Tag: Dualism

The More Beautiful World Our Hearts Know is Possible. Part 2.

The More Beautiful World Our Hearts Know is Possible.  Part 2. 


Part 1 discussed Charles Eisenstein’s outline of what he called the ‘old story’ of the world, at times called the ‘Story of Separation’. This was traced to its origins in western thought evolving into a ‘mechanistic’ view of life. I suggested that although nurse education understands concepts such a holism, actual adult nursing practice may still be based on the ‘old story’ which includes biomedical reductionism within a neoliberal discourse of ‘efficiency, economy and effectiveness’.

May 12th is ‘International Nurses Day’ and is being celebrated on twitter. For an, albeit self-selected, sample of nurses, and what they value, the tweets may present a particular view of what nursing is about. As such it is ‘espoused theory’, i.e. it is what we say we value and do. Following the #IND2016 reveals the thread and expressed values. It cannot however provide much of a clue as to the personal world views of nurses, their ‘epistemologies’, their ‘ways of knowing’ (empirical?) or their ‘ontologies’, ‘the meaning of existence or being’  (duality?).

An epistemology is how you think knowledge can be attained, it is about the nature, source and limits of knowledge, for example through sensory experience (empiricism). A biomedical epistemology bases its knowledge on physiology and anatomy, what can be measured and predicted according to laws of biological science. The subjective experience of illness cannot be taken as ‘proper knowledge’ because it cannot be seen, measured or is open to scientific experimentation or enquiry. The epistemology underpinning many alternative therapies accepts knowledge from theories of chakra, or theories such as ‘like cures like’ and argues that this knowledge is just as valid as knowledge derived from scientific randomised controlled trials favoured by biomedicine.


Ontology is the philosophical enquiry into the nature of being, becoming, existence and reality. A dualist ontology considers that there is a separation between the material existence of the human body and the external material world. It accepts that that mind and matter exist separately. Biomedicine adopts this understanding of the human body, that indeed the individual human body is a separate unit of existence from other human bodies, and indeed is separate from the whole of material existence. Therefore what happens to the individual affects only the individual, and what the individual does affects only their sphere of influence.


Student nurse education will be based on both these assumptions in the background. All of the work learning for example A and P and pharmacology are grounded in this world view. This holds for the majority of clinical skills learning. This holds true more for adult nursing than mental health and learning disabilities:


“Over the past few decades learning disability and mental health nurses…(are)… developing rapprochement with service users and a commitment to social models of care. In mental health care this can be seen in the development of recovery focussed care, while in learning disability Wolfensberger’s (1972) normalisation theory has had an equally radical impact. While adult nursing has also changed a great deal in the same time period, it has not undergone the seismic shifts in philosophy and approach to care that have taken place in these two disciplines. For very good reason, adult nursing remains committed to a biomedical vision of illness which, while cognisant of the importance of a holism, is tied to a physical approach to care.”  (Ion and Lauder 2015).


The context in which adult nurses work, and the nature of illness experienced by their patients, means that understanding health from the ‘new story’ view is perhaps idealistic for the majority of adult nurses.

The above descriptions of empiricist and dualist epistemology and ontology is what Eisenstein calls the ‘old story’. Thus, a brief outline of Eisenstein’s view of the ‘new story’ might provide a basis for some critical reflexivity. He variously calls it the ‘Story of Interbeing’, the ‘Age of Reunion’, the ‘Ecological Age’ or the ‘World of the Gift’.  Wendell Berry calls it the ‘world of love’ or ‘health as membership’.

This resonates with David Loy’s (1988) comment:


 “In this century it has become clear that the fundamental social problem is now the relationship between humankind as a whole and our global environment” (David Loy 1988 p 302).


Loy contrasts Eastern non dualist philosophical traditions, with mainly Western dualism in that:

 “….there is no distinction between “internal” (mental) and “external” (physical), which means that trees and rocks and clouds, if they are not juxtaposed in memory with the “I” concept, will be experienced to be as much “my” mind as thought and feelings” (p140).


This then is a non-dualist viewpoint in which ‘us’ includes the biosphere; we are indivisible as human beings from all life forms and all matter.


