by tore kierulf næss, oslo, norway
A potential new paradigm for the medical profession: a new philosophical / theoretical framework in medicine
“We will in this article highlight the importance of experience for your health. Thus, we also point out a URGENT need to revise the theoretical basis of medicine and the need to integrate this new knowledge into clinical practice, research, education and health policies. “
By “this new knowledge” is meant as a broad range of research done in recent times, which in different ways illustrate how experience affects human health. The account of the new knowledge begins with a discussion of epigenetics as a new field of research. Epi is Greek and means something like “on top of” or “in addition to” and epigenetics refers to what happens on the road from the DNA sequence of the genetic material until the biological function, that is, from genotype to phenotype.
Metaphorically, one can say that while before we understood the DNA as a set of recipes that are followed to the letter,we see today’s epigenetics more as a universal cookbook, in which the organism can pick and combine genetic material to create a large number of possible biological functions. The research article authors are referring to is about how epigenetic programming occurs in utero and in early childhood. It is also good evidence to suggest that the programming and reprogramming can occur throughout life, for example, in conjunction with psychotherapy.
The authors refer to specific areas where studies show that, and to some extent how, relational experiences intervene and characterize human molecular constitution. One example is that psychosocial stress in pregnancy, the maternal production of stress hormones from the adrenal glands, forms the foetal future regulation of these same hormones.
Another example shows how traumatic events in the mother’s own childhood can be traced in stress hormone regulation both in herself as an adult and with her children. In both cases, regulation is believed related to epigenetic mechanisms. This is especially the stress hormone cortisol, which has been studied.
Other examples are concerned with how relational experiences, such as loss, threat and feelings of powerlessness can be measured which changed the balance in the composition of immune signalling molecules in the blood, known as cytokines. Such a modified balance will affect the person’s tendency to inflammation. The authors refer to studies that indicated that when such changes are chronic, they contribute to the development of diseases that are considered the major diseases: obesity, cardiovascular disease, diabetes, COPD and osteoporosis – as well as psychological disorders such as depression, anxiety, behavioural disorders and addiction.
The idea that experience and psycho-social, (article authors call them existential aspects) influence health and disease is not new,
“Experienced clinicians have long enough recognized the importance of such basic existential conditions of life, but biomedicine has lacked formal scientific concepts that have made it possible to relate to the cohesion in a consistent manner.”
Here, however, it seems that the authors see a little blind in their own perspective, namely, the molecular biological. Who defines what qualifies as ‘biomedical’ formal scientific concepts “and” to relate to the cohesion in a consistent manner .
The article points to a urgent need to develop a experience orientated kind of medicine. The challenge for today’s medical science is that Doctors lack theoretical understanding of how experiences associated with self-image, relations and values become «inscribed» in the body. And they do not have a method to start releasing inscribed experiences. In a way the are helpless. Some might start to wonder if most medical research is not to be trusted?.
In Norway we have a long and specific medical tradition that sees experiences impact on health, not in the light of molecular mechanisms, but based on the physical.This tradition is called vegetotherapy. With vegetotherapy I mean the following: It is to work directly with the vegetative system with the intention to normalize the function of the vegetative processes in the human organism. The vegetative system consist of the hormonal balance, the immune system and the autonomous nervous system sympathetic / para- sympathetic.
(here a link to Self-regulated and experience oriented vegetotherapy) added by inge jarl clausen).
This article from the Norwegian Medical Journal Nr. 7 – 8. April 2011 points to a new paradigm in medical science. That experience is the most important factor that influences our biology, heath and life in general.
Human experiences is not only absent from contemporary evidence-based medicine, it is in fact explicitly eliminated by the mathematical analyses performed during assembly of evidence.
Background. Human beings are reflective, meaning-seeking, relational and purposeful organisms. Although experiences associated with such traits are of paramount importance for the development of health and disease, medical science has so far failed to integrate these phenomena into a coherent theoretical framework.
Material and method. We present a theory-driven synthesis of new scientific knowledge from a number of disciplines, including epigenetics, psycho-neuro-endocrino-immunology, stress research and systems biology, based on articles in recognised scientific journals and other academic works. The scientific sources have been deliberately chosen to provide insight into the interaction between existential conditions in the widest sense (biography) and biomolecular processes in the body (biology).
