Sunday, August 1, 2010

KBT2FOE: The Blog & YouTube Project

I may be retired now, so it seems like a good idea to figure things out. A few weeks ago, I got fired from my position as president of a healthcare 501 3c; at the age of 58 it may not be so easy to obtain another physician executive position. And to be honest I am not sure I really want to get another job.

And so I embark on a blog and YouTube adventure I am calling “KBT2FOE” pronounced KB Tsquared foe. The title stands for “Kent Bottles tries to figure out everything.” I am sure the topics will include health care, wellness, wisdom, books, work, behavioral economics, neuroscience, happiness, accountable care organizations, medical student education, and why pay for performance will never work.

But this first installment will try to give an overview of the project; Since both my parents died at age 83, I assume I have about 20 or 30 years left on this earth. What should I do with them?

Aristotle begins Metaphysics with the statement that “all human beings by nature desire to know.” And this is certainly true of me. I am curious, and I want to understand everything. And yet I have read enough to know that all humans suffer from an everyday illusion that Christopher Chabris and Daniel Simons label the “illusion of knowledge” (The Invisible Gorilla, 2010). Advertisers prey on this illusion to make us think we understand how expensive cables with superior shielding, gold-plated connectors, and greater dynamic range will improve the sound of one’s high-end stereo. And yet audiophiles in a blind test could not distinguish such an expensive set of cables from wire coat hangers used as speaker cables.

I first tumbled to this problem of trying to understand myself and my place in the world when I learned about split-brain experiments from Michael S. Gazzaniga. Only ten patients who underwent cutting the corpus callosum (the nerves that connect the left brain to the right brain) for treatment of severe seizures have been well studied. Such a patient was shown a chicken claw to his left hemisphere and a snow storm to his right hemisphere. He was then asked to pick out one image from a group of pictures; he chose a shovel with one hand and a chicken with the other hand.

When asked why he chose the shovel, the left brain, which did not know anything about the snow storm and why one hand picked a shovel, responded: “Oh, that’s simple. The chicken claw goes with the chicken, and you need a shovel to clean out the chicken shed.” We do not say we don’t know because you cut my corpus callosum; we make up a reason to make sense of a world we do not really understand. Gazzaniga calls this function the left brain interpreter and we all have one. This interpreter must find an explanation. “Lack of knowledge is of no importance, the left brain will find a solution! Order must be made. The first makes-sense explanation will do.” (Human: The Science Behind What Makes Us Unique, 2008)

Now as far as I know my corpus callosum is intact, but the above does give me pause about how successful my project to figure out everything will be. Am I about to embark on a task that will in reality be just as frustrating and meaningless as much of my work life? And yet I have to do something, don’t I? Is being Sisyphus satisfied all we can hope for in this life?

I am not a particularly wise person, but I can read about wisdom and that seems like a lofty, but unattainable goal for someone who is retired. Confucius was a wise man, and China is taking over the world so maybe I should see what he did at my age:

At fifteen, I set my heart upon learning.
At thirty, I had planted my feet firm upon the ground.
At forty, I no longer suffered from perplexities.
At fifty, I knew what were the biddings of Heaven.
At sixty, I hear them with a docile ear.
At seventy, I could follow the dictates of my own heart; for what I desired no longer overstepped the boundaries of right.
(Roger Walsh, Essential Spirituality, 1999)

So, I have two years in which to develop a docile ear to hear the biddings of Heaven. Heaven, not so sure about that one.

Erik H. Erikson must have been influenced by Confucius when he identified wisdom as a likely, but not inevitable byproduct of growing old. His final stage of psychosocial development was labeled “ego integrity versus despair,” and if you have a lot of the former you can face death wisely.

Ken Wilber likes the Spiral Dynamics theory of Don Beck and Christopher Cowan with its eight major waves of consciousness. The first six levels deal with subsistence and are marked by “first- tier thinking.” Who wants that? Give me “second-tier thinking” where “a chasm of unbelievable depth of meaning is crossed.” If you are one of the less than 2% of the world’s population that gets it, you can think both vertically and horizontally by using hierarchies (ranking) and heterarchies (linking). I think if you are at level seven (yellow, integrative) or level eight (turquoise, holistic) you really get it. (Ken Wilber, A Theory of Everything)