The principles of Eisenstein’s ‘new story’ are (p15):

  1. That my being partakes of your being and that of all beings. Our very existence is relational going beyond interdependence.
  2. What we do to another, we do to ourselves.
  3. Each of us has a unique and necessary gift to give to the world.
  4. The purpose of life is to express our gifts.
  5. That every act is significant and has an effect on the cosmos.
  6. We are fundamentally unseparated from each other, from all beings, and from the universe.
  7. Every person we encounter and every experience we have mirrors something in ourselves.
  8. Humanity is meant to join fully the tribe of all life on earth, offering our uniquely human gifts towards the well-being and development of the whole.
  9. Purpose, consciousness, and intelligence are innate properties of matter and the universe.

This view may be more applicable to one’s personal view than to clinical practice. It might be interesting to think what clinical practice might look like if we took these precepts seriously? The current design of hospitals and clinics, the clinical pathways we develop and the sort of practitioner we educate is based on the ‘old story’ of biomedicine, so we know what that looks like. It is our current world.  Could it be possible to redesign and to rethink?

This is philosophy, but Eisenstein argues this fits with what physics tells us about the world, it is more than ‘new age’ assertion and hope. There is a continuing divide however between the new paradigms of physics and biology and the Newtonian mechanistic world view of everyday experience. The one is the espoused theory – what scientists and philosophers say is so, and practical action – what we actually do and experience as adult nurses.

The issue goes beyond what clinical practice looks like and where it takes place. The ‘old story’ underpins our ecological, social and economic crises because it narrows the definition of what it is to be human, what reality is and thus what the possibilities are.

Yagelski (2011) calls this ‘the problem of the self’:

“My argument here is that the prevailing Western sense of the self as an autonomous, thinking being that exists separately from the natural or physical world is really at the heart of the life-threatening environmental problems we face”.

Student nurses in the Adult field in the UK are schooled, and experience, the ‘autonomous, thinking being’ separate from the natural, physical and social world. The political world is torn between Margaret Thatcher’s ‘no such thing as society, only individuals’ and a more social(ist) democracy. To date Thatcher’s view prevails as a core element of neoliberalism.

Adult nurses go to work within a mechanistic, empirical, patriarchal, separate, reductionist and biomedical context. This is a world in which the cause-effect relationship of the RCT is the gold standard for evidence. They will have a clear sense of boundaries between themselves and their patients and with other health professionals. The work context is similarly managed in a fragmentary way, units of work need to be measured and evaluated, processes clarified, evidence to be checked. Wendell Berry calls this the ‘world of efficiency’.

He also refers to the ‘world of love’, a world which Eisenstein might recognise as ‘Interbeing’.

However, this is a view that hospitals and industrialised medicine struggle to understand and thus cannot ‘heal’ or make ‘whole’. Berry accepts that the hospital does well at surgery and other procedures, treating the body and its parts as separate things.


Healing, however, meaning reconnecting and making whole, is alien to many medical practices. For example, any place of healing would emphasise and prioritise such things as rest and food. Whereas a hospital treats a body as a machine that needs fixing and that the rest it needs is a low priority. Both sleep and nutrition in acute hospitals continue to be topics addressed in the literature as not always delivered in the best way possible. The very design of hospitals seem antithetical to both.


Berry argues that rest, food and ecological health ought to be the basic principles of the art and science of healing, but currently healing is based on other principles: biomedicine technology and drugs. Berry criticises biomedical practices for making only tenuous links between healing, rest and food and no link at all between health and the soil:


Industrial medicine is as little interested in ecological health as is industrial agriculture” (p98).


This sentence makes no sense unless health is defined within a non-dualist, non-reductive ontology.


This disconnect between healing, health and medicine is illustrated by Berry by describing the experience of his brother’s heart attack. The debt to the hospital is acknowledged, as John his brother underwent a Coronary Artery Bypass graph. In the hospital the ‘world of love’ confronts the ‘world of efficiency’ – i.e. medical specialisation, machinery and procedures.


John came from the ‘world of love’ of family, friends, neighbours which the hospital struggled to deal with. This world of love seeks for full membership, it seeks to be joined. However the world of efficiency ignores this love as it must ‘reduce experience to computation, particularity to abstraction and mystery to a small comprehensibility’. In other words any experience that cannot be objectively measured and calculated is devalued and takes second place to the ‘real’ work of diagnosis, intervention and evaluation.  Hence the focus on vital signs, NEWS, blood gas analysis, blood tests (FBCs, U and Es), ECGs, urine output, X-rays and CT scans; the particularity of a patient’s pulse is abstracted to concepts such as hypovolaemia; the particularity of a real person is abstracted into a set pf physiological parameters transformed into documentation replete with risk scores and reduced into medical categories; the mystery of the pale, clammy patient, expressing chest pain has to be comprehended as myocardial infarction (or other diagnostic category that gives meaning).


