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 )) general term which may name it, which is abstracted and thus stripped of its direct causal attributes to become a member of a class with its own attributes, is a crucial one, a difference that makes a difference. An event has causes, but a class has relationships (25, p74 ). A living person is an event subject to a wide variety of causes over her/his lifetime and is a member of innumerable classes. The process of diagnosis consists of fitting a specific pattern of symptoms and signs exhibited by an individual patient in process, on-line into the general medical model to become a case of----, and thus a member of a class, which is abstract, off-line knowledge, a scientific model of disease. (This process has been called paradeixis (10). While one adds a large number of relationships thereby (those within the relevant disease concept of the current knowledge base), one thereby strips the case of the immediate causal relations available to it as an individual where they are felt as forces incurred in the ongoing living process she/he is immersed in. It is expected that these causal relations can be inferred as a result of controlled observations of a sufficient number of members of its class (cases of------). However the individual cannot be studied in this fashion. As previously mentioned, it has been known since Aristotle’s time that no science of individuals is possible. This is because the observations cannot be controlled by comparing them to other members of the same set under various conditions (as members of a set), but that as an individual she/he is incomparable, living in a unique situation. So, since all of us live our lives at least partly anecdotally, uniquely and incomparably and if anecdotal evidence is inherently unreliable, then how do we survive? By learning “force dynamics” (11,12,15) at a young age, so that we can compare events along the time lines of our lives along in the various kinds of causal relations we encounter enroute. We start out as babies pretty incompetent in the ways of the world (by Invest in ME (Charity Nr. 1114035) adult standards), but learn to regulate the movements of our bodies, our minds and our environments in ways reliable enough to allow most of us to live our “allotted” lifespan. We learn how each of these regions of existence “works”. This process of learning goes on throughout our lives and is refined by “experience” and also specific training and practices, by learning how to cope with many kinds of stressors, including illnesses and much more. This makes our actions more and more accurate and reliable as we gain experience before the inevitable “anecdotage” takes over. I would like to discuss three aspects of current situation regarding ME/CFS which are pertinent to what we have been discussing. 1/ Research vs. Clinical case definition. By the time he/she becomes a case, a patient has already been abstracted into a case. Research definitions of ME/CFS(16), which are there to select clusters of similar patients to facilitate research, often include as optional symptoms cognitive dysfunction and sensory overload, listed as separate entities without regard for any causal relations with other symptoms or from its background. In clinical definitions designed to facilitate the identification of ME/CFS in individual patients (14), the search for the pertinent causal background ( which is always unique) is facilitated by suggesting the connection of symptoms with various possible subsystems (pathophysiological systems that the symptom may be participating in) and by describing the various dynamical features of the symptom including on the force of interactions with other symptoms and the environment. These forces are observed directly at the commonsense level, and do not depend on whether these causal forces have been demonstrated to be explainable scientifically. They are there or they are not there. (continued on page 25) Page 24/74
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