Gavin Francis - How should we live?

Gavin Francis is a GP in Edinburgh, and also one of the best writers I know of on what it means to be a body moving through a life. In this conversation we got into territory I didn't quite expect — how much of modern spiritual hunger ends up in the consulting room, why a diagnosis can be both a relief and a trap, and what it actually looks like to help someone climb out of a dark period without reaching straight for a prescription.

He has a ten-point list he shares with patients in despair. It's practical without being glib, and I think it's quietly one of the most useful things in this episode.

We also talked about attention — how flow and deep engagement are being quietly eroded, what AI convenience might be costing us in terms of capability and friction, and why awe and equanimity aren't soft ideas but things that actually hold communities together.

He's thoughtful, unhurried, and genuinely humble about what medicine can and can't do. I came away with a clearer sense of what flourishing actually means — which is not the same thing as happiness, and is worth distinguishing.

If it resonates, please pass it on. You can find more conversations like this at This Examined Life — and if you'd like updates and new episodes delivered to you, sign up on Substack.

Transcript

Life As A Living Mystery

SPEAKER_01 0:00

We have to keep in focus. The idea that, you know, life is really miraculous that we're even here. It's kind of amazing. And we still don't understand how consciousness works, for example. We have no idea, really. There's lots of ideas at the edges of how we can influence consciousness, but we don't even know why we're aware of being. And so I feel a real sense of excitement and reverence about the fact that life itself is still a major mystery.

Kenny Primrose 0:33

How should we live? It's one of the questions that sounds almost too big to answer. And yet, in GP surgeries, in conversations across a desk, it gets asked and re-asked every single day. And the texture of what people bring through the door, in their suffering, their confusion, and their longing to feel more whole.

Meeting Dr. Gavin Francis

Kenny Primrose 0:54

Welcome to the Examined Life podcast. I'm Kenny Primrose. And today my guest is Dr. Gavin Francis, physician, author, and one of the most thoughtful voices on the intersection of mind, medicine, and what it means to be human. In his most recent book, The Unfragile Mind, he gives a kind of cartography of our inner lives, exploring how the language we use to describe our mental state can liberate or imprison us, and why so much of what we might call disorder can be better understood as the mind in motion, adapting, searching, and striving. We talk about labels and their shadow side, about the ancient Greek idea of eudaimonia flourishing rather than just happiness, about awe, reverence, flow, and we ask what patients over decades have actually taught Gavin about getting through dark times and back into the light. This is a conversation I find genuinely nourishing, and I hope you will too. Do please share it with others if you like it, and sign up for the mailing list on this examined life at Substack to receive updates and newsletters. Thank you for listening. Dr. Gavin Francis, thank you so much for joining me on the Examined Life podcast.

Flourishing Over Simple Happiness

Kenny Primrose 2:10

Oh thanks, Jenny.

SPEAKER_01 2:11

Thanks for having me on.

Kenny Primrose 2:12

An absolute pleasure. I've been aware of your work, I've read your books, and I always found them really compelling. And there's a sense in which you've written quite a lot of travel books, Island Dreaming and True North about adventures in the Arctic. And then you've been a cartographer of the human. So Adventures in Human Being and The Unfragile Mind, a book you recently published, where you're a cartographer of the mind. The examined life, the idea is around what it means to live a good life. It's broadly speaking about seeking wisdom for living now. Through the lens of a question that you think it'd be helpful to be asking ourselves. So I wonder, is there something that bubbles up for you there, Gavin?

SPEAKER_01 2:56

Well, the big question is how should we live? Isn't it? I mean, how should we face the challenges that we have every day? How should we try to live more humane, compassionate lives, curious lives? How should we inform ourselves without becoming disillusioned? How can we retain an element of lightness and humor and play in life when there's so many big, serious questions to address? How should we face up to suffering, the inevitability of suffering? Yeah, there's a lot of big questions that certainly flow through GP clinics that I attempt to help patients with every day, as well as the more common or garden problems that people take along to their general practitioner.

Kenny Primrose 3:44

Thank you. That's a that's a a beautifully rich question. And when you say kind of how should we live, are you thinking in order to to thrive, that we flourish, that we enjoy life, or that we are kind to one another, the two are not unrelated. Should in in what sense?

SPEAKER_01 4:04

Yeah, I like the approach taken by the ancient Greek philosophers, the idea that happiness, and the word used more commonly for happiness is actually eudaimonia, so it is much more like flourishing than it is like happiness. So imagine more a botanical metaphor of a plant that is really in full bloom, in full vigour, and is able to expand into its fullest sense of possibility of itself. And I think that in general practice, in a very modest way, principally my job is about the easing of suffering. You know, people come because they're suffering, either in mind or in body. And it can be something quite trivial, like an ingrown toenail, or it can be something quite major, like coming to terms with a neglected and abusive childhood. And so they're suffering in some kinds of way. And the job of the doctor is to use their medical training and experience in the service of the alleviation of that suffering. So that is about helping people to flourish in the broadest sense. And is bigger than just the individual, of course. You know, there's a lot of big public health questions in this too. Possibilities open to a single general practitioner in a communication with a single patient are relatively limited when a lot of the things that govern our lives are decided by politicians or decided at community level or society level. But we do what we can. I do believe that through the application of science with a little bit of kindness, it is possible to make a big difference to people's lives and help them figure out more clearly

The GP As Guide And Witness

SPEAKER_01 5:45

what their priorities could or should even be.

