Georg Ivanovas From Autism to Humanism - systems theory in medicine
The emphasis on specific diseases has generated the impression that diseases have a certain kind of distinct reality. They were no longer seen as a description or a map of the human condition. They have become a kind of an own territory (chap. 3.8). But as this is not the case, the epistemological inconsistency must appear somewhere. In fact, the growing knowledge about physiological processes makes it ever harder to subsume all findings under the label of one specific diseases. As a result there are shifting definitions of many diseases. The definitions depend more on the scientific approach and have less to do with the patients. A disease like asthma might be defined according to its phenomenology, pathophysiology, genetical influence or therapeutical possibilities (Holgate/Polosa 2006). Each time it will be a somehow different disease. The same is true for schizophrenia (Mueser/McGurk 2004). Osteoporosis might be seen as a disease, as a risk factor or as an emergent physiological phenomenon (chap. 4.6). Infections can be classified according to germs, typical symptoms, genetical disposition or the status of the immune system. The confusion about the chronic fatigue syndrome (chap. 2.1.e) is another expression of the epistemological difficulty to coin clear-cut diagnoses.
However, when disease is understood as a description of a human condition and not as an independent entity things become more intelligible. Characteristic traits then represent a part of a larger picture. Already at the very beginning of scientific medicine Bernard wrote: “Indeed when we wish to ascribe to a physiological quality its value and true significance, we must always refer it to this whole, and draw our final conclusion only in relation to its effects in the whole” (Bernard: 89). That is, a certain physiological (or pathophysiological) finding makes only sense in the context of the whole human, in the context of autopoiesis (chap. 4.8). The human has to be judged in his environment and not in isolation. For example, the rate of type 1 diabetes among the children of Pakistanis who migrated to the United Kingdom is the same as the rate among non-immigrants in the United Kingdom (11.7 per 100,000), or about 10 times as high as the incidence of type 1 diabetes in Pakistan (1 per 100,000) (Bach 2002). When Turkish families move to Germany children suffer as half as often from asthma. The more they adopt a German life-style the more their incidence of asthma approximates the German figures (Swarf 2006). Many factors play a role such as toxins (Stevens/Bradfield 2008), nutrition, genetics, epigenetics, family structure, stress and others. And despite the strong genetical component in obesity (Frayling et al 2007), the social network is even more important in its development (Christakis/Fowler 2007).
“The conditions necessary to life are found neither in the organism nor in the environment, but in both at once” (Bernard: 75). It is incredible how precisely Bernard defined these relations which today are considered as brand-new insights (Barabási 2007).
In order to understand what disease and therapy is, a bundle of contexts has to be taken into account. Only such a wider view is able to unite the multitude of observations. “It’s the network, stupid!”, exclaim the editors of PLoS Medicine, trying to explain that everything in medicine is connected (PLoS Medicine Editors 2008).
In such a view diseases are an emergent phenomenon. They can be called network pathologies, and might be defined as follows: “Network pathologies arise when the body self-organises in response to some disturbance, but becomes confused and ends up worse at self-regulation than before….There is clearly a failure of self-regulation, in which some parameter of a control system has been set wrong…It's not unreasonable to imagine that all these different causal factors are inputs to a network, and that they confuse it into thinking that its normal immune response is inadequate“ (Hyland 2001).
This first definition shows some important traits of network pathologies, misses, however, the fact that characteristics defined as pathological from an observer might be the means to maintain an equilibrium (chap. 5.2).