Skip to content

La Serenissima

DSC_0168

Henry James said of Venice: “There is nothing left to discover or describe and originality of attitude is completely impossible.”  So, fresh back from a trip to the city to celebrate our 25th wedding anniversary, here goes.

There is nowhere like it on earth.  Once you have turned the corner past the Piazzale Roma and crossed the Grand Canal you enter a place which in its design, history and beauty are unmatched by any other city.  It would be a hard heart, despite the crowds of tourists, not to be moved by a journey down the Grand Canal, by the view of the baroque masterpiece Santa Maria della Salute, (Venice’s thank offering for the passing of the plague in 1630/1) or by the familiar sight of St Mark’s Square, described by Napoleon as “the finest drawing room in Europe”.

This is not just a city.  Until its end in 1797, this was “La Republica Serenessima”, an independent state with over 1300 years of its own history and for much of that one of the major actors in European history.   Its authority was based on its supremacy as a naval power in the Mediterranean and its fearsome military capability centred in the Arsenal (which at its peak employed 16,000 men, invented the assembly line  and could turn out a warship in the time it took a 16th century French King to eat his dinner).  Its wealth was a product of its position as the gateway between the West and the East and its pivotal position in the spice and other long distance trade.

The discovery of the New World and the development of trans-Atlantic trade in the end marked the demise of Venice’s position but the fading of the city state’s fortunes took nearly three centuries.  That time of decline saw the continuation of Venice’s role as a cultural powerhouse with figures such as Vivaldi, Canaletto and Tiempelo.  The end came not with a bang but a whimper, with Venice ceded to Austrian at the conclusion of one of Bonaparte’s Italian campaigns.  There was no historic last act of defiance but rather the meek resignation of the last Doge and Council.

Despite its beauty it is not hard to sense and atmosphere of melancholy in Venice.  History is everywhere in the city but where is the future?  Much has been made of the environmental threats to the city, first dramatically highlighted in 1966 when an exceptionally high tide “alta acqua” catastrophically flooded much of the city, and this has prompted some investment in systems of flood defences, due to completed in 2016 which may offer some protection.

Perhaps more damaging however is the loss of the city’s indigenous population which has fallen below 60,000 from its peak of 170,000. While the city has, for a long time, been used to tourists (it was a standard destination on the aristocratic Grand Tour in the 18th century) there are now as many visitors (50,000 by an estimate in 2007) each day as there are inhabitants of the city.  For years a place apart (it was only connected in 1846 with the mainland), with its distinctive dialects (these used to vary between different sectors of the city) and culture it is danger of becoming a city, which in belonging to everyone, belongs to no one. As such it epitomises the impact of globalisation which is steadily eroding the sense of local identity on which so much of human culture is based. Is it possible to cherish Venice as a “living museum” without destroying its intrinsic heart and soul and leaving nothing but a “thinking man’s Disneyland”?  More generally can tourism (which I have enjoyed as much as anyone) promote the mass appreciation of the world’s treasures without, at the same time, leading to their destruction?

The city is not dead yet.  The last couple of times we have visited we have stayed in Cannaregio, the quarter (or more accurately sixth) of Venice furthest from St Mark’s Square and, as a result, still retaining an element of normal Venetian life.  There is a joy in the city in just walking around.  In addition to the churches, museums and famous monuments, Venice is full of hidden gems – the winding alleys, the square you stumble into when you’ve lost your way or the view looking down a canal of a familiar landmark.  Different weathers bring different moods.  Nowhere looks more atmospheric in rain or mist.  A touch of sunshine brings the city to life and makes it the photographer’s dream.  I always feel when I visit Venice that this is how I would imagine a city in my dreams if I had no other template to base it on.

Beyond the Piazzale Roma (a rare intrusion of ugliness into the city) a dominant experience is the absence of the car.  It is intriguing to see how every activity: ambulances, deliveries, waste removal) has to be done by water.  That proximity to water, much more significant elsewhere until the 20th century, is still the essence of Venice.  There is something intrinsically beautiful and calming about this phenomenon.

