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SECTION ONE

Health: what can we mean?

Definitions of health

Health is a euphemism, a jubilant term that conceals the pain, misery, suffering, illness and disease which afflicts some of us all the time, many of us often and very few of us never. The term Health refers to that state which is not really the province of doctors of medicine, whose constant focus and interest is in illness caused by disease and how that state can be remedied, along with ancillary aids to the invalid. The National Health Service in Britain is given the task of managing ill—health and so contradicts the ethos expressed by the World Health Organization which in 1946 defined health as:

A state of complete physical, mental, and social well—being and not merely the absence of disease or infirmity.

The years that followed the end of the Second World War evoked a necessary and healing optimism in leaders; it was the time of the formation of the NHS in Britain and a period of population recovery and relative stability with the hope of prosperity. Theirs was a doctrine of Hope and while such might well serve as an aspirational motto, it tells us nothing about the actuality of Health. Such a definition may have expressed a fine political ambition but was not really helpful as a biological maxim. Who would judge what might constitute “complete”? Would you know how close you came to completion and how could it be measured? How would you characterise a fall from this measure? Is not “complete” health a rather useless fiction? As for social health, as contingent as it is upon other people and political circumstances, it seems unreasonable to load all these onto an individual.

There is no useful purpose served by trying to reach a definition of an idealised state. Health is a relational state, highly dependent on time and circumstances. In good health the ratio between capability and performance has been stabilised. To each person, the most pertinent definition of Health comes from his or her subjective state based upon physiological concordances. There are several healths, some more easily measurable than others. Subjective health responds to the present moment whereas any other measure must imply states over time. While generalisations based upon statistical analysis are necessary tools for policymakers so that they may spot disease trends in the populations they serve, perhaps to avert them, they are coarse measures for the individual patient, especially if she or he is an outlier from the main body of the curve. Policy calls for top-down edicts as indeed, for all its idealism, is that definition pronounced by the World Health Organization. The attempt in this book to give an account of Health settles upon a functional and relativistic description as opposed to an idealistic or optimising one.

It seeks to express the degree of separation between the capacitance of an individual and his or her adaptive capability, their fitness to function, and so expresses at a global level the ratio between capacitance and adaptation.

Such an attempt might appear, in contrast with that of the WHO, to pamper the individual at the expense of sociality but, on the contrary, I would argue that while the primary role of the physician must include an assessment of the patient's social health, that responsibility during a consultation is discharged to one person at a time, even when the physician is an agent of the state. For all that it might sound like one, this is not a paean to individualism but an appeal to examine the narratives that bind us all.

Definition of health for the purposes of the current work

I had better get it over with and spend the rest of the book in explication (or even expiation).

Health describes a phase of POISE in which adequate energy is available coupled with a subjective sense of reserves both of which the healthy person wishes to maintain.

This book is dedicated to elaborating this notion of Poise and so will open out the deliberate circularity contained at present within this definition. While Poise in the sense that I shall try to define may be a temporary state, its degree of persistence is itself an index of health as longevity will ultimately decide. Phases are found throughout the physical world. A fundamental assumption made in this scheme views Life (at least in multicellular animals) as a multiphasic consortium derived from a physical world that is essentially biphasic.

As a notion of health that claims to be comprehensive (rather than “complete”), Poise must inevitably triangulate between physical, mental and sociolinguistic states. In short, Poise is the optimal outcome state of a multitude of functional series. I shall attempt to elaborate these during the course of this book. Health as an outcome must be the resolution of a range of tensions that characterise daily life. When this struggle—between burdens on adaption and responding capacity—is resolved in a person, they will tend towards well-being and recovery, but failure to do so will lead to an experience of life as a series of illnesses (such as those listed below in Common presentations of ill health). The phasic and developmental lives we all lead are naturally constructed of conflicting demands. The physiological collective that makes up the self must participate in the physical world; the psychic and social facets of the self must adapt to this fact of life. The adoption of plants for food and medicine into daily life will make the greatest contribution in their remarkable ways towards this adaptive project.

The scope and purpose of the model

This model of health is directed particularly but not exclusively to:

Non-infectious chronic diseases and syndromes which seem to defy classification. It focuses on the cyclical nature of most conditions. It aims to help maintain health by attention to the capacitance of the individual. It takes a systemic approach towards the patient to maintain continuities between the physiological and psychosocial.