Efficiency must ally itself to machinery – John was in the intensive care unit – to standardise, to provide numbers to predict and control. The efficient nurse will use all the tools that biomedical science gives to provide the best physical care. The effective nurse will use the appropriate biomedical tools and interventions which are evidenced based; the economic nurse will do so with the minimum of cost.


Love however cannot be standardised, is not a graph, a chart, anatomy, an explanation or a law:


“The world of love includes death, suffers it, and triumph over it. The world of efficiency is defeated by death; at death all its instruments and procedures stop. The world of love continues and of this grief is the proof” (p105).


The professional ‘field’ of adult acute care excludes the ‘amateur’, excludes the world of love. Descriptions from the professionals to the family that procedures were ‘normal’ failed to acknowledge that nothing about this was normal. Normality for them was biomedically defined, was what they have experienced with other patients. Lying in a hospital bed is pretty far from normal for everyone else.


The worlds of love and efficiency divided experience, however people can cross between. The amateur may not be able to cross into the world of efficiency. The machines and data are ‘a foreign land’, but the professional can cross into the world of love:


“During John’s stay…there were many moments in which doctors and nurses – especially nurses! – allowed or caused the professional relationship to become a meeting between two human beings” (p108).


Berry described on such moment. John’s wife Carol was waiting for news of the bypass operation, and as a nurse also knew the seriousness of the situation. Two nurses came to tell Carol that the operation had been a success and that during the procedure a balloon pump had been inserted into the aorta, a possibility that had never been mentioned.


Carol being unprepared for this news was disappointed and upset. The two nurses tried to reassure her by repeating what they had just said (professional and within the world of efficiency). Then there was a long moment when they just looked at Carol.


One of them then said “Do you need a hug?” Carol said “Yes”.


This brings us to a starting place, a starting place for healing and a crossing over into the world of love.


Many nurses today will understand this crossing over, many will intuit that the world of love is part of healing, of health as wholeness even while they work on the world of biomedical efficiency. This is a corrective to the isolationist, reductive and machine like process of ‘nursing’ care in some hospitals and care homes. However, at times we struggle to provide this ‘world of love’ as the Ombudsman report (2016) into the hospital discharge of older people testifies.


Eisenstein asks us to consider that separation causes distress and provides the wrong solutions. If we really believed and felt that the old person sitting alone in bedroom was us, would we want to change things?

I accept that I can’t do it. I can’t heal those around me. I’m stuck in the transition between the world of love and the world of efficiency. I am not able or willing to pay the heavy price to close the gap by myself.  I can make a difference, though, to some and Eisenstein argues that little differences can add up. What is my gift to the world? Having read Eisenstein , I have to admit it is not a question I’ve ever addressed. My sense of self is individual, is separate, is ‘dualist’ and yet I know it could be different? The new story is a vision of where I could be, it is not where I am.

I don’t think this is matter for individuals to provide an individual response to such issues as loneliness. It would be a ‘good thing’ of course if isolated lonely old people had visitors, and that the visitors themselves would benefit from that. However, that is the ‘old story’s’ solution. Many individuals do not have the time, energy, resources emotional and physical, the geography or the history to close the gaps. That is because our total system of care mirrors the social, economic and political systems that emphasise efficiency, effectiveness and economy and the sovereign individual. That is why our culture is increasingly turning to individual responsibility for health, education and welfare. Health and social care is framed within austerity budgetary constraints, we cannot think about anything other than the financial costs.

This means we cannot imagine or vision “a more beautiful world our hearts know is possible”.





Changing our mindset for health and sustainability.

Changing our mindset for health and sustainability.


“In this century it has become clear that the fundamental social problem is now the relationship between humankind as a whole and our global environment” (David Loy 1988 p 302).


As I have previously suggested, health care professionals are becoming more alert to the issue of climate change and how this might affect the health of populations in the future. Climate change is only one aspect of sustainability, others of course relate to issues such as food production, distribution and security. The solutions put forward to address the myriad issues appear to be based in two different, but not necessarily mutually exclusive, approaches: 1) the technico-rational and 2) philosophical. If health care professionals are to put forward plans of action then they need to consider some of their philosophical and ideological assumptions that underpin those solutions.  I would suggest that a little more philosophical enquiry into the nature of society and our relationship to ‘nature’ just might prompt a rethink of our reliance on technical solutions.


