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ОглавлениеSECTION FOUR
Poise as an ecological approach to health
Parallel worlds
We live simultaneously in two contrasting worlds but inhabit only one: we oscillate between them as if they were one. On the one hand we are experimenters and conduct trials in the world to see which ones work or most make sense. In this mode, we devise rules of thumb and engender a repertoire of empirical truths and observations from which we construct the routines of our daily lives. At the same time we may entertain wholesale explanations about the mystery of consciousness and the world it perceives, and may even be urged strongly to a determined knowledge of a world beyond the world we do perceive. Through complex explanations, we create routines in our daily lives which do not derive from the same empirical data that we employ in the other mode.
Presumably we exhibit these two modes because we are both hunters and hunted. Foraging requires a narrow concentration on a precise piece of ground with not only optical focus but also the neurological machinery to act on the discovery of prey or food. This focus is tiny in scale compared with the surrounding environment, whether that be savannah or forest. At precisely the same moment, if we lose awareness of the larger environment, we may fail to notice a predator that is devoting the same amount of focus in stalking us. In successful stalking we must conquer our fear; in evading our own predator we require successful amounts of vigilance and fear. It is a question of scale: by dominating our prey (which might be a speck of seed or a large mammal) we have to assume a larger virtual size; we are smaller than our predator by virtue of being in their sights.
This parallelism gives us larger brains than either our prey or our predator. It gives us our capacity for examining what is or seems to be, and simultaneously our capacity for contemplating what might otherwise be the case, perhaps one of the origins of imagination.
Individuals may develop tendencies in one direction or the other—engineers and priests, but also surgeons and doctors—but most of us contain capacities within us for trends that over time are opposite or at least asymmetric. The collective sense also depends upon a constructed world on the one hand—the built environment and the ordering of social routines—but quite as much a conceptual world upon the other—religious, philosophical and moral dimensions which transcend the empiric and the pragmatic.
Binaries: the garden with forking paths
X or Y? I am not drawing attention to the dual possibility of the sex chromosome but to the notion that each moment in time could be said to be either replete or oblivious to choice. How long is a moment, when do moments amount to an event? These are variable and subjective measures that arise from our situation and may be novel or patterned, intermittent or continuous. Although choice, when welcome, may increase our sense of agency, it nevertheless imposes a load upon capacitance. When there is a clear choice, the fork is binary for which the letter Y might serve as diagram, whether the choice be important or trivial.
When there are more than two choices or when the best course is imponderable, whether the outcome be unimportant or (to pun slightly) crucial, the letter X may signify better.
The human trajectory is a series of moments where choice is automatised, determined by the imaginary track that we follow or are led or driven along, so to speak. But when we pause our automatisation, we seem to stop on the track effortlessly and quickly come across an X or a Y, from where we trudge or stride or venture along what we thought was, and what might turn out to be, a new lane, until a binary Y turns up that may conceal an X. Binary patterns in the world help us recognise ordinary transitions the better to negotiate the Garden with Forking Paths (in homage to Jorge Luis Borges) and thereby give us the time and energy to recognise our arrival at a cross in the road.
Circadian binaries and transition zones
| Early | Late |
| Morning | Afternoon |
| Day | Night |
| Up | Down |
| To | From |
| Dawn | Dusk |
| Embryo | Foetus |
| Womb | World |
| Infant | Child |
| Child | Adolescent |
| Adolescent | Adult |
| Spring | Autumn |
This list of binaries may seem obvious and banal but they emphasise the link between the binary nature of mindedness and the cyclical and tidal structures in which we and all the elements of the biosphere are embedded. Of course multiple choices may present themselves at any presenting juncture or pause, but they represent the elaboration of an underlying branching structure with a binary root, an afferent and efferent pathway.
Monophyletic pathways adopted by plant taxonomy (Section 23) insist upon a Y and exclude anything more prolific than a single fork. I will develop this theme in Multiple Choice in Section 14 and elsewhere.
Symmetry
The mindedness hypothesis is based upon fundamental asymmetries (food and danger)38 against a background which is patterned, which is to say similarly asymmetric (day and night, summer and winter) where even these patterns are variable enough to compromise prediction. Even so, resource availability is inherently unpredictable while circadian rhythms can be quite well known, so the symmetry of opposites is not broken. Developmental binaries in the list above move in one direction and so can never be symmetrical except in the weak sense that old age and childhood share elements of dependence. Even in the long term, there is a clearly distributed pattern of energy and capacitance over the years which at the scale of a long lifetime peaks at the centre either side of the twin slopes of growing and declining capacity.
Symmetry between the two arms of the autonomic nervous system—between the storage of energy and its discharge—provides a critical index of health. The amount of symmetry may be inversely proportional to creativity as defined by the search for new and interesting patterns.
Energy is the key to Poise: storing it and spending it to the extent that circumstances permit and demand. If that is true it shows the inherent absurdity of separating mental and social demands from biological ones. “Circumstances” range over the entirety of human experience. I will pick up this point again from a clinical perspective in the note called Equilibrium in Part Two. In this Part One, Section 4 follows in several segments and elaborates on the model developed in Sections 1–3; the overall model continues in Section 5.