The purpose of the model is to assist the medical practitioner who wishes to move away from treating the condition itself towards helping the patient achieve and maintain health in the sense that I shall describe. There is nothing new at all in this ambition. Indeed writers on medicine have been banging on about it for centuries, but—like all platitudes—it has been advocated more often than it has been practised:³ the culture of diagnosis and treatment is resistant to holistic care in the face of our atavistic fear of disease. Now, this is not a call to stop treating disease as if we could wish it away, but rather to recognise that health may be positively encouraged and maintained, thereby setting limits on the power of disease. It is particularly aimed at encouraging the herbal practitioner away from tinkering locally with the disorder (nodding perhaps to novel, supposedly functional diagnoses), away from blind Remedial Culture where “What do you give for depression?” or “What is your favourite migraine remedy?” could be considered meaningful questions. In other words, to view health as a process and not a commodity. The medicinal plant can be an ally of such process and is itself more than a mere commodity. I would not wish to decry the administration of immediate aid to an itch, sore or pain: giving relief to another human being is one of the great satisfactions of life. The difference between remedy culture and holistic treatment is that in the former, the problem is considered to be known from the outset while in the latter, time and the patient will tell.

Traditional Humoral theories have taken this approach but as they were developed before microscopic techniques they relied almost entirely upon inference and apparent homologies: they were unable to see the detail behind the detail. If we are able to understand the degree to which human perception is dictated by scale, it should become easier to generate models which unite structure and function in a way that is less metaphorical and less likely to ascribe symptoms to cosmic meaning. The flowering of modern physiology derived from interconnected analyses permits us a glimpse below the surface phenomena.⁴ Old habits die hard, however, and it may seem more relevant to concentrate on the effects produced in the patient by “The heartache and the thousand natural shocks that flesh is heir to”5 rather than on her or his capacity to emerge into health.

The limitations of the model

This work inclines to observational description rather than scientific analysis but I hope that I shall at least be judged to have followed the three guiding principles: relevance of observation, coherence of argumentation and economy of interpretation (Occam's razor) in such a manner that the model is consistent with existing science and that it is capable of generating testable hypotheses.

The most cogent argument against ancient humoral theory (as it may be against psychoanalysis) deplores the range of interpretation available to explain the symptoms of a patient. Reliance on subjective inferences runs the risk of developing strategies that depend for their success too much upon chance. It does not help the patient for us to disavow modern mechanistic approaches until we find a way of accepting the limitations as much as the strengths of our own models as a route towards therapeutic efficacy. The extraordinary insights into biology made by systems theory, complexity theory and other models of self-organisation should not blind us to the difficulties of making them clinically useful.

There is, of course, a converse trouble with falling back on what might look like the solid ground of a naive reductionism that seeks a single explanation for a condition. It too is subject to flukes and placebos as well as failures. Where is the patient expected to go when the statutory strategy fails, or when the “condition”, though acknowledged as multifactorial, derives from an unknown cause? It is common to find as much naive reductionism in herbal and “alternative” medicine as it is in orthodox medicine, where the real object of treatment is the supposed condition, from which the grateful individual is hoped to emerge.

In the model I am formulating, the “condition” is seen more as a divergent state than an entity to be addressed. This divergence presupposes a trajectory towards which the patient might be redirected. Such a trajectory is not a static ideal but rather an unfolding potential that emerges from the endowment and natural history of the patient. Health is generated in and by time. Although this book is more concerned with health than hurt, the two will inevitably coexist: even the most robust will get something in the eye and as we learn we will fall over some of the time. The concept of Health as Poise is most certainly not a positivist ideal that suggests we ignore these hurts: we give them the local and timely attention as needed.

As with the synthesis of any scheme that has something in common with humoral medicine, it may be prone to the ill effects of formalism, functionalism and teleologism with an over-reliance on a mass of metaphor. I will try to provide a comprehensive model that is higher on functional analysis than metaphorical exhortation. A reasonable criticism of humoral systems from the modern perspective is that they tend to disregard one or more of the matrices⁶ that make up human life and replace it with a conceptual force or entity that is speculated to underpin existence, but which remains indefinable. While these entities may beguile and entertain us poetically, the matrices are facts of life in the sense that, for instance, our bones do live after us as might the genetic material they contain. By contrast, those concepts that we hope might explain these facts remain intangible. Apart from explanation, the construction of a model of what is observed helps us to abstract functions in order to predict future behaviour of the state to be modelled: how a disease will respond to intervention, in the case of medicine. I have tried to turn the problem around and describe ways of avoiding or reducing the illness so that the resultant state of health can be visualised.

Model of health in this current work

I am hoping to offer a naturalistic description of health which may, however, be formally defined. It bases itself upon adaptive capacity as an integrated biological concept and derives its form and function from circadian physiology. For health I have substituted the term Poise. Health is a word that sprawls through our culture, into the H in NHS on the one hand (which is quite properly dedicated to the management of ill health), to any commodity, from confectionery to yoghurt, or any lifestyle that is purported to promote it, on the other. During a recent heatwave, people enjoined to take special care were those suffering from “health conditions”. We all understood, of course, that conditions of ill health were meant, but the absurdities of this profligate use of the word abound. I aim to construct a model of health and integrate it with a scheme that assesses a person's loss of capacitance and then to restore it by the use of medicinal plants.