The first, technico- rational, approach implicitly accepts dominant modes of thinking, which could be called ‘modernist’.  It is often based upon various philosophical traditions without explicitly critiquing them. These traditions, such as rationalism, empiricism and dualism, can be traced back to the Enlightenment and the dawn of western science. These ideas of course underpin much of modern capitalism which is another taken for granted economic model underpinned by philosophical assumptions about how the social world works.


A modern exponent of this is Daniel Ben Ami who, in ‘Ferraris for All’, argues that what is required is more economic development and growth, i.e. much, much more of the same, in order that humanity can better control nature and to come up with scientific and technical solutions to such issues as ocean acidification, climate change and soil erosion. Capitalism, rationalism, empiricism and dualism are implicit in this way of thinking. In short, this accepts the current economic growth based model and an understanding of how we relate to nature through extraction and development of natural resources for human use. The answer for sustainability and human health is improved technologies. I think there are flaws in this approach, one of which is that it relies too much on assuming what brought us success in the past, i.e. capitalism and technological development, will continue to do so in the future. That is to say it is based on inductive logic and its flaw; past patterns might predict the future but cannot guarantee it. As Nicolas Naseem Taleb reminded us, there might be a black swan to confound the ‘all swans are white’ logic.


David Loy’s comment leads us to the second approach, the philosophical, in that we might want to examine some of the assumptions that underpin the technico-rational, and especially ‘dualism’ – the separation between man and nature, mind and body. Loy contrasts Eastern non dualist philosophical traditions, with mainly Western dualism in that  “….there is no distinction between “internal” (mental) and “external” (physical), which means that trees and rocks and clouds, if they are not juxtaposed in memory with the “I” concept, will be experienced to be as much “my” mind as thought and feelings” (p140). This then is a non dualist viewpoint in which ‘us’ includes the biosphere; we are indivisible as human beings from all life forms and all matter.


In Cartesian dualism, the Platonic tradition and the Judeo-Christian religious tradition, the self is separate from nature and is understood to be the source of awareness, meaning and value. This results in a devaluing of the physical world in which the human self is separate and superior.  The human ‘subject’ is separate from the natural ‘object’, and so what we do to ‘it’ is not part of ‘us’. Dumping toxins into the oceans is acceptable because the ocean is not part of us – it is a waste sink, we are doing something to a separate ‘it’. The human subject then becomes capable of confronting an objective world, a world which is there for our use.  The idea of human exceptualism (Catton and Dunlap 1978) – that man is special and apart from nature – takes root in this discourse.


This sentiment harks back to Francis Bacon, who argued in 1620 “The world is made for man, not man for the world”. In ‘The New Atlantis’ , Bacon thought that by and through the application of scientific and technological dominion over nature, men would usher in a new age of abundance and comfort.  This has echoes in Sigmund Freud’s (1927) assertion: ‘The principal task of civilization, its actual raison d’etre, is to defend us against nature’.


The call to have dominion over, to conquer, to harness, control or subjugate nature is predicated upon this idea of separateness from it. This control is thus predicated upon the self in opposition to nature which Yagelski (2011) calls  ‘the problem of the self ‘:  “My argument here is that the prevailing Western sense of the self as an autonomous, thinking being that exists separately from the natural or physical world is really at the heart of the life-threatening environmental problems we face”. Shabecoff (2001) suggested that concerns expressed in critiques by environmentalists of this dualist interpretation resulted in the ‘Heidelberg Appeal’ , a document signed by many scientists,  which reasserted that progress by man always involved harnessing nature to man’s needs.

However, we know that human health is inextricably bound with the physical and natural environment and what Charles Eisenstein calls ‘separation’, i.e. dualist thinking, results in practices that are injurious to us. In this regard Chivian and Bernstein (2010) argue the biodiversity is crucial to human health and I suggest that we might do better to consider ourselves part of nature not separate from it. Is it a philosophical step too far to consider that the clearing of Amazon rainforest is therefore as injurious to my health as contracting a virus?  Changing low energy light bulbs is a technical solution, perhaps I also need to change the way I think.






Transformation for health and sustainability: “consumption is killing us”

Transformation for health and sustainability: “consumption is killing us”


“In this century it has become clear that the fundamental social problem is now the relationship between humankind as a whole and our global environment” (Loy 1988 p 302).