Energy and Matter are interconverted in the ratio that Einstein famously demonstrated. Matter in biological systems organises itself into Informational circuits. These, according to Shannon's Theories of Information, are subject to many of the constraints faced by any thermodynamic system. Energy, Matter and Information are interconversions that stand behind all the operations that are manifest and behind those we select to treat.
It may be that Physics will inevitably rest upon Metaphysical assumption just as the Theory of Evolution by Natural Selection so rests in Biology, even if most of us believe that no more convincing rival assumption can explain the elaboration of the natural world. I propose one such metaphysic that holds binary symmetry to be intrinsic, and states: being cannot exist without non–being. This answers the question “Why is there something and not nothing?” with the reply “There can only be both”. Being goes on necessarily to bifurcate, maintaining binary opposition, symmetrical at first. If it could be explained how and why this should be the case, it would move from metaphysics to physics, if the boundary is really as clear as physicists would have us believe.
Gaia's sister: the biosphere—separations and divisions
Things and events
Where do we draw the line and with what do we draw it?
An arresting anecdote was related by a beekeeper during his talk to a group of herbalists, which I attended. It concerned his school days at an establishment run on strict vegetarian lines where they were told that if they ate cabbage which had inadvertently included a cabbage–white caterpillar, they had not transgressed, for what was a cabbage–white caterpillar other than a concentrated extract of cabbage, the animal's only food, after all. As an omnivore I might have stressed the extra intake of animal protein but a different point of view was being expressed on ideological grounds that inadvertently included another (and this was the point the beekeeper wanted to make) that suggested that the author of a plant extract could be biological rather than technological, or rather, he wanted to stress, what you call a thing rather depends upon the demarcation line that you care to draw. Bees are emblematic creatures to humans, emblems conserved among a wide range of human groups; beekeepers, who take the risk of being stung to death despite their white vestments, are members of their priesthood. The beekeeper talking to us herbalists was quite tentative in his suggestion that honey might be considered a plant extract, even a medicinal plant extract. I was less tentative in developing parallels between our sociality with those of bees. With social bees, the individual dies if the queen dies. To retort that here in Britain we happen to have a queen must sound facetious and puerile because if she dies we do not, and monarchy could be replaced with republicanism or some other system of order. The quip conceals the truism that some social order emerges necessarily from sociality and that political, socio–economic and religious philosophies attempt to codify the nature of the glue that binds people in the face of the perceptions that separate. Without heterogeneity we would not have politics, without cohesion we would not have societies. It is common to speak of social insects as “super-organisms” and quite simple to reject application of this concept to human organisation on many grounds but, as the beekeeper wanted to suggest, what you call a thing rather depends upon the demarcation line that you care to draw and whether you take an exclusively human–centred view of the biosphere.
In its entry for honey, the Penguin Encyclopaedia39 reads “Its intimate association with nature…has led to claims of specific health effects for honey, which are not justified.” The entry goes on to describe the sugar content of nectar, adding “The protein, mineral and vitamin content of honey is negligible.” The writer is very clear where the line for health is drawn and does not mention propolis, nor does it have an entry elsewhere. There is, as you would expect, an entry for Stradivarius who undoubtedly used propolis in the making of his violins. There are entries for wax, bees and beeswax but nowhere any mention of propolis. Now this may just be an oversight, though oversight is not the word commonly associated with the word Encyclopaedia. It may be that because the benefits of consuming propolis to “human health” (which we are trying to get at in this book) is a subject of controversy, the editor of the Encyclopaedia has censored its inclusion. I have never myself made any claims for the benefits of propolis but do think this phyto–complex (operating as glue in the beehive) to be as fascinating a metabolite as other plant products; it is rather like a loose but adherent collection of plant extracts.
Boundary conditions
If Gaia40 is an inclusive analogy between the physical world and the biosphere, living systems nonetheless quite evidently border upon non–living ones. At the system level, the boundary itself may be composed of intermediate boundaries and the number of these will contribute to the breadth of the boundary zone. In some ways all intermediates between extremes constitute an extended boundary: the differences between mountain scree and lakes, bogs and deserts, woods and meadows could be designated by the number of steps that separate them.
The interconnected-minded matrices in any system, the human body for example, show changes near a boundary as they are constrained by chemistry to give up the properties of one region for those of another. They do so for thermodynamic reasons if that is the basis of all organisation, the line–drawer in effect. We experience a world of objects and also processes: the tree, the leaf and the effect of the breeze moving within these objects. One could materialise the wind to air, but rather it is a movement through the material. Given enough time (and with nothing better to do), an observer could witness the emergence of the shoot from its bud and its subsequent decay on the forest floor, to look at a relatively short cycle. Even our perception of objects is a convenient shorthand for manoeuvring through the world: objects are processes held together in one place for an arbitrary length of time. Although it would be pedantic and pointless to draw attention to this in daily life: to insist that in reality there are no nouns, only verbs (no leaves, no trees), that things are clusters of events and will eventually disperse, it does have better meaning in biology where bordered states define the entity, always a temporary affair. An isolated border is sterile in the biological sense, meaningless on its own, soon dispersed.