So Venice still resplendent in its decline epitomises the challenges of how we reinterpret human and life and culture in the 21st century.  The city has survived many threats in the past.  Can it retain its character and charm in the age of globalisation or like an ancient Dowager will it fade gracefully into the mists of the lagoon and the past?

An ever fixed mark

250px-All_Saints,_Poplar

This may be one of the more personal blogs I write.  It seemed wrong, however, to pass over the milestone of our 25th wedding which we celebrated last week, without reflecting on this most significant of institutions which has been both, in some ways, the hardest and, most certainly, the most rewarding endeavour of my life.

Over the last 100 years marriage has been in significant decline.  Rates of marriage are now well more than 50% lower than in the 1950s and the overall numbers of marriages in recent years (recognising changes in population) are at their lowest levels since 1892. Marriage has been a major issue in political and wider public debate, not unsurprisingly so given the central role it plays in how we live our lives as individuals and as a society.

Being traditionalists (at least in our love of language) we chose to be married to the words of the 1662 Prayer Book.  It provides three famous rationales for marriage: the procreation of children, a remedy against sin and fornication and finally the provision of mutual society, help and comfort.

My sense is that the decline on marriage reflects in many ways the controversy over the second of these.  That is a perception of marriage (which it undoubtedly has been) as an instrument of social and religious control of individual behaviour.  Despite attempts to liberalise our view of marriage, including very positively, the introduction of equal marriage in recent years this legacy remains.  That is a great shame given the contribution which the other two purposes make to individual wellbeing and positive societal outcomes.

Marriage as a contract of commitment between two individuals and as the bedrock of long term support for any children should be cherished and encouraged.  Personal freedom and, in particular, the freedom to escape from loveless or in some cases abusive relationships is important but long term commitments also have their place in underpinning the stability of families and wider society.  Those long term commitments should be celebrated and supported although not at the expense of those groups such as single parents who already carry some of the heaviest burdens in society.

The skills of successful relationships are hard to teach and, at times, are hard to learn.  It is a shame that our culture devotes as little attention as it does to reflecting on this topic and to creating a positive narrative of shared lives rather than focusing on only either the saccharine sweet myth of the perfect match or its polar opposite.

So in 25 years what have I learnt? Three things stand out.

That relationships need working on.  There is a lovely image in one of RS Thomas’ poems about “how his wife is always at work mending the garment of our marriage”.  It is very apt.  Relationships are put under strain by events and pressures or sometimes just the relentless pressure of routine and life.  Like our favourite garments they can become frayed and torn. If we have the skill, the space for reflection and recovery, there is the possibility of repair but without that they can become broken for good.

That a good marriage is nurtured by what one has in common and by what is different between you. That has, at times, been a hard lesson to learn.  I am lucky in that my wife and I have many shared perspectives and interests but we do not agree on everything.  I have been slow to appreciate the importance of respecting differences, not trying to impose my view on every issue and finding the means of living with and not being resentful of those differences.

That finally the principal currencies of a good relationship are loyalty and commitment, though good times and bad, through sickness and health.  Love in spite of as much as love because of.   When we, as a society, place so much emphasis on choice and personal fulfillment it can be easy to forget the importance of these somewhat old fashioned qualities but they are very precious and fundamental to the institution of marriage.

So I will leave the last words of this blog to the ever perceptive William Shakespeare and the sonnet which my wife read out at our wedding and which I have cherished in the quarter of a century since:

Let me not to the marriage of true minds

Admit impediments. Love is not love

Which alters when it alteration finds,

Or bends with the remover to remove:

O no; it is an ever-fixed mark,

That looks on tempests, and is never shaken;

It is the star to every wandering bark,

Whose worth’s unknown, although his height be taken.

Love’s not Time’s fool, though rosy lips and cheeks

Within his bending sickle’s compass come;

Love alters not with his brief hours and weeks,

But bears it out even to the edge of doom.    

If this be error and upon me proved,    

I never writ, nor no man ever loved.

100 years on the experience of shell shock still has something to tell us about how we respond to mental distress

paul-nash-the-menin-road

In the autumn of 1914 the British army, began to see a worrying flood of psychological casualties in the wake of the new horrors of trench warfare in Northern France and Flanders.  100 years after the coining of the term “shell shock”, the image of soldiers reduced to shivering and hysterical wrecks remains one of the most haunting aspects of the Great War.  Furthermore, many of the lessons of the mass psychological distress generated by the War and the efforts to deal with it are still highly relevant to our understanding of and response to mental illness today.

