1. The Theory
1.01 Medicine
Sometimes it is worth taking the time to elucidate the etymolog- ical roots of a term. 'Med', so I have read, is Indo-Germanic and means 'to measure', 'to ensure compliance', 'to care'. And the word 'heal' is related to 'whole'.
Wikipedia describes medicine as an empirical science. Medicine, then, is pure empiricism. That is what I learned at the start of my clinical semester studying human medicine. This statement is based on the assumption that things can always turn out differently to what we know from our experience. And that was indeed the case at patients' bedsides. There was also talk of 'tried-and-tested techniques'; techniques that had proven their efficacy. At an early stage in our systems theory studies we were also introduced, without any further justification needed, to the maxim 'ut aliquid fieri' - the idea of simply doing something with the expectation that this will eventually bear fruit.
Now, 50 years on, the field of medicine has become double-blind. Subjective experience is no longer relevant. Instead, it is a question of providing double-blind, statistically sound evidence in service of a desire, an ability - perhaps even an obligation when one looks at the latest medical guidelines - to heal causes rather than symptoms. Though it should be noted that here, 'heal' is used in the sense of preserving life, of preventing death.
In medicine, measurements are used for a specific purpose, namely to heal, to prevent death. And healing, we are told, is a result of medical intervention.
It appears that whether or not a person has heard of the warning 'medicus curat natura sanat' - the physician cures while nature heals - issued by the physician Paracelsus (1493-1541) is nothing but an indication of whether or not they are trained in classics. The awareness of its relevance in our daily activities has been lost.
Although clinical measurement and observation is the first step in any medical intervention - in the words of Dr Franz Volhard, 'the gods placed diagnosis before therapy' - one must nonetheless ask the question: 'what is the doctor looking at?' or preferably 'what else could they look at?'.
Paracelsus Theophrastus Bombastus von Hohenheim (1493-1541)
1.02 Object
The quote from the German text Regulationskrankheiten from the year 1987, with which I have prefaced these musings on the prostate gland, is still an accurate description of how the field of medicine deals with organs classified as diseased in order to help - even 36 years later. This is also true of the organ that we will be discussing: the prostate gland. Objective observation, objective examination, objective assessment - these are the premises of today's scientifically defined medicine.
As in all the life sciences, observations must be objective and consensually verifiable or falsifiable. In medicine, this process of objective observation is referred to as diagnosis.
The diagnosing physician turns their focus to an object as they would to an item, a thing, 'that prohibits their own action, that they are confronted with, that offers resistance to their own movement'. This resistance may take the form of a mass, a feeling, a functional disorder, a thing that demands their attention.
An object, an item, a thing; a metaphorical cube, a black box that is distinct from its environment. This object has boundaries, is ascribed a name and a value.
To once again cite British mathematician and logician George Spencer-Brown, a distinction is made, an object appears and is given a name or an 'indication', and a value inevitably emerges.
Fritz B. Simon (2021) Systemtheorie reloaded. Online Seminar Series
4D Hypercube - Tesseract
1.03 Organ
Similarly to objects, organs are regarded as distinct from their environment, their boundaries are defined and they are given a name. Just like any object that is delineated and named, the organ is ascribed a certain value. This value reflects the significance of that organ to humans, to the phenomenologically distinct realms of being: a person's organism, their psyche, their social system.
As an anatomical and functional component of the organism, the organ is cognitively coupled with the organism. One could argue that the organ is under permanent cognitive observation by the organism, which is in turn observed by the consciousness, which is in turn coupled with the social system. This is an example of the 'expansion of the boundaries of the field of observation and investigation' as described and advocated in systems theory.
When an organ performs its function as a component of the organism, and the organism and organ work in perfect harmony as is biologically expected, this state of being of the organ and organism is not coupled with the consciousness; it resides unconsciously in the cognitive realm of the organism.
It is only when a state of non-alignment occurs, when an expected functional biological behaviour is not performed, that this dysfunctionality reaches the realm of the consciousness and from there the social system in the form of communication.
In other words, when an organ is not aligned with the expectations of the organism, with the expectations of the consciousness and/or the social system that are coupled therewith, the organ is observed, named and ascribed a value.
The organism expects the organ to perform its function. The consciousness expects the organ to behave discreetly, appropriately. The social system expects the organ to refrain from disrupting the social order. If the organ meets these expectations, it is granted the title of 'healthy'.
Fritz B. Simon (2021) Systemtheorie reloaded. Online Seminar Series
1.04 The Norm
Organs that are not disruptive are regarded by the organism, by the consciousness and by the social system as normal - as healthy. The term 'healthy' is a layman's term for which there is no more precise definition. This term is not used in scientific medicine, as there is no scientific criterion for measuring 'healthiness'.
The term 'ill' is also a layman's term. There is no scientific criterion for measuring 'illness' either. The term 'ill' is used within the social system to express the idea that a human within that system is not functioning as expected, for example because they cannot go to work. If a physician is of the opinion that such a person is able to return to work, they issue them with a doctor's note that provides social acknowledgement of their 'healthiness'.
Healthy and ill are not terms used in scientific, objective medicine. Instead, evidence is collected and diagnoses are made. Objective, physical measurements are taken. Data is gathered.
If, as systems theorist and physician Professor Fritz B. Simon notes, numerous different states of being fall under the definition of 'survival', this begs the question: which people in which state can provide data that defines the norm, the normal state, and can be used as a benchmark for objectively distinguishing between ill health and good health?
We are not talking about the subjective question of which measured values a person needs to demonstrate in order to feel fit and healthy, but the question of which values represent the norm, the state in which a person can objectively live their life or survive.
Seminar: Systemtheorie Reloaded with systems theorist and physician Fritz B. Simon
Normal Distribution Curve Gauß'sche Glockenkurve
In order to define this norm, tests are carried out on a statistically defined number of apparently healthy individuals. These individuals are divided into cohorts: newborns, infants, children, adults. For some of the tests, the adults are divided up by age and gender. A normal distribution curve is drawn over all the data collected, and the central 95% is defined as the norm.
1.05 Exceptions
Over the past four decades, only a small number of the normal ranges statistically defined by objective scientific medicine have been deviated from
when it became apparent that some of the values that fell within the normal distribution were actually correlated with changes in the organism that are classified as diseases.
This was the case for blood glucose. In some, usually elderly individuals, the hormone insulin is not produced by the pancreas in quantities appropriate to their diet and exercise regime. Their blood glucose level increases and this results in changes to their organs.
It was therefore decided, based on medical experience, to stop using the normal distribution values and to instead set the benchmark at a level typical of a young adult.
A similar process was applied to cholesterol, which is prone to increasing after the age of 35. In this case, a correlation with cardiovascular disease was postulated, though there is still no scientific evidence to back up this claim. No account was taken of the...