All life takes place on or close to a membrane: without such a structure the differential chemistry of life could not proceed. Bounded states are essential to charge separation and the storage of energy: the boundary resists its dispersal. Time is the measure of change in both Gaia and her younger sister.
Circadian, seasonal annual and epochal phases show state transitions rather than physical boundaries (dark to light, hot to cold, young to old) and help us envision our lives, our own personal sense of a continued self. The tellers of continuities at the larger scale of human history, the continuation of the generations, may construct boundaries to imply that forces that temporarily unite are as inevitable as forces that separate.
To transpose from political history, the fate of the ancien régime of Early Modern France or that of the Austro–Hungarian Empire that ended with the assassination of the Archduke Franz Ferdinand and his wife could be read with hindsight as a study in ecology: the existence of boundaries that contained for a while the flow of political, economic and social energy. Unlike biological systems, competition tends to win over cooperation, at least in the long term and on the larger scale. The Kings and Archdukes may be seen as fossils of history but are embodiments of an “old order” which had not the capacity41 to preserve its life. The guillotine and bullets which pierced the living boundaries of individuals unleashed the stored capacitance for competitive aggression on the largest human scale. As has been pithily remarked, the lesson from history is that we do not learn the lessons of history.
The distinction between a historian and a personal historian (the patient and the doctor) is that, in medicine, we use the past to alleviate the present and hope to alter the future. It is helpful to recognise that phase transitions in the patient's life have become boundary conditions where previous capacitance no longer holds.
Bounded states
Specialisation, which I seemed earlier to deplore,42 is of course necessary to the examination of detail that no generalisation can hope to accommodate. This book needs to be generalist because of its subject: integration is the basis of health. At the level of detail all manner of inconsistencies and even contradictions will inevitably occur which the specialist will condemn if he could so be bothered. The most perilous territorial waters for the generalist to navigate are those of medicine and science, though even the humanities may sneer at the interloper. All humans owe science a debt if only because the technologies that created the modern world are dependent upon the experimental method, but that method did not of itself create the techniques of modern surgery with anaesthesia. Good observation tested by rule of thumb of practice can foster progress if the cultural climate permits it. Professional opinion usually resists change until the borders of the paradigm are allowed to shift. Medicine is not unique in this conservatism. The purview of what constitutes the medical endeavour has now become too narrow and too broad, failing to recognise that people without disease may become ill. The medical industrial complex exerts considerable political pressure over those who resort to untestable modalities for relief. Science and Medicine are inevitably entangled but not really equivalent constructs. Medicine has evolved a taxonomy of disease from clinical observation and historical accident but such an enterprise can hardly be equipped to help people move towards a state of poise. Herbal Medicine (beyond the testing of drug plants and known active compounds from plants) is not easily amenable to testing by the scientific method. This expresses a regret, not a defiance of the paradigm. The Bio–psychosocial model of health links the biological facts of the inner mindedness with the social space which humans must occupy in health. It has been castigated as “one more disingenuous euphemism for psychosomatic illness”.43 It is difficult to avoid the suggestion that two separate classes of illness are conceived, and that a potent driver of the classification is financial and economic, driven by fears of unsustainable claims on health insurance. While it would be wrong and naive to suggest that the huge drains that disease makes upon public services could be better served by some rhetorical device instead of well–tested strategies, it must equally be said that over–extending the biomedical model—for which the scientific method is poorly adapted—does nothing for those who escape the narrowness of the definition. In fairness to McLaren, who spoke as a psychiatrist,44 he criticised the originator of the model (George Engels, also a psychiatrist) as presenting a model which could not lay claim to the scientific method, but accepted that it had merits in its ethical approach. Herbal medicine does not make claims on the insurance sector. As its practice is banned, limited or otherwise constrained in many parts of the world, the ideas in this book can hardly be seen as a threat to the pharmaceutical or medical industries. There are no ports or shores for a contemporary Mayflower to head for, so it befits us to develop explanatory models to help us envision the way we can best help alleviate the illness of our patients, whether or not it stems from disease, and help them towards greater health.
I take a break from these latter remarks lest it seem that herbal medicine is besieged for its lack of science (or that I have forgotten the invention of the paragraph). I assume that no practitioner of medicine would disparage the scientific method. Good scientists do not apply it to questions that they consider better answered by other means. The psychosocial model has been addressed in different modes and at all times by narrative and dramatic arts, music and architecture and by visual means, figurative or otherwise. Good medical doctors have always known this, but the discovery of antibiotics has led to some unkindness towards patients who are difficult to treat. At the heart of the ubiquitous use and abuse of powerful pharmaceuticals in the treatment of functional conditions lies a kind of mental laziness and an obsession with applying the scientific method to complex problems that are beyond its province. Punctilious search for evidence may seem punitive outside a laboratory, or a criminal court. No doubt this is an unintended consequence of the idealism behind the provision of affordable treatment for all, but the power over the practice of medicine exerted by the state and the power over the state exerted by economic interests has somewhat placed other approaches under siege. People who are ill need to be looked after irrespective of the medication or other intervention offered them. They need also to be freely communicated with in an individualised manner without condescension or rudeness: it is easy to patronise or infantilise those who are not overtly paying for services at the time, to describe their predicament only in generalised terms or even to refuse items or modes of information or communication that would be normal and to be expected in other transactions. Besides, the healing power of kindness is inestimable.
