Change and complexity

Our organism is composed of myriad interacting processes. In order to understand what is going on and help the patient, medicine reduces observed phenomena into relatively simple structures, known as cells, tissues and organs. Despite the ongoing  change of all body ingredients, known as turnover,  our appearance changes relatively little   otherwise we would not recognize each other. This constancy is a manifestation of a fundamental principle which controls our body called homeostasis. Despite the ongoing turnover body constituents are balanced and maintain an equilibrium called homeostasis. 

This simplification paved the way for the medical sciences, e.g., physiology, pathology and bacteriology which started in the 19th century and dominated the 20th.  Sophisticated technology provided insight into the workings of the body, revealing its immense complexity. Nevertheless medicine maintained  its accustomed simplifying strategy. Today medicine is overwhelmed by the information it has to deal with during the diagnostic process, which ought to be drastically simplified. But how? How to distinguish between the relevant and non relevant? 

The difficulty originates with the current concept of disease, or pathology. Disease is defined as a change of structure  of one or more constituents in the body. This change is called an aberration. In the past this definition was adequate since most aberrations required treatment.  Today the sophisticated equipment detects  many aberrations. Should all be treated? Since medicine generally lacks criteria for distinguishing between treatable and untreatable aberrations, it attempt to treat them all. Spreading new kinds of ailments called iatrogenic diseases. Diseases which result from unnecessary treatment.

The way out of this dilemma is to adopt a new strategy  for simplifying the complexity of the organism which will  indicate which aberrations require treatment. The proposed strategy implements also the self-healing capacity of the organism and augments the equilibrium concept.  While medicine postulates that  disease disrupts homeostasis (equilibrium), it is proposed here that disease is a new homeostasis. In other words  a disease evolves from one equilibrium to another.

Further reading: Complexity

A new simplifying strategy

Since the organism is so complex we shall never understand exactly how it functions. All we want to know is when it requires treatment. In other words a disease is a manifestation of the organism which requires treatment. For this purpose we define two entities, wisdom of the body (WOB) and mind. WOB is the realm of processes in the body of which we are unconscious. Mind is the site of our consciousness.  What concerns us here how the two entities communicate, and how interpret their messages.  Above all what messages indicates that the organism has to be treated.

Wisdom of the Body (WOB)

The organism is extremely complex. It is an open system consisting of myriad processes interacting with each other. At any instant it maintains an equilibrium, or homeostasis (steady state). Equilibrium maintenance is creative and unpredictable, and since the system is extremely complex it cannot be grasped by an outside observer. The system is regarded here as a self-maintaining non-linear black box  with inputs and outputs. Its capacity to control processes, is called Wisdom of the Body (WOB). WOB actually maintains life. Its existence is revealed to us by the fact that it maintains homeostasis, and by its response to perturbations.

Actually in all processes matter and energy stream, and WOB maintains a streaming equilibrium called homeorhesis.  Inputs and outputs enable WOB to interact with the outside world, and allow the physician to interact with WOB.

WOB represents two things

  1. A set of processes in the body, (black box) manifested by the body.
  2. Their creative control, which is also the control of the body. By creative we mean that WOB control is optimal (Will be discussed later).

Only the first is observable, while the second is deduced from the first.

Further reading:
Medical significance of WOB
WOB as non-linear computer

Coma

The nature of WOB can be best appreciated in a patient in coma who experienced a slight cerebral hemorrhage which left him unconscious. After being placed in a bed, he breathes peacefully, pulse and blood pressure are normal  His life is maintained by WOB. Some inputs and outputs which are responsible for consciousness were cut off, others like temperature and pain sensitivity prevail. Even the eye still perceives light, since the pupil responds. While we watch the patient, WOB controls processes and maintains homeorhesis.

