MENTAL FURNITURE #12
Speransky: A Basis for the Theory of Medicine
©1997 Dennis Leri
New theories about the nature of life, the nature of the universe, and the nature of consciousness can be found everywhere. Each new theory proclaims itself to explain nearly everything and thereby to constitute a new world view or paradigm. New paradigms -- Buddy, can you paradigm? -- are de rigueur. The new paradigms rely on the mathematics of non-linear dynamics to describe the surprising, sudden and seemingly a-causal qualitative shifts in a system. Non-linear dynamics are the basis for Chaos theory, Catastrophe theory, complexity theory, fractals, strange attractors, neural Darwinism, autopoiesis, etc. It is seen as the key to understanding the spontaneous emergence of qualitative different processes, properties and forms in living and non-living systems. The various theories deal with how life or some part of it came about and what it is. Some of the hottest new theories concern the notion of self-organizing systems. By appealing to the notion of self-organization the conditions for the emergence of life forms and their temporal existence can now be specified. For example, the Santiago School of NeuroEpistemology and its proponents Varela, Maturana and von Foerster have given us the notion of autopoiesis, self-making, to describe the realization of a living entity on its own terms. Autopoiesis specifies the way an organism is bounded and how that boundedness can maintain itself in relation to a medium (the milieu in which it appears). Their rigorous description of the character of any living entity and its relationship to other entities has shifted the primary emphasis away from the species as the engine driving evolution and onto the individual. In older evolutionary theories individuals were seen as dispensable to the greater good of the species. In autopoietic theory, individuals are not dispensable but central to evolution.
If an individual and its behavior are so important then surely there must be some post-modern notion of what constitutes a state of health and a state of pathology for any individual. But, here we see that modernity and post-modernity are woefully deficient in producing such notions. Consciousness, normal or altered, is explained without reference to the well being of individuals. Edelman's neural Darwinism, for example, explains the plumbing and wiring of consciousness and the importance of the nervous system in its particular relationship to the organism yet deals not at all with what it means to live a life, a particular life, your life or mine. But to find someone who poses questions related to defining health and pathology, who looks to study those actions constitutive of a healthy mind and body we must go to early part of the 20th century.
Moshe Feldenkrais often spoke with admiration about Russian researcher and theorist A.D. Speransky. When reading Speransky's book one is initially faced with grim, gruesome and grizzly accounts of experiments that nearly all have the same result: the test animal dies. Animals have their brains chopped up, frozen, and traumatized in all sorts of ingenious ways. Pages and pages of slightly differing experiments are catalogued. But, the grim task of reading becomes a sort of detective story of ever increasing interest. We travel back in time to Russia in the Twenties and Thirties. Hard questions about pathology and health were being asked and put to the test. Numerous twists and turns along the way led to some very startling propositions being put forth.
In one series of tests dogs are given morphine and after the morphine takes effect portions of their brains are frozen. After the morphine wears off the dogs' health cascades downwards in stages that mimic epilepsy. But, freeze the brain without morphine and the dogs pretty much recover just fine. Is the morphine a shock to the system? The animal recovers when morphine is given at the same time as the freezing or nearly so. Is time a factor? Give morphine long enough after the freezing to constitute it as a separate perturbation and the same results are obtained as when the morphine is given before the freezing: the animal falls into a horrible, seizure punctuated decline into coma and death. So, the system recovers from one shock but not two. And, the system that succumbs is a different system from the one that recovers. Smudgy Karma aside, the experiments give rise to serious questions about the nature of health, of pathology, and the role of the nervous system in all functions of an organism.
The question "What is pathology?" Speransky says, is as unanswered as the question "What is health?" Theories from physiology, biology and other sciences relating as they do to organismic functioning are not theories of health or pathology. Medicine has no theory, or rather it has many theories borrowed from other disciplines. Either way the result is the same. Ten years or so ago I heard an esteemed lecturer say the same thing at a U.C. Medical School lecture. Medicine as an art is a lot older than what we now call the scientific method. Empirically proven medical approaches whether allopathic, homeopathic, acupuncture or herbal, no matter how effective, have no theory in the modern sense. That is not to say they're not systematic or even logical, but only that the bases for their successes are without theoretical foundation.