No doubt the First World War was not the first conflict to generate psychological casualties.  Sophocles describes the Greek hero Ajax, descending into psychosis at the siege of Troy.  The Americans were aware during the Civil War of those whose nerves had been shot to pieces by the strain of battle.  It was the scale of the First World War, however, both in terms of the number of combatants, the brutality of the armaments and the size and relative sophistication of the medical apparatus put in place to manage casualties of all kinds which made it such a dominant issue in this conflict.

It is hard to put a precise level on the numbers affected.  In part this is because there were deliberate attempts at times in the war to manipulate the diagnosis to better manage the military implications.  Some numbers, however, illustrate the scale.  24,000 British soldiers sent back to England in the year to April 1916, 110,000 German soldiers passing through field hospitals with mental health problems in the first year of the War.

In terms of longer impact 120,000 individuals in Britain had by 1939 been awarded a pension on the ground of a primary psychiatric disability, 15% of all pensions awarded for disability.  This is probably an underestimate of the scale of the problem given the enormous efforts of the authorities in many cases to avoid their responsibilities for psychological casualties.  44,000 more received pensions for “Soldiers’ Heart” or “Effort Syndrome”, medically unexplained symptoms with a fundamentally psychological origin.

It was rapidly recognised that the term “shell shock”, despite the evocative image it conveys, was a misnomer.  Only a small minority of casualties were a direct and immediate impact of being caught under fire.  For some the trauma of seeing colleagues and friends killed was the trigger.    Many were the victims of acute exhaustion.  For some the strain of the war reawakened pre-existing mental health symptoms.  Shell shock affected all classes with 1 in 6 psychiatric casualties being officers.

Shell shock made issues around mental health and psychological distress visible in a society which had been used to keeping them firmly out of view in the country’s asylums and private hospitals.  It challenged the predominant orthodoxy which equated mental illness with an underlying genetic weakness or mental deficiency and removed a level of the deep stigma which surrounded mental health issues.  Amongst the horrors of full scale industrial warfare, experienced at first hand by so many, it was clear that anyone under sufficient strain could crack.  Such a view of the universality of the risk of mental distress remains a powerful route to changing attitudes towards mental illness.

Like other mental health problems individuals could show individual and collective resilience.  Well led units tended to have lower levels of psychological casualties than those with poor morale.  Good officers could spot men who were on the brink of a breakdown and ensure they were taken out of the front line.

The scale and horror of shell shock demanded action to address the problem.  By 1918 20 specialist hospitals for the longer term victims of shell shock had been established and a series of forward treatment centres had been established.  A number of humane and impressive practitioners emerged such as Charles Myers (credited with bring the term shell shock into the official medical canon), Ronald Rows the Medical Superintendent of Maghull Hospital and William Rivers, remembered for his treatment at Craiglockhart Hospital of Siegfried Sassoon.

But harsher and more brutal voices also abounded.  However beyond the power of the individual to control, shellshock still represented a desire to escape the horrors of the battlefield.  Some Generals and doctors were quick to push back the boundary between genuine medical symptoms and malingering.  At Passchendaele in 1917 it was decided that doctors alone could not determine a diagnosis of shell shock.  Others were quick to promote dramatic therapies based on the use of electric shocks or “forcible persuasion”.   In Germany psychiatrists, maligned amongst soldier activists, became targets of the brief November Revolution in 1918 on account of the brutality of their methods.  Finally during the First World War the British army executed 307 of its own soldiers for cowardice and other military offences.  Until the end of the War there was no systematic approach to assessing the medical condition of the accused.  Some of those shot were psychological casualties.

Some of the saddest stories surrounding shell shock come from after the War.  While many recovered sufficiently to return to normal civilian life others lived on with dreadful and debilitating symptoms.  Some disappeared into the county asylums as specialist provision was discontinued, perhaps, if they were lucky, preserving some small badges of status in terms of wearing suits rather the uniforms worn by the other patients.  Some were able to work, others not, often fighting an ongoing battle with the Ministry of Pensions, then as now producing all the tricks of the bureaucratic trade to limit its obligations.  This was not “a land fit for heroes.”

