I have briefly summarised (in Organisational Structure above) those manifestations of the terrain that we need to assess in the clinic. These involve observations that have so far survived the tests of time but we must remain very careful in their application. It will not help clinical development for us to envisage the terrain as some vague constitutional complement of characters, chosen to suit our particular bias, wheeled out to support a notion of illness as an ill–defined disturbance of balance in the patient's terrain. We need to revisit the structure of the terrain in Part Two: Assessment in Clinic Practice.
Stabilising the trajectory
The crucial determinant of a terrain stabilised on its trajectory is not a separate function but rather the supply of energy to our thalamic mind (coming soon) and the sensations of this supply to our hypothalamic mind, to our very mindedness.
If the continuation of life depends upon the incorporation of materials—the constructive phase—there must be a parallel scavenging for those materials and also a destruction of some substrate to liberate energy for the whole project we call metabolism. Composed of these two arms, catabolism first, then anabolism, we see the operation first of the normal law of thermodynamics followed by its temporary reversal. Philosophers of human history (beginning with “sacred” history and ending perhaps with Marx and Popper) have tried to formulate laws to describe and predict the cycle of construction and dissipation that seem to be the inevitable fate of empires and of new hegemonies that arise from the materials made available from prior destruction. All societies and cultures have creation myths, some arriving from a previous catabolism. Religions incorporate the certainty that all things must pass. Literature depicts the same on a smaller scale: the rise and fall of families or (e.g., in Thomas Hardy's The Mayor of Casterbridge), the rise and fall of fortunes. History, like Literature, is obsessed with dynasties, families and fortunes, the builders and wasters. The search for an overarching explanation reflects the lens through which the investigator peers: economics, psychology, sociology or—in the case of medicine—vectors of disease and other determinants of public health. When dealing with the health of the individual, because you cannot have a statistic of one, we do well to try to coalesce these methods as connected spheres. As all persons have a psyche, belong to a society and have biological dispositions, some heritable, some acquired, with the two interacting back and forth, it would be strange if we excluded any of these factors from our interpretations.
Which brings us back to physics, as all things must (return to dust). Living depends upon a constant source of energy. The matrices are structured to retain substrate as reserve supplies of this vital energy. The subjective awareness of this reserve is not “contained” in any one location but, however consciousness may be distributed, the hypothalamus receives the signal and sends it out back to the muscles and viscera enabling behaviour. If the sense of reserve is under tension, that is, the ratio between resource and reserve is narrowed, the signal to and from consciousness will be disturbed. That perturbation we call illness. Health as Poise stands out as a contrast with subjective illness. I have suggested a relationship between these entities and will put this before you in the next segment. While they may be figurative, they are formulated against anatomy and physiology.
Causality and scale: death and life
Things are the shape they are because of the shapes of their constituent molecules so physical laws constitute a primary cause of at least unicellular structure. Larger composite structures follow the behaviour of macromolecular assemblages. These generate systems that are constrained by friction and turbulence (in river systems for instance), and the oscillation between sol and gel states in biological cells and tissues. In the human, higher levels of organisation and control become entities in their own right and we are right to abstract them. If it were not so, to talk of a person's terrain would be a metaphorical exercise instead of the tool used by practitioners of terrain medicine to understand and influence biological function.
While the events culminating in Death may be a failure of macromolecular structures followed at the tissue level by molecular dissolution, it is not helpful to describe health at that kind of scale: the trajectory of Life is a movement of the terrain. Modern technological surgery and medication may intercede to delay death to a latter moment but is not well disposed to promote health from an early age. This is the level at which herbal medicine operates so well.
I should now expand the basis of the idea that I first described in Definitions of Health and the model I outlined in Axioms, Theorems & Ideology.
However Consciousness emerges, it can be described as a succession of states that respond and change according to environmental cues and also inner drives for obtaining comfort, food and towards or away from socio–sexual contact. The conscious self* responds also to events, however provisional and contingent. This response implies a decision or an impulse or even a necessity to act, whether that is “free” or determined. It seems to me that it must at least partly but cannot entirely be determined. The sequences of actions that bear at least the semblance of decisions modify the self sequentially and are associated with the conscious self.*
Each moment of conscious activity is entirely energy–dependent. The comfort of Consciousness is threatened when energy reserves are low or inaccessible. This discomfort may manifest itself vaguely or specifically;68 in either case, it constitutes what I call a loss of Poise.
An adequate sense of Poise over time constitutes Health. Adequacy is a quantitative pattern judged subjectively and related to the self's sense of adaptive burdens. It is therefore an existential concept of health.
The threat to Poise may trigger a nocebo pathway or precipitate noxious cascades that inevitably disturb the neuroendocrine posture. These may or may not be associated transiently with pathological indicators.
*The self as visualised here is composed of multiple arrays or matrices. Change of state at any one level in any matrix necessarily changes the state of every other. This integration of the matrices is a consequence of the whole structure of self, not from desire or by design but a biological necessity. There is no alternative to integration. Any rupture must be pathological and result in death. Severe tension short of rupture threatens consciousness and disturbs the voluntary disconnection we make as we go into sleep. Consciousness is an output of the active state of the self, sleep its quiescent mode.
Mindedness in the structure of poise
The thalamic mind
From the Aristotelian speculations through the anatomical errors and false inferences of Galen to the thought that Descartes expressed as the pineal gland being the seat of the soul, the notion of fixing a profound human function within an anatomical structure has proved irresistible. If it looks as if I am pursuing a similar fool's errand, to say that what I am proposing is meant simply as a metaphor would be a feeble excuse. I hope that the distinction that I make here between metaphor and matrix is a valid one and is necessary to be consistent with my notion of mindedness as detailed in 1/5: Mindedness in Section 3–the biological basis of the adaptive response.
Neurology, in common with modern Genomics, discerns a profound dichotomy in the Central Nervous System between functions which are well known to be anatomically well localised and those which, by contrast are highly distributive and plastic. Just as there is not a gene for a particular trait or behaviour, nor is there a structure for consciousness or thought or feeling. These “higher” functions are summative and distributed. The thalami—paired bilateral structures associated with the third ventricle—lie deep in