Georg Ivanovas From Autism to Humanism - systems theory in medicine
The normally assumed linear relation between cause and effect is, as we have seen, only a special case, observable under certain circumstances during a restricted period of time with no feedback mechanisms involved. As this is not the normal case most reactions are non-linear. Here some examples: In taking a cold bath the initial reaction is cold, the following reaction is warmth (Granichstaedten: 43). But staying too long in the cold bath changes the pattern and a beneficial effect becomes harmful (Granichstaedten: 44). Prießnitz observed that when a freezing person went in a warm bath and sweated the freezing stopped. When the person left the bath he froze again. Until here it is more or less a linear relationship. Freezing vanished, however, if the person was washed after the bath with a cold sponge (cited after Granichstaedten: 103). The paradox result is due to feedback mechanisms.
Nevertheless, it is still possible to make certain predictions. The Arndt-Schulz’ Rule of naturopathy is such an attempt to model different reactional patterns. It exists in several versions. It says: a small stimulus stimulates, a strong stimulus blocks or damages.
Hydrotherapy works with stimulating effects, e.g., washing with a cold sponge induces a reaction towards warmth. Similar effects are also seen in systemic psychotherapy, specially in the strategic method (chap. 5.2.b).. Actually, this kind of reaction is a typical pattern seen in all cybernetic systems when the system tries to counter-balance a perturbation.
In the classical pharmacology this effect has been investigated in detail under the notion of hormesis. “Hormesis, a dose-response relationship phenomenon characterized by low-dose stimulation and high-dose inhibition, has been frequently observed in properly designed studies and is broadly generalizable as being independent of chemical/physical agent, biological model, and endpoint measured” (Calabrese/Baldwin 2003). The stimulating-blocking relation has been proved for many substances and is well established. For example, suramin which is effective in the treatment of prostate cancer promotes tumour cell growth in low doses (overview in Calabrese 2008).
That a strong stimulus damages is obvious and needs no further discussion. The range of blocked reaction between stimulation and damage is nothing else then the rigidity discussed above. The general tendency in drug therapy is to remain in the range of blockage. First, because there is no theory of how to handle the changing pictures presented by a reaction of the organism. Such reactions are seen as disadvantageous. Second, the relation between drug administration and reaction becomes linear and trivial. Thus, an effective drug therapy has to have the ability to block the inner reactions, such that the system does not counter-react. But it has to be weak enough in order not to damage. That is, therapies based on the reaction towards a stimulus work on a total different level of human physiology than usual drug therapy making it difficult to compare the two.
Nevertheless, there is no fixed red line between stimulation, blockage and damage. The phase transition (chap 4.11) occurs according to the current condition of the person. Beta blockers might stimulate, block or harm depending on the inner and outer conditions, on the dosage, the duration, etc.
In order to understand correctly how a change is induced by a stimulus, three preconditions have to be met:
The first precondition is often met in orthodox medicine, although there is a tendency to combine treatments in an undisciplined way. This happens when for different sub-systems different uncorrelated or even antagonistic therapies are combined (Maesemeer et al 2003).
As a rule of thumb it can be said that therapists who use more drugs (or other kinds of interventions) individualize less, are more diagnose orientated and have no explicit theory of the process. Often the tensions between the practitioner and the hospital follow a similar pattern. Western hospitals are normally more diagnose biased. As a consequence they are more inclined to end up in a polypharmacy whereas the practitioner, knowing and understanding better the process of a patient, is more inclined to prescribe few drugs. However, this seems to differ from country to country.
Practitioners are mostly well aware of the second precondition and see change as a process. Especially those practitioners who accompany patients over longer periods of time and even might know three or four generations of a family will often instinctively understand typical patterns of an individual or a family reaction.
Understanding disease as a process has many implications. One is:
Do not disturb a process when the situation improves.
From a processual point of view this is obvious. When an operation is under way leading to the desired goal, every intervention into this operation might disturb it and change the operator, such that medium and long-term results are less favourable.
Judgment might, however, be difficult, as crises are natural and common in the process of healing (Hammer: 44). Not later than here the lack of a theory to judge this process becomes obvious.