We still do not understand  how WOB controls processes, and maintains life. We are therefore required  to assist it in its task, and minimize the harm by doing so. Not to interfere, but to assist! This is the wisdom of primum non nocere (Above all do not harm). Since our black box is an open system, it exchanges matter and energy with its surroundings. We are less concerned with its excrement, or urine, and turn our attention to its requirements, like water and nourishment.

We should be concerned not only with what to provide but also when to provide it. Medicine is less concerned with the 'when' and hastily connects the patient to a life line, which may impede with WOB requirements. Suppose that a slight dehydration promotes recovery. In order to find out when to treat we ought to understand better WOB inputs and outputs, which will be explained later.

Fortunately WOB can handle treatments initiated by our ignorance, and devotes itself to some less obvious tasks. It clears the hemorrhage, repairs the damaged brain, and grows new neurons. Cell death (necrosis) is a powerful stimulus for regeneration. This may take some time, yet when the patient awakes, he ought to be grateful first of all to his WOB.

Further reading:
Primum non nocere- Above all do not harm

Mind

The patient in coma illustrates a second fundamental concept, Mind. If he would not lose consciousness he would hardly require our assistance. He would eat and pee by himself, and WOB would mend  his damaged brain. His independence is provided by the mind. The patient in coma lacks a mind. He is mindless. Mind is an interface between WOB and its surrounding. Since the patient in coma is mindless, we serve as his mind substitute, and provide WOB with water and nourishment.

In the healthy individual, when WOB lacks water, it sends the mind a message of thirst which means :"Get me some water." The same message is communicated also during coma, yet since mind does not function, the requirement cannot be fulfilled. However, thirst is not the only message sent by WOB. It  is accompanied by other, less obvious messages which do not reach the mind, like dryness of the skin, and these may assist us in the decision when to hydrate the patient in coma. 

Mind is subset of WOB designed to interpret the outer world. It is an interface between WOB and the outer world. Like the Greek God Janus, mind faces two directions. Inward it listens to WOB messages and satisfies its demands. Outward, it interprets the outer world and guides WOB to resources.

Soul

Aristotle's soul is comparable to the WOB metaphor. It exists in humans, animals and plants, and is mortal. Mind is a separate entity which does not belong to the soul and is immortal. Catholic theologians, disliked this definition, and made the Soul immortal, serving for communication with God. They may be right, however we are concerned here with a medical metaphor created for improving medical treatment. After all, this immortal theological soul contributes only marginally to therapy, and has always been a source of diseases of the mind.

Further reading:
A blind lady who regained her eye sight
Ludwik Fleck the founder of the philosophy of modern medicine
WOB and Theology

Consciousness

Some equate mind with consciousness. Here, Mind is regarded first of all as an interface between WOB and its surroundings . It is the site, (or organ) of reasoning and consciousness, in the same way as the eye is the site (organ) for sensing light. In reality Mind is an integral part of WOB and does not exist by itself. Mind is a subset of WOB. This metaphor was created solely for medical purposes.

We are unaware of the working of our body. One does not sense his blood sugar level, or the intensity of hormonal secretions, which are unconscious. Whatever we  sense are messages from WOB to the Mind, indicating that it needs assistance. Such an unconsciousness differs from that of Freud and Jung, which belongs to the Mind. Freud's subconscious, or Jung's dreams  are products of the Mind and reside in it. What goes on in WOB can not be perceived. Consequently the patient in coma lacks Freud's subconscious.

Further reading
WOB and Mind:

Memory

Is stored in the entire WOB . Suppose that you learn how to ride a bicycle. You train WOB to support your wish. Once you mastered riding, it becomes automatic and handled unconsciously by WOB. The faculty of riding is remembered by WOB, while you (Mind) remember only that you can ride a bicycle. We ought therefore distinguish between WOB-memory which is unconscious, and the partly conscious Mind-memory. Immune memory is also unconscious. WOB knows how to handle infection. When we are repeatedly infected, the immune system (WOB) learns to handle infection better and better. It remembers its previous experience, which is known as immune memory.

