Is Lateral a Direction?

Damn! There they go again, pulling the masks off the faces of those of us who grew up hoping we were uniquely creative; those of us who eschewed the logical pathway of thoughts and instead stepped off the trail to see if anything was hiding in the bushes. That’s what we lateral thinkers like to think we do -I say ‘we’ laterally, of course. Although I certainly wasn’t a child in the 1960ies, it was a time when my hormones had settled sufficiently to allow me to think of things further afield -more laterally than chromosomally. In fact, I suspect it still wandered more than I would have liked, but the era was wrapped in sunlight and the resulting chiaroscuro made it hard to look in one direction only.

The stage was set, it seems, for someone like  Edward de Bono, a Maltese doctor and researcher, to write The Use of Lateral Thinking which espoused just what I had found myself doing: relaxing the need for vertical (logical?) thinking. Actually, he decided that several things needed to change if we wanted to be creative: things like recognizing that some ideas were especially persuasive, so we needed to find different ways of looking at them -and this meant pursuing a different way of approaching and solving problems, even if it involved incorporating serendipity.

It struck me as a relaxing way to approach life and although I never really went in for piercings or drugs, I could see how it might be seductive to some people. But it’s hard to maintain a belief when people keep poking holes in it. And it’s especially hard to feel safe within a dogma when the innards of the pillars you thought were supporting the roof are showing signs of decay. Still, I imagine stuff evolves as time moves on.

I suppose I did, anyway, although I couldn’t quite surrender the suspicion that there was value in approaching questions as if they were actually answers in disguise -well, at least that was the message I took from the lateral thinking craze. And then, I happened upon an essay in Aeon by Antonio Melechi, an honorary research fellow in the department of sociology at the University of York, which seemed to suggest that lateral thinking was, of all things, a pseudoscience:

Imagine my disappointment when I read that ‘Historians of science questioned why de Bono invested so much in the genius ‘eureka’ moment, when invention and paradigm shifts were more commonly the work of communal endeavour and disputation.’ Not that I’ve ever experienced a genius moment, or anything, but I’ve always revelled in sudden surges in understanding that seemed to spring from a good night’s sleep. ‘Psychologists had more questions than most. Lateral thinking clearly overplayed the importance of the creative breakthrough at the expense of trial and error, feedback and reflection, not to mention unconscious incubation.’

I suppose I’ve always been an incubator, though -much as the process may cast the strength of my underlying gender into shadowy regions. But nonetheless incubation, however unconscious, is still eurekoid, don’t you think? It’s still sort of lateral -something that conscious processes await until ideas can be suddenly and perhaps even mysteriously hatched from wherever.

De Bono and his lateral thinking has been criticized as being more derivative than seminal; but, does it matter who first named it? Melechi points out that, there has been ‘a long history of research into creativity, a rich treasury of thought and experiment that had almost certainly provided lateral thinking with most of its magpie principles and pre-owned methods.’ For example, in a lecture in 1880, the famous American philosopher and psychologist, William James ‘observed that the ‘highest order of minds’ had a knack for straying from the ‘beaten track of habitual suggestion… we seem suddenly introduced into a seething caldron of ideas, where everything is fizzing and bobbing about in a state of bewildering activity, where partnerships can be joined or loosened in an instant, treadmill routine is unknown, and the unexpected seems the only law.’

Actually, ‘Known to some Enlightenment philosophes as ‘negative imagination’, this mercurially creative sensibility remained in the shadow of pathology and degeneration for much of the 19th century, and it fell to a new wave of French psychologists to push for its study and rehabilitation.’ So, ‘the mathematician and polymath Henri Poincaré dug deep into the ‘sudden illuminations’ that punctuated his research. The unbidden insights that had propelled him to make discoveries across various fields were, Poincaré insisted, evidence of complex work being undertaken subliminally, over days and weeks, as he busied himself with unrelated issues.’

Gestalt psychology also identified the very notion of lateral thinking in all but name. ‘Wertheimer [psychologist Max Wertheimer] noted that logical-analytical thinking, or reproductive thinking, was hostage to repetition, habit and intellectual precedent. Insight and breakthrough, in science and everyday life, needed the irruption of ‘productive thinking’, the ability to look at a situation or problem from a new perspective.’

On and on goes the evidence to suggest that only the name ‘Lateral Thinking’ was new, and there I was thinking that I was finally surfing on a wave I could handle. That somehow it had unlocked the door to a personal heuristic (to use a lateral-thinkingly-derived change of idiom).

Perhaps there are no shortcuts to wisdom, though. There’s no sense in simply wandering through the woods only to stumble into an unsuspected field of flowers rather than the missing answer for which you were searching.

Is it a sign of Age, though, that searching always needs to be teleologically driven? Planned, in other words? That there needs to be a reason for the search, other than bald, ungarnished curiosity? That you need an already prepared question to get an answer…?