Despite the complexities and subtleties of human life, there may be during the analysis of a patient's health a glimpse of simple recurring themes. Simple adjustments to the trajectory may provide a window of opportunity for increasing capacitance or slowing its loss. The purpose of the model, then, is not intended as an explanation of phenomena but rather a device for integrating the physical world with the psychic, physiologic and sociolinguistic events seen in the clinic with the hope of helping the patient towards an increased capacity for Poise. I appreciate that at this stage, the term can mean very little. As they cajole you on the corporate telephone: “Bear with me” and I will come to that in a later section.

I have come to the subject with three drives: first, the clinical impulse and experience; second, an abiding love of astronomy with the solar and lunar effects upon human health, and third, the endobiogenic theories of Drs Christian Duraffourd and Jean-Claude Lapraz which I have closely observed and which have channelled my clinical experience for more than two decades.

Their model, previously the Neuroendocrine Theory of Terrain, renamed Endobiogenics, forestalled any criticism of a model that claimed to be scientific but was not quantifiable. Duraffourd and Lapraz were acutely aware of this limitation from the outset and it led them to the elaboration of the nested algorithms that constitute their Biology of Functions. I had only a handful of serious objections to endobiogenic theory, one of which was that qualitative terms were often missing when it seemed to me that they should play a vital part, especially in the practice of data collection from the patient. I believe my scheme is more comprehensive at least on this score and more, well, schematic. The employment of my approach in concert with a Biology of Functions could only be complementary and additive.

Meanwhile, it may help here to remove ourselves temporarily from generalisations and abstractions and to list quite simply the kinds of suffering we might be trying to address. These are chronic, largely subjective states rather than signs of infectious illness such as diarrhoea and vomiting, cough and breathing difficulties:

Common presentations of ill health

The patient may have arrived with a number of diagnoses attached. For some cultural reason, patients in Britain who seek out a herbalist are often at their last port of call whereas in some other parts of Europe, where urbanisation was not so precocious as here, medicinal plants might be their first. Television programmes about the natural world do not seem to penetrate this cultural bias against these most natural of remedies, even among gardeners. Some previous diagnoses may be important to the patient as hand luggage or they may have begun to question whether the label has outgrown its usefulness. Tact is called for, but if we are to question or even to disparage⁸ a previous label, we must be shown to have a more coherent response to the patient's troubles. There is nothing to be gained by disputation, even less so with a contrary person, so that the practitioner who offers a broad and comprehensive approach may, just by doing so, bring some peace and comfort: the mystery of illness itself produces secondary distress. While the bias of this book is to remain critical of labels as entities, it does not help anyone to take an ideological position against them, for to do so is to create another meta-label.

As well as dealing with the patient's diagnostic history in our assessment of the presenting complaint (discussed in Part Two), we must also gather the extent to which the complaint has previously been diagnosed as psychosomatic. We meet frequently with states which are generally held to be “psychological”, which indeed they are. This model will try to demonstrate that many such states are the product of physical states rather than entities in themselves. In other words, most manifestations are coupled somatopsychic-psychosomatic states resulting from losses of Poise. I am not trying to erect a new category just for the sake of it, but rather to show that if viewed this way, it is easier to administer more helpful prescriptions. If we embed the symptoms of individual patients within their history and generative state, it is easier to treat them without the need for labelling. Variation in human health seen in this way allows us to treat fluctuant phenomena more in the way that variability in climate and weather are accepted and responded to.⁹

As the concept of Poise is one based upon capacitance and adaptation, in another section we will examine their genesis on the macroscopic scale. Poise is at root a bioenergetic idea, so to develop the concept from its microscopic basis, we need to examine the biological basis of our adaptive response.

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³ For instance: “Do not ask what kind of disease a person has but what kind of person the disease has.” Attributed to Sir William Osler 1849–1919. Recently I heard it attributed to Hippocrates, no less.

⁴ Eastern humoral theory might proscribe tomatoes in the diet of an eczema sufferer on account of the bright colour while systematic biochemical analysis would make them indicated on account of the anti-inflammatory effects of this maligned fruit. I suppose quoting “like cures like” would get you out of this fix.

⁵ Hamlet III, i, line 64.

⁶ The concept of matrices is developed in Section 3 as the second of five interlocking biological ideas.

⁷ The making of lists does, for some, contain some pleasure within the compulsion! If a description of Health is to be dynamic and interrelational, the model must be more than a list of lists.

⁸ The important criterion here is to reduce any unhelpful burden a diagnosis may have placed upon the patient, not as any aggrandisement of the practitioner.

⁹ Even the weather is not free from emotional labelling: we may speak (in England at least) of a filthy night and foul (but not neurotic) weather!