Kenny Primrose 5:50

It's interesting and helpful. And I think probably lots of people reading your book would think I'd love to have Dr. Gan Francis as my GP. There is a kindness and a curiosity and something that feels bigger than clinical medicine. And I guess one of the thoughts I had when reading The Unfragile Mind, you say what, like a third of the things that come through your door are mental health related. I had the sense of the GP as priest or pastor. Is that something that that you would recognize? You know, in an increasingly kind of secular culture, the job of sitting with people's vulnerabilities, the despair, etc., would often be taken on by spiritual leaders. Yeah, no, thank you.

SPEAKER_01 6:39

It's always been a big part of the medical role, I think, is this sort of slight edging or blurred boundaries with the role of the clergy, you know, particularly if you think about palliative care. So quite often a doctor's role when someone is dying and the doctor's trying to keep somebody in their own home is to ease suffering, yes, to sort of ease the passage of that difficult process. But also there's something about witness. So part of the importance of the doctor being there at the bedside when someone's dying is because they've seen many other people die before. So there's a kind of guide aspect to it, because for many people and for many families, experiencing a loved one going through palliative care is something very, very new and very frightening. So to have just a presence there of somebody who's seen it happen many times before and itself has its value. So that's at one end the clergy type role. The other end, as you say, is this mental health aspect. And our society, Western society, in in this little northwestern corner of Europe where I practice, is extraordinarily medicalized. And we turn to medicine for the answers to all sorts of things that other societies would never turn to a doctor for. So there's a really wonderful intercultural psychiatrist in London called Dinesh Bugra, who did a lot of work on this, looking at how different cultural groups living in London approach problems such as, say, anxiety or low mood. And there are many cultural groups around the world who would never think of that as approaching something that you should take to a doctor. They would take it to a priest or some sort of imam or guru. When I meet people with those kinds of big questions, I proceed with great care because for some people, still that spiritual element is a really big part of their life. And I saw gently test out whether they have a faith or whether they have a different kind of priority and belief system that I should be tapping into and encouraging them to take use of. But if they don't have anything like that, then sometimes, yeah, it becomes a purely medicalized discussion. But medicalized in the broadest sense. So just when somebody has, for example, low mood and they're feeling very depressed. Back in the 90s and early noughties, medical science would have characterized that in these terms. It's all to do with, for example, serotonin levels in your brain or your synapses or your neurochemistry. We're now thankfully coming to the realization that that was a little bit of a dead end, and that there's far more in terms of our sociological situation, our psychological situation, our early childhood experiences, the traumas that we've been through that are relevant to your mood as an adult. So it's far less focused on that purely biochemical approach that might have been more common, say 30 years ago, and much more into a more, I would say, a more expansive and inclusive perspective on our mood being a sum of all sorts of different influences that are not just biological, but very much to do with the society that we're living in, the communities that we live in, pressures that we're having to face in terms of the economy and so on. So it doesn't mean that I can't, as a doctor, tap into that value of the traditional role of the clergy, but it does mean that you have to be a little bit of a shapeshifter, I think, as a good clinician, to be able to work out what is going to be most helpful or what approach is going to help most of the patient that's in front of you. To approach somebody with a very strong faith and adopt a purely medicalized perspective is not going to work, and vice versa. So it's about gently easing into a relationship with somebody to find out what's going to most help them.

When Labels Help Or Harm

Kenny Primrose 10:42

A sentence in your book, in fact, it's not a sentence in your book, maybe it's kind of the broader point of your book, is about language and the way language can liberate in some sense, but it can also imprison. And w one of the points that I got was the way that categories of illness or labels that we often ascribe are are often counterproductive to health, to wholeness, to human flourishing, if you like. I wonder if you wouldn't mind saying a bit about your experience of how language has shaped the way that you um you know think and operate as a general practitioner. Sure.

