Georg Ivanovas From Autism to Humanism - systems theory in medicine
Charles Sanders Peirce (1839-1914) presented an extensive logical work. As one of the first, Peirce was concerned with semantics, especially with signs and signification (semiotics). This part of his work has found an increasing interest in the last 30 years. Arts and artificial intelligence, both concerned with the question of how objects or facts express complexity, embraced Peirce’s work.
Peirce’s model, although not so easy to comprehend, shall be outlined in short:
Every object has certain qualities. These qualities are the respect or the ground how the object is categorized. But they are already an abstraction: “Moreover, the concept of a pure abstraction is indispensable, because we cannot comprehend an agreement of two things, except as an agreement in some respect, and this respect is such a pure abstraction as blackness. Such a pure abstraction, reference to which constitutes a quality or general attribute, may be termed a ground” (cited in Corrington: 120).
This resembles the modern notion of affordance as used in cognition research. Respect, ground and affordance indicate that notions like quality and meaning are a characteristic of relations, but do not exist as such.
Peirce embeds this poly-contextural ground into a three valued system:
Firstness is the ground, the probabilities of an object. It is an “intersection of an unlimited number of contextures” (Günther, 1979: 289), before it is attributed to any context. It was especially Freud and psychoanalysis with the technique of free association to show the magnitude of possibilities each fact and symbol has for human understanding. Dreams are but a flow of firstness only slightly interconnected.
Secondness is the correlation of the sign to an object, its correspondence to facts. It involves causal concepts. All theories about dreams (Freudian, Jungian or neurophysiological) connect the unshaped world of pictures to an unobservable process. Peirce mentions fever as a sign for a deeper causal agent. Medical textbooks teach secondness.
Thirdness is the level that connects firstness and secondness. It is the level where meaning is created in a relationship.
To make an example: A national flag has no meaning as such. The pure pattern would be firstness. Only if it is correlated with a country and represents a country (secondness) it becomes meaningful. The use of the flag causes reactions not inherent in firstness or secondness. Burning a flag causes a different physiological reaction than burning old trousers, although the tissue (the ground) might be the same.
Basically, this concept of firstness, secondness and thirdness resembles the concept of content and frame, with thirdness as both together. Peirce's concept does not seem to be all too exact, as researchers often discuss if something is firstness, secondness or thirdness.
Peirce's work is insofar remarkable as he made the study of signs and signification acceptable. In medicine there is a rudimentary theory of semiotics, found mainly in psychotherapy and in placebo research (Uexküll 2001; Walach/Sadaghiani 2002). In order to illustrate the importance of semiotics for the medical theory and practice I would like to make some examples.
Reference values have no semantic relevance. They are but deliberate limits (chap 2.6). But as soon as they exist, they serve as a sign that produces a complex behaviour on the side of the therapist. One colleague described something he called an “attack of vigintiphobia” (fear of the twenty). He became anxious when a home nurse called him an evening, saying that a baby had a bilirubin concentration of 20,5 mg/dl and she had started to do phototherapy at home. “Intellectually, I knew this plan was reasonable. But I was seized with an attack of vigintiphobia. I kept envisioning the child developing kernicterus. So I kept asking my wife to stop the film so I could fret about what to do. Ultimately, I did not call the home health nurse back to advise her to admit the baby to hospital, and of course the baby did just fine. But that evening the vigintiphobia was intrusive to the point that I remember thinking, ‚Who needs this? Next time I'll just follow the guidelines and admit such kids to the hospital, so I don't have to worry and can enjoy my movie’” (Newman 2003).
Every practicing physician has experienced similar examples.
In the first case (neurosis) a person is treated according to a given concept. In the second case (placebo effect) it is mostly smiled at and somehow excluded from the scientific frame.
Both approaches miss the basic point: A sign (a sip of alcohol or the idea of drinking alcohol) produces a physiological pattern of reactions. Physiology seems to be organized around such signs and complex behaviour is triggered by them.
One of the first to investigate such processes systematically was Pavlov with his concept of conditioned reflexes. He showed that even immunological response can be triggered by signs and that signs play a key role in the processing of the nervous system and in physiology, as well (Pawlow 1933).
