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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 but in an attempt to provide a useful window to the practitioner of herbal medicine from which to view all those variations and repetitions that we hear in the complaints of patients, those ubiquitous yet individualised phenomena which are difficult to place within medical categories. This view hopes to help practitioners (and patients) in their search for a unified view of health as a dynamic state. What has been called “the hard problem” of consciousness has rather got in the way of a designation of health: by including subjective states as axiomatically belonging to any description of health, I have not thereby made any claim to an explanation. I am not eliding mindedness with consciousness but simply pointing to an intricate continuity in the constituent elements of the architecture of the self and that of groups of selves. I hope I am pointing out the obvious that if consciousness is indeed an emergent state, it must—in some unknown way—be derived from forms that are at least cognate with it and which anticipate its potential, even if we do not know how. I am trying to do so without the invention of speculative categories. Poise is admittedly a novel word in this sort of discussion, but I hope it draws only upon ideas which are well established and are supported by a reasonable amount of evidence and calls upon only a moderate range of metaphor.

The more power any group wields by consensus the less it has need of ideology: statutory medicine has the advantage of historical and demographic assent and so has no need to claim it. It will be helpful for minority groups like practitioners of herbal medicine (however impressive the number of people who consult us) to eschew ideology because such postures are invariably associated with an increased likelihood of hypocrisy and the generation of excessive zeal, both obstacles to truth or, to put it a little less piously, of no ultimate benefit to patients.

Personalities restored

If we are to make reflections on the concept of health, we might consider that the first requirement should be integration: that we should be careful not to exclude approaches to human experience. We should therefore include what might be thought to pertain to medicine but to question, nonetheless, whether the practice of medicine is in the best position to understand the dynamic potential for health, when health is considered as more than the absence of disease or infirmity.

Treating whole systems as greater than the sum of their parts requires, axiomatically, a bias towards integration. Systems theory would seem to be an appropriate starting point for modelling health yet, for all its popularity and the interest shown in it by progressive healthcare professionals, it is not so easy to interpolate into the practice of phytotherapy: an appeal to systems theory can sound like an appeal to a commonsensical deity. I would ask for the restoration of the integrity of purpose as a perquisite rather than an ideology and suggest that the practitioner lower her or his border controls against seemingly disparate investigations and expressions of the human condition. It is a call, therefore, for lifelong eclectic study and, counter to the settling into professional routines, a ceaseless quest for the broadest approach without losing sight of the individual patient. In most traditions, however different their cultural forms may appear, the practitioner is someone who assesses, leads or induces, mediates and attempts to modify the outcomes for the client.

Axioms

Perhaps the term—as a self–evident truth—is almost obsolete given that modern mathematics has rendered Euclid's axioms, to mention the most famous, open to doubt and invalidation. Let us rather use it to indicate succinctly the assumptions from which we intend to proceed.

As for the main theme of human health, apart from the biological and circadian components that I wish to develop in the following segment, it might be helpful if I state here my particular integrative bias: I consider it as axiomatic that to understand the health of the individual, she or he needs to be considered as:

A psychosocial and psychosexual being who tends to seek a life that seems sufficiently purposeful to that individual.

Of course, the detailed study of each of these components (and there can hardly be fewer than four) might need to be conducted separately, but if the unity of the object of study thereby becomes fractured, the search for reintegration becomes a further level of study in itself. What needless proliferation! The latter part of my axiom emphasises our inherent tendency to pursue meanings, even nihilistic ones. Even the denial of meaning concerns itself with what it might mean to be purposive. Our linguistic nature makes the delivery of meaning and the interrogation of words for their hidden intentions unavoidable. I am not speculating here on the correlations between health and belief or the resolution of doubt. The necessary spadework is the province of a research institution, not an individual. While it is interesting to note that some sociological research has found positive correlations between belief and an overall improvement in certain measures of well–being, that is not a line I am pursuing. Nor do I wish to make any association between health and idealism and the resolution of difficulty, though such quite plausibly might be made, because I do not have any essentialist notions, psychological or philosophical to formulate.

By axiom I mean nothing more than the scope of my intention: a pragmatic realisation that I have to declare the range of my inquiry. I wish to elaborate a physicalist description of those assemblages which constitute physiological life on the one hand and to match it with a naturalistic view of those elements of human life that converge on the notion of potential health (that I have called Poise) on the other. The two other elements in the “axiom” imply a third, sequentiality: perhaps most intricately and exquisitely illuminated by the obligatory sequential rules found in human embryology. As herbal practitioners of biological medicine, we could be content to stop at the biology of the person from embryo to adult, but the axiom that I proposed a couple of paragraphs ago cannot dispense with those other elemental structures of human development.