From Speransky's A Basis for the Theory of Medicine: "..Disease was never looked upon as an independent quality, as a special form of biological processes; the starting point has always been formed by conceptions of a contrary nature. Taking as an indicator one or more groups of complex reactions that go to make up the conception of normality, disease was conceived as a distortion or alteration of these conditions. From this, it was rightly concluded that to understand a disease, it is necessary to know what is normal.”
"But we have also no suitable means of approaching the concept of normality. ... We cannot define disease as the antithesis of health, since neither side of such a medal bears any imprint.
"At the present stage of science, what has to be done is to look for the qualitative distinguishing features within each of these conceptions. It seems to me, that as far as disease in a complicated organism is concerned, we have succeeded in solving the task. The form in which the nervous component of the pathological processes makes its appearances does not occur under normal conditions. The pathological conditions are characterized by new reactions. The presence of the latter is evidence we are dealing with a real pathological process. Consequently, it is neither the disharmony of phenomena existing in normality, nor the disorganization of correlation in the functioning of separate parts of the organism, that defines its pathological state, but the emergence of new qualitatively distinct processes. The disorganization of correlations, disharmony, etc., are only a consequence of these last.
"There is no doubt, of course, that the basis for the development of neurodystrophic processes in the organism lies in the peculiarities of structure and function of the nervous system, i.e., in its physiological properties. But their distortion creates, as it were, a new type of nervous activity, the appearance of new reactions, not only unnecessary but directly harmful to the life of the individual. Hence, the question is one, not of degree, but of form, in other words, of qualitatively new biological phenomena."(198-9)
In Body and Mature Behaviour Moshe Feldenkrais takes Speransky's argument concerning the domain of pathologies relating to poisons, viruses, bacteria or physical trauma and extends it to the psycho-physical dynamics of human individuation. Cannot we assume, he hypothesizes, that the pathologies of everyday life, i.e., various neuroses, will follow the same dynamics laid out by Speransky. And those dynamics are that the nervous system is really and truly different in subsequent moments in time; that the same perturbation will affect the system differently at different moments; that different perturbations may yield the same response; that pathologies are not health plus some disturbing agents but self sustaining autonomous nervous system patterns; and that health being undefined needs some examples to study, e.g., Yogis and Judo masters. What means does Speransky employ that Feldenkrais builds upon?
For Speransky the problem begins with trying to find indicators of health or pathology more subtle than whether the animal is dead or alive. He has data galore but how is he to make sense of it? "... Analysis alone is not enough for setting the data in order, for systematizing them and creating a working hypothesis. Synthesis is required. ... Confusion in views does not depend on lack of details. ...We have to define the principles which at the given moment are best capable both of unifying the data..." (405, Theory of Medicine). To see the forest above the trees, to seek a point of view from which to make evaluations Speransky seeks to make the case for a unifying view by generalizing from his data. How exactly are a black rabbit and a white rabbit different or a tall man and a short one different? Appeals to blood chemistry, morphology or whatever merely maintain the same statistical principles. At whatever scale there are indicators meaningful to some discipline. But, taken together what do they indicate about health or pathology? While there is no shortage of signs signifying something to someone the essential nature and mechanisms of phenomena are elusive unless the search takes a different path. Speransky, having disabled answers and theories that lead nowhere new, finds hints in the questions he can now ask. All the indicators in all the allied disciplines whether formal like physiology and biology or methodological like clinical medicine intersect in being related to an emerging image and concept of the nervous system.
Speransky's conceptual leap was practically arrived at through thoughtful experiment. For a theory of medicine, to start with the central role of the nervous system "makes it possible to give suitable arrangement to all other facts, to find the proper place for each constituent and to determine the order of functioning of the separate parts." (401, Theory of Medicine) Speransky's characterization of health and pathology as emergent self-perpetuating states anticipated much theorizing now current. His thinking led to him being able to create pathological states mimicking certain diseases. He was also able to demonstrate that pathological states could be interrupted and health returned not fighting the irritant but by changing the state.
For Moshe Feldenkrais, Speransky's hints at the interdependence of all phenomenal indicators on nervous system functioning gave rise to his idea of mature behavior. Such behavior is not constituted by any of the many external indicators, e.g., societal or religious standards. Unique and dynamical patterns of neurophysical action whether neurotic or potent make up behavior. Mature behavior is that state of health that permits one to recover from the slings and arrows of outrageous fortune as well as to form and live a vision of life on one's own terms. A state of health is not achieved by treating parts of a system but by effecting a global change of state which connects the world around one to the world within one. |
