Because the present depends on energy immediately available and that in turn depends upon a reliable reserve supply, health requires the reserve to be the greater energy partner. That available for immediate use will always be contingent upon our circumstances in the short, medium and long terms and so the ratio will be prone to a constant readjustment. The ways in which this ratio can be maintained, lost and found again are the themes that I will be exploring in this book: in this first part theoretically, in the second part in the clinical setting. My thesis states that the fluctuation of this ratio is a fundamental index of health.
I have proposed that the most plausible ratio will lie close to the golden mean simply because we have, like all creatures, to conserve structure, information and energy in the face of random variables from without and from our own internal response to a quasi–random world. Being a ratio, there are no units. Even though the amounts of energy in the body could be quantified by extrapolation from our knowledge of the biochemical pathways involved, I am not proposing we test the notion by some totalising of adenosine triphosphate. Rather, I offer it as a heuristic device rather than as a biological fact. Diagrammatically (a preview of a more detailed one in Section 22), it would look something like this:
Although there are no amenable biomarkers to help us assess this postulated ratio in the clinic, the Genito–Thyroid Index can help given an overview of the amount of energy the thyroid axis is prepared to offer the metabolic undertaking. This is the second of a series—called the Biology of Functions—invented by Dr Christian Duraffourd, and developed by him in collaboration with Dr Lapraz and latterly Dr Hedayat. The index that precedes it, named the Genital Index, is simply the ratio between the red cell and white cell counts as numerated from a blood film.18
Although Poise (by contrast with the algorithmic Biology of Functions), offers a rough heuristic19 we are provided by a multitude of clinical pointers, some of which I shall rehearse in Part two. In the maintenance of health, medicinal plants can be our natural allies along with the help of the six nurtures. I discuss the ways in which they may operate in practice in Part Three and the context in which we operate in Part Two. For the rest of this part, I would like to examine the theoretical possibilities of the ecological approach to physiology that I am proposing.
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10 I have attended a number of symposia and conferences at the Institute of Psychiatry and the Hospital of Nervous Diseases that discussed overcoming historical and cultural divisions.
11 It has been a gradual process since doctors acquired legal power over the dead when the plague ravaged the population of Renaissance Italy. The attitude to doctors has always ranged between derision (Chaucer, Molière) and veneration, often by admiring and grateful patients. Alan Bennett makes a shrewd analysis of the rising social power of doctors in The Madness of King George and contrasts the impotence of humoral medicine in the face of a genetic condition (porphyria) suffered by the king. In Britain, doctors have suffered or benefitted from class snobbery for which the history of British cinema has many illustrations. We could all relate an anecdotal history of medicine: a dowager of my professional (certainly not social) acquaintance declared that doctors never came to the front door as they were considered trade.
12 The analysis by an insider in Glin Bennet's The Wound and the Doctor is unfortunately not entirely out of date. Some of the arguments in Thomas McKeown's The Role of Medicine—Dream, Mirage or Nemesis (Oxford 1979) are germane. The contributions made by Michael Balint and Donald Winnicott to the integration of the social and psychological seem not to be especially valued in medical education.
13 I will amplify this theme in Separations and Divisions in Section Four pages 48–56.
14 Aside from the narrowness of their approach, the Stimulus-Response (S–R) fails to incorporate the organism in the middle of that circuit as crucial interlocutor and recreator. The elevation of S–R to S–O–R is comparable to the rise in complexity that Newton discovered when moving from the solutions of the two–body to the three–body problems.
15 I would extend this partiality to theories in human development: see Section 13 re Staging.
16 Senseless in some literal meanings; see Sansonese's attempt to redefine the Japanese tradition as shamanic, a tradition already re–interpreted in the West.
17 Adapted from Ganong's Review of Medical Physiology 24th edition, Table 18-1.
18 Details are provided in Lapraz, Jean–Claude & Hedayat, Kamyar 2013.
19 I take this up in Section 18—The Entrainment of Poise.
SECTION THREE
The biological basis of the adaptive response
During any consultation, most of biology is invisible and must be inferred from appearances, as it has always been. We also examine one another in social situations: mutual interpretation is the basis, after all, of human interaction. Reading facial expression and looking at the skin is not the preserve of the clinician, nor even are the effects of the underlying circulation. Any malformations in the skeleton are immediately apparent to anyone. Before the era of microscopes and blood tests, it was clear to everyone, not only doctors and priests, that causes of illness were obscure, that hidden forces were at play (or at work).
The vision of the unaided anatomical eye was partly distorted by humoral ideas: the facts did not seem to fit the theories appropriately, or perhaps the details of the facts seemed trivial beside the explanatory framework provided by the ancients. Thinking was nobler than looking; anyone could look, but only the genius of Aristotle or Galen or Avicenna could know what they were seeing. Besides, not everyone had human cadavers at their disposal, though Galen was more likely to use animals for dissection than human victims of violence.
Medical training is more focused on human anatomy than on biology. It is this partiality which may distort the bias away from biological notions of health towards medical and cultural ones. However, let us put ourselves in the position faced by physicians in the ancient world whose notion of health was holistic and based upon notions of a balance between forces, impulses and tendencies: the term κρασις survived into the twentieth century in haematology, for example, as “blood dyscrasia”. The word poise that I have chosen to stand for health comes through French from the Latin for weight. A weighing scale is after all called a balance. Yet the subsidiary meanings indicate a resolution of opposing forces or tensions in the sense of a suspended preparedness (and weighing scales are suspended from a fixed point). An obsolete meaning of poise referred to the stabilising weight, or ballast and also to bias and momentum.20 These are all crucial elements to the bioenergetic model of Health as Poise that I will develop in these pages. This model, which ultimately wishes to talk about Human Health, relies upon biological ideas and does not seek to elaborate new categories but perhaps to emphasise old interrelationships and possibly to use old terms in newish ways.
By looking at someone we may have quite an accurate sense of their present state of well–being but however good our interpretation might be, our predictive assessment lacks any certainty (even if we have some history to go on) just because the matrices in solution (or in colloidal suspension) and