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SECTION SEVEN

Health and poise

The Hippocratic innovation viewed illness as an ecological distemper and not, as had been previously believed, the failure to pacify the gods. Medicine nudged its way into the priesthood. One of the unfortunate outcomes of humoral medicine concerns the assertion that environmental qualities like heat and damp are intimately connected with human health, an anthropomorphic construction projected upon the visible world. Typologies of human character—derived from the elements—were essentialist: constitutional flaws led inevitably to certain kinds of diseases. A hierarchy of good and unfortunate dispositions from sanguine to choleric was created. The four elements⁹⁴ were considered material in this scheme: qualities of the seen world were linked with observable bodily fluids. A smaller, materialist pantheon gave doctors power to intervene in human life rather than mediate as priests had done. When medicine failed, however, these humours proved as irreducible and ineluctable as the gods. Humoralism made the caprices of the pagan gods somewhat anachronistic by Galen's time, whatever the pieties to be observed, and was successfully incorporated into the monotheistic schemes of Christ and Mohammed. Even in the modern period, it survived: when Harvey, building upon the work of Italian anatomists, demonstrated the circulation of the blood in 1629, he continued to look backwards and remained a Galenist.

At this same period, the development of the achromatic lens revealed to physiologists an ecology within the microcosm that had previously been limited by the resolving power of the lens of the human eye. As the scales of time and the cosmos deepened and that of the human cell shortened, medicine was forced from synthetic systems to the cataloguing of this new rich world of detail. The subsequent rise of biological medicine in the two centuries that followed tended to separate the material agents (especially the infectious ones) from all other human experiences, giving rise to orphan, caretaker roles like psychiatry and the budding of psychology and sociology away from medicine and, most curious of all, tended to separate medicine itself from biology and drove in deeper the wedge between art and science.

Human life is known to its particular resident by the continuity of consciousness. If life is a state series, coupling events out there with experiences in here, the physics and biology out–there must interact continuously with the physics and biology in–here. To report a state of illness, it must be reflected, even if dimly, in a conscious state. To discover a disordered physiology incidentally before it manifests as an illness (as biological medicine is able to do) is to practise a modern form of augury. That capability of medicine does not detract from the existential nature of illness nor does it explain the subjective nature of wellness which surely is a positive feeling rather akin to that promoted by the World Health Organization. Perhaps I should just call “Poise” “wellness” and have done with it, but this latter idea, though so immediately appealing and understandable, may sound like little more than a successful pacification of the gods. I wish rather to integrate it with the biology on which it depends and upon relations within all the other human spheres.

Some definitions of health

In the first paragraph to this book, I described Health as a euphemism in the literal sense but perhaps it is better to call it an aspiration. To what, and how to restore it? These are the questions I am trying to address. The definition made by the World Health Organization (A state of complete physical, mental, and social well–being and not merely the absence of disease or infirmity) was certainly aspirational but did not take the trouble to suggest how that goal might be achieved. The who implied that political and social stability was necessary to personal well–being; however, the social health of each individual emerges at a much smaller scale and might be as easily constrained as enabled by the prevailing culture: the struggle against parental wishes and trends is not just the prerogative of the artist.

Health is, of course, the aspiration that unites nearly all people. We wish people happiness to go with it: I am sure there must be a clue there.

Whatever our circumstances, what can we really claim as our own? Our consciousness, our bodies, a sense of comfort. If these are disturbed we have lost our greatest possession and so cannot claim to have health even if we are fortunate in our material circumstances and our relationships. We may have more than we had and hope to have even more but more alone will not restore well–being. The key to restoration (when we lose it) involves our access to stored energy, the fundamental basis of biological life.

Metabolic systems work effectively only when there is inbuilt redundancy. This derives from Shannon's theory of Information which in turn follows from the laws of Thermodynamics. In another field, it will be obvious to those using computers that the size of a file has to be larger than its data because extra capacity is needed to store it and to interact with the storage device and external media.

The ability to store and to retrieve energy is fundamental to health and can be improved and enhanced at the neuroendocrine and at the organ and system levels by the use of medicinal plants in the context of a trusting therapeutic relationship.

The model I have developed in this first part seems complicated only if we think we are not. Experience has shown me that without a model, a theory of cure, medical practice and the outcome for patients will tend to be haphazard. Retaining confidence in your model as you subject it to daily scrutiny, without losing either faith or the habit of scepticism, provides a good ground for clinical excellence to develop. The model must also mature towards simplicity without losing sight of all the complexities.