I remember the case of a lady over 70 who would not recover after her gallbladder was removed. She vomited whenever she drank or ate something. A lot of attempts with all kind of food and drugs were made. But all failed and provoked only vomiting. After one week she was really in a bad condition. Then she asked for some Champaign. The ward doctor allowed her a small bottle. From this time on she recovered quickly and was well after a few days - with her daily glasses of Champaign. This cannot be called neurotic. Also the characterization as a placebo effect seems to be inappropriate although it is hardly possible to attribute this effect to the pharmaceutical ingredients of the Champaign.
It is futile and impossible to distinguish the object from its significance. This impossibility is supported by brain scan findings showing that imagination mimics the brain reaction seen during ‘real’ perception. “From a cortical point of view, sensory acquisition and sensory processing are inseparable” (Bensafi 2003). The object and the memory of it, present and past cannot be separated. Neither theoretical nor practical. This is underlined by the finding that imagined pain creates the same neuronal pattern as felt pain (Derbyshire et al 2004, Berns et al 2006).
Signs not only trigger physiological processes, they express them as well in communication. They are tokens for eigen-behaviour as von Foerster called it (chap. 4.2). Perception, communication and reaction are deeply interlocked with the signs they represent. For example, reading the word ‘smiling’ activates the facial muscles used during smiling (Foroni/Semin 2009). Or, physical purity is strongly connected to moral purity. Participants in a test which had been exposed to a process of physical cleanness found certain moral actions to be less wrong than did participants who had not been exposed to these manipulations (Schnall et al 2008).
It seems that signification is the glue holding communities together. This is why we are able to perceive complex phenomena just by the signs they represent.
One of the first approaches to observe communication of the spouse by Soskin and John (1963) was disappointing, as their categories did not show any reliable effect. The authors found out that an anecdotal account obtains a clearer description of processes and interactions as all measurements based on analytic methods (Gottman: 15-17).
The problem with analytical reductionist methods is that the various contexts of a fact are reduced to one and symbols are excluded by convention. Thus, signification is not observable anymore and is often even regarded as unscientific.
Milton Erickson (1902-1980) was a psychotherapist and hypnotherapist. He was known for his unconventional interventions. “I always invent a new treatment in accord with the individual personality” (cited in Zeig 1980: 104). If he had a system, he never taught it. Although he is known as a highly successful therapist, he must be called unscientific in the orthodox sense. He was a master in using signs and creating complex reactions through signification.
One case was a Viet Nam veteran with broken spinal cord, bound to a wheel chair, having convulsive pain attacks every 5 minutes night and day. Although he was operated twice, pain was not relieved. Erickson created a kind of scene. In the presence of the veteran he manipulated the clothes of the veteran’s wife in a rather indecent way. During this tense sequence the man had no pain. Supporting this experience of having no pain with hypnotherapy he was able to keep the patient free of pain (Zeig: 175-179). This case is vivid, clear, impressive and absolutely absurd from an orthodox-reductionist point of view. It is cited in full length (appendix V).
All this is strange to a normal medical scholar. It seems to be an invasion of magical practices into modern medicine. This overlooks that the logical structure is not too different from biofeedback or TENS therapies. They do the same, but their ‘magical’ signification is in line with the scientific orthodoxy. It is an irony that every practitioner uses magical practices, that every surgery, every injection, every issue of a prescription has a magical component. It is impossible not to act magically (on the level of signs), as much as it is impossible not to communicate.
Every physician has a lot of examples belonging into this category, like the girl diagnosed with ADHD (chap. 2.2). One might object that these are single cases. It must be single cases as they concern the individual ‘construction of reality’.
By the futile attempt of orthodox medicine to separate signs from signification, to “sift facts from meaning” (O’Halnon/Wilk 1987) the basics of perception and communication are violated.
What seems to be magical at first, is in most cases nothing else than a polyvalent logic taking the environment into account. This can be demonstrated with the well known example of different dimensions: A prisoner in a two dimensional world is safely locked up in a square. If this prisoner understands the third dimension he is able to leave the prison just climbing over the boarders of the square. From the two dimensional point of view this would look like magic.
Similarly we often experience people just vanishing from the prison of disease. Cancers disappear, deep depressions change from one day to another, people rise from wheel-chairs and smaller magical moments are to be seen in our everyday practice (Duffin 2008). Often (how often?) these changes are triggered by some kind of sign or symbol.