Georg Ivanovas From Autism to Humanism - systems theory in medicine
Watzlawick et al. developed a theory of communication which had been based on the ideas of Russell and Bateson. Their book Pragmatics of Human Communication (Watzlawick et al 1967) belongs to the most influential works of the social sciences in the second half of the 20th century. Their 5 axioms of communication contribute important insights, relevant for the semantics of medicine.
1. One cannot not communicate (Watzlawick et al: 51)
Concerning simple communication it is obvious. The husband not answering the question: ‘Where have you been tonight?” is highly communicating, as well as the child’s closing his eyes and ears when being questioned. The impossibility of non-communication is also important in every medical contact, in every therapy. There is no neutral stance of the physician and no udeno-therapy (chap. 2.2). A doctor cannot not treat. Whatever (s)he does has a meaning for the patient. Being friendly, reserved or rough has an impact.
Without a clear comprehension of this axiom the events observed in medicine cannot be described appropriately. Thus, this axiom will be treated in different forms throughout this work. Despite of the importance of communication in medicine, this issue is rarely investigated (Roter et al 2006).
2. Every communication has a content and a relationship aspect such that the latter classifies the former and is therefore a metacommunication (Watzlawick et al: 54)
This is Bateson’s concept of ‘content and frame’, just in other words. Metacommunication became only lately a topic of brain research (Hamilton/Grafton 2006; Friederici et al 2006), involving the impact of mirror neurons (chap. 4.2) or emotional body language (Gelder 2006).
3. The nature of a relationship is contingent upon the punctuation of communicational sequences between the communicants (Watzlawick et al: 59)
Every communication consists of a sequence of events. Nothing happens out of nothing. This axiom says that the outcome depends on where we start to observe and how we construct the sequence. In a quarrel it goes like that: You said… - I did it, because you made… - I did it because you yesterday …. etc. The outcome (e. g., who is responsible) depends on the events taken into the frame of observation. This had already been proved by the mathematician Bolzano.
Given is a sequence
S = a - a + a - a + a - a + a - a + a - a + a - a + a - a + a - a + …….
There are three possibilities to group it:
1. S = (a - a) + (a - a) + (a - a) + (a - a) + (a - a) + (a - a) + ……..
= 0 + 0 + 0 + 0 + 0 + ………..
2. S = a - (a - a) - (a - a) - (a - a) - (a - a) - (a - a) - (a - a) -
= a - 0 - 0 - 0 - 0 - 0 - ……….
3. S = a - (a - a + a - a + a - a + a - a + a - a + a - a + a - ……..)
= a - S
2 S = a or S = a/2
The result of the equation depends on the punctuation.
A typical example in medicine are multicentre trials. In combining the results of the centres in one way or another it is possible to prove either the effectiveness or the ineffectiveness of a therapy (Dubben/Beck-Bornholdt 2005: 137-156). Also the hen and egg question whether a gene function or a brain pattern is the cause or the consequence of a certain observed phenomenon belongs often into this category. May be it is no coincidence that in physics - a rather ‘simple’ science compared to medicine the books and articles of the last 300 years rarely mention the word cause, and much less causal chains (Hanson: 51-52), notions still important in medicine.
4. Human beings communicate both digitally and analogically. Digital language has a highly complex and powerful logical syntax but lacks adequate semantics in the field of relationship, while analogic language possesses the semantics but has no adequate syntax for the unambiguous definition of the nature of relationship (Watzlawick et al: 66-67)
This axiom is probably the most underestimated of the five. Digital communication concerns a content, which might consist of words or numbers. Whereas the frame information is analogical.
The digital communication has (according to Watzlawick et al.) the advantage to be more precise, such that formal logic can be applied (and, or, if-then, no). Analogical communication is not able to do this, but has the advantage to reveal similarities and relationships. Analogical communication is said to have no negation. An example for analogical versus digital information is: “A bunch of roses says more than a hundred words” but it is not so clear what it says.
The relationship between digital and analogical might better be demonstrated with watches. A digital watch gives us an exact time but the analogic watch more the feeling of time. In films, digital watches are used for count-downs, analogic watches are used when an appointment comes nearer. In sports, the digital result of a race gives a clear order, whereas the photography of the finish gives a very different (analogical) impression. The photographic outcome often does not seem to be as clear, precise and simple as the scoreboard suggests. However, we are used to believe more in digital signals.
Blood sugar testing is often done with test sticks. According to the blood sugar, the colour of the stick changes. With a reference table, the blood sugar can be estimated approximately (analogical method). The stick can be inserted into a machine, as well. Then the machine gives an exact value, let’s say 132. Now, the result of the machine is not more exact than the eye (Kleesiek 2003), but everybody thinks it is because it shows a precise digital value, different from the eyes approximate (120-140).
Digital expressions are always precise. They cannot be different. The question is only, if there is any equivalent in the observed that is as exact as the description.
The neglect of analogical thinking is one main reason why current medicine has difficulties to describe and even perceive its own problems. It does not see that it does not see (chap. 3.3). The other extreme is traditional Chinese medicine which is extremely metaphoric describing even physiology in an analogical form (chap. 5.6.b).
5. All communicational interchanges are either symmetrical or complementary, depending on whether they are based on equality or difference (Watzlawick et al: 67-70)
This recursive concept of schismogenesis will be discussed later in detail (chap. 4.2)