Journal of IiME Volume 2 Issue 2 www.investinme.org “ “TThhee mmoorree tthhiinnggss cchhaannggee,, tthhee mmoorree tthhiinnggss ss ttaayy tthhee ssaammee”” ( (ccoonn tt ii nnuueedd )) explanations to be deferred until later when we get our RCTs done a few years from now), and if one regards a syndrome as a dynamical pattern, a group of symptoms which constitute the surface manifestations of an underlying causal network or natural kind, the interactive forces of which can be directly felt implicitly even when not observed explicitly. In order to ‘see/feel’ this causal background one must not only observe just the surface manifestations but also feel the causal forces that underlies the surface. These disturbances are what the symptoms are ‘about’, their intentionality. If one separates fact. Other clinical practices have been disturbed the symptoms from what they are about by enumerating them, one decontextualises them (17), separating them from their usual causal background. Only if one observes the symptoms as they arise out of their dynamical background, can one feel this causal connection directly. Thus one must not only observe the symptoms when completed, but as they arise from the flowof- life context in a prospective temporal dynamics, headed towards the future. If these are symptoms observed only by the patient themselves, in a first person perspective, the outside observer can only learn of their causal background by questioning the patient concerning the circumstances of their emergence, maintenance, aggravation, remittance, etc., but also by empathizing with her/him as an undivided whole and questioning/relying on their description of symptoms and their context within the developing second person perspective of the doctor /patient relationship. This is prognostic and direct observation of the clinical course of illness, a dynamical observation which has been emphasized since time immemorial to be at the core of the clinical situation. It is applicable to individuals on-line as they live their lives and suffer their symptoms along with any concomitant deterioration of activities. This is not the numerical “prognosis” which is applicable to members of groups after the Invest in ME (Charity Nr. 1114035) by nominalist, static approaches to the clinical situation. These include estimation of the severity of illness as observed in real time by its impact on the life-world with its deictic, here and now, individual coordinates and not the timeless general coordinates of science or the time of pure succession required by algorithmic approaches. Without the on-line observationin-context of clinical practice one cannot see the impact of illness on a patient’s life flows, their concrete dis-ability, whatever the results obtained in situations which have been decontextualized for the sake of “objectivity”. Without prognosis it cannot directly and accurately measure the effects of therapy, nor choose preventive actions to improve both surface and deeper manifestations of their illness. Let me emphasize that while I feel that the disease title CFS/ME refers to a complex but discrete causal process which causes chronic severe, disabling dysfunction of an essential but extremely complex self-regulatory system of which we are only studying the HumptyDumpty fragments that have been opened up to become amenable to the study the linear causation within which science can identify causation. This search is well worthwhile since there is always the possibility that we can find a pragmatic cause within the complex bodily function, where a bit of biological matter such as viral nucleic acid or a vitamin-like chemical or a nutrient or a protein (e.g Ribonuclease-L) or a cascade of protein reactions, or a genomic dysfunction is responsible for the bodily dysregulation, despite its ultimate complexity. The difference between an individual event which is causally laden and occurring at a specific place in space and time and the (continued on page 24) Page 23/74
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