SPEAKER_01 11:26

So uh well the book opens with a description of my own issues in the past, in adolescence, in particular, with depression and anxiety. And uh in fact, I had a really wonderful relationship with my then GP, who was a kind of doctor of the old school. And he'd known me since I'd been a toddler, and he very much felt that labeling or giving my experience or my distress a label wouldn't necessarily have been helpful to me. And ultimately I found that was a bit of a gift from him because as I went on in my medical training, I started to encounter more and more people for whom the labels can occasionally be helpful, particularly in the short term, but then they can become self-fulfilling or they can lock people into expectations of um behaving or feeling a certain way. And I think that psychiatry has moved the most incredible amount in the last 50, 60 years through various cycles. So, you know, we moved from a sort of very Freudian psychoanalytical approach, say in the 40s and the 50s, then to this extraordinarily medicalized approach. It was all about neurotransmitters and drugs. And we moved into a phase that was very much about a belief in genetics and that there was a huge amount of money 20 years ago poured into the genetics of mental illness and psychiatry. And now we're moving into another phase itself, which is more about connections and wiring, and uh the idea that our neuronal hardware, if you like, or wetware, if you like, can determine a huge amount of how we feel. And so every different phase has got a different set of metaphors that it uses and a different set of expectations. And I argue in the book that they're all approximations, none of them are really good descriptions of reality, and that I want to move towards a more dynamic and flexible perspective. So to come back to your point about the use of labels, so labels can be unbelievably powerful in terms of dispelling things like shame. So you think of somebody, for example, who struggles at school and can't, their literacy is struggling, and they're made to feel as if they're stupid, or they're made to feel as if they're in the bottom of the class, and then they're given a label of dyslexia, and that label is immensely liberating because it suddenly says, You're not stupid, this is about the way that you are, and this is about your ability to comprehend written texts, and that liberates somebody from shame, which is really, really powerful. Now, that is an example of where I would argue, you know, we shouldn't. Why do we have the shame in the first place? Um so I would rather take one step back and get rid of the shame. But there's a good example of where a label can be immensely powerful. So somebody who's going through a very difficult time, maybe they've just moved away from home for the first time, they've got a lot of demands upon them, they're struggling to make their way in the workplace or in college or university, and they become very, very anxious. And at some point they get a label of a generalized anxiety disorder or panic disorder. Now that's an example where I've definitely seen it, and patients have come to me and told me that they found that ultimately unhelpful because that told them that there was something about their mind or brain which made it more difficult for them to cope with pressures and stresses, and that they there were certain things that they would always struggle to do. And so I have encountered people in the clinic who have told me that those labels were ultimately unhelpful and they wish that they'd never had them, and that they wish now that their experience had been framed more in terms of the peculiar or unique pressures that were they were subject to at that time. So I think there's a sort of very potted, two very extreme examples of when labels can be really helpful and when they can be really unhelpful. And so with each patient now, with each situation, I try to move again very, very gently and figure out is this a situation in which giving a label from the diagnostic and statistical manual of the Psychiatric Association, so that's the big table of diagnoses used, particularly in the United States, but also similar to the one used in Europe, is giving a label from that going to be helpful? And sometimes it is, and sometimes people are really, really keen for them. But there's many, many situations in which over the course of our conversations I realized that they aren't going to be particularly helpful. And I should point out, too, that as a GP, I'm talking about 90% of the conversations that take place in the health service in the UK occur with general practitioners. So only 10% take place in specialist care. And but that 90% of mental health conversations that are going on in GP clinics, they're at the mild and the moderate end. I'm not talking about the very extreme, severe manifestations of mental illness that end up taking people into hospital or even being detained under one of the mental health acts. I'm talking about the mild to moderate end, which is the bulk of it. And I'm making a call with this book for a bit more humility about how we approach our current understanding of the mind that is not as fixed or as final as some sectors of the media would have you believe. I'm making a call for a bit more compassion in how we approach these questions and always think about whether they're really helping the patient. And I'm also asking for a bit more curiosity that we think about alternative ways of approaching mental illness and mental health. And we remain curious about how we can always improve them for the better.

Kenny Primrose 17:32

Yeah, no, it's really it's really helpful. So I I've definitely seen a label being really uh kind of emancipatory for someone. And also a label that someone wants to shrug off, they're uncomfortable with it. But then you you you do get people who really want a label and it helps them become a victim in some sense. They kind of lose agency. I've got ADHD, so I can't do that kind of thing. What occurs to me, I suppose, is even if someone really wants a label, it's not always necessarily good for them.

SPEAKER_01 18:00

Is that something that you would well I would try and I would again I move very, very carefully because I don't want to adopt a sort of paternalistic approach, which would say that I know what's best for you. I can tell stories of people who for whom the label has proven self-fulfilling or ultimately negative a few years down the line. And I can tell stories about people I've encountered for whom that has been really, really helpful. So I've seen my job very much as a guide through these landscapes. And you know, I'm someone with lived experience of some kinds of mental health problems, but certainly not all kinds of mental health problems. Professionally, I've met people with the whole range of what's possible for the mind when the mind becomes awry. So I I've got a huge amount of experience that I can talk to people about in terms of what has proven helpful for others in the past versus some other people. And it's really important in this world. You mentioned ADHD. Now, some people with ADHD really value that tendency in themselves. They see it as an integral part of their identity and their approach to life, and they really value the positives that that brings them. There are other people who feel that it is just held them back, and for whom the idea, you know, ADHD, the D's are for deficit and disorder. So it's got the packs two negatives into one acronym. So it's telling you that you're deficient and that you're disordered. So some people they feel that's really true, and they feel that they are deficient in something which has held them back, and they feel it's a disorder, which is very good, that it's medicalized. And I meet other people who are similarly affected by that particular neurodiversity who feel that no, this is part of me, it's part of my truth, it's part of my identity. I want to celebrate, and it feels whole, just as it is, you know. As you mentioned earlier, the word health comes from a root meaning wholeness, and and their ADHD feels whole. So they wouldn't want to medicalize it into a disorder or a deficiency.