To explain why this may be so I will be addressing nonduality/dualism (Loy 1988) and anthropocentrism in order to argue that our future health and welfare is under grave threat from our particularized thinking. This will be done within the overall argument that current lifestyles in advanced industrial societies are unsustainable in the long term because they are based on certain perspectives , economic ideology and ‘one dimensional’ thinking (Marcuse 1964, Goodman 2011). In addition, if we wish to see health and welfare continue to increase across the globe, we will need an overhaul of our philosophies that underpin current assumptions about what the ‘good life’ is, and question whether current assumptions are sustainable. ‘Consumption’ has lead the UK into an economic impasse that will have serious health and social welfare consequences. This is because it based on the manufacture of demand (Harms and Kellner 2011), planned obsolescence (Fishman et al 1993), a linear model of ‘take-make-waste’ (Stubbs 2008) and fashion which all underpin the economy’s need for the drive for buying ‘stuff’. The current focus on the public debt as a cause of our economic woes is in fact a chimera, temporary and a distraction and not the real cause of our global malaise which predates the 2008 crash. Our requiem (Hamilton 2010) was being written long before the bursting of the financial bubble. While other countries enjoy GDP growth, their consumption patterns are also implicated in the impending environmental crisis. Thus, transformation of philosophy, economic models and education is required as business as usual assumptions have served ‘us’ poorly.


David Loy (1988 p140) argues when contrasting Eastern traditions (nondualist) with mainly Western (Cartesian) dualism “….there is no distinction between “internal” (mental) and “external” (physical), which means that trees and rocks and clouds, if they are not juxtaposed in memory with the “I” concept, will be experienced to be as much “my” mind as thought and feelings”. This then is a non dualist viewpoint in which ‘us’ includes the biosphere, we are indivisible as human beings from all life forms and all matter.


In reality as experienced in advanced industrial societies especially of the West, there is a dominant mode of discourse and experience which are based on various traditions of Western thought. In Cartesian dualism, the Platonic tradition and the Judeo-Christian religious tradition, the self is understood to be the source of awareness and therefore of all meaning and value. This ontological position of our ‘being’ in the world may devalue the physical world and nature merely into domains in which the self fulfills itself. The subject is separate from object. The human subject becomes capable of confronting the objective world, a word of controllable facts. The idea of human exceptualism (Catton and Dunlap 1978) – that man is special and apart from nature – takes root in this discourse.


This sentiment harks back to Francis Bacon, the father of modern empiricism who argued in 1620 “The world is made for man, not man for the world” . In his essay ‘The New Atlantis’ Bacon thought that by and through the application of scientific and technological dominion over nature men would usher in a new age of abundance and comfort. Barton Perry (2011) adds in his analysis of Bacon’s views on nature“Observe nature in order that you may use nature, thus converting it into the habitation, instrument, and treasure of man. Here is the supreme maxim of our modern world, and the chief ground of its peculiar confidence and hopefulness”. This has echoes in Sigmund Freud’s (1992 p197 orig. 1927) assertion: ‘The principal task of civilization, its actual raison d’etre, is to defend us against nature’.


The call to have dominion over, conquer, harness, control or subjugate nature is predicated upon this idea of separateness from it, it is dualist in origin: (human) self v (nature) other. This control is thus predicated upon the self in opposition to nature which Yagelski (2011) calls ‘the problem of the self ‘: “My argument here is that the prevailing Western sense of the self as an autonomous, thinking being that exists separately from the natural or physical world is really at the heart of the life-threatening environmental problems we face”. Shabecoff (2001) suggests that concerns expressed in critiques by environmentalists of this dualist interpretation resulted in the ‘Heidelberg Appeal’ (a document signed by many scientists) which reasserted that progress by man always involved harnessing nature to man’s needs.


This view of a separate self supports a world view that places this self at the centre of the search for truth and the at the centre of the universe, it is anthropocentric (Foreman 1991). The anthropocentric viewpoint of ‘us’ means humanity apart from nature, we are the central and most significant entities in the universe, we assess reality through an exclusively human perspective.


It is arguably the case that the anthropocentric view dominates in Western thought, making us incapable of making the interconnections between the stars, the external cosmos of the myriad galaxies, the internal human physiological cosmos, the ecosphere, the biosphere, and ourselves. We then delude ourselves when we think that we are separate entities, that we are able to control for our own benefit that which we are actually a part of. Thus we have triumphed over nature controlling it for our own ends resulting in the magnificence of cities such as New York, which have become our own natural habitat. This comes at a cost. We are unable to see systemically, inter-connectedly or interdependently. The separation between humanity and ecosphere is complete within consumer capitalism in its delivery of the dreams of avarice. If however we can see nondualistically then humanity is the natural world and so what we do to it we do to ourselves. In consuming nature we consumes ourselves.


