Georg Ivanovas From Autism to Humanism - systems theory in medicine
As patterns are a difficult issue. They have been called “natural or chance configurations” (Webster’s 1976). But neither the Encyclopaedia Britannica, nor the reliable Stanford Encyclopedia of Philosophy define the word at all (5.4.08). Even the Wikipedia article on pattern has the remark that it does not comply with Wikipedia’s quality standards (5.4.08). This deficit is remarkable, especially in such - normally talkative - soures. Pattern is not only one of the most central notions in the investigation of the living. It is (one of) the most important characteristic(s) of life. Bateson, who investigated this ubject his whole life, coined the expression 'The pattern that connects. One of his most cited statements gives an impression of the impact the idea of pattern has. He said:
As the issue of pattern is not settled at all, this chapter shall just present a few findings and thoughts about patterns crucial for medical practice.
Even without previous knowledge test persons are, to some degree, able to predict how a chaotic sequence continues, impossible if the sequence is random (Novak 2002). In this case, brain research has provided some nteresting insights.
Perception is not performed in a certain part of the brain. This has been known before (chap. 2.3.d). New is the knowledge that in cognition different parts all over the brain work together creating a certain specific pattern, so-called orientation maps (Kennet et al 2003). This pattern is different for every perceived item. Scientists have been able to predict with a nearly 80% accuracy what kind of item a proband has observed, just by analysing these brain patterns (Shinkareva et al 2008). Until now these have been only simple tools like a hammer. But these results show a more common trait: pattern creates pattern.
This does not happen only during the act of perception. For example, visual neurons show spontaneously orientation-maps even without being confronted with a visual stimulus (Ringach 2003). That is, although not confronted with an external stimulus the brain creates spontaneously internal patterns, even during sleep. As sleep and dreams facilitate problem solving (Wagner et al 2004, Cai et al. 2009) and help to extract rules from our experiences (New Scientist 2006), it can be assumed that the brain continuously tries to test patterns. Everybody knows this in being awake. When I learned ultrasound diagnostic (on these old machines that needed some fantasy), I saw signs of the pancreas even in carpets and wallpapers. The Rorschach tests is another tool playing with the spontaneous ability to recognize and to create patterns.
There are some indications that the testing of patterns is more effective if it is not done by purpose (Association for Psychological Science 2008). Thus, it is not surprising that the usual wandering of thoughts seems also to be helpful or even essential for problem solving (Mason et al 2007). As autism is characterized by a lack of daydreams (Pearson 2006b), it might be a condition where the understanding of patterns and the ability of learning of higher order is disturbed.
A physician is continuously confronted with patterns. Every disease is a kind of a pattern. Some are simple, some are complex as the viscero-neuro-muscular interplay (chap. 4.8.c).
If a physician understands such a pattern in an unclear situation it is called intuition. Intuition is a basic characteristic of medical practice (Edwards 2004). However, there is some difficulty to cope with intuition scientifically, despite of the fact that it became of some interest in brain research lately (Traufetter 2006). Most definitions of intuition are related to ‘unconscious’ or ‘instinctive’ knowledge. But such expressions are of no value as they replace only one explanatory principle by another. I propose as a definition of intuition: “the understanding of patterns without a theoretical method”.
The difficulty of medicine with both, intuition and patterns, is due to reductionism. The reductionist approach is based on the measurement of a restricted number of variables (chap. 2.1.b). Of course, it is possible to describe certain patterns mathematically in one way or another (Frank 2009), but this does not bridge the epistemological gap, the fact that quantity never produces a pattern (Bateson, 1988: 110-124). Patterns are simply beyond the epistemological tools of the current medical science. This fact might explain why diagnostic manuals are mainly concerned with symptom counting (chap. 2.1.e). Counting symptoms is in line with the concept of measurement. But it is not in line with principles perception (figure on ground) and of medical practice. This gap between medical practice and medical science is another part of the practitioner’s paradox (chap. 2.1.g).
Patterns are the result of an interaction of more than one variable (Ashby 1960: 34). The scientific investigation of such interactions became a major boost through cybernetics. Ashby’s homeostat was a first simple model of feedback interactions. Quite similar is the equation which describes the love between Romeo and Juliet with the presumption that the more Juliet loves Romeo, the more Romeo dislikes Juliet, but if she loses her interest, he regains his (Strogatz 1988).
The formula leads to a simple oscillation:
dr/dt = - aj and dj/dt = br
r(t) = Romeo’s love/hate for Juliet at time t
j(t) = Juliet’s love/hate for Romeo at time t
This equation (although not meant as a contribution to a scientific psychology) is a good approximate of what often happens in couples. It is a stable cybernetic situation with a fixed set point as described by systemic psychotherapy (cap. 5.2). If there is no set point but a slowly increasing distance between the couple through their recursive interaction we have a schismogenetic pattern (chap 4.2). Gottman, a pioneer in the mathematical investigation of marital patterns maintains to be able to predict divorce with 94% accuracy from six variables out of a questionnaire and a 45 minute videotaped interview.
An important question is about the relevance of such equations. “Are such speculations useful to clinicians? Only if they help organize our clinical experiences, and suggest something we might not have already thought of. That is the ultimate test for the utility of speculations” (Gottman/Levenson 2002).
But we should be aware of two important points. First, we use such equations anyway. We always organize our experience according to defined or mostly to undefined models. This is the simple testing of patterns which we call it intuition, experience or somehow else. Second, we test patterns not only in the field of behaviour. Every item in the web of polycontexturality is part of one or several patterns.