ADHD Identity Versus Deficit

Kenny Primrose 19:57

Yeah, yeah, that that that that is helpful. I the question is a personal one. I've I've been on the the waiting list for maybe four years. I get a I kind of text once a year saying you're still on the waiting list for ADHD. And I think I probably you know take the symptoms. Would I, you know, would it be very different if I actually had the label? I don't know. I'm not I'm I'm not sure. I might. I think the model, if I if I I mean you can correct me, Gavin, if I'm wrong, the idea that there's a deficit of dopamine and therefore I am more prone to certain behaviors to looking for that stimulation, that makes sense of me. But I kind of the way I deal with it is like cold water swimming or exercise or or you know, the there are there are ways to regulate my brain. So there's a story I can tell myself about my brain that's helpful, and yeah.

SPEAKER_01 20:50

Yeah, and and I think ADHD in particular has become very much to the fore in our societal discussions because there is a medication that can help some aspects of it. And so it's very easy to medicalize it because stimulant medication in the short term and for the first year or two certainly have proven effects on helping focus and concentration. And the data isn't so firm later on, and so long-term treatment is not so definite, that it definitely helps in the long term. But there is without a doubt many other, as you just alluded to, loads and loads of other kind of behavioural and psychological approaches that can really, really help with that tendency, whether the ones that you just mentioned or taking an occupational therapy approach. And so when I chat to patients that have been on a waiting list for an ADHD assessment for a long time, I often encourage them to explore all these other non pharmaceutical approaches to that issue. And there are many, as you just pointed, many different kinds of strategies and approaches that can be hugely, hugely beneficial. And also there's some evidence, too, that as people learn strategies, as they Get older, their need for that kind of more medicalized approach becomes less and less. So your brain is always changing. It's always an evolution. You're always learning from experience. You're always learning new things about yourself. You're always learning new approaches, new experiences are continually modifying how you approach the next challenge. And so that's a real positive.

Why Diagnoses Keep Rising

Kenny Primrose 22:20

You are listening to the Examined Life podcast with me, Kenny Primrose. I hope you're finding this conversation valuable. If you are, then please share it with someone you think would appreciate it. Send it on, post it on social media, or leave a review. Now, back to Gavin Francis and the question of what it actually means to flourish. I'm really keen to dig into the question of eudaimonia and you know how should we live? But one more question, kind of a new experience in the back of this, is there is a huge increase in diagnosis and in prescribed medication and so on. Do you see a kind of mental health crisis or a crisis in labelling, or uh have the two converged? We're labeling more, but you're also seeing more problems come through the door. And I guess is that is that something you would make sense of partly through the environmental factors that have changed, you know, screens or or you know, no longer working with our hands, there's all sorts of things you could point to as um causes.

SPEAKER_01 23:25

Yeah, but even even for things like hello mood, for example, I mean the huge rise in prescriptions for antidepressants that would seem anxiety more and more common. So my own view is that there are many, many factors involved in this, but the three most salient factors are probably that over the last 30 or 40 years, we have completely changed the way that we uh characterize the thresholds to be diagnosed with a mental illness condition or a mental disorder. So the threshold in terms of your distress and the impact on your life is much, much lower than it was 30, 40 years ago. So that stands to reason that you're going to see far, far more diagnoses. So if you drop the thresholds across the boundary, across the piece, that'll make a big difference. And the next thing that I think has had a huge impact is that we have very helpfully, in my view, destigmatized parental health problems. So as a society, we're far, far more able to talk about these things than they were, than we were even, say, 30 odd years ago when I started out in medicine. So people feel far more able now to come forward and to seek help for various kinds of problems, to seek expertise or seek wisdom or seek advice. And so on the whole, that has been a really positive thing. Although there are some there's some slight evidence of some drawbacks and some corners of that trend. And then the third thing I would say that is you just alluded to is we have utterly transformed the way that as a society we access information, like completely. We've just turned it upside down in 30 years. So or two years ago, you would have had there was a series of gatekeepers to these kind of diagnoses that you would have to go through. There was sort of various hurdles that you would have to get across to see through various professionals. But now anybody can access all the information and all the diagnostic tables and all the different criteria and all the research and everything immediately, just by a small box they carry in their pocket. So that has changed the way that as a society we talk about this. And I see that in terms of the way people come to the clinic with their distress. So, you know, even 20 years ago when I started as a GP, it would be much more likely people would say, I feel anxious, or I'm feeling really low, or I'm not having any joy. Whereas now people are far more likely to say things like, I have depression, or I have anxiety. So the slightly more medicalized language, which has come out of the ivory towers, if you like, of academia and is now fully accessible everywhere, has changed the way people talk about and think about mental illness. So when we look at those graphs with everything just going up and everything going worse, and prescriptions and so on, and diagnoses, then we have to take that into account that we're not counting the same things now as we were counting 20, 30 years ago. The thresholds are much lower and the barriers to getting these diagnoses are much lower. That's before we get onto the fact that we, without a doubt, know that our mental health is hugely influenced by the society and the communities that we live in. And if those societies and communities are experiencing more adversity in terms of sluggish economy now for many, many years, 15, 16 years we're talking about, with the

Flow, Screens, And Fragmented Attention

SPEAKER_01 27:00

austerity and so on, the problems, then you add in the pandemic and then you add in then the the you alluded to the screens rather than activities. That's also relevant to there's a wonderful book. I don't know if you've ever read it by the Hungarian American psychologist called Mihai Shiksh. Have you read it? Flow.