Consumption per se is not the issue, it is the form it takes within a particular structure of social meaning and which took on a new and very powerful form during the industrial revolution: The separation of man from nature allied to empiricism, science (Shabecoff 2001) and technical rationality (Marcuse 1964). Today, this leads to an inability to link the meaning of the use of oil as a natural and finite resource and oil as human artifact which is now embedded into our socio-political culture. Since the 1980’s a new economic creed was grafted onto this toxic stump of dualist thinking: neo-liberal economics (Shah 2010) in which free market ideology has made us servants of the economy and not its masters. The economy has become reified, as if it has a life of its own, as if we have forgotten that it is a human edifice with no concrete existence, that it can be torn down and refashioned, we have accepted a lie…that there is no alternative.


It took little time for the discoveries of science in partnership with extractive and manufacturing industries to raise the living standards and hence improve greatly the health of certain populations. There were genocidal casualties of colonial development, but for an increasing number of people on the planet ‘we have never had it so good’. The struggle for the pacification of existence (Marcuse 1964) has been turned into the struggle of the policing of resistance. Many no longer can resist the lures of new forms of social control that anaesthetises our critical faculties so that we are unable to posit alternatives to the current hegemony of consumer capitalism which includes it’s Chinese, Russian and Indian forms. Citizens are no longer citizens, we are primarily consumers of goods and services many of which are unnecessary, silly or just downright dangerous. Our political discourse becomes debased and is riven with debates about how best to manage consumer capitalism rather than posit any real alternative.


Our rapacious appetites results in the forced extraction and despoilment of the environment for oil, water, minerals and rare earth elements, and other environmental goods. The result is ocean acidification, water shortages, over fishing, oil wars and toxic chemical and nuclear dumps.

In subjugating nature, in controlling industrial processes, with the literally, earth shattering successes of nuclear technology and scientific achievements, we have created a brave new world fit for….buying stuff. Francis Fukuyama (1992) stated that we are at ‘the end of history’, free from ideological struggle, free….to buy stuff. Workers of the world may have united to lose their chains but they are now free to…buy stuff. In advanced industrial countries most of us are comfortable. Beveridge’s social evils of want, disease, ignorance squalor and idleness largely quelled, quelled so that we may…buy more stuff. The banks bring nations to their knees following a binge on cheap credit, financial sleight of hand, consumer debt and a housing bubble…and now to get out of recession we are exhorted to…buy even more stuff. Consumer confidence is the holy grail of discredited economic gurus whose pseudoscientific neo-liberal pontifications are as worthless as sex education to the whore of Babylon. The twin towers fall, so shocking the President that he exhorted Americans to ….go and buy stuff (Spiers 2003). We’ll counter the backward desert savages with shopping…..Prada versus prayer, Louis Vuitton versus Vengeance and Dior against Death.


Ferguson (2011) asks how western civilization came to dominate the world from humble beginnings in the 15th century. He argues that the West developed ‘6 killer apps’: competition, science, democracy, medicine and the protestant work ethic and consumerism. So there we have it the apogee of civilization includes our right to buy.


Spencer Wells (2010) argues that our culture has now reached a point where we must reevaluate our relationship to nature and consumption in order to survive. He argues that when we became farmers instead of hunter gathers we set in train new modes of social relationships. As populations expanded there was a need to apportion limited resources such as water, this results in social hierarchies and inequalities. Growing grain had many benefits but results now in a more crowded planet with populations that have become more sedentary and unhealthy.


Ben Ami (2010) tells us however that growth is good, consumption is good and we could have ‘Ferraris for all’. He argues that in advanced industrial societies we have seen decreases in infant and maternal mortality rates and increasing life expectancy coupled with control of infections. We live longer healthier lives. Hans Rosling in his online gapminder series also points out that these indicators are also rising in many developing countries, but he warns that success may literally cost the earth. So how can consumption be killing us?


Well, it isn’t. Goklany (2006) argues that economic growth, technological change and free trade has helped to power a “cycle of progress” that in the last two centuries enabled unprecedented improvements in every objective measurement of human well-being. Poverty, hunger, malnutrition, child labor, illiteracy and unsafe water have ceased to be global norms; infant mortality has never been lower; and we live longer and healthier lives. Further, Goklany’s research suggests that global agricultural productivity is up, food prices are down, hunger and malnutrition have dropped worldwide, public health has improved, mortality rates are down, and life expectancies are up. So that its then, we are fine.