Mind memory is known also as explicit, or declarative memory. It is assumed that the hippocampal brain region is associated with explicit memory. WOB memory is known also as implicit or non-declarative memory. Although neuroscience postulates that it resides in the brain, it is distributed all over the organism. It includes also the immune memory. We construct memories out of an interaction between prior knowledge (mind and WOB) and current incoming information.

Zygote

Any living entity has a WOB which sustains its life. A fertilized ovum which starts dividing and becomes a zygote is already extremely complex, and therefore controlled by a WOB. It is a pure WOB. It may appear to us simple or even primitive, yet how WOB controls a zygote beats our understanding. For a while, zygote lives on its own as a pure WOB. Soon however it will need more resources. After a week it embeds itself in the uterine mucosa and grows an interface, the placenta, which will serve it until birth. Placenta serves as a temporary mind of the embryo.

The new born is a pure WOB. It is solely controlled by WOB and lacks a mind. It is mindless. Now that it left its interface (placenta) behind, it has to grow a new one, which will function as a mind. Watching the new born reveals the sophistication of its WOB. Everything is taken care off, until the first cry initiated by WOB, signaling  the mother to provide some vital resources. For a while, mother will serve as WOB main interface and is regarded here as its temporary mind, until the growing child develops his own mind and becomes independent. WOB and mind evolve and their properties emerge. It is a creative evolution. Placenta serves as a mind of the growing embryo-WOB. So does its mother, which serves as a mind during the first weeks after birth.

Three definitions of disease

The definition of disease depends on the context in which it is defined. From WOB perspective
, disease occurs when it needs assistance and calls  the mind for help. Thirst is a disease signal which indicates that WOB loses control of water resources, and so is hunger. Pain is a general call for help. You inadvertently grabbed a hot object. WOB objects and you let it go. On the other hand when WOB is silent, it is healthy.

Suppose that you were imprisoned. You (mind) feel bad, and yet WOB is comfortable (and therefore healthy). Such situations are regarded here as diseases of the mind which depend on your attitude to a certain situation. Since if you would accept  imprisonment or even enjoy it, you would feel and be healthy.

The third definition is medical. Disease starts when WOB loses control of some functions and sends to the mind distress signals like malaise, or lassitude. You turn to your physician which diagnoses a certain disease. This definition of disease was created by medicine for communication between physicians, and for didactic purposes. Medical diseases are not real entities, like plants or animals.

Further reading:
Ludwik Fleck the founder of the philosophy of modern medicine
Cancer and Meditation

Health

As long as WOB controls processes and remains silent, you are healthy. Only WOB determines when you are sick. Some of its distress messages, like thirst and hunger can be handled by yourself (your mind), others require medical assistance. What about a cripple, is he healthy? As long as his WOB is silent he is. His crippling by itself is not a disease! On the other hand he might ask an expert to make him more comfortable by a surgery. Whatever the surgeon does to him cannot be regarded as cure, since he is essentially healthy. At best his condition might be regarded as a disease of the mind, but not a WOB disease. Only WOB determines when it is ill.

This disease definition excludes adjectives like, normal, or abnormal, which from the WOB perspective are meaningless, since it lacks messages which indicate abnormality. These concepts originate in our culture, and indicate to the mind that something in it (or in WOB) is unacceptable to the society, and is therefore regarded as abnormal. Like homosexuality, which was regarded by Freud as a mental disease, predisposing paranoia. This clash between society and WOB created a disease of the mind, called paranoia.

Further reading:
What is health?
The Normal and the Pathological
Gender and Wisdom of the Body

Aberration

Is a medical concept which highlights the conceptual chaos in which medicine operates. From the WOB perspective, as long as it remains silent, an aberration is meaningless. The notion of abnormality is also meaningless. An abnormality becomes a disease only when WOB calls for assistance to handle it. Yet medicine regards the organism as a complex (linear) machine, in which malfunctions are regarded as diseases
which have to be treated. Accordingly,  a wart, a tiny arteriosclerotic plaque or a genetic mutation, are diseases (aberrations) that require treatment. Since only WOB knows when it is sick, only it determines  when an aberration requires treatment. If  it calls for help the aberration is a disease, otherwise it is healthy.

