Georg Ivanovas From Autism to Humanism - systems theory in medicine
Most important for the development of semantics was Gregory Bateson. It was a major step in the history of science when Bateson went to the zoo, asking himself how monkeys know that they play when they are fighting in a play. In the fundamental paper A theory of play and fantasy; a report on theoretical aspects of the project for study of the role of paradoxes of abstraction in communication (Bateson 1972: 177-193) he postulated that the monkeys signalise in a certain way that the showed action is not the meant action. He postulated a ‘meta-information’ determining the ‘uttered information.’
It was a very prolific approach from which Bateson developed his concept of ‘frame and content’. It basically says that there is no statement or action as such. Everything happens in a certain frame and this frame gives meaning to the statement or action. There is always something ‘outside’ qualifying the content. For example, if you ask your partner in the morning if (s)he is angry because it seems so to you, (s)he might answer in a friendly way “oh yeah” or very strictly “not at all”.
It is the way how things are said that determines the meaning, not what is said (Shintel 2006).
This finding lead to the development of a refined theory of communication (chap. 3.7).
The frame giving meaning to its content is omnipresent. A more formal presentation has been given in the chapter on polycontexturality (chap. 3.5). For the field of perception it is well established that the context decides on the perceived. Often it even overrides the evidence gathered by our eyes, causing us to imagine things which aren’t really there (Zhaoping 2008). This fact constitutes a major problem in the eyewitnesses’ evidence (Gottesman/Intraub 2003).
In medicine the frame/content issue is fundamental, as well. Its importance for the assessment of the measured values has already been demonstrated (chap. 2.7). The following examples shall highlight some further implications and the wide applicability of this principle:
Is the dispute with the food industry to combat obesity a medical or a political issue? The first important conflict with food industry arose when Nestle promoted formula feeding instead of breast feeding for babies in African countries. This lead often to severe gastroenteritis and deaths, as most people had no clean water. Was the campaign ‘Nestle kills children’ political? If yes, is only the treatment of a dehydrated baby a medical action? And are breastfeeding campaigns a political, a social or a medical issue? This has again been under discussion when recently 50 000 children had been admitted to hospital and an unknown number has been exposed to long term harm through intoxicated formula milk in China (Coutsoudis et al. 2009). The answer to such questions, although of major importance for medicine, has nothing to do with the content, with facts. It is a ‘frame’- decision.
Or: In the United States adverse drug effects rank fourth to sixth in the list of causes of death (Lazarou et al 1998) and one in 12 of older people is prescribed the wrong drug (Rauch Goulding 2004). Up to 6,5% of all admissions to hospitals in the UK are due to adverse drug reactions (Pirmohamed et al 2004) and adverse drug effects that occur especially in elder people sum up to 5% a year (Gurwitz et al 2003). This can be seen as a good sign, as people are prevented from dying out of other causes, or as a bad sign indicating that drug therapy is often malpractice.
Or: Antibiotics are helpful, without doubt. However, their misuse is damaging. About six to eight million unnecessary therapies with antibiotics are estimated in the US alone for otitis (Hendley 2002). This leads to unnecessary side effects - which is an individual problem. It leads, as well, to the selection of highly pathogenic mutants - something that threaten us all (Levy 2002). Doctors are in the dilemma whether they should think of the individual or of the society first (Foster/Grundmann 2006).
Also it is unknown whether hospital treatment is really beneficial. Many found it harmful (Fisher 2003) and a reform of the health care system of veterans in the US showed that a reduction of the admission to hospitals is beneficial for the patients (Ashton et al 2003). Is it because older people who stayed in hospital commit more often suicide (Erlangsen et al 2005)? Is it because of nosocomal infects? Or is it because of medical injuries (Zhan/Miller 2003)? In the UK about 850 000 medical errors occur in NHS hospitals every year, resulting in estimated 40 000 deaths (Aylin 2004). In Spain, 6 of every 100 patients die in hospital due to adverse drug reaction, a study suggests (Universida de Granada 2008). Some even argue that going to hospital these days has become a bit of a lottery (Ananthaswamy 2003).
That is, the modern medical system can be seen as the best ever, or as harmful for mankind (Illich 1999, Wright 2003), suggesting that “if the entire pharmacopoeia were sunk to the bottom of the sea it would be all the better for mankind and all the worse for the fishes” (Holmes cited by Smith 2003d).
All these views have good arguments. Open fractures have a much better prognosis than 100 years ago, something true for most diseases. But the epidemiological reduction of mortality is not due to medical treatment (chap. 2.2). The answer to the question whether something is good, helpful or damaging lies often not in the facts, but depends on the criteria taken into account.
The fact that the meaning is a characteristic of the frame and not of the content is not only found in social behaviour. It is an integral part of every action in medical life, as already seen with the meaning of individual measurements (chap. 2.7). Every fact is polyvalent by its nature and true only in a singular context. It is therefore always necessary to ask for the logical theme under which an object shall be determined (Günther, 1979: 12).
Also this has already been seen very clearly by Bernard: “In science, ideas are what give facts their value and meaning. It is the same in morals, it is everywhere the same. Facts materially alike may have opposite scientific meanings, according to the ideas with which they are connected” (Bernard: 103).