Georg Ivanovas From Autism to Humanism - systems theory in medicine
An ontological analysis of many-valued structures shows that only a tiny, almost infinitesimal, part of them coincides with the concept of Being or reality that we have inherited from the Greeks. If we intend to use the full range of logical possibilities now available to us but still cling to ancient ontological concepts, the result will indeed not be a canon but logical chaos.
Gotthard Günther (1976: 251)
Reductionist medicine investigates a certain issue in a given frame. But medical practice consists of a multitude of frames. For example: “Choose one of the following. Asthma is a paediatric disease; an infectious disease; a developmental disease; an immunological disease; a genetic disease; or an environmental disease” (Lancet editorial 1997). Every theoretical approach leads to different concepts and definitions of a diseases (chap. 6.2). Therefore, statements and conclusions are often not comparable. What is true in one context may no longer be true in a different one. A solution cannot be found in more facts. The opposite is true. The more facts the more complex a situation becomes when no appropriate epistemology exists. The logical principle of contexts shall be demonstrated with the example of the citric acid or Krebs cycle. It is depicted as follows.
However, this cycle does not exist.
In the metabolism of the liver the citric cycle is but a small section within a multitude of connections (Gerok: 21), a thought line, a theoretical construct of an observer connecting certain biochemical processes.
the citric acid cycle (dark) in the context of the liver metabolism
The function of this network is influenced by a lot of factors like hormones, the function of the nervous system, or the nutrition. Also all kind of behaviour plays a role. For example, insulin and catecholamins are altered in a child observing the arguments of its parents (chap. 5.2). Thus, it can be expected that the whole and/or certain parts of the citric acid cycle (the step from fumarate to succinate, for example) might be altered by this and other experiences.
As a consequence, every part of any biochemical or physiological circle might be depicted within in a different context involving other cybernetic cycles. Thus, “every world datum in the contexturality of Being should be considered an intersection of an unlimited number of contextures” (Günther, 1979: 289). In chaos theory such an intersection is called local activity (Chua 2005) influenced and expressing the whole.
That is, a model like the citric acid cycle is only the reality of an observer who organises his/her perception according to a certain theory or to certain interests. “The simplest human question “what does the system do?” (which translates into “what was the system selected for”) usually has simultaneous multiple correct answers” (Brent/Bruck 2006).
How is it possible to handle such different contexts logically? Gotthard Günther was a forerunner in analysing such structures which he called polycontextural.
A mono-contextural design allows a two-valued logic, the Aristotelian Trinitarian axiom, the tertium non datur (chap. 2.1.d) (Günther, 1979: 291). In such a defined context something is true or not and a third is not allowed. This is the basis of all reductionist research, as well.
However, when the investigated parameter is an intersection of different contextures the situation changes dramatically: “If we consider such a point of intersection as belonging only to one contexture, the point can only be occupied (consecutively) by two values. If we consider it as belonging to two contextures, the point will still only be able to be occupied by two values but they may now belong to two different contextures” (Günther, 1979: 291).
The difference between a mono- and a polycontextural logic can be demonstrated with the process of negation. In Aristotelian logic the negation has a linear exchange value with its opposite. A double negation leads to the initial value, something no longer true in a poly-contextural pattern (Günther, 1976: 141-188).
This can be translated into medicine with the following example: a stem cell becomes specialised. Adding the substance reversin to a muscle cell, it becomes deprogrammed. Afterwards it can be brought to produce other tissues, such as bone or tendons (Chen et al 2004). The sequence
stem cell ? muscle cell ? stem cell ? bone cell
is a process of programming and deprogramming (which is a kind of negation) where the result depends on the context. In a stable context the exchange value of the stem cell and the specialised cell is linear. Under changing conditions the result becomes non-trivial (chap. 4.5). This is found in all kind of plasticity and in gene expression. For example, genetically similar fish have different gene expressions according to their life-style and genetically different fish have a similar gene expression when they share the same way of living (Giger et al 2006).
To demonstrate certain characteristics of polycontextural networks, Günther used the example of the heterarchical numerical pyramid based on the Peano order (Günther 1973).
It is a somehow simple and linear model with no recursive loops involved. Nevertheless, it demonstrates a characteristic called equifinality in general systems theory (chap. 4.7). There are different ways or possibilities to reach the bottom from the top and vice-versa. Different pathways might be used, just as different people use different routes to go from one point of a city to another. Or we ourselves might use different routes according to the time of the day, to the actual traffic or if a road is blocked.
