Journal of IiME Volume 2 Issue 2 www.investinme.org P Plluuss ççaa cchhaannggee,, pplluuss cc’’eess tt llaa mmêêmmee cchhoossee ( (ccoonn tt ii nnuueedd )) these signals in deference to regulation from the outside, using external rules, whether these be cognitive rules from a separated dualistic “mind” see (17) or from the outside as coercion. In either case this would have become an external control system, not a self-regulated one, and clumsy in its reaction to changing circumstances, thus less of a selfregulating system. But what you do need to do to modulate a self-organizing one is to become more mindful of your proprioceptive sensations, including your symptoms, where the observer is identical to the self-observing, self-organizing system. If internal symptoms are very interactive, they should be regarded as part of the syndrome (e.g. if a patient becomes fatigued after having a bowel movement, this interaction should be regarded as causally relevant to the fatigue if it is severe and consistent enough to contribute to disability. If general pain, gastrointestinal pain, headaches, depression or anxiety become sufficiently causally interactive, they should be included in the syndrome. The point is to try to estimate how causally interactive they are, a measure that can only be done using the dynamical methods of clinical medicine with its deictic individual coordinates of “here and now”. The ultimate cause of the disturbance is the dysregulation of a superordinate selforganizing system in its relation to its subordinate systems with both bottom-up and top down control. The ultimate cure is to reestablish proper bidirectional regulation. The dynamical difference between the delayed fatigue of ME/CFS vs. non-delayed normal fatigue implies a distinct change in causal network which underlies this change, and indicates that a causally relevant shift in the “kind” of fatigue is happening. It is not just a more severe variety of the normal kinds of fatigue. It is a distinctly different kind of fatigue, to be classified under a different taxon (20), thus implying a distinctly different Invest in ME (Charity Nr. 1114035) causal pattern lying beneath its surface manifestations. The features of this dynamical shift, if paid attention to, can thus orient research to find the relevant cause(s) responsible for this shift in dynamic patterns without having to render the whole causal system explicit (which may be impossible, or complex enough to keep researchers busy for many years ahead). If one continues to ignore this search for dynamically different kinds of fatigue by using static decontextualized models of “fatigue” conceived as a static entity, this type of research will continue to be blocked. 3/ ME/CFS “fatigue” as embedded in a system which regulates the basic complements of activity and rest, and its comparison with the regulation of blood glucose level in patients with “brittle” diabetes mellitus. Since “fatigue” by being considered as a nominal entity in isolation from what the fatigue is about- an altered bodily state- it will continue to be regarded as “subjective” feeling and thus not as an integral part of a regulatory system which must function orthogonally to the Cartesian type of subject/object split which is a prerequisite for our current scientific thinking to work. Fatigue is embodied, not floating around the subjective mind in an endless chain of cognitions. I will use the framework for a regulatory system first suggested by Ashby, a founding father of the dynamical systems approach (22). His model of the brain is that of a homeostat, a self-regulator. A self-regulator keeps “essential variables” within tolerable limits (unchanging) by changing itself in response to changes in the environment. The self-regulator is the part of the organism that changes in order to keep the essential variables the same. The essential variables must be kept the same if the whole organism is to survive. The changing part, the regulatory part of the system is designed to change on demand. The major parts of the organism that (continued on page 29) Page 28/74
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