So 100 years ago the phenomenon of shell shock brought mental health to the front of public attention and for a while captured a sense of genuine sympathy and support for those affected.  It helped cast a spot light on the totally inadequate state of provision for people with mental illness and encouraged the development of new more humane forms of treatment based on talking therapies.  My own organisation, the Tavistock Clinic, was born in 1920 out of the belief of some of those who had been involved in the treatment of shell shock that better care could be provided in the community.

A lot of that sense of optimism faded as the immediate experiences of the war were forgotten and as the pressure of another age of austerity beat down on any attempt to provide a more generous and effective system of provision.  In 2014 we live in another age where mental health problems are again coming to the fore and where more generous and less stigmatising attitudes towards those affected are developing.  Let’s make sure we take full note of the experience of those heroes who, 100 years ago, bore the scars of battle in their minds.

The Five Year Forward Look – A not insurmountable challenge

Five_year_forward_view

NHS England’s 5 year Forward View is, in general, a bold, grounded and salutary document which sets out clearly the challenges which we all face in ensuring that a thriving system of publicly funded universal health care is in place in 2020, despite the economic and other pressures which face us as a society. It is a document helpfully devoid of political spin which does not attempt to set out detailed prescriptions for how those challenges are met but rather provides a sense of permission for the actions which all of us involved in the system need to take to reshape the way in which healthcare is delivered in this country. It strikes the right balance in pervading a sense of optimism that these challenges can be overcome while arguing for realistic decisions about funding if that optimism is to be justified. The document is the most tangible sign so far of NHS England staking its claim as the leader of the new system and it is creditable that it has decided to do so, working together with the other major players in the post-Lansley NHS.

There were a number of things in the document I wanted to comment on, some where I support what has been said, some where I feel it could have gone further, some where I feel an important ingredient for change has been left out.

First I applaud the strength of statement supporting a commitment to delivering genuine parity of esteem to mental health. Recent announcements around waiting times for mental health have been a welcome first step towards trying to close the gap between rhetoric and reality in this respect and I am pleased to see there is recognition that this must go much further. However I am concerned that behind this promising start there may be a failure to realise the enormity of the task to ensure that people with mental ill health receive the same response at those with physical conditions. It is inconceivable, for instance, that we can close the treatment gap for the 75% of people with depression and severe anxiety who do not receive any form of treatment without a major rebalancing of resources.

In addition it is crucial that, across the NHS, we take a more psychologically informed view of health and health behaviours. There is no artificial boundary between our minds and bodies. Our psychological condition impacts crucially on our ability to recover but these insights are often far removed from how health professionals are trained and from how we organise services to care for patients. While I welcome the emphasis in the document on a more assertive engagement with public health and on earlier intervention to prevent or postpone chronic illness such an approach must also be informed by an understanding of the psychological and social environment in which people are motivated to look after their health. Exhortation and lecturing on their own will do little to persuade people to reduce their weight, drink less or take more exercise.

The document says some important and helpful things about the need to reshape the landscape of care away from the paradigm of the District General Hospital to a world where more care is delivered closer to home in the community but where, at the same time, specialist care is concentrated in a smaller number of centres of excellence. Sensibly in 2014, compared to 1962 when the last blueprint for hospital care was published, it indicates that how transformation is achieved must be a matter for local determination. It is also sensible to suggest that while it is self-evident that we will need, as a result of these changes, less hospital care it may be better, in some cases, to find ways of finding new approaches for existing facilities rather than always entering a toxic debate about closure. As was clearly illustrated to me when my elderly mother was recently hospitalised patients can understand why treatment, especially specialist treatment, may have to be remote but do not understand why care, especially more routine care, cannot be delivered locally in a way which keeps patients connected to their networks of family and social support. A particularly strong point was made in the document about the value of working with the nursing and residential sector to strengthen their ability to care for patients with complex needs.