Although this seems to be simple and self-evident, it is not. Such a view is a kind of epistemic revolution as it violates the basic principle of the Aristotelian logic saying that ‘the way up is like the way down’ (οδός άνω κάτω μία) (Günther, 1979: 274).
This fact has important impacts for medical research. First, all traits and pathways investigated in reductionist research are only one option. Second, an analysis of such pathways might lead to certain ‘causes’, but it does not allow to conclude from these ‘causes’ onto the behaviour of the human. Although this is a platitude in medical practice, the logical basis has to be understood in order to avoid a flawed reasoning. For example, it is possible to analyse a certain behaviour down to the genes. But it is impossible to conclude from the genes onto the behaviour (detailed analysis in appendix III). This is why the correlation between a certain trait and a gene is often as low as 8 % for most of today’s ‘genetically caused diseases’ (PaísanRuiz et al 2004). Similar is the case of brain metabolism where the stimulation of certain biochemical pathways through drugs leads to different clinical pictures and similar clinical pictures can be attained by stimulating different biochemical pathways (chap. 4.8.b).
All this cannot be explained when a gene or a biochemical pathway (logically: an intersection of a polycontextural network) is investigated with the Aristotelian principle of the tertium non datur. A higher order of logic is necessary.
An early attempt of such a higher form of logic was the Indian tetralemma. It was a logical operation used about two thousand years ago in judiciary. It exceeded the restrictions of the two-valued logic of ‘guilty not guilty’. It says that a case has to be investigated according to the following possibilities: the one, the other, both, neither, which constitute the classical tetralemma. Although not actually taught that way, it is a normal logical operation of every physician. Indian logic exceeds this frame, however, and continues with: not all of this - and even not that. (Kibéd/Sparrer: 77-93).
This procedure is in line with the findings of Günther who found that higher forms of logic can only be attained when the two-valued choice is rejected as such. But how is it possible to reject a two-valued choice? In medicine a rejection would be to see a disease like ulcus duodeni not as a local problem triggered by physiological processes or by a germ, but as an expression of a personality, connected to emotions (psychosomatic concept). Some traditions of CAM (as acupuncture or homeopathy) even reject the psychosomatic concept.
Each of these rejections is an extension of the context. It implies an environment for the two-valued choice with the ability to modify the basic values. The two-valued logic as such has no environment (Günther, 1976: 315). A recurrent otitis in a child is normally caused by a bacterium or a virus. The Trinitarian choice would be to decide on the germ. A rejection of this choice would be to see the disease as a lack of resistance. Leukocytes, antibodies and the genome would be important on this logical level which is no longer concerned with the local process. It investigates the general physiological condition. A rejection of this would be to see the recurrent otitis and the lack of resistance as a result of social behaviour (nutrition, exercise, exposition to climatic factors, etc.). On this logical level higher forms of learning (chap. 4.3), like robustness (chap. 6.4) become important.
The classical reductionist medicine creates a situation without environment as all influencing factors are held stable. Thus, the polycontextural structure becomes invisible or is even dissolved. This is insofar useful as the results of such a research become reliable and true. “As an ultimate foundation, truth implicates a two-valued state” (Günther, 1976: 217, my translation). But although two-valued states are true, they are simultaneously meaningless.
In a polycontextural setting (taking other contexts into account) statements might still be logically correct but their value is no longer a truth-value (Günther, 1976: 219). “A change of values in a many-valued order may under given circumstances produce a change of meaning” (Günther, 1976: 317).
This fact is crucial for medical reasoning. It implies that only reductionist research is true. But to a certain extend - as seen before (chap. 2.1.b, 2.7) - it is meaningless. The meaning arises in a given context, but then it is not true anymore, at least according to the Aristotelian principles. That is, the attempt to attain true complex results is a logical contradiction, in line with Gödel’s incompleteness theorem (chap. 3.3). The use of probabilities to solve this problem is at most a restricted tool of orientation as it is neither true (chap. 2.1.d) nor meaningful (chap. 2.5.h).
The polycontextural model is an appropriate tool to solve the autistic-undisciplined thinking. It is not too difficult in a given problem as with the relation wine and health (chap. 2.1.c), or Helicobacter and peptic ulcer (chap. 2.8.b) to define the different levels of environment. Moreover, it is to a certain extend possible to outline the meaning-giving relation between these different levels.
(1) This illustration is taken from Günthers Life as Poly-Contexturality. It is an aggregation of the illustrations 5 and 6 and is used by courtesy of von Goldammer.