Kenny Primrose 27:24

Yeah, yeah, yeah, yeah. It's uh it's a really and you mentioned it in your book, and it's it's something that just for me comes up again and again. I had a a week that wasn't that enjoyable, it didn't feel that rich the other. And it was partly because I hadn't had any really focused, everything had been fragmented. There was no flowy time where I was engaged in meaningful activities. So this last week actually has been great. I've read a couple of books, I've written, I've I've had like single focused attention of the sort that Chi Sen Me High would speak about. And as a result, you know, I'm I'm much more buoyant and my time feels like it's been spent well. That's great.

SPEAKER_01 28:01

You know, he goes through all these different activities. And I mean, what what a kind of service to humanity that man did by saying and going through the hundreds and hundreds of surveys and seeing, right, how happy are people after doing all these different things? How happy do they feel? How much at ease do they feel? And he showed that, you know, screen time is consistently less satisfying than other kinds of activities. He showed that most people are happiest when they're at mealtimes with others that they love, and preparing and sharing food makes people happiest. And after that, it tends to be doing things with your hands, making something, being creative of something, something that you can see the result of what you've done with afterwards. And he pointed out, I mean, he was writing in the 90s, that he pointed out that that the activity, the common activity that made people feel least satisfied then was watching television because it made no demand on the mind. It was so passive. So he compared that even to reading, in which you have to constantly use your imagination to construct or to make sense of the words. I thought that was really a wonderful contribution in terms of us thinking about how we might flourish. The eudaimonia that you referred to, the idea of flowing, and uh the the idea of flow and our mental experience is constantly in flow and it's dynamic and adaptive, is one that animates his book, The Unfragile Mind, very much. And I think you know, a lot a lot of that perspective is inspired by the work of Chick Chiang Yang.

Kenny Primrose 29:31

I agree, it's such a helpful idea. I do kind of think to get into flow, you re there's there's some resistance required, right? It's good, it's going to mean engagement. And I I do wonder if convenience and ease is killing us.

SPEAKER_01 29:45

Well, that's fascinating. I never really thought of it that way, but you know,

AI, Friction, And Doing Hard Things

SPEAKER_01 29:48

in order to flow, you need to have some constraints, don't you? You need limitations. If there's no riverbank, it just goes flat across the plane and then flow stops.

Kenny Primrose 29:59

And you think of this brave new world of AI that we're entering, where you can outsource your thinking and your writing, which is ultimately your thinking, and things like that, and that how denatured your experience is when that happens. And I, you know, as an educator, as a teacher, I I really and a parent, I really worry about, you know, we we need to actively opt to do the harder things in order to flourish in some way.

SPEAKER_01 30:28

I'm just a bit nervous about this, the fact that government isn't stepping in, actually, because I, you know, some of the most powerful and richest people in the world that the world has in fact ever known, are really forcing this on us just now. You can hardly open any app without being obliged to use AI in some way. And I'm thinking of there was a wonderful piece in the British Journal of General Practice recently by a GP who struggles a little bit with the literacy and fast typing to write up their notes, and so has been using an AI recorder to record their consultations and summarize their consultation. And as somebody who is a real early adopter of tech, this GP was surprised to find actually that the quality of the recall and the understanding of the patient's problems diminished usually. So even though this particular GP does struggle a little bit with the typing up and the summarizing in the timescales available, they've gone back to it because the quality of recall and the quality of the evolving relationship is so much better when you have to engage your brain in order to summarize and think carefully about the patient's problem.

Kenny Primrose 31:39

I think there's so many of us, including myself, who are kind of at a basic level lazy. And that's why this is such dangerous technology, because we will we'll opt for the easy option. I had a conversation with a philosopher of technology called Michael Sarcasis, and his question was what should we be doing for ourselves, even if a machine can do it for us? You know, presupposing that machine does it more efficiently and maybe more effectively. Because there's something of flourishing that we can only find through a kind of a bit of friction, a bit of a bit of challenge and difficulty. Which is, you know, what Cheeks and Mihai said, that the the flow channel, you need you need some challenge. The flow channel exists between anxiety and boredom, right?

SPEAKER_01 32:24

Uh and then and then there's a joy in the mastery of a particular skill, which is just completely absented once you get a machine to do it. It's terrifying what it's actually doing to the academy. And I know a lot of academics who are really dispirited by how many of their students are obviously just turning to AI to do a lot of this work. And it means that that we're going to see a transformation over the next 10 years or so of what the value of university education is, because a lot of the the tasks that senior academics are setting their students are now being routinely across society turned over to AI. So what are we? We need to keep training the students to be able to do it themselves and to be able to think critically and interrogate things in a way that AI makes it more difficult for us to do. So I think we're going to see a complete transformation of how we use it, but also what is the value of academic expertise.

