Georg Ivanovas From Autism to Humanism - systems theory in medicine

6. Systemic Medicine

previous -- home -- content -- next

6.6 Hardening

Many deaths caused by Britain’s winters (chap 2.1.d) are a result of a reduced adaptability. The death rates in the UK are higher than everywhere else in Europe, including the countries with much colder winters. A 5°C drop in temperature is associated with a 7% increase in admissions for stroke and a 12% increase in admissions for heart attack (Dobson 2004). After the winter 2003/2004 there was a lot of discussion on how to prevent such casualties. I would like to pick out one topic to demonstrate some important characteristics of robustness.

It had been proposed to heat all public buildings and even the bus stations during cold weather (Keatinge/Donaldson 2004). Of course, there are a lot of arguments against such a move. It would be rather expensive, would promote climate change, and both consequences (lack of money and a different climate) might even lead to a higher mortality. But the main argument in this context is that the heating of public areas does nothing to improve the robustness of the people. It might even diminish it.

Bleuler who never heated the floors in his hospital and also kept the ward rooms on a quite low temperature, maintained that he had no deaths during the Spanish flu 1918/1919 whereas comparable institutions had quite a lot of casualties. He insisted that providing a frame of healthy conditions, that is, to promote robustness, is the best way to prevent and treat most diseases (Bleuler 1962: 54-56).

This natural way to improve robustness is called hardening (chap. 5.4.a). The benefit of hardening is not restricted to a defined trait as cold. It improves robustness in general. Body exercise, another way of improving robustness, prevents and heals a wide range of diseases (Blech 2007b) and does not only improve the function of the muscles and the bones. That is, in order to judge the therapeutic effects of an intervention, the higher levels of learning have to be taken into account (chap. 4.3).

The exposure to cold weather is not as effective to prevent cold related deaths as heating, at least as a short term measure, but it might improve the adaptation to warm weather, as well. This is of some importance, as heat stroke is highly underdiagnosed (Bouchama/Knochel 2002), and the consequences of hot weather are normally only discussed during heat waves like in France where between August 4 and 18, 2003 about 15.000 people died (Poumadère et al 2005). That is, linear interventions like heating during cold or cooling during heat might prove to be effective in observational studies. But as they do not improve robustness or even might diminish it, they might lead to an increase of overall mortality.

It is crucial to understand this when the effects of a drug therapy shall be judged. Beta blockers are good for a lot of illnesses ranging from hypertension to glaucomas and states of agitation. However they increase rigidity, such that the ability to adapt to heat is decreased and heat stroke becomes more probable (Bouchama/Knochel 2002). As a consequence, all knowledge about the efficacy of beta blockers gained in specific trials is invalid in times of climate change with more hot summers, just to name a dramatic change of the context. On the other side: a therapy increasing robustness might be less effective than beta blockers in the specific context, but it might lower all-cause mortality under changing weather conditions. But such developments cannot be observed under constant conditions.


Our society has the tendency to avoid strong and changing stimuli. Everything is levelled through all kinds of interventions. Room temperature is constant. Nutrition is without strong tastes. Intense emotions are regarded as pathological and are immediately flattened with drugs. And all that seems to be somehow effective in a first order frame of observation, but it reduces robustness, is a kind of weakening.

Having walked with groups of persons who never had left flat streets for decades, I have observed their difficulties to maintain balance when confronted with the uneven ground of goats’ paths. But as soon as they started to move more smoothly they changed fundamentally. They even become able to think in a more complex way. This observation is supported by the findings that bodily exercise improves mental abilities (Aot et al 2004; Weuve et al 2004), protects against Alzheimer’s disease (Schubert 2005) and even induces the growth of new brain cells (Wild 2005b). Even such a simple stimulus as vibrating insoles helps elder people to maintain balance more easily (Priplata et al 2003). However, I suppose that linear movements, as done in a fitness centre, are not as effective as walking under natural conditions. Fitness centres do not provide the incessant change of the stimulus. The linear stimulus might lead to a first order training. The continuous change of the stimulus leads to a second order learning, including anticipation of following movements, complex balancing etc. In the mountains nobody can read a newspaper or see television as sometimes seen in fitness centres.

The same is true for medicine. In the seventies of the last century there had been a tendency for programmed births. The time of delivery was freely chosen when all was prepared. Due to drug treatment everything was painless. A journal propagated the ideal that women even might read a newspaper giving birth.

This is a more prominent example of how medical practice tries to keep alterations in a small range whereas natural life expresses itself in a nonlinear and complex way.

previous -- home -- content -- next