Where do we draw the line and with what do we draw it?
Physiology is a description of processes while pathology is a description of the malfunction of those processes. The line is not so easy to draw: the body resolves local damage to tissue, or conflict with microorganisms principally by the natural process of inflammation, essential to normal functioning. Medicine as a theatre where inflammatory and other processes are pushed back to normality is a necessary and universal social undertaking. If not abused by power, its operations are benign and involve a great many people in cooperative and life–enhancing altruism. We can see a clear distinction, however, between managing someone whose vital functions are broken and helping someone manage. This margin drawn between remedial medicine with all its inevitable generalisations and a medicine that seeks a more adaptive state within the terrain will not help the patient if it creates any separation in his sense of self. Nor will the practitioner of terrain medicine do so well without the benefits of scientific testing, and should be grateful when investigations are helpful.
To peddle remedies without knowing the recipient well (or even at all) is, putting it most charitably, to make a generalisation based upon commercial considerations. (Orthodox pharmacists know this and are prompted by social concern and are part of a medical enterprise; the same cannot be said for internet traffickers.) The distinction between an effective remedy and a bogus one is clearer to make when one is marketing it as a commodity. The commodification of health is ancient but in modern consumer society, the medication becomes pivotal in the nominal association between disease entity and its remedy.
The freely engaged consultation changes the whole approach to medication. It sets in place a social contract based upon goodwill and Hippocratic maxims with the hope only of a good outcome for both parties: providing help and hope to one and a fee and the reward of reputation and esteem to the other. I do not wish to imply that the consultation permits and even sanctifies the administration of ineffective remedies but that, as herbalists prescribe personalised complex mixtures, these do not easily submit to testing of results in the way needed and demanded of pharmaceuticals. They do, however, admit to generalisable concepts, to clearly defined intentions: to modify the present ecological states of an individual with respect to their evolution. We should, it goes without saying, draw a line that excludes treatment strategies containing counterfactual elements or defy facts that science says can reliably be known. We are all in the position in this miraculous life of acting effectively in the unknowable but that does not give any honourable practitioner a passport into arbitrary nonsense. Many of the plants used by herbalists show promising, reproducible properties when examined and have led an anecdotal life for many centuries, millennia in some cases. The whole of phytochemistry is coherent and plausible. Indeed, to take a view that plants have no physiological effects and therefore potential medicinal benefits is an implausible belief showing an unscientific amount of prejudice. We draw lines with our beliefs and recruit those facts that suit us to endorse those beliefs and discount those that might show a bias in a different direction to the one we wish to pursue. The act of separation—between sheep and goats, as it were—is always rhetorical even if the facts themselves were unearthed by the scientific method.
To summarise my attempts to draw the line I would say that disordered physiology very commonly leads to illnesses which are not themselves signs of disease and that pathological disease, the other way around, inevitably does lead to disordered physiology. The principal exception to this concerns infectious diseases where the individualised approach has a subordinate place in their management, especially in epidemics. Herbal remedies may be palliative and even helpful in sustaining the person who is ill from infectious disease and help the terrain mediate its course but have little if any influence on the infective agent. Aside from the incalculable benefits of antibiotics, anaesthesia and some of the newer disease–modifying agents, modern medicine should face its limitations, which means we all should face them lest hubris force itself upon us. The line drawn between cure and failure is most arbitrary when palliation or the induction of remission is all that is hoped for, even when the classification of the patient's condition is not in doubt.
From an epidemiological vantage point, while the statistical method is needed for treating populations, the individualised approach defies analysis. Even then, the use of rigorous historical analyses takes almost as long as history to evaluate and to develop hypotheses, and these are too dependent on inference to fully satisfy the scientific method.45 The line drawn between History and Science, each depending upon different notions of evidence, is a territorial one. While the patient's history may be all important for the holistic herbal practitioner, that bias does not constitute a refusal to recognise the powerful analytical tools provided by reductionism. Conversely, those epidemiologists who postulate that the evolution of disease is unique to each individual have grappled with limitations in statistical methods in their search for an expression of the uniqueness of an individual's evolution and response.46
From a clinical perspective, the individualised approach starts from the common-sense view that humans are primarily expressive, and will always return to this primary signifier. Loss of function turns to the technical capacity of the patient, thence—and this is the purpose of the assessment—to the biological source of any loss of function or fall in well-being. The critical position taken here hinges on the clinician not drawing a line: just as the matrices are interdependent, the evolution of the psychic and physical, social and emotional states constitute the loss of poise. These two phases are interlocked with the biological in the way figured by the Manx triskelion. Whichever leg seems uppermost, a simple rotation will engage the other two. This interdependence cannot be fragmented: no change in any of these states can occur without a concomitant shift in all the matrices, at every level, distributed across a wide range of tissues.