The shift to out of hospital care clearly needs us to crack the delivery of integrated care. The vision document says some helpful things about the structural options which might help to facilitate this and again rightly stresses that “one size will not fit all”. It is important however that the NHS does not, as its default position, focus solely on structure while ignoring the issues of how it facilitates different models of collaboration between practitioners in the community and the underlying issues of behaviours and relationship which underpin this. It is one of the most abiding lessons of the closure of the long stay mental health hospitals that you cannot just take staff out of an institutional setting of care and expect them to behave in a different way. These questions as much as structural and financial ones need attention.

Finally I welcomed the recognition in the document of the need for the NHS to be working not just in the community but to be of the community. So there was an important reference to the role of the NHS as a local employer and of its responsibility to look after the health and wellbeing of its workforce. There was a healthy message about the opportunity to work more closely with the voluntary sector who can, at times, have a reach and impact which the NHS cannot replicate and I welcomed the emphasis on volunteering and working with carers and families. A greater emphasis on public health and early intervention should also see the NHS concerned not just about what it does itself but how it can support other organisations such as schools and employers to manage health issues.

It seems a feature of our digital age that the lifespan of reports and strategy documents seems to be shrinking and it will be interesting to see how frequently this document is quoted in 5 years’ time. It is, today, a welcome contribution to the debate, running with the grain of debate about the nature of the problems facing us, encouraging innovation, not over promising delivery and setting rather than following the tone of political debate.

There is no doubt a challenge ahead of us to save the NHS but I accept the premise of the document statement that it is one that with the right effort and encouragements we can meet.

Encouraging the Good Life

Aristotle2

Doing my job I am lucky to get to go to the launch of some of the excellent publications produced by members of the clinical team at the Tavistock and Portman. A book I have just finished reading is “The Good Life” by Graham Music, a Child and Adolescent Psychotherapist who has spent a career working with troubled children and adults.  As well as being a tour de force of the current evidence on the psychology of altruism, the book reinforces the moral case for doing what we can to create the conditions for happiness and wellbeing and for supporting those individuals whose early life experiences are traumatic and destructive.

Graham’s argument is that empathy and altruism are natural instincts of the human species, which emerge at an early stage in human development and are reinforced by the development of secure attachment with parents and other caregivers. He also demonstrates, as Aristotle concluded centuries ago, when we feel good we are likely to do good and, by contrast, stress in our own lives can reduce our propensity to help others.

Our instincts towards “goodness” are not exclusive. We are also programmed to act selfishly to protect our interests and those of our group.  Those instincts are not always bad and have served the human species well over our evolution but there is a question of balance and for recognising the importance of the conditions which promote our better side.

All in all Graham’s book and the science he explains are powerful arguments for policy makers and others giving more attention to issues of child development and adult wellbeing.   From time to time this has registered in the public debate but without leading, despite the rhetoric to many fundamental shifts in approach.

Amongst many there are three particular areas of public policy which are worth looking at in the light of this analysis.

The first, and probably most significant, is what we do to support children’s’ early years to encourage the healthy development of the greatest number of children and reduce the level of harm incurred by those children who are victims of abuse or maltreatment.

The focus should be both on parents and children. Parenthood, despite all the other social and economic advantages I enjoyed, was the one of the tasks in life I was personally least prepared for.  I learnt on the job and it took me years to feel confident in the role.  I was lucky with the support our received from my family and social networks.  Others are not so well placed.

You cannot necessarily teach parenthood in the classroom but you can do more to support parents whether through generous provision for parental leave, targeted evidence based programmes such as the Family Nurse Partnership which support young mothers or the wider provision of parenting programmes and advice. Support for when couples experience difficulties in their relationships is also crucial given the immensely negative impact which parental separation or dysfunctional parental relationships can have on children.  While I have no desire to return to a past where many, particularly women, were trapped in lives with loveless or cruel partners I also believe that we underestimate the value of support those who wish to mend their relationships.

We also need to have an honest debate, led by young people themselves, about what constitutes a good childhood. Every age has its myths about childhood and, whatever society does, children can have happy or unhappy lives depending on their own circumstances.  Nonetheless there seems no doubt that there is greater pressure on the current generation of young people, whether in relation to academic achievement, body image or peer pressure.  This in it is turn is leading to an undeniable increase in the incidence of mental health problems in children and adolescents.