The calculus of poise

The informatic output of a system is obliged to be larger than the system itself. Shannon's theory of Information tells us that the inbuilt redundancy of a system cannot exceed certain limits, which is another way of saying that if we interconverted information and energy, reserve beyond a certain level is a hindrance, and below it the system ceases to operate effectively, if at all. The ratio between the system and its reserve is not a fixed amount but will return after excursions to a characteristic ratio and so can vary within the expression of its means. To take a well–known example that occurs widely in plant forms, the output of the fractions expressed by numbers in the Fibonacci series starts widely enough, at 0.5 but never larger, and converges rapidly to the Golden Mean. Actually, random numbers will also converge, but less rapidly.

Increase in the complexity of a biological system (like us) leads to a robustness in the face of environmental chaos. Redundancy has the capability of optimising plenty and accommodating to scarcity.

Development (the opposite of envelopment) and evolution (rolling out) are roughly synonymous (though French doctors, I notice, are more likely to speak of the evolution rather than development of a condition). I think it is helpful to bear both nuances in mind when discussing health. Development of the individual mimics evolution in that the person cannot choose the environment exactly, but the uterine environment, where the initiation takes place, has already been chosen by evolution, both of the species and the germ-line. The conceptus has to choose a response and the quality of that response will modify its development. Unlike evolution, there already exists a plane—a landscape already grooved by choice—a finitude of possible forms defined by mother and the child's unique novel genome. The metabolic repertory of prokaryotes, by contrast—an almost infinitude of possible forms—allows them to generate new beings every 20 minutes or so but not long enough to create a more complex body. Our metabolism—less inventive and therefore more vulnerable to random variation—cannot be completely stochastic: it has to have some unidirectional patterning. That is the point of life: reacting to a random world, but not blindly nor unaided.

As I shall try to elaborate in later sections, patterning—both inherited and adopted—frees us up to respond to chance. Although this is a narrow binary choice (odds equally for and against a benefit) a rapid succession of choices creates a pattern of our own making and offers us the opportunity, slim as it may be, to avert our own imprisonment and to make the best of what comes our way and what we have. That may not always be much but it is what we have and constitutes our capacity for health. We can augment this by the six or more nurtures. Furthermore, medicinal plants allow us to improve our capacitance and so increase poise.

Mindedness, which I described at the start of Section 3 as both product and producer of the circularity and recursiveness of Life, is a turning towards and away from the fundamental binary in life. This tropism is seen most easily in a unicellular organism as it turns towards areas of higher nutrient and away from inhibitory, toxic zones. It has a mind to do so, hence the invention of the name. As any system gets larger and its informatic output increases, the ratio between available information/energy is conserved but the size grows accordingly as does the buffer.

A buffer functions to smooth out delays in processing capacity (or capacitance, the fourth of the five interlocking ideas in Section 3). As the organism gets more complex, reserve must always include buffering, as well as ballast to smooth out fluctuations. Even in unicellular organisms, motile systems use more energy, but the capacity for movement makes mindedness more capable. Once motility is incorporated into the ground-plan of the structure as happened in both invertebrate and vertebrate bodies, the mindedness converges towards a mind, so that the movements of any mammal (to take an example that is easily visible in everyday life), is as purposeful and as mindful as it can be. To be otherwise would be too costly, mortally so. This proprioceptive mind is the basis of all animal movement, our own included. As I have tried to elaborate this in the human body in The Thalamic Mind in Section 5 The Terrain: Mind and mindedness, this Mind is so much larger than the Cognitive Mind even though we feel that this cannot be the case. This presumption of ours is our hubris from which (according to Moravec's paradox) it is so difficult to escape, unless you are a ballet dancer, martial artist or other high–functioning user of the Thalamic Mind. If they are too high functioning, they may sometimes suffer losses in sociality. Children do not always relinquish their proprioceptive Eden without protest as they are led by the nose of curiosity to enter our cognitive morass, with all its delights and frustrations.