Only when this open space is revealed in its three aspects—expressive, technical and biological—can the clinician assess whether some degree of specialisation may be required, though there is also a duty (quite aside from legal and ethical considerations) to ascertain the extent to which a patient is already a refugee from specialists. I have seen so many circular referrals to one sub-specialist after another where a general practitioner has been engaged not so much in a washing of hands but rather in the fashion of a desultory ringmaster. Diagnoses and interventions of a specialist, whether physical, pharmaceutical or psychological, are as likely to be over-described but poorly defined. Of course the therapist must always be aware of the challenges when treading close to the edge of her or his field, and be on guard against vanity masquerading as power of discernment. The courage shown by an individual patient or practitioner is usually greater than an institution but, against that, a committee is less likely to exhibit foolhardiness. Specialisation is in some ways equivalent to scale on a map, or to the detail revealed by the size of magnification on a microscopic slide. Moving over an ecosystem, you can concentrate on one element or its subdivision. The unit under discussion then has a name and a gradation: the cabbage on which the caterpillar grazes and the other grazers in the open field and the distinction with its borders and other natural lines that describe the landscape. One can move from meadow to stream, from wood to hillside and notice the distinct changes and the different experiences these changes engender, having changed the scale but without altering a sense of the whole.
Of course there are edges to things and events: the words limbs and limbic attest to their position at the hinge of some other structure, but the whole point about the interconnected matrices described in previous sections is that no line can be drawn between them except temporarily for the artificial purposes of exposition. The greatest biodiversity occurs at boundaries.
However convenient it may be to think of the body as a discrete object, an entity, it is more appropriate to think of it as an ecosystem, sterile only in parts. Even self–embodied elements in the blood, such as white blood cell populations, respond in part to the outside world as it presents to ducts in the skin and mucous membranes of our exposed digestive and respiratory organs. Nor is sterility the point as the mucous halo surrounding the ovum as it waits to be fertilised negotiates with the sperm to choose the next incumbent of the attendant womb. When the body is considered to be a collection of ecosystems, with organisational compartments that are fully porous, the introduction of complex material from a plant, which is what happens every day with food, would seem to an unbiased mind an obvious source of primary medication that will easily move in and between the matrices.
Essentialism
Even though I have used the word “essential” several times so far, I have used it to mean absolutely necessary to a process or an entity. I use the word “entity” because it is crucial to our survival that we recognise things, living and non-living, as discrete objects that we will have to negotiate: not bump into, trip over, be eaten or ostracised by. At the human scale, objects and beings are separate, and it would be pedantic to speak otherwise. “The world is so full of a number of things, I'm sure we should all be as happy as kings” wrote Robert Louis Stephenson, half ironically. Our world of things is so obvious and commonsensical that daily life does not stop to question it in the way that philosophers must. Their search for the reality “behind” appearances is one that consumes not just philosophers but which we delegate to them, to scientists and to the tenets of religious and other beliefs.
At the scale of deep time, Darwin's Theory of Natural Selection shows us that all beings emerge from previous forms. These slow transformations disabuse us of the previously held Platonic notion that everything that has being exists in its essential form on the plane of the ideal, a kind of ever–present afterlife. Plato deepened the division of realist and idealist with which Christians, including Darwin, have since had to contend. Darwin is the great example of observation being the handmaid of good science, philosophy, art, medicine and living. His observations were made in conjunction with the astonishing laterality of the discoveries in animal, vegetable and mineral forms catalogued by Louis Agassiz (1807–1873) and other adventurers like Alexander von Humboldt (1769–1859), Baron Cuvier (1769–1832) whose five forenames I'll not bother to list, and the extraordinary family of botanists, naturalists and philosophers led by Karl Schimper (1803–1867).
It is perhaps worth also reminding ourselves that misogyny and sexism, racism and supremacist ideas are all examples of Essentialism. In this context, all these kinds are, as Adam Phillips puts it, mystery–mongering.47
Essential can of course mean necessary to, for example, petrol (essence in French) is essential for an internal combustion engine to operate, and when lawyers stipulate in contracts that “time is of the essence”, you can see how easily one slips into essentialist mode in the Aristotelian sense of something being necessary to being called that thing, in contrast to the Platonic idealisation of the essence of a thing. Lemon oil without any limonene is unlikely to be recognised by the nose but “essential oil” was an unfortunate choice. Intuition founded on the physical leads one easily towards analysis and discovery, but this materialism does not at all exclude transcendence. Let's not have more false distinctions.
Soil
Soil is both generator of and receptor to life, a matrix with a permissive, enabling role. Contemporary conservation in these latter days of assault on Gaia tends to focus on species and habitats but, and the following point was brilliantly illustrated by Timothy Walker,48 the most durable repository of terrestrial life is as much the soil as the species that inhabit it. Soil is a macrosystem that generates microsystems: a matrix of air and moisture creates an almost infinite web of small scale enclosures.
