The Medical Model—its Limitations
and Alternatives (1976)
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?
and Attempted Suicide: Its Origin and Course (1977)
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?
of Sight But Not Out of Mind (1977)
who professionally care for others are often much harsher with themselves.
Overall, doctors have higher suicide risks than their patients. Why?
Psychiatry: Progress or Regress? (1977)
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
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?
Adjustment or change? Radical
issues in psychiatry (1978)
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)
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?
Analysis in Medical Practice: Part 1 (1981)
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?
Analysis in Medical Practice: Part 2 (1982)
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
A Psychosomatic Approach (1982)
by expanding the biomechanical approach into a more multifaceted holism, can
we broaden and deepen understanding and engagement with individuals?
The Psychosomatic Mosaic (1982)
further coaxing of the biomechanical into a broader holism. How can
individual illnesses be encountered and understood in family systems?
Magic or Medicine? The Psychology of the Placebo (1984)
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?
Physician Heal Thyself: The
Paradox of the Wounded Healer (1984)
are the personal vulnerabilities of doctors? How are these related not only
to individual wounds, but to idealised roles and depersonalised trainings?
Babel or Bible?
Order, Chaos and Creativity in Psychotherapy (1986)
of mind are only ever ‘good-enough’, for now. What happens when
psychotherapists (and others) elevate their theories to a realm of Immaculate
Three Types of Encounter in the
Dialogue, Dialectic and Didacticism (1987)
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?
of Gladys Parlett (1988)
people often want skilful, if ritualised, human contact. What happens if we
unimaginatively and excessively medicalise this? Gladys, in the 1980s,
The Front Door of
Aspects from General Medical Practice (1989)
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)
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?
shot in his own interest. Technototalitarianism and
the fragility of the therapeutic dance (2005)
have become accustomed to almost everything being prepacked, containerised
and computer-coded. This has happened to knowledge. What happens to personal
Reform and the need for Live, Human Sacrifices: Homogeny
and Hegemony as Symbols of Progress (2006)
are the hidden psychological currents that may lie behind zealous attempts to
‘modernise’ and standardise? Some motives may be obscured and dark. How are
Modern Times: True Parables from the Frontline of the NHS
is often called ‘progress’. Looking at changes in healthcare, this considers
two themes: ‘Imagination’ and ‘Belonging’. When is change progress?
Published in Journal
of Holistic Healthcare, vol 14, Issue 2, Summer 2017
Country for Old Men:
The Rise of Managerialism and the New Cultural Vacuum (2009)
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
Love's Labour's Lost
The pursuit of The Plan and the eclipse of the personal (2010)
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
Would Anyone Use an Unproven Therapy?
in the Mist (2010)
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.
Idiomorphism: the Lost Continent
How diagnosis displaces personal understanding (2011)
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?
Resolved or Abandoned?
Irresponsibly lost Transference: a professionally embarrassed tale (2011)
increasingly talk of managed and schematised personal change, but often the
catalysts are serendipitous. What can happen?
Sense and Sensibility:
The danger of Specialisms to holistic, psychological care (2011)
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
How to help Harry - Friend or Foe? The
scientific and the scientistic in the fog of the
others to change can be a very delicate dance. Attempts at ‘civic
engineering’ frequently miss nuances of meaning and opportunity. Does this
matter? Why? Published
in Journal of Holistic Healthcare, vol 14,
Issue 3, Autumn 2017
Eric - diagnosis may
sometimes be necessary; it is rarely sufficient
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
Fallacies in Blunderland:
commissioning, contracting ... do such devices really ‘drive up’ the quality
of healthcare? Are there other, absurd and darker consequences? What are
Family to Factory: The dying ethos of personal healthcare (2012)
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?
Understanding the Other: Four
elemental questions for therapeutic psychology. A personal view (2012)
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
Words and Numbers: Servants or Masters?
Caveats for holistic healthcare
Part 1 (2012)
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.
If you want good
personal healthcare, see a Vet. Caveats for holistic healthcare Part II (2012)
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
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
disconnections in Psychological Healthcare. A letter for
embattled colleagues. (2013)
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! Sound-bite seminars for modern
Institutional atrocities: The
malign vacuum from industrialised healthcare (2013)
neglect or abuse in our care of the vulnerable within our advanced Welfare
State seems shockingly perverse. How and why does this happen?
Orwell: Healthcare’s hollow governance (2013)
smallest difficulties with others are often rich in political complexity.