I kept getting the colors and levels mixed up, and I worry that I am stuck in “first-tier thinking.” And I really do not like the color turquoise, never have. So I was relieved to find that Robert Kegan and Lisa Laskow Lahey use only three levels of adult mental complexity: the socialized mind, the self-authoring mind, and the self-transforming mind. No way am I stuck at the socialized mind because I am not a faithful follower who seeks direction. It looks like I am somewhere between a self-authoring mind (agenda driven guy with own compass and frame; solves problems and is independent) and a self-transforming mind (problem finding guy who likes contradictions and paradoxes). (Immunity To Change, 2009)

So maybe I should spend the next 20 years trying to progress along one or all of these theories of psychosocial development. Since I don’t have a job, I might as well work on something. And near as I can tell from all the jargon, to get higher up on the scales you got to get as far away from yourself as you possibly can.

When I read David Foster Wallace’s commencement speech to the 2005 graduating class at Kenyon College, I realized this guy understands the left brain interpreter and the split brain conclusions.

A huge percentage of the stuff I tend to be automatically certain of is, it turns out, totally wrong and deluded. Here’s one example of the utter wrongness of something I tend to be automatically sure of. Everything in my own immediate experience supports my deep belief that I am the absolute center of the universe, the realest, most vivid and important person in existence.

This guy thinks just like me, but I hear he was a lot smarter than me. I wish I had met him before he killed himself. But the following advice makes sense if you want to develop yourself further.

It’s a matter of my choosing to do the work of somehow altering or getting free of my natural, hard-wired default setting, which is to be deeply and literally self-centered, and to see and interpret everything through this lens of self

The really important kind of freedom involves attention, and awareness, and discipline, and effort, and being able truly to care about other people and to sacrifice for them, over and over, in myriad petty little unsexy ways, every day.

Sounds like a plan, but how do you do it? And why did he commit suicide? I think I need to be careful here. And the next advisor may have died by starving herself to death. The coroner's report said that "the deceased did kill and slay herself by refusing to eat whilst the balance of her mind was disturbed." I love to eat. Bummer.

Simone Weil died at age 34, some say because she refused to eat more than those suffering under the German occupation of France in World War II. Weil believed that beauty requires us “to give up our imaginary position as the center….A transformation then takes place at the very roots of our sensibility, in our immediate reception of sense impressions and psychological impressions.” Elaine Scarry who turned me on to Weil writes, “It is not that we cease to stand at the center of the world, for we never stood there. It is that we cease to stand even at the center of our own world. We willingly cede our ground to the thing that stands before us.” Scarry goes on to say that this radical decentering makes us no longer the hero of our own story; we become what folklorists call the lateral figure or donor figure. (On Beauty and Being Just, 1999)

Matthew B. Crawford in Shop Class As Soulcraft: An Inquiry into the Value of Work (2009) makes the same point as Weil and Scarry by quoting Iris Murdoch who believes to see the world clearly you need to undergo “unselfing.”

Anything which alters consciousness in the direction of unselfishness, objectivity and realism is to be connected with virtue. Virtue is the attempt to pierce the veil of selfish consciousness and join the world as it really is.”

So I got time on my hands, and I have to “unself” myself. I am not really sure how to go about that. But that will be content of the KBT2FOE blogs and YouTube videos. I have to figure out how to work the flip camera and to get as far away from myself as possible and perceive the world as it really is. I did sign up to volunteer in the food warehouse for Philabundance. Maybe that’s a step in the right direction.


  1. Kent

    All the best to you - sometimes the slamming of one door shudders others to open onto better views.

    Volunteering for Philabundance is definitely a smart move in my view. It gives you something to do, is worthwhile - you may even meet good people who you otherwise never would.

    Great meeting you last week too!

    Good works come out of clearings.


  2. Blogspot limits how much I can say, so I’m going to have to split my comments in two.
    Part One.
    Wow, Kent, I am truly astonished to hear that the [name of institute withheld] dumped you. I know how that feels. I was dumped by a famous Three Letter Corporation after ten years of what I thought was solid and faithful service. I understand that feeling that you've been discarded. All you can do is continue to do what you do well. In your position, a physician with a solid reputation and a following within the Health 2.0 community, I would keep taking on problems of the U.S. healthcare system. Any and all of those problems. I know some are close to your heart. Go after them. I'll follow you. Shameless plug: I'm still hoping you'll answer my call for speakers at SXSW (assuming my proposal really selected) on the topic of finding a way to help healthcare workers everywhere share learning experiences.