The human terrain—the inner landscape—is analogous to the soil in that it expresses the web of material relationships that permit life to manage itself and thrive, but the limitation with this metaphor is that the soil itself is a product of natural forces and is almost the glue that binds together species of all realms. In this relational sense, terroir as viniculturists call it, might be a better analogy for terrain. Certainly, plants create and need soil not only to thrive but to maintain the other members of the consociation of their niche and of the larger associations in the ecosystem they inhabit.
As plants evaginate their structures to extend outwards into sunlight and air, and animals invaginate them to protect their metabolic processes from too much oxygen and ultraviolet, the congruence of the metaphor holds if we consider the biome of our intestines to be our soil on which our inner landscape subsists. My notion of the matrices could simply be stated as internal ecology.
Recently, a patient asked me for help with recurring cholecystitis associated, as you would expect, with gallstones. Her naturopath had asked her to test her thyroid function in case it was involved in her associated fatigue. Well, of course thyroid function would be involved just as the condition of any soil and the stresses experienced by its plants will be affected by recent rainfall and wind compared with the average. Measurements of transient conditions may confirm your expectations but offer little if any aetiological insight. As Dr Duraffourd has pointed out, a blood test shows how much thyroxine is in the blood but does not tell you how the terrain maintained those norms, nor where the costs were sustained. A terrain, like a soil, is the result of a web of dynamic relationships that change as the day, the month, the season wears on.
Gaia's children: fauns and fauna
Biotic factors as much as climate create the soil, which creates in turn the conditions for most land plants and terrestrial animals to survive and prosper. The larger the fauna, the more they impose upon Gaia. The greatest imposition is the built environment because it is not very quickly recycled and resorbed into the ecosystem, liberating its trapped but unusually degraded resources. Leaving aside bees and beavers, the special human capacity for technology and our use of metaphor create marks on the landscape that are lines of distinction, not those made by pathways. Trade routes followed geographical imperatives until the recent human past.
If the concept of the Interconnected Matrices49 is accepted, human behaviour emerges from and reformulates the matrices upon which our life is built: it declares simply that axiomatically, life cannot be disconnected from its origins in space and time at any scale or any level of analysis. There may come a point, however, when the invention (though it emerges from the matrices of human life) has become detached from it with a life of its own, or at least effects upon Gaia that she cannot readily absorb. Is it meaningful to speak of culture as a matrix? Clearly it derived from human life and has no independent existence of its own, but a line of demarcation exists between its artefacts and the biological and psychosocial matrices that gave rise to them. An example close to our physiology is the distinction between music (the stuff people make and engage in) and musicality, the propensity for humans to make music as a consequence of neuro–sociology. Apart from the voice, musical instruments can only count as inventions. Steven Pinker has marshalled sophisticated arguments to claim that even vocal music is a cultural invention: like literacy it answered a need but was not itself an evolved faculty and became universal only because of the pleasure it gave and the cooperative spirit it engendered. Stephen Jay Gould and Elisabeth Vrba coined the term exaptation to denote this link between functions that were not primarily evolutionary and the inventions that emerged from such inventions. Gene–Culture Co–evolution theories would argue that in any case, there is a feedback loop between human inventions and the biology from which it emerged. The concepts of Mindedness (see Section 3) and the interconnected Matrices are congruent with this view. From neurological evidence, music has many integrative functions (such as grasping and climbing) for the musculo–skeletal matrices.
I would go further and hypothesise that music functions as:
• A necessary primer for language and provides the trigger for the germination of the seed of linguistic grammar and the emotionality of communication
• A necessary primer for the integration of movement, both for upper limb grasping and the alternation needed for bipedal walking, standing, twisting and turning
• A source of pleasure to allay the fears of us as a prey animal and to encourage social cooperation as an adaptive tool for a weak but clever predator
• Preceding the Tower of Babel, it mimics aspects of the human voice and communicates effectively across barriers of dialect.
The ubiquitous nature of music in adult life is matched by the universal exposure of babies to music, and the special way we speak to babies—and this is not only a parental impulse—has many elements of music that would be out of place in normal speech and do not of course have lexical or logical intention. These include repetitions, rhythmic movements with a constructed sense of timing and a deliberate change in pitch and timbre that has no semantic intention. It is not utilitarian speech. Adaptive deficits are seen where there is a profound absence of musicality, which is highly suggestive that musicality precedes music as an artefact of culture, though of course it is an important non-verbal marker of cultural identity.
The reason for including music here is that, if musicality connects deep structures in our neurophysiology, then the great therapeutic value that is actually found will surprise no one and should be in the back of one's mind when evaluating the health of our patients: both as a diagnostic criterion (rhythms of life and discordance within) and even as an adjunct to prescription by way of recommendation of a musical experience unknown to the patient, or even a referral to a music or movement therapist.
Music, like the pituitary gland, contains both vertical and horizontal axes: the harmony of the moment depends upon vertical (stacked, simultaneous) relations while rhythm can only be extracted along the horizon of time. Music conveys simultaneity and sequentiality in a single passage. Scales reflect the relativism of pitch and the direction up or down. Harmony and rhythm fill in the clues across. The scales within the neuro–endocrine matrices are driven by the hypothalamic pacemakers that respond in turn to rhythms of life, those expected and those that are puzzling.