Results. The human organism literally incorporates biographical information which includes experienced meaning and relations. Knowledge from epigenetics illustrates the fundamental biological potential for contextual adaptation. Intriguingly, different types of existential stresses can enhance disease susceptibility through disturbances to human physiological adaptation systems, mediated in part through structural influences on the brain. Experiences of support, recognition and belonging, on the other hand, can help to strengthen or restore a state of health.
Interpretation. New knowledge from integrative research projects reveals a need for theoretical and practical reorientation in medicine with respect to understanding health, on both the individual and the community level.
Human beings have unique characteristics that distinguish them from all other known organisms – a capacity for self-reflection, for designing sophisticated symbolic structures, for attaching metaphorical concepts to experiences and for building models and categories with the aid of the imagination. Nevertheless, the traditional scientific methodology of biomedicine fails to take account of the self-aware, meaning-seeking, purposeful and relational nature of humans (1). Doctors therefore lack theoretical understanding of how experiences associated with self-image, relations and values become «inscribed» in the body.
During the past decade, empirical documentation has demonstrated that experience – the information that an individual acquires during a lifetime of sensing and acting – is of fundamental biological relevance. Unfortunately, such experience does not lend itself easily to standardised interpretation; it is always an experience of something for someone, in a unique context (2). In this article, we attempt to exemplify the importance of subjective experiences for health.
New integrated stress research – the concept of allostatic overload
Long-term overtaxation of the physiological adaptability of human beings may lead to health impairment. This phenomenon, called «allostatic overload» is a consequence of physiological «wear and tear» due to strong and/or persistent threats to an individual’s existence or integrity (the word encompasses both mental and physical aspects). The human body’s reaction to stressors, which in our culture can be classified as physical (e.g. undernourishment, overfeeding, malnutrition, pollution, lack of sleep, lack of exercise, infections, noise) prove to converge at the same biological «level» as stressors we would classify as psychosocial (e.g. a life characterised by threats, neglect, abuse, poverty or overwhelming caregiving burdens): Both categories of stress can contribute over time to the development of autonomic dysfunction, changes in the immune system, chronic low-grade inflammation, endocrine disruptions and accelerated cell aging, measured as telomere shortening (Box 1).
Chronic metabolic disturbances related to experienced overload of the human organism appear to contribute, at least partly through epigenetic mechanisms, to the development of the major, complex diseases of our time – cardiovascular disease, overweight, diabetes, chronic obstructive pulmonary disease,unclear fatigue symptoms, other immunological and inflammation-driven diseases, osteoporosis, depression, anxiety, so-called behavioural disorders, substance dependence and other complaints classified as psychiatric, cognitive complaints, adverse pregnancy outcomes in the form of premature births and low birth weight, pain syndromes and chronic fatigue etc.
Recent trauma research provides insight into how detrimental childhood experiences may lead to toxic stress which is reflected in disturbed maturation of brain structure in the developing individual. Neuroimaging studies have linked such structural changes (gray and/or white matter alterations) to experiences of verbal abuse, harsh corporal punishment and sexual abuse . The plasticity and vulnerability of the brain appear to vary with the individual’s age; the detrimental potential of adverse experiences will depend on when they occur and how long they last .
The brain appears to remain receptive to relational effects throughout life. Fortunately, favorable brain changes can also occur, in response to experiences which promote healing and health (salutogenesis). A number of studies have documented structural changes in the brain associated with successful psychotherapy . On a more general level, a recent meta-analysis demonstrated that strong social relations provide as good protection against premature death as smoking cessation, and this statistical protection is numerically greater than the risk associated with, for example, obesity and physical inactivity . This protective effect is independent of age, gender and a number of other factors, and is therefore unlikely to be limited to sub-groups.
We strongly emphasize the need to revise the theoretical foundation of medicine, and the necessity of integrating this new knowledge into clinical practice, research, teaching and health policy.
Article is edited and translated by Inge Jarl Clausen, firstname.lastname@example.org