Kenny Primrose 33:29

Yeah, it's it's it's huge. And as you say, so those those students who are doing that are not only not learning, not developing those muscles, um, but it's so demoralizing. Like the arc of AI bends towards demoralization. Why would I try hard? I mean, it's writing's hard and it's good because it's hard. And if you can get that done far quicker, far more easily and efficiently, then you you know why why wouldn't you? I I mean this is a really helpful context, I think, to talk about this question of flourishing. So, I mean, you've had decades of GP experience as well as all sorts of other interesting experiences, and thought deeply about these things. What, Gavin, are the the kind of features, would you say, of uh you know, a flourishing life or a life well lived that maybe we have to be a bit deliberate about?

SPEAKER_01 34:25

Hmm.

Humility, Compassion, And Reverence

SPEAKER_01 34:27

Um well, do you know there's some overarching principles that I touch on in the book, which are kind of distillations, if you like, of some of the more religious perspectives on what the value and purpose of life can be, um, and that I keep coming back to. So obviously humility comes up in every single world philosophy because we don't know everything, and when you think you do, that is definitely the hubris just before the fall, and uh compassion, which is a big part of medical practice, so trying to work on your compassion and kindness, particularly at the beginning within your own society and community, and then more broadly. And then I love the idea as well that we need to, in this modern world, we have to focus more on the value of reverence and respect. We have to keep in focus the idea that life is really miraculous that we're even here. It's kind of amazing. And we still don't understand how consciousness works, for example. We have no idea really. There's lots of ideas at the edges of how we can influence consciousness, but we don't even know why we're aware of being. And so I feel a real sense of excitement and reverence about the fact that life itself is still a major mystery. In the book, I have a chapter on low mood and depression. It touches on some of the really dark, difficult conversations that as a GP you get involved in about people who are feeling so low that they want to end their lives. I also touch on some of the elements of what helps people get back to themselves, if you like, what gives life its value again. And there's a 10-point list in it. I could quickly read out if you like, which I think probably gives a more um rounded, broad perspective on what can add value and purpose to life. So there's this ten-point list.

Ten Patient-Taught Ways Back

SPEAKER_01 36:30

Number one, learn something. Number two, think of good things you've done. Three, take care of what you eat. Four, keep in touch with your friends and loved ones. Five, keep physically active. Six, be kind to yourself, seven. Get involved and make a contribution to example of volunteering. Eight, take a break and rest. Nine, ask for help and share what you're feeling. Ten, make something get creative. So I think those are ten points that patients have taught me over the years that have helped them most get out of dark periods and dark times. And I try to implement a few of them in my life, even though it's not always convenient or straightforward to do so. What are the things that you do that you think have most impact for you? Yeah, making time to spend time with loved ones and family. So making time to set aside doing the things that Chik Jen Miyai said was so important, you know, making and sharing of food, insisting on that kind of habit and tradition with family. Making something, getting creative is a big part of my life, trying to give back a bit to my community and do things that you're not immediately remunerated for, but which connect you with others and the idea that there's a community here that can flourish if everybody does a little bit extra. You gain more than you lose by that sort of contribution, I think. So yeah, those are the ones that jump out.

Kenny Primrose 37:55

These are really helpful, actually. But they also feel like they're kind of at odds with uh the values of our the culture that I've grown up in, you've grown up in, are kind of efficiency, transactional, marketplace kind of thinking. And and so you've got to unless you have a kind of a faith community that encourages these things, where do you look where do you learn to do them from? Because I feel like there's yeah.

SPEAKER_01 38:19

I

Community Beyond Faith Groups

SPEAKER_01 38:20

think there's lots of them going on that have got nothing to do with faith communities now. So, you know, for kids, there's like sports clubs and martial arts clubs and that kind of thing. For there's in around most of the towns around where I live, I've got these Andes Man's Club. So oh yeah, that's a great initiative. It's fantastic bringing men together to talk about things or actually just do things with their hands in the vicinity of one another. Side by side, yeah, yeah, exactly. They don't talk to one another, they do things together. Um and um more broadly, there's uh you know community kind of action involvement groups. And in Edinburgh, where I practice, there's uh a volunteer exchange, if you like. So there's a website which shows all the different kinds of places that you can volunteer. So I often direct people to that to look at what kind of thing would engage their enthusiasm, what would they be interested in in tapping into. And if we don't do that and everybody shrinks away to become purely, as you say, transactional or only based on their only only looking out for their individual gain, then I don't know, it's a kind of it's a much hollower way to live, I think. So lots of opportunities outside uh faith groups.

Kenny Primrose 39:41

Yeah, you're right. As as soon as I said that, actually, that the there are lewd. I do find that the some of these some of these uh other virtues are are held really effectively in um I think in faith groups they have a story and they they the reverence, the hope, the compassion, the humility is kind of contained well, and you can get bits of them in lots of other places, but they are when they work well, they seem to seem to hold a lot of these things that make for you know a good life or a flourishing life quite well. You you have a nice bit in your in your book on awe, that's presumably

Awe, Bipolar Upswings, And The Body

Kenny Primrose 40:20

related to reverence. Oh yeah, very much.