If this sounds like an over–extended metaphor, consider the uniquely human ability to recognise transposed pitch, enabling us to translate intact between child and adult, male to female and back again. Language depends absolutely on recognising the signal from vocalising structures of very different sizes. If language were only a logical structure, it would not so easily contain the emotionality required for bonding between parent and infant and between members of the same group. Music provides the immediately recognisable emotionality to the communication, and therefore to the quality of the communication. Musicality connects our social and psychic selves and, through rhythmic movement, exercises our technical capabilities. Music itself leads to technical invention, hence reinforcing human development as technological beings.
Separations and divisions
In the domestic sphere, whether an item separated from food in the dish ends up in the stockpot or on the compost heap will involve various types of discrimination.
From an ecological perspective, what you call an area rather depends upon the demarcation lines that you care to draw and whether you take an exclusively human–centred view of the biosphere and see us as the delinquent children of Gaia's sister, or rather that you dissolve separations into transitions for most functional purposes. The boundaries that permit the accumulation of energy that all life needs for its persistence must remain porous to exchange. This part has touched upon the discontinuities between habits of mind and the spaces they inhabit. Let us now move on to continuities within and without the human terrain.
Fixation
The human triangular
In the simple geometry of planes, a line may demarcate but cannot enclose space: you need more than two and at least three lines. After the triangle, a series of polygons succeeds, starting with the square. We use such geometry in the technosphere because it is difficult to build even a temporary shelter without approximations to straight line geometry. In the biosphere, more precise geometry is possible from the hive to the shells of molluscs. At least on the material plane, the triangle is a stronger and more rigid structure than a square, and is integral to the geodesic dome and to the wonderfully stable tables made by furniture designer and maker David Colwell. These artefacts are made on principles of tensegrity, and follow structures found in nature. Molecular bio–tensegrity has been used to explain the formation of cytoskeletons and the helical structure of DNA, and to the spontaneous self-assembly of proteins, and even organs. Quadrilaterals provide useful intermediates in natural structures and endow modular structures with flexibility besides being needed for standing beside walls and the cubic storage needed by our uniquely acquisitive species, whatever Rudolf Steiner had to say about straight lines.
Triangles may also have greater conceptual strength than the quadrilaterals favoured by ancient humoral theories where the relative quantities of the four “elements” are indeterminable. In Axioms (Section 2) I proposed that to understand the health of an 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.
This concept of the human is founded upon the triangular relations between bios, psyche and the sociolinguistic being. While you might say that a societal being cannot exist without biology, a non–social human being cannot partake in human life; nor can you operate socially without a psyche. So much is obvious, yet we partition our physiological medicine as if it operates in a different sphere to the psychological and sociological. Only when physical health cannot be adequately explained by medicine do we call in the experts. This partition is based upon an absurd separation of the primordial triangular functions of humanity and reduces it to a mere division of labour. (See also Triangles of Identity in Section 17.)
Oscillation
A good deal of the nearly 70% of water in the human body contributes more to colloidal systems than to solutions. The sol-gel ratio inside cells is not only variable but may oscillate and so propagate a weak wave of the type that Wilhelm Reich claimed to see. Although his methods and findings have been discredited, that is not to say that he observed nothing or that all of his observations were artefacts or entirely delusional, but they were not what he said they were. Biological systems can only take up an intermediate position between fixity and fluidity. Rigidity obstructs flow of material and information (and surely Reich was perceptive about the armoured character of rigid resistance against the soft pulsatile signals from the sensorium), while Fluidity needs to be contained to be effective. Constraints allow us to optimise our potential.
All biochemical reactions are initiated in solution close to or upon a membrane. Even the membrane itself is a colloid of different and denser material than the cytosol and often behaves like a complex mixture of hydrogels. In the extracellular matrix, materials are both manufactured and broken up and the degradation products enter the stream towards their expulsion by the emunctory organs.
Fixation
The chemical nature of colloids is triangulated between hydrophilic and hydrophobic macromolecules and smaller solutes. The fixed oscillation between sol and gel depends upon circadian and the other tidal rhythms but a huge amount of stochastic variance operates as a response to external challenges and environmental pressure. Although bone cells have a constant metabolism (even if slower in turnover than other tissues), it is reasonable to describe them as permanent and persistent in that they may be observed by archaeologists many millennia after death. Ossification requires that minerals come out of solution to form tissues that give us enough rigidity for locomotion while conserving elasticity for adaptability to diverse types of ground.
Differentiation is necessary to multicellular life and separation of ions with different resting potentials enables the propagation of a wave. Just as a membrane allows cellular functions to proceed unhindered by the different environment of the surrounding fluid, animal speciation itself erects genetic barriers to allow experience to accumulate effectively and prevent a world of memory-less hybrids. The situation is much more plastic in plants but then they have only two food sources in the atmosphere and strive to bask in it rather than extract it from the biosphere.