What does this mean? Two apparently trivial examples from healthcare
administration are explored.
Language is not just data: it
is a custodian of our humanity (2013)
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)
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?
know their patients, families and communities' - Really? (2013)
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?
Health Commissioner. Goodbye, Family Doctor? The new
healthcare reforms and their threat to personal doctoring. (2013)
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?
All is Therapy; All is Diagnosis.
Unmapped and perishing latitudes of healthcare
in medical science have often subtly and inadvertently subverted human connections
and understandings. Vignettes spanning sixty years show how and why.
Ill-faring Welfare. The hinterland of our headlines (2013)
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?
Majoritarian Healthcare! (2013)
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)
What do mobile communications, Internet sex
and modern schematised health systems have in common? – a
computer mediated disconnection of intended content from embedding human
context. What happens?
Form Devouring Essence: When
brokered services tend broken hearts (2014)
Our healthcare rhetoric of data and systems
has largely destroyed our capacity to make the kind of personal bonds that
understand and heal human dissonance. Stephen and his plight serve to
illustrate and explore this.
The doomed brief of GP Clinical Commissioning Groups (2014)
The corralling of
GPs to design and commission health services cannot counter the inherent
disintegration and depersonalisation of Marketisation.
A glimpse from the frontline.
Some Countercultural Caveats for Pastoral
Healthcare – the fractious coexistence of packaged care and therapeutic
has a crisis of competence, morale and humanity. This currently eludes
enormous funds and myriad think-tanks. The elusions are subtle. What are
Neglect in NHS Healthcare? (2014)
We have turned familes into factories.
 Packaged Mindfulness? Some
unpackaged pieces of mind. Can our integrity and wisdom thrive with
Our increasing push-buttoned and systems-managed world has
produced myriad losses of human relationship and personal sentience. Can this
then be countered by modern packaging of ancient wisdom and practices? Is
this our wisest approach?
A day in the life (2014)
Man Overboard! A
brief autobiographical cross-section
England 2014: Vichy France 1941: The old ghosts in our new NHS machine
prescribed schemes to increase democratic accountability in Welfare are easy
to intend, yet very difficult to implement. They can easily backfire to
unanticipated forms of oligarchy or totalitarianism. How does this happen?
 Our unravelling humanity: do we
need more regulations? (2014)
To its credit the government seems to now be
understanding the importance of lost human connections. The response, though,
is predictable: it is to add to Healthcare’s already massive regulation. This
may add rather more to our problems. How?
PBR, PBC, PCT, CCG, CMHT, CBT, NICE,
QUOF: NHS Alphabetti spaghetti? A guide for the
perplexed: a critical glossary (2014)
What do the plethora
of NHS institutional terms mean? Why are they important to understand? And
what is their relationship to one another? Can this help explain our current
malaise in healthcare? Here is a critical glossary.
for Common Mental Health Problems: The awkward dance between managed systems
and human meaning (2014)
A greater and calmer
sentience is key to much of our better health and life-experiences. Can we
mass-produce methods to achieve this?
Our Welfare is ill-fared by yet
more strictures and structures (2014)
Surely, all Welfare
professionals should forever be more strictly appraised and registered? Here
are some reasons why not.
 Six Suicides and One Homicide.
The catastrophe of jettisoned personal containment in healthcare (2015)
Care and treatment are different though
synergistic. The increasing trend to executise
treatment over care destroys this critical complementarity. The consequences
show us how important are such balances.
Healthcare's Hole in the Heart : Can we have value for money and not lose our
Efficiency has now become cardinal in healthcare
management. Increasingly methods from competitive production industries have
been adopted. Yet the results are often paradoxical and demotivating. Why is
Appraisals: how do we assure
safety without asphyxiation? (2015)
‘We can’t carry on like this!’ is now a familiar cry of impotent frustration
throughout Welfare services. Clearly we need challenges to our dysfunctional
order. Yet our officials’ responses are often redolent of the last gasps of
Empire: draconian authority with officious nervousness. What is happening?
This example – of General Practitioner Appraisals – is a telling microcosm.
A Fortunate Man: the
vulnerability of vocation. A major work revisited (2015)
A Fortunate Man – a searching portrait of a country GP by essayist and
novelist John Berger – was first published in 1967. It projected a highly
personal view of medical practice: one undertowed
by rich human complexity. Nearly fifty years later, what does this anciently
pioneering book offer us?