Answers lie all around us, scattered like those wildflowers in the meadow; surely what we really need to do is find the right questions. The right keys that fit the locks. I don’t know about you, but I have always travelled with questions stuffed in my pockets. And so, if I happen to stumble upon an answer I hadn’t expected to be sleeping just off the trail somewhere, I merely fumble around in my jacket for the suitable question that I didn’t even know I was carrying.

Is that Lateral Thinking?

The Doors of Persuasion

The Doors of Perception, by Aldous Huxley -I loved that book; I read it when I was a teenager and was intrigued by the idea that there could be doors to abstractions as well as to rooms -doors to other areas, other places. Invisible portals that existed alongside more tangible things, and yet magical, somehow -like the door to Communication.

Communication is such an obvious and basic requirement to enable us to function that it is often invisible until pointed out. Almost everything we do is a form of communication; writing, creating, building -perhaps even imagining- are all done for someone else to notice –despite our ego-dominant protestations to the contrary. We, none of us, live in a vacuum –nor would we be able to, even if we mistakenly thought we might like to try it for a while.

No, the need to communicate is a given; we are social creatures. And there are many reasons for it: to reach out and feel the presence of another is a major one -to share the solitude we all inhabit and reassure ourselves that we are not alone.

And yet the other main purpose of communication –the imparting of information- can be more difficult. Is more difficult. We are all unique, and we guard the differences behind a variety of walls: culture, education, gender… There are so many ways. So many reasons. So many locks on so many doors. The art of communication has always involved the art of persuasion; to open a door, you must first want to open it -and trust that what is on the other side is neither harmful, nor antithetical to what you have become accustomed to, or are able to accept. Willing to accept.

In medicine, to open doors, we have often relied on the magic of arcane knowledge. But although communication through authority can force, it cannot persuade. Cannot convince people that what we advise is necessarily in their best interest, especially if the advice flies in the face of what they have always believed, what those around them have always lived, or what their culture or milieu has always prohibited. There is always other advice, other authorities they can consult that harmonize more readily with what they have been taught, so why should Western Medicine, as we have come to classify ourselves, be specially privileged?

I’m not convinced that in all cases, and in all circumstances it should be. There is usually not one answer that suffices, not just one approach to a problem. But if someone has come to a doctor for advice, or more unfortunately, has been swept into his purview through circumstances not of her choosing, it would be helpful to approach the issue with all the respect it demands. The trust one engenders as the doctor is assigned; it has not yet been earned on that first encounter. Authority of the sort we as doctors possess breaks down rapidly when it attempts to enforce an opinion. Contradicts a belief.

If I, for example, say that something is my belief, I may be closing a door unless the person to whom it is addressed already shares that opinion. Especially if uttered in a fashion or in a circumstance that negates the other person’s opinion -makes them lose face, or does not allow for a compromise that permits their own beliefs, and makes allowances for their own cultural practices. I am not talking life-and-death situations where emergency surgery is required to remove a ruptured appendix, say, or an antibiotic is needed to rescue the body from an overwhelming sepsis… More the situation where there may well be other options –some, perhaps not as appropriate or effective, but where the choice could still be construed as a matter of opinion –mine.

Each of us is the agent of our own lives and we should be free to decide for ourselves what path to walk. Some choices may be unwise and later we may wish we had chosen something else, but wherever possible, the choice should not be forced upon us. And indeed, one of the major premises of medical ethics forbids just that: the principle of autonomy –we should be free to choose whatever option we wish, even if the doctors disagree.

So, if we feel persuaded about the validity of our own beliefs, our own view of the world, it behooves us to unlock the doors of persuasion, not coercion. We are not always right –and that is surely not the point- but we have the best interests of our patients at heart and believe we can help. We do that by earning their trust, their respect, and their confidence. The object, after all, is not to prove that they are wrong and we are correct, but rather to help them to see that, in the face of the legion choices they could make, the one we suggest is most likely to produce the results we both desire.

I sometimes find that is the hardest part. It is difficult for me to listen sensitively to a monologue on ‘cleansing’, say, when I do not accept the thesis that disease is caused by toxins in the gut that need to be removed. It smacks too much of bloodletting, or leeches, of purgatives and enemas, of spells cast on the unwary… Attestations that the poor heart would fain deny, yet dare not. Even placebos help for a while, after all -it is the kingdom of Hope.

But it is not enough to merely try to keep an open mind -as the King says in Hamlet: My words fly up, my thoughts remain below: Words without thoughts never to heaven go. The object, where ever possible, is to stop for a moment to listen -no matter what is said. There is often fear in the other voice. And it’s a dare of sorts that the patient issues: ‘Prove me wrong; convince me if you can -I need something- but first, listen, then explain your point of view. Let me believe I have been heard…’

I want to believe that hope springs eternal in both our breasts.