Except that since he wrote that in 2006 the world saw one food crisis in 2008 and this year 2011 the UN’s Food and Agriculture Organisation are giving the global food market ‘critical’ status, again. The Millennium Development Goals have still to be met and maternal and infant mortality is still at numbers too high in many countries to enable any level of complacency.

However, if you view the world anthropocentrically within the frame of reference of consumer capitalism and you happen to live in advanced industrial nations in wealthy suburbs. You can even muster hard empirical evidence to show the beneficence of the global economic system.


The problem with this viewpoint is time frame. Seen from the last 200 years enormous, unprecedented progress has without doubt been made. However the time frame for a proper assessment of the current global system is much longer than that. Even in human time frames the last 200 years is a very short period of history. Depending on definition, the Roman Empire lasted over 400 years, and from the steps of the senate, Julius Ceaser may have dreamed of a millennium of Roman domination. World history is littered with the ruins of human civilizations, hubris comes before a fall. We are not Rome or Byzantium. We have controlled the natural environment (up to a point) to produce food and shelter for billions. However there is a poverty of spirit, a neglect of the ‘bottom billion’, willful ignorance of the casualties of inequalities based capitalism, a disconnect from environmental destruction and a lack of vision of alternatives that may lead to more healthy, sustainable lives on a finite planet as we bump up against limits.


Of course, assertions about limits needs some evidence. A key paper in this respect is that which addresses the issue of planetary boundaries – i.e. that there are limits to what we can achieve on this planet, that we need urgently to identify what these limits are and then to address what socio-economic conditions would allow all of humanity to live within the planet boundaries. If we do not do this, the argument runs, then the ecosystem services upon which all of us (the biosphere) may well collapse leading to a cull of humanity inline with the extinctions we are already exacting on the living world right now. Rockstrom et al (2009) have tried to identify what the key boundaries are and what the limits are within each. They suggest that humanity has already transgressed three of nine boundaries:


  1. CO2 emissions for climate change.
  2. Biodiversity loss.
  3. Biochemical boundaries – the nitrogen cycle (the phosphorous cycle has not yet been transgressed)

The other boundaries discussed include:

  1. Ocean acidification
  2. Stratospheric ozone depletion
  3. Global fresh water use
  4. Change in land use
  5. Atmospheric aerosol loading (not yet quantified).
  6. Chemical pollution (not yet quantified).

They also argue:

In the last 200 years, humanity has transitioned into a new geological era—termed the Anthropocene—which is defined by an accelerating departure from the stable environmental conditions of the past 12,000 years into a new, unknown state of Earth”.


In order to maintain a global environment that is conducive for human development and well-being, we must define and respect planetary boundaries that delineate a “safe operating space” for humanity. We must return to the long-term stable global environment that nurtured human development”.


Consumption may be killing us in more prosaic ways. The Roberts and Edwards (2010) thesis in The Energy Glut is that fossil fuels are making whole populations fat. We have replaced food with fossil fuels as our main energy source, while at the same time they argue we are eating less than we did, and certainly no more. We have become sedentary, replacing walking and cycling (active transport) with mechanical modes of transport mainly the motor car. Whole societies are using the energy oil has given us to replace physical labour. The upside is the construction of advanced civilizations and huge increases in food production, and the ability to buy stuff, the downside is that as countries develop populations get fat, more get obese and we contribute to climate change.


There is also the argument for a poverty of spirit leading to poor mental health fuelled by ideas such as ‘Affluenza’ (see both books of that name by Oliver James and Clive Hamilton and Richard Denniss).




My frame of reference is that healthy lives depend on a healthy socio-economic and physical environment as outlined in the Social Determinants of Health approach (Dahlgren and whitehead) which has as its outer layer in the model ‘general socioeconomic, cultural and environmental factors’, i.e. social and environmental structures. Thus, I largely agree with Peter Morrall (2009) who argues that patterns of illness and disease are largely determined by issues of social structure and increasingly physical environments. Social structures protect some while damning others to misery and poverty as evidenced in the inequalities in health literature. The affluent even in poor countries and difficult environmental conditions live in ‘safe’ enclaves where they can ensure clean water and a ready supply of food, even in famine stricken countries, money buys food. However, even the affluent will be affected by global changes in certain key environmental limits.