SPEAKER_01 40:24

So I try I wrote try to write about awe in the context of actually bipolar illness and the the upswings of bipolar illness. So I mean, as as you know, and as many of your listeners know, bipolar illness can be the most devastating of mental uh disorders. It can be really destructive in a life. Um I've also encountered many patients, and there's many great artists who've written about the fact that their tendency to bipolar illness is something that they see as an integral part of themselves, and they actually don't want to lose it. So, and that is because of the positive upswings that can sometimes happen before a manic episode gets really destructive. So the medical term, which I don't like much, but it's used a lot, is hypomanic. So you're not fully, you're not psychotic or dangerous in terms of your mania yet, but you're feeling filled with possibility, you're feeling like you are um uh extremely talented and you're feeling very creative, and you don't have so much need for sleep, and you can create something new that humanity has never seen before, and so on. And that feeling is connected to awe in the sense of being stupefied by the beauty and the possibility of life. The chapter is called A Fire Hose of Epiphanies, which is a quote from a memoir by Holter Jarin, who's a botanist who wrote a memoir of her bipolar illness. Awe itself is something intimately connected to my world of practice of medicine, just because the body is so unbelievably awe-inspiring. You know, before you even get to the brain, just the functioning of the body is really quite extraordinarily complex. We don't really understand it, and it's to me, it's just amazing that it goes on and on with just a bit of food and water now and again. And there's and I go through some of the aspects of our bodily anatomy that are to me really sort of mind-blowing. You know, like our bones are stronger than reinforced concrete, you know, there's as much DNA in our body that if you strung it out, it would reach the edge of the solar system. And yet we're all walking around with this. And so when I sit down with a patient in clinic, it can be really refreshing for me to tap into that sense of awe and possibility about human life and what human life's possibilities could actually be.

Kenny Primrose 42:52

It's one of those emotions, transcendent emotions, that seems to have, you know, it's got physiological tell signs, but it makes you kind of more pro-social, more a sense of interconnected with the with the natural world and and and with other people. And humility seems to be one of its kind of byproducts. At least I find I used to, in fact, I did it yesterday with another GP. We we went for a run and then a swim in the sea. And on the way back, I'm always much more magnanimous as a driver. I I just feel just like reset in some way.

SPEAKER_01 43:27

That's great. So you're yeah, there's this idea, isn't there, that the awe is a positive sense of your own tiny insignificance before the magnificence of nature. But that in itself, so that that is tied to humility because you feel very tiny before this huge power of whatever, whether it's beauty that you're admiring or whether you're you believe in creation, and you feel a kind of sense of of humility before that magnificence. But that in itself means. You it's immediately connected on to this idea that life is short. You know, you're not going to be here forever. You might as well be kind.

Kenny Primrose 44:08

Yeah. Yeah. And it makes you kind of very present to the wonder that's around you. I think another, maybe a cousin of that, is just a sense of poignancy. You know, like life is short, this is it. These moments that we have, they don't last long. And yeah, I like to think about that, you know, you're a you are a drop in the ocean. Yeah. So humility comes with that thought. But that ocean would be different without you. And the there's a nice

Small Choices With Ripple Effects

Kenny Primrose 44:32

you're not totally insignificant. You can make a difference.

SPEAKER_01 44:35

And every choice you make, every decision you make has implications and repercussions that could go on changing the world long after you'll be gone. Do you know even the most modest encounter could change something? You know, somebody could read a book that makes them do something slightly different one day, which then they have different encounters, which then has ripple effects on to change everything. So even the smallest and most apparently insignificant of changes in the way you choose to live today, well, could have big implications for the world, the unfolding of the world and for people you don't even know.

Kenny Primrose 45:09

Yeah, butterfly flaps its wings. And occasionally you hear back about those things, but for the vast majority of the time, you've got no idea. There's no feedback on the impacts you're making. It's quite a quite a thought. I wonder if I could add to that list, or maybe uh within that list is kind of belonging, a sense of belonging in community and individualism that I I've been enculturated into, and I think is just hammered home by social media and things like that is antithetical to a lot of these ways of being or experiences of life, whether it's you know, humility, reverence, or to some extent flow, because I think flow takes you out of yourself rather than Yeah.

SPEAKER_01 45:53

So um Yeah, individualism it's taken us down the the it's taken us down

Individualism, Autism, And Kids’ Distress

SPEAKER_01 46:00

a bit of a blind ending, I think, as a society, because it's been really pushed on us for for quite a few decades now. The idea in the mental health context that your mental health is just about your responses to the world. I've had some really lovely conversations with people about this book who've got a diagnosis diagnosis of autism and autistic spectrum disorder about exactly that. You know, there's some people, just as we were discussing earlier with other kinds of neurodiversity, who feel that it is very much something that holds them back in life, but other people who say that no, it's just describes me as part of my identity. I feel whole just as I am. It's an interesting reflection, isn't it, that when someone struggles with social situations and social contexts, that we don't blame the society. Our current model is to give the person a label of a disorder. So if you struggle with social engagement, instead of saying, well, maybe society should be more accommodating, we turn that back on itself and say that the individual must be disordered in some way, which for some people feels very, very wrong. And I would like us to gather a more expansive, broader, kinder, kind of communitarian idea that we all create the social context by which other people are obliged to live. We've all got a hand in that. And so similarly, with the big expansion in labeling of mental and emotional distress among young people, and I've been asked about this a few times in my perspective in the GP clinic, and you know, why is it that young people are struggling so much? And my instincts is often to try and turn that in his head into and say, well, hang on a minute, we're the adults, we create the world that they're growing up in. Do you know? Can we take some responsibility here for the creating the world in which young people are finding it so difficult and feeling so distressed? You know, they don't vote, they don't decide how their world is constructed. So if children are reporting more emotional distress, what are we doing wrong about that? And what as the adults in the room can we do to try and improve things for them? You know, it's up to us, really. Not so much up to them.

