Medical Care

Medical Education

Some Topics

  • Illness as Complexity and Chaos

    I have abandoned the idea of neatly packaged diseases. Health problems tend to cluster in groups and evolve over time. Many factors contribute to the final end-stage disease, listed as diagnoses in medical records. Non-specific illnesses may be misunderstood by physicians who have been taught to make diagnoses of specific disorders. Often patients with mild symptoms are proceeding toward a major illness, but they may suffer in an ill-defined state for months or years.

    As illnesses progress, more specific features tend to emerge-dysfunction and tissue changes become more obvious, and medical diagnoses become more useful. A heart attack or stroke, both calamitous events with obvious features, fit the medical model well and tend to be diagnosed reliably and treated in a standard fashion. These are end-point events - the underlying pathology takes years to develop and increasing dysfunction is often ignored as the pathology progresses toward a dramatic conclusion. Other processes may remain ill defined; chronic fatigue, muscle pains, headaches and cognitive dysfunction may make life miserable for many years before a more definable disease such as arthritis becomes apparent.

    I propose a process interpretation of dysfunction over a category definition. In other words, we should be more inclined to ask, "What is the source of the problem and how does the problem develop in the body over what period of time?" These are more useful questions to answer than, "What is the problem called?" If we know more about the way of the disease, then we are better equipped to alter its progression, especially by removing its origin. Since the food supply of an individual is an important biological determinant, diet revision should be an early diagnostic and treatment strategy in medicine, especially when the precise nature of the disease is unclear.

    Modern ideas in science describe the complexity of the natural world in terms of networks, systems, information and control, turbulence, chaos, fractals, strange attractors, and self-organizing systems. The first insight is that the human body is not a simple, linear machine. We are unstable, rhythmic, pulsing creatures with many different body-mind states, strongly influenced by our sense organs and exquisitely touch sensitive. We seldom respond the same way to any repeated stimulus. As the astronomer, John Barrow in his Theories of Everything describes the difference between linear and nonlinear:

    "...If a situation is linear or dominated by influences that are linear, it will be possible to piece together a picture of its whole behavior by examining it in small pieces. The whole will be composed of the sum of its parts...the output of a linear operation varies steadily and smoothly with any change in its input...Non-linear problems are none of those things. They amplify errors so rapidly that an infinitesimal uncertainty in the present state of the system can render any future prediction of the state worthless after a short period. Their outputs respond in discontinuous and unpredictable ways to very small changes in their inputs."

    Stuart Kaufmann, writing about evolution, describes the complexity and chaos of living systems:

    "Because of chaos, dynamic nonlinear systems that are orderly at first may become completely disorganized over time. Initial conditions that are very much alike may have markedly different outcomes...Biology is filled with complex systems; the thousands of genes regulating one another within the cell; the network of cells and molecules mediating the immune response; the billions of neurons in the neural networks underlying behavior and learning; the ecosystem webs, replete with co-evolving species..."

    Kaufmann goes on to describe how order and disorder interact in living systems to produce the prolific array of ever-changing living forms on the planet. The life course of an individual human being can be viewed as a courageous effort to order chaos, to derive meaning and to understand something of this prodigious universe. If our path is irregular, difficult, and challenged by dysfunction and disorder we should not be surprised. Our problem-solving strategy when disorder threatens is to go back to the input to renew order.

    Learn more about self-regulation

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    These brief essays by Dr. Stephen Gislason are taken from his book Self Care and Medical blogs.

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