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 )) symptom severity and its changes over time. This struggle in attitude has also resulted in two distinctly different approaches to the significance of syndromes or clusters of symptoms, a concept first used by Sydenham in the 17th century (6,7). A statistical measurement of symptom clustering will characterize it numerically, but cannot give any immediate clues as to the cause of this clustering. The idea embedded in so-called “research definitions” of CFS/ME is to establish symptom clustering by numerical measure, but to leave the search for causes for later science to decide. But what if that does not happen? We can act on the assumption that a cause will be found or that it will not be found, or that too many will be found each of which contribute uncertain force and relevance to the individual illness depending on its type (linear, circular, immediate, delayed, permissive, helping, enabling, allowing, formal efficient, final, pragmatic, etc) with the causal network assumed to be simple linear or complex and nonlinear, but with the whole situation certainly confused and uncertain. This will leave the diagnosis of syndromes in a limbo state, suspended between those that are expected to be caused somatically, and thereby explained, and those that are expected to be somatically unexplained, thus somato-form (having the form of somatic diseases but not the causal content) or caused mentally, “ín the head” as a default assumption. This indeterminate causal state arises when one follows exclusively a Humean type of perception, the acausal presentational immediacy which defers the question of cause and, in Whitehead’s description, avoids the direct perception of “causal efficacy” (8). Hume’s strategy avoids the immediate causal question of why these immediately perceived symptoms have clustered into a syndrome until later, to be decided by science plus inference, (presumably using the prospective, controlled observations of scientific experiment), with Invest in ME (Charity Nr. 1114035) presumably more authority. However, as Montgomery has stated, working oncologists have estimated that they spend about 5% of their time using science to solve their problems in clinical judgment, and the rest doing “common-sense” (1, p 164). Aristotle already knew that science was not able to handle individual situations alone, and that is what clinical medicine is all about. While being informed by the general knowledge of science, a clinical judgment must be made using “phronesis” or practical wisdom(1,pp 3341, 9 pp57-60), which is about unique situations, more or less comparable, and comes from a different sort of knowledge that allows the first person observations of the individual patient to be extended by the second person observations of the patient/ doctor while also bringing them together to interact with the third person general knowledge of science. This last interaction requires a fourth type of explanation that has been called paradeictic or pattern matching is used to bring first person and second person observations governed by deictic coordinates into interaction with the third person knowledge of apodeixis (10). So what is this common sense? And why is it used so often, when scientific knowledge is so much better? It is because it is how we have all have learned about “how the body and the world works”, i.e. the causal efficacy of its structures, based on the direct perception of the dynamic patterns of activity continuing since our babyhood. The implicit assumption that every felt effect has a cause which can and should be sought for is known as essentialism(11). It has been used by all of us since well before we could articulate anything like a theory of realism and is also expressed in the protolanguage of pain, fatigue, sleep, attraction , avoidance, smiles, cries, sneezes, coughs, nausea, anorexia, etc. The direct (anecdotal, uncontrolled) perception of causal efficacy has been demonstrated experimentally by and indirectly by Talmy as described in 12) who has introduced the (continued on page 22) Page 21/74

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