Photo by Ruskin Kyle
Location and vocation – some grand entrances: St James Church (Home to the author's NHS surgery for nearly three decades)
How to use this website: some navigational aids
Table of contents
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A. Professional profile
A. Professional Profile
David Zigmond initially trained in Medicine in the 1960s. From this he developed a lifetime interest in the often dislocated but creative tension between art and science in understanding ourselves, one another and any effort to be 'helpful'. His explorations led to a crystallisation of humanistic and person-centred approaches to understanding (medically, 'diagnosis'), and influence (medically, 'treatment').
In the decades following his qualification he trained in General Medical Practice, Psychiatry and Psychotherapy (both psychoanalytic and humanistic) – an amalgam initially not uncommon, but later almost impossible, so now extinct. His professional involvement continued in all of these activities throughout his career – both as a frontline practitioner in the National Health Service and in postgraduate education of psychotherapists, doctors and other healthcare professionals.
His numerous articles, since the 1970s, investigate often-overlooked social and psychological aspects of care. His perspectives combine, particularly, the pragmatically humanistic with the accessibly philosophical. The resulting appeal, for disciplined and imaginative eclecticism, is more compatible with traditions of liberal education than with the current march towards regulation and hegemonised training.
He pioneered the distinction between dis-ease and disease, and the use of the terms psychoecology, pastoral healthcare, headspace, heartspace and technototalitarianism: the developed themes are evident throughout his many writings.
Such sustained effort has needed kindred colleagueial guidance and support. He is a founder member of the Family Doctor Association and the British Holistic Medical Association. Political and organisational concerns are shared in his contributions to Doctors For The NHS and the Centre for Welfare Reform.
Growing trends to the industrialisation of healthcare have increasingly (if unwittingly) displaced quality and continuity of personal contact. Later articles and letters sought to raise awareness and debate about the seriousness and complexity of this loss.
Such problematic loss has derived from a convergence of developments in technological expedience and the subsequent culture change. Key to these are the 4Cs (competition, commissioning, commodification and computerisation) and the bolstering REMIC culture (remote management, inspection and compliance). These become recurrent themes.
Clearly, we can only offer our best healthcare when we manage thoughtful choreography between art and science: his writing reflects this with language composed to be both poetic and precise.
B. Author's note and acknowledgements
This website’s selection of articles, from 1976, were published in a variety of journals. I am grateful for each publisher's permission to reconvey them here. Acknowledgement of the original publication and date are to be found at the end of each article. They are found in Section L.
Letters from later years are found in Section K. These were sent to politicians, managers, journals and newspapers. All share the mission of furthering reflection and debate about the human complexity of our healthcare, and the consequent hazards of excess proceduralism and industrialisation.
The older articles were written for mainstream medical journals and readers, and have a more formal style and format than later writings, which generally adhere far less to traditional and academic convention.
In 2005 I became belatedly aware of the nature and threat posed by the industrialisation, marketisation and computerisation of NHS Healthcare. This is reflected in the articles and letters written since.
For those wanting a gentle trial introduction I suggest starting with the shorter letters, which present the skeleton of my ideas. The longer essays and articles 'flesh out' these basics with further exploration, documentary narrative and, sometimes, verbally tone-poemed description to attempt to capture subtler aspects of humanity and experience – important strands in the art of Medicine, now largely imperilled.
Late in 2016 my small NHS GP practice was closed by official decree, with dramatic suddenness. The events were representative of much deeper and wider difficulties throughout welfare services. A description, articled analysis and correspondence are clustered into Section G.
I have not changed the old-fashioned, generic 'he' to the now politically-correct 'he/she', merely because it sounds and looks cumbersome (to me).
I decided on only minor editorial revisions, and only to the older articles. With these I have shaved, tightened, reshaped and sharpened some of the language, but have left the design of argument, analysis, examples and narrative as it was.
