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 )) here it is easy to slide into an attitude that since by definition somatoform disorders simulate the form of real diseases, that the patients’ experience is not to be trusted. Their illness has been moved from being regarded as a physical kind to a mental kind without giving them the benefit of the considerable doubt. This in turn entails large shifts in trust and attitude from other people and agencies, stigma of a regulatory disorder that have been assigned to the mental side and of the consequences of this- how patients are treated in general at all levels of supervision, the types of treatment offered and how it is administered (21). It interferes with the assessment of symptoms as they have been removed from a natural realm into a distinctly separate symbolic realm, the fruit of Cartesian dualism between mind and body and thus an ontological shift that many patients can feel proprioceptively as a nondual jolt in their second-person discourse with their physicians with immense practical repercussions. Far more preferable would be to give the benefit of doubt to the patient and assume that there is an underlying natural causal network underlying the disease, of which we know fragments but not the complete story. In the meanwhile we should focus scientifically on the evolutionary development of symptoms, what somatic symptoms refer to and what has been the selective value to justify their retention? The biological function of these symptoms is to refer to their underlying causes in the interest of better selfregulation of a mobile organism living in a group. What is the system that they refer to? We should continue studying clinically the dynamic causal patterns that patients produce in their illnesses to identify sites where a shift in pattern makes scientific search in the region exposed more likely to be fruitful. It is a bit like searching for oil. Since these symptom patterns are discovered arising from the anecdotal experience of individual patients, Invest in ME (Charity Nr. 1114035) the lack of anecdotal trust in patient experience has been aggravated by the current thrust towards “evidence based medicine” with its push towards exclusive reliance on general knowledge vs. particular knowledge without accepting a complementary relation between these different kinds of knowledge which are both necessary. We should return to observing patient experience precisely as the symptoms, embedded in the flux of life, arise to out of their causal background in discrete dynamical patterns. In ME/CFS the dominant symptom of fatigue should be observed on-line by both patient and physician as it functions in the selfregulatory system of activity/rest modulation and look for the essential variables that stabilize the system so that the patient can learn to selfregulate it better on an ongoing basis. The interactions between fatigue and other symptoms should be studied for the causal efficacy that makes a syndrome into a dynamical causal entity. These should be distinguished by their dynamics from the external parameters that affect the state of the as a whole, stabilize it, destabilize it, change its dynamic form, etc. In studying these dynamical details it will also be helpful to search for “homeostatic clusters”(24) which are crucial for steadying the system. These studies can be expanded to as examination of how the individual organism can stay self-regulated in the larger social and cultural environment despite the impingement of external regulatory forces which exert greater forces and work according to a different dynamics and undergo parametric change all the time. But this will need yet another study- the world goes on changing, and we stay the same by changing with it. Bibliography:1/ Kathryn Montgomery, “How Doctors Think”, Oxford U. Press, 2004. (continued on page 32) Page 31/74

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