As well as dealing with the patient's diagnostic history in our assessment of the presenting complaint (discussed in Part Two), we must also gather the extent to which the complaint has previously been diagnosed as psychosomatic. We meet frequently with states which are generally held to be “psychological”, which indeed they are. This model will try to demonstrate that many such states are the product of physical states rather than entities in themselves. In other words, most manifestations are coupled somatopsychic-psychosomatic states resulting from losses of Poise. I am not trying to erect a new category just for the sake of it, but rather to show that if viewed this way, it is easier to administer more helpful prescriptions. If we embed the symptoms of individual patients within their history and generative state, it is easier to treat them without the need for labelling. Variation in human health seen in this way allows us to treat fluctuant phenomena more in the way that variability in climate and weather are accepted and responded to.9
As the concept of Poise is one based upon capacitance and adaptation, in another section we will examine their genesis on the macroscopic scale. Poise is at root a bioenergetic idea, so to develop the concept from its microscopic basis, we need to examine the biological basis of our adaptive response.
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3 For instance: “Do not ask what kind of disease a person has but what kind of person the disease has.” Attributed to Sir William Osler 1849–1919. Recently I heard it attributed to Hippocrates, no less.
4 Eastern humoral theory might proscribe tomatoes in the diet of an eczema sufferer on account of the bright colour while systematic biochemical analysis would make them indicated on account of the anti-inflammatory effects of this maligned fruit. I suppose quoting “like cures like” would get you out of this fix.
5 Hamlet III, i, line 64.
6 The concept of matrices is developed in Section 3 as the second of five interlocking biological ideas.
7 The making of lists does, for some, contain some pleasure within the compulsion! If a description of Health is to be dynamic and interrelational, the model must be more than a list of lists.
8 The important criterion here is to reduce any unhelpful burden a diagnosis may have placed upon the patient, not as any aggrandisement of the practitioner.
9 Even the weather is not free from emotional labelling: we may speak (in England at least) of a filthy night and foul (but not neurotic) weather!
SECTION TWO
Axioms, theorems and ideology
Split personalities
Specialisation provides no doubt some benefits, but separating out strengths may weaken social coherence. English culture particularly seems almost proud of its division into the Two Cultures, but it is not just the Arts and Sciences: even medicine is bedevilled by separation so that biology is somehow secularised away from the clinic. This gives some clinical judgement a curiously parochial sound and one that is scientifically narrow as well. Psychiatry and neurology tentatively seek fusion but think that it may prove difficult.10 Psychiatry itself has followed a two-streamed course; Freud trained as a neurologist then strayed into anthropology and literature and has never been forgiven for it. Herbal medicine in particular shares borders with horticulture and literature and other mythic realms of discourse yet seems frozen into rather an abridged historical narrative, separating humoral explanations from their philosophical and cultural contexts. This separation may ask its adherents to stand behind the kind of inauthentic banners so characteristic of the tourist industry, as if humoralism was true because it was quaint, as antiquarian as Morris dancing (and I mean no disrespect towards the dancers whom I enjoy watching), to be brought out on special occasions.
Quite apart from the impoverishment visited upon education and cultural life by this trend to specialise and separate, the move to ameliorate its malign effects by erecting paper bridges leads, in both educational curricula and in educating media, to the spreading of a patronising soothing emulsion as if nothing is really too difficult if you try, except for those things that are so difficult it is not worth trying. While building fences may enforce distinctions, pretending that there are no distinctions to be made adds an abiding air of unreality.
Power separates: medicine occupies a special case in splitting itself off as it has come to acquire great political and socio-legal power.11 This has led to a kind of conservatism that tends to reduce the incentive towards intellectual curiosity. In fairness, dealing every day with life and death must lead to a kind of warrior-caste separateness12 and an impatience with meddling by uninitiates and those who may seem to have easier decisions to make.
If there is any ideology in this present work, it is not a call for fusion in the sense that distinctions are not to be made, but rather for a reinstatement of that revival in the early modern period of enthusiasm for the embracing and unifying of lived experience with all of the natural world. As I have tried to show elsewhere, discontinuities are at most temporary and partial. If human experience is unitary and is at once defined physically (biology and ecology), emotionally and socially then it makes no sense to separate physiology from psychology, sociology and all the humanities. Each “discipline” should illustrate the others and so complement the narrow definitions that we are obliged to make when we separate out a particular set of phenomena for temporary convenience. It is especially strange in trying to talk about health if one thought that it were the exclusive province of medicine or indeed the extreme opposite of that given by the World Health Organization in 1947 as if to read:
A state of physical well-being as a result of the absence of disease or infirmity. (!)
I must accept the criticism, indeed I make it myself, that in order to arrive at an integrated view of health one must incorporate material over which a single person cannot hope to have special knowledge or expertise. Even this admission may seem too much of an understatement. Yet, with the advantage of modern technology, the possibility arises of denoting at least the pointers and indicators: of emphasising connections over separations, pathways as boundaries.13 In scientific fields, especially physics, the search for a unified theory is at the centre of the endeavour but in sociology and anthropology, meta-analyses have become a source of suspicion. In biology, too, inferences that stretch the data have been the subject of hostile criticism. The cartography of modern knowledge resembles a world of walled city states, neither at war nor at peace. In medicine, we could rephrase ancient understanding in those areas where ancient misunderstanding has since been illuminated. Modern medicine is keen to repudiate the mistakes. Modern herbal medicine could realise the benefits of the Hippocratic tradition, so saving the baby without any veneration for the metaphorical bathwater. Our integrative drive benefits from and is not hampered by modern knowledge. Our historical vantage should allow us to restate the question of health by allowing biology, together with the unexplained nature of consciousness, to sit in bed together.
Powerful territorial imperatives inform the urge to separateness so that psycho–therapists can be embarrassed by any notion that the psyche might be considered as if it were grounded in biology; medical doctors will not wish to cross lines of demarcation over the human body itself. Linguists “frame” the questions in contrasting political and philosophical theorems. In philosophy itself, it is almost impossible to use the word “mind” in connection with other categories. My modest ambition, in all its naivety, is to integrate what is known at the “atomic” level of the organelle and at the cellular boundaries, with all our structures as derived therefrom together with our experience and functions that emerge from such structures. In other words, an inclination to favour continua over the perception of discontinuity. I do so not as a rhetorical appeal to “holism” as an end in itself nor to reinvigorate the absurdities of behaviourism,14