The three tenses of time categorise personality as I discuss in Sections 14, 19 and elsewhere. At the larger scale of a population, the length of the present is arbitrary but could be said to be as long as half a generation, a nominal 14 years. Humans as with the other large social animals are unusual in having often three generations living together at any time, unlike the majority of animals that die at menopause. The personality of each of us reflects our development, the bios of which is relatively fixed though still contingent upon uterine life and the accidents and incidents of early social and family life. The psyche is reformulated at puberty but with material from the previous phases. The separation in time between the generations is variable within a fixed range. Our experiences with other members of our cohort may serve to strengthen this separation, depending upon experiences with our peers. The bonds and the conflicts in the vertical time series preoccupied Freud almost to the exclusion of the lateral relationships between siblings, cousins and contemporaries. As we move along the escalator (up or down depending upon our age), as our sinews desiccate and our capacitance lowers, we choose, in the face of inevitable change, to fixate on previous sources of comfort and relinquish our grasp of others.
Resistance and submission to ceaseless flux may be an index of personality, but it also consumes generations and societies. The attempt to fixate structures that will persist and not be eroded by time drives the resistance to cultural change but also motivates the less conservative artists, designers and authors, more so the male as we cannot give birth and nor can we have the certitude afforded by maternity. Writing creates stones out of words. Even stones weather, mostly by water: the “element” that gives life removes any possibility for permanence.
If the egg from which we sprang was made by our grandmother, and her by hers, we have direct biological input from five generative pairs. We might add their eight immediate progenitors, but beyond them the ancestors are too numerous to ascribe any real biological influence on ourselves, and certainly nothing of our culture, leaving aside the fantasy of aristocrats. Our children are the only contribution to inheritance. Yet, as they age, the power to influence their behaviour diminishes and, even with arranged marriages, our unique identity is soon dissolved and merges with the ocean of humanity. We cannot even know anyone beyond our great–grandparents and great–grandchildren.
Human psychosocial life is faced with an analogous challenge between preserving modes of cultural life that confer identity and provide comfort against the inevitable transitions of time, to say nothing of external threats. Small wonder that religions have evolved books to resist the deformations of time. Circadian rhythms provide the only stabiliser of flux in biological life from which psychological health derives. Cultures codify days, create weeks and determine a social response to season.
Poised as we are between past and future, any clues with predictive value will aid survival if stored but will lose that value if fixed. Cultures are less fluid than the families, peer groups and individuals that make them up and seem pained to understand that while substance remains, it is dissolved and reformed at each generation.
War, famine, pestilence, disease and mere unhappiness have kept doctors and priests busy for millennia. Natural philosophy has skirted around the great scourge of mental illness if it has considered it at all.50 Philosophy in its practical discursive sense as elaborated by some of the less dogmatic but strongly principled practices of psychotherapy have developed positive insights into our psyche.51 An ecological approach to health separates only briefly if at all the psychic and social territories from the biological source of existence. Medicinal plants are unique in sharing their biology with us; as for the psyche and the social context, the herbalist has the choice to rise to the challenge.52
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38 Although there may have occurred in evolutionary time, a progression from grazing to scavenging to death to predation, no successful progression can have happened without the concurrent preparatory development of the enzymatic and structural matrices.
39 Ed. David Crystal, Penguin Books 2002.
40 Referring to the Gaia principle formulated by James Lovelock (1919–), co–developed with Lynn Margulis (1938–2011) but fully anticipated by Alexander von Humboldt (1769–1859).
41 See Capacitance in Section 3, The biological basis of the adaptive response.
42 In Split Personalities in Section 2, Axioms, Theorems and Ideology.
43 McLaren, N. “The Biopsychosocial Model and Scientific Fraud.” Paper presented to RANZCP Congress, Christchurch, NZ, May 2004.
44 Revised version: “When does Self-Deception become Culpable?” Chap. 8 in McLaren, N. Humanizing Madness: Psychiatry and the Cognitive Neurosciences. ISBN 978-1-932690-39-2.
45 E.g., the Thrifty Phenotype hypothesis promoted by the epidemiologist Professor David Barker formerly of Southampton University (Bibliography).
46 E.g., Dr Christopher Wild 2005, Complementing the Genome with an “Exposome”: The Outstanding Challenge of Environmental Exposure Measurement in Molecular Epidemiology; Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, co-sponsored by the American Society of Preventive Oncology.
It must be said that he was talking about the disease of cancer not about illness.
47 Misogyny, in London Review of Books, 41 (5): 5.
48 At a meeting of the Linnean Society of London in June 2015 entitled Plant Conservation—now is the time to change our minds. Former director of the University of Oxford Botanic Garden & Harcourt Arboretum, he was involved not only in species recovery programmes for both native and exotic plant species but also in the restoration of native habitats. He says, paraphrasing Norman Borlaug, another ecologist, “For too long the conservation of species has been focussed, to the point of obsession, on conservation of plants in their habitats. If the measurements of species extinctions are believed this is not working. It can be argued that now is the time to separate the conservation of plant species and the conservation of ecosystem services.”
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.