As for movement and energy, a continual differential calculus operates between available energy and its many reservoirs. The optimal ratio in the presence of a forward impulse, restrained or unfettered depending upon the needs of the moment, constitutes poise. It is a position, not a commodity, a posture with as much variability as our bodies have for movement. If the overweening pride of the Conscious Memorious Mind can be restrained and become subservient to the proprioceptive mind, Poise can easily be maintained, and even retained.

The binary tropisms of mindedness extend into and permeate each ecosystem as the trophic fields (however complex the networks may become) originate from the primary zones of prey and predation. Tropism can hardly be separated from trophic function so that heliotropism in the aerial parts of plants and their geotropism in the soil is one of the primary tropes of mindedness on earth. The energetic necessities of poise will be discussed in Section 18.

The tripos of human life

Sociality, like all creation, is a reproductive act (a hormonal product therefore of the Reproductive Axis in conjunction with the somatic axis, that of construction). The psyche emerges from our bios and so cannot be separated or disentangled from all the invisible threads of mindedness, the enzymatic matrix and the familial constellation. In common with all organisms on the planet, both our structure and our functions are punctuated and phased by circadian, tidal, lunar, seasonal, circannual time and develop our individual lives along even longer spans.

People become ill all the time. Health as poise is not an account of people who never get ill or are in some way blessed. Rather it describes those who manage their well periods well and recover well from illness. It is not an inherent state but one that can be managed by good nurture and using plants to advantage.

State of the system

The inexorable circadian punctuation, with its sequentiality of days, in tune with the musical enumeration of walking, all conspire with our love of narrative and enumeration. We divide and subdivide day into its parts and moments, not fixed in symmetry but phasic and proportionate.

Health relates the current and conscious state of the system and cannot be less provisional than life itself. Health as category has all the character of an aspiration but is more of a current post–rationalisation, constantly and anxiously revisited. Newborns are not teleological in this respect: it is a fiction we learn and for which we come to yearn. Sleep is the region of life where health is ensured and refreshed and paradoxically suspends the consciousness that annotates our health.

Fixity in life, as in politics, provides the most temporary of benefits and is maladaptive in the long run. To paraphrase Heraclitus, we need variance to obtain some fixture.

Intermission

By way of recapitulation, this book is about the avoidance of subjective illness (about which little has been written) and says very little about the ever–present threat of disease (about which a great deal has been said). It hopes to show possible paths to health by way of a relativistic physiological model of adaptation. The model focuses on the integration of chronobiology with the notion of the neuroendocrine terrain. According to this model, the avoidance of illness correlates with the achievement of poise.

It may have helped officials at the World Health Organiszation to have defined health so optimistically after the World War had finished as:

physical, mental, and social well–being and not merely the absence of disease or infirmity

but that bold statement alone will not do any good to our patients. If we are to help them to health, we must have a workable model on which to build a therapeutic strategy. The elaboration of the model cannot be simplistic yet we must be able to put it simply, so I shall try to focus on the practical aims of therapy in this recapitulation.

Disease may be silent at first but will inevitably cause the subjective state of illness. Disease itself will be attended by objective markers so, while it may be mysterious, its presence is unambiguous and the feeling of illness unsurprising. However, people frequently experience illness yet (sometimes after exhaustive investigation) have no signs of disease to show for their suffering.

Between illness caused by disease and illness with no apparent cause, lies an intermediate state of conditions (for example, migraine) that possess some elements of disease and many of unexplained illness.

These three arbitrary points on the spectrum of the experience of illness are all open to modification by the physiological diagnostic model presented here: the book is emphatically not about the management of psychosomatic medicine, as the body of all illness and of all disease has both somatopsychic and psychosomatic limbs. No illness is “all in the mind” and every illness is in All the Minds.

The movement between the burdens and joys of consciousness is bound to disturb. Illness, as distinct from disease, manifests a response of consciousness to disordered physiology. The sense of disorder may be caused by incipient disease or impending infection but is as likely to be precipitated by contingent events or physical and mental dysfunction. Yet what is physical and mental dysfunction but a loss of capacitance—the failure of a response to events (and there may be no “adequate” response, to the loss of a child, for instance) and perceived needs. Every response is coupled with the storage and liberation of the required energy. “Perceived need” will incorporate a lifetime of patterning and the editing by the terrain of those stored by past generations in light of current circumstances.

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⁹⁴ Ascribed to Empedocles (c. 500–430 BCE). The four elements were associated with the four humours by Polybus (fl. c. 390 BCE).