Social structure results from a dialectic relationship between objective ‘social facts’ and subjective ‘social action’ which occur within distinct forms of power relationships. The key power relationships operating at present is the hegemonic stranglehold of advanced consumer capitalism in which a very small percentage of the world’s population own the majority of the world’s wealth and enjoy its income. Many do not understand or recognise the notions of limits, while others put undue faith on the resourcefulness of humanity to solve the problems but to do so within the frame of reference of ‘business as usual’ unaware that their selves are interconnected and interdependent within a much wider framework of meaning.


Thus there is a need to transform thinking. Currently education is the problem not the solution. David Orr (2004) argues that we are educating graduates to be clever not intelligent, and this applies in many if not all disciplines. Cleverness built the atomic bomb, intelligence questions our need for it. Cleverness invented credit default swaps, intelligence called for financial regulation. Cleverness develops markets for things we don’t need, spends money we have not got and distracts us with bright shiny things. Intelligence understands bread and circuses.


To encourage and transform thinking there is a need to engage in provocative pedagogy whereby students engage in intellectual critique through being challenged with provocative positions.   They need a sociological imagination to connect their personal troubles with public issues, to fully understand their personal biographies as related to wider social forces at this point in history.


Thinking in private without action is in Panton’s phrase merely ‘mental masturbation’ (Panton 2003). Marx (1848) once wrote that philosophers have sought to understand the world, the point however is to change it. So transformative education is critical, provocative and challenging leading to some form of moral action based on a deeper understanding of the human and biosphere condition. This is what Universities are for. However, Peter Morrall (2009b) suggests that Universities in many subjects are losing this vision. They are becoming ‘training warehouses’ bogged down by managerialism, bureaucracy, commodification and consumerism. Education is being increasingly defined and seen as a commodity to be bought, whose only useful purpose is to lead the purchaser into paid employment, whose worth is judged by its ability to do just that.


Students in this view are becoming dulled by an all encompassing ideology which narrows the focus on careers and higher pay. Universities may become ‘educational’ establishments focused on providing work skills and applied knowledge. Worthy as this is (and of course is professionally necessary) but without critical enquiry and the ‘search for truth’ there is little point to the university.


Medical and nursing disciplines cannot be immune from this process. It is not enough to learn how the body works and what to do when it goes wrong. This is navel gazing of the worse kind. Many doctors and nurses have for a long time been pioneers for social action, acting on behalf of the poor, weak and vulnerable. That is their ethic. That has been their historic mission, the problems of this messy little world may not mean a hill of beans to many but without a reawakening of consciousness and a reconnection of self to others, which includes the biophere, the future looks grim. Peter Morrall has argued that we as health professionals and/or academics have an ethical responsibility to take individual, collegiate, and organisational action with regard to the social ills which affect human health and happiness.


However, taking a stand is hard. Ethics is hard. Ethics requires thinking. We may be the only sentient being on the planet who can think and reflect on our existence and the search for ‘truth’ It may be that we have a special responsibility to think about our decisions and why we make them. Damon Horowitz has recently argued (2011) “ Not only can we think, we must. Hannah Arendt said, “The sad truth is that most evil done in this world is not done by people who choose to be evil. It arises from not thinking.” That’s what she called the “banality of evil.” And the response to that is that we demand the exercise of thinking from every sane person


It requires some moral framework to guide that thinking, we are required to think about the human condition and the consequences of our actions. John Kenneth Galbraith said that ‘communities are too comfortable to care’, while John Stuart Mill argued “It is better to be a human being dissatisfied than a pig satisfied; better to be Socrates dissatisfied than a fool satisfied”. Affluence, satisfaction, happiness and over consumption can dull thinking and harden our sensibilities to suffering. Provoking dissatisfaction may not produce more happiness but it may encourage an exploration of eudaemonia.



Evidence is mounting that current consumption patterns are costing the earth, the result is a paradox and whether you think this is a good thing may depend on what values you hold and what indices you choose to look at. So at one level this is about values at another there is an empirical question regardless of whether you like or value consumer society or not. The question is will empirical reality overwhelm us and confer our squabbles about resources to the dustbin of history?


We have 4 options (Elliot 2011):


  1. Do nothing because advanced industrial capitalism is robust and self correcting, we have plenty of oil and climate change is a fantasy.
  2. Argue that there is an incompatibility between sustainability and current economics. However alternatives to globalization are not well worked out and would not attract popular support (yet?).
  3. Bring human ingenuity to bear on the problems, invest in green technologies, develop global governance and change our relationship to the biosphere.
  4. File it all under ‘too difficult’ and hope it is not too late to respond when the crisis breaks.

If you choose not to decide you still have made a choice, my guess is that we will do 1 and 4.


Benny Goodman 2011

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