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 )) While touring the U.K recently, I was visiting Berkeley Castle. It was full of visitors and a number of subgroups were assigned to a docent to inform us concerning all the sites, times and gory details of its historical events. Each subgroup was assigned a different route. Since Berkeley Castle is not that big, the paths of each group crossed 3-4 times during the tour. Another group had a very unhappy baby as a member who was crying most of the time, and whose noise was sometimes close, sometimes distant. I noted that the docent began to lose her ability to keep her docentic speech train coherent during the times when the crying was loud. While this may have been explainable as a normal level of interference, it became apparent that the docent’s cognitive impairment was so bad that she had to stop talking until the other group left the vicinity with each contact. After a decent interval her narrative resumedsmooth and coherent- until the next meeting with this particular noisy group, when the cognitive disturbance repeated itself. This did not happen during contact with other quieter groups. These interactive effects reappeared consistently until the end of the tour ( about 34 times). While one interruption may be explained by chance and/or other causal variables, not a consistent 4, and there was a palpable interactive causal force observable at the times of these interactions, even by myself as an outside but informed observer. It is a common symptom duplex of ME/CFS that sensory overload will aggravate what I call “cognitive fatigue”- fatigue as a dynamic event and not a constant defect. The interrelation between these 2 events (the baby crying and the cognitive fatigue), when repeated consistently, was enough for me to assign interactive causality, whatever her own knowledge was about it and the direction of causation was certain the noise caused the confusion). This type of event if noticed was felt as dynamical and not subjective (as felt by the adult and her observers) , since there Invest in ME (Charity Nr. 1114035) were no feelings of fatigue associated with the deterioration of cognitive fatigue (as far as I know since I did not ask her). The crying of the baby was steadily vociferous, and showed no apparent fatiguing during our relatively short time of observed interaction. This is one of the problems with cognitive fatigue- it has the dynamics of fatigue, but is often not accompanied by subjective feeling of fatigueunlike the fatigue accompanying musculoskeletal exertion, and may not be directly observed by the perpetrator. But it is a very specific and consistent inter-relation, often noted by the patient when she/he is asked about it, and whose causal nature is confirmed by prognostic observation- over the course of repeated interactions over time. This everyday causal relation between interior and environmental events is not often included in discussions of scientific causation. But it is very real, and does not need an RCT to confirm it. It is also important, since it is affecting her competence as a docent. The causal relationship is confirmed by its felt force and consistency over time. It is the correlation dynamics (18) that confirms the causal relevance/irrelevance of this connection between the 2 variables of a baby crying and a docent’s cognitive dysfunction. It is a causal interaction depending on the loudness of the crying and the vigor of the cognitive system involved. The point of cognitive fatigue is that it is dynamical- her mind does not work well in the presence of the disturbing variable, but is fine under many other circumstances. I would expect it to be regarded as inconsistent if the observer is looking for static entity called “loss of concentration” exclusively, since it is not always there. Perhaps the patient cannot screen out other sensations to concentrate on what she is doing, but it is important for her to identify this specific interaction, since she could prevent it in the future by avoiding the situations where it occurs. Thus it will allow her to apply a specific preventive measure that she can learn. Unfortunately this type of (continued on page 26) Page 25/74

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