The second area is the ongoing need to look at the overrepresentation in the criminal justice system of people with a history of stunted emotional development, especially as a result of childhood abuse or trauma. Despite occasional rhetoric to the contrary we are still happy to be tough on crime but not on the causes of crime. As well as supporting parenting and healthy child development there is a case for interventions to address mental health problems with their roots in problems with attachment and other issues with childhood attachment.  While I recognise the case for strengthening the formal evidence base, practitioners like Graham see the impact which long term psychotherapy can have in helping people with significantly troubled pasts to improve their social functioning and reintegrate with society.

The final area is the wider appreciation of wellbeing as a dimension of public policy. This has its critics amongst those who are wary of those who pretend that teaching people the techniques of mindfulness can be an effective substitute for resolving more fundamental issues of deprivation or providing effective and appropriate mental health services for those in distress.  Increasingly I believe, however that wellbeing does matter for public policy alongside strategies for economic growth and that there is a roll for national and local government to measure wellbeing and develop strategies for increasing it.

A role for the state however does not take away responsibility for individuals or wider civil society. The decline of organised religion, at least in some parts of our society, has created a space which other forms of philosophy, belief and community  must be encouraged to fill.  As individuals we need to give more priority to understanding ourselves and promoting our positive mental health and wellbeing.

The Greek philosophers saw the good life as the central tenet of human knowledge and enquiry. Graham’s book reinforced, from a scientific perspective, my belief that everyone is born with some potential for good and that there are interventions we can make, most especially in childhood to give individual the best chance to realise that potential.  We must make this a central tenet of debate and priorities in our own society.

The Good Life  – Well-being and the new science of altruism, selfishness and immorality by Graham Music is available at http://www.karnacbooks.com/Product.asp?PID=35203

First do no harm

6034295189_7500f703a7

I had the privilege yesterday of joining a discussion with David Dalton, Chief Executive of Salford Royal Hospital, in particular focusing on the inspiring work he has led around improving patient safety and quality.

I was really struck by what David said about the start of his journey, that you cannot really improve safety if you are not honest and transparent in the first place about the current state of affairs and the intrinsically risky nature of healthcare.  Given the number of patients seen by the NHS, harm whether avoidable or otherwise, is inevitable and as the providers of care we must be honest with the public about that fact.

There is a growing and welcome move in the NHS towards greater transparency which I fully support.  Initially organisations and individual teams and practitioners are very nervous about publishing data about performance and, in particular, safety and data can always be misinterpreted and used out of context.  However in general, as I once heard it put very eloquently, publish and be damned is the right approach and the more you publish the less you will be damned as commentators and the public become better educated about the context from which to judge individual performance and events.

Transparency also helps at the local level so again I was impressed with what David said about the fact that individual wards in the hospital will post data about the most recent incidents and other aspects of performance.  There is an example to follow here from food hygiene.  The practice of requiring restaurants and other food outlets to publish their food hygiene ratings prominently where customers enter the premise normalises the issue and creates an important pressure on those who are not complying with standards.  Done appropriately the same approach can work in healthcare normalising the general run of performance and creating an incentive on those who have issues to address to do so.

A second theme of the discussion was about learning.    My experience of healthcare is that when things do go publicly wrong considerable effort is put into investigating what happened, establishing root causes and identifying lessons learnt.  Such investigations can often be quite emotional searing for those involved and that, if an avoidable fault is discovered, my experience is that there is a genuine desire for making sure that it doesn’t happen again. Yet in large complex organisations with a constant turnover of staff and leadership those lessons can easily be lost.  A learning culture is an easy aspiration to make but one which is difficult to deliver in reality.

There are two approaches which I believe can help.

First is the use of decision support.  While I was at NHS Direct, which used decision support routinely in the delivery of real time clinical care, I was struck by how powerful the system could be in helping to disseminate lessons from those cases where things had gone wrong.  15 years later the use of decision support in clinical is still relatively uncommon and I wonder how many lives might have been saved if it had been adopted more widely.