Further reading:
Cancer and Metaphysics
Wisdom of the Body

Symptoms and signs

“In medicine, a sign is a feature of disease as detected by the doctor during physical examination of a patient. It is therefore "objective", as opposed to the patient's experience (symptom), which is (relatively) subjective.” http://en.wikipedia.org/wiki/Sign_%28medicine%29

In reality since the doctor is not interested in normal signs,  he regards signs as aberrations which have to be treated. (v. Medicine of Homo Faber).  While signs are objective findings, symptoms are subjective feelings of the patient, less interesting since they cannot be measured. How does one quantify misery?  At best signs contribute to the diagnostic process. They serve also  for the communication between physicians and for teaching purposes .

WOB and mind signals

Yet within the framework of the “New kind of Medicine”  both tools are inadequate. Here we deal with two identities or metaphors: WOB which is the realm of unconscious processes, and Mind, the site of our consciousness. Any phenomenon observed in a human is regarded here as a signal or message  from  WOB and mind. The message  has two components: {WOB[signal], Mind[signal]}. Thus any disease is manifested  by  the two kinds of message, and has two components: disease = WOB[disease] and Mind[disease].

WOB and mind cancer

The significance of cancer manifestations depends on the signals which accompany them. We shall distinguish between WOB signals e.g., pain, loss of appetite or malaise., collectively called WOB[cancer], and mind signals e.g., a death apprehension or a sense of guilt, called Mind[cancer]. By significance we mean whether the observed condition has to be treated or not. Mind[cancer] is initiated when a woman detects the lump in her breast.  An instant earlier she was healthy, since   WOB and mind were silent . Upon detecting the tumor she got Mind[cancer], and  since WOB is silent  she does not have WOB[cancer] yet! She will get it when WOB will break its silence and send a message, like pain.

The significance of an aberration (symptom) depends on the two kinds of signal accompanying it: {WOB[aberration], Mind[aberration]}. A patient with a hemangioma in his face, who is disturbed by his appearance has a Mind[hemangioma], and  since WOB is silent he does not have a WOB[hemangioma].  

Further reading:
WOB and mind schizophrenia
Therapy – Signal manipulation

WOB and mind diseases

Any agent which depletes resources causes disease. Starvation or dehydration are  reversible  diseases. While WOB diseases roughly correspond with organic diseases, mind diseases encompass more than psychiatric conditions. The mind was likened above to the Greek God Janus.  Facing inward it satisfies  WOB demands. Facing outward  it  interprets society norms which under circumstances may be unpleasant and even cause misery, a condition called here mind-disease. This negative role of the mind is illustrated by the following parable by Bertold Brecht.

Culture as a mask

Imagine yourself acting in a play in which nobody knows what  mask he wears. How should the actor know whom he is impersonating?  He may infer his role  from the conduct of others who deal with him.  At first his movement impersonates himself and not the mask.  Gradually his posture will change until it conforms to the mask.  This is how he is formed. (Bertold Brecht’s “Aus nichts wird nichts” )

The mask of cancer

A healthy female undertook mammography and proceeds to her  physician to get the results. Since her WOB is silent she  feels  healthy and is healthy, impersonating herself and not the mask whose nature she does not know. Yet  her physician is preoccupied with her cancer mask. His worries and the sense of urgency initiate in her a gradual change in her posture  until she conforms to the mask. Whereupon she sinks into the abyss of  misery,  called here mind-cancer.  Unfortunately medicine  does not appreciate the gravity of her mind-cancer which overshadows that of WOB cancer.

Additional reading:
Death and dying
Death denial

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