Medical and social historians may enjoy finding anachronisms and (now) historic relics: Doctors' white coats and Residents' Messes, dissection tables, Mental Hospitals, accessible family doctors, militaristic professional titles and patriarchies have all but disappeared. Likewise, the designation of 'Psychosomatic', though certainly not the problems, or the practitioners’ now lesser understood human predicaments. The older articles may thus seem quaintly dated. But their long motivating quest, for holistically caring systems and psychologies – of resonance, imagination and dialogue — is, I believe, now evermore relevant.
We have many warning signs: how will we heed them?
C. Introduction to the writings of David Zigmond by Professor Andree Tylee
D. Obituary: St James Church Surgery 1987-2016
E. The Family Doctor and the Grid by Dr William House
F. What is the British Holistic Medical Association?
G. Contention with NHS England and the Care Quality Commisssion
H. David Zigmond's Books and Pulse review
David Zigmond's new book
I. Book launch videos
Book Launch Videos
Dr Zigmond, founder member of BHMA, GP, psychiatrist and author, has published the anthology of his writings. Meet him in the video below speaking at the London launch of his books held at the Royal Society of Medicine in October 2015.
J. Radio podcasts
K. Letters, chronologised
Vocation or Corporation?
 The NHS needs human sense as much as money and systems
 Government may like giant
GP practices, but what about the rest of us?
 Revitalising the NHS? Get
rid of the Internal Market
Our oppressive Care Quality
Commission: our depressed NHS
‘Stakeholders’ in suicide
prevention: isn’t that all of us?
Prevention of Suicide. The
crux of personal continuity of care
Dying with, or from,
dementia? An important distinction
 Older people often need a
different kind of hospital
 Our ailing profession: our
consequent fractious collegial misunderstandings
 CQC Inspection and closure
of my NHS General Practice. Farewell from a long career
 Price and value in personal
care: the planned closure of community pharmacies
 Our burgeoning NHS problems are more organisational than
 How and why do we retire?
Ill omens for younger doctors
 Only personally fulfilled
practitioners can deliver good personal healthcare
 General Practice needs more
than recruits and money: we need to refind our
 Plummeting morale of junior
doctors: one branch of our blighted tree of Welfare
 Can we reduce childhood Sepsis by more vigilant
management? I doubt it
 GPs’ demoralisation is due
to our loss of human connection
 How to make our NHS sustainable? We are losing
personal morale and commitment faster than money (re cross-party review)
 "Airline levels of
safety in healthcare"? No, we can't
 How to make our NHS sustainable? We are losing personal morale and commitment faster than money: Letter to ex Health Ministers, January 2016
 Competence or Compliance?
The corrosive cost of professional practitioner Appraisals
 Burgeoning need: collapsing staff morale – the management
conundrums of the NHS
 ‘Curing Dementia’: Medical possibility or
 In public service we need personal integrity,
not personal loyalty
 The Extinction of Care by
Treatment: Our healthcare’s heart-failure
 The loss of personal
containment in pastoral healthcare
 Reclaiming the NHS: Let’s discard the entire Internal Market
 Repealing the Health and Social Care Act: why stop there?
 The death of Robin Williams: can we ‘treat’ our
 Personal continuity of care
in Mental Health Services
 Personal continuity of care in hospitals.
