49 See 2/5 The Interconnected Matrices on page 25.
50 I try to make the necessary distinctions elsewhere (mental states in Section 14) where I would suggest that mental illnesses of some kinds are biological while others are psychological. There is no reason for us to make a generalised choice as Psychiatry has in the past tended.
51 I would again cite Viktor Frankl's Man's Search for Meaning (see 3/5 in Section 3, Life as Trajectory).
52 In this context, it seems appropriate to quote Viktor Frankl: When we are no longer able to change a situation, we are challenged to change ourselves. Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.
SECTION FIVE
The Terrain: mind and mindedness
Time and Space are the great continuities against which all differentiations can occur. These changes are inevitable and not exactly reversible, of that we can be certain. The path of no return taken by our trajectory across the epigenetic landscape is dependably rhythmic even if the details cannot be entirely predicted. If we plotted the trajectory of our phenotype in phase space, it could be made in three dimensions to resemble a spiral. Each turn of the spiral would witness change in the whole but later turns show similarities in form with earlier ones while the scale changes over time. That rather abstract and oversimplified figure does correspond with common experience in that we grow and change but also show continuity and similarity with our earlier selves. A similar view of the history of the world was taken by the philosopher Giambattista Vico (1668–1744) who called the stages of each thread of the helix a gyre.53 Life shows some pattern, some recurrence, some similarities with earlier selves. Why a circle or ellipse arising into a spiral? Because biological systems are recursive and we get our cues from planetary orbits that are elliptical. Time pulls the ellipse upwards like a coiled spring, from the plane to a spiral.
The phenotype undergoes definite and continual change with known sequential stages. Even though the processes are mostly hidden, their outcomes are plain to see. The epigenetic management of these programmed physiological changes must also absorb or rebuff all the accidents and incidents that will befall any individual. These irresistible changes—shared by all, but unique in detail—converge on the physical and functional self. All these turns contribute to personality and the sense of experience and self. Change, as Heraclitus pointed out so pithily, is our only constant. Adaptation to this constant requires a paradoxical resistance to its disintegrating force, yet resistance to change needed for growth would mark the demise of the embryo. The stage at which the phenotype emerges cannot be defined with great certainty: fertilisation is a prerequisite, of course, but the vertebrate body plan is not revealed before gastrulation. This is the first important stage of differentiation into tissue types, a kind of topological evolution. One could think of the first six weeks of embryogenesis as a kind of experiment, given that aborted missions of this risky enterprise are common enough. After six weeks of gestation, the new fingerprints are formed, surely a mark of confidence in the future and the onset of recognisable individuality. By the thirteenth week of gestation, the ground plan is complete: growth and development proceed apace. During this time, the foetus has to negotiate with its mother for food against the backdrop of the negotiation that she had with her own mother. The fertilised egg is of course maternal but was developed initially in the grandmother's womb given that the mother was born with her eggs already composed. The notion of imprinting derives from animal ethology; it is a more difficult idea to establish and test in humans, but if we accept the inference that a reference state is established it would be reasonable to point to this gestational period as an obvious candidate. To reject the idea would be to suggest that no enduring record of previous states can be registered. The persistence of the individual does require a stable form from which to evolve: the initiation of the constitutional state. The initial state is modified at each stage of maturation but the terrain is probably closed soon after the growing plates in the long bones close to further stimulation of growth. It is the initial state to which we refer when poise is threatened.
The genome may be the informatic repository but the epigenetic apparatus responds to events. This—the milieu of proteins—creates the organism in its adaptive sense, serving the needs of itself as it develops. The organ systems and matrices yield products and mobilise those within. The pace is made by internal cues including the presence or absence of the Y–chromosome. Pace of development is thought to be dominated by the paternal contribution (irrespective of X or Y) and certainly by levels of maternal androgen, but ultimately delimited by nutrient. The response of the organism to its own command over resources provides another feedback loop. As well as proximal sources, these signals become attuned to the maternal hypothalamus which must be entrained primarily by the sun, the transcendent pacemaker that dominates geophysical events. Control operates thus without a single director unless one conceives as the totality of the matrices as a singularity. In a world of weak but persistent signals from within and without, selfness moves towards singularity, but one that may not maintain itself independently. Independence signifies nothing more than a separate address, a place with its scope, a scale on a map. The Himalayas are not to be expected on a map of France nor the Côte d'Azur on one of Nepal but these separated accounts of a portion of the world, though partial, are not fictional. Human consciousness reminds the self of its contrary predicament needing both separateness and fusion for meaning, and needing meaning for selfness. In this way our psychic and social and linguistic selves, dependent utterly on our biology, are by turns and between individuals intimate and dominant to the self, subsidiary to the whole.
The definition of the Terrain by Dr Christian Duraffourd adopts all these notions and casts the individual—“autonomous, self–regulating, and self–managing”54—in his milieu, and emphasises her or his health as an outcome of adaptation. He declares that the endocrine system is the only agent that could mediate the management of the whole organism. While the neuroendocrine system may be all–pervasive, there remains a vestige of the autocrat in this description, some paradox between self–management and the presence of a manager. This may be partly linguistic but when I put to his co–author Dr Jean–Claude Lapraz that the operation of the “pituitary loop” (see later) rendered the action of the organs as somehow passive to higher control and so conjured up an image of a Vatican regulating its flock, he acknowledged this top–down bias and said that Duraffourd had since modified the definition, though I have not seen this in the teaching material and I perceive a similar dialectical approach, for all its brilliance and clarity, in the remarkable consolidation of Endobiogenics made by Dr Kamyar Hedayat.55 By contrast, I have elaborated the idea of the interconnected matrices to minimise such a Cartesian bias though I cannot, unfortunately, match their clarity of synthesis. When it comes to the physiological detail I do not attempt a definition on the lines of Duraffourd and Lapraz because it is detail in my scheme that is precisely lacking. Even if it were available at every turn it would become too cumbersome for a definition to carry. Like them, therefore, I let texts in physiology56 that are up–to–date substantiate the broad strokes of theory. I must acknowledge my gratitude to the army of researchers, collaborators and editors that make such detailed information and insight available to us.
The necessity for a concept of terrain
Modern medicine derives its strength from specialisation and attention to the details in the systems of survival. Many practices are based upon empirical evidence, with a grand admixture of habit and tradition: reductionism is as much a source of opinion as any other type of knowledge. The divisions between specialisations are recognised as arbitrary but are used as methods of organisation. In any industrial process, parallel hierarchies tend to establish themselves. The sheer size and social dominance of the medical complex requires it to be coherent against the common enemy of disease and uncontainable illness.
If by contrast we seek a coherent model that unifies biology with our expressive selves, such a model should aim for more than rhetorical unity. The models of self–organising