Rick and Ajita:
How may we reconcile systems of healthcare with our subtle humanity? (2015)
Systems – our ordering of commonalities – have contributed greatly to our
treatment of structural disease. Elsewhere systems are much more problematic.
Rick and Ajita show us how and why.
Professional Appraisals? We learn more about the governors than the governed (2015)
Professional Appraisals have become often absurdly complex, cumbersome and
remote, and then blindly authoritarian. Now they obscure and destroy more
than they can assure. What, then, do Appraisals tell us?
Off-piste: only fresh tracks
lead to fraternalism in healthcare (2016)
Care Pathways – executively designed systems for all – can easily displace
the nourishment of our healthcare from fraternalism. What is that? Two
intimate vignettes illustrate.
From Balint to Square-bashing. Fifty years’ experience of
General Practice (2016)
Our healthcare’s increasing employment of complex technology is often
accompanied by a disinheritance of our human complexity. This inverse
relationship is undesigned but ever-more important.
A personal history of the culture explains. Published in British Journal
of General Practice, July 2016
Preventing Overdiagnosis? Yes, but what kind? Part 1: Geography (2016)
‘Preventing overdiagnosis’ should be an undeniable
call. Yet even to agree a definition will prove impossible. To understand why
it requires us to look far beyond the workaday tenets of our professional
practice: the hinterland is vast. This is the first of two parts.
Preventing Overdiagnosis? We need fewer systems and more philosophy
Part 2: Geology (2016)
Contemporary medical practice now harvests two new and increasing tranches of
diagnosis: first, subjective experiences of discordance, disturbance or
distress; then symptomless but risk-linked biometric anomalies. These have
led to a massive medicalisation of areas of life often better otherwise
Revitalising Holism. We need literature of wit and grit
more than piety and idealisation (2016)
‘Holism’ can easily become a politically correct, liberal healthcare
catechism. A recently published book of sterling values, The Snake in the
Clinic, illustrates the problem. Here is a review.
 Our ailing
profession. We need more than resilience and replenishment (2016)
The malaise among NHS healthcarers is akin to the
patient dying from an internal haemorrhage: oral replenishments, or even
transfusions, may be very inadequate.
A recent day conference parried this perspective.
Can Art’s courageous experiments also be accessible? A review
of a brief work of brilliant obscurity (2016)
Sometimes art and philosophy tantalise us with ideas or experiences we can
never quite ‘get’. Sometimes, we may suspect, this is the author’s intent.
Can this, nevertheless, enrich us?
Why Do We Retire? Ill omens for younger doctors
The nature of our departures from our work often tells us much about what
kind of problems are being left behind. The individual may escape, but what
about the wider community?
note to Death by Documentation (2016)
Documentation: The penalty for corporate non-compliance (2016)
Our organisational efforts to assure fail-safety, uniformity and probity can
easily – in excess – turn destructive beyond anyone’s wish or anticipation.
This tale tells how such ‘mission creep’ happens and how it is sustained.
Practice is the Art of the Possible: but we are turning it into a tyranny of
the unworkable. Reflections on our inspections regime (2016)
There used to be a tacit assumption that healthcare (and welfare generally)
was mostly imperfectible, but that practitioners
would generally do their best. All that has been replaced by something very
different. This long letter – to an NHS inspection manager – shows in detail
how we lose our professional trust, identity and integrity.
and closure of my NHS General Practice. Farewell from a long career
Letter to Chief Medical Inspector of Care Quality Commission, November 2016
Proof of the Pudding is in the Eating: Actual and virtual realities: how our
inspection culture unhinges, (2016)
What’s really going on? How do we know? Who do we listen to: the participants
or officially designated inspectors? This response to a contended official
report – that rapidly closed down a small and very popular GP surgery –
portrays our difficulties.
expedience the death of our professional spirit? What our colleagueial
utterances are telling us (2016)
Short-term adaptations to survive may – longer term – have the reverse
effect. How can this be? This short dispatch, from an ailing frontline of our
Too Big to Talk About. Organisational momentum: its
paralytic wake (2016)
Corporatism often enlarges and entrenches itself by increasing demands for
compliance. Eventually though, unchecked, this will sicken any organisation.
Such is now evidently ailing our NHS. A brief glimpse from a small conference
provides a sample.
I, Daniel Blake.
Industrialised humanity: why and how should we care for one another?