Critics will of course say that medicine does not always lend itself to computerised algorithms and that may to some extent be true.  However the clue is in the name, decision support is there to support the clinician not take their place. However there must be advantages in bringing to the clinicians attention, at the point of a decision, key information including any factors from adverse events which might impact on what they do.

The second strategy rests in the power of stories.  My time as the leader of a patient organisation convinced me of the power of stories as a vehicle for changing attitudes or behaviour in healthcare.  Personal stories not only convey the facts of a situation they also connect us with the emotions of those who were involved.  That emotion can be the most powerful factor in getting us to engage with what has happened and what it might mean for our future actions.  While circulars and guidelines and more factual  presentations are important , stories and their emotional impact are a relatively untapped approach to help us understand and disseminate the consequences of when things go wrong in healthcare.

The final point at the end of our conversation was a sense that this was the right conversation for us, as a group of health care leaders, to be having.  All of us had some personal experience of what happens when things go wrong.  We could have been talking about money or structures or integration or whole load of other issues which impact on the working life of a NHS Chief Executive.  However if we did n’t feel strongly about safety and the avoidance of harm and were n’t interested in what we could do differently to address those issues you could argue we were in the wrong business.

Two is better than One

WalesMillenniumMuseum

There is the old joke of what do you call a person who only speaks one language – an Englishman.  It may be a stereotype but it’s probably never been truer as the number of students studying modern languages at GCSE, A Level and University continues to decline relentlessly.  More than the lack of the knowledge itself I am always grieved by the contempt which is sometimes shown in this country to other languages: their uselessness, their incomprehensibility, the outrageousness of speaking them on the streets of London.

As a person of Welsh descent brought up in England, I have always had an interest in languages and admired those who were fluent in more than one.  For the Welsh, more so than the Irish or the Scots, the preservation of our distinctive and ancient language has been intimately tied up with our sense of national identity.  There is a Welsh saying “gwlad heb iaith, gwlad heb galon” a country without a language is a country without a heart.  It is if the language carries a great part of our national and cultural DNA to be passed on from one generation to another. It is one of the achievements of my adult life I am proud of that I’ve been able to ensure that I am not the first generation of my family not to speak Welsh.

But in additions to the specifics of my I might wish to learn the language of my family, there are good general reasons for being able to speak more than one language.

Sometimes it is useful.  While I think the utilitarian argument is often grossly overdone in respect of any form of educational activity there are times when it can be directly helpful.  Although in my own lifetime the ability to speak English (or rather American) has spread enormously, certainly in Europe, not everybody speaks our language and if you want to quickly go about your business being able to say something in the local language can be useful.

But if the strictly utilitarian was the only tests then I think the decline in the study of languages might be justified.  However there are other reasons.

The first is the sheer fascination and beauty of different languages.  Learning other languages and how they describe both the commonplace and the special is like seeing the world in colour when you have been used to seeing it only in black and white.  You appreciate nuances of meaning and appreciation which are invisible when only looked at through the lens of your own native tongue.   The English say “Indian Summer”, the Welsh say “Small summer of Michaelmas”.  We both refer to that occasional blast of late summer weather which we experience at the end of September.

This is heightened when you can appreciate the links between different languages.  The words in each language which are related to each other, the words they have more explicitly borrowed from each other.  Our word triumph which comes from Etruscan through Latin, alcohol which comes from Arabic, kiosk from Turkish.  A knowledge of other languages can often be a key to understanding and communicating better in your own native tongue.

The second and, for me, most significant reason is one of empathy.  By learning someone else’s language you acquire not only an understanding of the practicalities of their life, you also get an insight into their psychology and at times their soul.  It is possible to learn some things in translation but things can also be lost in translation.  Hearing and reading in the original language adds a greater depth of understanding which in, most cases, is well worth well the effort.  Diversity is the delight of our species and languages are the ultimate expression of that diversity.

Finally if you are not convinced by any of the arguments above there is one left.  The mental effort of learning other languages is good for us.  Researchers  think that the ability to speak another language might be a protective factor for the onset of dementia.  So two might indeed be better than one.

Follow

Get every new post delivered to your Inbox.

Join 6,284 other followers