Restoring the role of the General Physician
 Thank Goodness we now have
business-sense to safeguard our Welfare
 Form Devouring Essence: When brokered services tend broken hearts
 Dementia is not only (or even) a disease: it is
a signal of our community cohesion
 Dr Frankenstein’s Reprise:
Industrialisation of Personal Healthcare. Adverse effects of sequestered
psychiatric in-patient services
 Loneliness in the ailing
elderly: social and healthcare responses
 Re-establishing personal bonds and understandings in NHS Care Letter to Secretary of State for Health, October 2013
 NHS Healthchecks:
more automation and less intelligence
 How Care Pathways obliterate
care: More industrial follies from the NHS
 Physis: healing, growth and the
hub of personal continuity of care
 The rise of business culture
in the NHS; our consequent loss of
 'Fixing the NHS is
 Continuity of Care: Of course, but whose? A Sleight of Slogans
 ‘Evidence’ is both more
and less than it seems. The rise of scientism and the demise of the personal
 Eric: Another victim of
Hypertrophic Obstructive Management Coagulopathy
 Further NHS Reforms: inevitable and
commissioning and commercialisation: the growing threats to personal
 Five Executive Follies
L. Articles, chronologised
What it says in the title! Uses the example of an ailing, elderly man struggling with later-life changes. The biomechanical can only take us so far: after that we need a certain kind of imagination. What is that?
Serious kinds of mental illness and self-harm are most easily designated. But what about more subtle forms of self-damage and self-sabotage? What are they?
 Out of Sight But Not Out of Mind (1977)
Those who professionally care for others are often much harsher with themselves. Overall, doctors have higher suicide risks than their patients. Why?
 Scientific Psychiatry: Progress or Regress? (1977)
Medicine and Psychiatry operate from a premise of taking responsibility and defining reality for others. What are the implications for those who need to reclaim these capacities, for themselves?
 Illness as Strategy and Communication (1977)
Illness is often best understood and approached beyond the biomechanical. Experiences or conflicts not otherwise manageable can find a refuge and conduit in illness. How and why?
Often mental distress is designated in a way that further ‘pathologises’ and stigmatises the sufferer. How may we, rather, reframe our problems in ways that are self-realising and empowering?
 The Elements of Psychotherapy (1981)
A short survey written for Doctors. How may thinking and talking with another person help the harmony of body, mind and relationships? How to start and when to stop?
A clear and flexible model helping us understand the different parts of ourselves and others. How are these related to our unique stories, and then our patterns of concord or discord?
A continuation of Part I. How are so many repetitive unhelpful patterns set up in childhood, to last a lifetime? If we can understand, when is this helpful in redirection?
 A Psychosomatic Approach (1982)
How, by expanding the biomechanical approach into a more multifaceted holism, can we broaden and deepen understanding and engagement with individuals?
 The Psychosomatic Mosaic (1982)
A further coaxing of the biomechanical into a broader holism. How can individual illnesses be encountered and understood in family systems?
Placebos are fascinating phenomena of induced interpersonal healing, sometimes by accident! How does this happen? What are the developmental and transactional psychological theories that can explain?
What are the personal vulnerabilities of doctors? How are these related not only to individual wounds, but to idealised roles and depersonalised trainings?
Theories of mind are only ever ‘good-enough’, for now. What happens when psychotherapists (and others) elevate their theories to a realm of Immaculate Truth?
Knowledge, language and understanding are all human activities and constructions. What are the different types when we encounter others? How do we then ‘pack’ or ‘unpack’ the experience of these others? How, when and why does it matter?
 The Psychoecology of Gladys Parlett (1988)
Distressed people often want skilful, if ritualised, human contact. What happens if we unimaginatively and excessively medicalise this? Gladys, in the 1980s, forewarns us.
The communicative skills - enabling others to heal, grow and become more resilient - have been distilled and documented, especially by psychotherapists. What happens in other venues with these kinds of complex exchanges? How is this enacted in General Practice?
 The Shadow of Venus: Atavism and Sexuality (1995)
Our sexuality is one of the more tragi-comic deciders of destiny. Can an understanding of our evolution, as a species and as individuals, explain why?
We have become accustomed to almost everything being prepacked, containerised and computer-coded. This has happened to knowledge. What happens to personal knowledge?
What are the hidden psychological currents that may lie behind zealous attempts to ‘modernise’ and standardise? Some motives may be obscured and dark. How are they expressed?