Fraternal wisdom from a film maker (2017)
How do we best assess the complex needs of others? Are these best served by
always increasing systems – now particularly computerisation and proceduralisation – to determine our human contact? A
recent film I, Daniel Blake, cautions with courageous wisdom.
is Compliance Necessary for Public Safety? The policing of Welfare: a
personal story (2017)
Imposing managerial order onto some aspects of our natural human complexity
is far more easy and attractive to design than to sustain. Our misplaced and
excessive efforts can lose us far more than we gain. Here is one salutary
story and a broader analysis of social control.
is less about eliminating root causes than tending our many branches.
Reflections on causation in healthcare (2017)
Attributing causes to human behaviour and predicaments may seem often
essential and sometimes easy: it is frequently tricky. With the pursuit of
‘root causes’ this is especially so – the greater our efforts, the more we
are likely to miss. An intimately observed example explains.
the NHS Internal Market. Too big to talk about? (2017)
Our healthcare culture is now largely controlled by notions of commerce,
ubiquitous surveillance and micromanagement. The inevitable depersonalisation
is increasingly disliked by both healthcarers and
patients. Nevertheless we seem unable to reverse these effects. What is
happening? How do we respond?
is Change Progress? Are we throwing the baby out with the bath water? (2017)
Risk management and quality assurance must always be good, surely? Not
necessarily. More of something good is not always better. Sometimes we can
add more problems than we take away. A complex public event and two private
 David Zigmond: Biography for Centre for Welfare Reform (2017)
 Should All Doctors be
Resuscitators? Unfactored costs of
prescribed risk management Rhetoric is easier than
Being prepared for unlikely risk or adversity may sound like
good counsel. But only so far: beyond that other things are damaged. This speculative
analysis is of a recent safeguarding inspection. It demonstrates how
apparently sensible procedures may, when extended, distort and implicate far
more than we usually imagine or intend. What happens? How do we understand?
Cost of Everything and the Value of Nothing (2017)
A recent book NHS
For Sale provides a trenchant analysis of how the market brings waste,
expensive complexity and inevitable corruption to healthcare. But the damage is even more extensive: this
review and reflection explores.
 A Healthy Heart for the NHS?
What is the price of sacrificing personal relationships for public money? (2017)
A recent article, Back in the emergency
room, conveys clearly the twenty-five years of economic waste and
organisational inefficiency brought by the serial reforms to our NHS.
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)
welfare services are increasingly controlled by RMIC (remote management,
inspection and compliance) regimes. Evidence of long-term benefits of RMIC
are patchy and contentious; evidence of damage or harm is much more
substantial, and by many indices.
These problems, and the difficulty engaging
authorities, are illustrated by three letters between a coercively
‘decommissioned’ GP and a governing authority (the Care Quality Commission).
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.
alert: This article describes much of the content of the film.
Vu. Twenty-first century healthcare reforms and post-war urban renewal (2017)
Two large reforming movements in recent history
have lost their human sense as they have gained momentum. What did they
overlook? What can we learn?
Boadicea and The Machine. The
price of survival as a frontline medical practitioner (2017)
NHS doctors describe increasing stress, pressure,
demoralisation and alienation. What is this like to work in? Why is this
happening? A recent book, Your Life In My Hands: A Junior Doctor’s Story,
offers vivid description and challenging analysis.
People or Procedures? Personalised treatment can be very
different to personal care. Why? (2017)
Recent advances in genetic mapping herald some
dramatically positive developments in hi tech healthcare. Yet this is
paralleled by unprecedented ailing demoralisation and alienation within the
service that will deliver these. How do we explain this discrepancy? What can
 Not So Sapiens After All. Lessons for Welfare from a
history teacher (2017)
The trials and tribulations of our Welfare system
have deeper and more complex roots than many can imagine. A recent and
remarkable book Sapiens: A Brief History of Humankind can greatly help deepen and broaden our understanding.
 One Small Altercation: a Massive Residuum How do large
systems deal with outliers? (2017)
Speaking truth to power may be straightforward in
intent but rarely in course. This essayed letter to a health service
safeguarding board (NHS Care Quality Commission) illustrates typical
difficulties – personal, practical, philosophical and ethical. The questions
raised are crucial throughout our tribulated Welfare services.
Whatever happened to professional judgement and
The erosion of a gratifying sense of
professionalism is now – belatedly – often cited as a major factor in the
collapsing morale of NHS doctors. How has this happened?
 Why are we so resistant to holism? (2017)
technologies – so irresistibly convenient – often enter our lives with
costs that are more subtle: our more natural senses of personal context,
meaning and relationship. Why does this happen? What can we do about