Human development

The study of human development after birth is not without controversy and by no means settled but no one I think denies that development is sequential even though some (like Bandura) doubt that it is determined by stages. He could be said to sit between the Behaviourists (whose notions of operant conditioning he thought inadequate) and Chomsky who deplored Skinner's Behaviourism on more fundamental grounds and demonstrated that imitation cannot explain language acquisition. Behaviourism has fortunately died its own death but critics of Chomsky (like George Lakoff) have effectively complained that he has thrown out the baby of mimesis with the bathwater of crude reductionism.

Freud decided (there is no other word for it) that our impulses towards life are fundamentally sexual, Erikson that they are social, with Adler altering the nature but not the intensity of Freud's declarations and Jung extensifying the scope. An element of territoriality seems to characterise these divisions. Viktor Frankl brought the consideration of meaning to human impulse. Is it too simplistic to suggest that they were all partially right, that one impulse does not exclude the others?¹⁵ Even so, these partial explanations must (in my view) be compatible with biology, which is not at all to say they are so reduced. There are many strands to the discussion that need to be integrated into a primary formulation, even before we consider how to apply such a formulation in practice.

Mind, thoughts, conceptions

Given that in the history of philosophy, each defined position has elicited a number of opposing viewpoints, one simple naive conclusion might be that pluralism (in the face of insistent theories of monism) must be the defining characteristic of any attempt at an explanatory device of human experience. Philosophy of Mind has historically tended to define a direction from the natural world to sense–perception or the other way around. The notion that they must operate in both directions is not just a way of avoiding an impossible choice by refusing to settle on one or the other, but rather a naturalistic assumption about the continuity of life with matter and the emergent properties of mental processes. I tend to think that an eclectic approach requires differing schools of philosophy to be seen as complementary and necessarily so, rather than incompatible, just as I see no conflict between introspective analysis and objective measurement. In spite of the numerous postulates that I make in this book, I have genuinely tried to record reflections rather than deliver a “treatise”, and hope that I have sufficiently accepted and adopted the provisional nature of all inquiry.

Since the advent of personal computers, the distinction between temporary, virtual forms and their consolidation in more durable media by being “saved” to them, is commonplace to all users of this ubiquitous technology. Is it now so problematic to consider thoughts as virtual structures that are created by neural operations? They are real only for so long as they are fed by a source of power or are incorporated by inclusion within a matrix. These structures may be based upon linguistic grammars and collections of images from recollected templates in the visual centres, the whole fed with a set of modes constructed—some converging, some conflicting—from structures within the limbic system. These operations (or modes or moods) are mostly derived from and modified by experience but may be created separately from intrinsic elements (which is surely the basis of imagination). They remain virtual unless they are laid down in memory although even here they are constantly refashioned whenever retrieved. If they are written down or spoken to others or recorded in some other way, they may persist as human artefacts, though seen always through the filter of interpretation.

The patient's way of telling personal experiences and the practitioner's particular arrangements for the recording of them is of course contingent upon so many accidental features of the lives of the people involved, including those not present but who are chosen to feature in the narrative or who are called upon, whether figuratively or physically, to present themselves.

Clinical practice may seem distant from academic philosophy but in our reflective practice—given that the data obtained leads us to those choices we make in our prescriptive acts—do we not then have need of an explanatory framework? If we want such a framework to be consistent at any one time, then time itself suggests that the framework must evolve to accommodate the acts of critical reflection and the effects of our prescriptions reported by our patients. Incorporation in the literal sense is the process of mind and body over time, time being the driver and determinant of development.

The sound of one hand clapping

To separate out the five (or if you prefer four plus one) axes is as senseless and provocative as the zen phrase above.¹⁶ It is not that integration seems like the right thing to do but rather the separate components are meaningless on their own.

At the molecular level, the metabolic process arises from the interweaving of endocrine steroids with hormones made from protein derivatives connected obligatorily by the mobile glue of enzymes (all of them also proteins).

At the axis level, the steroids are responsible for the maintenance of life and also for the differentiation of its structures. You could say that the adrenal axis is for the immediate term and the gonadic for the longer term, though these two hands have to clap together. The proteins are responsible for the enactment of the processes, with the thyroid providing metabolic energy and the somatic amassing storage, so that thyroxine contrasts in a sense with insulin. At the pituitary level, the stimuli seem to be unevenly distributed given the relative number¹⁷ of secretory cells in the gland:

The greatest variability seems to be with lactotropes which presumably respond to the varying intensity of TRH. This pulse generator, by virtue of being composed of a mere three peptides, can be made very quickly. It is not clear from the text in Ganong (and perhaps nobody knows) but I assume that higher levels of prolactin are derived from somatotropes but also from thyrotropes, given that the TRH will mobilise TSH. Such an interpretation would favour the endobiogenic view.