    You've looked into, and shared, a lot of interesting works for models of wisdom and continuation, but some of them are a little disturbing. Aristotle? Confucius? I don't know too many who can measure up to such high standards. No longer suffered perplexities at 40? I'm past fifty and still not certain about that "firmly upon the ground” concept. I know I'm perplexed by what Confucius says he felt at 50.

    As for David Foster Wallace, ironically, both you and I—based on my samplings of your writings and my own—write like DFW. At least, that's what says. I hope that doesn't mean much, as far as ultimate life choices go. DFW ended, as you know, in a foolish act of destruction. I almost went that route myself, a while back. I don't recommend it. Despite the clear attractions of their writings, I think we have to view works by writers like DFW and Simone with a weather eye out for self-deception and depression. We all need to see and know our own inner darkness, but we also need to know how hypnotic and attractive that darkness can be. Be informed. Don’t be taken in.

  3. Part two
    On the topic of sources of great wisdom, Socrates, at least the one we all know from Plato's writings, once said something I thought fell into the trap such views of inner darkness weave. In the Phaedrus, Socrates equates insanity with wisdom. Have you ever sat and listened—really listened—to the ranting of a schizophrenic? It's difficult to do. We all grow up learning to edit out lunacy. Once a discussion goes orthogonal, the little voice in the back of your head starts waving its vacuum-hose arms, shouting, "Danger Will Robinson!"

    Sixteen years ago, I sat talking to my young ward's birth mother, trying to understood this healthy-looking, rational-seeming woman, who I'll call Jane. Why had the state of Texas taken four children from Jane? We were visiting with her and her ex-mother-in-law (who had custody of the Jane's second child), and with a dazed-looking child (Jane's second), who everyone was just ignoring. I was trying to get Jane's view of her latest child, of why I and my then-wife (Jane's half-sister) should or should not be taking him away from her. Jane told me a horrifying tale of rape while she was strapped to a gurney in the hospital (which her attorney later denied—Jane wasn't in the hospital within six months of the conception), and I asked how the rape affected her view of her latest son. I'll never forget her reply. "Well, I hoped he'd be healthy and all, but then, I was sitting in the park, watching some white birds fly into the windows of this big building. Closed windows, but they kept going in and out. That's when it hit me, they were flying in and out of the windows, and I thought, 'This could be a cure for AIDS.' I tried talking to doctors about it, but they won't listen."

    Over the years, I've vacillated between (1) certainty that Jane's talk was simply the uncontrolled synapses of a schizophrenic with a history of going off her meds, and (2) wondering if those uncontrolled synaptic jumps didn't actually have some bearing on reality. Did she absorb some scraps of overheard medical conversation, of permeable and impermeable surfaces? What, then were the white birds? Leukocytes? Monocytes, traveling through cell walls?

    Remember that quote of yours from Gazzinga, "Order must be made." Nine years ago, a handful of nasty shark incidents on the Gulf Coast and Altlantic seaboard of the U.S. prompted the media to name that season the "Summer of the Shark." One ichthyologist explained the media frenzy with a statement reminiscent of Gazzinga. He said, "Humans are pattern seeking animals. If we can't find the patterns we need, we'll create them."

    So, seeking patterns, we go in through the Gate of Horn and out through the Gate of Ivory. In the end, I think it's just important that, like Aeneus, we not remain within. Keep searching Doc, and keep sharing what you find. You do it well.

  4. Kent - sorry to hear of your dislocation, but I am certain that I want to follow your journey of discovery. I tend to be pessimistic about theories of thought and meaning as most are unprovable and do not survive very long - until they are renamed and recycle for the next generation. We all create our own reality and perhaps your journey will lead you to a reality more to your pleasing. As for me - I will continue to apply my limited cognitive resources towards understanding neuroscience. Maybe if we gain a better understanding of perception and cognition - how we create our reality - we can understand more about ourselves. And if that doesn't work there's always the hypersexual and excessively violent American entertainment conglomerate to distract me from my failure to understand my place in the cosmos.

  5. Kent,

    Great new start. Look forward to more of your private views.

    Best wishes,

    Gary Schwitzer

  6. Kent,

    Sorry to hear about the firing. I hope this new chapter presents you opportunities that bring you joy and fulfillment. I look forward to reading about your quest from the sidelines.

    All the best,

    Tom Getchius