When we become ill, a cause is sought—the chill, the person sneezing on the Tube, a children's party—to provide the comfort of explanations. If a person develops a disease and enters the purlieu of medicine, a more elaborate aetiology is sought, one that may provide more comfort to practitioner than patient. The comfort of explanations contains more than a hint of cause as blame.62
Considering illness as a reduction in poise from an aetiological point of view, framed according to notions of the terrain, the practitioner must try to formulate in the patient's hearing a constitutional profile. That means trying to understand the person's initial state, the challenges they faced at developmental stages and their current state. Each state negotiates with previous ones and so is itself an outcome and a source of what follows. Changes in state follow the phases of geophysical time in any case. The ratio between the matrices in which the crucial elements of the terrain are embedded must alter anyway with time whether with too much or too little challenge. The changing ratios, the inherent rationality of the system expresses how cause and effect become entangled. Nudging these ratios back into a state where illness will tend to subside and lose its force is the primary purpose of the application of medicinal plants to the patient's terrain.
Although chains of cause and effect may become lost in complex systems, one may discern and follow threads of failure, of the “for want of a nail” variety.63 These may be taken as a mark of deficiency states.
Reason
The word connects the mind's capacity to appreciate the balance or ratio between things and events, connecting us with the sense of causality. Paradoxically, the uniquely human abilities of our prefrontal cortex to draw inferences from premises require minuscule computational power when compared with that needed by the sensorimotor apparatus for walking, dancing or jumping. This physical part of mindedness, the “proprioceptive or thalamic mind” (that integrates the colossal requirements of every animal body) contrasts with the integrating surface of the “hypothalamic mind” which sends its outflow into the body via the pituitary. Some of the messages are as if in a bottle placed upon the tides, others like an alarm bell. In either case, the replies to the messages are incorporated. The huge asymmetry of these two “minds”, similar in quantity between the governed and governors in human history, is striking in that our sense of ourselves favours an image of governor. The ratio between the single emperor and the millions of subjects is not a bad simile for the reason with which we hope to govern ourselves. But, rather like the historical demands made by rulers of the estate, the relative amounts of energy dedicated to each party are inversely proportional to their numbers. The power of our conscious minds is puny compared to that of our bodies.
Knowing how to do anything is elementally animal; plants also know how to be alive. The proprioceptive mind is nothing short of a whole living system responding to the world so as to continue. Knowing about things and teaching this knowledge must be what we call and know as reason. Fundamentally we do this for social as much as for cognitive purposes; Mercier and Sperber (2017) make an excellent case for reasoning as a mode of social explanation for the purposes of reputation and justification rather than as a purely cognitive enterprise.64
Bipolarity
We are all bipolar. The alternate cycling of night and day imprints a binary oscillation upon body and mind. The ebb and flow of all the tidal waves—of air and water created by sun and moon—impinge upon us and, like all waves, are composed of peaks and troughs, the twin poles. I am not at all referring to mental disorders but to the daily oscillation between high and low, up and down, echoed seasonally and circannually. Such is life.
As for behavioural patterns, it may be that there are those who become beached on a high and stranded in the low. If this tendency is unstable and the becalmed or lifted states are triggered easily by, for example, low blood sugar, surges of cortisol or noradrenaline, or flights or sudden bankruptcies in dopamine (all resulting perhaps from some perceived aggression or challenge), or whatever else interferes with the flow from high to low (contingencies acknowledged sometimes as trivial), such a person is cyclothymic. By contrast, if the tendency is stable and cannot easily be undone by contingent events, such a person may be bipolar in the more psychiatric sense of the word, though there are grades long before psychiatric help needs to be sought. Here the trigger is hidden within the circannual and seasonal oscillations but the person is pushed too far in either direction for a safe and easy return. The paradox is important to recognise: bipolarity is an insensitivity to contingent circadian events and to the return swell of the circannual rhythm while cyclothymia denotes a hypersensitivity to fluctuations in the circadian rhythm, and usually also to the other tides.65 From an energetic point of view, bipolarity may indicate a deficiency of ballast to restrain the surge or of energy to restart the climb. This lack of ballast suggests a failure of or resistance to diurnal entrainment. The line of a cyclothymic's trajectory takes an unpredictable random walk. The life of a cyclothymic is all weather and no climate. Upland sun plants will help them.
While it may be helpful to view bipolarity as an essential part of the experience of every creature, not just the human, being enmeshed within the basic rhythms of life, clinically, it is most important to discriminate between these two contrasting expressions. As prescribing patterns should rightly be derived from clinical findings, the importance of these kinds of observation must be obvious and will be discussed more fully in Part II.
Facts and occasions
Physics establishes the facts of the world; biology describes the occasions experienced by living creatures which are not themselves facts but rather types. Our search for the facts, which are really events in the lives of our patients, are often difficult to circumscribe as they are often ideas about the self which the events are supposed to embody. Even verifiable events (such as a surgical intervention) may become preoccupations that are recruited as evidence to support the idea of self. The clinician needs a good memory to detect congruences between the report of events and their meanings.
Things and events
Things are only events that condense out of the world over deep time. It would be cumbersome and inconvenient to see all nouns as verbs, even though that is what they are: we do not have enough of our own time, let alone geological time. Thus, a rock is a thing; we can leave it to geologists to ponder the processes that gave rise to it and to physicists to explain that solid things are really all a shimmer. The point is not so trivial or irrelevant to biological medicine as it might appear. Ecology is a measure of energy and nutrient moving through a system, determined by the interacting matrices that constitute it. We may identify unitary species which is our way of slowing time and creating borders so that we might understand the events that make up the “things” that inhabit the system. The size of the system will depend upon other systems that we reify into geography, geology, climate, soils (with their biotic ecology). All will abut other systems, demarcated by changes in quantities and therefore qualities. Living “things” are concatenations of events. It may be convenient to typify a disease as a thing, but illness can never be so described: it is always an event. An event is a bordered set of things.66
Conscious life is registered as a series of events of variable duration in which “decisions” are taken and “choices” made. Biological life is a series of events of duration that is not fixed but varies narrowly within limits set by circadian cycles. The choices are not entirely random but biased by mindedness.
The structure of the terrain
The terrain may be less visible than our skins and less defined than our muscles and skeletons but is a physical structure nonetheless. The fact that it is in solution and not palpable should not deter us from trying to elucidate an underlying matrix of coordination. The balance to be struck between the level of abstraction and the degree of inclusion needs to be founded on sound biology and an inclusive physiology. The French clinicians Duraffourd and Lapraz (and now, collaboratively, in English by Dr Kamyar Hedayat) argue with great cogency for the isolation of the neuroendocrine system as the only plausible candidate for the terrain. Adaptation