 Modern Times: True Parables from the Frontline of the NHS (2007/2017)
Change is often called ‘progress’. Looking at changes in healthcare, this considers two themes: ‘Imagination’ and ‘Belonging’. When is change progress?
The more we control, the less free we are to explore. If we increase the culture of management, what happens to the spirit of enquiry? And patient care? A historical account.
In psychiatric and psychological healthcare, personal attachments and investments in therapeutic work have been eclipsed by ‘objective’ attempts at management. What has this been like for patients and staff? A thirty-five year spanned portrait.
Much of the most effective work healthcare workers do is inexplicit and undesignated. What does it, then, consist of? The Wizard of Oz has much to tell us.
Diagnosis is a professional convention enabling us to cluster and code. Sometimes it is essential and crucial to help. At other times more is lost than gained. What? Why? Who?
Psychotherapists increasingly talk of managed and schematised personal change, but often the catalysts are serendipitous. What can happen?
Few would want an operation done by a non-specialist. So is specialisation always a good thing, with every kind of distress? Can we go too far? What happens then?
Helping others to change can be a very delicate dance. Attempts at ‘civic engineering’ frequently miss nuances of meaning and opportunity. Does this matter? Why?
Centralised planning and control are key to the success of many healthcare initiatives, for example the containment of dangerous infectious diseases. But what are the limits of this approach? Eric shows us what can happen in mental healthcare.
Competition, commissioning, contracting ... do such devices really ‘drive up’ the quality of healthcare? Are there other, absurd and darker consequences? What are these?
NHS healthcare has transformed looser, informal, colleagueial networks of care into tighter, sharper, more managed ‘production units'. We have turned families into factories. What have we lost?
When attempting to understand and help the anguish of another, what kind of knowledge helps us most? What lies behind and beyond designated systems? Can one have a ‘holistic psychology'?
Holism’s fuller engagement with realities is an aspiration and ideal. It can never be complete, and in practice, there are many obstructions. These range from our use of language to our highly managed and industrialised culture. How does this happen? What are the consequences? This is the first of two articles.
The over-explicit and over-schematic can block our perception of larger and more subtle realities. This second of two articles portrays how this happens, and what we may be left with.
 Democratic Fatigue: information overload (2012)
Is increasing choice and information always what we want? Do these necessarily facilitate democratic sense and empowerment? The non-participation in recent Police Commissioner elections suggests otherwise. Parallels in healthcare are instructive.
Throughout our most important, difficult and intimate relationships we must be able to listen carefully to what we do not want to hear - without this much is jeopardised. This is true, too, in many of our healing encounters - often these require our best attempts to creatively contain dissonance.
 PsychoTapas (2013)
PsychoTapas! Sound-bite seminars for modern conferences!
Flagrant neglect or abuse in our care of the vulnerable within our advanced Welfare State seems shockingly perverse. How and why does this happen?
 Beyond Orwell: Healthcare’s hollow governance (2013)
Our smallest difficulties with others are often rich in political complexity. What does this mean? Two apparently trivial examples from healthcare administration are explored.
Computers and informatics have become central to NHS healthcare. All experience and activity are now subject to official technical designations. This changes our communications: language becomes increasingly lackeyed to the computer’s requirements. Much else is lost. What?
 Post Mid Staffs: A Plenitude of Platitudes (2013)
Can the harmful excesses of depersonalisation in healthcare be usefully addressed by further redesign of systems and management? Or do we need a different kind of thinking and vocabulary?
GPs are increasingly employed as task-directed, upper-echelon healthdroids. They are losing the pastoral skills that depend on holistic views and vernacular understandings. Why is that?
The idea, now diktat, that GPs should lead the complex provision of healthcare for localities may subtract more than it adds to overall health-welfare. How and why could this happen?
Advances in medical science have often subtly and inadvertently subverted human connections and understandings. Vignettes spanning sixty years show how and why.
Despite ever-increasing funding and management initiatives, our public welfare services seem riddled with unhappiness, corruption and sometimes cruelty. These are alarming paradoxes: how do we understand them?