Kenny Primrose 48:21

Yeah, that's a really helpful uh answer. I think it also implicitly points to a bit of a societal problem that you'll find in the GP practice, and I find in schools, that people expect institutions to do their jobs rather than say the communities that used to exist, if we live in atomized cultures now, and so lots of the things that parents and communities would have done in in the past now turn up at school as problems. And it's like kind of you fix it. But yeah, this this sense of okay, we're we're the adults in the room, but we can actually do something about this. There's some agency here, yeah, is is I think a helpful challenge.

SPEAKER_01 49:06

Yeah, absolutely. And it's it's worth us thinking as a society around what changes we would like to see to make the environment in which kids are growing up stronger and more robust. I mean, my own view is that we should be piling tons of resource into this. You know, there's there's a wonderful study by that I referred to in the book by James Heckman, who's won a Nobel Prize as an economist, for showing that for every dollar you invest in preschool child care and child support and family support, you save seven dollars further down the line in terms of medical bills and prison bills and all the problems that are attendant upon that. So giving kids the best start in life is actually one of the most powerful things that you can do as a society. But kids don't vote.

Kenny Primrose 49:57

Yeah, what a powerful bit of work he's done in pointing that out. And yeah, you just hope it falls on the right desk in terms of uh being able to pull levers there. I I I wonder if we could kind of try and pull some of the things you've said together. The the question is how how should we live in order to to flourish eudaimonic kind of well-being? And your prescription as a GP is is kind of but partly this this 10-point list, but also inculcating a sense of humility, compassion, reverence, hope, flow in in kind of finding meaningful work. These are all things that we are would it be fair to say that we're wired for them as as human beings?

SPEAKER_01 50:43

This is our you know well, my own view is that I'm gently trying to move it away from this 2020s obsession with wiring. I don't think it's a helpful metaphor. Not metaphor, is it okay? We're not wired at all where well we're wired if you could have a circuit board made of wet jelly, which can build itself and heal itself. So I think there's something very deep in humanity that means that all these different world philosophies all over the globe have all come upon these same basic principles. And there's definitely we need to find a way to for flourishing to keep a sense of lightness and play as well, otherwise it can all become a bit too solemn. And play and joking and uh humour are also really fundamental

Equanimity, Play, And Closing Thanks

SPEAKER_01 51:33

aspects of humanity. And then also another ingredient, if I could, that I might try and add, is the idea of being even-tempered or equanimity in the face of problems and adversities. Do you know there's because we can't see all ends, we don't know what are going to what aspects are going to turn out for good or for bad. And so I think there's wisdom in the idea that we, if we could develop the capacity to be a little bit more even-tempered than our current social media climate allows, or our current news cycle allows, and be able to take a slightly slower pace before jumping to decisions, that would also help us to flourish as a community and as a society. How many times have you have you seen something bad arise out of something good, or something good arise out of something bad? And so as soon as something bad or good happens, we don't need to jump to a conclusion. We can wait and see.

Kenny Primrose 52:32

Well, Dr. Gavin Francis, it's been such a pleasure to talk to you today. Uh uh about all sorts of things, including your uh your book, The Unfragile Mind, which is available wherever books are sold.

SPEAKER_01 52:44

Yeah. Oh, thanks very much, Kenny. I've really enjoyed it. And all the best with your own many projects and your own human flourishing. Thank you very much.

Kenny Primrose 52:53

That was Dr. Gavin Francis on The Examined Life. I found myself sitting with his 10-point list long after the recording ended. Learn something, make something, keep in touch with people you love, ask for help, rest. None of it is complicated, all of it is hard. Harder perhaps in a culture that prizes efficiency and speed over depth and connection. What struck me most was something that Gavin said almost in passing, that the threshold for what counts as flourishing and what counts as disorder, shift with culture and with economics, and with the stories we tell ourselves. Which means that in some sense, there are ours to renegotiate. His book, The Unfragile Mind, is available wherever books are sold. I really enjoyed reading it, particularly if you've ever found a label helpful or limiting. Or simply if you've wondered whether you might have a mind that you can trust. Also, love it when anyone sends mail feedback, leaves a review, sends it on to somebody else who might enjoy it. Really helps other people hear about the podcast. Let me finish then by thanking Dr. Gavin Francis for giving up his time and offering his wisdom to me and you listeners of the Demored Life. Really appreciate that. Also, Moby for some of the music you heard at the beginning in the middle, and Colin Primrose, my brother, for the music you hear in the background now. Thank you for listening. I'll be back soon with more questions that we should be asking ourselves.