). For these people being open, transparent, non-judgemental ... means their vision is refreshed by a perpetual rain.

Only then will they see poverty and be reminded of it -
even if poverty and even more so if poverty
represents where they came from ...

Image source: Equator Network

Additional links:

Reith Lectures 2009 BBC 'A New Citizenship'

'Poverty' on W2tQ

Political care (knowledge) domain links resource

Books: Psychiatry and Technology - Phillips, ed. (2008)

Despite the necessity of new (inc. secondhand when possible) titles, the overall push is to reduce the shelf and box count. This means that:

Phillips, James (ed.) (2008). Philosophical Perspectives on Technology and Psychiatry. Oxford University Press.

- will soon have a new home. Before that another look to support the effort here:

"It hardly needs stating that treatment algorithms, the evidence-based approach, and treatment manuals are useful tools in psychiatric practice. What issue is then being addressed in referring to them as examples of technical reason? The issue is that they, and other examples of the technical approach, can at their worst turn psychiatric treatment (or medical treatment for that matter) into a mechanical procedure. The patient becomes an instance of a diagnostic category, and the treater becomes a generic treater. Follow the technicized approach too literally, and one schizophrenic becomes interchangeable with the next, and one psychiatrist with another. In this situation of the fungible patient and the fungible treater, the individuality of both is lost, and the need for individual judgement on the part of the psychiatrist is rendered obsolete." p.9. Introduction.

Hodges' Health Career - Care Domains - Model
Axes and Care (knowledge) Domains

"Qualified users [of technology] have a professional responsibility to be reflective users. They should be 'thinkers'. Reflective use means being able to step back and become more conscious of one's professional activity." p.46. Chapter 2 Examples from Psychiatry.

"A concern for objective truth is at the heart of the scientific enterprise. An unfortunate consequence of the rigid dichotomies associated with a scientistic epistemology is that objective truth is defined in opposition to subjective values. The result is the 'Either/Or' thinking characteristic of the 'science wars' where science is either reduced to a relativistic exercise of political power or characterized as a value-neutral exercise progressing in an inevitable fashion determined solely by the facts." p.120. Chapter 6 Rational Argumentation.

Butterflies make the news go-round

In health, social care and the news media at large there are themes that recur. While every summer has its silly season, there is a strange irregular-regularity in the way the light is re-cast on issues important to us all. It may be triggered due to a tragic incident involving a child, older person, or a whole family. At other times the stimulus for further exposure and prompt for debate is found when different coloured papers have their political say. The political opposition can force or be forced into a reaction.

Chaos is hardly a new kid in town, but there are many groups such as Society for Chaos Theory in Psychology & Life Sciences who are trying to understand and apply this infant science to specific disciplines and even conjoin and create new ones. I mention chaos due the question of migration.

Where do the various items of news head to when they disappear off the media's smörgåsbord?

Maybe they are still there, they just merge into the background noise? This movement is not just a binary, metronomic tick-tock, in and out of the media's eyes. It's more complex than that.

Like the butterflies beloved of chaoticists everywhen, perhaps these issues travel an unpredictable and yet inevitable course through the four fold space of Hodges' model? They travel together and yet in separate lanes, like the horses racing at an amusement arcade. When one reaches the socio-cultural-political boundary, that is when things happen and the volume is ramped up.

Events may frequently have their origin in the intrapersonal domain (it takes a person to find a tango partner), but one way or another - either heading south through the social domain or east and south through the sciences domain - news worthy items will and do repeat themselves.

Original image source: http://10outof10.blogspot.com/2008/04/lorenz-father-of-chaos-theory-died-at.html