 Bingo! Majoritarian Healthcare! (2013)
Transparency, Accountability and Democracy can seem like a protective triumvirate for public decision making, but these can easily turn shallow, demotic and false. Here is a small example of what is coming.
Where in the World are You? Miraculous
cyber; insidious dislocation (2013)
Form Devouring Essence: When
brokered services tend broken hearts (2014)
The doomed brief of GP Clinical Commissioning Groups (2014)
Some Countercultural Caveats for Pastoral
Healthcare – the fractious coexistence of packaged care and therapeutic
Neglect in NHS Healthcare? (2014)
 Packaged Mindfulness? Some
unpackaged pieces of mind. Can our integrity and wisdom thrive with
A day in the life (2014)
England 2014: Vichy France 1941: The old ghosts in our new NHS machine
PBR, PBC, PCT, CCG, CMHT, CBT, NICE,
QUOF: NHS Alphabetti spaghetti? A guide for the
perplexed: a critical glossary (2014)
for Common Mental Health Problems: The awkward dance between managed systems
and human meaning (2014)
Our Welfare is ill-fared by yet
more strictures and structures (2014)
Healthcare's Hole in the Heart : Can we have value for money and not lose our
Appraisals: how do we assure safety
without asphyxiation? (2015)
A Fortunate Man: the
vulnerability of vocation. A major work revisited (2015)
Rick and Ajita:
How may we reconcile systems of healthcare with our subtle humanity? (2015)
Professional Appraisals? We learn more about the governors than the governed (2015)
Off-piste: only fresh tracks
lead to fraternalism in healthcare (2016)
From Balint to Square-bashing. Fifty years’ experience of
General Practice (2016)
Preventing Overdiagnosis? Yes, but what kind? Part 1: Geography (2016)
Preventing Overdiagnosis? We need fewer systems and more philosophy
Part 2: Geology (2016)
Revitalising Holism. We need literature of wit and grit
more than piety and idealisation (2016)
Can Art’s courageous experiments also be accessible? A review
of a brief work of brilliant obscurity (2016)
Why Do We Retire? Ill omens for younger doctors
 Introductory note to Death by Documentation (2016)
Documentation: The penalty for corporate non-compliance (2016)
is the Art of the Possible: but we are turning it into a tyranny of the
unworkable. Reflections on our inspections regime
and closure of my NHS General Practice. Farewell from a long career
expedience the death of our professional spirit? What our colleagueial
utterances are telling us (2016)
Too Big to Talk About. Organisational momentum: its
paralytic wake (2016)
I, Daniel Blake.
Industrialised humanity: why and how should we care for one another?
Fraternal wisdom from a film maker (2017)
is Compliance Necessary for Public Safety? The policing of Welfare: a
personal story (2017)
is less about eliminating root causes than tending our many branches.
Reflections on causation in healthcare (2017)
the NHS Internal Market. Too big to talk about? (2017)
is Change Progress? Are we throwing the baby out with the bath water? (2017)
 Should All Doctors be
Resuscitators? Unfactored costs of
prescribed risk management Rhetoric is easier than
Cost of Everything and the Value of Nothing (2017)
 A Healthy Heart for the NHS?
What is the price of sacrificing personal relationships for public money? (2017)
The author, though, does not address the human damage and cost. Here is a corrective.
Wrong, wrong, WRONG … OUT! How can we contain
one-size-fits-all policies? Three struggling letters (2017)
 Hi Tech With Many Human Hearts. Vitalising humanity from a film maker (2017) A recent film Heal the Living (directed by Katell Quillévérré, 2016) weaves a rich tapestry. Life’s vicissitudes, human paradox and interconnectedness – all are here: holism at its most raw and tender.
Spoiler alert: This article describes much of the content of the film.
Section Contents Copyright ©; Dr David Zigmond 1976, 2017
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