The adrenal gland helps maintain the circulatory volume by secretion of mineralocorticoids and of blood glucose by glucocorticoids, without which human life would simply be impossible. After this primary role of maintenance and survival, the second phase proceeds by seizing nutrient (if supply is adequate and there is not too high a charge imposed by constant stress). The energy for development and differentiation (gonadic axis) is made available by TSH permitting entry into cells of appropriate hormones. Any surplus is partitioned for growth between the two anabolic axes. All of this depends upon the rate of pulsation of the hypothalamic generators: CRH :: GnRH. These are both tuned to circadian rhythms.

Is TRH truly a reactive hormone?

Academic really, when you think of the connections between hypothalamus with the limbic system and also the extensive aminergic and cholinergic circuits of the brain and spinal cord. Serotonin, noradrenaline, adrenaline, histamine, dopamine: they make the other hand clap and the limbs move. I probably haven't answered your question.

There is no life without motion

Perhaps I am stalling because in the next section, I am going to broach the theory of mindedness and the scale of this project embarrasses me, but in an attempt to settle stage fright, a down–to–earth breakdown (of the subject, I mean) might break the ice.

The most symmetric solid body is a sphere and most of us start as a nearly spherical zygote. It becomes geometrically difficult to maintain the size of the sphere as cells divide. Eventually, gastrulation breaks the spherical symmetry and establishes bilateral symmetry in its place. Motion through a fluid requires flagellae, limbs or other projections so even unicellular organisms broke with spherical symmetry. Otherwise living forms would have remained passive spheres wandering through a nutrient field, which is difficult to envisage in a physical environment which is heterogenous and a world which is asymmetric to time. Locomotion by limbs involves the coupling of oscillators that requires huge amounts of circuitry and computational power as we shall see in Moravec's paradox in Section 6.

The spherical sun radiates, the moon reflects. We do not posses their spin but we and all living things are patterned by them. Biological systems are pushed or push themselves as far as they can from chemical equilibrium in order to retain for themselves the energy to operate which cells can only do in the presence of excess or redundant energy: an obligatory operating reserve. These arrangements of symmetry breaking acquire less randomness than exists in the outer world and constitutes a small but crucial bias. This is not a teleological theory but one that suggests that the energy of the biological impulse is carried over to the other spheres of human life, the psyche and the social.

There is no life without energy

Our experiences of colour, sound and time are not intrinsic properties of matter but an expression of our particular relationship with the physical world. These adaptive perceptual modes differ between different forms of life as each evolves along with its ecological niche: our range of hearing differs from that of bats, of vision from that of bees, to take the commonly known examples. Our sense of time is much slower than that of flies and much faster than deep-water fish. It also varies according to time of day, stage of life and according to levels and types of stress, so that everything “slows down” as a calamitous traffic accident unfolds, for instance. An individual's relationship with the tenses of time itself, with past and future is an index of personality that I will discuss more fully in Sections 5 and 14. Time in many ways defines our capacitance.

The interconversions between matter and energy is for physicists. The word “fuel” has no real meaning unless there is a biological (or technological) engine that has an absolute need for one. This is the nub of the meaning of human health, according to the axiom of poise that I want to elaborate in this book. The idea is absurdly simple and obvious.

The very few minutes left to us when we are starved of oxygen provides a vivid reminder of the urgency of fuel which the “life–giver” enables. To enable the fuel to be presented to the fires of combustion, there must always be a supply. If our lives are not to be arbitrary, that supply cannot be broken because the moment we run out of fuel we die. Utterly unlike a vehicle with an internal combustion engine, we cannot be revived if we run out of fuel. There must therefore be some kind of ratio between that in use and that in reserve and if that ratio is altered by circumstances, we must be made aware of it. A drain on the ratio would be a drain on health and generate signs as symptoms as surely as any reflex, the fight or flight posture to take the most obvious example. The preservation of a comfortable reserve—the word is chosen deliberately—provides us with the fundamental capacity for health. If the reserve is threatened or temporarily reduced, we will feel it and, if healthy (and, of course, if circumstances permit) we will have the capacity to redress that balance.

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.